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Diclofenac (systemic): Drug information

Diclofenac (systemic): Drug information
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For additional information see "Diclofenac (systemic): Patient drug information" and "Diclofenac (systemic): Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Serious cardiovascular thrombotic events:

Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction (MI) and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.

Diclofenac is contraindicated during the perioperative setting of coronary artery bypass graft (CABG) surgery.

Serious gastrointestinal bleeding, ulceration, and perforation:

NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

Brand Names: US
  • Cambia;
  • Cataflam [DSC];
  • Lofena;
  • Zipsor;
  • Zorvolex [DSC]
Brand Names: Canada
  • APO-Diclo;
  • APO-Diclo SR;
  • Cambia;
  • Diclofenac-50;
  • PMS-Diclofenac;
  • PMS-Diclofenac K [DSC];
  • PMS-Diclofenac-SR [DSC];
  • SANDOZ Diclofenac;
  • SANDOZ Diclofenac Rapide;
  • SANDOZ Diclofenac SR;
  • TEVA-Diclofenac EC;
  • TEVA-Diclofenac SR;
  • TEVA-Diclofenac-K;
  • Voltaren;
  • Voltaren Rapide;
  • Voltaren SR
Pharmacologic Category
  • Analgesic, Nonopioid;
  • Nonsteroidal Anti-inflammatory Drug (NSAID);
  • Nonsteroidal Anti-inflammatory Drug (NSAID), Oral
Dosing: Adult

Dosage guidance:

Safety: Avoid or use with caution in patients at risk for cardiovascular disease, GI disease, kidney impairment, chronic liver disease, or a bleeding diathesis. Consider proton pump inhibitor coadministration in patients at risk for GI bleeding (eg, taking dual antiplatelet therapy or an anticoagulant, ≥60 years of age, high diclofenac doses) (Ref).

Dosing: Use the lowest effective dose for the shortest duration. For diclofenac potassium and sodium salt formulations, the US maximum daily dose is 150 to 200 mg/day; however, Health Canada recommends not exceeding 100 mg/day to limit risk of vascular events (Ref). Diclofenac acid maximum dose is 105 mg/day.

Dosage form information: Diclofenac potassium and sodium salt formulations are approximately equivalent and dosed the same. Diclofenac acid 35 mg is approximately equivalent to diclofenac salts 38.5 mg. Zorvolex capsules (brand and generic) have been discontinued in the United States >1 year.

Acute pain

Acute pain (monotherapy or as adjunctive agent):

Oral: Diclofenac potassium or sodium formulations: 100 to 150 mg/day in divided doses as needed or scheduled (may choose immediate release [given in 2 to 4 divided doses], delayed release [given in 2 to 4 divided doses], or extended release [given once daily]); may administer 100 mg as an initial loading dose followed by a maintenance dose; maximum dose (after day 1): 150 mg/day (Ref).

Oral: Diclofenac acid: 18 mg or 35 mg 3 times daily as needed or scheduled; maximum dose: 105 mg/day.

Ankylosing spondylitis

Ankylosing spondylitis:

Oral: Diclofenac potassium or sodium formulations: 100 to 150 mg/day in divided doses (may choose immediate release [given in 2 to 4 divided doses], delayed release [given in 2 to 4 divided doses], or extended release [given once daily]); maximum dose: 150 mg/day (Ref).

Dysmenorrhea

Dysmenorrhea:

Oral: Diclofenac potassium or sodium formulations: 150 mg/day in divided doses (may choose immediate release [given in 2 to 4 divided doses] or delayed release [given in 2 to 4 divided doses]); may administer 75 to 100 mg as an initial loading dose followed by a maintenance dose; maximum dose (after day 1): 150 mg/day. Begin at menses onset or 1 to 2 days prior to onset of menses for severe symptoms; usual duration: 1 to 5 days (Ref).

Gout, treatment, acute flares

Gout, treatment, acute flares (off-label use):

Oral: Diclofenac potassium or sodium formulations: 100 to 150 mg/day in divided doses (may choose immediate release [given in 2 to 4 divided doses], delayed release [given in 2 to 4 divided doses], or extended release [given once daily]). Initiate within 24 to 48 hours of flare onset; reduce dose as symptoms improve. Discontinue a few days after resolution of clinical signs (usual total duration: 5 to 7 days); longer duration may be required if therapy is delayed (Ref).

Migraine, acute treatment

Migraine, acute treatment:

Note: For use as monotherapy in mild to moderate attacks not associated with vomiting or severe nausea; may be used in combination with triptans for severe migraine (Ref).

Oral (powder for oral solution or IR tablet): 50 to 100 mg as a single dose (Ref).

Osteoarthritis

Osteoarthritis:

Oral: Diclofenac potassium or sodium formulations: 100 to 150 mg/day in divided doses (may choose immediate release [given in 2 to 4 divided doses], delayed release [given in 2 to 4 divided doses], or extended release [given once daily]); maximum dose: 150 mg/day.

Oral: Diclofenac acid: 35 mg 3 times daily; maximum dose: 105 mg/day.

Rectal (Canadian product): Substitute for the final oral daily dose: Insert 50 mg or 100 mg suppository as a single dose.

Rheumatoid arthritis

Rheumatoid arthritis:

Oral: Diclofenac potassium or sodium formulations: 100 mg/day in divided doses (may choose immediate release [given in 2 to 4 divided doses], delayed release [given in 2 to 4 divided doses], or extended release [given once or twice daily]); if needed, may increase to a maximum dose of 200 mg/day in divided doses (Ref). Note: For the ER formulation, the maximum dose should be given in 2 divided doses according to the manufacturer.

Rectal (Canadian product): Substitute for the final oral daily dose: Insert 50 mg or 100 mg suppository as a single dose.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Oral, rectal:

Altered kidney function:

CrCl ≥60 mL/minute: No dosage adjustment necessary (Ref).

CrCl >30 to <60 mL/minute: No dosage adjustment necessary (Ref). However, use of analgesics other than nonsteroidal anti-inflammatory drugs may be preferred. If necessary, use the lowest effective dose for the shortest duration possible; avoid in patients at high risk for acute kidney injury (ie, volume depleted, hypotensive, older adults, or taking concurrent nephrotoxic medications) (Ref).

CrCl ≤30 mL/minute: Avoid use due to increased risk of acute kidney injury (Ref).

Hemodialysis, intermittent (thrice weekly): Not expected to be significantly dialyzable (highly protein bound) (Ref): No dosage adjustment necessary. Avoid use in patients with residual kidney function (Ref).

Peritoneal dialysis: No dosage adjustment necessary. Avoid use in patients with residual kidney function (Ref).

CRRT: Avoid use (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Avoid use (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; use with caution to avoid adverse effects and discontinue if hepatic function worsens.

Dosing: Older Adult

Unless alternative agents are ineffective and a gastroprotective agent can be administered, avoid short-term scheduled use in combination with corticosteroids, anticoagulants, or antiplatelet agents or chronic use with or without medications that increase risk for bleeding (Ref).

Refer to adult dosing; initiate using lowest recommended dose and frequency.

Dosing: Pediatric

(For additional information see "Diclofenac (systemic): Pediatric drug information")

Dosage guidance:

Dosing: Use the lowest effective dose for the shortest duration.

Dosage form information: Different oral formulations are not bioequivalent; do not interchange products.

Oral:

Acute pain

Acute pain (mild to moderate): Children ≥12 years and Adolescents: Immediate-release capsule (Zipsor): Oral: 25 mg 4 times daily (Ref).

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis: Limited data available: Children and Adolescents: Immediate-release tablet: Oral: 2 to 3 mg/kg/day in divided doses 2 to 3 times daily; maximum daily dose: 150 mg/day (Ref).

Migraine

Migraine: Limited data available: Children ≥12 years and Adolescents: Powder for oral solution (eg, Cambia): Oral: 50 mg (1 packet) as a single dose at onset of migraine (Ref).

Rectal: Rectal formulation not available in the United States. Note: Approved indications, strengths, and ages vary by country; see product-specific labeling for details.

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis: Limited data available: Children: Suppository (12.5 mg or 25 mg only): Rectal: 1 to 3 mg/kg/day in divided doses 2 to 3 times daily (Ref).

Osteoarthritis

Osteoarthritis: Limited data available: Adolescents ≥16 years: Suppository (50 mg or 100 mg): Rectal: Insert 50 or 100 mg suppository at bedtime as a substitute for the last daily oral dose; maximum daily dose: 100 mg/day (oral and rectal) (Ref).

Postoperative pain

Postoperative pain: Limited data available: Rectal suppository (12.5, 25, or 50 mg): Children and Adolescents: Suppository (12.5 mg, 25 mg, or 50 mg): Rectal: Initial dose: 1 to 2 mg/kg/dose once followed by 1 mg/kg/dose 3 times daily; round dose to nearest available suppository size; maximum single dose: 50 mg/dose; maximum daily dose: 3 mg/kg/day; treatment should not exceed 4 days duration (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Children and Adolescents: There are no pediatric-specific dosage adjustments provided in the manufacturer's labeling; some experts have suggested the following:

KDIGO 2012 guidelines provide the following recommendations for NSAIDs (Ref):

eGFR 30 to <60 mL/minute/1.73 m2: Temporarily discontinue in patients with intercurrent disease that increases risk of acute kidney injury

eGFR <30 mL/minute/1.73 m2: Avoid use.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, may require dosage adjustment due to extensive hepatic metabolism.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions may be reported for diclofenac specifically or as class effects for nonsteroidal anti-inflammatory drugs.

>10%:

Cardiovascular: Edema (33%)

Gastrointestinal: Nausea (3% to 14%)

1% to 10%:

Cardiovascular: Hypertension (2%)

Dermatologic: Diaphoresis (1%), pruritus (7%), skin rash

Gastrointestinal: Abdominal pain (4% to 7%), constipation (8%), diarrhea (6%), duodenal ulcer, dyspepsia (2%), flatulence (2% to 3%), gastric ulcer, gastrointestinal hemorrhage, gastrointestinal perforation, heartburn, upper abdominal pain (3%), vomiting (3% to 6%)

Hematologic & oncologic: Anemia, prolonged bleeding time

Hepatic: Increased liver enzymes (including increased serum alanine aminotransferase [2%], increased serum aspartate aminotransferase)

Nervous system: Dizziness (1% to 4%), drowsiness (3%), headache (4% to 10%)

Neuromuscular & skeletal: Back pain (4%), limb pain (3%), musculoskeletal pain (4%)

Otic: Tinnitus

Renal: Altered kidney function, increased serum creatinine (2%)

Respiratory: Sinusitis (3%)

<1%:

Cardiovascular: Acute myocardial infarction, cardiac arrhythmia, flushing, heart failure, hypotension, palpitations, syncope, tachycardia, vasculitis

Dermatologic: Alopecia, ecchymoses, erythema multiforme, exfoliative dermatitis, fixed drug eruption, skin photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

Endocrine & metabolic: Hyperglycemia, weight changes

Gastrointestinal: Change in appetite, colitis, eructation, esophagitis, gastritis, glossitis, hematemesis, melena, pancreatitis, peptic ulcer, rectal hemorrhage, stomatitis, xerostomia

Genitourinary: Cystitis, dysuria, hematuria, oliguria, polyuria, proteinuria

Hematological & oncologic: Agranulocytosis, aplastic anemia, eosinophilia, hemolytic anemia, leukopenia, lymphadenopathy, pancytopenia, purpuric disease, thrombocytopenia

Hepatic: Fulminant hepatitis, hepatic failure, hepatic necrosis, hepatitis, jaundice

Hypersensitivity: Anaphylaxis, angioedema

Infection: Infection, sepsis

Nervous system: Abnormal dreams, anxiety, asthenia, coma, confusion, depression, hallucination, insomnia, malaise, meningitis, nervousness, paresthesia, seizure, tremor, vertigo

Ophthalmic: Blurred vision, conjunctivitis

Otic: Auditory impairment

Renal: Interstitial nephritis, kidney failure

Respiratory: Asthma, dyspnea, pneumonia, respiratory depression

Miscellaneous: Fever

Frequency not defined:

Cardiovascular: Coronary thrombosis

Endocrine & metabolic: Fluid retention

Gastrointestinal: Gastrointestinal inflammation

Hepatic: Hepatotoxicity

Nervous system: Cerebrovascular accident

Renal: Renal papillary necrosis

Postmarketing:

Genitourinary: Azotemia (Gurwitz 1990)

Hypersensitivity: Drug reaction with eosinophilia and systemic symptoms

Contraindications

Hypersensitivity to diclofenac (eg, anaphylactic reactions, serious skin reactions) or bovine protein (Zipsor only) or any component of the formulation; history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other nonsteroidal anti-inflammatory drugs; use in the setting of coronary artery bypass graft surgery.

