Diclofenac Sodium

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Mar 27, 2023

Warnings

Diclofenac Sodium Risks, Warnings, and Complications

Diclofenac sodium can cause or worsen serious health problems in some people. Talk to your doctor or pharmacist about other treatment options if you are at increased risk of complications from diclofenac sodium.

CARDIOVASCULAR EVENTS: Taking NSAIDs, including diclofenac, carries an increased risk of serious cardiovascular events like heart attack and stroke. This can happen within a few weeks of starting the medicine. People with pre-existing heart problems and those taking high doses of diclofenac or taking it for a prolonged time are at higher risk of developing these serious side effects. Your doctor will prescribe the lowest dose possible for the shortest time to treat your symptoms. Before starting diclofenac sodium, tell your healthcare provider if you have heart disease or a prior heart attack. You should not take this medicine if you have had or will shortly have a coronary artery bypass graft (heart bypass surgery). Call 911 or seek emergency medical help if you develop chest pain, difficulty breathing, trouble speaking or walking, or weakness on one side of your body.
GASTROINTESTINAL COMPLICATIONS: Taking NSAIDs, including diclofenac, can lead to a greater risk of acid damage to the stomach. This can lead to potentially dangerous stomach bleeding and ulcers. Many health conditions and other medications can increase your risk of these problems, including older age; previous stomach bleeding; taking other NSAIDs, steroid medicines, or blood thinners; smoking; drinking alcohol; liver problems; or poor health. Tell your doctor about all your medical problems and medications before starting diclofenac sodium. Take the lowest possible dose for the shortest time to minimize your risk. Stop taking diclofenac sodium and call your doctor without delay if you notice blood or coffee grounds in your vomit, black or tarry stools, or persistent stomach pain.
FLUID RETENTION: Taking diclofenac can lead to fluid retention in the body. This can lead to new or worsening swelling in the arms and legs, high blood pressure, or heart failure. In addition, diclofenac can make certain medications prescribed for these conditions (such as water pills, ACE inhibitors, and ARBs) less effective. Diclofenac may not be right for you if you have severe heart failure. Keep an eye on your blood pressure readings while on this medicine and tell your doctor if they are high. Call your doctor without delay or seek emergency medical care if you develop trouble breathing, fatigue, swelling, or sudden weight gain.
KIDNEY DAMAGE: Taking diclofenac can slow down blood flow to the kidneys and cause acute kidney injury. Older adults and people taking certain other medicines to treat blood pressure, such as diuretics (water pills), ACE inhibitors, and ARBs, and those with kidney disease, liver disease, or heart failure are at greater risk. The risk is also higher if you have severe vomiting, diarrhea, or bleeding resulting in loss of body fluids. Tell your doctor if you have pre-existing kidney problems before starting this medicine. Diclofenac may not be right for you if you have severe kidney problems. Call your doctor without delay if you develop difficulty urinating, pain with urination, cloudy, discolored or bloody urine, or back pain while on diclofenac sodium.
LIVER DAMAGE: Very rarely, diclofenac can cause drug-induced liver damage. This life-threatening complication can happen within a month of starting the medicine. Risk factors include taking other drugs that can cause liver damage, such as acetaminophen (Tylenol), or drinking alcohol. There may not be any symptoms of liver damage, so if you are on diclofenac for a long time, your doctor may order lab tests to keep an eye on your liver function. Stop diclofenac and call your doctor right away if you develop fever, chills, tiredness, abdominal pain, nausea, vomiting, yellowing of the skin or eyes, light-colored stools, or dark urine.
SEVERE ALLERGIC REACTIONS: Rarely, taking diclofenac can cause a severe allergic reaction called anaphylaxis (throat tightening and difficulty breathing), severe asthma attacks, or severe skin reactions. Tell your doctor if you have ever had an allergic reaction to NSAIDs, including aspirin. People who have asthma or frequent stuffy or runny nose or nasal polyps (growths) should discuss the pros and cons of taking this medicine with their healthcare provider. Stop taking diclofenac sodium and get medical help immediately if you develop throat tightening, difficulty breathing, skin rash, peeling, blistering, or swelling of the face.
RISK DURING PREGNANCY: Taking diclofenac during pregnancy can cause harm to an unborn baby by causing too little amniotic fluid around the baby. This complication can occur within days of starting the medicine and may lead to serious kidney and heart problems in the baby. Before starting diclofenac sodium, tell your provider if you are pregnant, could be pregnant, or are planning a pregnancy.

