8 Diclofenac Interactions to Watch Out for

Got creaky joints or an aching back? You might turn to nonsteroidal anti-inflammatory drugs (NSAIDs) for some relief. It’s a popular choice. In fact, in 2010, over 29 million U.S. adults regularly took an NSAID to relieve pain or inflammation (swelling).

Since NSAIDs are so frequently used, it’s important to know how to take them safely. Drug interactions — which can raise the risk of side effects or affect how a medication works — should be considered when starting any medication. Below, we’ll review eight notable interactions for a commonly prescribed NSAID: diclofenac (Cambia, Cataflam). But keep in mind that there are more possible interactions than what’s discussed here.

1. Other NSAIDs

You shouldn’t take diclofenac with other NSAIDs, like ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Most NSAIDs work similarly and can cause comparable side effects. These can be mild, like heartburn. But they can also be serious, like stomach ulcers or kidney damage.

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You won’t get any extra pain relief by taking diclofenac with another NSAID. But, there’s a higher risk for side effects, such as kidney injury and stomach bleeding.

Also, be on the lookout for NSAIDs included in some over-the-counter (OTC) combination products. They’re found in some cold medications, menstrual cramp relief products, and some antacids.

It’s important to check the list of ingredients on the “Drug Facts” label on OTC products. This will tell you what medications are included. Be sure to ask your pharmacist for advice on what’s safe to combine with diclofenac.

2. Aspirin

Some people take low-dose aspirin once a day for heart protection. If you take this NSAID, check with your healthcare provider before taking it with diclofenac. There’s an interaction to know about that’s different from how other NSAIDs interact.

Regular use of diclofenac might make aspirin’s heart benefits less effective if they’re taken at the same time. This is because diclofenac and aspirin can both affect how blood platelets form clots in the body. When taken together, medications like diclofenac can actually reduce aspirin’s antiplatelet effects. So aspirin may not work as well to prevent blood clots that cause heart attacks or strokes.

If your healthcare provider gives you the OK to take diclofenac and aspirin, you should separate them. Take your low-dose aspirin first, at least 30 minutes before diclofenac.

3. Antithrombotics

Antithrombotics are medications that help treat or prevent blood clots. They include two classes of medications: anticoagulants (“blood thinners”) and antiplatelet medications. 

Anticoagulants slow down how fast your blood clots. Common anticoagulants are: 

• Warfarin (Coumadin, Jantoven)

• Rivaroxaban (Xarelto)

• Apixaban (Eliquis)

Antiplatelet medications help prevent your platelets from sticking together. Common examples include:

• Clopidogrel (Plavix)

• Prasugrel (Effient)

• Ticagrelor (Brilinta)

As discussed above, diclofenac also has antiplatelet effects. Taking it with anticoagulants or antiplatelets increases your risk of serious bleeding and heart-related complications. This is true even if you only take a few doses. Your risk is even higher if you’re taking antithrombotics after having a heart attack.

If you’re taking a blood thinner or antiplatelet medication, ask your healthcare provider about safer options to treat pain. Diclofenac and other NSAIDs are usually avoided because of the bleeding risks with this combination.

4. Blood pressure medications

It’s best to talk to your healthcare provider before taking diclofenac with blood pressure medications. NSAIDs, like diclofenac, can raise your blood pressure. This can make it harder for blood pressure medications to work effectively, especially if you take diclofenac regularly. This interaction can also make it more difficult to keep your blood pressure at an ideal range.

Taking diclofenac with some blood pressure medications can also be hard on the kidneys. Diclofenac can temporarily lower your kidney function. And certain blood pressure medications affect the kidneys. Combining them with diclofenac can raise your risk of kidney damage.

