Diclofenac

Pronunciation

(dye KLOE fen ak)


U.S. Brand Names

Cataflam®; Solaraze™; Voltaren®; Voltaren Ophthalmic®; Voltaren®-XR



Synonyms

Diclofenac Potassium; Diclofenac Sodium



Generic Available

Yes



Canadian Brand Names

Apo-Diclo®; Apo-Diclo Rapide®; Apo-Diclo SR®; Cataflam®; Diclotec; Novo-Difenac; Novo-Difenac K; Novo-Difenac-SR; Nu-Diclo; Nu-Diclo-SR; Pennsaid®; PMS-Diclofenac; PMS-Diclofenac SR; Riva-Diclofenac; Riva-Diclofenac-K; Voltaren®; Voltaren Ophtha®; Voltaren Rapide®



Use

Immediate release: Ankylosing spondylitis; primary dysmenorrhea; acute and chronic treatment of rheumatoid arthritis, osteoarthritis

Delayed-release tablets: Acute and chronic treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis

Extended-release tablets: Chronic treatment of osteoarthritis, rheumatoid arthritis

Ophthalmic solution: Postoperative inflammation following cataract extraction; temporary relief of pain and photophobia in patients undergoing corneal refractive surgery

Topical gel: Actinic keratosis (AK) in conjunction with sun avoidance

Use - Dental

Immediate-release tablets: Acute treatment of mild to moderate pain



Use - Unlabeled/Investigational

Juvenile rheumatoid arthritis



Pregnancy Risk Factor

B/D (3rd trimester)



Pregnancy Implications

Safety and efficacy in pregnant women have not been established. Exposure late in pregnancy may lead to premature closure of the ductus arteriosus and may inhibit uterine contractions.



Lactation

Enters breast milk/use caution



Contraindications

Hypersensitivity to diclofenac, any component of the formulation, aspirin or other NSAIDs, including patients who experience bronchospasm, asthma, rhinitis, or urticaria following NSAID or aspirin; porphyria; pregnancy (3rd trimester)



Warnings/Precautions

Fatal asthmatic and anaphylactoid reactions have occurred in patients with "aspirin triad." Use with caution in patients with CHF, hypertension, dehydration, decreased renal or hepatic function, history of GI disease (bleeding, ulcers, or previous GI symptoms with NSAID use), or those receiving anticoagulants and/or corticosteroids. Use lowest effective dose for shortest period possible; bleeding risk has been correlated to dose and duration of therapy. Gastrointestinal bleeding may occur without prior symptoms of gastrointestinal irritation. Elderly are at a high risk for adverse effects from NSAIDs. As many as 60% of elderly can develop peptic ulceration and/or hemorrhage asymptomatically.

Use of NSAIDs can compromise existing renal function especially when Clcr<30 mL/minute. CNS adverse effects such as confusion, agitation, and hallucination are generally seen in overdose or high-dose situations; however, elderly may demonstrate these adverse effects at lower doses than younger adults. Withhold for at least 4-6 half-lives prior to surgical or dental procedures.

Rare cases of severe hepatic reactions (including necrosis, jaundice, fulminant hepatitis) have been reported. Vision changes (including changes in color) have been rarely reported with oral diclofenac.

Topical gel should not be applied to the eyes, open wounds, infected areas, or to exfoliative dermatitis. Monitor patients for 1 year following application of ophthalmic drops for corneal refractive procedures. Patients using ophthalmic drops should not wear soft contact lenses. Ophthalmic drops may slow/delay healing or prolong bleeding time following surgery. Elderly are at a high risk for adverse effects from NSAIDs.

Adverse Reactions

>10%:

Local: Application site reactions (gel): Pruritus (31% to 52%), rash (35% to 46%), contact dermatitis (19% to 33%), dry skin (25% to 27%), pain (15% to 26%), exfoliation (6% to 24%), paresthesia (8% to 20%)

Ocular: Ophthalmic drops (incidence may be dependent upon indication): Lacrimation (30%), keratitis (28%), elevated IOP (15%), transient burning/stinging (15%)

1% to 10%:

Central nervous system: Headache (7%), dizziness (3%)

Dermatologic: Pruritus (1% to 3%), rash (1% to 3%)

Endocrine & metabolic: Fluid retention (1% to 3%)

Gastrointestinal: Abdominal cramps (3% to 9%), abdominal pain (3% to 9%), constipation (3% to 9%), diarrhea (3% to 9%), flatulence (3% to 9%), indigestion (3% to 9%), nausea (3% to 9%), abdominal distention (1% to 3%), peptic ulcer/GI bleed (0.6% to 2%)

Hepatic: Increased ALT/AST (2%)

Local: Application site reactions (gel): Edema (4%)

Ocular: Ophthalmic drops: Abnormal vision, acute elevated IOP, blurred vision, conjunctivitis, corneal deposits, corneal edema, corneal opacity, corneal lesions, discharge, eyelid swelling, injection, iritis, irritation, itching, lacrimation disorder, ocular allergy

