Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

1. Arthrotec

Descriptions

Diclofenac and misoprostol combination is used to relieve the symptoms of arthritis (eg, osteoarthritis or rheumatoid arthritis) in patients who may develop stomach or duodenal ulcers from taking nonsteroidal anti-inflammatory drugs (NSAIDs).

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve symptoms of arthritis such as inflammation, swelling, stiffness, and joint pain. Misoprostol is used to decrease the risk of having stomach and bowel ulcers.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

• Tablet, Enteric Coated

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of diclofenac and misoprostol combination in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of diclofenac and misoprostol combination in the elderly. However, elderly patients may be more sensitive to the effects of diclofenac and misoprostol combination than younger adults, and are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving this medicine.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Ketorolac

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Abciximab
• Acenocoumarol
• Amiloride
• Amineptine
• Amitriptyline
• Amitriptylinoxide
• Amoxapine
• Anagrelide
• Apixaban
• Ardeparin
• Argatroban
• Aspirin
• Bemetizide
• Bemiparin
• Bendroflumethiazide
• Benzthiazide
• Betrixaban
• Bivalirudin
• Budesonide
• Bumetanide
• Cangrelor
• Capecitabine
• Ceritinib
• Certoparin
• Chlorothiazide
• Chlorthalidone
• Cilostazol
• Citalopram
• Clomipramine
• Clopamide
• Clopidogrel
• Cyclopenthiazide
• Cyclosporine
• Cyclothiazide
• Dabigatran Etexilate
• Dalteparin
• Danaparoid
• Deferiprone
• Deflazacort
• Desipramine
• Desirudin
• Desmopressin
• Desvenlafaxine
• Dexamethasone
• Dexketoprofen
• Diazoxide
• Dibenzepin
• Diflunisal
• Digoxin
• Dipyridamole
• Dipyrone
• Dothiepin
• Doxepin
• Droxicam
• Duloxetine
• Edoxaban
• Emtricitabine
• Enoxaparin
• Eplerenone
• Epoprostenol
• Eptifibatide
• Escitalopram
• Ethacrynic Acid
• Etodolac
• Etofenamate
• Etoricoxib
• Etozolin
• Felbinac
• Fenoprofen
• Fepradinol
• Feprazone
• Feverfew
• Floctafenine
• Flufenamic Acid
• Fluoxetine
• Flurbiprofen
• Fluvoxamine
• Fondaparinux
• Furosemide
• Ginkgo
• Gossypol
• Heparin
• Hydrochlorothiazide
• Hydrocortisone
• Hydroflumethiazide
• Ibuprofen
• Iloprost
• Imipramine
• Indapamide
• Inotersen
• Ketoprofen
• Lepirudin
• Levoketoconazole
• Levomilnacipran
• Lithium
• Lofepramine
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Magnesium Salicylate
• Mavacamten
• Meadowsweet
• Meclofenamate
• Mefenamic Acid
• Melitracen
• Meloxicam
• Melphalan
• Mesalamine
• Methotrexate
• Methyclothiazide
• Methylprednisolone
• Metolazone
• Milnacipran
• Morniflumate
• Nabumetone
• Nadroparin
• Naproxen
• Nefazodone
• Nepafenac
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Nortriptyline
• Olsalazine
• Opipramol
• Oxaprozin
• Oxyphenbutazone
• Parecoxib
• Parnaparin
• Paroxetine
• Pemetrexed
• Pentosan Polysulfate Sodium
• Pentoxifylline
• Phenindione
• Phenprocoumon
• Phenylbutazone
• Phenyl Salicylate
• Piketoprofen
• Piretanide
• Piroxicam
• Polythiazide
• Potassium Citrate
• Prasugrel
• Prednisolone
• Prednisone
• Proglumetacin
• Propyphenazone
• Proquazone
• Protein C
• Protriptyline
• Quinethazone
• Reviparin
• Rivaroxaban
• Rofecoxib
• Salicylamide
• Salicylic Acid
• Salsalate
• Selexipag
• Sertraline
• Sibutramine
• Sodium Salicylate
• Sparsentan
• Spironolactone
• Sulfasalazine
• Sulfinpyrazone
• Sulindac
• Sulodexide
• Tacrolimus
• Tenofovir Alafenamide
• Tenofovir Disoproxil Fumarate
• Tenoxicam
• Tianeptine
• Tiaprofenic Acid
• Ticagrelor
• Ticlopidine
• Tinzaparin
• Tirofiban
• Tolfenamic Acid
• Tolmetin
• Torsemide
• Trazodone
• Treprostinil
• Triamterene
• Trichlormethiazide
• Trimipramine
• Trolamine Salicylate
• Valdecoxib
• Venlafaxine
• Vilazodone
• Vorapaxar
• Vortioxetine
• Warfarin
• Xipamide

