Diclofenac
- Atc Codes:D11AX18#M01AB05#M02AA15#S01BC03
- CAS Codes:15307-81-0#15307-86-5#15307-79-6
- PHARMGKB ID:15307-81-0#15307-86-5#15307-79-6
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Unlabeled Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Caution and personalized dose adjustment in patients with the following genotypes
- Other genes that may be involved
- Substrate of
- Inhibits
- Induces
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Agilomed, Algefit, Dedolor, Deflamat, Deflamm, DiclacHexal, Diclobene, Diclofenac, Diclomelan, Diclostad, Diclosyl, Difene, Dolo-Neurobion, Dolostrip, Dolpasse, Pennsaid, Solaraze, Tratul, Voltaren; Belgium: Cataflam, Dicloabak, Diclofast, Diclofenac, Docdiclofe, Flector, Motifene, Voltapatch, Voltaren; Bulgaria: Almiral, Cataflam, Diclac, Diclofenac, Dicloral, Feloran, Naclof, Naklofen, Uniclophen, Voltaren, Voltfast; Cyprus: Allvoran, Almiral, Areston, Cataflam, Diclac, Difenac, Flector, Neritan, Remethan, Ruvominox, Taks, Vofenac, Voltaren; Czech Republic: Almiral, Diclo, Diclofen, Diclofenac, Dicloreum, Diky, Dolmina, Dorosan, Flector, Monoflam, Myogit, Naklofen, Olfen, Rewodina, Uniclophen, Uno, Veral, Voltaren; Denmark: Diclodan, Diclofenac, Diclon, Difenet, Diklofenac, Fenacop, Flector, Modifenac, Solaraze, Voltaren; Estonia: Almiral, Cataflam, Diclac, Dicloberl, Diclofenac, Dicloflex, Diclomelan, Diclorapid, Feloran, Naklofen, Olfen, Ortofen, Urigon, Voltaren; Finland: Alterflex, Diclofenac, Diclomex, Diklofenac, Eeze, Flector, Motifene, Solaraze, Voltaren, Voltfast; France: Dicloced, Diclofenac, Flector, Solaraze, Voltarendolo, Voltarene, Voltereactigo, Xenid; Germany: Allvoran, Combaren, Diclabeta, Diclac, Diclo, Dicloberl, Diclodoc, Diclofenac, Diclofenbeta, Diclowal, Difen, Dignofenac, Dolgit-Diclo, Effekton, Flector, Jenafenac, Jutafenac, Monoflam, Myogit, Olfen, Optalidon Zahnschmerz mit Diclofenac, Prekursan, Remethan, Rewodina, Sandoz Schmerzgel, Sigafenac, Solaraze, Sylmes, Voltaren, Voltarene, Xelaran; Greece: Actisuny, Anthraxiton, Batafil, Delimon, Denaclof, Diclofast, Diclofenac, Diclojet, Dicloplast, Dicloral, Difend, Evinopon, Fenoclof, Flefarmin, Inflaforte, Miniflam, Olfen, Optobet, Pain-Out, Pennsaid, Rheumavek, Ruvominox, Sfinac, Topalgon, Urigon, Vilonit, Voltaren, Voltum, Vurdon; Hungary: Cataflam, Diclac, Diclofenac, Diclomel, Doloflex, Flameril, Flector, Fortedol, Voltaren; Ireland: Cataflam, Diclac, Diclo, Diclofenac, Difene, Flector, Kyflam, Otriflu, Solaraze, Voltarol, Voltfast; Italy: Algosenac, Dealgic, Deflamat, Diclocular, Diclofan, Diclofenac, Dicloftil, Dicloral, Dicloreum, Diclotears, Diep, Dolaut, Doroxan, Dropflam, Eminocs, Fenadol, Fender, Flector, Itami, Leviogel, Misofenac, Momenlocaldol, Novapirina, Pennsaid, Solaraze, Traulen, Voltadol, Voltadvance, Voltalgan, Voltaren, Voltfast, Zeroflog; Latvia: Almiral, Cataflam, Diclac, Diclo, Dicloberl, Diclofenac, Dicloflex, Diclogen, Diclomelan, Diclorapid, Dikloferol, Felogel, Feloran, Inflamac, Majamil, Naklofen, Natrija Diklofenaks, Olfen, Ortofen, Ortofena, Profenac, Uniclophen, Voltaren; Lithuania: Cataflam, Diclac, Dicloberl, Diclofenac, Dicloflex, Diclomax, Diclomelan, Diclorapid, Feloran, Inflamac, Majamil, Naklofen, Natrija Diklofenaks, Olfen, Ortofeno, Uniclophen, Voltaren; Malta: Almiral, Areston, Catafast, Cataflam, Fenadol, Olfen, Remethan, Urigon, Voltaren, Vostar; Netherlands: