How does this medication work? What will it do for me?
Diclofenac powder belongs to the group of medications known as nonsteroidal anti-inflammatories (NSAIDs). It is used to treat a migraine attack and works by reducing pain and swelling. This medication should not be used continuously to prevent or reduce the number of migraines you experience or to relieve pain other than that associated with migraine.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each individual dose sachet contains 50 mg of diclofenac potassium when mixed in water. Diclofenac potassium (powder for oral solution) is a white-to-off-white, buffered, flavoured powder for oral solution packaged in individual dose sachets. Non-medicinal ingredients: aspartame (equivalent to 25 mg phenylalanine), flavouring agents (anise and mint), glycerol behenate, mannitol, potassium bicarbonate, and saccharin sodium.
How should I use this medication?
The usual adult dosage is one individual dose sachet at any time during a migraine attack.
Directions for use: Open one sachet only when ready to use and empty the contents into 30 mL to 60 mL of water only. Do not use any other liquids. Mix it to ensure that the powder is completely dissolved and drink the water-powder mixture immediately after mixing.
Taking diclofenac with a meal may delay pain relief, but food may reduce possible stomach and intestinal side-effects.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor.
Store this medication at room temperature and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take diclofenac powder if you:
- are allergic to diclofenac or to any ingredients of the medication
- are breast-feeding
- are in the third trimester of pregnancy
- are planning to have, or have recently had, heart bypass surgery
- are under 18 years of age
- currently have or recently had an inflammatory disease of the stomach or intestines, such as stomach or intestinal ulcer or ulcerative colitis
- have bleeding in the brain or a bleeding disorder
- have had an allergic reaction (including asthma symptoms) to ASA or other anti-inflammatory medications (e.g., naproxen, ketorolac)
- have high levels of potassium in the blood
- have severe uncontrolled heart failure
- have severely impaired or deteriorating kidney function
- have significant liver impairment or liver disease
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- sun sensitivity
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- change in the amount or colour (red or brown) of your urine
- dizziness or lightheadedness
- hearing problems
- loss of appetite
- painful or difficult urination
- swelling of the feet and lower legs
- symptoms of anemia (e.g., fatigue, shortness of breath)
- unexpected stiff neck
- vomiting that worsens or persistent indigestion, nausea that worsens, stomach pain, or diarrhea
- weight gain
Stop taking the medication and seek immediate medical attention if any of the following occur:
- symptoms of a heart attack (e.g., chest pain, shortness of breath, sweating, anxiety)
- symptoms of an allergic reaction (e.g., skin rash, hives, itching or swelling of the face, lips, tongue or throat, difficulty swallowing or breathing; or flu-like symptoms, especially if they occur before or with a skin rash)
- symptoms of asthma (e.g., shortness of breath, wheezing, any trouble breathing or chest tightness)
- symptoms of heart failure (e.g., shortness of breath, leg/ankle swelling)
- symptoms of liver problems (e.g., yellow colour to skin and eyes, with or without itchy skin)
- symptoms of stroke (e.g., sudden headache, dizziness, weakness or numbness, difficulty speaking, vision changes)
- symptoms of ulcer or bleeding of the stomach (e.g., vomiting blood, black stools, or abdominal pain)
- vision changes
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
HEALTH CANADA ADVISORY
June 8, 2021
Health Canada has issued new information concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs). To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
A previous advisory on non-steroidal anti-inflammatory drugs (NSAIDs) was issued on October 30, 2020.
Allergy: Some people who are allergic to other anti-inflammatory medications also experience allergic reactions to diclofenac. Before you take diclofenac, inform your doctor about any previous adverse reactions you have had to medications, especially ketorolac or ibuprofen. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing, or swelling of the face and throat.
Asthma attacks: If you have asthma, seasonal allergic rhinitis, nasal polyps, chronic obstructive lung disease (e.g., chronic bronchitis or emphysema), or chronic infections of the lungs, you may experience asthma attacks while taking diclofenac powder.
Bladder symptoms: This medication can cause bladder symptoms such as frequent or painful urination and blood in urine. If you develop these symptoms, stop taking this medication and contact your doctor immediately.
Drowsiness/dizziness: Some people have reported dizziness, lightheadedness, and confusion while taking this medication. Avoid operating motor vehicles and doing other potentially hazardous activities until you have determined how this medication affects you.
Fertility: As with other NSAIDs, it may be more difficult for a couple to conceive if the woman is taking diclofenac. Stopping the medication allows the body's chemistry to return to normal which often resolves this issue.