Canadian labeling: Additional contraindications (not in US labeling): Severe uncontrolled heart failure; active gastric/duodenal/peptic ulcer; active GI bleed or perforation, regional ulcer or enteritis, gastritis, ulcerative colitis, or recurrent ulceration; cerebrovascular bleeding or other bleeding disorders; inflammatory bowel disease; severe hepatic impairment; active hepatic disease; severe renal impairment (CrCl <30 mL/minute) or deteriorating renal disease; known hyperkalemia; patients <16 years of age (suppository, tablet) or <18 years of age (packet only); breastfeeding; pregnancy (third trimester); recent history of bleeding or inflammatory lesions of rectum/anus (suppository only).

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactoid reactions: Even in patients without prior exposure anaphylactoid reactions may occur; patients with "aspirin triad" (bronchial asthma, aspirin intolerance, rhinitis) may be at increased risk. Contraindicated in patients who experience bronchospasm, asthma, rhinitis, or urticaria with nonsteroidal anti-inflammatory drug (NSAID) or aspirin therapy.

• Cardiovascular events: Relative risk appears to be similar in those with and without known cardiovascular disease or risk factors for cardiovascular disease; however, absolute incidence of serious cardiovascular thrombotic events (which may occur early during treatment) was higher in patients with known cardiovascular disease or risk factors and in those receiving higher doses. New-onset hypertension or exacerbation of hypertension may occur (NSAIDs may also impair response to ACE inhibitors, thiazide diuretics, or loop diuretics); may contribute to cardiovascular events; monitor blood pressure; use with caution in patients with hypertension. May cause sodium and fluid retention; use with caution in patients with edema. Avoid use in heart failure (FDA 2015). Avoid use in patients with recent MI unless benefits outweigh risk of cardiovascular thrombotic events. Use the lowest effective dose for the shortest duration of time, consistent with individual patient goals, to reduce risk of cardiovascular events; alternate therapies should be considered for patients at high risk.

• CNS effects: May cause drowsiness, dizziness, blurred vision, and other neurologic effects which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving). Discontinue use with blurred or diminished vision and perform ophthalmologic exam. Periodically evaluate vision in all patients receiving long term therapy.

• Drug reaction with eosinophilia and systemic symptoms: Potentially serious, sometimes fatal, drug reaction with eosinophilia and systemic symptoms (DRESS), also known as multiorgan hypersensitivity reactions, has been reported with NSAIDs. Monitor for signs and symptoms (eg, fever, rash, lymphadenopathy, eosinophilia) in association with other organ system involvement (eg, hepatitis, nephritis, hematological abnormalities, myocarditis, myositis). Early symptoms of hypersensitivity reaction (eg, lymphadenopathy, fever) may occur without rash; discontinue therapy and further evaluate if DRESS is suspected.

• GI events: Avoid use in patients with active GI bleeding. In patients with a history of acute lower GI bleeding, avoid use of non-aspirin NSAIDs, especially if due to angioectasia or diverticulosis (Strate 2016). Use caution with a history of GI ulcers, concurrent therapy known to increase the risk of GI bleeding (eg, aspirin, anticoagulants and/or corticosteroids, selective serotonin reuptake inhibitors), advanced hepatic disease, coagulopathy, smoking, use of alcohol, or in elderly or debilitated patients. Use the lowest effective dose for the shortest duration of time, consistent with individual patient goals, to reduce risk of GI adverse events; alternate therapies should be considered for patients at high risk. When used concomitantly with aspirin, a substantial increase in the risk of gastrointestinal complications (eg, ulcer) occurs; concomitant gastroprotective therapy (eg, proton pump inhibitors) is recommended (Bhatt 2008).

• Hematologic effects: Platelet adhesion and aggregation may be decreased; may prolong bleeding time; patients with coagulation disorders or who are receiving anticoagulants should be monitored closely. Anemia may occur; patients on long-term NSAID therapy should be monitored for anemia. Rarely, NSAID use has been associated with potentially severe blood dyscrasias (eg, agranulocytosis, thrombocytopenia, aplastic anemia).

• Hepatic effects: Transaminase elevations have been reported with use; closely monitor patients with any abnormal LFT. Rare, sometimes fatal severe hepatic reactions (eg, fulminant hepatitis, hepatic necrosis, hepatic failure) have occurred with NSAID use; discontinue immediately if clinical signs or symptoms of liver disease develop or if systemic manifestations occur.

• Hyperkalemia: NSAID use may increase the risk of hyperkalemia, particularly in the elderly, diabetics, renal disease, and with concomitant use of other agents capable of inducing hyperkalemia (eg, ACE inhibitors). Monitor potassium closely.

• Renal effects: NSAID use may compromise existing renal function; dose-dependent decreases in prostaglandin synthesis may result from NSAID use, reducing renal blood flow which may cause renal decompensation (usually reversible). Patients with impaired renal function, dehydration, hypovolemia, heart failure, hepatic impairment, those taking diuretics and ACE inhibitors, and elderly patients are at greater risk of renal toxicity. Rehydrate patient before starting therapy; monitor renal function closely. Long-term NSAID use may result in renal papillary necrosis and other renal injury.

• Skin reactions/hypersensitivity: NSAIDs may cause serious skin adverse events (sometimes fatal), including exfoliative dermatitis, fixed drug eruption (including generalized bullous fixed drug eruption), Stevens-Johnson syndrome, and toxic epidermal necrolysis; may occur without warning; discontinue use at first sign of skin rash (or any other hypersensitivity).

Disease-related concerns:

• Aseptic meningitis: May increase the risk of aseptic meningitis (rarely), especially in patients with systemic lupus erythematosus (SLE) and mixed connective tissue disorders.

• Asthma: Contraindicated in patients with aspirin-sensitive asthma; severe, potentially fatal bronchospasm may occur. Use caution in patients with other forms of asthma.

• Bariatric surgery: Gastric ulceration: Avoid chronic use of oral nonselective NSAIDs after bariatric surgery; development of anastomotic ulcerations/perforations may occur (Bhangu 2014; Mechanick 2020). Short-term use of celecoxib or IV ketorolac are recommended as part of a multimodal pain management strategy for postoperative pain (Chou 2016; Horsley 2019; Thorell 2016).

• Coronary artery bypass graft surgery: Risk of MI and stroke may be increased with use following CABG surgery.

• Hepatic impairment: Use with caution in patients with hepatic impairment; reduced doses may be required due to extensive hepatic metabolism. Patients with advanced hepatic disease are at an increased risk of GI bleeding and kidney failure with NSAIDs (AASLD [Biggins 2021]; AASLD [Runyon 2013]).

• Renal impairment: Avoid use in patients with advanced renal disease; discontinue use with persistent or worsening abnormal renal function tests.

Special populations:

Older adult: Older adult patients are at greater risk for serious GI, cardiovascular, and/or renal adverse events.

Dosage form specific issues:

• Oral solution: May contain phenylalanine.

• Zipsor: Contains gelatin; use is contraindicated in patients with history of hypersensitivity to bovine protein.

Other warnings/precautions:

• Appropriate use: Oral solution: Indicated only for the acute treatment of migraine (not indicated for migraine prophylaxis or cluster headache). Acute migraine agents (eg, NSAIDs, triptans, opioids, ergotamine, or a combination of the agents) used for 10 or more days per month may lead to worsening of headaches (medication overuse headache); withdrawal treatment may be necessary in the setting of overuse.

• Bioequivalence: Different formulations of oral diclofenac are not bioequivalent, even if the milligram strength is the same; do not interchange products.

• Surgical/dental procedures: Withhold for at least 4 to 6 half-lives prior to surgical or dental procedures.

Product Availability

Zorvolex capsules (brand and generic) have been discontinued in the United States >1 year.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral, as acid:

Zorvolex: 18 mg [DSC], 35 mg [DSC] [contains fd&c blue #1 (brilliant blue), fd&c blue #2 (indigotine,indigo carmine)]

Generic: 35 mg [DSC]

Capsule, Oral, as potassium:

Zipsor: 25 mg [contains gelatin (bovine)]

Generic: 25 mg

Packet, Oral, as potassium:

Cambia: 50 mg (1 ea, 9 ea) [anise-mint flavor]

Generic: 50 mg (1 ea, 9 ea)

Tablet, Oral, as potassium:

Cataflam: 50 mg [DSC]

Lofena: 25 mg

Generic: 25 mg, 50 mg

Tablet Delayed Release, Oral, as sodium:

Generic: 25 mg, 50 mg, 75 mg

Tablet Extended Release 24 Hour, Oral, as sodium:

Generic: 100 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsules (Diclofenac Potassium Oral)

25 mg (per each): $16.09 - $17.69

Capsules (Zipsor Oral)

25 mg (per each): $18.62

Pack (Cambia Oral)

50 mg (per each): $118.26

Pack (Diclofenac Potassium(Migraine) Oral)

50 mg (per each): $46.67 - $106.43

Tablet, 24-hour (Diclofenac Sodium ER Oral)

100 mg (per each): $2.70 - $2.81

Tablet, EC (Diclofenac Sodium Oral)

25 mg (per each): $1.42

50 mg (per each): $0.80 - $1.47

75 mg (per each): $0.56 - $1.77

Tablets (Diclofenac Potassium Oral)

25 mg (per each): $34.45 - $38.00

50 mg (per each): $0.36 - $2.76

Tablets (Lofena Oral)

25 mg (per each): $38.71

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Packet, Oral, as potassium:

Cambia: 50 mg (1 ea, 3 ea, 9 ea) [contains aspartame, saccharin sodium]

Suppository, Rectal:

Voltaren: 50 mg (30 ea); 100 mg ([DSC])

Generic: 50 mg (30 ea); 100 mg ([DSC])

Tablet, Oral, as potassium:

Voltaren Rapide: 50 mg [contains corn starch]

Generic: 50 mg

Tablet Delayed Release, Oral, as sodium:

Voltaren: 50 mg [DSC] [contains corn starch]

Generic: 25 mg, 50 mg

Tablet Extended Release 24 Hour, Oral, as sodium:

Voltaren SR: 75 mg [DSC] [contains polysorbate 80]

Voltaren SR: 100 mg

Generic: 75 mg, 100 mg

Administration: Adult

Oral: Do not crush delayed-release or ER tablets. May administer IR formulations with food or milk to avoid gastric distress.

Cambia, Zorvolex: Administering with food may cause a reduction in effectiveness.

Bariatric surgery: Tablet, delayed and extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Do not cut, crush, or chew. Nonsteroidal anti-inflammatory drugs are generally not recommended for regular use postbariatric surgery.

Administration: Pediatric

Oral:

Immediate release: Administer with milk or food to decrease GI upset; take with full glass of water to enhance absorption.

Oral solution: Empty contents of packet into 1 to 2 ounces (30 to 60 mL) of water (do not use other liquids); mix well and administer right away. Administering with food may reduce effectiveness.

Rectal: Suppository (products not available in US): Remove plastic film prior to insertion; insert well into the rectum; for best results, bowels should be empty prior to insertion (Ref).

Use: Labeled Indications

Ankylosing spondylitis: Acute or long-term use in the relief of signs and symptoms of ankylosing spondylitis.

