Do NSAIDs Like Ibuprofen Increase Your Risk of Heart Attacks?
The FDA strengthened the warning on NSAIDs stating that high doses over a long period of time can increase the risk of heart attack. Here’s what you should know.
diclofenac sodium
Used for Actinic Keratosis, Eye Inflammation, Osteoarthritis, Rheumatoid Arthritis
Used for Actinic Keratosis, Eye Inflammation, Osteoarthritis, Rheumatoid Arthritis
Diclofenac is a prescription non-steroidal anti-inflammatory drug (NSAID) that works well to treat pain and swelling in certain conditions, such as osteoarthritis, rheumatoid arthritis, and menstrual cramps. Diclofenac comes in different formulations, including delayed-release tablet and powder packet for oral solution. Similar to other NSAIDs, it has warnings for serious side effects, such as stroke, heart attack, and stomach bleeds, especially with higher doses and longer use.
What is Diclofenac?
What is Diclofenac used for?
- Mild to moderate pain
- Osteoarthritis
- Rheumatoid arthritis
- Ankylosing spondylitis (arthritis of the spine)
- Migraine attacks
- Menstrual cramps
How Diclofenac works
Diclofenac is a NSAID. It works by blocking certain proteins in your body that cause pain and swelling.
Drug facts
| Common Brands | Cambia, Lofena, Zipsor, Zorvolex |
|---|---|
| Drug Class | NSAID |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
Side effects of Diclofenac
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Up to 10% of people taking diclofenac experience:
- Headaches
- Dizziness
- Ringing in the ear
- Swelling in the arms and legs
- Nausea
- Vomiting
- Heartburn
- Stomach bleeds, ulcers, and damage
- Passing gas
- Stomach pains
- Constipation
- Diarrhea
- Rash
- Dry and itchy skin
- Anemia
- Bleeding that's hard to stop
Diclofenac serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: dizziness, tiredness, cold sweat, trouble breathing, chest pain or tightness, anxiety
- Stroke: tiredness, lightheadedness, blurred vision, difficulty speaking, difficulty walking, weakness on one side of the body
- Stomach bleeds: blood in your vomit, stool that looks like black coffee grounds, pain in your stomach that doesn't go away
- Heart failure: trouble breathing, tiredness, swelling in your body, sudden weight gain
- Liver damage: fever, chills, fatigue, nausea, vomiting, yellowing of the skin or whites of the eyes, clay-colored stool, dark urine
- Kidney damage and high potassium: nausea, muscle weakness, tingling sensations in your muscles, changes in how much you urinate
- Severe asthma attack: chest pain, cough, difficulty breathing, wheezing
- Serious allergic or skin reaction: fever, rash, body aches, cough, swelling of the face, peeling skin, painful blisters all over your body
When do Diclofenac possible side effects begin and end?
Time passed since treatment started:
H
D
W
M
Risk for stomach pains
Risk for nausea or vomiting
Risk for heartburn
Risk for stomach bleeds or ulcers
Seek immediate medical care if you experience this side effect.
If a line continues to the right, you'll likely keep experiencing this side effect once it starts.
The following Diclofenac side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Burning, itching, redness, skin rash, swelling, or soreness at the application site
itching skin
Less common
Blood in the urine
dry, itching, or burning eyes
headaches, including migraines
increased sensitivity of the skin to sunlight
pain or tenderness around the eyes and cheekbones
redness of the skin
redness or swelling of the eyes
runny or stuffy nose
skin rash other than at the application site
tightness in the chest
troubled breathing
ulcers or sores on the skin, other than at the application site
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Chills
general feeling of discomfort or illness
joint pain
loss of appetite
muscle aches and pains
scaly, thick, or tingling skin
shivering
sweating
trouble sleeping
unusual tiredness or weakness
vomiting
Less common
back pain
belching
bleeding skin
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
dizziness
increase in body movements
indigestion
lack or loss of strength
loss of or change in taste
loss or thinning of the hair
neck pain
sleepiness or unusual drowsiness
stomach upset or pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Get your GoodRx coupon
N/A
GoodRx discount
$8.85
Pros and cons of Diclofenac
Pros
- Available in many different formulations, such as tablet, capsule, and powder
- Available in a long-acting form that only needs to be take once per day
- Diclofenac potassium (Cambia) powder can help with migraine pain in as quickly as 15 minutes.