Otic: Tinnitus (1% to 3%)

<1%, postmarketing, and case reports (limited): Oral dosage forms: Acute renal failure, agranulocytosis, allergic purpura, alopecia, anaphylactoid reactions, anaphylaxis, angioedema, aphthous stomatitis, aplastic anemia, appetite changes, aseptic meningitis, asthma, azotemia, bloody diarrhea, blurred vision, bullous eruption, cirrhosis, colitis, CHF, dermatitis, dry mouth, dry mucous membranes, eczema, eosinophilia, epistaxis, erythema multiforme major, esophageal lesions, GI hemorrhage, hearing loss, decreased hemoglobin, hemolytic anemia, hepatic necrosis, hepatitis, hepatorenal syndrome, hypertension, interstitial nephritis, jaundice, laryngeal edema, leukopenia, malaise, melena, nephrotic syndrome, oliguria, pancreatitis, papillary necrosis, photosensitivity, proteinuria, purpura, Stevens-Johnson syndrome, swelling of lips and tongue, taste disorder, thrombocytopenia, urticaria, visual changes, vomiting

Overdosage/Toxicology

Symptoms of overdose include acute renal failure, vomiting, drowsiness, and leukocytosis. Management of NSAID intoxication is supportive and symptomatic.



Drug Interactions

(minor) of CYP1A2, 2B6, 2C8/9, 2C19, 2D6, 3A4; CYP1A2 (moderate), 2C8/9 (weak), 2E1 (weak), 3A4 (strong)

SubstrateInhibits

ACE inhibitors: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure

Angiotensin II antagonists: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure

Anticoagulants (warfarin, heparin, LMWHs) in combination with NSAIDs can cause increased risk of bleeding.

Other antiplatelet drugs (ticlopidine, clopidogrel, aspirin, abciximab, dipyridamole, eptifibatide, tirofiban) can cause an increased risk of bleeding.

Cholestyramine and colestipol reduce the bioavailability of diclofenac; separate administration times.

Corticosteroids may increase the risk of GI ulceration; avoid concurrent use.

Cyclosporine: NSAIDs may increase serum creatinine, potassium, blood pressure, and cyclosporine levels; monitor cyclosporine levels and renal function carefully.

CYP1A2 substrates: Diclofenac may increase the levels/effects of CYP1A2 substrates. Example substrates include aminophylline, fluvoxamine, mexiletine, mirtazapine, ropinirole, theophylline, and trifluoperazine.

CYP3A4 substrates: Diclofenac may increase the levels/effects of CYP3A4 substrates. Example substrates include benzodiazepines, calcium channel blockers, mirtazapine, nateglinide, nefazodone, tacrolimus, and venlafaxine. Selected benzodiazepines (midazolam and triazolam), cisapride, ergot alkaloids, selected HMG-CoA reductase inhibitors (lovastatin and simvastatin), and pimozide are generally contraindicated with strong CYP3A4 inhibitors.

Gentamicin and amikacin serum concentrations are increased by indomethacin in premature infants. Results may apply to other aminoglycosides and NSAIDs.

Hydralazine's antihypertensive effect is decreased; avoid concurrent use.

Lithium levels can be increased; avoid concurrent use if possible or monitor lithium levels and adjust dose. Sulindac may have the least effect. When NSAID is stopped, lithium will need adjustment again.

Loop diuretics efficacy (diuretic and antihypertensive effect) is reduced. Indomethacin reduces this efficacy, however, it may be anticipated with any NSAID.

Methotrexate: Severe bone marrow suppression, aplastic anemia, and GI toxicity have been reported with concomitant NSAID therapy. Avoid use during moderate or high-dose methotrexate (increased and prolonged methotrexate levels). NSAID use during low-dose treatment of rheumatoid arthritis has not been fully evaluated; extreme caution is warranted.

Thiazides antihypertensive effects are decreased; avoid concurrent use.

Verapamil plasma concentration is decreased by diclofenac; avoid concurrent use.

Warfarin's INRs may be increased by piroxicam. Other NSAIDs may have the same effect depending on dose and duration. Monitor INR closely. Use the lowest dose of NSAIDs possible and for the briefest duration.

Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid ethanol (may enhance gastric mucosal irritation).

Herb/Nutraceutical: Avoid cat's claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, red clover, horse chestnut, green tea, ginseng (all have additional antiplatelet activity).

Stability

Store above 30°C (86°F); protect from moisture, store in tight container.



Mechanism of Action

Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation of prostaglandin precursors. Mechanism of action for the treatment of AK has not been established.