Dysmenorrhea: Treatment of primary dysmenorrhea.

Migraine, acute treatment: Acute treatment of migraine attacks with or without aura in adults.

Osteoarthritis: Relief of signs and symptoms of osteoarthritis.

Pain, acute: Relief of mild to moderate acute pain in pediatric patients ≥12 years of age (Zipsor) and adults.

Rheumatoid arthritis: Relief of signs and symptoms of rheumatoid arthritis.

Use: Off-Label: Adult

Gout, treatment, acute flares

Medication Safety Issues
Sound-alike/look-alike issues:

Diclofenac may be confused with Diflucan

Cataflam may be confused with Catapres

Voltaren may be confused with traMADol, Ultram, Verelan

Older Adult: High-Risk Medication:

Beers Criteria: Diclofenac is identified in the Beers Criteria as a potentially inappropriate medication to be avoided for chronic use in patients 65 years and older (unless alternative agents ineffective and patient can receive concomitant gastroprotective agent) due to increased risk of GI bleeding and peptic ulcer disease in older adults in high-risk category (eg, older than 75 years of age or receiving concomitant oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents). In addition, avoid for short-term scheduled use in combination with oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents unless alternatives are ineffective and patient can receive concomitant gastroprotective agent (Beers Criteria [AGS 2023]).

International issues:

Diclofenac may be confused with Duphalac brand name for lactulose [multiple international markets]

Flexin: Brand name for diclofenac [Argentina], but also the brand name for cyclobenzaprine [Chile] and orphenadrine [Israel]

Flexin [Argentina] may be confused with Floxin brand name for flunarizine [Thailand], norfloxacin [South Africa], and ofloxacin [US]

Metabolism/Transport Effects

Substrate of CYP1A2 (Minor), CYP2B6 (Minor), CYP2C19 (Minor), CYP2C8 (Minor), CYP2C9 (Major with inhibitors), CYP2C9 (Minor with inducers), CYP2D6 (Minor), CYP3A4 (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits UGT1A6;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of 5-Aminosalicylic Acid Derivatives. Risk C: Monitor

Abciximab: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Abrocitinib: Agents with Antiplatelet Effects may increase antiplatelet effects of Abrocitinib. Risk X: Avoid

Acalabrutinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Acemetacin: May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid

Alcohol (Ethyl): May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. Risk C: Monitor

Aliskiren: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Aliskiren. Risk C: Monitor

Aminoglycosides: Nonsteroidal Anti-Inflammatory Agents may decrease excretion of Aminoglycosides. Data only in premature infants. Risk C: Monitor

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Anagrelide: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Angiotensin II Receptor Blockers: Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Angiotensin II Receptor Blockers may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Angiotensin-Converting Enzyme Inhibitors. Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Risk C: Monitor

Anticoagulants (Miscellaneous Agents): Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Anticoagulants (Miscellaneous Agents). Risk C: Monitor

Antiplatelet Agents (P2Y12 Inhibitors): Agents with Antiplatelet Effects may increase antiplatelet effects of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor

Artesunate: Diclofenac (Systemic) may increase active metabolite exposure of Artesunate. Risk C: Monitor

Aspirin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may decrease therapeutic effects of Aspirin. Aspirin may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Specifically, the risk for bleeding may be increased. Aspirin may decrease serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Management: In general, avoid regular, frequent use of NSAIDs with aspirin whenever possible. If combined, monitor for increased bleeding and a reduced cardioprotective effect of aspirin. Risk D: Consider Therapy Modification

Bemiparin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Bemiparin. Management: Avoid this combination if possible, due to an increased risk of bleeding. If coadministration cannot be avoided, monitor patients closely for clinical and laboratory evidence of bleeding. Risk D: Consider Therapy Modification

Beta-Blockers: Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Beta-Blockers. Risk C: Monitor

Bile Acid Sequestrants: May decrease absorption of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Bisphosphonate Derivatives: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern. Risk C: Monitor

Caplacizumab: Agents with Antiplatelet Effects may increase adverse/toxic effects of Caplacizumab. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Cardiac Glycosides: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Cardiac Glycosides. Risk C: Monitor

Collagenase (Systemic): Agents with Antiplatelet Effects may increase adverse/toxic effects of Collagenase (Systemic). Specifically, the risk of injection site bruising and or bleeding may be increased. Risk C: Monitor

Corticosteroids (Systemic): May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor

CycloSPORINE (Systemic): Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of CycloSPORINE (Systemic). Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase serum concentration of Nonsteroidal Anti-Inflammatory Agents. Management: Consider alternatives to nonsteroidal anti-inflammatory agents (NSAIDs). Monitor for evidence of nephrotoxicity, as well as increased serum cyclosporine concentrations and systemic effects (eg, hypertension) during concomitant therapy with NSAIDs. Risk D: Consider Therapy Modification

CYP2C9 Inducers (Moderate): May decrease serum concentration of Diclofenac (Systemic). Risk C: Monitor

CYP2C9 Inhibitors (Moderate): May increase serum concentration of Diclofenac (Systemic). Risk C: Monitor

Dasatinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Deferasirox: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor

Deferiprone: UGT1A6 Inhibitors may increase serum concentration of Deferiprone. Risk X: Avoid

Deoxycholic Acid: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Desirudin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Desirudin. Risk C: Monitor

Desmopressin: Nonsteroidal Anti-Inflammatory Agents may increase hyponatremic effects of Desmopressin. Risk C: Monitor

Diosmin: May increase serum concentration of Diclofenac (Systemic). Risk C: Monitor

Direct Oral Anticoagulants (DOACs): Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Direct Oral Anticoagulants (DOACs). Risk C: Monitor

Drospirenone-Containing Products: May increase hyperkalemic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Enoxaparin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Enoxaparin. Management: Discontinue nonselective NSAIDs prior to initiation of enoxaparin whenever possible. If coadministration cannot be avoided, monitor patients closely for clinical and laboratory evidence of bleeding. Risk D: Consider Therapy Modification

Eplerenone: Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may increase hyperkalemic effects of Eplerenone. Risk C: Monitor

Fondaparinux: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Fondaparinux. Management: Discontinue nonselective nonsteroidal anti-inflammatory agents prior to the initiation of fondaparinux, if possible. If coadministration is required, monitor patients closely for signs and symptoms of bleeding. Risk D: Consider Therapy Modification

Glycoprotein IIb/IIIa Inhibitors: Agents with Antiplatelet Effects may increase antiplatelet effects of Glycoprotein IIb/IIIa Inhibitors. Risk C: Monitor

Heparin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Heparin. Risk C: Monitor

Heparins (Low Molecular Weight): Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Heparins (Low Molecular Weight). Risk C: Monitor

Herbal Products with Anticoagulant/Antiplatelet Effects: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

HydrALAZINE: Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of HydrALAZINE. Risk C: Monitor

Ibritumomab Tiuxetan: Agents with Antiplatelet Effects may increase antiplatelet effects of Ibritumomab Tiuxetan. Risk C: Monitor

Ibrutinib: Agents with Antiplatelet Effects may increase adverse/toxic effects of Ibrutinib. Specifically, the risk of bleeding and hemorrhage may be increased. Risk C: Monitor

Inotersen: Agents with Antiplatelet Effects may increase adverse/toxic effects of Inotersen. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Ketorolac (Nasal): May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid

Ketorolac (Systemic): Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Ketorolac (Systemic). Risk X: Avoid

Limaprost: May increase adverse/toxic effects of Agents with Antiplatelet Effects. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Lithium: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Lithium. Management: Consider reducing the lithium dose when initiating a NSAID. Monitor for increased lithium therapeutic/toxic effects if a NSAID is initiated/dose increased, or decreased effects if a NSAID is discontinued/dose decreased. Risk D: Consider Therapy Modification

Loop Diuretics: Nonsteroidal Anti-Inflammatory Agents may decrease diuretic effects of Loop Diuretics. Loop Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. Risk D: Consider Therapy Modification

Lumacaftor and Ivacaftor: May decrease serum concentration of CYP2C9 Substrates (High Risk with Inhibitors or Inducers). Lumacaftor and Ivacaftor may increase serum concentration of CYP2C9 Substrates (High Risk with Inhibitors or Inducers). Risk C: Monitor

Macimorelin: Coadministration of Nonsteroidal Anti-Inflammatory Agents and Macimorelin may alter diagnostic results. Risk X: Avoid

MetFORMIN: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of MetFORMIN. Risk C: Monitor

Methotrexate: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Methotrexate. Management: Avoid coadministration of higher dose methotrexate (such as that used for the treatment of oncologic conditions) and NSAIDs. Use caution if coadministering lower dose methotrexate and NSAIDs. Risk D: Consider Therapy Modification

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methoxyflurane: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Methoxyflurane. Risk X: Avoid

Mifamurtide: Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Mifamurtide. Risk X: Avoid

Miscellaneous Antiplatelets: Agents with Antiplatelet Effects may increase antiplatelet effects of Miscellaneous Antiplatelets. Risk C: Monitor

Nadroparin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Nadroparin. Management: Coadministration of NSAIDs and nadroparin is not recommended due to an increased risk of bleeding. If coadministration is required, monitor patients closely for clinical and laboratory signs of bleeding. Risk D: Consider Therapy Modification

Naftazone: May increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): Nonsteroidal Anti-Inflammatory Agents (Topical) may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of gastrointestinal (GI) toxicity is increased. Management: Coadministration of systemic nonsteroidal anti-inflammatory drugs (NSAIDs) and topical NSAIDs is not recommended. If systemic NSAIDs and topical NSAIDs, ensure the benefits outweigh the risks and monitor for increased NSAID toxicities. Risk D: Consider Therapy Modification

Nonsteroidal Anti-Inflammatory Agents: May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk for gastrointestinal toxicity is increased. Risk X: Avoid

Obinutuzumab: Agents with Antiplatelet Effects may increase adverse/toxic effects of Obinutuzumab. Specifically, the risk of bleeding may be increased. Management: Consider avoiding coadministration of obinutuzumab and agents with antiplatelet effects, especially during the first cycle of obinutuzumab therapy. Risk D: Consider Therapy Modification

Omacetaxine: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Risk C: Monitor

Pentosan Polysulfate Sodium: Agents with Antiplatelet Effects may increase adverse/toxic effects of Pentosan Polysulfate Sodium. Specifically, the risk of hemorrhage may be increased. Risk C: Monitor

Phenylbutazone: May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid

Pirtobrutinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Potassium Salts: Nonsteroidal Anti-Inflammatory Agents may increase hyperkalemic effects of Potassium Salts. Risk C: Monitor

Potassium-Sparing Diuretics: Nonsteroidal Anti-Inflammatory Agents may increase hyperkalemic effects of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Potassium-Sparing Diuretics. Risk C: Monitor

PRALAtrexate: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Avoid coadministration of pralatrexate with nonsteroidal anti-inflammatory drugs (NSAIDs). If coadministration cannot be avoided, closely monitor for increased pralatrexate serum levels or toxicity. Risk D: Consider Therapy Modification

Probenecid: May increase serum concentration of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Prostaglandins (Ophthalmic): Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic). Risk C: Monitor

Quercetin: May increase serum concentration of Diclofenac (Systemic). Risk C: Monitor

Quinolones: Nonsteroidal Anti-Inflammatory Agents may increase neuroexcitatory and/or seizure-potentiating effects of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Quinolones. Risk C: Monitor

Resveratrol: May increase serum concentration of Diclofenac (Systemic). Risk C: Monitor

Salicylates: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase adverse/toxic effects of Salicylates. An increased risk of bleeding may be associated with use of this combination. Risk X: Avoid

Selective Serotonin Reuptake Inhibitor: May increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may decrease therapeutic effects of Selective Serotonin Reuptake Inhibitor. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk. Risk D: Consider Therapy Modification

Selumetinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Serotonin/Norepinephrine Reuptake Inhibitor: May increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor

Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider Therapy Modification

Sodium Phosphates: May increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Sulprostone: Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Sulprostone. Risk X: Avoid

Tacrolimus (Systemic): Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Tacrolimus (Systemic). Risk C: Monitor

Tenofovir Products: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose due to a potential risk of acute renal failure. Diclofenac appears to confer the most risk. Risk D: Consider Therapy Modification

Tenoxicam: May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid

Thiazide and Thiazide-Like Diuretics: Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Thrombolytic Agents: Agents with Antiplatelet Effects may increase adverse/toxic effects of Thrombolytic Agents. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Tipranavir: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Tolperisone: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may increase therapeutic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Tricyclic Antidepressants: May increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents. Tricyclic Antidepressants may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of major adverse cardiac events (MACE), hemorrhagic stroke, ischemic stroke, and heart failure may be increased. Risk C: Monitor

Vancomycin: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Vancomycin. Risk C: Monitor

Vanzacaftor, Tezacaftor, and Deutivacaftor: May increase serum concentration of CYP2C9 Substrates (High risk with Inhibitors). Risk C: Monitor

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Vitamin E (Systemic): May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Vitamin K Antagonists: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Vitamin K Antagonists. Management: Consider alternatives to this combination when possible. If the combination must be used, monitor coagulation status closely and advise patients to promptly report any evidence of bleeding or bruising. Risk D: Consider Therapy Modification

Volanesorsen: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Voriconazole: May increase serum concentration of Diclofenac (Systemic). Risk C: Monitor

Zanubrutinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Reproductive Considerations

Nonsteroidal anti-inflammatory drugs (NSAIDs) may delay or prevent rupture of ovarian follicles. This may be associated with infertility that is reversible upon discontinuation of the medication. Consider discontinuing use in patients having difficulty conceiving or those undergoing investigation of fertility.

