Diclofenac Sodium

Diclofenac Sodium

Diclofenac Sodium Recall

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Questions & Answers

Side Effects & Adverse Reactions

  • CARDIOVASCULAR EFFECTS

    Cardiovascular Thrombotic Events

    Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs, both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk factors for CV disease may be at greater risk. To minimize the potential risk for an adverse CV event in patients treated with an NSAID, the lowest effective dose should be used for the shortest duration possible. Physicians and patients should remain alert for the development of such events, even in the absence of previous CV symptoms. Patients should be informed about the signs and/or symptoms of serious CV events and the steps to take if they occur.

    There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use. The concurrent use of aspirin and an NSAID does increase the risk of serious GI events (see WARNINGS, GI Effects).

    Two large, controlled, clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10 - 14 days following CABG surgery found an increased incidence of myocardial infarction and stroke (see CONTRAINDICATIONS).

    Hypertension

    NSAIDs can lead to onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including diclofenac sodium extended-release tablets, USP should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.

    Congestive Heart Failure and Edema

    Fluid retention and edema have been observed in some patients taking NSAIDs. Diclofenac sodium extended-release tablets should be used with caution in patients with fluid retention or heart failure.

    Gastrointestinal Effects - Risk of Ulceration, Bleeding, and Perforation:

    NSAIDs including diclofenac sodium extended-release tablets, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine, which can be fatal. These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Only one in five patients, who develop a serious upper GI adverse event on NSAID therapy, is symptomatic. Upper GI ulcers, gross bleeding, or perforation caused by NSAIDs occur in approximately 1% of patient treated for 3-6 months, and in about 2-4% of patients treated for one year. These trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy. However, even short-term therapy is not without risk.

    NSAIDs should be prescribed with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding. Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients with neither of these risk factors. Other factors that increase the risk for GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status. Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore special care should be taken in treating this population.

    To minimize the potential risk for an adverse GI event in patients treated with an NSAID, the lowest effective dose should be used for the shortest possible duration. Patients and physicians should remain alert for signs and symptoms of GI ulceration and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI adverse event is suspected. This should include discontinuation of the NSAID until a serious GI adverse event is ruled out. For high risk patients, alternate therapies that do not involve NSAIDs should be considered.

    Renal Effects

    Caution should be used when initiating treatment with diclofenac sodium extended-release tablets in patients with considerable dehydration.

    Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a nonsteroidal anti-inflammatory drug may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors and the elderly. Discontinuation of non-steroidal anti-inflammatory drug therapy is usually followed by recovery to the pretreatment state.

    Advanced Renal Disease

    No information is available from controlled clinical studies regarding the use of diclofenac sodium extended-release tablets in patients with advanced renal disease. Therefore, treatment with diclofenac sodium is not recommended in these patients with advanced renal disease. If diclofenac sodium extended-release tablets therapy must be initiated, close monitoring of the patient’s renal function is advisable.

    Hepatic Effects

    Elevations of one or more liver tests may occur during therapy with diclofenac sodium extended-release tablets. These laboratory abnormalities may progress, may remain unchanged, or may be transient with continued therapy. Borderline elevations (i.e., less than 3 times the ULN [ULN = the upper limit of the normal range]) or greater elevations of transaminases occurred in about 15% of diclofenac-treated patients. Of the markers of hepatic function, ALT (SGPT) is recommended for the monitoring of liver injury.
    In clinical trials, meaningful elevations (i.e., more than 3 times the ULN) of AST (GOT) (ALT was not measured in all studies) occurred in about 2% of approximately 5,700 patients at some time during diclofenac treatment. In a large, open-label, controlled trial of 3,700 patients treated for 2-6 months, patients were monitored first at 8 weeks and 1,200 patients were monitored again at 24 weeks. Meaningful elevations of ALT and/or AST occurred in about 4% of patients and included marked elevations (i.e., more than 8 times the ULN) in about 1% of the 3,700 patients. In that open-label study, a higher incidence of borderline (less than 3 times the ULN), moderate (3-8 times the ULN), and marked (> 8 times the ULN) elevations of ALT or AST was observed in patients receiving diclofenac when compared to other NSAIDs. Elevations in transaminases were seen more frequently in patients with osteoarthritis than in those with rheumatoid arthritis.

