Diclofenac

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Also indexed as:

Cataflam, Voltaren, Voltaren XR

Combination List

Combination drug:

• Arthrotec

Diclofenac is used in the treatment of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. It is in a class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs).

Herbs

Summary of Interactions for Diclofenac

Depletion or interference	Calcium Lithium L-tryptophan*
Adverse interaction	None known
Side effect reduction/prevention	None known
Supportive interaction	Stinging nettle
Reduced drug absorption/bioavailability	Trikatu Willow*

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

Calcium

Diclofenac decreases the amount of calcium lost in the urine,¹ which may help prevent bone loss in postmenopausal women.²

L-tryptophan

Diclofenac causes complex changes to L-tryptophan levels in the blood,³ but the clinical implications of this are unknown. More research is needed to determine whether supplementation with L-tryptophan is a good idea for people taking diclofenac.

Lithium

Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression. Diclofenac may inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral.⁴ Since minor changes in lithium blood levels can produce unwanted side effects, diclofenac should be used with caution in people taking lithium supplements.

Interactions with Herbs

Stinging nettle(Urtica dioica)

In a controlled human study, people who took stinging nettle with diclofenac obtained similar pain relief compared to people taking twice as much diclofenac with no stinging nettle.⁵ More research is needed to determine whether people taking diclofenac might benefit from also taking stinging nettle.

Trikatu

Trikatu, an Ayurvedic herbal preparation that contains Piper nigrum (black pepper), Piper longum (Indian Long pepper), and Zingiber officinale (ginger), decreased both blood levels and the medicinal effect of diclofenac in a study in rabbits.⁶

Willow(Salix alba)

Willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of aspirin to individuals taking diclofenac results in a significant reduction in blood levels of diclofenac.⁷ Though there are no studies investigating interactions between willow bark and diclofenac, people taking the drug should avoid the herb until more information is available.

Other Interactions

Food

Taking diclofenac with food may lower the maximum concentration of the drug in the blood and may delay, but not decrease, absorption.⁸ NSAIDs such as diclofenac should be taken with a meal to reduce stomach irritation.

Smoking

Injury to the stomach caused by NSAIDs such as diclofenac can resolve naturally despite continued administration of the drug. However, the stomach lining of smokers is less likely to adapt to injury, leading to continued damage from the drug.⁹

Alcohol

Chronic consumption of alcohol can aggravate injury to the stomach and duodenal lining caused by diclofenac.¹⁰ To prevent added injury, consumption of alcoholic beverages should be avoided in individuals taking diclofenac.

References

1. Sharma S, Vaidyanathan S, Thind SK, et al. The effect of diclofenac sodium on urinary concentration of calcium, uric acid and glycosaminoglycans in traumatic paraplegics. Br J Urol 1991;68:240-2.
2. Bell NH, Hollis BW, Shary JR, et al. Diclofenac sodium inhibits bone resorption in postmenopausal women. Am J Med 1994;96:349-53.
3. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184-213.
4. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184-213.
5. Chrubasik S, Enderlein W, Bauer R, Grabner W. Evidence for antirheumatic effectiveness of Herba Urticae dioicae in acute arthritis: a pilot study. Phytomedicine 1997;4:105-8.
6. Lala LG, D'Mello PM, Naik SR. Pharmacokinetic and pharmacodynamic studies on interaction of Trikatu with diclofenac sodium. J Ethnopharmacol 2004;91:277-80.
7. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184-213.
8. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184-213.
9. Lipscomb GR, Campbell F, Rees WD. The influence of age, gender, Heliobacter pylori and smoking on gastric mucosal adaptation to non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 1997;11:907-12.
10. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2889-91.

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Last Review: 01-21-2009

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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires February 2010.

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