Indications: Inflammatory and degenerative forms of rheumatism: rheumatoid arthritis, including juvenile forms; ankylosing spondylitis; osteoarthrosis and spondylarthritis.
Non-articular rheumatism. Acute attacks of gout. Painful post-operative and post-traumatic inflammation and swelling, pain following dental surgery, and painful inflammatory conditions in gynecology.
Feverish illnesses, especially as an adjuvant to chemotherapy in infectious diseases.
Properties: Diclofenac is a non-steroidal compound with marked antirheumatic, anti-inflammatory, analgesic, and antipyretic properties. Its active substance strongly inhibits prostaglandin synthetase and also has an inhibitory effect on platelet aggregation.
It is suitable for the treatment of inflammatory and degenerative rheumatic diseases, as well as for use in painful conditions due to inflammation of nonrheumatic origin and in post-operative pain. In the presence of inflammation resulting from infection, Diclofenac exerts an antipyretic effect; it also serves to supplement causal chemotherapy for febrile infections.
Diclofenac ampoules are particularly suitable for use as initial therapy for inflammatory and degenerative rheumatic diseases, as well as for the treatment of painful conditions due to inflammation of non-rheumatic origin.

Administration For adults the dosage is generally 1 ampoule daily, injected deep intragluteally into the upper outer quadrant. In severe cases two injections, separated by an interval of a few hours, can be given per day (one into each buttock). Later, Diclofenac tablets or suppositories should be administered instead.

Observe
Side-effects: Diclofenac is generally well tolerated. At the start of treatment, however, patients may sometimes complain of epigastric pain, eructation, nausea, and diarrhoea, or of dizziness or headache. These unwanted effects are usually of a mild nature and normally abate after a few days despite continuation of the medication.
There have been isolated reports of anaphylactoid reactions, mild skin rash, and peripheral oedema, as well as slightly elevated transaminase values.
Administration of the suppositories may occasionally give rise to local irritation.

Contra-indications: Peptic ulcer. Hypersensitivity to the active substance. Like other non-steroidal anti-inflammatory agents, Diclofenac is also contraindicated in asthmatic patients in whom attacks of asthma, urticaria, or acute rhinitis are precipitated by acetylsalicylic acid or by other drugs with prostaglandin-synthetase inhibiting activity.
Interactions: When given concomitantly with lithium, non-steroidal antirheumatic agents raise the latter's blood concentration. Concomitant ingestion of acetylsalicylic acid has the effect of lowering the plasma concentration of Diclofenac. When administered concurrently with anticoagulants or antidiabetic agents, however, Diclofenac exerts no influence on their activity.
Note: Patients with gastro-intestinal symptoms or with severe hepatic or renal damage should be kept under close surveillance.
In the very rare instances where peptic ulceration or gastrointestinal bleeding occurs in patients under treatment with Diclofenac, the drug should be withdrawn.