Talk to us for advice on the most suitable medicine for your needs. Anti-inflammatory gels — e. Voltaren Emulgel - You can rub-on this anti-inflammatory gel to the affected area and it can be safely used with Paracetamol tablets. Stronger anti-inflammatories — e.
Diclofenac Voltaren Rapid - While the strongest Diclofenac tablets are only available on prescription — your pharmacist can sell you the Voltaren Rapid 25mg if it is appropriate for your needs. You can purchase Voltaren Rapid Codeine containing tablets e. Nuromol and Maxigesic - When you need stronger pain relief than Paracetamol or Ibuprofen on their own, this combination is able to be safely used for short term pain relief.
Nuromol Tablets Nuromol is the only clinically proven pain relief tablet to contain ibuprofen mg and paracetamol mg. This unique combination ensures they are released together to target pain more effectively, so you can quickly get on top of distracting pain and continue on with your day. Talk to your doctor or pharmacist if these side effects bother you or do not go away:. You're less likely to have side effects with diclofenac gel or plasters. This is because less medicine gets into your body.
But you may still get the same side effects, especially if you use a lot on a large area of skin. Using diclofenac gel or plasters can affect your skin. It can make your skin:. These serious side effects are rare and happen in less than 1 in 1, people.
In rare cases, it's possible to have a serious allergic reaction anaphylaxis to diclofenac. These are not all the side effects of diclofenac. For a full list, see the leaflet inside your medicine packet. This is because diclofenac may cause problems for your unborn baby. For example it can affect your baby's circulation and it can cause you to have too little amniotic fluid surrounding your baby in the womb.
Your doctor will only advise you to take diclofenac while you're pregnant if the benefits of taking the medicine clearly outweigh the risks. There may be other treatments that are safer for you. Paracetamol is generally the best painkiller to take during pregnancy. You can take diclofenac while breastfeeding. Only very small amounts get into breast milk which are unlikely to cause side effects in your baby.
Many breastfeeding mothers have used it without any problems. If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your midwife, health visitor, pharmacist or doctor as soon as possible. For more information about how this medicine can affect you and your baby, read this leaflet on diclofenac on the Best Use of Medicines in Pregnancy BUMPs website.
There are some medicines that affect the way diclofenac works. Tell your doctor if you're taking:. It's not possible to say that complementary medicines or herbal remedies are safe to take with diclofenac.
They're not tested in the same way as prescription medicines or medicines sold in pharmacies. They're generally not tested for the effect they can have on other medicines.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. It works by reducing hormones that cause inflammation and pain in the body. When you apply diclofenac gel, plasters or patches to your skin, it works in the same way as when you take it as a tablet or capsule.
But the gel, plaster or patch only works on the area you have put it on. Diclofenac takes 20 to 30 minutes to work if you take it as tablets or capsules. Suppositories take a few hours to work. There's no difference in how well the tablets, capsules or suppositories work. The doses of diclofenac are the same for each. If you're using diclofenac gel, plasters or patches on your skin, it usually takes 1 to 2 days to work.
For arthritis, you may need to use the gel for up to 7 days on the painful joint to feel the full effect. Depending on why you're taking diclofenac, you may only need to take it for a short time. For example, if you have a sore back or toothache, you may only need to take diclofenac for 1 or 2 days.
You may need to take it for longer if you have a long-term condition, such as rheumatoid arthritis. If you need to take diclofenac tablets or capsules for a long time, your doctor may prescribe a medicine to protect your stomach from side effects.
It's best to take the lowest dose of diclofenac for the shortest time to control your symptoms. Talk to your doctor if you're unsure how long you need to take it for.
Diclofenac tablets and capsules can cause an ulcer in your stomach or gut if you take them for a long time or in big doses. There's also a small risk of heart failure or kidney failure if you take very big doses mg a day for a long time. It's best to take the lowest dose that works for the shortest possible time.
If you need to take diclofenac very often or you're taking a big dose, talk to your doctor about the best way to treat your pain. The type of painkiller that's best depends on what type of pain you have and the cause of your pain. Ibuprofen and naproxen also belong to this group of painkillers.