Based on available information, NSAIDs can be continued in patients with rheumatic and musculoskeletal diseases who are planning to father a child (ACR [Sammaritano 2020]).

Pregnancy Considerations

Diclofenac crosses the placenta.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) close to conception may be associated with an increased risk of miscarriage due to cyclooxygenase-2 inhibition interfering with implantation (Bermas 2014; Bloor 2013).

Birth defects have been observed following in utero NSAID exposure in some studies; however, data are conflicting (Bloor 2013). Nonteratogenic effects, including prenatal constriction of the ductus arteriosus, persistent pulmonary hypertension of the newborn, oligohydramnios, necrotizing enterocolitis, renal dysfunction or failure, and intracranial hemorrhage, have been observed in the fetus/neonate following in utero NSAID exposure (Bermas 2014; Bloor 2013). Maternal NSAID use may cause fetal renal dysfunction leading to oligohydramnios. Although rare, this may occur as early as 20 weeks' gestation and is more likely to occur with prolonged maternal use. Oligohydramnios may be reversible following discontinuation of the NSAID (Dathe 2019; FDA 2020). In addition, nonclosure of the ductus arteriosus postnatally may occur and be resistant to medical management (Bermas 2014; Bloor 2013).

Maternal use of NSAIDs should be avoided beginning at 20 weeks' gestation. If NSAID use is necessary between 20 and 30 weeks' gestation, limit use to the lowest effective dose and shortest duration possible; consider ultrasound monitoring of amniotic fluid if treatment extends beyond 48 hours and discontinue the NSAID if oligohydramnios is found (FDA 2020). Because NSAIDs may cause premature closure of the ductus arteriosus, prescribing information for diclofenac specifically states use should be avoided starting at 30 weeks' gestation.

Based on available information, NSAIDs can be continued during the first 2 trimesters of pregnancy in patients with rheumatic and musculoskeletal diseases; use in the third trimester is not recommended (ACR [Sammaritano 2020]).

NSAIDs may be used as part of a multimodal approach to pain relief following cesarean delivery (ACOG 2019).

Treatment for migraine headaches in pregnant patients should be individualized (AHS [Ailani 2021]). The acute treatment of migraine headaches during pregnancy should be initiated with an agent other than an NSAID. If an NSAID is needed as second-line therapy, treatment should be limited to the second trimester and total duration of therapy should be no longer than 48 hours. An NSAID other than diclofenac may be preferred (ACOG 2022).

Breastfeeding Considerations

Diclofenac may be present in breast milk.

The milk concentration of a woman treated with oral diclofenac 150 mg/day was reported to be 100 mcg/L (equivalent to an infant dose of ~0.03 mg/kg/day). Diclofenac was not detected in breast milk when 100 mg/day orally was administered to 12 women for 7 days or as a single dose of 50 mg IM immediately postpartum.

Nonopioid analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs), are preferred for breastfeeding patients who require pain control peripartum or for surgery outside of the postpartum period (ABM [Martin 2018]; ABM [Reece-Stremtan 2017]). NSAIDs are considered compatible for use in patients with rheumatic and musculoskeletal diseases who are breastfeeding; agents with a short half-life and established safety data in infants may be preferred (ACR [Sammaritano 2020]). NSAIDs may be used to treat acute migraine in lactating patients (ACOG 2022).

The manufacturer recommends that the decision to breastfeed during therapy consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. Maternal use of NSAIDs should be avoided if the breastfeeding infant has platelet dysfunction, thrombocytopenia, or a ductal-dependent cardiac lesion (ABM [Martin 2018]; ABM [Reece-Stremtan 2017]; Bloor 2013).

Dietary Considerations

Oral immediate-release formulations may be taken with food to decrease GI distress. However, food may reduce effectiveness of oral solution and diclofenac acid (capsule). Some products may contain phenylalanine.

Monitoring Parameters

CBC, chemistry profile, weight, edema, LFTs (baseline and periodically during chronic therapy), renal function (serum BUN, serum creatinine, urine output); occult blood loss; BP; observe for bleeding, bruising; GI effects (abdominal pain, bleeding, dyspepsia); mental confusion, disorientation.

Mechanism of Action

Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors; has antipyretic, analgesic, and anti-inflammatory properties

Other proposed mechanisms not fully elucidated (and possibly contributing to the anti-inflammatory effect to varying degrees), include inhibiting chemotaxis, altering lymphocyte activity, inhibiting neutrophil aggregation/activation, and decreasing proinflammatory cytokine levels.

Pharmacokinetics (Adult Data Unless Noted)

Note: Characteristics of various oral dosage forms are similar unless specifically noted below.

Absorption: ~50% (systemically available).

Distribution: ~1.3 to 1.4 L/kg.

Protein binding: >99%, primarily to albumin.

Metabolism: Hepatic; undergoes first-pass metabolism; forms several metabolites (1 with weak activity).

Bioavailability: 55%.

Half-life elimination: ~2 hours; ~1 hour (liquid filled capsule [Zipsor]).

Time to peak, serum: Note: Fasted values reported; may be delayed with food.

Cambia: ~0.25 hours.

Cataflam, Zorvolex: ~1 hour.

Zipsor: ~0.47 ± 0.17 hour.

Tablet, delayed release (diclofenac sodium): 2.3 hours.

Tablet, extended release (diclofenac sodium): 5.3 hours.