Fluid and electrolyte balance: Diclofenac can cause fluid retention and edema (swelling). If you have congestive heart failure, high blood pressure, or any other condition that might lead to fluid retention, you should discuss with you doctor how this medication may affect you medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Diclofenac can cause high blood potassium levels. If you are a senior, have diabetes or kidney failure, or are taking certain medications that can increase potassium levels (e.g., enalapril, ramipril, valsartan, amiloride and other similar medications), you should discuss with your doctor whether any special monitoring is needed.
Heart problems: Diclofenac and other similar medications may increase the risk of heart attacks, strokes, and blood clots. The risk is greater with higher doses and long-term use. If you are at risk of heart problems (e.g., have high blood pressure, high cholesterol, diabetes, peripheral arterial disease, heart failure, or coronary artery disease, or you smoke), you should discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Infection: This medication may mask the signs of an infection, such as a fever.
Kidney function: This medication is not recommended for people with kidney problems. Long-term use of diclofenac may lead to a higher risk of reduced kidney function. This is most common for people who already have kidney disease, liver disease, or heart failure; for people who take diuretics (water pills); and for seniors.
Liver function: This medication may cause liver problems and is not recommended for people with liver problems. If you develop signs of a liver problem (such as yellow skin or eyes, dark urine, pale stools, abdominal pain, or itchy skin), stop taking the medication and see your doctor as soon as possible.
Stomach problems: Stomach ulcers, perforation, and bleeding from the stomach have been known to occur during therapy with diclofenac. These complications can occur at any time, and are sometimes severe enough to require immediate medical attention. The risk of ulcers and bleeding are increased for people taking higher doses of diclofenac for longer periods of time.
If you are prone to irritation of the stomach and intestines, particularly if you have had a stomach ulcer, bloody stools, or diverticulosis or other inflammatory disease of the stomach or intestines (such as ulcerative colitis or Crohn's disease), discuss with your doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Stop taking the medication and contact your doctor immediately if you experience symptoms or signs suggestive of stomach ulcers or bleeding in the stomach (black, tarry stools). These reactions can occur at any time during treatment without warning.
Sun sensitivity: This medication may make your skin more sensitive to the sun. While you are using this medication, avoid excessive sun exposure, including tanning beds and sun lamps. If you experience sunburn with itching, swelling, and blistering, stop using this medication and contact your doctor.
Pregnancy: This medication should not be used during pregnancy, especially during the third trimester. Women who are trying to become pregnant should not take this medication. Tell your doctor if you become pregnant while taking this medication.
Breast-feeding: This medication passes into breast milk. This medication should not be used by breast-feeding mothers.
Children: This medication is not recommended for children under 18 years of age.
Seniors: The safety and effectiveness of seniors taking this medication haven not been established. Seniors appear to have a higher risk of side effects with this medication. The lowest effective dosage for the shortest possible duration should be used.
What other drugs could interact with this medication?
There may be an interaction between diclofenac powder and any of the following:
- angiotensin II receptor blockers (ARBs; e.g., candesartan, irbesartan)
- angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril, enalapril)
- antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
- anticoagulants (e.g., heparin, warfarin)
- "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
- barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
- beta-blockers (e.g., metoprolol, atenolol)
- bisphosphonates (e.g., alendronate, etidronate, pamidronate, risedronate, zoledronic acid)
- corticosteroids (e.g., prednisone)
- diuretics (water pills; e.g., furosemide, hydrochlorothiazide, spironolactone)
- glucocorticoids (e.g., dexamethasone, prednisone)
- herbal medications that affect blood clotting (e.g., ginkgo biloba, garlic, ginger, ginseng, glucosamine)
- medications for diabetes (e.g., glyburide, gliclazide)
- medications that affect blood clotting (e.g., acetylsalicylic acid (ASA, aspirin), clopidogrel, enoxaparin, dalteparin, heparin, lepirudin, tinzaparin, or warfarin)
- medications used to treat stomach or intestinal ulcers, reflux, or excessive acidity (e.g., ranitidine, omeprazole, esomeprazole, pantoprazole)
- other NSAIDs (e.g., ASA, naproxen, indomethacin)
- other products containing diclofenac
- potassium supplements
- quinolone antibiotics (e.g., ofloxacin, ciprofloxacin)
- SNRIs (e.g., venlafaxine)
- SSRIs (e.g., paroxetine, fluoxetine, citalopram, sertraline)
- tricyclic antidepressants (e.g., amitriptyline, doxepin, imipramine)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
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