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- What is diclofenac and misoprostol, and how does it work (mechanism of action)?
- What brand names are available for diclofenac and misoprostol?
- Is diclofenac and misoprostol available as a generic drug?
- Do I need a prescription for diclofenac and misoprostol?
- What are the side effects of diclofenac and misoprostol?
- What is the dosage for diclofenac and misoprostol?
- Which drugs or supplements interact with diclofenac and misoprostol?
- Is diclofenac and misoprostol safe to take if I'm pregnant or breastfeeding?
- What else should I know about diclofenac and misoprostol?
What is diclofenac and misoprostol, and how does it work (mechanism of action)?
Arthrotec is a combination of diclofenac and misoprostol. Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) similar to ibuprofen (Motrin or Advil), naproxen (Naprosyn), and others that is used to treat inflammation, pain, and fever. Diclofenac, like other NSAIDs works by inhibiting the production of prostaglandins. Prostaglandins are a family of chemicals produced by the cells of the body that promote inflammation, pain, and fever. In addition, they support the function of platelets that are necessary for the clotting of blood, and protect the lining of the stomach from the damaging effects of acid.
Prostaglandins are produced by the enzyme cyclooxygenase (Cox). There actually are two Cox enzymes, Cox-1 and Cox-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only Cox-1 produces prostaglandins that support platelets and protect the stomach. Diclofenac blocks both Cox enzymes and reduces prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding. Misoprostol is a synthetic (man-made) prostaglandin that stimulates secretion of mucus in the gastrointestinal tract. Mucus protects the lining of the stomach from acid. Misoprostol has been shown to reduce the frequency of ulcers of the stomach caused by NSAIDs. Arthrotec was approved by the FDA in December 1997.
What are the side effects of diclofenac and misoprostol?
Arthrotec has the side effects of diclofenac and misoprostol. The most common side effects are:
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.
Other important 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.
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What is the dosage for diclofenac and misoprostol?
For osteoarthritis the recommended dose is Arthrotec 50 given three times daily. Patients who cannot tolerate this regimen may be treated with Arthrotec 50 or 75 twice daily. The recommended dose for treating rheumatoid arthritis is Arthrotec 50 given 3-4 times daily. If this regimen is not tolerated, Arthrotec 50 or 75 twice a day may be used. Administering Arthrotec twice daily is less effective for preventing ulcers. Taking Arthrotec with food may reduce stomach upset. It is recommended that Arthrotec not be taken with alcohol because of the increased risk for ulcers.
Which drugs or supplements interact with diclofenac and misoprostol?
(Please also see the drug information for diclofenac.) Diclofenac is generally used with caution in patients taking blood thinning medications (anticoagulants), such as warfarin (Coumadin), because of the increased risk of bleeding.
Antacids reduce the absorption of misoprostol and may delay absorption of diclofenac. Magnesium-containing antacids worsen misoprostol-associated diarrhea. Therefore, Arthrotec should not be administered with magnesium-containing antacids.
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.
Is diclofenac and misoprostol safe to take if I'm pregnant or breastfeeding?
Diclofenac and misoprostol are secreted in breast milk. Arthrotec is not recommended for use by nursing mothers.
What else should I know about diclofenac and misoprostol?
What preparations of diclofenac and misoprostol are available?
Tablets (diclofenac/misoprostol): Arthrotec 50 (50 mg/200 g), Arthrotec 75 (75 mg/200 g) .
How should I keep diclofenac and misoprostol stored?
The tablets should be kept at room temperature, 15 C - 30 C (59 F - 86 F).
Diclofenac and misoprostol (Arthrotec) is a NSAID drug prescribed for the treatment of the signs and symptoms of rheumatoid arthritis and osteoarthritis. Side effects, drug interactions, warnings and precautions, and pregnancy safety should be reviewed prior to taking this medication.
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Rheumatoid Arthritis Quiz: What is Rheumatoid Arthritis?
How is rheumatoid arthritis different from other forms of arthritis, such as osteoarthritis and gout? Take the Rheumatoid...
Picture of Osteoarthritis
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Related Disease Conditions
Rheumatoid Arthritis (RA)
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Ankle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within...
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of cartilage in the joints. Also...
Shoulder bursitis is inflammation of the shoulder bursa. Bursitis may be caused by injury, infection, or a rheumatic condition....
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Treatment & Diagnosis
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Medications & Supplements
- meloxicam (Mobic) Side Effects
- naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
- ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and others)
- celecoxib (Celebrex)
- Drugs: Questions to Ask Your Doctor or Pharmacist about Your Drugs
- Drug Interactions
- piroxicam, Feldene
- misoprostol, Cytotec
- flurbiprofen (Ansaid is a discontinued brand)
- fenoprofen, Nalfon
- Aspirin vs. NSAIDs (Side Effect and Use Differences)
- etodolac, Lodine (Discontinued)
- sulindac, Clinoril
- diflunisal, Dolobid
- valdecoxib, Bextra
Prevention & Wellness
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Facts and Comparisons 4.0. Online Edition Arthrotec prescribing information. Pfizer Inc., 2005.