    Almost all meaningful elevations in transaminases were detected before patients became symptomatic. Abnormal tests occurred during the first 2 months of therapy with diclofenac in 42 of the 51 patients in all trials who developed marked transaminase elevations.

    In postmarketing reports, cases of drug-induced hepatotoxicity have been reported in the first month, and in some cases, the first 2 months of therapy, but can occur at any time during treatment with diclofenac. Postmarketing surveillance has reported cases of severe hepatic reactions, including liver necrosis, jaundice, fulminant hepatitis with and without jaundice, and liver failure. Some of these reported cases resulted in fatalities or liver transplantation.

    Physicians should measure transaminases periodically in patients receiving long-term therapy with diclofenac, because severe hepatotoxicity may develop without a prodrome of distinguishing symptoms. The optimum times for making the first and subsequent transaminase measurements are not known. Based on clinical trial data and post-marketing experiences, transaminases should be monitored within 4 to 8 weeks after initiating treatment with diclofenac. However, severe hepatic reactions can occur at any time during treatment with diclofenac.

    If abnormal liver tests persist or worsen, if clinical signs and/or symptoms consistent with liver disease develop, or if systemic manifestations occur (e.g., eosinophilia, rash, abdominal pain, diarrhea, dark urine, etc.), diclofenac sodium extended-release tablets should be discontinued immediately.

    To minimize the possibility that hepatic injury will become severe between transaminase measurements, physicians should inform patients of the warning signs and symptoms of hepatotoxicity (e.g., nausea, fatigue, lethargy, diarrhea, pruritus, jaundice, right upper quadrant tenderness, and "flu-like" symptoms), and the appropriate action patients should take if these signs and symptoms appear.

    To minimize the potential risk for an adverse liver related event in patients treated with diclofenac sodium extended-release tablets, the lowest effective dose should be used for the shortest duration possible. Caution should be exercised in prescribing diclofenac sodium extended-release tablets with concomitant drugs that are known to be potentially hepatotoxic (e.g., antibiotics, anti-epileptics).

    Anaphylactoid Reactions

    As with other NSAIDs, anaphylactoid reactions may occur in patients without known prior exposure to diclofenac sodium extended-release tablets. Diclofenac sodium extended-release tablets should not be given to patients with the aspirin triad. This symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs. (See CONTRAINDICATIONS and PRECAUTIONS, Preexisting Asthma.) Emergency help should be sought in cases where an anaphylactoid reaction occurs.

    Skin Reactions

    NSAIDs, including diclofenac sodium extended-release tablets, can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. Patients should be informed about the signs and symptoms of serious skin manifestations and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity.

    Pregnancy

    In late pregnancy, as with other NSAIDs, diclofenac sodium extended-release tablets should be avoided because it may cause premature closure of the ductus arteriosus.

Legal Issues

There is currently no legal information available for this drug.

FDA Safety Alerts

There are currently no FDA safety alerts available for this drug.

Manufacturer Warnings

There is currently no manufacturer warning information available for this drug.

FDA Labeling Changes

There are currently no FDA labeling changes available for this drug.

Uses

  • Carefully consider the potential benefits and risks of diclofenac sodium extended-release tablets, USP and other treatment options before deciding to use diclofenac sodium extended-release tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals (see WARNINGS).

    Diclofenac sodium extended-release tablets are indicated:

    • For relief of the signs and symptoms of osteoarthritis
    • For relief of the signs and symptoms of rheumatoid arthritis

History

There is currently no drug history available for this drug.

