- Commonly used painkiller ‘should be banned over heart risk’
- Diclofenac vs. ibuprofen: Differences, similarities, and which is better for you
- What are the main differences between diclofenac vs. ibuprofen?
- Conditions treated by diclofenac and ibuprofen
- Is diclofenac or ibuprofen more effective?
- Coverage and cost comparison of diclofenac vs. ibuprofen
- Side effects of diclofenac and ibuprofen
- Drug interactions of diclofenac vs. ibuprofen
- Warnings of diclofenac and ibuprofen
- Frequently asked questions about diclofenac vs. ibuprofen
- What is ibuprofen?
- Are diclofenac and ibuprofen the same?
- Is diclofenac vs. ibuprofen better?
- Can I use diclofenac vs. ibuprofen while pregnant?
- Can I use diclofenac vs. ibuprofen with alcohol?
- Is diclofenac better than ibuprofen for back pain?
- Is diclofenac safer than ibuprofen?
- Can I take diclofenac and ibuprofen?
- What’s the dose of diclofenac and how often can I take it?
- How do you take diclofenac?
- What if I forget a dose of diclofenac?
- More information about diclofenac
- Diclofenac Topical (osteoarthritis pain)
- What is diclofenac?
- How to take diclofenac
- Take care with diclofenac
- Precautions – before taking diclofenac
- Possible side effects
- Learn more
Commonly used painkiller ‘should be banned over heart risk’
Another study, also published in 2011, indicated diclofenac raised the risk of dying from heart attack or stroke four-fold.
Writing in the journal PLoS Medicine Dr Patricia McGettigan, who led the 2011 study, said drugs regulators needed to take action now.
She said: “The regulators need to look at medicine like this on the basis that the evidence that it causes harm has been known for years but its sale and prescription patterns in England are only slowly drifting down.
“If it is not going to change appropriately then the regulators need to act, particularly when there is a safer alternative available.”
About five million prescriptions are made for diclofenac every year, according to official data. Although many take it regularly, lots of people take it as a ‘one off’, meaning it is likely that well over a million take it every year. The risks are highest in those who take it regularly.
Dr McGettigan, who has trained as both a pharmacist and doctor, noted the increased risk from diclofenac was not much less that from another drug, which was withdrawn in 2004. Vioxx, an arthritis drug, was found to raise the chance of heart attack and stroke by 45 per cent.
Diclofenac still appears on the World Health Organisation’s list of “essential medicines” in 74 countries, according to Dr McGettigan and her colleague David Henry, chief executive of the Institute for Clinical Evaluative Sciences at the University of Toronto, who contributed to the study.
Professor Henry said: “Given the availability of safer alternatives, diclofenac should be de-listed from national essential medicines lists.”
Dr McGettigan added: “Diclofenac has no advantage in terms of gastrointestinal safety and it has a clear cardiovascular disadvantage,” she said.
“Because it’s been around for so long people have become familiar with it and almost don’t believe it could have a side effect like this.
“There are strong arguments to revoke its marketing authorisations globally.”
A spokesman for the UK drugs regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA), said diclofenac was “an extremely important NSAID”.
He said: “For most patients the risks of side-effects are outweighed by the benefits these drugs bring in managing pain.”
He continued: “The MHRA has carefully reviewed the safety profile of diclofenac as new data becomes available. This has resulted in updates to information for healthcare professionals and patients, and numerous communications to ensure that any risk to patients is minimised.
“Our advice remains that these medicines should be used for the shortest time necessary and at the lowest dose possible to control symptoms.”
A European review, instigated by the MHRA, was currently taking place, he added.
Maureen Talbot, senior cardiac nurse at the British Heart Foundation, urged caution when prescribing NSAIDs but did not say diclofenac should be banned.
She said: “The risks associated with non-steroidal anti-inflammatory painkillers, which include diclofenac, have been known for some years and they should always be prescribed with caution.
“Anyone taking these painkillers should be made aware of both their risks, especially of cardiovascular disease and internal bleeding, and benefits in treating debilitating pain such as that caused by arthritis.
