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Diclofenac is a potent inhibitor of prostaglandin synthesis in vitroDiclofenac concentrations reached during therapy have produced in vivo effectsProstaglandins sensitize afferent nerves and potentiate the action of bradykinin in inducing pain in animal modelsProstaglandins are mediators of inflammationBecause diclofenac is an inhibitor of prostaglandin synthesisits mode of action may be due to a decrease of prostaglandins in peripheral tissues.

Gastrointestinal experiences includingabdominal painconstipationdiarrheadyspepsiaflatulencegross bleeding/perforationheartburnnauseaGI ulcersgastric/duodenaland vomiting.

During concomitant use of VOLTAREN and ACE-inhibitorsARBsor beta-blockersmonitor blood pressure to ensure that the desired blood pressure is obtainedDuring concomitant use of VOLTAREN and ACE-inhibitors or ARBs in patients who are elderlyvolume-depletedor have impaired renal functionmonitor for signs of worsening renal functionsee WARNINGSRenal Toxicity And HyperkalemiaWhen these drugs are administered concomitantlypatients should be adequately hydratedAssess renal function at the beginning of the concomitant treatment and periodically thereafter.

Advise patients to report symptoms of ulcerations and bleedingincluding epigastric paindyspepsiamelenaand hematemesis to their health care providerIn the setting of concomitant use of low-dose aspirin for cardiac prophylaxisinform patients of the increased risk for the signs and symptoms of GI bleedingsee WARNINGSGastrointestinal BleedingUlcerationAnd Perforation

Advise patients to stop VOLTAREN immediately if they develop any type of rash and contact their healthcare provider as soon as possiblesee WARNINGSSerious Skin Reactions

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inform pregnant women to avoid use of voltaren and other nsaids, starting at 30 weeks gestation because of the risk of the premature closure of the fetal ductus arteriosus see warnings; premature closure of fetal ductus arteriosus .

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