Meds and you

27 September 2013

Diclofenac and misoprostol

The combination of diclofenac and misoprostol is the active ingredient of Arthrotec tablets (Nappid code: 8133044-006, 014 & 869805-002).


The combination of diclofenac and misoprostol is the active ingredient of Arthrotec tablets (Nappid code: 8133044-006, 014 & 869805-002).

General Information
Diclofenac is a non-steroidal anti-inflammatory medication. It is prescribed to relieve inflammation, swelling, stiffness and pain. It is of particular use in arthritic conditions, muscle injury, acute gout attacks and for broad-spectrum pain relief.

Misoprostol is an anti-ulcer drug used for the prevention of NSAID- (a group of anti-inflammatory drugs which includes diclofenac) induced gastric ulcers.

Because of the risk of abortion associated with this product, this combination should be used with great caution in women of child-bearing age.

How does this combination work?
Diclofenac blocks the production of the chemical in body that is responsible for pain, swelling and inflammation. It, unfortunately, also reduces certain chemicals called prostaglandins that play a protective role in the stomach. Misoprostol is a synthetic prostaglandin analog that replaces these protective chemicals.

Fast facts
Drug schedule: schedule 4
Available as: the combination of diclofenac and misoprostol is available as tablets.
What does it do? Diclofenac reduces pain and inflammation while misoprostol reduces the associated risk of stomach ulcers.
Overdose risk: low
Dependence risk: low
Is the combination of diclofenac and misoprostol available as a generic? no
Is the combination of diclofenac and misoprostol available on prescription only? yes

User informationBr> Onset of effect: within 1 hour for pain relief
Duration of action: 12 - 24 hours, depending on dosage form used
Dietary advice: the combination of diclofenac and misoprostol should be taken with food to prevent gastrointestinal irritation.
Stopping this medicine: you should consult your doctor before discontinuing this drug.
Prolonged use: prolonged use is more likely to cause side effects.

Special precautions
Consult your doctor before using this drug if:

  • you have asthma
  • you are pregnant, or plan to become pregnant
  • you have been diagnosed with a cardiovascular disorder
  • you have high blood pressure
  • you have liver or kidney disease
  • you have a stomach ulcer
  • you have a bleeding disorder
  • you are taking blood-thinning medication
  • you have porphyria
  • you are allergic to aspirin or any other medication
  • you are taking other medication

Pregnancy: avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.
Breastfeeding: avoid. This medication is passed through breast milk and may affect your baby adversely. Consult your doctor before use.
Porphyria: avoid, as it is unknown how this medication may affect your condition.
Infants and children: this medication is not intended for use in children under the age of 18 years.
The elderly: caution is advised in the elderly as side effects are more likely.
Driving and hazardous work: caution is advised as use of this medication may lead to dizziness, light-headedness and/or sedation. Avoid such activities until you know how this medication affects you.
Alcohol: avoid concomitant use of alcohol with this medication as it may worsen stomach irritation.

Possible side effects:

Side Effect
Consult your doctor

Only if severe
In all cases
gastrointestinal disorders














swelling (feet/ankles)


rash/ itch


difficulty breathing


blood in vomit

dark, tarry stools


chest pain


vaginal bleeding




Drug interactions:

blood pressure medication reduced pressure-lowering effect
alcohol potential gastrointestinal symptoms
warfarin warfarin dosage may need adjustment
asthma medication reduced effect of asthma medication; risk of asthma attack
oxytocin increased effect of oxytocin; administer 6 - 12 hours apart
antacids containing magnesium increased incidence and severity of diarrhoea
cardiac glycosides, digoxin risk that heart failure may be more severe
corticosteroids potential gastrointestinal symptoms
ciclosporin potential diclofenac toxicity
methotrexate potential methotrexate toxicity
diuretics potential risk of kidney damage
blood-glucose-lowering drugs risk of prolonged low blood sugar
baclofen potential baclofen toxicity
other nsaids potential risk of gastrointestinal bleeding
probenecid risk of diclofenac toxicity
quionolone antibiotics risk of seizures
tacrolimus increased risk of kidney damage
zidovudine increased risk of zidovudine toxicity

Disease interactions

Consult your doctor before using this drug if you have asthma, you are pregnant, or plan to become pregnant, you have been diagnosed with a cardiovascular disorder, you have high blood pressure, a liver or kidney disease, a stomach ulcer, a bleeding disorder, or if you have porphyria.

Overdose action

A small overdose is no cause for concern. In case of intentional large overdose, seek emergency medical attention.

Recommended dosage

See each individual agent.

(This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.)


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