Pharmacodynamics/Kinetics

Onset of action: Cataflam® is more rapid than sodium salt (Voltaren®) because it dissolves in the stomach instead of the duodenum

Absorption: Topical gel: 10%

Protein binding: 99% to albumin

Metabolism: Hepatic to several metabolites

Half-life elimination: 2 hours

Time to peak, serum: Cataflam®: ~1 hour; Voltaren®: ~2 hours

Excretion: Urine (65%); feces (35%)

Dosage

Adults:

Oral:

Analgesia/primary dysmenorrhea: Starting dose: 50 mg 3 times/day; maximum dose: 150 mg/day

Rheumatoid arthritis: 150-200 mg/day in 2-4 divided doses (100 mg/day of sustained release product)

Osteoarthritis: 100-150 mg/day in 2-3 divided doses (100-200 mg/day of sustained release product)

Ankylosing spondylitis: 100-125 mg/day in 4-5 divided doses

Ophthalmic:

Cataract surgery: Instill 1 drop into affected eye 4 times/day beginning 24 hours after cataract surgery and continuing for 2 weeks

Corneal refractive surgery: Instill 1-2 drops into affected eye within the hour prior to surgery, within 15 minutes following surgery, and then continue for 4 times/day, up to 3 days

Topical: Apply gel to lesion area twice daily for 60-90 days

Dosage adjustment in renal impairment: Monitor closely in patients with significant renal impairment

Dosage adjustment in hepatic impairment: No specific dosing recommendations

Elderly: No specific dosing recommendations; elderly may demonstrate adverse effects at lower doses than younger adults, and >60% may develop asymptomatic peptic ulceration with or without hemorrhage; monitor renal function

Administration

Oral: Do not crush tablets. Administer with food or milk to avoid gastric distress. Take with full glass of water to enhance absorption.

Ophthalmic: Wait at least 5 minutes before administering other types of eye drops.

Topical gel: Cover lesion with gel and smooth into skin gently. Do not cover lesion with occlusive dressings or apply sunscreens, cosmetics, or other medications to affected area.

Monitoring Parameters

Monitor CBC, liver enzymes; monitor urine output and BUN/serum creatinine; occult blood loss, hemoglobin, hematocrit



Dietary Considerations

May be taken with food to decrease GI distress.

Diclofenac potassium = Cataflam®; potassium content: 5.8 mg (0.15 mEq) per 50 mg tablet

Patient Education

Oral: Take this medication exactly as directed; do not increase dose without consulting prescriber. Do not crush or chew tablets. Take with 8 oz of water, along with food or milk products to reduce GI distress. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. Avoid alcohol, aspirin and aspirin-containing medication, or any other anti-inflammatory medications unless consulting prescriber. You may experience dizziness, nervousness, or headache (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea, vomiting, dry mouth, or heartburn (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or constipation (increased exercise, fluids, fruit, or fiber may help). GI bleeding, ulceration, or perforation can occur with or without pain; discontinue medication and contact prescriber if persistent abdominal pain or cramping, or blood in stool occurs. Report chest pain or palpitations; breathlessness or respiratory difficulty; unusual bruising/bleeding or blood in urine, stool, mouth, or vomitus; unusual fatigue; skin rash or itching; jaundice, unusual weight gain, or swelling of extremities; change in urinary pattern; change in vision or hearing (ringing in ears). Consult prescriber if you are pregnant. This drug should not be used in the 3rd trimester of pregnancy. Consult prescriber if you are breast-feeding.

Pregnancy/breast-feeding precautions:

Ophthalmic: For ophthalmic use only. Apply prescribed amount as often as directed. Wash hands before using. Tilt head back and look upward. Gently pull down lower lid and put drop(s) in inner corner of eye. Do not let tip of applicator touch eye; do not contaminate tip of applicator (may cause eye infection, eye damage, or vision loss). Close eye and roll eyeball in all directions. Do not blink for 1/2 minute. Apply gentle pressure to inner corner of eye for 30 seconds. Wipe away excess from skin around eye. Do not use any other eye preparation for at least 10 minutes. Do not share medication with anyone else. May cause sensitivity to bright light (dark glasses may help); temporary stinging or blurred vision may occur. Inform prescriber if you experience eye pain, redness, burning, watering, dryness, double vision, puffiness around eye, vision changes, other adverse eye response, worsening of condition, or lack of improvement.

Gel: This preparation is for topical use only. Treatment may take up to 3 months. Do not use more often than recommended; use at regular intervals. Wash hands before and after use. Follow directions on prescription label. Gently apply enough of the gel to cover the lesion. Advise prescriber if you are using any other skin preparations. Avoid direct sunlight and sunlamps while using this medication. You may experience dry skin, itching, peeling, swelling, or tingling at site of application. If severe skin reaction develops, stop applications and notify your prescriber at once.

Anesthesia and Critical Care Concerns/Other Considerations

The 2002 ACCM/SCCM guidelines for analgesia (critically-ill adult) suggest that NSAIDs may be used in combination with opioids in select patients for pain management. Concern about adverse events (increased risk of renal dysfunction, altered platelet function and gastrointestinal irritation) limits its use in patients who have other underlying risks for these events.

