Voltaren Ophthalmic, (diclofenac ophthalmic) dosing, indications, interactions, adverse effects, and more

Sections

Sections diclofenac ophthalmic
Dosing & Uses
Adverse Effects
Warnings
Pregnancy
Pharmacology
Images
Patient Handout
Formulary

Dosing & Uses

AdultPediatric

Dosing Strength

ophthalmic solution

0.1%

Dosing Strength

ophthalmic solution

0.1%

Cataract Surgery

1 gtt in affected eye(s) four times daily for 2 weeks, beginning 24 hours post-surgery

Corneal Refractive Surgery

1-2 gtt in affected eye(s) within 1 hour pre-op & 15 minutes post-op; continue 1-2 gtt four times daily for 3 days

Safety & efficacy not established

Frequency Not Defined

Mild ocular stinging, irritation

May slow corneal wound healing

Lacrimation

Increased IOP

Keratitis

Dizziness

Insomnia

Pain

Fever

Chills

Nausea/vomiting

Abdominal pain

Corneal deposits

Corneal edema

Conjunctivitis

Irritation

Eyelid swelling

Corneal perforation

Corneal thinning

Contraindications

Hypersensitivity to ASA, NSAIDs, or components of the formulation

Cautions

Contains sodium sulfite which may cause allergic reactions in susceptible individuals NSAIDs may slow or delay healing

Potential for cross-sensitivity to other NSAIDs or aspirin

Interferes with platelet aggregation and may increase bleeding of ocular tissues; use caution in patients with predisposition to bleeding

Corneal effects, including keratitis, reported

Remove contact lenses before application, may reinsert 10 minutes after instilling drops

Corneal adverse reactions may occur in patients with keratitis after continued use that may result in loss of vision; discontinue use in patients with evidence of corneal epithelial damage

Use caution in patients with diabetes (may be at risk of corneal adverse effects that may result in loss of vision)

Use caution in patients with complicated ocular surgeries, corneal denervation, repeat ocular surface disease, or corneal epithelial defects

Use caution in patients with rheumatoid arthritis

Pregnancy & Lactation

Pregnancy Category: C

Lactation: Excretion in milk significantly lower than systemic acministration of diclofenac; possibly compatible

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Mechanism of Action Nonsteroidal anti-inflammatory agent; inhibits COX-1 and COX-2, which results in decreased formation of prostaglandin precursors

Pharmacokinetics

Absorption: Negligible

BRAND	FORM.	UNIT PRICE	PILL IMAGE
diclofenac sodium topical -	1.5 % drops
diclofenac sodium topical -	1 % gel
diclofenac sodium topical -	20 mg/gram /actuation(2 %) solution
diclofenac sodium topical -	1.5 % drops
diclofenac sodium topical -	1 % gel
diclofenac sodium topical -	1.5 % drops
diclofenac sodium topical -	3 % gel
diclofenac sodium topical -	3 % gel
diclofenac sodium topical -	20 mg/gram /actuation(2 %) solution
diclofenac sodium topical -	3 % gel
diclofenac sodium topical -	1 % gel
diclofenac sodium topical -	1.5 % drops
diclofenac sodium topical -	3 % gel
diclofenac sodium topical -	1.5 % drops
diclofenac sodium topical -	1 % gel
diclofenac sodium topical -	1 % gel
diclofenac sodium topical -	1 % gel
diclofenac sodium topical -	3 % gel
diclofenac sodium topical -	1.5 % drops
diclofenac oral -	75 mg tablet
diclofenac oral -	50 mg tablet
diclofenac oral -	50 mg tablet
diclofenac oral -	75 mg tablet
diclofenac oral -	50 mg tablet
diclofenac oral -	50 mg tablet
diclofenac oral -	75 mg tablet
diclofenac oral -	100 mg tablet
diclofenac oral -	100 mg tablet
diclofenac oral -	25 mg tablet
diclofenac oral -	50 mg tablet
diclofenac oral -	25 mg tablet
diclofenac oral -	100 mg tablet
diclofenac oral -	50 mg tablet
diclofenac oral -	75 mg tablet
Pennsaid topical -	20 mg/gram /actuation(2 %) solution
diclofenac ophthalmic (eye) -	0.1 % drops
diclofenac ophthalmic (eye) -	0.1 % drops
diclofenac ophthalmic (eye) -	0.1 % drops
diclofenac ophthalmic (eye) -	0.1 % drops
diclofenac ophthalmic (eye) -	0.1 % drops
diclofenac ophthalmic (eye) -	0.1 % drops

Patient Handout

Select a drug:

DICLOFENAC SODIUM SUSTAINED-ACTION TABLET - ORAL

(dye-KLOE-fen-ack SOE-dee-um)

COMMON BRAND NAME(S): Voltaren-XR

WARNING: Nonsteroidal anti-inflammatory drugs (including diclofenac) may rarely increase the risk of a heart attack or stroke. This effect can happen at any time while taking this drug but is more likely if you take it for a long time. The risk may be greater in older adults or if you have heart disease or increased risk for heart disease (for example, due to smoking, family history of heart disease, or conditions such as high blood pressure or diabetes). Do not take this drug right before or after heart bypass surgery (CABG).Also, this drug may rarely cause serious (rarely fatal) bleeding from the stomach or intestines. This effect can occur without warning symptoms at any time while taking this drug. Older adults may be at higher risk for this effect.Stop taking diclofenac and get medical help right away if you notice any of these rare but serious side effects: stomach/abdominal pain that doesn't go away, black/tarry stools, vomit that looks like coffee grounds, chest/jaw/left arm pain, shortness of breath, unusual sweating, confusion, weakness on one side of the body, trouble speaking, sudden vision changes.Talk to your doctor or pharmacist about the benefits and risks of taking this drug.