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acebutolol
• Atenolol
• Azilsartan
• Azilsartan Medoxomil
• Benazepril
• Betaxolol
• Bisoprolol
• Candesartan
• Captopril
• Carteolol
• Carvedilol
• Celiprolol
• Cholestyramine
• Ciprofloxacin
• Colestipol
• Enalapril
• Enalaprilat
• Eprosartan
• Esmolol
• Fosinopril
• Irbesartan
• Labetalol
• Levobunolol
• Lisinopril
• Losartan
• Metipranolol
• Metoprolol
• Moexipril
• Nadolol
• Nebivolol
• Olmesartan
• Oxprenolol
• Penbutolol
• Perindopril
• Phenylbutazone
• Pindolol
• Propranolol
• Quinapril
• Ramipril
• Sotalol
• Spirapril
• Telmisartan
• Timolol
• Trandolapril
• Valsartan

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Anemia or
• Asthma or
• Bleeding problems or
• Congestive heart failure or
• Edema (fluid retention or body swelling) or
• Heart attack, recent or history of or
• Heart or blood vessel disease or
• Hypertension (high blood pressure) or
• Inflammatory bowel disease or
• Kidney disease or
• Liver disease (eg, hepatitis) or
• Porphyria (blood disorder) or
• Stomach or bowel ulcers or bleeding, history of or
• Stroke, history of or
• Systemic lupus erythematosus (SLE)—Use with caution. May make these conditions worse.

• Aspirin-sensitive asthma or
• Aspirin (or other NSAIDs) sensitivity, history of or
• Kidney disease, severe or
• Stomach or bowel bleeding, active—Should not be used in patients with these conditions.

• Coagulopathy (bleeding problem) or
• Liver disease, advanced—Use with caution. May increase risk for stomach or bowel bleeding.

• Dehydration or
• Hypovolemia (low blood volume)—Use with caution. Must be corrected first before using this medicine.

• Heart surgery (eg, coronary artery bypass graft [CABG])—Should not be used to relieve pain right before or after the surgery.

Proper Use

For safe and effective use of this medicine, do not take more of it, do not take it more often, and do not take it for a longer time than ordered by your doctor. Taking too much of this medicine may increase the chance of unwanted effects. Do not change the dose or stop using this medicine without checking first with your doctor.

This medicine should come with a Medication Guide or a patient information leaflet. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Do not take diclofenac and misoprostol combination with magnesium-containing antacids. Antacids may be taken with diclofenac and misoprostol combination, if needed, to help relieve stomach pain, unless otherwise directed by your doctor. However, do not take magnesium-containing antacids, since they may cause diarrhea or worsen the diarrhea that is sometimes caused by this medicine.

Do not give this medicine to another person.

Take this medicine with food to prevent diarrhea and stomach upset.