If you need to take an NSAID long term, your doctor or pharmacist may recommend ibuprofen or naproxen instead of diclofenac. This is because they're less likely to cause heart problems. If NSAIDs do not get rid of your pain, you can try painkillers that you can buy from pharmacies and shops, such as paracetamol or co-codamol paracetamol combined with low-dose codeine.
If the medicine you buy is not controlling your pain, your doctor may recommend additional treatment to help your pain, such as exercise or physiotherapy. Diclofenac does not work for some types of pain, such as nerve pain.
Your doctor will have to prescribe a different medicine to treat peripheral neuropathy nerve pain. Diclofenac tablets and capsules can cause an ulcer in your stomach or gut if you take them for a long time or in big doses, or if you're elderly or in poor general health.
Your doctor may tell you not to take diclofenac if you have a stomach ulcer or have had one in the past. If you need to take diclofenac but you're at risk of getting a stomach ulcer, your doctor may prescribe another medicine for you to take alongside diclofenac to protect your stomach.
It's important to take your diclofenac tablets or capsules after a meal or snack, or with a drink of milk. They'll be less likely to upset or irritate your stomach. The most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the stomach.
But stomach ulcers are not always painful and some people may have other symptoms, such as indigestion, heartburn and feeling sick. If you're prone to stomach ulcers or have had one before, take paracetamol instead of diclofenac as it's gentler on your stomach.
Stop taking diclofenac and contact your doctor if you think you may have symptoms of a stomach ulcer. These can include intense pain in the centre of your stomach, indigestion, heartburn and feeling sick. No, diclofenac is not addictive, but it's important to always take it as prescribed. When you stop taking diclofenac tablets or capsules, or stop using the suppositories, the effects will wear off after about 15 hours. When you stop using the gel, plasters or patches, the effects will wear off after 1 or 2 days.
Taking anti-inflammatory medicines, like diclofenac, in large doses or for a long time can affect ovulation in women. This may make it more difficult to get pregnant. Do not take diclofenac if you're trying to get pregnant, or if you're having tests for infertility.
Diclofenac will not affect any contraceptives, including the combined pill or emergency contraception. Yes, you can drink alcohol while taking diclofenac. The nondominant forearm was placed into the warm-water bath for exactly 2 minutes.
Fifteen seconds before transferring the forearm into the cold-water bath, a blood pressure cuff was inflated to 20 mmHg below the diastolic blood pressure and the eyes were covered with eye-patches.
Subjects placed their forearm in a fixed position with the fingers wide apart into the cold-water bath for a maximum time period of 2 min. They were instructed to clearly indicate the time of the first pain sensation as well as the time of intolerable pain, at which the forearm was removed from the cold-water bath.
The time from the immersion of the forearm into the cold-water bath to the first pain sensation was measured, and is defined as the pain threshold. The pain tolerance is defined as the time from immersion of the forearm into the cold-water bath until the time of intolerable pain.
A training session was carried out before the study to screen out volunteers with a pain tolerance of less than 15 sec or more than sec and to familiarise the volunteers with the study procedure. The pain experiments were conducted on study days before drug administration 10—15 min before drug administration and 1, 1. Subsequently, the changes from baseline were determined and for each study day the area under the pain threshold change versus time curve and the area under the pain tolerance change versus time curve were calculated.
Adverse events were evaluated by the following method: The volunteers were required to list each symptom fatigue, headache, dizziness, blurred vision, nausea, itching, exanthema and any other symptom on a visual analogue scale VAS rated from 0 not present to 10 most severe at zero h baseline, before drug intake , 2, 4 and 6 hours after drug intake.
Codeine and its metabolites were determined using HPLC-electrospray mass spectrometry analogous to a previously published method[ 24 ] with minor modifications.
