Diclofenac for pain and inflammation

Name of medicine

Diclofenac sodium (often referred to as diclofenac)
Common brands: Defenac, Dicloflex, Diclovol, Diclozip, Fenactol, Flamrase, Voltarol

Why is it important for my child to take Diclofenac?

This leaflet is about the use of diclofenac to reduce mild-to-moderate pain and inflammation. This might be after an injury, or due to a long-term condition such as juvenile arthritis. Diclofenac will help your child to feel less pain. It works best for inflammation and long-term pain when taken regularly for a few days.

What is Diclofenac available as?

• Tablets: 25 mg, 50 mg
• Dispersible tablets: 10 mg (special order), 50 mg
• Suppositories: 12.5 mg, 25 mg or 50 mg

When should I give Diclofenac

• Diclofenac tablets are usually given three times a day. This should be first thing in the morning, early afternoon and at bedtime. Ideally, these times are at least 4 hours apart.
• Suppositories are given twice a day. This should be one in the morning, and one at bedtime. Ideally these times should be 10–12 hours apart.

Your doctor will tell you how often to give diclofenac to your child.

How much should I give?

Your doctor will work out the amount of Diclofenac (the dose) that is right for your child. The dose will be shown on the medicine label.

How should I give Diclofenac?

Tablets

• Tablets should be swallowed with a glass of water, squash or juice. Your child should not chew the tablet.

Dispersible tablets

• Dissolve the tablet in a glass of water or squash. Your child should drink it all, straight away. You can give the mixture to your child using a spoon or oral syringe.

Suppositories

• Suppositories are inserted into the rectum (back passage).
• Ideally your child should open their bowels (do a poo) before you administer Diclofenac suppositories.
• Wash your hands with soap and hot water.
• Your child should be lying on his or her side or front.
• Hold one buttock gently to one side so that you can see the back passage.
• Unwrap the suppository and hold the it with the rounded end close to the back passage.
• Use one finger to push the suppository gently into the back passage. It needs to go in by about 2 cm. (You can use lubricating gel to make the insertion more comfortable.)
• Your child should stay lying down for about 15 minutes, and ideally for an hour, so that the suppository doesn’t come out.
• Wash your hands again with soap and hot water.
• If your child empties their bowels (does a poo) within 30 minutes of inserting a suppository, you may need to insert another one.

When should the medicine start working?

•  Your child should start to feel less pain within an hour of taking diclofenac.
• If your child is taking diclofenac for inflammation, they will need to take it regularly for about 3 weeks for it to work properly. For arthritis, it may take up to 12 weeks for the full benefit to be felt.

What if my child is sick (vomits)?

Tablets or liquid medicine

• If your child is sick less than 30 minutes after having a dose of diclofenac, give them the same dose again.
• If your child is sick more than 30 minutes after having a dose of diclofenac, you do not need to give them another dose.

Wait until the next normal dose. If your child is sick again, seek advice from your GP, pharmacist or hospital. They will decide what to do based on your child’s condition and the specific medicine involved.

Suppositories

• If your child is sick at any time, you do not need to give them another dose, as the suppository will still work

What if I forget to give it?

If your child is in pain, give the missed dose as soon as you remember. You must then wait at least 6 hours before giving the next dose.

What if I give too much?

• If you think you may have given your child an extra dose of diclofenac by mistake, wait at least 12 hours before giving another dose.
• If your child may have had more than a double dose of diclofenac, or you are not sure, contact your doctor or local NHS services (details at end of leaflet), or take your child to hospital straight away.
• Take the medicine container or pack with you, even if it is empty. This will be useful to the doctor. Have the packet with you if you telephone for advice.
• If your child has heart, kidney or liver disease, you must be particularly careful not to give too much diclofenac.

Are there any possible side effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side effects).

Side effects you must do something about

Other side-effects you need to know about

• Diclofenac may cause stomach pain, indigestion and heartburn, and your child may feel sick or be sick (vomit). You can help to reduce this by giving diclofenac with food.
• If these symptoms carry on, they may be signs of irritation to the stomach and oesophagus (food pipe). Contact your doctor if this happens.
• Diclofenac suppositories may irritate your child’s bottom.

• Your child may get diarrhoea.

There may sometimes be other side effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side effects to a UK safety scheme at mhra.gov.uk/yellowcard

Can other medicines be given at the same time as Diclofenac?

• You can give your child medicines that contain paracetamol, unless your doctor has told you not to.

Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal and complementary medicines.

Is there anything else I need to know about this medicine?

• Diclofenac is one of a group of drugs called ‘nonsteroidal anti-inflammatory drugs’ (NSAIDs). If your child has previously reacted to other drugs of this type, you should tell your doctor before starting diclofenac.
• Diclofenac can make asthma worse in some children, but this is rare.
• Diclofenac can cause stomach bleeding or an ulcer in the gut when taken regularly for long periods of time. Give diclofenac to your child with some food to help prevent this. Your doctor may prescribe an antacid, a medicine for indigestion, such as ranitidine.
• Your child’s skin may become more sensitive to sunlight. Keep them out of strong sun, and use a high-factor sun block (at least SPF 15). It is particularly important to avoid sunburn. They should not go on a sun bed.
• Your child should drink plenty of fluids, such as water, while they are taking this medicine. If your child becomes dehydrated (not enough water in the body), diclofenac may affect their kidneys. If you are concerned, contact your doctor or nurse. 

General advice about medicines

• If you are not sure a medicine is working, contact your doctor but continue to give the medicine as usual in the meantime. Do not give extra doses, as you may do harm.

• Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.

• Try to give medicines at about the same times each day, to help you remember.

• Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.

• Make sure that the medicines you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Where should I keep this medicine?

• Make sure that children cannot see or reach the medicine.

• Keep the medicine in the container it came in.

• Keep the medicine in a cupboard, away from heat and direct sunlight.

• It does not need to be kept in the fridge.

Who to contact for more information?

Your doctor, pharmacist or nurse will be able to give you more information about Diclofenac and about other medicines used to treat pain.

Copyright disclaimer

Version [1]. © NPPG, RCPCH and WellChild, all rights reserved. Review by December 2016.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk.

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.