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Diclofenac

Also indexed as: Cataflam, Voltaren, Voltaren XR

Combination drug: Arthrotec

Illustration

Diclofenac is used in the treatment of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. It is in a class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs).

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

Beneficial May Be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.

Calcium

Lithium

L-tryptophan*

Beneficial May Be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.

Stinging nettle

Avoid Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.

Trikatu

Willow*

Side effect reduction/prevention

None known

Adverse interaction

None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Calcium
Diclofenac decreases the amount of calcium lost in the urine,1 which may help prevent bone loss in postmenopausal women.2

L-tryptophan
Diclofenac causes complex changes to L-tryptophan levels in the blood,3 but the clinical implications of this are unknown. More research is needed to determine whether supplementation with L-tryptophan is a good idea for people taking diclofenac.

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression. Diclofenac may inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral.4 Since minor changes in lithium blood levels can produce unwanted side effects, diclofenac should be used with caution in people taking lithium supplements.

Interactions with Herbs

Stinging nettle (Urtica dioica)
In a controlled human study, people who took stinging nettle with diclofenac obtained similar pain relief compared to people taking twice as much diclofenac with no stinging nettle.5 More research is needed to determine whether people taking diclofenac might benefit from also taking stinging nettle.

Trikatu
Trikatu, an Ayurvedic herbal preparation that contains Piper nigrum (black pepper), Piper longum (Indian Long pepper), and Zingiber officinale (ginger), decreased both blood levels and the medicinal effect of diclofenac in a study in rabbits.6

Willow  (Salix alba)
Willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of aspirin to individuals taking diclofenac results in a significant reduction in blood levels of diclofenac.7 Though there are no studies investigating interactions between willow bark and diclofenac, people taking the drug should avoid the herb until more information is available.

Interactions with Foods and Other Compounds

Food
Taking diclofenac with food may lower the maximum concentration of the drug in the blood and may delay, but not decrease, absorption.8 NSAIDs such as diclofenac should be taken with a meal to reduce stomach irritation.

Smoking
Injury to the stomach caused by NSAIDs such as diclofenac can resolve naturally despite continued administration of the drug. However, the stomach lining of smokers is less likely to adapt to injury, leading to continued damage from the drug.9

Alcohol
Chronic consumption of alcohol can aggravate injury to the stomach and duodenal lining caused by diclofenac.10 To prevent added injury, consumption of alcoholic beverages should be avoided in individuals taking diclofenac.

References:

1. Sharma S, Vaidyanathan S, Thind SK, et al. The effect of diclofenac sodium on urinary concentration of calcium, uric acid and glycosaminoglycans in traumatic paraplegics. Br J Urol 1991;68:240–2.

2. Bell NH, Hollis BW, Shary JR, et al. Diclofenac sodium inhibits bone resorption in postmenopausal women. Am J Med 1994;96:349–53.

3. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.

4. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.

5. Chrubasik S, Enderlein W, Bauer R, Grabner W. Evidence for antirheumatic effectiveness of Herba Urticae dioicae in acute arthritis: a pilot study. Phytomedicine 1997;4:105–8.

6. Lala LG, D'Mello PM, Naik SR. Pharmacokinetic and pharmacodynamic studies on interaction of Trikatu with diclofenac sodium. J Ethnopharmacol 2004;91:277–80.

7. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.

8. Davies NM, Anderson KE. Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin Pharmacokinet 1997;33:184–213.

9. Lipscomb GR, Campbell F, Rees WD. The influence of age, gender, Heliobacter pylori and smoking on gastric mucosal adaptation to non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 1997;11:907–12.

10. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2889–91.

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