Diclofenac, Injection

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KEY POINTS

• This medicine is given by injection to relieve pain.
• NSAIDs may increase the chance of a heart attack or stroke that can lead to death. This medicine may cause ulcers and bleeding in the stomach and intestines at any time during treatment.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: nonsteroidal anti-inflammatory drug (NSAID)

Generic and brand names: diclofenac, injection; Dyloject

What is this medicine used for?

This medicine is a nonsteroidal anti-inflammatory drug (NSAID). It is given by injection to relieve pain. It may be used alone along with other pain medicines.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before you take this medicine, be sure to tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• A heart attack or recent heart surgery
• A stroke or transient ischemic attack (TIA)
• Asthma
• Bleeding problems or blood disorders such as anemia
• Heart failure or problems with swelling in ankles, feet, or hands
• High blood pressure
• Kidney or liver disease
• Stomach or intestinal problems such as ulcerative colitis, Crohn’s disease, heartburn, ulcers, or bleeding

Tell your provider if you take steroids such as prednisone or medicine that reduces the chance of blood clots forming such as warfarin (Coumadin). Also, tell your healthcare provider if you regularly drink alcohol.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. This medicine is not usually given to pregnant women because it can harm the baby, especially in late pregnancy. If you become pregnant, contact your healthcare provider right away. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

Injections of this medicine are given by a healthcare provider.

What should I watch out for?

Warning: This medicine may cause ulcers and bleeding in the stomach and intestines at any time during treatment. This may happen without warning symptoms. You may be at higher risk if you smoke, are over the age of 65 or in poor health, drink alcohol, or take this medicine for a long time. If you have stomach pain, or bloody or black tarry bowel movements, stop taking this medicine and contact your healthcare provider right away.

This medicine has been linked with increased risk for high blood pressure. NSAIDs may increase the chance of a heart attack or stroke that can lead to death. This chance increases if you:

• Use NSAIDs for a long time
• Have heart disease

Talk with your healthcare provider about this.

You may have swelling of the ankles, feet, or hands while taking this medicine. If this becomes bothersome, contact your healthcare provider.

This medicine should not be used right before or after a heart surgery called coronary artery bypass graft (CABG). Talk with your healthcare provider about this.

This medicine may cause an allergic reaction in people who have asthma or who have had allergic reactions to aspirin or other pain medicines. If you develop hives, itching, a rash, tightness in your chest, or trouble breathing, stop taking this medicine and contact your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.

Do not take other pain medicines or drink alcohol while you are taking this medicine unless your healthcare provider approves. They may increase the risk of stomach upset.

Check the labels of all nonprescription and prescription medicines you take. Taking other medicines that contain NSAIDs while you take this medicine may lead to an overdose. Ask your healthcare provider or pharmacist if you have any questions.

This medicine may cause blurred vision, dizziness, or drowsiness. Do not drive or operate machinery unless you are fully alert. Contact your healthcare provider if these problems continue or get worse.

This medicine may make your skin more sensitive to the sun, which may lead to painful sunburns. Wear protective clothing, a hat, and sunscreen lotion when you need to be outdoors.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching, rash; trouble breathing; chest pain or tightness in your chest; swelling of your lips, tongue, and throat); slurring of speech; sudden weakness in one part or side of your body; sudden, severe, or continued headache, or one that is different from a usual headache.

Serious (Report these to your healthcare provider right away.): Confusion; feeling faint; mouth or lip sores; hearing problems or ringing in your ears; vision changes; dark urine; yellowing of your skin or eyes; loss of appetite; bloody or black tarry bowel movements; severe vomiting, stomach pain, or diarrhea; swelling in ankles, feet, or hands or any unexplained swelling; decreased urination or trouble urinating; severe or unusual tiredness or weakness; unusual bruising or bleeding; shortness of breath; skin rash or blisters with fever; severe itching.

