THE PREPARATION DESCRIPTION IS NOT INTENDED FOR
MEDICATION WITHOUT PARTICIPATION OF THE DOCTOR!

Therapeutic actions : Diclofenac belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It works by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury or certain diseases and would otherwise go on to cause pain, swelling and inflammation. Arthritic conditions are one example of such a diseases. Diclofenac is used to relieve pain and inflammation in a wide range of conditions, including arthritis, gout, sprains, fractures, back pain and following minor surgery. All the medicines in the NSAID group reduce inflammation caused by the body's own immune system and are effective painkillers, but must be taken with or after food to avoid stomach related side effects

Contraindications and cautions: Not to be used in:

• Bleeding from the stomach or intestines or a history of this
• Current or previous peptic ulcer
• People in whom aspirin or other medicines in this class (NSAIDs), cause attacks of asthma, itchy rash (urticaria) or nasal inflammation (rhinitis)
• Suspected peptic ulcer

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Use with caution in:

• A type of life long inherited blood disease caused by a defect in the liver (hepatic porphyria)
• Asthma or history of asthma
• Bleeding tendencies
• Blood clotting disorders
• Blood disorders
• Crohn's disease
• Current or previous heart failure
• Current or previous high blood pressure
• Decreased heart function
• Decreased kidney function
• Decreased liver function
• Elderly people
• Inflammation of the bowel and back passage
• People who have recently had major surgery
• People with symptoms of stomach or intestinal disorders
• This medicine is not recommended for use in pregnancy, particularly the third trimester, unless considered essential by your doctor. Seek medical advice from your doctor.
• The medicine passes into the breast milk, but at normal doses it is unlikely to harm the baby. Discuss with your doctor.

Important

• This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
• During long-term treatment, routine blood tests are recommended to monitor kidney function, liver function and levels of blood components, particularly in the elderly.
• This medicine may mask the signs and symptoms of infection.
• Close medical supervision is important in people with symptoms of gastrointestinal disorders, particularly in the elderly.
• Close medical supervision is important in people suffering from severe impairment of liver function

Adverse effects: Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Headache
• Dizziness or loss of balance
• Excess gas in the stomach and intestines (flatulence)
• Inability of the heart to pump blood efficiently (heart failure)
• Blood disorders
• Skin rashes
• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
• Indigestion (dyspepsia)
• Ulceration of the stomach or intestine
• Inflammation of the liver (hepatitis)
• Loss of appetite
• Severe blistering skin reaction affecting the tissues of the eyes, mouth, throat and genitals.(Stevens-Johnson Syndrome)
• Bleeding from the stomach or intestine
• Decreased kidney function
• Allergy to active ingredients (hypersensitivity) such as facial flushing, skin rash, itch, narrowing of airways (bronchospasm) or swelling of lips, tongue or throat (angioedema)
• Alteration in results of liver function tests

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

Interactions: It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Diclofenac may increase the blood levels of lithium, digoxin and methotrexate. There may be an increased risk of bleeding from the gut if diclofenac is taken with blood thinning or anti-clotting medicines such as warfarin. The effect of diuretics such as frusemide (furosemide) may be reduced by diclofenac. The use of diclofenac with potassium-sparing diuretics may result in an increase in blood potassium levels. Potassium levels should be monitored. When taken together with ciclosporin, there may an increased risk of kidney damage. There may be an increased risk of side effects such as stomach irritation if diclofenac is taken with corticosteroids such as prednisolone. Diclofenac should not be taken with any other NSAID, due to an increased risk of side effects. Convulsions may occur when diclofenac is taken together with quinolone antibiotics. This may occur in patients with or without previous history of epilepsy or convulsions.