Defanac (diclofenac)

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting, indigestion or abdominal pain.
- Excess gas in the stomach and intestines (flatulence).
- Loss of appetite.
- Headache.
- Dizziness.
- Balance disorders involving the inner ear (vertigo).
- Skin rashes.
- Ulceration of the stomach or intestine.
- Bleeding from the stomach or intestine.
- Drowsiness.
- Anxiety.
- Depression.
- Difficulty sleeping (insomnia).
- Fluid retention (oedema).
- Changes in blood pressure.
- Sensation of ringing or other noise in the ears (tinnitus).
- Allergic reactions such as severe skin rashes, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm).
- Kidney, liver or blood disorders.
- Small increased risk of heart attack (myocardial infarction) or stroke, particularly at high doses (150mg daily) and in long-term treatment.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before taking this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Indigestion remedies such as antacids should not be taken at the same time as enteric-coated diclofenac tablets, as they will stop the special coating from working.

Diclofenac should not be taken in combination with painkilling doses of aspirin or any other oral NSAID, eg ibuprofen, as this increases the risk of side effects on the stomach and intestines. Selective inhibitors of COX-2 such as celecoxib or etoricoxib should also be avoided for the same reason.

There may be an increased risk of ulceration or bleeding from the gut if diclofenac is taken with corticosteroids such as prednisolone.

There may also be an increased risk of bleeding from the gut if diclofenac is taken with the following medicines:

- anti-blood-clotting (anticoagulant) medicines such as warfarin
- anti-platelet medicines to reduce the risk of blood clots or 'thin the blood', eg low-dose aspirin, clopidogrel, dipyridamole
- SSRI antidepressants, eg fluoxetine, paroxetine, citalopram
- venlafaxine.

Diclofenac may enhance the effect of blood-thinning or anti-clotting medicines (anticoagulants) such as warfarin. As this may increase the risk of bleeding, people taking diclofenac with an anticoagulant should be closely monitored by their doctor.

Diclofenac may reduce the removal of the following medicines from the body and so may increase the blood levels and risk of side effects of these medicines. People taking diclofenac with any of these should be closely monitored by their doctor:

- digoxin
- lithium
- methotrexate.

Ciclosporin may increase the blood level of diclofenac, and your doctor may prescribe a lower than normal dose of diclofenac if you are taking ciclosporin.

There may be an increased risk of side effects on the kidneys if diclofenac is taken with any of the following medicines:

- ACE inhibitors, eg enalapril
- angiotensin II receptor antagonists, eg losartan
- ciclosporin
- diuretics, eg furosemide
- tacrolimus.

Diclofenac may oppose the blood pressure lowering effects of certain medicines to treat high blood pressure, such as the following:

- ACE inhibitors such as captopril
- angiotensin II receptor antagonists, eg losartan
- beta-blockers such as propranolol
- diuretics such as furosemide.

Other medicines containing the same active ingredient

Dexomon SR	Dicloflex	Diclomax
Diclozip	Econac suppositories	Fenactol
Flamatak MR	Flamrase	Motifene
Pennsaid	Rheumatac retard	Rhumalgan
Volsaid retard	Voltarol emulgel	Voltarol emulgel P
Voltarol gel patch	Voltarol injection	Voltarol ophtha
Voltarol rapid tablets	Voltarol suppositories	Voltarol tablets

Diclofenac enteric-coated tablets, sustained-release tablets, suppositories and injection are also available without brand names, ie as the generic medicine.

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