Precautions Before Starting Diclofenac Sodium

Tell your health care provider if you are allergic to diclofenac sodium, any of the active or inactive ingredients in diclofenac products, other NSAIDs, or any other medicines. Your pharmacy can give you a list of ingredients in diclofenac formulations.

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, non-prescription (OTC) medications, vitamins, and herbal supplements. This will help avoid dangerous interactions between diclofenac and your other medications.

Give your doctor a complete medical history. Diclofenac sodium may not be right for people with certain medical conditions, such as asthma, frequent stuffy or runny nose, nasal polyps, porphyria, blood clots, ulcers or bleeding in your stomach or intestines, any bleeding disorders, heart disease, heart failure, stroke, liver disease, kidney disease, diabetes or swelling of the hands or feet. If you have phenylketonuria (PKU), you should know that the diclofenac powder and solution are not safe for you because it contains aspartame, which is a source of phenylalanine.You should also tell your provider if you smoke and if you have or have ever had high cholesterol or high blood pressure.

Discuss the benefits versus risks of taking diclofenac with your provider if you are 65 years of age or older. There may be other safer alternatives available.

Tell your doctor if you are pregnant, could be pregnant, planning a pregnancy, or are breast feeding.

Precautions During Use of Diclofenac Sodium

Keep all your healthcare appointments during your treatment with diclofenac sodium.

Tell all your healthcare providers you are on diclofenac sodium before any procedure, including dental procedures.

Tell your doctor if you become pregnant while taking diclofenac sodium. This medication can cause harm to an unborn baby.

Diclofenac Sodium Drug Interactions

Certain other drugs can affect how diclofenac sodium works. Possible interactions between diclofenac sodium and other medicines can increase the risk of severe adverse effects. Some of the medications that can interact with diclofenac include:

Anticoagulants (blood thinners) such as warfarin (Coumadin, Jantoven)
Aspirin
Other NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
Oral steroids such as dexamethasone, prednisone (Rayos) and methylprednisolone (Medrol)
Selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine (Luvox), citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), sertraline (Zoloft) and paroxetine (Brisdelle, Paxil, Pexeva)
Serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR)
Acetaminophen (Tylenol)
Angiotensin receptor blockers (ARBs) such as olmesartan (Benicar, in Azor, in Benicar HCT, in Tribenzor), losartan (Cozaar, in Hyzaar), candesartan (Atacand, in Atacand HCT), azilsartan (Edarbi, in Edarbyclor), irbesartan (Avapro, in Avalide), eprosartan (Teveten), and telmisartan (Micardis, in Micardis HCT, in Twynsta)
Angiotensin-converting enzyme inhibitors such as lisinopril (in Zestoretic), enalapril (Vasotec, in Vaseretic), benazepril (Lotensin, in Lotrel), captopril, fosinopril, quinapril (Accupril, in Accuretic, in Quinaretic), moexipril (Univasc, in Uniretic), perindopril (Aceon, in Prestalia), ramipril (Altace), and trandolapril (Mavik, in Tarka)
Beta blockers such as metoprolol (Lopressor, Toprol XL, in Dutoprol), atenolol (Tenormin, in Tenoretic), nadolol (Corgard, in Corzide), labetalol (Trandate), and propranolol (Hemangeol, Inderal, Innopran)
Water pills (diuretics)
Immunosuppressants such as cyclosporine (Gengraf, Neoral, Sandimmune)
Heart medicines such as digoxin (Lanoxin)
Insulin and oral medications used to treat diabetes
Medications prescribed for seizures
Psychiatric medications such as lithium (Lithobid)
Antifungals like voriconazole (Vfend)
Antitubercular drugs like rifampin (Rifadin, Rimactane, in Rifamate, in Rifater)
Cancer treatment drugs like methotrexate (Otrexup, Rasuvo, Trexall)

Give your doctor or pharmacist a list of all the medicines you take, including prescription drugs, OTC (non-prescription) drugs, dietary supplements, and herbal products. Also, tell your healthcare professionals if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription medications.

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