Other: Mild fever, chills, muscle pain, diarrhea, nausea, tiredness, gas, headache, dizziness, constipation, injection site pain or swelling.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik)
• Aliskiren (Tekturna) and aliskiren/hydrochlorothiazide (Tekturna HCT)
• Alzheimer’s disease medicines such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon)
• Angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• Antibiotics such as ciprofloxacin (Cipro), gentamicin, levofloxacin (Levaquin), ofloxacin, rifampin (Rifadin), rifapentine (Priftin), and tobramycin
• Antidepressants such as amitriptyline, duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor), sertraline (Zoloft), venlafaxine (Effexor), and vilazodone (Viibryd)
• Antifungal medicines such as fluconazole (Diflucan), ketoconazole (Nizoral), and voriconazole (Vfend)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), fosphenytoin (Cerebyx), phenobarbital, phenytoin (Dilantin, Phenytek), and primidone (Mysoline)
• Aprepitant (Emend)
• Aspirin and other salicylates
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), pindolol, and sotalol (Betapace, Sorine)
• Calcium channel blockers such as amlodipine (Norvasc), amlodipine/atorvastatin (Caduet), diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), nimodipine (Nymalize), nisoldipine (Sular), and verapamil (Calan, Covera, Verelan)
• Cancer medicines such as abiraterone (Zytiga), capecitabine (Xeloda), floxuridine, fluorouracil (Adrucil, Carac, Efudex, Fluoroplex), pemetrexed (Alimta), and pralatrexate (Folotyn)
• Cidofovir (Vistide)
• Corticosteroids such as cortisone, dexamethasone, fludrocortisone, hydrocortisone (A-Hydrocort, Cortef), methylprednisolone (Medrol, Solu-Medrol), prednisolone (Omnipred, Orapred, Prelone), prednisone (Prednisone Intensol), and triamcinolone (Aristospan, Kenalog)
• Delavirdine (Rescriptor)
• Diabetes medicines such as chlorpropamide, glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Glynase), and tolbutamide
• Digoxin (Lanoxin)
• Diuretics (water pills) such as amiloride, bumetanide, chlorothiazide (Diuril), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (Microzide), spironolactone (Aldactone), and triamterene (Dyrenium)
• Doxepin (Silenor)
• Gemfibrozil (Lopid)
• Immunosuppressants such as cyclosporine (Gengraf, Neoral, Sandimmune) and tacrolimus (Astagraf, Prograf, Protopic)
• Lithium (Lithobid)
• Medicines that contain nonsteroidal anti-inflammatory medicines (NSAIDs) such as allergy, cold, or cough medicines or other pain or fever medicines
• Medicines to treat bone loss such as alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel, Atelvia), and zoledronic acid (Reclast, Zometa)
• Medicines to treat or prevent blood clots such as abciximab (ReoPro), apixaban (Eliquis), argatroban, bivalirudin (Angiomax), clopidogrel (Plavix), dabigatran (Pradaxa), dipyridamole (Persantine), lepirudin (Refludan), prasugrel (Effient), rivaroxaban (Xarelto), tirofiban (Aggrastat), and warfarin (Coumadin)
• Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
• Natural remedies such as alfalfa, anise, bilberry, cat’s claw, celery, chamomile, chaparral, comfrey, dong quai, evening primrose, fenugreek, feverfew, fish oil, flaxseed, garlic, ginkgo, ginseng, glucosamine, grape seed, green tea, horse chestnut, kava, ma huang, pennyroyal, red clover, SAMe, turmeric, valerian, and willow
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as celecoxib (Celebrex), diclofenac (Cambia, Voltaren, Zipsor), diflunisal, etodolac, flurbiprofen, ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, meclofenamate, nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Pentosan (Elmiron)
• Probenecid
• Propranolol (Hemangeol, Inderal, InnoPran)
• Sulfamethoxazole/trimethoprim (Bactrim, Septra)
• Tenofovir (Viread)

Do not drink alcohol while taking this medicine. Also, do not take other pain medicines while you are taking this medicine without your healthcare provider's approval.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.