Other Information

  • Diclofenac sodium extended-release tablets, USP are benzeneacetic acid derivative. Diclofenac sodium extended-release tablets of 100 mg (pink) are available for oral administration. The chemical name is 2-[(2,6-dichlorophenyl)amino] benzeneacetic acid, monosodium salt. The molecular weight is 318.14. Its molecular formula is C14H10Cl2NNaO2 and it has the following structural formula:

    image description

    The inactive ingredients in diclofenac sodium extended-release tablets include: carnauba wax, cetostearyl alcohol, colloidal silicon dioxide, compressible sugar, copovidone, gum acacia, hydroxypropyl methylcellulose, iron oxide red, magnesium stearate, polyethylene glycol, povidone, sugar, talc, titanium dioxide.

    Meets USP Dissolution Test 2.

Diclofenac Sodium Manufacturers


  • Direct Rx
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Direct Rx]
  • Blenheim Pharmacal, Inc
    Diclofenac Sodium Tablet, Delayed Release [Blenheim Pharmacal, Inc]
  • Proficient Rx Lp
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Proficient Rx Lp]
  • Direct Rx
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Direct Rx]
  • Rxchange Co.
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Rxchange Co.]
  • Proficient Rx Lp
    Diclofenac Sodium Tablet, Delayed Release [Proficient Rx Lp]
  • Pd-rx Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Pd-rx Pharmaceuticals, Inc.]
  • Falcon Pharmaceuticals, Ltd.
    Diclofenac Sodium (Diclofenac Sodium) Solution [Falcon Pharmaceuticals, Ltd.]
  • Stat Rx Usa
    Diclofenac Sodium Tablet, Delayed Release [Stat Rx Usa]
  • Keltman Pharmaceuticals Inc.
    Diclofenac Sodium Tablet, Delayed Release [Keltman Pharmaceuticals Inc.]
  • Physicians Total Care, Inc.
    Diclofenac Sodium Tablet, Extended Release [Physicians Total Care, Inc.]
  • Physicians Total Care, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Physicians Total Care, Inc.]
  • Cardinal Health
    Diclofenac Sodium Tablet, Delayed Release [Cardinal Health]
  • Remedyrepack Inc.
    Diclofenac Sodium (Diclofenac Sodium) Tablet, Delayed Release [Remedyrepack Inc. ]
  • Mckesson Packaging Services A Business Unit Of Mckesson Corporation
    Diclofenac Sodium Tablet, Delayed Release [Mckesson Packaging Services A Business Unit Of Mckesson Corporation]
  • Rebel Distributors Corp
    Diclofenac Sodium Tablet, Delayed Release [Rebel Distributors Corp]
  • Pack Pharmaceuticals, Llc
    Diclofenac Sodium Tablet, Delayed Release [Pack Pharmaceuticals, Llc]
  • Pack Pharmaceuticals, Llc
    Diclofenac Sodium Tablet, Delayed Release [Pack Pharmaceuticals, Llc]
  • Unit Dose Services
    Diclofenac Sodium Tablet, Delayed Release [Unit Dose Services]
  • Pd-rx Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Pd-rx Pharmaceuticals, Inc.]
  • Pd-rx Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Pd-rx Pharmaceuticals, Inc.]
  • Stat Rx Usa Llc
    Diclofenac Sodium Tablet, Delayed Release [Stat Rx Usa Llc]
  • Remedyrepack Inc.
    Diclofenac Sodium Tablet, Delayed Release [Remedyrepack Inc. ]
  • Rebel Distributors Corp
    Diclofenac Sodium Tablet, Delayed Release [Rebel Distributors Corp]
  • Remedyrepack Inc.
    Diclofenac Sodium Tablet, Delayed Release [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Diclofenac Sodium Tablet, Extended Release [Remedyrepack Inc. ]
  • H.j. Harkins Company, Inc.
    Diclofenac Sodium Tablet, Delayed Release [H.j. Harkins Company, Inc.]
  • Unit Dose Services
    Diclofenac Sodium Tablet, Delayed Release [Unit Dose Services]
  • Aphena Pharma Solutions – Tennessee, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Aphena Pharma Solutions – Tennessee, Inc.]
  • Watson Laboratories, Inc.
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Watson Laboratories, Inc.]
  • Teva Pharmaceuticals Usa Inc.