Excretion: Urine (~65%); bile (~35%).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Almiral | Cataflam | Clofast p | Clofen | Diclo | Diclo k | Dicloflam k | Diclogesic | Diclomax | Diclopid | Fast flam | Infla ban | Joflam | K flam | Neoflam | Olfen | Olfen sr | Rhumalgan | Rofenac | Tabiflex | Voldic K | Voltagesic | Voltaren | Voltfenac | Voltic | Votrex | Zorvolex;
  • (AR) Argentina: Acloxigenac | Ainedif | Aktiosan | Aldoron nf | Algioxib | Anaflex | Anaflex mujer perlas | Banoclus | Befol | Befol ap retard | Befol vl | Blokium | Blokium p | Calmoflex | Cataflam | Curinflam | Curinflam a.p. | Curinflam gesic | D.f.n | Damixa | Diastone | Diastone retard | Diclac | Diclac 150 uno | Diclofenac 100 ap kilab | Diclofenac cevallos | Diclofenac df | Diclofenac gen med | Diclofenac hex 50 d | Diclofenac hexa | Diclofenac hexa retard | Diclofenac Hlb | Diclofenac larjan | Diclofenac northia | Diclofenac potasio | Diclofenac puntanos | Diclofenac richet | Diclofenac sant gall | Diclofenac surar pharma | Diclofenac techsphere | Diclofenac teva | Diclofenac trb pharma | Diclogesic | Diclogrand | Diclolabsa | Diclolabsa potasico | Diclolam | Diclomar | Diclonex | Diclonovag | Diclopoen | Diclovann k | Difenac | Dioxaflex | Dioxaflex cb | Dioxaflex Migra | Dioxaflex vl | Disipan | Disipan nf | Dolo tomanil | Dolofenac | Dolvan | Doxtran | Faboflem | Fada diclofenac | Flexana | Flexipen | Flexiplen | Flexiplen retard | Flogenac | Flogolisin | Flotac | Fluxpiren | Ibuxim diclo | Iglodine | Imanol | Klonafenac | Lafenac | Lorbifenac | Metaflex | Metaflex n.f. | Nalgiflex | Norviken vent3 | Oxa | Oxa 75 | Reumosan | Rodinac | Silfox | Tomanil | Venzidiak | Vesalion | Viartril nf | Vimultisa | Vimultisa p | Virobron nf | Volforte | Volmas | Voltaren | Voltaren dolo | Voltaren migra | Xedenol | Xedenol cb;
  • (AT) Austria: Dedolor | Deflamat | Diclac | Diclachexal | Diclobene | Diclobene uno | Diclofenac | Diclofenac 1A Pharma | Diclofenac G.L. | Diclofenac genericon pharma | Diclofenac kabi | Diclofenac sandoz | Diclomelan | Diclostad | Dolpasse | Fenaren | Tratul | Voltaren | Voltaren dolo | Voltaren retard;
  • (AU) Australia: Apo diclofenac | Apohealth anti-Inflammatory pain relief | Blooms the chemist anti inflammatory pain relief | Chemists own diclofenac 25 | Clonac | Diclac | Diclofenac | Diclofenac an | Diclofenac sandoz | Diclohexal | Dinac | Fenac | Fenac ec | Imflac | Inflamax | Pharmacor diclofenac | Pharmacy action diclofenac 25 | Pharmacy choice diclofenac | Priceline pharmacy diclofenac | Trust difenac | Viclofen | Voltaren | Voltaren rapid;
  • (BD) Bangladesh: A fenac | A-fenac k | Alcofen | Almiral | Alterin | Alterin tr | Anfenac | Anodyne | Anuva | Apain | C-fenac | Cataflam | Clofen | Clofenac | Clonac | Cofac | Decafen | Denac | Diclo | Dicloberl | Diclofen | Diclofenac | Diclomol | Diclonac | Diclora | Diclorex | Diclotab | Diclowal | Difen | Difenac | Dilock | Dinac | Dix | Edifenac | Erdon | Fenac | Fentab | Ficlon | G-diclofenac | Gefenac | Genac | Hi fenac | Hitflam | Inflacin | Intafenac | Kalinac | Lardon | Locopain | Lonac | Medifen | Megafen | Mobifen | Moov | Movonac | Nasida | Neofen | Neofenac | Nopain | Norfen | Nortid | O clofen | Orafen | Orfenac | Orgafen tr | Penac | Proladin | Pronac | Refain | Reutren | Ronac | Rotafen | S-fenac | Sifen | Tenac tr | Tolfenac | Ultaran | Ultrafen | Verdan | Volcan | Volfen | Voltalin | Voltanac | Voltaren | Voltarol | Voltid | Vurdon | Vurdon sr;
  • (BE) Belgium: Cataflam | Diclofemed | Diclofenac bexal | Diclofenac eg | Diclofenac eurogenerics | Diclofenac lagepha | Diclofenac ratiopharm | Diclofenac sandoz | Diclofenac teva | Diclofenac teva generics belgium | Diclotop | Docdiclofe | Motifene | Polyflam | Voltaren;
  • (BF) Burkina Faso: Diclac | Diclo | Diclo denk | Dicloberl | Diclofenac ubigen | Diclopal | Dicofen | Dolex sr | Dolotren | Dynapar ec | Dynapar sr | Flotac | Olfen | Philco diclo | Voltarene | Voltarene dolo;
  • (BG) Bulgaria: Almiral | Areston instant | Cataflam | Diclac | Diclofenac | Diclofenac duo | Feloran | Naklofen | Naklofen duo | Veral | Voltaren | Voltaren dolo | Vurdon;
  • (BR) Brazil: Abiflan | Artren | Augelit | Baldaflam | Baldaren | Belfaren | Benevran | Bexai | Biofenac | Cataflam | Cataflex | Catalgem | Cataren | Cinaflan | Clofen k | Clofen s | Clofenak | Clofenid | Decorfen | Deltaren | Desinflex | Desinflex retard | Dflam | Diclac | Diclo p | Diclof | Diclofan | Diclofarma | Diclofen | Diclofenaco colestiramina | Diclofenaco de colestiramina | Diclofenaco potasico | Diclofenaco potassico | Diclofenaco sodica | Diclofenaco sodico | Diclofenax | Diclokalium | Diclonaco | Diclonatrium | Diclonax | Diclonil | Diclosod | Diclosodico | Dicloton | Dicoplex | Difenan | Dioxaflex | Dkaflan | Dnaren | Dorflan | Dorgen | Dryltac | Fenaflan | Fenaflan d | Fenaren | Fenburil | Fisioren | Fladon | Flamalgen | Flamatrat | Flanakin | Flanaren | Flexamina | Flodin duo | Flogan | Flogiren | Flogonac | Flotac | Furp diclofenaco | Genoren | Globaren | Hiclofen | Hynaren | Infladex | Inflamax | Inflamex | Inflaren | Inflaren-k | Kindaren | Lfm diclofenaco de potassio | Lfm diclofenaco potassico | Luparen | Naclofan | Naclofen | Neotaflan | Neotaren | Nevralren | Olfen | Optamax | Poltax | Probenxil | Prodofenaco p | Resodic | Reuflen | Reumaren | Sifdiclop | Sifnaco | Sintofenac | Sodix | Somaflex ap | Tonaflan | Vendrex | Volflanil | Voltaflan | Voltaflex | Voltaren | Voltrix | Zotac;
  • (CH) Switzerland: Amavita dicloren | Coop vitality diclofenac | Deflamat | Diclac | Diclo-basan | Diclofenac actavis | Diclofenac adico | Diclofenac genericon | Diclofenac helvepharm | Diclofenac rivopharm | Ecofenac | Flector | Flector dolo forte | Inflamac | Inflamac 75 retard | Olfen | Olfen duo release | Tonopan | Tonopan forte | Tonopan neue formel | Voltaren | Voltaren dolo | Voltaren dolo forte | Voltaren Migraene;
  • (CI) Côte d'Ivoire: Adco diclofenac | Diclo pharma 5 | Diclocare | Diclofen | Diclofenac generis | Diclosha sr | Diclowal | Dicofen sr | Dolex | Dolex sr | Doloren | Dynapar aq | Dynapar sr | Flotac | Lofnac | Ronfenac | Rufenac | Xenid;
  • (CL) Chile: Artren | Autdol | Brevedol | Cataflam | Deflamat | Diclac | Diclofenaco | Diclofenaco andromaco | Diclotaren | Dignofenac | Elitiran | Flamesan | Flotac | Lertus | Merpal | Pevoran | Pirexyl | Piroflam | Pro lertus | Prolertus | Promerpal | Sipirac | Traumus | Turbogesic | Voltaren | Zorvolex;
  • (CN) China: Antine | Apo diclo | Bi ke | De fu ka | Di fu na | Diclac | Diclofenac sodium suppositories (ii) | Didofence sodium | Difene | Difnal | Fei ya ning | Fen jia tai | Fu ta jie | Fu ta lin | Ge de | Jing qing | Kaflan | Novolten | Olfen | Pu ta ning | Tian xin li de | Tong du ding | Voren | Votalin | Wan li shu | Xi shu | Xin pu fen | Yi er song | Yi ke | Yi ke lin | Yi lin | Zhi qing;
  • (CO) Colombia: Algifen | Artren | Artrites | Atiflan | Berifen | Cataflam | Clofenil | Cytectol | Dflam | Diclodol | Diclofenac | Diclofenaco | Diclofenaco retard | Diclofenaco sodico | Diclomelan | Diflenac | Diflotec | Dilofar | Dioxaflex | Dormex | Fastpain max | Fenaclide | Fenamed | Flamydol | Flotac | Klafenac-r | Lumbal | Palldoll qrp | Profenac | Quimar | Suifenac | Volfen | Voltaflex | Voltaren;
  • (CR) Costa Rica: Acteric | Diclofenaco sodico;
  • (CY) Cyprus: Areston;
  • (CZ) Czech Republic: Almiral | Apo diclo | Dicloalgan | Diclofen | Diclofenac | Diclofenac al | Diclofenac aurobindo | Diclofenac dr. muller pharma | Diclofenac duo chemark | Diclofenac duo pharmaswiss | Dicloreum | Dicuno | Dolmina | Ecofenac | Flamrase | Flector rapidcaps | Monoflam | Myogit | Olfen | Rewodina | Veral | Voltaren | Voltaren actigo extra;
  • (DE) Germany: Allvoran | Arthrex | Benfofen | Diclac | Diclac dispers | Diclac dispers akut | Diclac Dolo | Diclo | Diclo 1A pharma | Diclo AL akut | Diclo denk | Diclo Divido | Diclo kd | Diclo saar | Diclo sandoz | Diclo-attritin | Diclo-puren | Diclodoc | Diclofen | Diclofenac | Diclofenac actavis | Diclofenac al | Diclofenac atid | Diclofenac Dura | Diclofenac heunet | Diclofenac kalium AL | Diclofenac Kalium STADA | Diclofenac natrium micro labs | Diclofenac Nch | Diclofenac ratiopharm | Diclofenac sandoz | Diclofenac stada | Diclofenac Truw | Diclofenac zentiva | Diclofenbeta | Diclophlogont | Diclotin | Diclowal | Difene | Doragon | Duravolten | Effekton | Jenafenac | Jutafenac | Monoflam | Myogit | Optalidon Zahnschmerz | Prekursan | Rewodina | Rheumasan d | Sigafenac | Voltaren | Voltaren dolo | Voltaren resinat | Xelaran;
  • (DK) Denmark: Diclofenac pliva | Diclofenac ratiopharm | Diclosup | Fenacop | Vostar;
  • (DO) Dominican Republic: Acrofenan | Acteric | Agilac | Anflamat | Artricom | Artridene | Artrikpiran | Bergeron | Calozan | Campal | Cataclofen | Cataflam | Cedob | Cladonac | Curinflam | Diclo K | Diclo k | Diclo lp | Diclofar | Diclofel | Diclofenac | Diclofenac alfa | Diclofenac df | Diclofenac k | Diclofenac Lam | Diclofenac sodico | Diclofenac sodico calox | Diclofenaco | Diclofenaco cinfa | Diclofenaco mk | Diclofenaco potasico | Diclofenaco sodico | Diclohem P | Diclonova pot | Diclopharm | Dicloplex | Dicloplex Retard | Dicloquin | Diclowal | Diclowal s | Dicloxal P | Dignofenac | Diklason | Dioxaflex | Diril | Dolflam | Dolo Nav | Dolocure | Dolotren | Domiopass | Elifenac | Eslofenac | Fernasin | Flamydol | Flogozan | Flotac | Fustaren | Inadic | Katafenac | Lertus | Lufenac | Lunizol | Menafenac | Neurogesic | Ortoflex | Oxa | Oxa Uno | Oxaflex | Pentacxin | Ragofenac | Sadol | Suifenac | Viavox | Volfenac | Voltaren | Zorvolex;