Blood pressure medications that affect the kidneys include:

• Angiotensin-converting enzyme (ACE) inhibitors like lisinopril (Zestril)

• Angiotensin II receptor blockers (ARBs) like losartan (Cozaar)

• Diuretics (“water pills”) like furosemide (Lasix) and hydrochlorothiazide (Microzide)

If you’re taking more than one of these medications, the risk for kidney damage with diclofenac goes up. For example, you may take both an ARB and a diuretic. Discuss alternative pain relievers with your healthcare provider. Acetaminophen (Tylenol) might be a safer choice, as it’s not hard on the kidneys.

5. Certain antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are a commonly prescribed group of antidepressants. Examples include citalopram (Celexa) and fluoxetine (Prozac).

Both SSRIs and diclofenac have risks for stomach-related side effects and bleeding. When combined, these risks go up. This can lead to stomach ulcers or bleeding.

Be sure to tell your healthcare provider if you have a history of ulcers. If they say you need to take both an SSRI and diclofenac, ask about ways to protect your stomach. They may suggest taking additional medication, like omeprazole (Prilosec) or famotidine (Pepcid AC).

6. Lithium

Lithium (Lithobid) is a first-choice medication prescribed for people living with bipolar disorder. It tends to interact with many medications. This includes diclofenac.

The kidneys remove lithium from the body. Because diclofenac can lower your kidney function, it can slow down this process. Taking diclofenac with lithium can lead to high lithium levels in the blood. High lithium levels can cause serious side effects like confusion, blurry vision, or seizures. 

Despite this interaction, there may be times people need to take both medications. If this is the case, you may need more frequent blood tests. These would help make sure your lithium levels aren’t getting too high and your kidneys are working well. 

7. Methotrexate

Methotrexate (Trexall) is a common medication prescribed to treat autoimmune disorders like rheumatoid arthritis (RA). NSAIDs, including diclofenac, may also be a part of your treatment plan. But ask your healthcare provider before mixing NSAIDs with methotrexate on your own.

Methotrexate is cleared from the body by the kidneys. Since diclofenac lowers kidney function, it can increase methotrexate levels in the blood. High levels of methotrexate can cause serious complications, like a low platelet count or liver damage. This interaction is more likely to cause problems if you take diclofenac and methotrexate on the same day.

Some healthcare providers might say it’s OK to take low-dose methotrexate and diclofenac. If so, they may recommend going for more frequent blood tests. These tests would help keep a closer eye on your methotrexate levels and kidney function.

8. Alcohol

Thinking of having a glass of wine with dinner? For many folks taking NSAIDs, the occasional alcoholic beverage may be fine. But there are still some things to consider. Alcohol seems to increase the likelihood of diclofenac’s stomach side effects, including stomach bleeding.

If you're taking diclofenac, speak with your healthcare provider first before drinking any alcohol. Even if they say it’s OK, it’s best to drink in moderation. If you have other health conditions or take other medications that raise the risk of stomach irritation, consider skipping alcohol altogether.

How can I avoid or manage potential interactions with diclofenac?

Certain risk factors may make diclofenac interactions more serious. Talk to your healthcare provider if you have kidney problems, are over 75 years old, or have had stomach ulcers in the past.

You can also ask your healthcare provider about using a topical form of diclofenac, like Voltaren gel. These dosage forms are applied directly to the area you’re treating. Far less medication gets absorbed into your bloodstream this way. Because of this, there are minimal effects on the stomach, kidneys, or platelets — the three usual areas of concern in regard to diclofenac interactions.

When should I contact my healthcare provider about a diclofenac interaction?

It’s best to avoid or manage diclofenac interactions before they happen. Be sure to share a complete medication list with your healthcare provider and pharmacist. They’ll help look for potential interactions and suggest ways to manage them.

Call 911 or seek medical help right away if you have any of these symptoms:

• Severe stomach pain

• Bloody stools

• Stools that are black and sticky like tar

• Swelling or fluid retention in your arms or legs

• Chest pain

• Shortness of breath

• Weakness on one side of your body

• Slurred speech

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Written by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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