Key takeaways:
Diclofenac (Cambia, Cataflam) is a nonsteroidal anti-inflammatory drug (NSAID). It interacts with several other medications and alcohol.
Common diclofenac interactions include aspirin, blood thinners, and methotrexate (Trexall). Certain antidepressants and blood pressure medications also interact. The main risks with many interactions are stomach or intestinal bleeding and kidney damage.
Topical forms of diclofenac, like Voltaren gel or the Flector patch, are less likely to have interactions. This is because less medication reaches your bloodstream compared to oral forms.
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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, it’s estimated that about 30 million people take NSAIDs every day. Diclofenac (Cambia, Cataflam) is an example of a commonly prescribed NSAID.
As with any medication, it’s good to know how to stay safe while taking diclofenac. This includes knowing about drug interactions — which can raise the risk of side effects or affect how a medication works. So what does diclofenac interact with, and how can you avoid or manage them?
Good to know: This article focuses on interactions with oral diclofenac. Topical forms of diclofenac — such as gels, patches, and eyedrops — still have the same interactions. But there’s generally a lower risk of complications. This is because less of the medication reaches your bloodstream compared to oral forms. But you should still discuss topical diclofenac interactions with your healthcare team before starting it.
Diclofenac interactions at a glance
The following medications and substances interact with diclofenac:
Other NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
Aspirin (an NSAID that also acts as antiplatelet medication)
Anticoagulants, such as warfarin (Coumadin, Jantoven) and rivaroxaban (Xarelto)
Antiplatelet medications, such as clopidogrel (Plavix) and ticagrelor (Brilinta)
Blood pressure medications, such as lisinopril (Zestril) and losartan (Cozaar)
Certain antidepressants
Lithium (Lithobid)
Methotrexate (Trexall)
Alcohol
Certain herbal supplements, like ginkgo biloba and ginseng
This isn’t a full list of all possible diclofenac interactions. Sharing your medication list with your prescriber and pharmacist can help you steer clear of any interactions.
Certain risk factors may make these interactions more serious. Talk to a healthcare professional before taking diclofenac if you:
Are are over age 65
Have diabetes
Have kidney disease
Have heart problems, including high blood pressure
Have a history of stomach ulcers
Below is information about nine notable diclofenac interactions and how to manage them.
1. Other NSAIDs, such as ibuprofen
You shouldn’t take diclofenac with other NSAIDs, such as ibuprofen and naproxen. 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.
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 your products’ OTC labels. 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
Aspirin is also an NSAID that some people take once a day for heart protection. But it works a bit differently from others in its class. And the way it interacts with diclofenac is different from how other NSAIDs interact.
More about side effects: Many interactions raise the risk of serious diclofenac (Cambia, Cataflam) side effects, such as bleeding or kidney damage.
People who shouldn’t take diclofenac: Learn which people should avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac.
Recommended dosages: Read about the typical diclofenac dosages recommended for each version of the medication.
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 prescriber gives you the OK to take diclofenac and aspirin, you should separate them. Take your low-dose aspirin first, at least 2 hours before diclofenac.
3. Antithrombotics
Antithrombotics (blood thinners) are medications that help treat or prevent blood clots. They include two classes of medications: anticoagulants and antiplatelet medications.
Anticoagulants slow down how fast your blood clots. Common anticoagulants are:
Dabigatran (Pradaxa)
Antiplatelet medications help prevent your platelets from sticking together. Common examples include:
Prasugrel (Effient)
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 the combination for a few days. 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 prescriber 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 a healthcare professional before taking diclofenac with blood pressure medications. NSAIDs, such as diclofenac, can raise your blood pressure. This can make it harder for blood pressure medications to work well, especially if you take diclofenac regularly. This interaction can also make it more difficult to keep your blood pressure within its ideal range.
Taking diclofenac with some blood pressure medications can also put extra strain 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, such as lisinopril
Angiotensin II receptor blockers (ARBs), such as losartan
Diuretics (“water pills”), such as 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 team. Acetaminophen (Tylenol) might be a safer choice, as it doesn’t typically affect 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.
