Generic Name: diclofenac-misoprostol, Oral tablet

Arthrotec

All Brands

  • Arthrotec
SECTION 1 of 4

Highlights for diclofenac-misoprostol

Oral tablet
1

Diclofenac sodium/misoprostol is an oral drug used to treat joint pain from rheumatoid arthritis and osteoarthritis.

2

Your doctor may prescribe this medication if you have a high risk of getting stomach inflammation from other pain medications.

3

This medication should be used at the lowest effective dose and for the shortest amount of time possible.

4

This medication can cause serious side effects on your heart, kidneys, skin, stomach, and intestines.

IMPORTANT INFORMATION

FDA Warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Pregnancy warning. Don’t take this medication if you’re pregnant or trying to get pregnant. This medication can harm the fetus when given to pregnant women. Speak with your doctor right away if you’re taking this medication and think you have become pregnant.

Heart surgery warning. If you use diclofenac sodium/misoprostol and are going to have a procedure called coronary artery bypass graft, you’ll need to stop taking this medication before surgery. Talk to your doctor about when you need to stop taking it and how long after the procedure you have to wait before taking it again. 

Heart problems. This medication can increase the risk of heart problems, such as heart attack and stroke. This risk is greater for people who have heart disease. These conditions can be fatal. The risk of heart problems increases the longer you take this medication. 

Gastrointestinal problems. This medication can increase the risk of gastrointestinal problems, such as: 

  • bleeding
  • ulcers
  • holes in your stomach and intestines 

These conditions can be fatal. These problems can happen at any time and sometimes without any warning. People older than 65 years are at an increased risk of these problems.

Bleeding more easily

This medication may cause you to bleed more easily, including bleeding from your gums.

Serious skin reactions

These skin reactions can be fatal and can occur without warning. Call your doctor or get emergency medical help if you have a skin rash, itching, blistering, peeling skin, or a fever.

Drug Features

Diclofenac sodium/misoprostol is a prescription drug. It’s available as an oral delayed-release tablet.

Diclofenac sodium/misoprostol is a combination of two or more drugs in a single form. It’s important to know about all the drugs in the combination because they each may have unique traits. 

Diclofenac sodium/misoprostol is available in its generic form. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand.  Talk to your healthcare provider to see if the generic will work for you.

Why It's Used

Diclofenac sodium/misoprostol is used to treat the symptoms of rheumatoid arthritis and osteoarthritis in adults. Your doctor may prescribe this medication if you’re at risk for stomach ulcers from other pain medicines.

How It Works

This medication is a combination of diclofenac sodium and misoprostol. Diclofenac sodium is a nonsteroidal anti-inflammatory drug (NSAID).

More Details

How It Works

This medication is a combination of diclofenac sodium and misoprostol. Diclofenac sodium is a nonsteroidal anti-inflammatory drug (NSAID). Misoprostol is a prostaglandin analog.

Diclofenac works to reduce pain, swelling, and fever. However, NSAIDs can cause stomach and intestinal ulcers. Misoprostol works to reduce the risk of stomach ulcers in people who take NSAIDs.

SECTION 2 of 4

diclofenac-misoprostol Side Effects

Oral tablet

Most Common Side Effects

The most common side effects that occur with diclofenac sodium/misoprostol include:

  • diarrhea

  • dizziness

  • gas or heartburn

  • headache

  • menstrual cramps and menstrual irregularity

  • stomach cramps and stomach pain

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening or if you think you’re experiencing a medical emergency, call 9-1-1.

  • allergic reactions, such as:

    • skin rash
    • itching or hives
    • swelling of your face, lips, or tongue
  • abnormal bleeding. Symptoms may include:

    • black or bloody stools
    • blood in your urine or vomit
  • blurred vision

  • heart attack. Symptoms may include:

    • chest pain
    • difficulty breathing or wheezing
    • nausea or vomiting
  • stroke. Symptoms may include:

    • slurred speech or weakness on one side of your body
  • kidney problems. Symptoms may include:

    • unexplained weight gain or swelling
    • feeling tired or weak
  • yellowing of your skin or the whites of your eyes

Pharmacist's Advice
Healthline Pharmacist Editorial Team

Diclofenac sodium/misoprostol may cause dizziness and drowsiness. Don’t drive a car, operate machinery, or perform similar activities that require alertness until you know how this medicine affects you. 

Mild side effects may go away within a couple of weeks. Talk to your doctor or pharmacist if they’re more severe or don’t go away.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

diclofenac-misoprostol May Interact with Other Medications

Oral tablet

Diclofenac sodium/misoprostol may interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce the chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol Interactions

Alcohol and diclofenac sodium/misoprostol interact with each other. Drinking alcohol while taking this medication increases your risk of stomach side effects, such as bleeding and ulcers. You shouldn’t drink alcohol while taking this drug.

Medications That Might Interact with This Drug

Antiviral drug
  • cidofovir

Combining these medications can lead to a poisonous effect on your kidneys. If you need to take cidofovir, stop diclofenac sodium/misoprostol 7 days before starting cidofovir. 

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Examples are:

  • ketorolac
  • ibuprofen
  • naproxen

Don’t use ketorolac with this medication. Combining them can lead to serious side effects, including stomach pain and bleeding.

Using NSAIDs with this medication isn’t recommended. Combining them increases your risk of gastrointestinal and kidney side effects. 

Disease-modifying antirheumatic drug (DMARD)
  • methotrexate 

Don’t take medium to high doses of methotrexate with this medication. If you combine the two drugs, your body won’t be able to clear methotrexate as easily. This can cause too much of it to build up in your body and lead to severe blood toxicity, stomach and intestinal toxicity, or death.

If you’re taking lower doses of methotrexate, use caution when taking diclofenac sodium/misoprostol.

