Diclofenac is a drug that doctors often prescribe when we have a condition like body pain, joint pain, or arthritis. You may have used this drug too. But it is not just a painkiller. There are several things that we need to be very careful about when using it. Let's talk about that today.
What is Diclofenac?
Simply put, diclofenac is a medicine used to treat mild to moderate pain, swelling, and conditions like arthritis. It belongs to a class of drugs called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) . Specifically, it works by reducing the production of chemicals in our body that cause pain and swelling. In Sri Lanka, this medicine can be found under brand names like Voltaren.
Things you need to tell your doctor before taking this medicine
It is very important to tell your doctor about your medical history before using diclofenac. This is because it can be dangerous to use this medicine with certain medical conditions. Be sure to tell your doctor if you have any of the following conditions:
| Your situation | Why should you inform? |
|---|---|
| Heart related problems: Things like high blood pressure, heart attack, heart failure, and recent bypass surgery (CABG). | This medicine may increase the risk of heart attack and stroke. |
| Risks of bleeding: Taking blood-thinning medications, intestinal bleeding, and bleeding disorders. | Diclofenac increases the risk of stomach and intestinal bleeding. |
| Kidney or liver disease | The risk of damage to these organs may increase. |
| Lifestyle habits: Frequent drinking and smoking. | These habits further increase the risk of stomach ulcers. |
| Other health conditions: Asthma, Anemia, Steroid use, Trying to conceive, Pregnancy, Breastfeeding, Allergies to Diclofenac or other medications. | Each of these situations may require a change in treatment regimen or special care. |
How should I use the medicine?
It is very important to follow your doctor's instructions exactly when using this medicine.
- Do not break, crush, or chew this tablet. These come with a special coating that is designed to dissolve in the intestine (Enteric-coated). So swallow the tablet whole with a glass of water.
- If you experience stomach upset after taking this medication, taking it with a meal may reduce the discomfort.
- Do not stop taking the medicine until your doctor tells you to.
- If you are over 65 years of age, you may need a lower dose. Your doctor will decide.
- If you accidentally take too much medicine: If you think you have taken too much medicine, go to the nearest hospital Emergency Department (ETU) immediately. Alternatively, call the National Poisons Information Centre at the Colombo National Hospital .
- If you miss a dose: Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose at the scheduled time. Never take a double dose.
Other medications that may interact with this medicine
Diclofenac can interact with other medications, so tell your doctor about all the medications you are taking (including vitamins and herbal remedies).
In particular, taking diclofenac with the drugs Cidofovir, Ketorolac, and Methotrexate is completely prohibited.
In addition, problems may occur with the following:
- Alcohol
- Aspirin and other similar medications
- Blood pressure medication
- Medicines that prevent blood clotting (e.g. Warfarin)
- Other NSAIDs (e.g., Ibuprofen, Naproxen)
- Types of steroids (e.g. Prednisone)
- Lithium
- Cyclosporine
Things to be careful about when taking medicine
Risk of stomach ulcers and bleeding
This is the main risk with diclofenac. Stomach ulcers and bleeding can occur without warning . Smoking, alcohol consumption, aging, and poor health increase this risk.
If you have severe stomach pain, vomit blood (brown, like coffee grounds), or have black, tarry stools, it could be a sign of stomach bleeding. If this happens, see a doctor immediately.
Heart attack and stroke risk
Diclofenac is not a medicine that prevents heart attack or stroke. In fact, long-term use of this medicine or if you already have heart disease may increase your risk of heart attack and stroke.
During pregnancy
If you are pregnant, you should think twice before taking this medicine. Taking this medicine, especially between the 20th and 30th weeks of pregnancy, can harm the unborn baby. After the 30th week, taking this medicine is completely prohibited.
Severe skin reactions
Severe skin reactions can occur even weeks after starting the medication. Seek immediate medical attention if you experience symptoms such as fever, body aches, red or purple blisters on the skin, or peeling skin.
Side effects that may occur due to medication
Like any medication, diclofenac can cause side effects. Some are serious, some are common.
| Side effect | Description |
|---|---|
| Serious side effects that should be reported to the doctor immediately | |
| Allergic reactions | Skin rash, itching, swelling of the face, lips, tongue, difficulty breathing. |
| Bleeding | Black/tarry stools, vomiting blood or coffee grounds, and red/dark brown urine. |
| Heart attack symptoms | Pain or tightness in the chest, shoulder, or arm, nausea, difficulty breathing. |
| Stroke symptoms | Sudden numbness or weakness in the face, arm, or leg, difficulty speaking, difficulty walking, severe headache. |
| Symptoms of kidney/liver damage | Decreased urine output, swollen ankles, yellowing of the skin or eyes, pain in the upper right side of the stomach. |
| Side effects that are usually not serious, but should be reported to the doctor if they persist | |
| Headache | - |
| Nausea, stomach discomfort | - |
| Appetite | - |
Take-Home Message
- Before taking diclofenac, be sure to tell your doctor about all of your medical conditions and other medications you are taking.
- Swallow this tablet whole with water without breaking, crushing, or chewing. If you have an upset stomach, take it with food.
- Always be aware of signs of stomach bleeding, such as severe stomach pain, black stools, and blood in the vomit. If this occurs, seek medical advice immediately.
- Keep in mind that this medication may increase the risk of heart attack or stroke. It does not prevent these diseases.
- Avoid taking this medicine during pregnancy, especially in the last three months.
- This medicine is for you only. Never share it with others.
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