“If you are taking these powerful drugs and are worried, discuss your concerns with your GP or pharmacist who will be able to help you decide whether the benefits outweigh the risks.”
Diclofenac vs. ibuprofen: Differences, similarities, and which is better for you
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
With so many treatment options for arthritis, it can be overwhelming to choose the best medication for you. If you experience pain from arthritis on a regular basis, you may be recommended a nonsteroidal anti-inflammatory drug (NSAID) like diclofenac or ibuprofen. These drugs work by decreasing the production of prostaglandins, or chemicals responsible for inflammation.
Diclofenac and ibuprofen are commonly used NSAIDs that can treat inflammation and pain from osteoarthritis and rheumatoid arthritis. Both drugs are nonselective NSAIDs which means they block the COX-2 and COX-1 enzymes responsible for prostaglandin production. Because the COX-1 enzyme also has protective effects on the lining of the stomach, blocking this enzyme can cause gastrointestinal side effects.
What are the main differences between diclofenac vs. ibuprofen?
Diclofenac is a prescription drug that also goes by the brand name, Voltaren. It is available as a generic medication used to treat osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, or arthritis that affects the spine. Diclofenac sodium comes as a delayed-release tablet, extended-release tablet, and topical gel or solution. It is FDA approved for adults 18 years and older.
Ibuprofen is a commonly taken NSAID that can be purchased over-the-counter (OTC) or with a prescription. Ibuprofen can be found by its brand name, Advil or Motrin. OTC ibuprofen can be used for mild pain and fever while the prescription-strength ibuprofen can be used for more severe pain from arthritis. It is FDA approved to treat pain in adults and children 6 months and older.
|Drug class||Nonsteroidal anti-inflammatory drugs (NSAID)||Nonsteroidal anti-inflammatory drugs (NSAID)|
|Brand/generic status||Brand and generic available||Brand and generic available|
|What is the generic name?
What is the brand name?
|What form(s) does the drug come in?||Oral tablet, enteric-coated Oral tablet, extended-release
|What is the standard dosage?||50 mg two to three times per day||400 to 800 mg every six to eight hours|
|How long is the typical treatment?||Daily as instructed by your doctor||Not longer than 10 days or as instructed by your doctor|
|Who typically uses the medication?||Adults||Adults|
Conditions treated by diclofenac and ibuprofen
Diclofenac is used to treat osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. It can also help treat dysmenorrhea or pain from menstrual cramps and migraines. Ibuprofen can also treat osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. As an NSAID painkiller, ibuprofen can also treat dysmenorrhea and migraines as well as mild pain and fever in non-prescription doses.
Is diclofenac or ibuprofen more effective?
Diclofenac needs a prescription by your healthcare provider and is considered a more potent NSAID than ibuprofen. For arthritis, diclofenac is usually dosed as 25 to 50 mg up to a daily dose of 150 mg. Ibuprofen is prescribed at higher doses of 800 mg up to a daily dose of 3200 mg.
In a meta-analysis from the Journal of Arthritis Research and Therapy, diclofenac was found to be more effective than ibuprofen for arthritic pain relief. The study reviewed data from 176 studies with over 146,524 patients. The risk of stomach-related effects were also found to be lower with diclofenac compared to ibuprofen. Diclofenac was found to be more effective when compared to other NSAIDs like celecoxib and naproxen.
Both diclofenac and ibuprofen are comparable in appropriate doses. Discuss your treatment options with your doctor as one might work better for you.
Coverage and cost comparison of diclofenac vs. ibuprofen
Most medicare and health insurance plans cover the generic version of diclofenac. The average retail cost of diclofenac can be around $60. This cost can be lowered to $20-30 with a SingleCare coupon card.
For generic ibuprofen, the cost is often covered by most medicare and insurance plans. Without insurance, the average retail cost can range from $3 to almost $7 per bottle. However, with an ibuprofen coupon, the price can be as low as $3.
|Typically covered by insurance?||Yes||Yes|
|Typically covered by Medicare?||Yes||Yes|
|Standard dosage||50 mg||400-800 mg|
|Typical Medicare copay||$3-$46||$0-$22|
Side effects of diclofenac and ibuprofen
Common side effects of diclofenac and ibuprofen include gastrointestinal side effects such as diarrhea, indigestion, flatulence or gas, stomach pain or cramps, heartburn, and constipation. These medications can also affect the central nervous system (CNS) and cause side effects such as dizziness and headache. Other side effects include pruritus (itching) and edema (swelling in the hands, arms, legs, or feet).
