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Diclofenac and misoprostol

Generic name: diclofenac and misoprostol [dye-KLOE-fen-ak-and-mye-so-PROST-ole]
Name of the brand: Arthrotec
Dosage formats: oral delayed release tablet (50 mg–200 mcg; 75 mg–200 milligrams) or oral tablet (50 mg–200 mcg)
Class of drug: nonsteroidal anti-inflammatory drugs

What is Diclofenac and misoprostol

Diclofenac is an anti-inflammatory nonsteroidal drug (NSAID). Misoprostol decreases stomach acid and substitutes for protective substances found in the stomach, which are diminished in the stomach due to the NSAIDs. Diclofenac is a combination drug that is used to treat osteoarthritis and rheumatoid arthritis in patients who are at the highest risk of developing intestinal or stomach ulcers. Diclofenac and misoprostol could be used for reasons that are not mentioned in this guide.

Side effects of Diclofenac and misoprostol

See a doctor immediately when you are experiencing symptoms or warning signs of an allergic reaction (sneezing or running nose, wheezing, hives, difficulties breathing, swelling on your throat or face) or a severe reaction to your skin (fever or sore throat, eye burning, irritation, and red or purple skin itching that blisters and peels).

Stop taking diclofenac or misoprostol, and seek medical attention in the event of a severe reaction to a drug that could affect the body's many organs. Symptoms may include an itch or fever, swelling of the glands, muscle aches, abnormal bruising, severe weakness, or discoloration of your eyes or skin.

Seek medical attention immediately when you show indications of a stroke or heart attack. chest pain spreading into your shoulder or jaw A sudden feeling of weakness or numbness in one area of your body, slurred speech, or feeling breathless

Diclofenac and misoprostol could have serious negative side effects. Stop taking diclofenac or misoprostol, and consult your physician immediately if you experience:

  • The very first indication of any rash on the skin, regardless of its severity;
  • Breathlessness (even when exerting only a little);
  • Weight gain or swelling;
  • Symptoms of stomach bleeding: bloody or tarry stool and the spouting of the blood or vomit that looks like coffee grounds
  • Liver problems: less appetite and stomach discomfort (upper right side) fatigue, itching, dark urine, stools that are clay-colored, and jaundice (yellowing of the eyes or skin);
  • Kidney problems: no or little urine output; swelling of your ankles and feet; feeling fatigued or short of breath;
  • Red blood cells are low (anemia)—pale skin, uncharacteristically tired, lightheaded or sluggish, cold hands and feet.

Common negative effects of diclofenac as well as misoprostol can be:

  • Abnormal vaginal bleeding
  • Heartburn indigestion, stomach pain, gas;
  • Nausea, vomiting;
  • Diarrhea, constipation, or

This isn't a complete list of possible side effects, and other side effects could occur. Contact your doctor to seek medical advice on adverse effects. You can report any adverse reactions to the FDA at 1-800-FDA-1088.


Do not take this medication if you are pregnant. Misoprostol may cause birth defects, miscarriage, early labor, and ruptures of the uterus. You must pass positive pregnancy tests within two weeks prior to when you begin taking diclofenac or misoprostol. You might need to begin using this medication only on the second or third day of a regular menstrual cycle. Make sure you are using effective hormonal contraception when you're taking diclofenac or misoprostol.

Diclofenac may increase the chance of suffering a fatal cardiac attack as well as a stroke. Do not take this medication immediately prior to or following the heart bypass surgery (coronary artery bypass graft, or CABG). Diclofenac can also trigger diarrhea or stomach bleeding, which could be fatal.

Before you take this drug

Diclofenac increases the chance of having a fatal heart attack or stroke, even if you possess any risks. Don't take diclofenac or misoprostol prior to or immediately following coronary bypass surgeries (coronary bypass grafts (CABG)).

Diclofenac can cause diarrhea or stomach bleeding, which could be fatal. These issues can happen in a matter of minutes when taking diclofenac or misoprostol, particularly in older people.

This medication if you have an allergy to diclofenac or misoprostol or:

  • If you're experiencing bleeding within your intestines, stomach, or
  • If you are pregnant; or
  • If you've experienced a previous asthma attack or a severe allergic reaction following using aspirin or an NSAID,

Speak to your doctor if you have ever suffered from:

  • Heart diseases, high blood pressure, high cholesterol, diabetes, or if you smoke
  • A stroke, heart attack, or blood clot
  • Stomach ulcers, bleeding, or ulcers
  • Asthma;
  • Porphyria (a genetic disorder of enzymes that results in symptoms that affect the nervous system or skin);
  • Kidney disease or liver failure and
  • Fluid retention.

Avoid using this medicine when you are expecting. Misoprostol and diclofenac can trigger birth defects, misscarriage, early labor, and ruptures of the uterus. Utilize a reliable method for birth control in order to stop pregnancy while taking this medication. Contact your physician immediately in case you fall pregnant while taking treatment.