- All brands of diclofenac are available as lower-cost generics.
Cons
- Typically have to take multiple times a day (except for the powder and extended-release tablet)
- Not recommended for use in children (except for diclofenac potassium (Zipsor) capsules, which can be used in children age 12 years and older)
- Not recommended for use in pregnancy, especially starting in the second trimester or later
- Not the best option if you're 65 years or older, or have kidney, heart, liver, or bleeding problems
Pharmacist tips for Diclofenac
- You can take diclofenac with or without food. If it hurts your stomach, try taking it with food or milk to help. But, doing so might affect how fast your body absorbs the medication and how well it works.
- Don't break, crush, or chew the diclofenac tablets or capsules without first checking with your provider if it's safe to do so. Typically, this medication needs to be swallowed whole. Some diclofenac pills have a special coating that affects how the medication is absorbed in the body.
- Keep in mind that diclofenac potassium (Cambia) powder can only treat migraine attacks, but won't prevent them from happening. Mix the powder only with water, not any other types of liquid. Once you've mixed the powder well, drink it immediately. A single dose can provide up to 24 hours of pain relief. A second dose isn't recommended because researchers haven't studied whether it’s safe or if it works well to relieve further migraine pain.
- If you're using diclofenac for arthritis, it won't prevent your condition from getting worse. Some things you can do to prevent your arthritis from getting worse include physical therapy, exercise, or taking other medications. Discuss with your provider what the best options are for you.
- Diclofenac can put you at higher risk for bleeds when you get injured. Let your provider know if you've had any recent falls or injuries. Sometimes, bleeds on the inside of your body might not show any outward symptoms. Get medical help right away if you experience signs of bleeds, such as bruises that don't go away, bleeds that take a long time to stop, or blood in your vomit.
- Diclofenac can cause anemia (low red blood cell levels). Let your provider know if you experience symptoms of anemia, such as feeling tired or weak, having pale skin, trouble breathing, or cold hands and feet.
- Let your provider know if you're breastfeeding or planning to breastfeed. Limited information suggest that diclofenac is likely safe to take during breastfeeding, but more research is needed in this area. Depending on the type of pain you have, your provider can recommend treatment options to ease your symptoms during pregnancy.
Risks and warnings for Diclofenac
Diclofenac can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart attack and stroke
- Risk factors: History of heart problems, including heart attack | Taking high doses of diclofenac | Taking diclofenac for a long time | History of heart bypass surgery
Diclofenac can raise your risk of having blood clots, heart attacks, or strokes. This can happen as early as within the first weeks of starting this medication. People with heart problems, those taking high doses of diclofenac, and those taking diclofenac for a long time have a higher risk of this happening. That’s why it’s important to take the lowest possible dose for the shortest possible time. If you have heart problems, talk to your healthcare provider before starting this medication. Don't take diclofenac if you've had or will be having heart bypass surgery. Call 911 or seek immediate medical help if you experience chest pain, trouble breathing, weakness on one side of your body, or trouble speaking or walking.
Stomach bleeding and ulcers
- Risk factors: History of stomach bleeding or ulcers | Older adults | Taking aspirin (Aspir-Low), other NSAIDs, corticosteroids, blood thinners, or SSRIs | Drinking alcohol | Smoking | Having poor health | Bleeding problems | Liver problems | Taking diclofenac for a long time | Taking high doses of diclofenac
Diclofenac can cause stomach bleeding and ulcers, which can be dangerous. There are many conditions and medications that raise your risk of this problem, so speak with your provider before starting this medication. Stomach bleeding and ulcers can occur without warning or symptoms, so it's best to take the lowest possible dose for the shortest possible time to minimize your risk. If you notice blood in your vomit, stool that looks like black coffee grounds, or if you have pain in your stomach that doesn't go away, stop taking diclofenac and talk to your healthcare provider right away.