Samples 1. For the determination of the conjugates of norcodeine and normorphine, urine was hydrolysed[ 25 ] prior to extraction. The limits of quantification achieved with this method were 0. Diclofenac and the internal standard 4'-methoxydiclofenac were detected at nm at a retention time of Recovery was between 85 and The following pharmacokinetic parameters were determined from serum concentration-time data and urine concentration data for codeine cod , codeineglucuronide CG , norcodeine NC , morphine morph , morphineglucuronide MG , morphineglucuronide MG and normorphine NM :.
C max - peak serum concentration [pmol ml -1 ], obtained from the visual inspection of the serum concentration-time curves. Adverse events are presented in two different manners: 1. A p value of less than 0. Peak serum concentrations C max of codeine ; — pmol ml -1 vs. Peak serum concentrations C max of morphine The total amount excreted of codeine and its metabolites excreted was Only minor side effects occurred and no rating higher than 5 was reported on a VAS scale.
The possible pharmacokinetic interaction between codeine and diclofenac could have clinical implications: One could have speculated that by inhibiting codeine glucuronidation other metabolic pathways of codeine, especially O-demethylation to morphine may then be favoured in extensive metabolizers of CYP2D6, resulting in elevated morphine serum levels and a greater analgesic effect, and, possibly also increased adverse effects.
A direct influence of diclofenac on O-demethylation of codeine to morphine via interaction with CYP2D6 has been excluded. Considering our previous in vitro data[ 10 ], it was important to verify whether codeine glucuronidation was inhibited by diclofenac in vivo after administration of a commonly used dose.
In this study, codeine and diclofenac were given in a dose commonly used for clinical treatment of pain. This might be a result of inhibition of renal excretion of both glucuronides by diclofenac or its glucuronide. In our opinion, these minor changes are not of clinical relevance after single dose administration.
Nevertheless, the observed non significant decrease in renal clearance especially of MG in the diclofenac containing regimen, might play a role during chronic treatment with opioids. In this study, we did not investigate a possible influence of codeine on the pharmacokinetics of diclofenac because it has been previously demonstrated that codeine does not influence the relative bioavailability of diclofenac in vivo. The pharmacokinetic data for codeine and its metabolites obtained in our study are supported by the data obtained by other investigators.
Kirkwood et al. Furthermore, it is unlikely that a multiple dose regimen of diclofenac e. Therefore, in our opinion, steady-state administration of diclofenac will also not alter codeine glucuronidation in vivo. Concerning codeine glucuronidation, our pharmacokinetic results demonstrate that in vitro conditions studied did not necessarily reflect the in vivo conditions at therapeutic doses.
There are several studies demonstrating the benefit of the combination of NSAIDs plus opioids in comparison to opioids alone in the treatment of postsurgical pain, pain induced by arthrosis and chronic pain in cancer patients. In our study, we used the cold pressor test for analysing the analgesic effects of opioids because it has been proven to be sensitive to the effects of codeine and morphine in several studies.
In case of a pharmacokinetic interaction between codeine and diclofenac leading to higher serum levels of morphine and MG, an increase in pain threshold and pain tolerance would have been postulated.
A placebo part of the study was omitted because the primary objective was the assessment of a pharmacokinetic interaction. Because we could exclude a pharmacokinetic interaction between codeine and diclofenac, the synergistic analgesic effects in the above mentioned studies are likely to result solely from the different pharmacodynamic mode of actions.
Most postsurgical patients and many cancer patients have an inflammatory component to their pain, which responds to cyclooxygenase inhibition. A single dose of diclofenac does not alter the glucuronidation of codeine in healthy volunteers, which is in contrast to recent in vitro data. The formation of morphine from codeine was not affected.
The combination of codeine and diclofenac was well tolerated. We are grateful for the excellent technical assistance of Mrs. Anja Riebe, Mrs. Erika Schneider, Mrs. Sonja Seefried and Mrs. Monika Seiler. National Center for Biotechnology Information , U. BMC Clin Pharmacol. Published online Feb Susanne Ammon 1 Dr. Claudia Marx 1 Dr. Christoph Behrens 1 Dr. Ute Hofmann 1 Dr. Ernst-Ulrich Griese 1 Dr.
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