More serious adverse effects include stomach ulcers and renal or liver problems. These side effects are more likely to occur if you have a history of them or are taking other medications that can interact with NSAIDs.
This may not be a complete list. Consult your doctor or pharmacist for other side effects.
Source: DailyMed (Diclofenac), DailyMed (Ibuprofen)
Drug interactions of diclofenac vs. ibuprofen
Diclofenac and ibuprofen are NSAIDs that can interact with blood pressure medications like angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, and diuretics. NSAIDs may reduce the blood pressure lowering effects of these antihypertensive medications.
Taking NSAIDs with blood thinners like aspirin or warfarin can increase the risk of bleeding. These medications can interact and increase the risk of stomach ulcers. Taking NSAIDs with SSRI antidepressants can also increase the risk of bleeding.
NSAIDs can also interact with other medications and increase their levels in the body. Taking NSAIDs with drugs like lithium, digoxin, and methotrexate can increase the risk of adverse side effects.
Consult a doctor or pharmacist if you are taking any medications before starting an NSAID.
|Selective serotonin reuptake inhibitor (SSRI) antidepressant||Yes||Yes|
|Serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant||Yes||Yes|
|Angiotensin-converting enzyme (ACE) inhibitors||Yes||Yes|
|Angiotensin receptor blockers (ARBs)||Yes||Yes|
This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.
Warnings of diclofenac and ibuprofen
Using NSAIDs can lead to an increased risk of cardiovascular events such as heart attack and stroke, especially if you have a medical history of them. NSAIDs may worsen heart failure or alter the effects of blood pressure medications. NSAIDs can also increase the risk of gastrointestinal events such as bleeding or ulcers in the stomach and intestines.
Diclofenac and ibuprofen should be avoided or monitored in people with liver or kidney problems. Taking NSAIDs can increase the risk of toxicity in the liver and kidneys.
NSAIDs should not be used during late pregnancy. Taking NSAIDs after 30 weeks of gestation can cause premature closure of the ductus arteriosus, a blood vessel in the fetal heart. Talk to your doctor about using NSAIDs during early stages of pregnancy as they should only be taken if the potential benefits outweigh the risks.
Frequently asked questions about diclofenac vs. ibuprofen
Diclofenac is an NSAID used to treat arthritis in adults. It is FDA approved for osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. Diclofenac often comes as a prescription oral tablet or topical gel and is used two or three times a day.
What is ibuprofen?
Ibuprofen is an NSAID used to treat pain and inflammation from arthritis. It is available over the counter to treat pain and fever in adults and children. Prescription-strength ibuprofen is also available and is usually taken every 6 to 8 hours.
Are diclofenac and ibuprofen the same?
No, diclofenac and ibuprofen are not the same. Diclofenac is a prescription NSAID while ibuprofen can be purchased over-the-counter or with a prescription. Diclofenac is only prescribed for adults while ibuprofen can be used in children.
Is diclofenac vs. ibuprofen better?
Diclofenac is considered more potent than ibuprofen and needs to be taken two or three times per day. Ibuprofen often needs to be taken in higher doses to treat pain from arthritis.
Can I use diclofenac vs. ibuprofen while pregnant?
NSAIDs like diclofenac and ibuprofen should be avoided during pregnancy. Taking NSAIDs during the latter part of pregnancy may cause fetal heart problems. Consult a doctor if you are pregnant.
Can I use diclofenac vs. ibuprofen with alcohol?
Diclofenac and ibuprofen should be avoided with alcohol. Drinking alcohol with NSAIDs can lead to an increased risk of bleeding and other side effects such as dizziness and headache.
Is diclofenac better than ibuprofen for back pain?