Cataflam, Dicloabak, Diclofenac, Eminocs, Misofenac, Naclof, Normulen, Otriflu, Voltaren; Poland: Apo-Diclo, Biofenak, Cataflam, Diclac, Dicloabak, Dicloberl, Diclobion, Diclofenac, Dicloratio, Dicloreum, Diclotard, Dicloziaja, Difadol, Difen-UD, Diklonat P, Dikmed, Diky, Felogel, Feloran, Flector, Majamil, Naclof, Naklofen, Olfen, Rewodina, Tarfenac, Veral, Voltaren, Voltenac; Portugal: Cataflam, Clofen, Dagesil, Dicloabak, Diclodent, Diclofar, Diclofenac, Diclospray, Dofene, Dolacen, Dorcalor, Fenac-Gel, Fenil-V, Flameril, Flector, Frenalgil, Olfen, Otriflu, Painex, Pennsaid, Solaraze, Voltadol, Voltaren; Romania: Almiral, Clafen, Diclac, Diclofenac, Diclogesil, Dicloral, Dicloreum, Diclosin, Diclotard, Epifenac, Flogofenac, Refen, Rheumavek, Tratul, Uniclophen, Voltaren, Vurdon; Slovakia: Almiral, Diclobene, Dicloreum, Diclofenac, Diky, Dolmina, Flector, Myogit, Rewodina, Uniclophen, Veral, Voltaren; Slovenia: Diclo, Dicloflex, Diclojet, Naclof, Naklofen, Olfen, Voltaren; Spain: Algipatch, Dicloabak, Diclofenaco, Di-Retard, Dolotren, Dolo-Voltaren, Luase, Ratioparch, Voltadol, Voltalgial, Voltaren, Xibol; Sweden: Alterflex, Diclofenac, Diklofenak, Flector, Instantin, Modifenac, Solaraze, Voltaren; UK: Diclofenac, Dicloflex, Diclomax, Dyloject, Econac, Fenactol, Mobigel, Motifene, Rheumatac, Rhumalgan, Solaraze, Volsaid, Voltarol.
North America
Canada: Diclo, Diclofenac, Difenac, Pennsaid, Voltaren; USA: Cambia, Cataflam, Diclofenac, Flector, Pennsaid, Solaraze, Voltaren, Zipsor.
Latin America
Argentina: Ainedif, Aldoron NF, Anaflex, ATM 101, Banoclus, Befol, Calmoflex, Curinflam, Diastone, Diclac, Diclofenac, Diclofilab, Diclogesic, Diclogrand, Diclolam, Diplomar, Diclonex, Difenac, Disipan, Dolofenac, Dolo Tomanil, Dolvan, Doxtran, Flexin, Flexiplen, Flogolisin, Iglodine, Imanol, Kinalgin, Klonafenac, Levedad, Lorbifenac, Metaflex, Nalgiflex, Natura, Norviken, Oxa, Pronix, Quer-Out, Silfox, Viartril NF, Vimultisa, Volforte, Voltaren, Xenedol; Brazil: Ana-Flex, Arten, Benevran, Biofenac DI, Cataflam, Cataflex, Clofenid, Deltaflogin, Deltaren, Diclo P, Diclofenaco, Diclogenom, Diclonaco, Diclonax, Diclonil, Diclosódico, Dioxaflex, Dnaren, Fenaflan, Fenburil, Fladon, Flamatrat P, Flanakin D, Flanaren, Flodin Duo, Flogan, Flogiren, Inflamax, Lindaren, Maxilerg, Neotaflan, Neotaren, Olfen, Ortoflan, Poltax, Probenxil, Prodofenaco, Sodix, Still, Vendrex, Voltaflan, Voltaflex, Voltaren, Voltrix; Mexico: 3A Ofteno, Alsidexten, Ariflam, Atalak, Cataflam, Clo-Far, Clonodifen, Coral Wermar, Deflox, Dicfafena, Diclac, Diclofenaco, Dicloran, Diclosol, Dioxaflex, Dirret, Docril, Dofen, Dolflam, Dolofenac, Doltarac, Evadol, Fenagel, Fenalgin, Fervex, Flamydol, Flankol, Flogoken, Fustaren, Galedol, Lifenac, Liroken, Lodyfen, Lonatec, Lufac-Z, Mafena, Manacon, Merxil, Nediclon, Neo-Dolaren, Pharmaflam, Practiser, Precifenac, Selectofen, Solof, Still, Volfenac, Voltaren.
Asia
Japan: Adefuronic, Anavan, Aspizone, Begita, Blesin, Bolabomin, Daispas SR, Dichronic, Dichrophenon, Diclod, Diclofenac, Diclostar, Difenac, Docell, Fenacidon, Fenytaren, Irinatolon, Meclophen, Mericut, Naboal, Neriodin, Pinanac, Prophenatin, Rectos, Saffrac, Sannax, Savismin SR, Sofarin, Sorelmon, Stafulmin, Strongcoll SR, Thicataren, Volmagen, Voltaren, Vonafec, Vonfenac, Youfenac.