  • (EC) Ecuador: Acrofenac | Acteric | Artren | Berifen | Cataflam | Clofen | Clofen t | Deflamat | Desinflam | Diclo azul | Diclo cien | Diclo K | Diclo k | Diclocien | Diclofenac | Diclofenac apotex | Diclofenac mk | Diclofenaco | Diclofenaco genfar | Diclofenaco mk | Diclofenaco potasico | Diclofenaco retard | Diclofenaco rocnarf | Diclofenaco sodico | Diclonac s | Diclowal | Diflox | Dignofenac | Dioxaflex | Disflam K | Divafen | Doclopen | Dolocordralan | Dolostop | Dynapar | Dynapar sr | Fenagen | Flamydol | Flamydol retard | Flenac | Flexen | Flexiplen | Flogam | Flotac | Gladox | Grofenac | Hit | Inyeccion de diclofenaco de sodio | Kroflenaco | Lertus | Lertus sr | Librafenac | Libraflam | Merpal | Prolertus | Turbogesic | Volfenac | Voltaren | Voltaren dolo | Voltaren retard | Voltaren sr | Zorvolex;
  • (EE) Estonia: Almiral | Cataflam | Diclac | Diclobene | Dicloberl | Diclofen | Diclofenac | Diclofenac stada | Diclomax | Diclomelan | Diclonac | Diclonat p | Diclophenac | Dicuno | Effekton | Feloran | Flogofenac | Inflamac | Naklofen | Naklofen duo | Olfen | Ortophen | Rewodina | Sanfinac | Veral | Voltaren | Voltarol | Volxol;
  • (EG) Egypt: Actifast | Adwiflam | Antiflam | Arthrofast | Cataflam | Declofenac | Declophen | Diclac | Diclasium | Diclofenac | Dicloferaz | Dicloflam | Diclonatrium | Diclorapid | Diclosp | Dolphin | Dolphin-k | Epifenac | Fenaclomex | Flotac | Meroflam | Mipaflam | Oflam | Olfen | Pharofen | Potafen | Potaflam | Protofenac | Rapidus | Rapiflam | Rheumarene | Romalex | Sigmafenac | Suppofen | Unirapecure | Voltaren | Voltinac k | Zacaglone | Zitoxanal;
  • (ES) Spain: Di | Diclofenaco aldo union | Diclofenaco alter | Diclofenaco aristo | Diclofenaco bayvit | Diclofenaco bexal | Diclofenaco cinfa | Diclofenaco clariana | Diclofenaco edigen | Diclofenaco lepori | Diclofenaco llorens | Diclofenaco mundogen | Diclofenaco normon | Diclofenaco ratiopharm | Diclofenaco rubio | Dolotren | Luase | Voltaren;
  • (ET) Ethiopia: Adiflam | Almiral | Cataflam | Clofenac sr | Declophen | Diclo denk | Diclo denk 100 retard | Dicloas | Diclofenac | Didlyn | Divido | Dofec | Dynapar ec | Epifenac | Fensupp | Regunac | Remethan | Voldic K | Voltaren | Voren;
  • (FI) Finland: Clofemex | Diclofenac | Diclofenac bmm pharma | Diclometin | Diclomex | Dicuno | Motifene | Trabona | Voltaren;
  • (FR) France: Diclofenac | Diclofenac arrow | Diclofenac biogaran LP | Diclofenac delbert | Diclofenac g gam | Diclofenac gnr | Diclofenac ivax | Diclofenac merck | Diclofenac mylan LP | Diclofenac rpg | Diclofenac sandoz | Diclofenac teva | Flector | Voldal | Voltarendolo | Voltarene | Voltarene LP | Xenid;
  • (GB) United Kingdom: Acoflam | Closteril | Defanac | Dexomon | Diclo sr | Diclofenac | Diclofenac arrow | Diclofenac arun | Diclofenac berk | Diclofenac cox | Diclofenac kent | Diclofenac sandoz | Dicloflex | Diclomax | Diclotard | Diclovol | Diclozip | Difenor | Digenac xl | Dyloject | Econac | Fenactol | Flamatak | Flamrase | Flexotard | Isclofen | Lofensaid | Rheumatac | Rhumalgan | Slofenac | Valdic | Valenac | Volraman | Volsaid | Voltaren | Voltarol | Voltarol Joint Pain | Voltarol p | Voltarol Pain-eze;
  • (GH) Ghana: Diclo dor | Diclofen | Diclonova | Ronfenac;
  • (GR) Greece: Anthraxiton | Contralg | Delimon | Evinopon | Fenoclof | Flefarmin | Javipren | Rheumavek | Ruvominox | Urigon | Vilonit | Voltaren | Voltarol acti go | Vurdon;
  • (HK) Hong Kong: A-fenac k | Almiral | Apo diclo | Artharen | Cataflam | Chilon | Clofec | Clofenac | Diclofen | Diclofenac | Diclogesic | Dicofen | Difena | Difenac | Difenol | Difisal | Dinac | Dynapar sr | Erdon | Eunac | Eurofenac | Euroflam | Fenac | Fenadium | Inflanac | Lesflam | Olfen | Painoff | Prophenatin | Qualifenac | Remafen | Ren | Rhemofenax | Sawto | Shoren | Synfenac | Taks | Turbogesic | Umeran sr 100 | Uniren | Vartelon | Vidaclofen | Volna-k | Volta | Volta t.m. | Voltaren | Volton | Voren | Votan;
  • (HR) Croatia: Diclac duo | Diclo duo | Naklofen | Naklofen duo | Voltaren | Voltaren forte | Voltaren rapid;
  • (HU) Hungary: Cataflam | Cataflam dolo | Cataflam dolo rapid | Cataflam v | Diclac | Diclofenac al | Diclofenac stada | Diclomel | Diflam | Flector dolo rapid | Fortedol | Huma-difenac | Olfen | Voltaren dolo;
  • (ID) Indonesia: Araclof | Berifen | Cataflam | Catanac | Clofecon | Deflamat | Diaflam | Dicloflam | Diclophlogont | Diflam | Eflagen | Erphaflam | Exaflam | Fenaren | Flamic | Flamigra | Flazen | Galtaren | Gratheos | Inflam | Kadiflam | Kaditic | Kaflam | Kamaflam | Linac | Matsunaflam | Megatic | Merflam | Mirax | Nacoflar | Nadifen | Nadiflam | Neurofenac | Nichoflam | Nilaren | Potazen | Proklaf | Reflamid | Renadinac | Renvol | Scanaflam | Scantaren | Tirmaclo | Voltaren | Volten | Voren | Yariflam | Zelona | Zorvolex;
  • (IE) Ireland: Cataflam | Diclac | Diclo | Diclomax | Diclomel | Difene | Kyflam | Vologen | Voltaren | Voltarol;
  • (IL) Israel: Abitren | Betaren | Cataflam | Voltaren;
  • (IN) India: Aclomax | Activa | Adiflam | Agile | Agile-d | Agile-k | Aglofen | Alapen | Aldinac | Alkoran | Anaida | Antiflame | Aquagesic | Ardis | Argesic | Ark | Artifen | Artilov | Clofac | Clofenac | Daclotenac | Dan | Deccaran | Decifen | Defenac | Delta-k | Demo | Denac | Dici-k | Diclo | Diclo k | Dicloact | Diclodol | Diclodyne | Diclofam | Diclofen | Diclofenac | Dicloflam | Dicloflame | Diclogen | Diclogin | Diclogold | Diclomax | Diclomol | Diclomove | Diclonac | Diclonat-tr | Diclonij | Diclopace | Dicloran | Dicloric | Diclorumatin-mr | Diclostar | Diclot | Diclotal | Dicloter | Diclowin | Dicnac | Dicol | Dicoliv | Dicron | Difen | Difend | Difisal | Dilofen | Dilona | Dimobid | Diran | Divexx | Divon | Divorel | Divorel-k | Dizep sr | Dofec | Doflex | Dolex | Dolo-k | Doloact | Dolocide | Dolocide k | Dolosure sr | Dykay | Dynapar | Dynapar aq | Dynapar sr | Dynec | Efetran | Eldofen | Emfen | Esgipyrin ds | Exflam | Famoov | Fen | Fenac | Fenacon | Fenadec | Fenak | Fencure | Fensupp | Flagon | Flanac | Flexyl | Flexyl-k | Fortafen | Frenac | Haloran | Inac | Jonac | Justin | Klofen | Larfen | Lipcy | Lynec | Lysoflam dig | Maxidic | Maxofen | Medinac | Mirafen | Movonac | Nac | Nac sr | Naclo | Nacpot | Neodol | Neodol-k | Neuroflam | Normove | Nudiclo | Nufenac | Ontac | Osteoflam | Oxalgin | Powerflam | Profenac | Reactin | Relaxyl | Remobile | Remobile-k | Rheufen | Rheufen x | Rolod-k | Rumarden | Runac | Scor | Solunac | Spasmcare | Sprintex | Subsyde | Supanac | Superaflam | Supra-k | Tromagesic | Tromax | Ultra-k | Unofen-k | Valfen | Vewodina | Vivian | Vivogesic | Volflam sr | Voligesic | Volini | Voliran | Vovcad | Vovecom | Voveran | Vovo | Welnac | Zedonac | Zefort | Zix | Zobid | Zovenac | Zoxin | Zydiclo;
  • (IQ) Iraq: Diclo | Diclofenac | Diclofenac s awa | Diclofenac sr awa | Furafen | Kindifenac k | Voltex | Voltex k;
  • (IS) Iceland: Klofen l | Vostar | Vostar R | Vostar-S;
  • (IT) Italy: Algosenac | Dealgic | Deflamat | Diclofan | Diclofenac | Diclofenac doc | Diclofenac eg | Diclofenac hexal | Diclofenac mylan generics | Diclofenac ratiopharm | Dicloreum | Dicloreum cr | Dicloreum dolore | Fenadol | Fender | Flectorgo | Flogofenac | Forgenac | Itamifast | Lisiflen | Novapirina | Safidol | Voltadvance | Voltadvancego | Voltaren | Voltfast;
  • (JO) Jordan: Almiral | Cataflam | Clofen | Diclofen | Diclogesic | Diclomax | Diclosal | Diclotab | Diclover | Difen | Divido | Dolvic k | Infla ban | Nalgofen | Olfen | Optifen | Rapidus | Rofenac | Rofenac d | Tratul | Voldic | Voldic K | Voltaren | Votrex;
  • (JP) Japan: Adefuronic jdolph | Adefuronic kayaku | Adefuronic zupo | Adefuronic-L | Anavan | Aspizone | Blesin | Bolabomin | Bolabomin amel | Bolabomin merck hoei | Bolabomin tsuruhara | Buseton | Celtanac | Celtanac choseido | Chlorgy | Daispas | Denbal | Dichronic | Dichrophenon | Diclofe.sod.kob.yk | Diclofe.sod.ohara | Diclofe.sod.yutoku | Diclofenac na nissin | Diclofenac sodium sr ze | Dicsanal | Difenac | Docell | Fenacidon | Fenytaren | Gautelin | Hizemin | Irinatolon | Meclophen | Mericut | Milnac | Naboal | Neriodin merck hoei | Neriodin wakamoto | Nifleriel | Pentiate | Pinanac | Poltajen | Prophenatin | Saffrac | Sannax | Savismin | Seecoren | Shignol | Sofarin | Sorelmon | Strongcoll | Supiaren | Thicataren | Tsudohmin | Verice | Volmagen asahikasei | Volmagen choseido | Volmagen hexal | Volmagen taisho | Voltaren | Vonafec hisamitsu | Vonafec nissin | Vonfenac | Youfenac | Youfenac mita;
  • (KE) Kenya: Adiflam | Adiflam sr | Almiral | Bionac | Carefenac | Cataflam | Clofen | Clofenac | Clofenac sr | Cosflam | Cosflam sr | D fenac | D pott | Daifen | Deklomol | Diclac | Diclo denk | Dicloas | Diclofen sr | Diclofenac | Diclofenac sodium bp | Diclogen | Diclogen retard | Dicloject | Diclomed | Diclomol | Diclomol sr | Diclopill | Dicloran | Diclosafe | Diclovita | Dicofen | Difisal | Difisal sr | Diflame sr | Dinac | Dinac 100 retard | Dits | Dola cr | Dyclomax | Dyclomax Sr | Dynapar aq | Dynapar ec | Dynapar sr | Elfenac | Fast flam | Fedac sr | Fenac | Flotac | Knac | Lofnac | Medifenac | Mexit | Nasida sr | Nelac | Nudiclo | Olfen | Osteoflam | Penofen | Phlogin | Profenac | Remethan 100 r | Rheumac | Rheumac sr | Rheumarene | Rhumalgan | Rokon | Rufenac | Subsyde | Umeran SR | Velredin | Voltamed | Voltaren | Voltaren retard | Voltaren sr;