Diclofenac is FDA-approved for arthritis that affects the spine. It may be more effective in lower doses compared to ibuprofen. Diclofenac and ibuprofen, like most NSAIDs, can help with pain management and inflammation.
Is diclofenac safer than ibuprofen?
Diclofenac needs a doctor’s assessment and prescription to use. Ibuprofen is over the counter and is therefore deemed safer for general ailments like pain or fever.
Can I take diclofenac and ibuprofen?
No. Diclofenac and ibuprofen should not be taken together since they work in a similar way. Taking them together can increase the risk of adverse events and side effects.
What’s the dose of diclofenac and how often can I take it?
The diclofenac dose that your doctor prescribes, how often to take it and how long for depends on what’s causing your pain and the form of diclofenac you’re using.
You might be prescribed diclofenac to take only when needed, for example to relieve a migraine. Or, if you have more long-term or ongoing pain, for example because you are recovering from an injury or you have arthritis, your doctor may ask you to take diclofenac every day on a regular basis. This gives a better anti-inflammatory effect and avoids the painkilling effect wearing off, which will provide better pain relief.
If you need to take diclofenac for long periods of time your doctor may also prescribe you a medicine to help protect your stomach.
It’s important to follow the instructions given by your doctor and printed in the leaflet that comes with the medicine.
Never take more than the recommended dose of diclofenac. Always use the lowest possible dose for the shortest possible time to relieve your symptoms.
How do you take diclofenac?
Diclofenac comes in various forms. How to take it depends on the form you’ve been prescribed.
Diclofenac sodium 25mg and 50mg gastro-resistant tablets (eg Dicloflex, Fenactol)
- These tablets have a special coating that allows the tablet to pass through the stomach before it dissolves, reducing the risk of stomach irritation and indigestion.
- These tablets are usually taken two or three times a day. Follow your doctor’s instructions.
- Swallow these tablets whole with a drink. Don’t break, crush or chew them.
- You can take them either with or without food.
- Don’t take antacids (indigestion remedies) in the two hours before or after taking these tablets. Antacids stop the special stomach-protecting coating of the tablet from working.
Diclofenac sodium 75mg and 100mg modified-release tablets and capsules
- Modified-release tablets and capsules are designed to release the diclofenac slowly and continuously over a few hours as the medicine passes through the gut. This provides more prolonged relief from inflammation and pain.
- Brands include Dicloflex Retard, Dicloflex SR, Econac SR, Econac XL, Enstar XL, Fenactol Retard, Fenactol SR, Diclomax Retard, Diclomax SR and Motifene.
- These forms of diclofenac are usually taken once or twice a day, depending on the particular brand you’ve been prescribed. Be sure to follow the instructions given by your doctor.
- Diclofenac modified-release tablets and capsules must be swallowed whole with a drink. Do not break, crush or chew them.
- Take each dose with or after food or a drink of milk.
Diclofenac potassium 25mg and 50mg tablets (eg Voltarol rapid)
- Diclofenac potassium is absorbed into the body faster than diclofenac sodium, so tablets containing the potassium salt start to work more quickly.
- These tablets are usually taken two or three times a day, as directed by your doctor.
- Take the tablets with or after food or a drink of milk to avoid irritating the stomach.
Diclofenac 12.5mg, 25mg, 50mg and 100mg suppositories (eg Voltarol, Econac)
- Suppositories can be especially useful if you can’t take diclofenac by mouth, for example because you feel or are being sick, or have just had an operation.
- The suppositories melt in the rectum and the diclofenac is absorbed into the bloodstream through the rich supply of blood vessels found in this area.
- Suppositories can be used once, twice or three times a day. Follow your doctor’s instructions.
What if I forget a dose of diclofenac?
Try to space your doses evenly over the day. If you forget to take a diclofenac dose at your usual time take it as soon as you remember, unless it’s nearly time for your next dose. In this case just leave out the forgotten dose and take the next dose as usual. Do not take a double dose to make up for a missed dose.
More information about diclofenac
- What is diclofenac used for and what should I know before taking it?
- Who shouldn’t take diclofenac?
- What are the side effects of diclofenac?
- Can I take other medicines with diclofenac?