In short-term use, NSAIDs vary considerably in their effect on blood pressure. When NSAIDs are used in patients with hypertension, appropriate monitoring of blood pressure responses should be completed and the duration of therapy, when possible, kept short. The use of NSAIDs in the treatment of patients with congestive heart failure may be associated with an increased risk for fluid accumulation and edema; may precipitate renal failure in dehydrated patients.

Cardiovascular Considerations

In short-term use, NSAIDs vary considerably in their effect on blood pressure. A recent meta-analysis (see References) showed that indomethacin and naproxen had the largest effect on blood pressure. Other NSAIDs, including piroxicam, ibuprofen, and sulindac had less of an effect. Ibuprofen combined with captopril or losartan may attenuate the antihypertensive effects of ACE inhibition or receptor blockade on sitting or 24-hour ambulatory diastolic blood pressure. When NSAIDs are used in patients with hypertension, appropriate monitoring of blood pressure responses should be completed and the duration of therapy, when possible, kept short. The use of NSAIDs in the treatment of patients with congestive heart failure may be associated with an increased risk for fluid accumulation and edema. One study showed that NSAID use in elderly patients had an increased risk of hospitalization for heart failure. This study gives compelling reasons to avoid or limit the use of NSAIDs in patients with congestive heart failure, particularly in the elderly population.



Dental Health: Effects on Dental Treatment

NSAID formulations are known to reversibly decrease platelet aggregation via mechanisms different than observed with aspirin. The dentist should be aware of the potential of abnormal coagulation. Caution should also be exercised in the use of NSAIDs in patients already on anticoagulant therapy with drugs such as warfarin (Coumadin®).



Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions



Mental Health: Effects on Mental Status

May cause nervousness or dizziness; may rarely cause depression



Mental Health: Effects on Psychiatric Treatment

May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may decrease the clearance of lithium resulting in elevated serum levels and potential toxicity; monitor serum lithium levels



Dosage Forms

Gel, as sodium (Solaraze™): 30 mg/g (50 g)

Solution, ophthalmic, as sodium (Voltaren Ophthalmic®): 0.1% (2.5 mL, 5 mL)

Tablet, as potassium (Cataflam®): 50 mg

Tablet, delayed release, enteric coated, as sodium (Voltaren®): 25 mg, 50 mg, 75 mg

Tablet, extended release, as sodium (Voltaren®-XR): 100 mg

References

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Brogden RN, Heel RC, Pakes GE, et al, "Diclofenac Sodium: A Review of Its Pharmacological Properties and Therapeutic Use in Rheumatic Diseases and Pain of Varying Origin,"Drugs, 1980, 20(1):24-48.

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Clive DM and Stoff JS, "Renal Syndromes Associated With Nonsteroidal Anti-inflammatory Drugs,"N Engl J Med, 1984, 310(9):563-72.

Conlin P, Moore T, Swartz S, et al, "Effect of Indomethacin on Blood Pressure Lowering by Captopril and Losartan in Hypertensive Patients,"Hypertension, 2000, 36(3):461-5.