You'll need to take an examination for pregnancy within 2 weeks prior to starting to take diclofenac or misoprostol. It is possible that you will need to begin using this medication on the second or third day of your normal menstrual cycle. It might not be safe to breastfeed while taking this medication. Consult your physician regarding any risks.

How to take Diclofenac and misoprostol?

Follow the instructions on the prescription label and study all medication guidelines. Make sure you are using the dose that works for your condition.

Consume diclofenac along with misoprostol to reduce gastric upset. Suck the tablet completely, and make sure you don't crush, chew, or break it. Don't share this medicine with anyone other than yourself, even if they suffer from similar symptoms as you do.

If you take diclofenac or misoprostol for a long time, you might require regular medical testing in the office of your doctor. Place it in a cool, dry place far from heat and moisture.

Details on dosage

Usual Adult Dose for Osteoarthritis:

A tablet (diclofenac 50 mg, misoprostol 200 mg) 3 times per day
Maximum doses include: diclofenac 150 mg/day, misoprostol 200 mcg/dose, and 800 mg/day.

Monitor the response to the first therapy and adjust the dosage and frequency to meet the individual's needs. You may also consider the possibility of titration for individual components, when appropriate.
If you have a patient who has intolerance, diclofenac 25 mg-misoprostol 200 mg or diclofenac 50 mg-misoprostol 200 mg daily, taken orally, may be taken, but these regimens are not as efficient in the prevention of ulcers.
For the prevention of gastric ulcers, Misoprostol 200 mg three times per day is equivalent to 200 mg four times per day. Both are more secure than 200 mg twice every day.
For the purpose of duodenal ulcer prevention, misoprostol 200 mg four times per day can be more secure than 200 mg two or three times per day; however, it is not well-tolerated.

Use: To treat symptoms and signs of osteoarthritis in people who are at risk of developing nonsteroidal inflammation medication (NSAID)-inducing gastric and duodenal ulcers as well as their complications.

Usual Adult Dose for Rheumatoid Arthritis:

1 tablet (diclofenac 50 mg, misoprostol 200 mcg) orally, 3 to 4 times daily.
Maximum doses: diclofenac, 225 mg/day; misoprostol, 200 mg/dose; and 800 mg/day.

If you have a patient who has intolerance, diclofenac 75 mg, misoprostol 200 mg, or diclofenac 50 mg, misoprostol 200 mg, taken every day, orally, can be taken, but these regimens are not as efficient in the prevention of ulcers.
Monitor the response to beginning therapy and adjust the dose and frequency according to the individual's needs. Consider the possibility of titration for individual components, if necessary.
For the prevention of gastric ulcers, misoprostol 200 mg 3 times a day is equivalent to 200 mg four times a day. Both are more effective than 200 mg twice daily.
To prevent duodenal ulcers Misoprostol 200 mg 4 times per day can be more secure than 200 mg 2 or 3 times per day, but it is not well-tolerated.

Use: To treat the symptoms and signs of rheumatoid arthritis in patients who are at the highest risk of developing NSAID duodenal and gastric ulcers and their complications.

What happens if I miss the dose?

Do not take the medicine for as long as you are able, but avoid your missed dosage if it's close to the time of the next dose. Don't take two doses at a time.

What happens if I overdose?

For medical emergencies, seek emergency medical help immediately or call for assistance at the Poison Help Line: 1-800-222-1222.

What should be avoided?

Avoid direct sun exposure as well as tanning beds.. Diclofenac and misoprostol may cause your burn to occur more quickly. Protect yourself with protective clothes and apply sunblock (SPF 30 or more) while you're outdoors. Do not use an antacid without consulting your physician. Make sure you only use the antacid recommended by your physician. Certain antacids may make it more difficult for the body to take diclofenac as well as misoprostol.

Do not drink alcohol. It could increase your chance of bleeding in your stomach caused by diclofenac. Consult a physician or pharmacist prior to using any other medications for swelling, pain, fever, cold, or influenza symptoms. These medicines may contain ingredients that are similar to diclofenac (such as aspirin, ibuprofen, ketoprofen, or naproxen).

Interaction with other drug

Talk to your doctor prior to taking this medication if you are taking medication for depression. Taking certain antidepressants together with an NSAID can cause bleeding or bruises easily.

Inform your physician of any additional medications you are taking particularly:

  • Cyclosporine;
  • Lithium;
  • Methotrexate;
  • Blood pressure or heart medication such as diuretics or "water pills"
  • Oral diabetes medicine;
  • A blood thinner, warfarin (coumadin, jantoven);
  • Other forms of diclofenac: cambia, cataflam, flector, voltaren, zipsor, and zorvolex
  • Other nsaids: aspirin, ibuprofen (advil, motrin), naproxen (aleve), celecoxib (celebrex), indomethacin, the meloxicam, and many others.
  • Steroid medicine—prednisone, dexamethasone, and others.

This list isn't complete. Other medications can affect diclofenac or misoprostol, which includes prescription and over-the-counter medicines, vitamins, and herbal products. There are many possible interactions between drugs that are listed here.