Drug combinations
Diclofenac and Acetominophen
Diclofenac and Amoxicillin
Diclofenac and Ampicillin
Diclofenac and Codeine
Diclofenac and Cyanocobalamin (Vitamin B~12~)
Diclofenac and Gentamicin
Diclofenac and Misoprostol
Diclofenac and Orphenadrine
Diclofenac and Pridinol
Diclofenac and Tobramycin
Diclofenac, Betamethasone, and Cyanocobalamin (Vitamin B~12~)
Diclofenac, Cyanocobalamin (Vitamin B~12~), and Prednisolone
Chemistry
Diclofenac Potassium: C~14~H~10~Cl~2~KNO~2~. Mw: 334.24. (1) Benzeneacetic acid, 2-[(2,6-dichlorophenyl)amino]-, monopotassium salt; (2) Potassium [o-(2,6-dichloroanilino)phenyl]acetate. CAS-15307-81-0; CAS-15307-86-5 (diclofenac)(1992).
Diclofenac Sodium: C~14~H~10~Cl~2~NNaO~2~. Mw: 318.13. Benzeneacetic acid, 2-[(2,6-dichlorophenyl)amino]-, monosodium salt. CAS-15307-79-6 (1973).
Pharmacologic Category
Skin and Mucous Membrane Agents, Miscellaneous. Analgesics and Antipyretics; Other Nonsteroidal Anti-inflammatory Agents. (ATC-Code: D11AX18; M01AB05; M02AA15; S01BC03).
Mechanism of action
Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase (COX/PTGS).
Therapeutic use
Ankylosing spondylitis. Primary dysmenorrhea. Acute and chronic treatment of rheumatoid arthritis, or osteoarthritis. Postoperative inflammation following cataract extraction. Temporary relief of pain and photophobia in patients undergoing corneal refractive surgery. Actinic keratosis. Relief of osteoarthritis pain in joints (e.g. ankle, elbow, foot, hand, knee, wrist). Acute pain due to minor strains, sprains, and contusions.
Pregnancy and lactiation implications
May lead to premature closure of the ductus arteriosus and may inhibit uterine contractions in late pregnancy, therefore, the drug should be avoided in this stage (3^rd^ trimester of pregnancy). Not recommended during lactation.
Unlabeled use
Juvenile rheumatoid arthritis.
Contraindications
Hypersensitivity to diclofenac, aspirin, other NSAIDs, or any component of the formulation. Perioperative pain in the setting of coronary artery bypass surgery. Pregnancy (3^rd^ trimester).
Warnings and precautions
Avoid use in bronchospasm, asthma, rhinitis, or urticaria (anaphylactoid reactions may occur). Caution in patients with coagulation disorders who are receiving anticoagulants (platelet adhesion and aggregation may be decreased; may prolong bleeding time), or are on long-term NSAID therapy (anemia may occur). Risk of cardiovascular thrombotic events, including MI, stroke, and new onset or worsening of pre-existing hypertension (use caution with fluid retention, heart failure, or hypertension). May increase risk of GI irritation, ulceration, bleeding, and perforation (caution in history of GI disease (bleeding or ulcers), concurrent therapy with aspirin, anticoagulants and/or corticosteroids, smoking, use of alcohol, elderly or debilitated patients). May cause serious skin adverse events including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Do not administer to patients with aspirin-sensitive asthma (severe bronchospasm may occur) and use caution with other forms of asthma. Contraindicated for treatment of perioperative pain in the setting of coronary artery bypass surgery (risk of MI and stroke). Use with caution in decreased hepatic function (rarely, severe hepatic reactions (e.g. fulminant hepatitis, liver failure) have occurred). Use may compromise existing renal function (patients with impaired renal function, dehydration, heart failure, liver dysfunction, those taking diuretics and ACEI, and the elderly are at greater risk of renal toxicity). Not recommended for use in advanced renal disease. Long-term NSAID use may result in renal papillary necrosis. The elderly are at increased risk for adverse effects (especially peptic ulceration, CNS effects, and renal toxicity). Patients using ophthalmic drops should not wear soft contact lenses. Ophthalmic drops may slow/delay healing or prolong bleeding time following surgery. Should not be applied topically (gel) to the eyes, mucous membranes, open wounds, infected areas, or to exfoliative dermatitis; and concomitant use with sunscreens, cosmetics, lotions, moisturizers, insect repellents, or other topical medication on the same skin sites should be avoided. Sunlight exposure to treated areas should also be avoided. Topical patch should not be applied to the eyes, mucous membranes, open wounds, infected areas, or to exudative dermatitis and should not be worn during bathing or showering.