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International Brand Names

Abdiflam® (ID); Abdol® (GT); Abitren® (IL); Abitren Inject® (IL); Aclofin® (ID); Acoflam® (GB); Acu-diclofenac® (ZA); Adco-Diclofenac® (ZA); A-Fenac® (BD); A-Fenac K® (BD); Afenilak® (GT); Agilomed® (AT); Agofenac® (CH); Aktiosan® (AR); Algifen® (CO); Algosenac® (IT); Allvoran® (DE); Almiral® (BG, CZ, HK, JO, RO, RU, SG, SK, TH, UA); Almiral Gel® (TH); Amminac® (TH); Ammi-Votara® (TH); Ana-Flex® (BR); Anodyne® (BD); 3-A Ofteno® (MX); Apain® (BD); Apo-Diclo® (CA, CZ, NZ, PL); Apo-Diclofenac® (ZA); Apo-Diclo Rapide® (CA); Apo-Diclo SR® (CA); Arcanafenac® (ZA); Arclonac® (TH); Arthrex Cellugel® (RO); arthrex® (DE); Arthrotec® (AT, FI, GB, IE, SE); Arthrotec Forte® (FI); Arthrotec® forte (SE); Arthru-Derm® (ZA); Artren 50® (CL); Artrenac® (MX); Artren® (BR, CL, CO, EC); Artridene® (CO); Artrifenac® (GT, HN, PA, SV); Artrites® (CO); Artrofenac® (CO, IT); Athrofen® (CH); Atomo desinflamante geldic® (AR); Atranac® (ID); Banoclus® (AR); Benevran® (BR); Berifen® (CR, EC, GT, HN, ID, PA, SV); Be-Tabs Diclofenac® (ZA); Betaren® (IL); Biofenac® (BR); Biofenac Gotas® (BR); Blesin® (JP); Blokium® (AR); Blokium Gel® (AR); Brevedol® (CL); BSP Diclofenac Sodium® (ZA); Catafalm-V® (HU); Cataflam® (AR, BD, BE, BG, BR, CA, CL, CO, CR, EC, GT, HN, HU, ID, IE, IL, LU, MT, MX, NL, NO, NZ, PA, PL, PT, SG, SV, TH, TR); Cataflam Dispersable® (CL); Cataflam Dispersible® (BE, LU, MX); Cataflam Infantil® (CL); Catanac® (ID, TH); C-Fenac® (BD); Chinclonac® (TH); Clofec® (SG, TH); Clofenac® (BD, SG); Clofenak® (BR); Clofen® (EC); Clofon® (TH); Clonac® (BD); Curinflam® (AR); Curinflam Gel® (AR); Damixa® (AR); Damixa rapid® (AR); Damixa retard® (AR); Dealgic® (IT); Decafen-SR® (BD); Declophen® (RO); Dedolor® (AT); Deflagesic® (GT); Deflamat® (AT, CH, CL, ID, IT, TR); Deflamm® (AT); Deflox® [suspension] (MX); Demac® (TH); Desinflam® (AR, EC); Dexomon® (GB); D-Fenac® (BD); D.F.N.® (AR); D.F.N.® [compr.] (AR); Diaflam® (ID); Dichronic® (JP); Diclac® (AR, AT, CH, DE, HU, IE, LU, PL, RO); Diclax® (NZ); Diclo 1A Pharma® (DE); Diclo Abz® (DE); Diclo-basan® (CH, DE); Diclobene® (AT, RU); Dicloberl® (BD, PL, RO, RU); Diclobion® (PL); Diclo Carino® (DE); Diclocular® (IT); Diclodan® (DK); Diclo-Denk® (DE); Diclo dispers® (DE); Diclo-Divido® (DE); Diclodoc® (DE); DicloDuo® (PL); Diclo Eu Rho® (DE); Diclofan® (IT); Diclofar® (DO); Diclofel® (DO); Diclofemed® (BE); Diclofenac acis® (DE); Diclofenac-Akri® (RU); Diclofenac AL® (DE, HU, RO); Diclofenac Alter® (PT); Diclofenac Atid® (DE); Diclofenac Basics® (DE); Diclofenac BC® (BE); Diclofenac-B® (HU); Diclofenac-Chinoin® (HU); Diclofenac Chris® (DE); Diclofenac "Ciba"® (AT); Diclofenac Copyfarm® (DK); Diclofenac® (CZ, NO, PL, RO, RU, YU); Diclofenac Denver Farma® (AR); Diclofenac DOC® (IT); Diclofenac Dorom® (IT); Diclofenac Duo BMS® (RO); Diclofenac Duo Pharmavit® (HU, RO); Diclofenac EG® (BE, IT); Diclofenac Epifarma® (IT); Diclofenac-Eurogenerics® (LU); Diclofenac Fada® (AR); Diclofenac Fecofar® (AR); Diclofenac Genericon® (AT, CH); Diclofenac GNR® (IT); Diclofenac Helvepharm® (CH); Diclofenac Heumann® (DE); Diclofenac Hexa® (AR); Diclofenac Hexan® (IT); Diclofenac-K® (DO); Diclofenac Larjan® (AR); Diclofenac Lindo® (DE); Diclofenac Merck® (IT, PT); Diclofenac Natrium® (BG); Diclofenac-Natrium Lindo® (DE); Diclofenaco Aldo Union® (ES); Diclofenaco Alter® (ES); Diclofenaco Bayvit® (ES); Diclofenaco Britisfarma® (ES); Diclofenaco Cinfa® (ES); Diclofenaco Clariana Pic® (ES); Diclofenaco® (CL, EC, ES); Diclofenaco de Potassio® (BR); Diclofenaco Dietilamonio® (BR); Diclofenaco Distriquimic® (ES); Diclofenaco Edigen® (ES); Diclofenaco Esteve® (ES); Diclofenaco Gel® (CL); Diclofenaco Geminis® (ES); Diclofenaco Genfar® (EC); Diclofenaco L.CH.