diclofenac and misoprostol, Arthrotec (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
Combining NSAIDs with angiotensin receptor blockers (for example, valsartan [Diovan], losartan [Cozaar], irbesartan [Avapro]) or angiotensin converting enzyme inhibitors (for example, enalapril [Vasotec], captopril [captopril]) in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.
Diclofenac may increase blood levels of digoxin (Lanoxin)and lead to digoxin toxicity. Digoxin levels should be monitored.
PREGNANCY: Since misoprostol can cause abortions, Arthrotec should not be used by women who are pregnant. Women also should avoid pregnancy for one month or one menstrual cycle after discontinuing Arthrotec.
NURSING MOTHERS: Diclofenac and misoprostol are secreted in breast milk. Arthrotec is not recommended for use by nursing mothers.
SIDE EFFECTS: Arthrotec has the side effects of diclofenac and misoprostol. The most common side effects are stomach pain, diarrhea, dyspepsia, nausea, and flatulence. Diarrhea and abdominal pain may resolve after 2-7 days. Magnesium containing antacids worsen diarrhea caused by misoprostol. Taking Arthrotec with food and avoiding antacids containing magnesium may reduce the occurrence of diarrhea. Serious side effects include gastrointestinal ulcers and bleeding; liver dysfunction; severe skin reactions, allergic reactions, and kidney failure. Severe bronchospasms may occur in patients with aspirin-sensitive asthma. Like other NSAIDS, Arthrotec may cause heart attacks and strokes; accumulation of fluid and worsen heart failure; cause or worsen hypertension and kidney failure.
Last Editorial Review: 1/5/2012
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