Liver damage
- Risk factors: History of liver damage | Taking other medications that can cause liver damage | Taking high doses of diclofenac | Taking diclofenac for a long time
Very rarely, diclofenac can cause life-threatening liver damage. This can happen as early as within the first month of starting this medication. Your risk is higher if you take diclofenac with other medications that can also cause liver damage, such as acetaminophen (Tylenol). Liver damage can happen with or without symptoms, so if you take this medication for a long time, you might need to get lab work done regularly to check your liver. Stop diclofenac and talk to your healthcare provider right away if you experience symptoms, such as fever, chills, fatigue, nausea, vomiting, yellowing of the skin or whites of the eyes, clay-colored stool, and dark urine.
High blood pressure, heart failure, and swelling of your arms and legs
- Risk factors: High blood pressure | Heart failure | Taking certain high blood pressure medications, such as water pills, ACE inhibitors, and ARBs
Diclofenac can raise your blood pressure, and it can also cause your body to hold onto more water. This can lead to new or worsening blood pressure problems, heart failure, and swelling of your arms and legs. Diclofenac can also cause some blood pressure and heart failure medications, such as furosemide (Lasix), lisinopril (Zestril), and losartan (Cozaar), to not work well. Diclofenac isn't recommended if you have severe heart failure, so discuss with your provider before starting this medication. Monitor your blood pressure closely while taking diclofenac. Let your provider know right away if you notice any changes in your blood pressure or experience symptoms, such as trouble breathing, tiredness, swelling in your body, or sudden weight gain.
Kidney damage and high potassium levels
- Risk factors: Kidney or liver problems | Heart failure | Taking certain high blood pressure medications, such as water pills, ACE inhibitors, or ARBs | Older adults | Loss of body fluid through conditions such as severe vomiting, bleeding, or diarrhea | Using diclofenac for a long time
Diclofenac can damage your kidneys by slowing down blood flow to the kidneys. The risk is higher if you're taking certain blood pressure medications (like ACE inhibitors, ARBs, or water pills), or have certain conditions (like kidney or liver problems and heart failure). Kidney damage is usually reversible once you stop taking diclofenac. This medication isn't recommended if you have very severe kidney problems, so discuss the risks and benefits of taking it with your provider. Let your provider know if you notice a change in how often you urinate after starting diclofenac as this can be a sign of kidney damage.
In addition, kidney damage from diclofenac can also lead to high potassium levels. Sometimes, this medication can cause high potassium levels even in people with normal kidneys. If you experience signs of high potassium levels, such as nausea, muscle weakness, or tingling sensations in your muscles, tell your healthcare provider right away because it might be dangerous.
Severe asthma attack
- Risk factors: Asthma and stuffy nose with or without nasal polyps | Allergic reaction to aspirin or other NSAIDs
Diclofenac can cause your airways to tighten, which might lead to severe asthma attacks. Be careful using this medication if you have asthma. People who've experienced asthma attacks triggered by aspirin (Aspir-Low) or other NSAIDs in the past should avoid diclofenac. Get medical help right away if your throat tightens and you can't breathe.
Severe allergic or skin reaction
- Risk factors: Past allergic reactions to other NSAIDs | Allergy to bovine (cow) ingredients (for people taking Zipsor only)
Diclofenac might cause sudden, very serious, and sometimes life-threatening allergic and skin reactions. Avoid Zipsor (diclofenac) if you're allergic to bovine (cow) products because it contains gelatin, which is made from cows. Symptoms of serious reactions include fever, body aches, rash, peeling skin, painful blisters all over your body, and swelling of the face. Stop the medication and get help right away if you experience these symptoms.