® (CL); Diclofenaco Lepori® (ES); Diclofenaco Llorens® (ES); Diclofenaco MK® (CR, DO, GT, HN, PA, SV); Diclofenaco MK potasico® (CR, DO, GT, HN, PA, SV); Diclofenaco Mundogen® (ES); Diclofenaco Normon® (ES); Diclofenaco Oftal Lepori® (ES); Diclofenaco Pliva® (ES); Diclofenaco Potassico® (BR); Diclofenaco Ratiopharm® (ES); Diclofenaco Resinato® (BR); Diclofenaco Rubio® (CR, DO, ES, PA, SV); Diclofenaco Sodico® (BR, CL); Diclofenaco Sodico MK® (CO); Diclofenac PB® (DE); Diclofenac Pharmavit® (HU); Diclofenac Pliva® (DK, IT); Diclofenac-PP® (HU); Diclofenac Ratiopharm® (BE); Diclofenac-ratiopharm® (DE); Diclofenac ratiopharm® (DK); Diclofenac-ratiopharm® (HU, IT, LU, RU); Diclofenac Richet® [gel] (AR); Diclofenac-Rivopharm® (CH); Diclofenac Sandoz® (DE); Diclofenac Slovakofarma® (SG); Diclofenac Sodico Biologici Italia® (IT); Diclofenac Sodico Higea® (CO); Diclofenac Sodico® (HN, IT); Diclofenac Sodic® (RO); Diclofenac Sodium E/C® (PL); Diclofenac Sodium® (GB, IL, SG); Diclofenac Stada® (DE, HU, PL, TH); Diclofenac Teva® (IT); Diclofenac T ratiopharm® (SE); Diclofenac UNP® (DK); Diclofenac Vramed® (BG); Diclofenax® (BR); Diclofen® (BD, BG, BR, CZ, JO, RO, TH); Diclofenbeta® (DE); Diclofen Cremogel® (RO); Dicloflam® (TR); Dicloflanac® (AR); Dicloflex® (GB); Diclo-F® (RU); Dicloftal® (PT); Dicloftil® (IT); Diclo-Gall® (RO); Diclo-Gel Sandoz® (DE); Diclogen® (RU, TH); Diclogesic® (AR, HK, JO, KW, LB, MT, MY, RO); Diclogrand® (AR); Diclohexal® (AU, ZA); Diclo® (IE); Diclo KD® (DE); Diclo-K® (EC); Diclo KSK® (DE); Diclolan® (TH); Diclomax Retard® (GB, IE); Diclomax® (RU); Diclomax SR® (GB); Diclomec Ampul® [inj.] (TR); Diclomec Jel® (TR); Diclomelan® (AT, RU); Diclomel® (IE); Diclomel SR® (HU, IE); Diclometin® (FI); Diclomex® (FI); Diclomex Rapid® (FI); Diclomol® (BD, TH); Diclonac S® (EC); Diclonat P® (RU); Diclon® (BD, DK); Diclo P® (BR); Diclophar® (BE); Diclophlogont® (DE); Dicloplast® (IL); Dicloplus® (AR); Diclopoen® (AR); Diclopoen Gel® (AR); Diclo-Puren® (DE); Dicloral® (IT); Dicloran Gel® (IN, RU); Dicloran® (IN, MX); Dicloratio® (PL); Diclorengel® (IL); Dicloreum® (CZ, IT, PL, RU); Diclorex® (BD); Diclo-saar® (DE); Diclosal Gel® (RO); Diclo SchmerzGel® (DE); Diclosian® (TH); Diclosifar® (CH); Diclosin® (RO); Diclostad® (AT); Diclosyl® (AT); Diclotard® (RO); Diclotaren® (CL); Diclotaren Gel® (CL); Diclotaren-R® (CL); Diclotec (CA); Diclotop® (BE); Diclo uno 1A Pharma® (DE); Diclovol® (GB); diclo von ct® (DE); Diclowal® (DO, HN, PA, SG, SV); Diclo-Wolff® (DE); Dicloxal® (DO); Dicloxal-P® (DO); Diclozip® (GB); Dicogel® (CL); Difelene® (TH); Difenac® (HK, SG, TH); Difenak® (TR); Difen® (AR); Difene® (AT, IE); Difenet® (DK); Difeno® (TH); Difnal® (SG); Digenac® (GB); Dignofenac® (EG, JO, LB); Diklofenak Biochemie® (SE); Diklofenak NM® (DK); Diklofenak NM Pharma® (SE); Diklofenak® (YU); Diklofen® (YU); Dikloron® (TR); Dinac® (AU, BD, TH); Dinaclord® (CO); Dinefec® (TH); Dioxaflex® (AR, BR, CO, CR, DO, GT, HN, PA, SV); Dioxaflex