Arthrotec FDA Prescribing Information, 2010
Top diclofenac and misoprostol Related Articles
Ankle Pain and TendinitisAnkle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
celecoxibCelecoxib (Celebrex - Discontinued Brand) is a NSAID (nonsteroidal antiinflammatory drug) that is used to treat pain, arthritis pain, menstrual cramps, and colonic polyps. Celebrex is also used relief of pain, fever, swelling, and tenderness caused by osteoarthritis, juvenile arthritis, rheumatoid arthritis, and ankylosing spondylitis. There are important drug interactions to review when taking Celebrex. Side effects should also be reviewed.
Drug InteractionsDrug interactions occur frequently. Get facts about the types of drug interactions, what substances or other things that may interact with drugs such as OTC drug and prescription drugs, vitamins, food(s) (grapefruit), and laboratory tests. Find out how to protect yourself from potential drug interactions.
Drugs: What You Should Know About Your DrugsImportant information about your drugs should be reviewed prior to taking any prescription drug. Side effects, drug interactions, warnings and precauctions, dosage, what the drug is used for, what to do if you miss a dose, how the drug is to be stored, and generic vs. brand names.
fenoprofenFenoprofen (Nalfon) is a nonsteroidal antiinflammatory drug (NSAID) used for the treatment of pain and inflammation due to osteoarthritis and rheumatoid arthritis. Fenoprofen (Nalfon) is also used for the treatment of mild to moderate pain for conditions such as menstrual cramps, tendinitis, and bursitis. Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking any medication.
flurbiprofenflurbiprofen (Ansaid - discontinued brand) is a medication prescribed for the treatment of inflammation and pain caused by osteoarthritis, rheumatoid arthritis, soft tissue injuries like bursitis and tendinitis. Side effects, drug interactions, dosage, and pregnancy safety information should be reviewed prior to taking this medication.
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce mild to moderate pain, inflammation, and fever. Ibuprofen works by blocking an enzyme that makes prostaglandin (a hormone-like substance that participates in a variety of body functions), which results in lower levels of prostaglandins in the body. Lower levels of prostaglandins reduce pain, inflammation, and fever.
Ibuprofen is prescribed to treat diseases and conditions that cause mild to moderate pain, fever, and inflammation. For example, Pain from strains and sprains; pain from cuts, scrapes, and puncture wounds; muscle aches and pains; tooth pain; common cold; mild headache; some arthritis conditions; joint pain; and to reduce fever.
Common side effects of ibuprofen include, diarrhea, constipation, nausea, heartburn, belly pain, drowsiness, headaches, tinnitus (ringing in the ears), and mild rash.
More serious side effects and adverse effects include, increased bleeding after injury, stomach ulcers, impaired kidney function, severe allergic reaction (anaphylaxis), blood clots, heart attack, heart failure, and high blood pressure.
The maximum dose prescribed under a doctor's care is 3.2 g daily. Otherwise, the over-the-counter (OTC) maximum daily dose is 1.2 g daily. Dosage depends upon the age, weight, and any current medical conditions of the patient. Several drugs interact with ibuprofen so check with your doctor, pharmacist, or other health care professional with questions in regard to this drug. Doctors don't know if it is safe to take ibuprofen if your are pregnant, therefore it is not recommended if you are pregnant. According to the American Academy of Pediatrics, ibuprofen is safe to take while breastfeeding.
REFERENCE: FDA Prescribing Information.
Knee BursitisBursitis of the knee results when any of the three fluid-filled sacs (bursae) become inflamed due to injury or strain. Symptoms include pain, swelling, warmth, tenderness, and redness. Treatment of knee bursitis depends on whether infection is involved. If the knee bursa is not infected, knee bursitis may be treated with ice compresses, rest, and antiinflammatory and pain medications.
meloxicamMeloxicam (Mobic) is a NASAID prescribed for the treatment of swelling, tenderness, and pain caused by the inflammation of arthritis conditions such as osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis in persons over two years of age. Side effects, drug interactions, and pregnancy safety information should be reviewed prior to taking this medication.
misoprostolMisoprostol (Cytotec) is a drug prescribed for the treatment of of the pain and inflammation of conditions such as arthritis, and for the prevention of stomach ulcers in patient's treated with nonsteroidal antiinflammatory drugs (NSAIDs). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking any medication.
naproxenNaproxen (Aleve, Anaprox, Naprelan, Naprosyn) is in the class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen is prescribed for the treatment of mild to moderate pain, inflammation, and fever. Side effects, drug interactions, and pregnancy information should be reviewed prior to taking this medication.
OsteoarthritisOsteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of cartilage in the joints. Also known as degenerative arthritis. Osteoarthritis can be caused by aging, heredity, and injury from trauma or disease.
Osteoarthritis PictureOsteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. See a picture of Osteoarthritis and learn more about the health topic.
piroxicamPiroxicam (Feldene) is a NSAID prescribed for the treatment of rheumatoid arthritis and osteoarthritis. Side effects, drug interactions, warnings and precautions, and pregnancy safety information should be reviewed prior to taking this medication.
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Take the RA QuizHow is rheumatoid arthritis different from other forms of arthritis, such as osteoarthritis and gout? Take the Rheumatoid Arthritis (RA) Quiz to rest your RA IQ.
Shoulder BursitisShoulder bursitis is inflammation of the shoulder bursa. Bursitis may be caused by injury, infection, or a rheumatic condition. Symptoms include pain, swelling, tenderness, and pain with movement of the shoulder joint. Treatment may involve ice compresses, rest, and anti-inflammatory medications and depends on whether there is an infection.