Swallow the tablets whole. Do not chew, crush, or dissolve it.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • For osteoarthritis:
    • Adults—One tablet of Arthrotec® 50 3 times a day. Your doctor may adjust your dose as needed and tolerated. Some patients who cannot tolerate the usual dose can be given Arthrotec® 75 2 times a day or Arthrotec® 50 2 times a day. Each Arthrotec® 50 contains 50 milligrams (mg) diclofenac sodium and 200 micrograms (mcg) misoprostol, while Arthrotec® 75 contains 75 mg diclofenac sodium and 200 mcg misoprostol.
    • Children—Use and dose must be determined by your doctor.
  • For rheumatoid arthritis:
    • Adults—One tablet of Arthrotec 50 3 or 4 times a day. Your doctor may adjust your dose as needed and tolerated. Some patients who cannot tolerate the usual dose can be given Arthrotec® 75 2 times a day or Arthrotec® 50 2 times a day. Each Arthrotec® 50 contains 50 milligrams (mg) diclofenac sodium and 200 micrograms (mcg) misoprostol, while Arthrotec® 75 contains 75 mg diclofenac sodium and 200 mcg misoprostol.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant, especially during the later part of pregnancy can cause miscarriage, premature birth, very serious birth defects, or tearing of the uterus. If you are a woman who can bear children, your doctor may give you a pregnancy test within 2 weeks before you start using this medicine to make sure you are not pregnant. Use an effective form of birth control to keep from getting pregnant while you are using this medicine and after the last dose. The most effective forms of birth control are hormone birth control pills, patches, shots, vaginal rings, or implants, an IUD, or a vasectomy (for men). One of these forms of birth control should be combined with a condom, a diaphragm, or a cervical cap. You must have a negative pregnancy test before you will be allowed to take this medicine. If you think you have become pregnant while using this medicine, tell your doctor right away.

This medicine may increase your risk of having blood clots, heart attack, or stroke. This is more likely in people who already have heart or blood vessel disease. People who use this medicine for a long time might also have a higher risk. Check with your doctor right away if you have swelling and pain in your arms, legs, or stomach, chest pain, trouble breathing, loss of sensation, confusion, or problems with muscle control or speech.

This medicine may cause bleeding, perforation, or ulcers in your stomach or bowels. These problems can happen without warning signs and are more likely to occur if you have had a stomach ulcer, if you smoke or drink alcohol regularly, are over 60 years of age, in poor health, or using certain medicines (eg, steroid medicine, blood thinner).

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Your blood pressure might get too high while you are using this medicine. This may cause headaches, dizziness, or blurred vision. You might need to measure your blood pressure at home. If you think your blood pressure is too high, call your doctor right away.

This medicine may cause a serious type of allergic reaction called anaphylaxis, which can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing or swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Serious skin reactions including Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) can occur during treatment with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, chest pain, chills, cough, diarrhea, fever, itching, joint or muscle pain, painful or difficult urination, red skin lesions, sore throat, sores ulcers, white spots in the mouth or on the lips, swollen glands, unusual bleeding or bruising, or unusual tiredness or weakness. .

Check with your doctor right away if you have bloody urine, a decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.

Hyperkalemia (high potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you have stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, or weakness or heaviness of the legs.

This medicine can cause worsening of your heart failure. Check with your doctor right away if you have chest pain, decreased urine output, dilated neck veins, extreme fatigue, irregular breathing, irregular heartbeat, swelling of the face, fingers, feet, or lower legs, tightness in the chest, trouble breathing, or weight gain.

This medicine may cause diarrhea in some people. The diarrhea will usually disappear within a few days as your body adjusts to the medicine. However, check with your doctor right away if the diarrhea is severe or does not stop after a week.

Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with this medicine. Therefore, do not regularly drink alcoholic beverages while taking this medicine, unless otherwise directed by your doctor.

This medicine may cause a delay in ovulation for women and may affect their ability to have children. If you plan to have children, talk with your doctor before using this medicine.

Taking nonsteroidal anti-inflammatory drugs (eg, acetaminophen, aspirin or other salicylates, or ketorolac, Toradol®) together with this medicine on a regular basis may increase the chance of unwanted effects. The risk will depend on how much of each medicine you take everyday, and on how long you take these medicines together. If your doctor directs you to take these medicines together on a regular basis, follow his or her directions carefully. However, do not take acetaminophen or aspirin or other salicylates together with this medicine for more than a few days, and do not take any ketorolac (eg, Toradol®) while you are taking this medicine, unless your doctor has directed you to do so and is following your progress.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or non-prescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