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Teva Pharmaceuticals Usa Inc.]
  • Aphena Pharma Solutions – Tennessee, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Aphena Pharma Solutions – Tennessee, Inc.]
  • Bryant Ranch Prepack
    Diclofenac Sodium Tablet, Extended Release [Bryant Ranch Prepack]
  • Bryant Ranch Prepack
    Diclofenac Sodium Tablet, Delayed Release [Bryant Ranch Prepack]
  • Lake Erie Medical Dba Quality Care Products Llc
    Diclofenac Sodium Tablet, Delayed Release [Lake Erie Medical Dba Quality Care Products Llc]
  • Ncs Healthcare Of Ky, Inc Dba Vangard Labs
    Diclofenac Sodium Tablet, Delayed Release [Ncs Healthcare Of Ky, Inc Dba Vangard Labs]
  • Pd-rx Pharmaceuticals, Inc.
    Diclofenac Sodium (Diclofenac Sodium) Tablet, Film Coated, Extended Release [Pd-rx Pharmaceuticals, Inc.]
  • Lake Erie Medical Dba Quality Care Products Llc
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Lake Erie Medical Dba Quality Care Products Llc]
  • Sandoz Inc
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Sandoz Inc]
  • Lake Erie Medical Dba Quality Care Products Llc
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Lake Erie Medical Dba Quality Care Products Llc]
  • Dispensing Solutions, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Dispensing Solutions, Inc.]
  • Actavis Elizabeth Llc
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Actavis Elizabeth Llc]
  • Actavis Elizabeth Llc
    Diclofenac Sodium Tablet, Delayed Release [Actavis Elizabeth Llc]
  • Pd-rx Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Pd-rx Pharmaceuticals, Inc.]
  • Avkare, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Avkare, Inc.]
  • Clinical Solutions Wholesale
    Diclofenac Sodium Tablet, Delayed Release [Clinical Solutions Wholesale]
  • Dispensing Solutions, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Dispensing Solutions, Inc.]
  • American Health Packaging
    Diclofenac Sodium Tablet, Delayed Release [American Health Packaging]
  • St Marys Medical Park Pharmacy
    Diclofenac Sodium Tablet, Delayed Release [St Marys Medical Park Pharmacy]
  • Mylan Institutional Inc.
    Diclofenac Sodium Tablet, Delayed Release [Mylan Institutional Inc.]
  • Mylan Pharmaceuticals Inc.
    Diclofenac Sodium Tablet, Delayed Release [Mylan Pharmaceuticals Inc.]
  • Bluepoint Laboratories
    Diclofenac Sodium Tablet, Delayed Release [Bluepoint Laboratories]
  • Preferred Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Preferred Pharmaceuticals, Inc.]
  • Mylan Pharmaceuticals Inc.
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Mylan Pharmaceuticals Inc.]
  • Proficient Rx Lp
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Proficient Rx Lp]
  • Carilion Materials Management
    Diclofenac Sodium Tablet, Delayed Release [Carilion Materials Management]
  • Bryant Ranch Prepack
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Bryant Ranch Prepack]
  • Preferred Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Preferred Pharmaceuticals, Inc.]
  • Preferred Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Preferred Pharmaceuticals, Inc.]
  • Preferred Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Preferred Pharmaceuticals, Inc.]
  • Preferred Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Preferred Pharmaceuticals, Inc.]
  • Preferred Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Film Coated, Extended Release [Preferred Pharmaceuticals, Inc.]
  • Sandoz Inc
    Diclofenac Sodium Tablet, Delayed Release [Sandoz Inc]
  • Preferred Pharmaceuticals, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Preferred Pharmaceuticals, Inc.]
  • Blenheim Pharmacal, Inc.
    Diclofenac Sodium Tablet, Delayed Release [Blenheim Pharmacal, Inc.]
  • Proficient Rx Lp
    Diclofenac Sodium Tablet, Delayed Release [Proficient Rx Lp]

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