Last updated: 04.03.2019
Helen Marshall, BPharm, MRPharmS Helen Marshall, BPharm, MRPharmS A UK registered pharmacist with a background in hospital pharmacy.
Diclofenac Topical (osteoarthritis pain)
Topical diclofenac for osteoarthritis comes as gel (Voltaren) to apply to the affected skin area four times a day to treat arthritis pain. Topical diclofenac for osteoarthritis also comes as a 1.5% liquid (Pennsaid) to apply to the knee four times a day. Topical diclofenac for osteoarthritis also comes as a 2% liquid (Pennsaid) to apply to the knee twice a day. Apply diclofenac gel (Voltaren) or liquid (Pennsaid) at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use topical diclofenac (Pennsaid, Voltaren) exactly as directed. Do not use more or less of it or use it more often or for a longer period of time than prescribed by your doctor. Do not apply the gel or liquid to any area of your body that your doctor did not tell you to treat.
Apply diclofenac gel (Voltaren) or liquid (Pennsaid) to clean, dry skin. Do not apply the medication to skin that is broken, peeling, infected, swollen, or covered with a rash.
Diclofenac gel (Voltaren) and liquid (Pennsaid) are only for use on the skin. Be careful not to get the medication in your eyes, nose, or mouth. If you do get the medication in your eyes, rinse your eyes with plenty of water or saline. If your eye(s) are still irritated after one hour, call your doctor.
After you apply diclofenac gel (Voltaren) or liquid (Pennsaid), you should not cover the treated area with any type of dressing or bandage and you should not apply heat to the area. You should not shower or bathe for at least 30 minutes after you apply the liquid (Pennsaid) and for at least 1 hour after you apply the gel (Voltaren). Do not cover the treated area with clothes or gloves for 10 minutes after you apply the gel (Voltaren), or until the liquid (Pennsaid) has dried if you are using the liquid.
To use topical diclofenac gel (Voltaren), follow these steps:
- Before you use a new tube of diclofenac gel (Voltaren) for the first time, open the foil seal that covers the tube and then puncture the opening of the tube using the spiked top of the cap.
- Place one of the dosing cards from the package on a flat surface so that you can read the print. If the print is backward, flip the dosing card over.
- Using the lines on the dosing card as a guide, squeeze the correct amount of gel onto the dosing card evenly. Make sure the gel covers the entire area marked for your correct dose. Put the cap back on the tube.
- Clean and dry the skin area where you will apply the medication.
- Apply the gel to the directed skin areas, using the dosing card to help apply the gel to the skin. Use your hands to gently rub the gel into the skin. Make sure to cover the entire affected area with the gel.
- Hold the end of the dosing card with your fingertips, and rinse and dry the card. Store the dosing card until next use, out of reach of children. Do not share the dosing card with another person.
- Wash your hands well after you apply the gel, unless you are treating your hands. If you are treating your hands, do not wash them for at least one hour after you apply the gel.
To use topical diclofenac 1.5 % liquid (Pennsaid), follow these steps:
- Clean and dry the skin area where you will apply the medication.
- Apply the liquid to your knee 10 drops at a time. You can do this by dropping the liquid directly onto the knee or by first dropping it onto the palm of your hand and then spreading it onto the knee.
- Use your hand to evenly spread the liquid around the front, back, and sides of the knee.
- Repeat this step until 40 drops of liquid have been applied and the knee is completely covered with the liquid.
- If your doctor has told you to apply the liquid to both knees, repeat steps 2 to 4 to apply the medication to your other knee.
- Wash and dry your hands well after you apply the liquid.
To use topical dicofenac 2% liquid (Pennsaid), follow these steps:
- You will need to prime the pump that contains this medication before you use it for the first time. Remove the cap from the pump and hold the pump upright. Press down the top of the pump four times and catch any medication that comes out on a paper towel or tissue. Throw away the paper towel or tissue in a trash can.
- When you are ready to apply your medication, wash your hands well with soap and water.
- Hold the pump at an angle and press down the top of the pump to dispense the medication onto your palm. Press down the top a second time to dispense another pump of medication onto your palm.