Harm to unborn babies
- Risk factors: Currently pregnant
If diclofenac is taken during or after the second trimester of pregnancy, it can lower the amniotic fluid (the fluid that surrounds the baby in the womb). This can occur as soon as 2 days after starting the medication and result in serious kidney problems in your unborn baby. Babies born to mothers who take diclofenac starting in the third trimester of pregnancy or later can also develop heart problems. If you're thinking of getting pregnant or become pregnant, talk to your provider about the risks and benefits of using diclofenac.
Diclofenac dosage
The average cost for 1 tube of 100g of 1% of Diclofenac is $14.45 with a free GoodRx coupon. This is 48.70% off the average retail price of $28.17. 
Tablet
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 50mg | 60 tablets | $16.37 | $0.27 |
| 25mg | 60 tablets | $24.95 | $0.42 |
| 75mg | 60 tablets | $14.38 | $0.24 |
Typical dosage for Diclofenac
Different types of diclofenac are not interchangeable with each other because they're not absorbed by your body in the same way. Discuss with your healthcare provider if you want to switch between different types of diclofenac.
In addition, your dose might be lower if you have liver problems.
Diclofenac sodium delayed-release (DR) tablets
- Osteoarthritis: The typical dose is 50 mg by mouth two to three times a day, or 75 mg two times a day.
- Rheumatoid arthritis: The typical dose is 50 mg by mouth three to four times a day, or 75 mg two times a day.
- Ankylosing spondylitis: The typical dose is 25 mg by mouth four times a day, with an extra 25 mg at bedtime if needed.
Diclofenac sodium extended-release (ER) tablets
- Osteoarthritis or rheumatoid arthritis: The typical dose is 100 mg by mouth once a day.
Diclofenac potassium capsule (Zipsor)
- Mild to moderate pain (age 12 years and older): The typical dose is 25 mg by mouth four times a day.
Diclofenac potassium tablet (Lofena)
- Mild to moderate pain, including menstrual cramps: The typical dose is 50 mg by mouth three times a day.
- Osteoarthritis: The typical dose is 50 mg by mouth two to three times a day.
- Rheumatoid arthritis: The typical dose is 50 mg by mouth three to four times a day.
Diclofenac potassium powder for solution (Cambia)
- Migraine attacks: The typical dose is one packet (50 mg total) by mouth as a one-time dose when you have a migraine attack. Mix the packet with 2 to 4 tablespoons (30 mL to 60 mL) of water and drink the entire mixture right away.
- Mild to moderate pain: The typical dose is 18 mg or 35 mg by mouth three times a day.
- Osteoarthritis: The typical dose is 35 mg by mouth three times a day.
More on Diclofenac dosage
Interactions between Diclofenac and other drugs
Diclofenac may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Diclofenac. Please note that only the generic name of each medication is listed below.