Contact® (CO); Dioxaflex Gel® (AR); Dioxaflex Parches® (AR); Dioxaflex Rapid® (AR); Dioxaflex Spraygel® (AR); Dioxaflex Suspension® (AR); Di Retard® (ES); Disipan® (AR); Divoltar® (ID); Doflex® (IN); Dolaren® (MX); Dolaut® (IT); Dolflam® (MX); Dolgit-Diclo® (DE); Dolmina® (CZ); Dolo Nervobion® (ES); Dolopasse® (AT); Dolorex® (TR); Dolostop® (EC); Dolo Tomanil® (AR); Dolotren® (DO, ES, GT, HN, PA, SV); Dolotren Topico® (ES); Dolo Voltaren® (ES); Dolpasse® (AT); Doriflan® (BR); Doroxan® (IT); Dosanac Gel® (TH); Dosanac® (TH); duravolten® (DE); Ecofenac® (CH); Econac® (GB); Effekton® (DE); Effigel® (CH); Elitiran® (CL); Elitiran Gel® (CL); Elitiran-GP® (CL); Enzed® (GB); Epifenac® (EG, JO, KW, LB, RO); Erdon® (BD); Exaflam® (ID); Fabofem® (AR); Feloran® (BG, CZ, PL, RU); Fenac® (AU, TH); Fenactol® (GB); Fenadol® (IT); Fenagel® (TH); Fenagen® (EC); Fenaren® (AT, BR, ID); Fenburil® (BR); Fender® (IT); Fengel® (CL); Fenil-V® (PT); Ficlon® (BD); Flamar® (ID); Flamatak® (GB); Flamenac® (ID); Flameril® (HU, NZ, PT); Flamrase® (CZ, GB, IE); Flamydol® (CO, CR, GT, HN, PA, SV); Flanakin® (BR); Flector® (CH, FR); Flector EP® (AT, CH, CZ, HU); Flector Tissugel® (BE, IT); Flenac® (EC); Flexamina® (BR); Flexotard® (GB); Flogam® (EC); Flogan® (BR); Flogofenac® (IT, RO); Flogozan® (CR, DO, GT, HN, PA, SV); Flotac® (AR, BR, CO, CR, DO, EC, GT, HN, PA, SV); Fluxpiren® (AR); Forgenac® (IT); Fortedol® (HU); Fortenac® (CH); Fortfen® (ZA); Frenac® (IN); Fustaren® (MX); Galedol® (MX); G-Diclofenac® (BD); Genac-50® (BD); Grofenac® (CH); Hexal Diclac® (AU); Hit® (EC); Hitflam® (BD); Huma-Difenac® (HU); I-Gesic® (IN); Imanol® (AR); Imanol Gel® (AR); Inac® (SG); Infla-Ban® (BG, JO, KW, LB, MA, MY, SY, ZA); Inflamac® (CH, CZ); Inflamac SR® (CZ); Inflamax® (BR); Inflanac® (HK, SG, TH); Inflaren® (BR); Inflaren K® (BR); Inflaren K Gel® (BR); Inflased® (TR); Jenafenac® (DE); Jutafenac® (DE); Kaflam® (ID); Kalidren® (TR); Kalium Diklofenak Dexa Medica® (ID); Katafenac® (HN, SV); Kemoren® (ID); Klafenac® (CO); Klafenac-D® (CO); Klonafenac® (AR); Klotaren® (ID); Laflanac® (ID); Lenitil® (AR); Lertus® (CL); Levedad® (AR); Leviogel® (IT); Lexobene® (DE); Liberalgium® (ES); Librafenac® (EC); Libraflam® (EC); Lifenac® (MX); Liroken® (MX); Lisiflen® (IT); Lofenac® (TH); Lofensaid® (GB); Logesic® (MX); Lonac® (BD); Luase® (ES); Luparen® (BR); Magluphen® (AT); Majamil® (PL); Majamil prolongatum® (PL); Masaren® (TH); Matsunaflam® (ID); Medaren® (TH); Med-Diclofenac® (RO); Medifen® (BD); Megafen® (BD); Merck-Diclofenac® (ZA); Merpal® (CL); Merxil® (MX); Micro-Diclofenac® (ZA); Mifenac® (DE); Miocalm® (AR); Miyadren® (TR); Mobifen® (BD); Modifenac® (DK, NO, SE); Molfenac® (IT); Monoflam® (CZ, DE); Motifene® (BE, GB); Myogit® (CZ, DE); Myonac® (TH); Naclof® (BD, BG, CZ, NL, PL, RO, RU, SI, TH); Nacoflar® (ID); Naklofen® (HR, PL, RO, RU, SI); Natura Fenac® (AR); N-Diclofenac® (RO); Neofen® (BD); Neriodin® (JP); Neurofenac® (ID); Nichoflam® (ID); Nilaren® (ID); Norfenac® (CO); Nortid® (BD); Novapirina® (IT); Novarin® (BD); Novo-Difenac (CA, RO); Novo-Difenac K (CA); Novo-Difenac-SR (CA); Nu-Diclo (CA); Nu-Diclo-SR (CA); Oftic® (CL, EC); Olfen® (CH, CY, CZ, EG, HK, HU, IL, JO, KW, LB, PL, PT, SG, SI, TH); Orfenac® (BD); Ortoflan® (BR); Ortophen® (RU); Ostaren® (TH); Oxa