USES: See also Warning section.The sustained-action tablet form of diclofenac is used to reduce pain, swelling (inflammation), and joint stiffness from arthritis. Reducing these symptoms helps you do more of your normal daily activities.Diclofenac is known as a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body's production of certain natural substances that cause inflammation. This effect helps to decrease swelling, pain, or fever.Ask your doctor about non-drug treatments and/or using other medications to treat your pain.

HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking diclofenac and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually once daily. Take this medication with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise. Do not lie down for at least 10 minutes after taking this medication. If stomach upset occurs while taking this medication, take it with food, milk, or an antacid.Swallow the tablets whole. Do not crush or chew the tablets. Doing so can release all of the drug at once, increasing the risk of side effects.There are different brands and forms of this medication available. Because different forms do not have the same effects at equal strengths, do not switch forms of diclofenac unless your doctor tells you to.The dosage is based on your medical condition, response to treatment, and other medications you may be taking. To reduce your risk of stomach bleeding and other side effects, take this medication at the lowest effective dose for the shortest possible time. Do not increase your dose or take this drug more often or for longer than prescribed. Discuss the risks and benefits with your doctor or pharmacist.For certain conditions (such as arthritis), it may take up to 2 weeks of taking this drug regularly until you get the full benefit.Tell your doctor if your condition gets worse.

SIDE EFFECTS: See also Warning section.Upset stomach, nausea, heartburn, diarrhea, constipation, gas, headache, drowsiness, dizziness, or blurred vision may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: hearing changes (such as ringing in the ears), mental/mood changes, easy bleeding/bruising, difficult/painful swallowing, symptoms of heart failure (such as swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).Get medical help right away if you have any very serious side effects, including: signs of kidney problems (such as change in the amount of urine, pink/bloody urine), unexplained stiff neck.Diclofenac may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, including: nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: See also Warning section.Before taking diclofenac, tell your doctor or pharmacist if you are allergic to it; or to aspirin or other NSAIDs (such as ibuprofen, naproxen, celecoxib); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: asthma (including a history of worsening breathing after taking aspirin or other NSAIDs), blood disorders (such as anemia, bleeding/clotting problems), growths in the nose (nasal polyps), heart disease (such as previous heart attack), high blood pressure, liver disease, stroke, swelling (edema, fluid retention), stomach/intestinal/esophagus problems (such as bleeding, heartburn, ulcers).Kidney problems can sometimes occur with the use of NSAID medications, including diclofenac. Problems are more likely to occur if you are dehydrated, have heart failure or kidney disease, are an older adult, or if you take certain medications (see also Drug Interactions section). Drink plenty of fluids as directed by your doctor to prevent dehydration and tell your doctor right away if you have pink/bloody urine or any unusual change in the amount of urine.This drug may make you dizzy or drowsy or cause blurred vision. Alcohol or marijuana (cannabis) can worsen these effects. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medicine may cause stomach bleeding. Daily use of alcohol and tobacco, especially when combined with this medicine, may increase your risk for stomach bleeding. Limit alcohol and stop smoking.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be at greater risk for stomach/intestinal bleeding, kidney problems, heart attack, and stroke while using this drug.Before using this medication, women of childbearing age should talk with their doctor(s) about the benefits and risks. Tell your doctor if you are pregnant or if you plan to become pregnant. This medication may harm an unborn baby and cause problems with normal labor/delivery. It is not recommended for use in pregnancy from 20 weeks until delivery. If your doctor decides that you need to use this medication between 20 and 30 weeks of pregnancy, you should use the lowest effective dose for the shortest possible time. You should not use this medication after 30 weeks of pregnancy.This medication passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: aliskiren, ACE inhibitors (such as benazepril, lisinopril), angiotensin II receptor blockers (such as losartan, valsartan), cidofovir, corticosteroids (such as dexamethasone, prednisone), lithium, methotrexate, "water pills" (diuretics such as furosemide).This medication may increase the risk of bleeding when taken with other drugs that also may cause bleeding. Examples include anti-platelet drugs such as clopidogrel, "blood thinners" such as dabigatran/enoxaparin/warfarin, among others.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (aspirin, NSAIDs such as ibuprofen, ketorolac, naproxen). These drugs are similar to diclofenac and may increase your risk of side effects if taken together. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should keep taking the aspirin unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe stomach pain, slow/shallow breathing, extreme drowsiness.

NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood count, liver/kidney function, blood pressure) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.Lifestyle changes (such as weight loss if needed, strengthening/conditioning exercises) may help improve your flexibility and joint function. Consult your doctor for specific instructions.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Store at room temperature in a tightly closed container away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Formulary

FormularyPatient Discounts

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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier	Description
1	This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2	This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC	NOT COVERED – Drugs that are not covered by the plan.

Code	Definition
PA	Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL	Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST	Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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