1. Diclofenac-misoprostol oral tablet is available as a brand-name drug and a generic drug. Brand name: Arthrotec.
  2. Diclofenac-misoprostol comes only as a delayed-release oral tablet.
  3. Diclofenac-misoprostol oral tablet is used to treat joint pain from rheumatoid arthritis and osteoarthritis.

FDA warnings

  • This drug has black box warnings. A black box warning is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Pregnancy warning: Don’t take this medication if you’re pregnant or trying to get pregnant. This medication can harm your pregnancy. Talk to your doctor right away if you’re taking this medication and think you have become pregnant.
  • Heart surgery warning: If you use this drug 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 warning: 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 longer you take this medication, the more the risk of heart problems increases.
  • Gastrointestinal problems warning: This medication can increase the risk of gastrointestinal problems, such as bleeding, ulcers, or 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.

Other warnings

  • Bleeding warning: This medication may cause you to bleed more easily, including bleeding from your gums.
  • Serious skin reactions warning: This drug can cause skin reactions that 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.

Diclofenac-misoprostol is a prescription drug. It comes as an oral delayed-release tablet.

This drug 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 each drug may affect you in a different way.

Diclofenac-misoprostol is available as the brand-name drug Arthrotec. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in every strength or form as the brand-name drug.

Why it’s used

Diclofenac-misoprostol is used to treat the symptoms of rheumatoid arthritis and osteoarthritis. Your doctor may prescribe this medication if you’re at risk of stomach ulcers from other pain medications.

How it works

This medication is a combination of diclofenac and misoprostol. Diclofenac 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.

Diclofenac-misoprostol oral tablet may cause dizziness and drowsiness. Don’t drive a car, use machinery, or perform similar activities that require alertness until you know how this drug affects you.

This medication can also cause other side effects.

More common side effects

The more common side effects that can occur with diclofenac-misoprostol include:

  • diarrhea
  • dizziness
  • gas or heartburn
  • headache
  • menstrual cramps and menstrual irregularity
  • stomach cramps and stomach pain
  • nausea or vomiting
  • constipation
  • increase in liver enzymes (shown in a test that your doctor can do)

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • 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
    • trouble breathing, or wheezing
    • nausea or vomiting
  • Stroke. Symptoms may include:
    • slurred speech
    • weakness on one side of your body
  • Kidney problems. Symptoms may include:
    • unexplained weight gain or swelling
    • feeling tired or weak
  • Jaundice. Symptoms may include:
    • yellowing of your skin or the whites of your eyes

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.

Diclofenac-misoprostol oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with diclofenac-misoprostol are listed below.

Blood pressure drugs

Diclofenac may decrease the blood pressure–lowering effects of some drugs used to control blood pressure. Using diclofenac with certain blood pressure medications may also increase your risk of kidney damage.

Examples of these blood pressure drugs include:

  • angiotensin-converting enzyme (ACE) inhibitors, such as benazepril, captopril, enalapril, and lisinopril
  • angiotensin II receptor blockers, such as candesartan, irbesartan, losartan, and olmesartan
  • beta blockers, such as acebutolol, atenolol, metoprolol, and propranolol
  • diuretics (water pills) such as furosemide or hydrochlorothiazide

Cancer drug

Using the cancer drug pemetrexed with diclofenac may increase the effects of pemetrexed. Symptoms may include fever, chills, body aches, mouth sores, and severe diarrhea.

Other NSAIDs

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). Don’t combine it with other NSAIDs unless directed by your doctor, as this may increase your risk of stomach and bleeding issues. Examples of other NSAIDs include:

  • ketorolac
  • ibuprofen
  • naproxen
  • celecoxib
  • aspirin

Drugs that affect the flow of blood

Taking diclofenac with other drugs that affect the flow of blood through your body can increase your risk of bleeding. Examples of these drugs include:

  • warfarin
  • aspirin
  • selective serotonin reuptake inhibitors (SSRIs), such as escitalopram, fluoxetine, paroxetine, and sertraline
  • serotonin norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine, duloxetine, venlafaxine, and levomilnacipran

Bipolar disorder drug

If you take lithium with diclofenac, it may increase the amount of lithium in your body to harmful levels. Your doctor may monitor your lithium levels closely.

Immunosuppressant drug

Taking cyclosporine, a drug that weakens your immune system, with diclofenac may increase your risk of kidney problems.

Corticosteroids

Using corticosteroids (such as prednisone and prednisolone) with diclofenac isn’t recommended. Combining these drugs may increase your risk of bleeding.

Acid-reducing drugs

Using acid-reducing drugs that contain magnesium with diclofenac-misoprostol isn’t recommended. Combining these drugs may reduce the ability of diclofenac-misoprostol to work as well as it should. It can also increase your risk of diarrhea.