Antitermico Pediatrico® (AR); Oxa® (AR); Oxa Gel® (AR); Oxa Sat® (AR); Painex Gele® (PT); Painex® (PT); Panamor® (ZA); Pennsaid® (CA, GB, IT); Pevoran® (CL); Pharmflam® (ZA); Pirexyl® (CL); Piroflam® (CL); PMS-Diclofenac (CA); PMS-Diclofenac SR (CA); Polyflam® (BE, LU); Posnac® (TH); Potazen® (ID); Primofenac® (CH); Proladin® (BD); Pronac® (BD); Prostanac® (ID); Provoltar® (ID); Putaren® (TH); Q-Med Diclofenac® (ZA); Rapten-K® (YU); Rapten® (RU); Ratiogel® (PL); Reclofen® (ID); Refen® (RO); Remafen® (HK, SG); Remethan® (CY, TH); Renadinac® (ID); Renvol® (ID); Rewodina® (CZ, DE, PL, RO); Rheumabet® (ID); Rheumatac® (GB); Rheumavek® (RO); Rhewlin® (SG); Rhumalgan® (GB); Rhumanol Creamagel® (TH); Ribex Flu® (IT); Riva-Diclofenac (CA); Riva-Diclofenac-K (CA); Rodinac® (AR); Rolab-Diclofenac Sodium® (ZA); Romatim® (TR); Rumatab® (TH); Ruvominox® (RO); Sandoz Schmerzgel® (DE); Sanfinac® (RO); Scanaflam® (ID); Scantaren® (ID); Selectofen® (MX); Sigafenac® (DE); Sintofenac® (BR); Sipirac AP® (CL); Sipirac® (CL); Sipirac Gel® (CL); Slofenac® (GB); Solaraze® (DE, FR, GB, IE, IT, SE); Soludol® (BD); Sorelmon® (JP); Still® (BR); Subsyde® (TH); Taks® (TH); Tarjena® (TH); Tarjen® (TH); Thicataren® (JP); Tomanil® (AR); Tonopan Neue Formel® (CH); Topfans® (IT); Trabona® (FI); Tratul® [caps.] (AT, RO); Tratul® [compr.] (AT); Tratul® [inj./rect.] (AT, RO); Traumus® (CL); Turbogesic® (CL); Ultrafen® (BD); Unguent Antialgic® (RO); Uniclophen® (CZ, YU); Uniren® (SG, TH); Uno® (CZ); Valenac® (GB); Valto® (ID); Veenac® (TH); Veltex® (ZA); Veral® (BG, CZ, HU, PL, RU); Vesalion® (AR); Vifenac® (CH); Vimultisa® (AR); Vistal® (CL); Volclofen® (HN, SV); Voldal Gé® (FR); Volfenac Gel® (MX); Volfenac Retard® (MX); Volfenac® (TH); Volnac® (TH); Vologen® (IE); Volraman® (GB); Volsaid® (GB); Voltadex® (ID); Voltaflex® (BR); Voltanac® (TH); Voltapatch® (BE); Voltaren® (AR, AT, AU, BD, BE, BG, BR, CA, CH, CL, CO, CR, CZ, DE, DK, DO, EC, ES, FI, GT, HK, HN, HR, HU, ID, IL, IT, LU, MT, MX, NL, NO, NZ, PA, PL, PT, RO, RU, SE, SG, SI, SV, TH, TR, ZA); Voltaren Colirio® (ES); Voltaren D® (AR); Voltaren Dispers® [cpr.] (AT, DE); Voltaren Dispersible® (CH, NZ); Voltaren Dispersible® [Tab.] (CH); Voltaren Dolo® (CH, DE, HU); Voltarène Emulgel® (FR); Voltarène® (FR); Voltaren Emulgel® (AR, AT, AU, BE, BG, BR, CH, CL, CO, CZ, DE, ES, FR, HK, HU, ID, IL, IT, MT, MX, PL, PT, RO, RU, SG, TH, TR, YU, ZA); Voltaren K® (DE); Voltaren Migra® (AR); Voltaren Ophtha® (AT, AU, BE, CA, CH, DE, FI, HU, ID, IL, LU, NO, NZ, SE, SG, TR, ZA); Voltaren Rapid® (AT, AU, CH, CZ, FI, HR, PT, RO, RU); Voltaren Rapide® (CA); Voltaren Resinat® (DE); Voltaren Retard® (AR, CH, CL, RO, TR); Voltaren SR® (BG, HU, IL, NZ, PL, TR); Voltaren Suppositories® (NZ); Voltaren T® (SE); Voltarol Emulgel® (GB, IE); Voltarol® (GB, IE); Voltarol Ophtha® (IE, SE); Voltarol Rapid® (GB); Volta® (TH); Voltenac® (PL); Voltfast® (IT); Volverac Eye® (TH); Voren® (ID); Voren YSP® (SG); Vostar Retard® (DK); Votamed® (TH); Votrex® (EG, JO, KW, LB, SY); Voveran® (IN); Vurdon® (RO); Waridiclowal® (DO, PA, SV); Xedenol® (AR); Xenid® (FR, LU); Xenid gel® (FR); Xepathritis® (ID); X-Flam® (ID); Xina® (AR); Zegren® (ID); Zeroflog® (IT); Ziten® (DO); Zolterol® (SG)



Review Date: 1969-12-31 Reviewed By: Keywords: ,
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