1. Stomach pain

Less common

1. Black, tarry stools
2. bladder pain
3. bloody or cloudy urine
4. burning feeling in the chest or stomach
5. burning while urinating
6. chest pain, discomfort, or tightness
7. chills
8. cough
9. deep or fast breathing with dizziness
10. difficult, burning, or painful urination
11. difficulty swallowing
12. dizziness
13. double vision
14. feeling of constant movement of self or surroundings
15. fever
16. frequent urge to urinate
17. heartburn
18. increased sensitivity of the skin to sunlight
19. increased volume of pale, dilute urine
20. indigestion
21. itching, skin rash
22. lightheadedness
23. longer or heavier menstrual periods
24. lower back or side pain
25. nosebleed
26. numbness of the feet, hands, and around the mouth
27. pain or burning in the throat
28. pain with swallowing
29. redness or other discoloration of the skin
30. seeing double
31. sensation of spinning
32. severe sunburn
33. sores, ulcers, or white spots on the lips or in the mouth
34. sore throat
35. stomach upset or tenderness
36. swollen glands
37. unusual bleeding or bruising
38. unusual tiredness or weakness
39. vaginal bleeding
40. vomiting with or without blood

Incidence not known

1. Ankle, knee, or great toe joint pain
2. anxiety
3. black, tarry stools
4. bleeding gums
5. blindness
6. blistering, peeling, or loosening of the skin
7. bloating or swelling of the face, arms, hands, lower legs, or feet
8. bluish color of the skin
9. blurred vision
10. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
11. burning, dry, or itching eyes
12. cloudy or dark urine
13. decreased frequency or amount of urine
14. decreased vision
15. diarrhea
16. difficulty in speaking
17. dilated neck veins
18. discharge, excessive tearing
19. dizziness, fainting, or lightheadedness when getting up suddenly from a lying or sitting position
20. drowsiness
21. excessive muscle tone
22. eye pain
23. fainting
24. fast, irregular, pounding, or racing heartbeat or pulse
25. general feeling of illness
26. headache, severe and throbbing
27. hoarseness
28. inability to move the arms, legs, or facial muscles
29. inability to speak
30. increased sensitivity to pain or touch
31. increased thirst
32. irregular, fast or slow, or shallow breathing
33. joint pain, stiffness, or swelling
34. large, hive-like swelling on the pain, face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
35. light-colored stools
36. lightheadedness
37. loss of appetite
38. loss of consciousness
39. muscle stiffness, tension, or tightness
40. nausea
41. nervousness
42. night blindness
43. pain or discomfort in the arms, jaw, back, or neck
44. pains in the stomach, side, or abdomen, possibly radiating to the back
45. pain, warmth, or burning in the fingers, toes, and legs
46. pale or blue lips, fingernails, or skin pale skin
47. pinpoint red spots on the skin
48. pounding in the ears
49. problems with vision or hearing
50. rapid weight gain
51. red skin lesions, often with a purple center
52. redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
53. redness or soreness of the skin
54. seizures
55. severe stomach cramping
56. slow heartbeat
57. slow speech
58. sneezing
59. sores, welts, or blisters
60. stiff neck or back
61. tremor
62. trouble breathing
63. unusual bleeding or bruising
64. unusual weight gain or loss
65. upper right stomach pain
66. uterine cramping and bleeding
67. vomiting of material that looks like coffee grounds, severe and continuing
68. yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

1. Belching
2. excess air or gas in the stomach or bowels
3. full feeling
4. passing gas

Less common

1. Breast pain
2. change in or loss of taste
3. confusion about identity, place, and time
4. constipation
5. continuing ringing or buzzing or other unexplained noise in the ears
6. decreased concentration
7. depression
8. difficulty in moving
9. dry mouth
10. frequent urge to defecate
11. increased clear or white vaginal discharge
12. irritability
13. itching of the vagina or genital area
14. lack or loss of strength
15. loss or thinning of hair
16. pain during sexual intercourse
17. seeing, hearing, or feeling things that are not there
18. straining while passing stool
19. thick, white vaginal discharge with no odor or with a mild odor
20. trouble sleeping

Incidence not known

1. Blemishes on the skin
2. decreased interest in sexual intercourse
3. inability to have or keep an erection
4. loss in sexual ability, desire, drive, or performance
5. pimples
6. sleepiness or unusual drowsiness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: April 01, 2024

Original article: https://www.mayoclinic.org/drugs-supplements/diclofenac-and-misoprostol-oral-route/precautions/drg-20061810