Chemotherapy drug
  • pemetrexed 

Don’t take these medications together. If you combine them, your body may not be able to clear pemetrexed fast enough. This could lead to increased side effects of pemetrexed. If you need to take both drugs, your doctor may monitor you for kidney side effects, stomach side effects, and blood cell production.

Bone loss drugs (bisphosphonates)

Use caution when taking both of these medications together. Combining them can cause toxicity in your kidney and stomach.

Examples of these drugs include:

  • alendronate (Fosamax)
  • risedronate (Actonel)
  • ibandronate (Boniva)

Anticoagulants and gingko

It‘s not recommended to take these medications with diclofenac sodium/misoprostol. Combining them can increase your risk of gastrointestinal bleeding.

Cholesterol-lowering drug
  • cholestyramine

Combining these medications may decrease the effect of diclofenac. If you need to take both of these medications, you should stagger the doses.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with stomach bleeding

Don’t take this medication if you have an active bleed in your stomach or intestines. Use it with caution if you have had a prior history of stomach ulcers or bleeding.

People with heart problems

This medication can increase the risk of serious heart problems, such as heart attack and stroke, in people who have heart disease or risk factors.

Use this medication with caution if you have high blood pressure. It can worsen blood pressure, which can raise your risk of heart problems. Monitor your blood pressure closely while taking this medication.

People with kidney disease

If you have kidney disease, use this medication with caution. If you have advanced kidney disease, don’t take it at all. This medication is removed through your kidneys. Your kidneys may not be able to remove the drug from your body like it should. This can cause a buildup of the drug in your body, which can cause toxic effects.

People with liver damage

Use this medication with caution If you have liver damage. If you take this medication long term, your doctor may periodically check your liver function. This medication is processed through your liver. If your liver is damaged, it may not be able to process the drug like it should. This can cause a buildup of the drug in your body, which can cause toxic effects.

Pregnant women

Diclofenac sodium/misoprostol is a pregnancy category X drug. This drug should never be taken during pregnancy. This medication harms the fetus when given to a pregnant woman.

Speak with your doctor right away if you’re pregnant or plan to become pregnant.

Women who are nursing

This medication may pass through breast milk to the nursing baby. Talk to your doctor before breastfeeding while taking this medication.

For Children

There is not enough evidence to show that this medication is safe and effective in children.

Allergies

Don’t take this drug again if you’ve ever had an allergic reaction to it or either diclofenac or misoprostol. Taking it a second time after an allergic reaction could be fatal.

SECTION 4 of 4

How to Take diclofenac-misoprostol (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Rheumatoid arthritis
Form: Oral delayed-release Tablet
Strengths: 50 mg diclofenac sodium/200 micrograms misoprostol, 75 mg diclofenac sodium/200 micrograms misoprostol
Adult Dosage (ages 18 years and older)
  • 50 mg diclofenac sodium/200 micrograms misoprostol taken 3–4 times per day.
  • If you can’t take that high of a dose, your dose can be decreased to 50 mg diclofenac sodium/200 micrograms misoprostol taken twice per day or 75 mg diclofenac sodium/200 micrograms misoprostol taken twice per day.
Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Special Considerations

Seniors: People aged 65 years and older might react more strongly to this medication. If you’re a senior, you may need a smaller dose.

Osteoarthritis
Form: Oral delayed-release Tablet
Strengths: 50 mg diclofenac sodium/200 micrograms misoprostol, 75 mg diclofenac sodium/200 micrograms misoprostol
Adult Dosage (ages 18 years and older)
  • 50 mg diclofenac sodium/ 200 micrograms misoprostol taken 3 times per day.
  • If you can’t take that high of a dose, your dose can be decreased to 50 mg diclofenac sodium/200 micrograms misoprostol, taken twice per day or 75 mg diclofenac sodium/200 micrograms misoprostol, taken twice per day.
Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Special Considerations

Seniors: People aged 65 years and older might react more strongly to this medication. If you’re a senior, you may need a smaller dose.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Diclofenac sodium/misoprostol comes with risks if you don’t take it as prescribed by your doctor.

If You Don’t Take It At All, Miss Doses, or Stop Taking it

If you don’t take it at all, miss doses, or stop taking it, your arthritis pain may get worse.

If You Take Too Much

Contact a poison control center or emergency department right away.

What to Do If You Miss a Dose

If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, wait and take a single dose. Don’t take extra doses.

How to Tell If the Drug Is Working

You may be able to tell this drug is working if you experience less joint pain.

Diclofenac sodium/misoprostol is a short-term drug treatment.

Important Considerations for Taking Diclofenac sodium/misoprostol
take with or without food You can take this medication with or without food. Taking it with food may help to prevent upset stomach
do not cut or crush Don’t crush or cut the oral tablet
storage Store at 68–77°F (20–25°C) See Details
refillable prescription Prescription is refillable
luggage Travel See Details
clinical monitoring Clinical Monitoring See Details
prior authorization needed Insurance See Details

Store at 68–77°F (20–25°C)

Make sure to keep the container tightly closed. 

Note: Be careful of moist environments, including bathrooms. To keep drugs away from moisture, store them somewhere other than your bathroom and any other damp location.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt this medication.
  • You may need to show your pharmacy’s preprinted label to identify the medication. Keep the original prescription-labeled bottle with you when traveling.

Clinical Monitoring

Your doctor may monitor your kidney function and liver function while you take this medication. They may do these tests more often if you’re at high risk of developing problems from this medication. Your blood counts may be checked regularly to make sure that they’re normal. You may have a stool exam done to check for blood.

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for diclofenac sodium/misoprostol.

Are There Any Alternatives?

There are other medications available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

What does the pill look like?

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on May 4, 2015

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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