  • (KR) Korea, Republic of: Acitan | Aipexin | Alfenac | Anacen | Athronac | Austaren | Austaren f | Baredan | Betanaxin | Betapen | Betapenac | Borero | Cabinexin | Cadexin | Cafenac | Carufen | Cataflam | Catas | Clentac | Clinfenac | Clodifen | Clofenac | Clonac | Clovana | Cnac | Daihan diclofenac | Depain | Dibeta | Dibeta c | Dicknol | Dicle | Diclo | Diclofenac | Diclofenac guju | Diclofenac sodium injection huons | Diclon | Dicofenac | Dicolon | Difeclo | Difein | Difenac | Diferami | Difexin | Dilonac | Dinacs | Dinopen | Dipeamine | Direxin | Disacten | Dymenic | Emcotin | Esfenac | Febnac | Fenaca | Fenaccan | Fenaclo-beta | Freejex | Globeta | Glofenac | Hana diclofenac sodium | Hawon diclofenac | Hawon diclofenac beta | Hifenac | Impegol | Jeil diclofenac sodium | Jexsta | Kenaksin | Kinpoin | Korus diclofenac | Kyungdong diclofenac | Linac | Lopenac | Lopenak | Mepharen | Merofenac | Mino-v | Monaten | Newbeta | Newfenac | Newvoraren | Orphenac | Os beta | Ows | Painac | Penacle | Progofenac | Pumaron | Retilon | Rolactin | Rotilac | Samjin diclofenac sodium | Sendifen | Sendifen-beta | Sendifen-f | Shinfenac | Shinpoong diclofenac sodium | Sinil Diclofenac Sodium | Sodinac | Sofenac | Tapain | Tapain-beta | Tapenaxin | Tarenac | Toraren | Tyfenac | Unipenak | Valentac | Voltaren | Voraren | Yufenac | Yupain;
  • (KW) Kuwait: Adwiflam | Cataflam | Clofen | Diclo | Diclo k | Diclo na | Diclofast | Diclogesic | Diclomax | Diclopid | Epifenac | Grofenac | Infla ban | Joflam | Neoflam | Olfen | Rapidus | Rheumarene | Rofenac | Rumafen | Voltaren | Voltic | Votrex;
  • (LB) Lebanon: Cataflam | Clofen | Cloren | Diclocell | Diclofenac | Diclofenac genericon | Diclogesic | Diclomax | Diclorism | Diclotab | Dikloron | Dilo | Dolmina | Dolonil | Flector | Flogofenac | Flotac | Grofenac | Joflam | Olfen | Primafenac | Rapidus | Remethan | Rofenac | Rofenac d | Tratul | Voldic K | Voltaren | Votrex | Xenid | Zorvolex;
  • (LT) Lithuania: Almiral | Apo diclo | Betaren | Cataflam | Darvec | Diclac | Diclobene | Dicloberl | Diclofenac | Diclofenac stada | Diclomax | Diclomelan | Diclonac | Diclonat p | Dicloran | Dicuno | Effekton | Feloran | Feloran Uno | Flogofenac | Inflamac | Majamil | Naclofen | Naklofen | Naklofen duo | Olfen | Ortophen | Rewodina | Rheumavek | Sanfinac | Ultrafen | Veral | Voltaren | Voltaren limedika | Xenid;
  • (LU) Luxembourg: Cataflam | Diclac | Diclofenac eg | Docdiclofe | Motifene | Polyflam | Voltaren;
  • (LV) Latvia: Almiral | Betaren | Cataflam | Diclac | Diclobene | Dicloberl | Dicloberl n | Diclofenac | Diclofenac rph | Diclofenac stada | Dicloferol | Diclogen | Diclomax | Diclomelan | Diclomol | Diclonac | Diclonat p | Dicloran | Diclorapid | Dicuno | Difisal | Effekton | Feloran | Flogofenac | Inflamac | Majamil | Naklofen | Naklofen duo | Olfen | Ortophen | Profenac | Rewodina | Rheumavek | Sanfinac | Ultrafen | Veral | Voltaren | Voltaren acti | Voltaren resinat | Xenid;
  • (MA) Morocco: Apo diclofen | Cataflam | Diclo | Dicloberl | Diclofenac win | Diclomax | Dicloreum | Difal | Fenac | No flam | Voltarene | Xenid;
  • (MT) Malta: Olfen;
  • (MX) Mexico: Afenilak | Alsidexten | Ariflam | Artrenac | Atalak | Cataflam | Cataflam dd | Cataflam junior | Clo far | Clonafec | Coral | Deflox | Dflam | Dicfafena | Diclac | Diclofen.so.gi | Diclofenac | Diclofenaco | Diclofenaco gi | Diclofenaco gi mav | Diclofenaco gi mer | Diclofenaco kendri | Diclofenaco sodico | Diclopisa | Diprovic | Dirret | Docril | Dofen | Dolflam | Dolflam-retard | Dolo pangavit d | Espitec | Evadol | Fenak | Flamydol | Flotac | Fustaren | Galedol | Genoren | Lertus | Lertus sr | Lifenac | Liroken | Logesic | Mafena | Mafena retard | Manacon | Merxil | Metracin | Nediclon | Ormofen | Practiser | Precifenac | Rotumal | Soldoflam | Volfenac | Volfenac retard | Voltaren | Voltaren dolo | Voltaren retard | Voltaren sr;
  • (MY) Malaysia: Almiral | Apo diclo | Avonac | Cataflam | Clofec | Clofenac | Diclac | Diclac retard | Diclo | Diclocip | Diclofenac | Diclofenac Siu Guan | Diclogesic | Diclohexal | Diclomol | Dicloran | Dicloren | Diclosian | Diclotroy | Diclowal | Difenac | Difnal | Difnal-k | Dyfenac | Fenac | Fenadium | Fenadium F | Inac | Inflanac | Jonac | Klofen | Lesflam | Naklofen | Neo pyrazon | Olfen | Pritaren | Profenac | Remafen | Remethan | Venac | Vokam | Voltaren | Voren | Votan | Vovo;
  • (NG) Nigeria: Ac diclo | Acofenac | Al douleurs | Alben diclofenac potassium | Animol | Annoxy | Aramac | Ashfort diclofenac sr | Auscel diclofenac | Ausfnac | B fenac | Bacadic | Befenac | Bentren | Betaren | Betaren 100 sr | Bhp | Bumacaps | Butaflam | Capifen | Chidinick diclofenac sodium | Cinafenac | Clamfenac | Clofenac | Clotafen | Codico | Curefenac | Delidic | Diclofenac | Diclofenac sandoz | Diclogen | Diclokris | Diclosuit | Diclosure | Diclozone | Dimkpain | Dipen | Docteo | Dogofen | Doublemol | Dovefenac | Dozifenac | Edp diclofenac sodium | Edufenac | Felitone diclofenac potassium | Fenal | Frafenac | Glafenac | Gombefenac | Greenfenac | Greenhope diclofenac potassium | Grinflam | Hydiclo | Iykonfenac | Jawadiclo | Jozofenac | Kachanpen | Kinglion diclofenac sodium | Klovac | Klusyl diclofenac | Krishat diclofenac | Kv diclofenac | Labrelax | Labumol | Liricon diclofenac potassium | Lofnac | Macdiclo | Madifency | Marley diclofenac | Masedor | Masterfen | Mayateo diclofenac | Mecure diclofenac | Meem diclofenac potassium | Moriofenac | Mujid diclofenac potassium | Mujid diclofenac sodium | Nasafen | Nci osteifen | Nemedin | Neosteoval | Olfen | Olfen sr | Olphin diclofenac | Ostomed | Otevo | Panac | Panfenac | Pawafenac | Phomnac | Prinogold | Qualifenac | Radiklo | Remflam | Replek diclofenac retard | Rgi diclofenac | Rumaflam | Sadiko | Santufenac | Sd diclofenac potassium | Sivofenac sr | Softhealth diclofenac potassium | Solofenac | Starsteo | Sunymet diclofenac | Sureclofen forte | Tavpal | Tfp diclofenac sodium | Topfenac | Toranac | Tribumol | Tyonex diclofenac potassium | Ulsto fenac | Vistafenac | Voltaren | Votradec | Zemdimol | Zesnac | Zestefenac | Zestefenec | Zikafenac | Zoflam | Zuteo | Zydiclo;
  • (NL) Netherlands: Cataflam | Diclofenac kalium | Diclofenac kalium actavis | Diclofenac na | Diclofenackalium | Diclofenacnatrium Alpharma | Diclofenacnatrium delphi | Diclofenacnatrium flx | Diclofenacnatrium Merck | Voltaren | Voltaren k;
  • (NO) Norway: Cataflam | Diclo 1A pharma | Diclofenac | Diclofenac bluefish | Diclofenac bmm pharma | Diclofenackalium | Dicuno | Ignorin | Modifenac | Otriflu | Voltaren | Voltarol;
  • (NZ) New Zealand: Apo diclofenac | Cataflam | Diclax | Diclofenac | Diclofenac sandoz | Diclohexal | Flameril | Oraflam | Pharmacy health diclofenac | Voltaren | Voltaren osteo;
  • (PA) Panama: Diclo k | Diclofenaco;
  • (PE) Peru: Acefenac | Anaflex mujer | Apo diclo | Aproxol | Artren | Cataflam | Cordralan | Cordralan R | Deflamat | Diclo k | Diclodor | Diclof | Diclofast | Diclofen | Diclofenac | Diclofenaco | Diclofenaco labot | Diclofenaco sodico | Diclokem | Diclomed | Diclomek | Diclotek | Dioxaflex cb nf | Diphadic long | Divon | Dolfenex | Dolfenex sr | Dolo quimagesico | Dolo tanderil | Dolocordralan | Dolofarmalan | Dolofarmalan fast | Dolofenac | Dololiviolex | Dolopress | Dolotren | Fevran b | Flexitol | Flogene | Flotac | Lavidic long | Motriflam | Olfen | Redex | Syfen sr | Tanderil | Terbofenaco | Volfenac | Voltaren;
  • (PH) Philippines: Acuflam | Boren | Cataflam | Cataflin | Clofenex | Curafen sr | Diclofam | Diclofenac colestyramine | Diclogen | Diclon | Diclovic | Diclowal | Dictas | Diflac | Diflosid | Disod | Dosanac | Gofenac | Lobafen | Lofenax | Philflam dr | Pyrazon | Ritemed diclofenac sodium | Sitiflam | Subsyde | Vifenac | Voltaren | Voltaren rapid | Vontrafen | Voren | Votan | Zolterol;
  • (PK) Pakistan: Achedec | Aclonac k | Adfenac | Adfenac p | Adfenac sr | Adik | Adik sr | Aksofenac-k | Alcazar | Almiral | Altoron | Anac | Anaren | Anfenax | Antiflam | Apeflam | Araam | Aramfen | Ardi-k | Arnil | Arnil p | Artecid | Arthopot | Artifen | Artinil k | Artonec | Artonec sr | Astefenac | Avenac | Avorek | Basocap | Beflam | Caflam | Camotaren | Carafenac p | Catafen | Citiflam | Clo tassium | Clodium-K | Clofenac | Clonap | Clop | Cloran-S | Confenac k | Cyclofen | Daiko p | Dardnil | Declam | Dectil | Defenac | Deflam | Dejafin | Delves | Demsun | Demsun p | Denum | Denum k | Denum s | Detaflam | Detran p | Dianic | Dic P | Dic s | Dicast sr | Dicgesic k | Dick | Diclac | Diclo p | Diclo-Heim | Diclodex | Diclofen | Diclofenac | Diclofil | Dicloflam-p | Diclogen | Diclogesic | Diclokalium | Diclolac | Diclomed | Diclonov | Diclopal | Diclopel sr | Dicloran | Dicloras | Diclorep | Dicloscot | Diclosel p | Diclosel s | Diclotab | Diclotim | Diclotram | Diclovat | Diclovel | Diclowal | Diclozaf | Diclozan | Dicmaf | Dicmaf sr | Dicnac p | Dico sr | Dicolive | Dicorum | Dicota | Dicpot | Dicto | Dicto sr | Difen | Difenac | Difisal sr | Difnac | Difold | Difsom | Difsom p | Diklonat p | Dinak | Diosim | Diosim sr | Disney | Dolo-k | Dyclo | Dyclo-p | Dycloxan | Dyna-K | Ephanac | Evofenac | Fapa | Fastaid plus | Fedgesic | Fen-k | Fenac | Fenik-k | Fentolit SR | Fist | Flamatrol | Flamex | Flamsak | Flaren | Forgenac | Frendic | Frendic s | Frodic-P | Glif K | Grofenac | Heltron sr | Hirun | Hirun sr | Hondic | Infast | Inflaban | Inflanac | Jaslokan | Jaslokan sr | Jesnil sr | Jupavolt k | Kafenac | Kaldic | Kalfen | Kaliofenac | Kaydic | Kenac | Kesiflam | Ketagesic | Keygesic | Klic | Klodic | Lofen | Loflam | Lofsim | Lonac | Lopran | Luxafen k | Macdafin | Macdicol | Magnopyrol ds | Matic | Maxit | Mediflam | Megafenac | Mobil K | Moov k | Motaar | Mouflam | Moven | Movonac | Muskel | Nacta | Nadium | Natrium | Neclof | Nepnop | Neurofenac | Newdik | Newfenac | Nfen | Nipgesic | Noltren | Oberon | Odic | Opain | Optel-P | Ostefen | Osti P | Paiko s | Painext | Painext sr | Painnil | Painnil P | Painrest | Panslay | Paplofen p | Penfen | Phlogin | Potanic P | Potran | Puldol | Qrelif | Qufen | Qufen k | Quikrel | Rakafen | Rapiget | Regofenac | Regopyrin | Reho | Reldic | Relsec | Remethan | Rheugin | Rheumatin | Rheumatin k | Rheuyan | Ronset | Rubor | Saifenac | Saifenac sr | Signa | Sintral sr | Sofac | Sofac p | Sonal | Sondic | Spon-K | Stop-P | Swiso | Swiso p | Ticclo sr | U Tran | Ultrafen | Vaclo-pot | Valron | Valron p | Veloft | Veloft sr | Visodic | Volden fort | Voldos | Volfen | Volfenac | Volnac | Voltaflam | Voltec p | Voltral | Voltrex | Voren | Vorenac | Voveron | Vurdon | Welclof | Weldiclof | Xion | Yarnil | Zefam | Zeta fenac k | Ziclofen | Ziclofen s | Ziclopel;