Another group of antidepressants has a similar interaction with diclofenac: serotonin and norepinephrine reuptake inhibitors (SNRIs). Example SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor XR).
SNRIs work similarly to SSRIs. SNRIs also carry a risk of bleeding. The risk of serious bleeding goes up if you take both an SNRI and diclofenac.
If your prescriber says you need to take both diclofenac and an SSRI or SNRI, ask about ways to protect your stomach. They may suggest taking additional medication, such as omeprazole (Prilosec) or famotidine (Pepcid AC).
6. Lithium
Lithium 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 is a common medication prescribed to treat certain cancers and autoimmune disorders, such as rheumatoid arthritis (RA). NSAIDs, including diclofenac, may also be a part of your autoimmune treatment plan. But ask a healthcare professional before mixing NSAIDs with methotrexate on your own.
Your kidneys help clear methotrexate from your body. Since diclofenac lowers kidney function, it can raise 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 professionals 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 prescriber 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.
9. Some herbal supplements
It’s not just prescription and OTC medications that interact with diclofenac. There are also some supplement interactions that you need to be aware of. Some herbal supplements may increase your risk of bleeding when combined with diclofenac. These include:
Bilberry
Chamomile
Dong quai
Fenugreek
Feverfew
Garlic
Ginger
Ginseng
Horse chestnut
Meadowsweet
Motherworth
Red clover
Tamarind
Turmeric
Willow
There may be other supplements and vitamins that interact with diclofenac. Be sure to share a complete medication list with your healthcare team, including supplements. They can check for potential interactions and suggest ways to manage them.
Good to know: The interaction discussed here is usually only a problem if you’re taking these products in supplement form. Consuming them in your diet, such as eating garlic or drinking chamomile tea, is unlikely to cause a problem. But if you consume large amounts of these products, it’s a good idea to ask your prescriber or pharmacist if you should reduce your dietary intake of them.
Frequently asked questions
It’s generally safe to take diclofenac with Tylenol (acetaminophen). They work in different ways to treat pain. And they aren’t known to interact. But you may need to avoid both medications if you have liver problems.
You may need to avoid diclofenac gel (Voltaren Arthritis Pain) if you can’t take other NSAIDs. A healthcare professional can help determine if it’s a safe option for you. You also shouldn’t use diclofenac gel for sprains, bruises, or sports injuries. It hasn’t been shown to work well for this type of pain. And if you’re pregnant, nursing, or younger than age 18, talk to a healthcare professional before using diclofenac gel.
Common oral diclofenac side effects include nausea, headaches, and heartburn. These side effects are generally mild and can be managed at home. Less common but serious diclofenac side effects include stomach bleeding, kidney damage, and heart problems. These side effects can become life-threatening and require medical attention.
It’s generally safe to take diclofenac with Tylenol (acetaminophen). They work in different ways to treat pain. And they aren’t known to interact. But you may need to avoid both medications if you have liver problems.
You may need to avoid diclofenac gel (Voltaren Arthritis Pain) if you can’t take other NSAIDs. A healthcare professional can help determine if it’s a safe option for you. You also shouldn’t use diclofenac gel for sprains, bruises, or sports injuries. It hasn’t been shown to work well for this type of pain. And if you’re pregnant, nursing, or younger than age 18, talk to a healthcare professional before using diclofenac gel.
Common oral diclofenac side effects include nausea, headaches, and heartburn. These side effects are generally mild and can be managed at home. Less common but serious diclofenac side effects include stomach bleeding, kidney damage, and heart problems. These side effects can become life-threatening and require medical attention.
The bottom line
Diclofenac (Cambia, Cataflam) is a nonsteroidal anti-inflammatory drug (NSAID) that interacts with many medications. Common medications that interact with diclofenac include blood thinners, certain antidepressants, and blood pressure medications. Aspirin, methotrexate (Trexall), and alcohol also interact. Topical diclofenac, such as gel or the patch, is less likely to cause complications. This is because less medication reaches your bloodstream compared to oral diclofenac. Be sure to tell your healthcare team about everything you’re taking.
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