More on Diclofenac interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abciximab
- Acenocoumarol
- Amiloride
- Amineptine
- Amitriptyline
- Amitriptylinoxide
- Amoxapine
- Anagrelide
- Apixaban
- Ardeparin
- Argatroban
- Aspirin
- Bemiparin
- Bendroflumethiazide
- Benzthiazide
- Betamethasone
- Betrixaban
- Bivalirudin
- Budesonide
- Bumetanide
- Cangrelor
- Ceritinib
- Certoparin
- Chlorothiazide
- Chlorthalidone
- Cilostazol
- Citalopram
- Clomipramine
- Clopamide
- Clopidogrel
- Cortisone
- Cyclopenthiazide
- Cyclosporine
- Dabigatran Etexilate
- Dalteparin
- Danaparoid
- Deferiprone
- Deflazacort
- Desipramine
- Desirudin
- Desmopressin
- Desvenlafaxine
- Dexamethasone
- Dexketoprofen
- Diazoxide
- Dibenzepin
- Diflunisal
- Digoxin
- Dipyridamole
- Dipyrone
- Dothiepin
- Doxepin
- Droxicam
- Duloxetine
- Edoxaban
- Enoxaparin
- Eplerenone
- Epoprostenol
- Eptifibatide
- Escitalopram
- Ethacrynic Acid
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Feverfew
- Floctafenine
- Flufenamic Acid
- Fluocortolone
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Furosemide
- Ginkgo
- Gossypol
- Heparin
- Hydrochlorothiazide
- Hydrocortisone
- Hydroflumethiazide
- Ibuprofen
- Iloprost
- Imipramine
- Indapamide
- Inotersen
- Ketoprofen
- Lepirudin
- Levomilnacipran
- Lithium
- Lofepramine
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Magnesium Salicylate
- Meadowsweet
- Meclofenamate
- Mefenamic Acid
- Melitracen
- Meloxicam
- Mesalamine
- Methotrexate
- Methyclothiazide
- Methylprednisolone
- Metolazone
- Milnacipran
- Morniflumate
- Nabumetone
- Nadroparin
- Naproxen
- Nefazodone
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Nortriptyline
- Olsalazine
- Opipramol
- Oxaprozin
- Oxyphenbutazone
- Paramethasone
- Parecoxib
- Parnaparin
- Paroxetine
- Pemetrexed
- Pentosan Polysulfate Sodium
- Pentoxifylline
- Phenindione
- Phenprocoumon
- Phenylbutazone
- Phenyl Salicylate
- Piketoprofen
- Piroxicam
- Polythiazide
- Prasugrel
- Prednisolone
- Prednisone
- Proglumetacin
- Propyphenazone
- Proquazone
- Protein C
- Protriptyline
- Reboxetine
- Reviparin
- Rivaroxaban
- Rofecoxib
- Salicylamide
- Salicylic Acid
- Salsalate
- Sertraline
- Sibutramine
- Sodium Salicylate
- Spironolactone
- Sulfasalazine
- Sulindac
- Tacrolimus
- Tenofovir Disoproxil Fumarate
- Tenoxicam
- Tianeptine
- Tiaprofenic Acid
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Torsemide
- Trazodone
- Treprostinil
- Triamterene
- Trichlormethiazide
- Trimipramine
- Trolamine Salicylate
- Valdecoxib
- Venlafaxine
- Vilazodone
- Vorapaxar
- Vortioxetine
- Warfarin
- Xipamide
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acebutolol
- Alacepril
- Atenolol
- Azilsartan
- Azilsartan Medoxomil
- Benazepril
- Betaxolol
- Bisoprolol
- Candesartan Cilexetil
- Captopril
- Carteolol
- Carvedilol
- Celiprolol
- Ciprofloxacin
- Enalapril
- Enalaprilat
- Eprosartan
- Esmolol
- Fosinopril
- Irbesartan
- Labetalol
- Levobunolol
- Lisinopril
- Losartan
- Metipranolol
- Metoprolol
- Moexipril
- Nadolol
- Nebivolol
- Olmesartan Medoxomil
- Oxprenolol
- Penbutolol
- Perindopril Erbumine
- Pindolol
- Practolol
- Propranolol
- Quinapril
- Ramipril
- Sotalol
- Spirapril
- Telmisartan
- Timolol
- Trandolapril
- Valsartan
How much does Diclofenac cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Diclofenac contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Diclofenac will not be safe for you to take.
- History of asthma, hives, or other allergic reactions after taking aspirin or another NSAID
- Use of diclofenac 10 to 14 days after open heart surgery
- Bovine (cow) allergy (for diclofenac potassium (Zipsor) capsules only)
What are alternatives to Diclofenac?
There are a number of medications that your doctor can prescribe in place of Diclofenac. Compare a few possible alternatives below.
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Learn about common diclofenac interactions, including medication, supplement, and alcohol interactions.
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Diclofenac images