  • (PL) Poland: Cataflam | Diclac | Diclac duo | Dicloberl | Diclofenac | Diclomax | Dicloratio | Dicloratio retard | Dicloratio uno | Dicloreum | Diclotard | Dicuno | Difadol | Diklofen | Feloran | Flectorgo | Majamil prolongatum | Naklofen | Olfen | Olfen uno | Rewodina | Veral | Voltaren | Voltaren acti forte | Voltaren sr;
  • (PR) Puerto Rico: Cataflam | Diclofenac sodium delayed release | Diclofenac sodium dr | Diclofenac sodium er | Diclofenac sodium extended release | Dyloject | Lofena | Voltaren;
  • (PT) Portugal: Cataflam | Clofen | Diclof | Diclofenac | Diclofenac mylan | Diclotec | Difnan | Dolacen | Dorcalor | Fenil v | Flameril | Olfen | Painex | Poliartrine | Voltaren;
  • (PY) Paraguay: Akesis bl | Alarflog | Algiflan | Algiflan lp | Antidol | Antiflex | Beyca flex | Curinflam | Diacevit | Diclofen | Diclofen 100 lp | Diclofen 75 lp | Diclofenac janvier | Diclofenac medicine | Diclofenac potasico imedic | Diclofenac potasico kirei | Diclofenac potasico variquin | Diclofenac sodico landerlan | Diclofenac sodico quimfa | Diclofenac sodico variquin | Diclofenaco genfar | Diclofenaco sodico 50 mg dutriec | Diclofenaco sodico mintlab | Diclogrand | Difenac 100 retard nf | Difenac 75 sr nf | Difenac nf | Difenac rl | Dioxaflex | Dioxaflex cb | Dioxaflex retard | Dolovit | Eca | Eca flex | Efagesic | Flamax | Flamirex | Flexidol | Flexidol retard | Flexiplen | Isoxiflam | Levomin | No dol | Pan reumadil | Pirafen | Pro difenac | Pro flexidol | Relaflex | Rexalgan | Rexfar | Sindrolen | Tonoflex | Vinil | Vinil retard | Voltaren | Voltaren retard | Zorvolex;
  • (QA) Qatar: Apo-Diclo | Cataflam | Clofast-P | Clofen Julphar | Clofen Retard | Declophen | Declophen SR | Diclo | Diclo ID | Diclofast | Diclofen | Diclogesic | Diclogesic Children | Diclogesic Retard | Diclomax | Diclopid | Dicloran | Diclowal | Diclowal Retard | Dikloron | Divido | Emifenac | Epifenac | Fast-Flam | Finac SR | Finac SR (EC) | Grofenac | Grofenac Retard | Infla-Ban | Infla-Ban SR | JoFlam | Miyadren | Neoflam | Oflam | Olfen Dispersible | Olfen-100 SR Depocaps | Olfen-50 Lactab | Olfen-75 | Olfen-75 SR Depotabs | Optifen | Optifen SR | Rapidus | Remethan | Rheumarene | Rodinac | Rofenac | Rofenac SR | Rofenac-D | Rumafen | Solvast | Tabiflex | Voldic | Voldic SR | Voldic-K | Voltaren | Voltaren D | Voltaren Retard | Voltaren SR | Voltarol | Voltfast | Voltic | Votrex;
  • (RO) Romania: Almiral | Clafen | Declophen | Diclac | Dicloberl | Diclofen | Diclofenac | Diclofenac arena | Diclofenac duo pharmaswiss | Diclofenac helcor | Diclofenac sodic | Diclogesic | Dicloreum | Epifenac | Feloran | Forgenac | Raplon | Refen | Remethan | Rewodina | Rheumafen | Rheumavek | Voltaren | Voltaren rapid;
  • (RU) Russian Federation: Almiral | Apo diclo | Bioran | Clofenac | Diclac | Diclobene | Dicloberl | Diclofen | Diclofenac | Diclofenac bufus | Diclofenac fpo | Diclofenac mff | Diclofenac ratiopharm | Diclofenac reneval | Diclofenac retard obolenskoe | Diclofenac retard obolenskoje | Diclofenac sandoz | Diclofenac velfarm | Diclogen | Diclogesic | Diclomax | Diclomelan | Diclonac | Diclonat p | Dicloran | Diclorium | Diclovit | Flotac | Flotak | Forgenac | Naklofen | Naklofen duo | Naklofen sr | Neodol | Olfen | Ortofen | Ortofer | Ortophen | Rapten | Rapten duo | Rewodina | Sanfinac | Swissjet duo | Tabuk di | Umeran | Veltavel | Veral | Voltaren | Voltaren acti | Voltaren rapid | Votrex | Xenid;
  • (SA) Saudi Arabia: Apo diclo | Cataflam | Clofast p | Clofen | Diclac | Diclogesic | Diclomax | Diclopid | Diclorism | Dolvic k | Fast flam | Infla ban | Joflam | Oflam | Olfen | Rapidus | Rheumarene | Rofenac | Rumafen | Tabiflex | Voltaren | Votrex;
  • (SE) Sweden: Diclofenac bmm pharma | Diclofenac ratiopharm | Diclofenac T ratiopharm | Dicuno | Diklofenak Copyfarm | Diklofenak merck nm | Diklofenak mylan | Diklofenak nm pharma | Diklofenak orifarm | Diklofenak sandoz | Diklofenak t abece | Diklofenak T Actavis | Diklofenak t apofri | Diklofenak T Copyfarm | Diklofenak T Evolan | Eeze | Eezeneo | Ignorin | Voltaren | Voltaren t;
  • (SG) Singapore: Almiral | Apo diclo | Cataflam | Clofec | Diclo | Diclo denk | Diclofenac | Dicloreum | Diclowal | Difenac | Difnal | Dosanac | Fenac | Fenadium | Flogofenac | Inac | Inflanac | Neodol 50 | Olfen | Pritaren | Remafen | Remethan | Voltaren | Voren;
  • (SI) Slovenia: Dicuno | Naklofen | Naklofen duo | Olfen | Voltaren;
  • (SK) Slovakia: Almiral | Diclac | Diclobene | Diclofenac | Diclofenac al | Diclofenac duo | Dicloreum | Dicuno | Dolmina | Flector ep | Inflamac | Olfen | Rewodina | Veral | Voltaren | Voltaren actigo;
  • (SL) Sierra Leone: Dibumol | Dili | Lofnac | Miral diclofenac | Ronfenac | Voltika | Welcofen;
  • (SR) Suriname: Apo diclofenac | Clofenac | Clofenac sr | Diclo | Diclo denk | Diclofenac mk | Diclofenac na | Diclofenac na cf | Diclofenacnatrium ec mylan | Diclofenacnatrium retard mylan | Dicloflame | Diclon | Diclowal | Diclowal retard | Diclowal s | Dicol denk retard | Dynapar sr | Remethan | Vivian | Voltabid | Voltaren sr;
  • (TH) Thailand: Almiral | Antiren-f | Artharen | Bufenac | Cataflam | Catanac | Chai fenac | Clonac | Diclo sr | Diclofen | Diclofenac | Dicloflex | Diclogesic | Diclomac | Diclonac | Diclopain | Dicomed | Difenac | Dinac | Doflam | Donac | Dynapar aq | Fenac | Fenacstar | Flogofenac | Inflanac | Klyzen | Myogit | N zen | Neofenac | Neritan | Olfen | Olfenac | Ostaren | Pipfenac | Remethan | Staren | Vesconac | Vivian | Volclonac r | Volfen | Volfenac | Volta | Voltanac | Voltaren | Voren | Votamed | Vtop s;
  • (TN) Tunisia: Dicloberl | Diclofen | Diclogesic | Diclopal | Dicloreum | Forgenac | Voltarene | Votrex | Xedol | Xenid;
  • (TR) Turkey: Benseri | Cataflam | Deflamat | Dicloflam | Diclogesic | Diclomec | Dicloponac | Difenak | Difenject | Diflodol | Dikloron | Dikloron sr | Dolorex | Feoptidin | Kalidren | Miyadren | Rapidus | Rodinac | Turktipsan Diklofenak sodyum | Volfenaks | Voltaren;
  • (TW) Taiwan: Adefuronic | Almiral | Batafil | Blesin | Bolabomin | Boltonin | Cataflam | Clofen | Clofen P | Coyenpin | Deflam-K | Diclo denk | Diclof | Diclofen | Diclofenac | Diclofon | Diclomelan | Diclophen | Dicloton | Dicok | Difen | Difenac | Diltaren | Ellic | Fenytaren | Flamquit | Formin | Grofenac | Lidonin tai yu | Meitifen | Neriodin | Olfen | Peiflam | Prophenatin | Psutarin | Remethan | Roitonin | Shoren tf | Sorelmon | Staren | Sumofen e.c. | Tsudohmin | Venton | Volna-k | Voltaren | Voren | Voren-k | Vortagen e.m.;
  • (UA) Ukraine: Almiral | Argett duo | Bioran | Clodifen | Diclac | Diclobene | Dicloberl | Dicloberl retard | Diclobru | Diclodev | Diclofen | Diclofenac | Diclogen | Diclomax | Diclonac | Dicloran | Diclosafe | Diclotard | Diclovit | Dolox retard | Feloran | Naklofen | Naklofen duo | Olfen | Olfen lactab | Ortofen forte | Ortophen | Ortophenum | Ortophenum forte | Rapten | Rapten retard | Rewodina | Rheumavek | Sanfinac | Veral | Volfenac | Voltaren;
  • (UG) Uganda: Adiflam | Adwiflam | Agodic | Agonac | Artimed | Cataflam | Clofenac | Clofenac sr | Decifen sr | Diclo denk | Diclo denk 100 retard | Dicloas | Diclodyne | Diclofen | Diclofenac | Diclogen retard | Diclogesic | Diclomol | Diclomol sr | Dicloran | Dicloran sr | Dicloren | Difenac | Dinasod | Fensupp | Knac | Lofnac | Lufenac | Maxit | Olfen | Pinnadip | Umeran SR | Voldic K | Voltamed | Voltaren | Voltaren retard | Voltaren sr | Voren;
  • (UY) Uruguay: Algilem | Aliviol | Befol | Cataflam | Diclofenac | Diclopharm | Dioxaflex | Flogene | Flogosin | Flogosin s | Flotac | Oxa | Supel | Voltaren | Xedenol | Yargon;
  • (VE) Venezuela, Bolivarian Republic of: Aflamax | Artren | Bioflenac | Campal | Cataflam | Clofen | Clofenac | Diclodet | Diclodex | Diclofen P | Diclofenac | Diclofenac k | Diclofenac potasico | Diclofenac sodico | Diclofenaco | Diclofenaco potasico | Diclofenaco sodico | Diclofevin | Diclofex | Diclomedc | Difenac | Dikaspen | Diklason | Disodex | Dival | Dival forte | Dolcan | Dotron | Fexicaps | Flamydol | Flotac | Geldenak | Klafenac | Lofnac | Noriflam | Ofaflan | Poltax | Unifenac | Valdipot | Viavox | Voltaren;
  • (VN) Viet Nam: Capulco | Diclomark | Elaria | Fenagi | Lofnac | Mekofenac | Richfenac | Stadlofen | Uptaflam;
  • (ZA) South Africa: Acu-diclofenac | Adco diclofenac | Apo diclofenac | Arcanafenac | Austell diclofenac | Cataflam | Clofelam | Diclofenac biotech | Diclofenac oethmaan | Dicloflam | Diclohexal | Difen | Dynak | Flexagen | Fortfen | K fenak | Micro diclofenac | Motifine | Mylan diclofenac | Panamor | Veltex | Voltaren | Voltaren acti go;
  • (ZM) Zambia: Adiflam | Adiflam sr | Agonac | Ar diclo | Balnac | Cataflam | Clofen | Clofenac | Clofenac sr | Decifen | Defnil | Dflam | Dicinac | Diclo denk | Diclofenac | Diclofil | Dicloflame | Diclogen | Diclokant | Diclomove | Diclonac | Difisal | Dinac | Doloact | Dolphin | Dynapar aq | Dynapar sr | Flagon | Flotac | Knac | Lydic | Panamor | Profenac | Remethan | Rufenac | Subsyde | Umeran | Voltaren | Voltfast | Voltika | Zobid;
  • (ZW) Zimbabwe: Almiral | Bioran | Cataflam | Diclofenac | Panamor | Panamor at | Remethan | Vivian | Voltaren
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