Bone-loss drugs (bisphosphonates)

Use caution when taking diclofenac with bisphosphonates. Combining them can cause dangerous effects in your kidney and stomach. Examples of these drugs include:

  • alendronate
  • risedronate
  • ibandronate

Drugs that affect certain liver enzymes

Diclofenac-misoprostol is cleared by your body through the liver. Combining it with CYP2C9 inhibitors (such as voriconazole) or inducers (such as rifampin), which are also cleared through the liver, may change the amount of diclofenac-misoprostol in your body. Your doctor may need to change your dosage of diclofenac-misoprostol.

Methotrexate

Taking methotrexate with diclofenac can lead to harmful levels of methotrexate in your body. This can raise your risk of infection and kidney issues.

Digoxin

Taking digoxin with diclofenac can lead to increased levels of digoxin in your body and increased side effects. Your doctor may monitor your digoxin levels closely.

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’re taking.

This drug comes with several warnings.

Allergy warning

If you have an allergy to aspirin or other similar NSAIDs, such as ibuprofen or naproxen, you could have an allergic reaction to diclofenac. Call your doctor right away if you have any signs of:

  • wheezing
  • trouble breathing
  • hives
  • itchy rash

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t use this drug again if you’ve ever had an allergic reaction to it or to diclofenac or misoprostol. Using it again could be fatal (cause death).

Alcohol interactions warning

Avoid drinking alcohol when using this drug. Alcohol can increase your risk of stomach bleeding and ulcers from using diclofenac.

Warnings for people with certain health conditions

For 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 a prior history of stomach ulcers or bleeding.

For 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.

For 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 dangerous effects.

For 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 as it should. This can cause a buildup of the drug in your body, which can cause dangerous effects.

Warnings for other groups

For pregnant women: This drug should never be taken during pregnancy. It can harm your pregnancy.

Talk to your doctor if you’re pregnant or plan to become pregnant. Call your doctor right away if you become pregnant while taking this drug.

For women who are breastfeeding: This drug may pass through breast milk to a child who is breastfed. Talk to your doctor before breastfeeding while taking this medication.

For children: There isn’t enough evidence to show that this medication is safe or effective for use in children.

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

Drug forms and strengths

Generic: Diclofenac-misoprostol

  • Form: oral delayed-release tablet
  • Strengths: 50 mg diclofenac/200 mcg misoprostol, 75 mg diclofenac/200 mcg misoprostol

Brand: Arthrotec

  • Form: oral delayed-release tablet
  • Strengths: 50 mg diclofenac/200 mcg misoprostol, 75 mg diclofenac/200 mcg misoprostol

Dosage for rheumatoid arthritis

Adult dosage (ages 18 years and older)

  • Typical dosage: 50 mg diclofenac/200 mcg misoprostol taken 3–4 times per day.
  • Dosage increases: If needed, your dosage can be decreased to 50 mg diclofenac/200 mcg misoprostol taken twice per day, or 75 mg diclofenac/200 mcg misoprostol taken twice per day.

Child dosage (ages 0–17 years)

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

Dosage for osteoarthritis

Adult dosage (ages 18 years and older)

  • Typical dosage: 50 mg diclofenac/200 mcg misoprostol taken 3 times per day.
  • Dosage increases: If needed, your dosage can be decreased to 50 mg diclofenac/200 mcg misoprostol, taken twice per day, or 75 mg diclofenac/200 mcg misoprostol, taken twice per day.

Child dosage (ages 0–17 years)

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

Special dosage considerations

For seniors: People aged 65 years and older might react more strongly to this medication. If you’re a senior, you may need a lower dosage.

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.

Diclofenac-misoprostol is used for short-term treatment. It comes with risks if you don’t take it as prescribed by your doctor.

If you stop taking the drug or don’t take it at all: If you stop using diclofenac and still have swelling and pain, you could have joint or muscle damage that doesn’t heal.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you use too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • stomach ulcer
  • stomach bleeding
  • headache

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

How to tell if the drug is working: You should have less joint pain.

Keep these considerations in mind if your doctor prescribes diclofenac-misoprostol for you.

General

  • You can take this medication with or without food. Taking it with food may help to prevent upset stomach.
  • Don’t crush or cut the oral tablet.

Storage

  • Store diclofenac-misoprostol at 77°F (25°C).
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You shouldn’t need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

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

You should check your own blood pressure from time to time. Home blood pressure monitors are available at most pharmacies and online.

Shop online for blood pressure monitors.

Sun sensitivity

You may have increased sensitivity to the sun while using diclofenac. To protect your skin, use sunscreen with SPF 30 or greater.

Availability

Not every pharmacy stocks this drug. However, you may be able to order it. When filling your prescription, be sure to call the pharmacy first to make sure they stock this drug or can order it for you.

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

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.

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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.