- Use your palm to apply the medication evenly to the front, back, and sides of your knee. Do not massage your knee while you are applying the medication.
- If your doctor told you to apply the medication to both knees, repeat steps 3-4 to apply the medication to your other knee.
- Wash your hands well with soap and water as soon as you finish applying the medication.
- Replace the cap on your pump and store the pump upright.
Easy-to-read medicine information about diclofenac – what it is, how to take it safely and possible side effects.
|Type of medicine||Also called|
What is diclofenac?
Diclofenac is in a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs). It is used to treat different types of pain, such as pain from osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, painful periods (dysmenorrhoea), dental pain, migraine and pain resulting from injury or after surgery. It blocks the inflammation process and in this way eases swelling and pain. In New Zealand diclofenac is available as tablets, suppositories and can be given as an injection.
Lower strengths of diclofenac tablets and capules (Voltaren Rapid®) can be bought from a pharmacy without a prescription.
- The dose of diclofenac will be different for different people depending on your condition.
- Usually, you only need to take diclofenac for a short time, only while you have pain and swelling.
- The usual dose is 25–50 mg up to 3 times a day (every 8 hours) OR 75 mg up to twice a day (every 12 hours).
- Always take your diclofenac exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.
How to take diclofenac
If you are unsure about how to take your diclofenac, ask your pharmacist. The following is a guide:
|Formulation||How to take it|
|Tablets and capsules||
- Limit or avoid alcohol while you are taking diclofenac. Alcohol can increase the risk of side effects like stomach upset.
- If you forget to take a dose, take it when you next need pain relief and then continue as before, taking your doses every 8 or 12 hours if needed. Do not take 2 doses together to make up for a forgotten dose.
Take care with diclofenac
For most people, taking diclofenac is safe. However, extra care is needed if you have high blood pressure, high cholesterol, diabetes, stomach ulcers or kidney problems or if you smoke. It can also be harmful if you take it when you are dehydrated or have been sick with nausea or vomiting. Discuss with your doctor whether taking diclofenac is suitable for you.
NSAIDs (except low-dose aspirin) increase the chance of a heart attack or stroke, which can lead to death. These serious side effects can occur even in the first weeks of using an NSAID and the risk may increase the longer you are taking them, and if you are taking high doses. Some other medicines contain NSAIDs, including those used for colds and the flu, so always read the labels and avoid taking multiple medicines that contain NSAIDs.
Precautions – before taking diclofenac
- Do you have high blood pressure or problems with your heart?
- Do you have any problems with the way your kidneys or liver works?
- Have you had stomach ulcers?
- Do you have inflammatory bowel disease?
- Are you pregnant, planning a pregnancy or breastfeeding?
- Do you have any breathing problems or asthma?
- Have you had an allergic reaction to a medicine, particularly to any other NSAID (such as aspirin, naproxen and ibuprofen) or a COX-2 such as celecoxib?
If so, it’s important that you tell your doctor before you start taking diclofenac. Sometimes a medicine isn’t suitable for a person with certain conditions or taking other medicines, or it can only be used with extra care.
Possible side effects
|Side effects||What should I do?|
- Diclofenac interacts with some medicines, especially those used for high blood pressure, so check with your doctor or pharmacist before you start taking it.
- Do not take other NSAIDs, such as ibuprofen or naproxen, or COX-2s, such as celecoxib, while taking diclofenac. This can increase your risk of side effects.
- Taking NSAIDs together with medicines called ACE inhibitors or ARBs and diuretics (water pills) can be harmful to your kidneys. This is called the triple whammy. If you are taking ACE inhibitors or ARBs and diuretics, tell your doctor or pharmacist before starting diclofenac.
Examples of ACE inhibitors are captopril, cilazapril, enalapril, lisinopril, perindopril, quinapril and trandolapril.
Examples of ARBs are valsartan, losartan and candesartan.
Examples of diuretics are furosemide, bumetanide, bendroflumethiazide, chlortalidone, indapamide and metolazone.
The triple whammy SafeRx
The following links have more information on diclofenac:
Diclofenac (Māori) New Zealand Formulary Patient Information
- Diclofenac sodium (systemic) New Zealand Formulary