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Diclofenac / misoprostol Side Effects

For the Consumer

Applies to diclofenac / misoprostol: oral tablet enteric coated


Oral route (Tablet, Enteric Coated)

Diclofenac sodium/misoprostol should not be administered during pregnancy as abortion, premature birth, or birth defects can occur. Avoid use in women of childbearing potential unless the patient requires NSAID therapy and is at high risk of developing complications from gastric or duodenal ulcers and meets the following criteria: has a negative serum pregnancy test within 2 weeks of treatment initiation, uses effective contraception, receives oral and written warnings of the hazards of misoprostol, and initiates therapy only on the second or third day of her next normal menstrual period. NSAIDs cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use. Diclofenac sodium/misoprostol is contraindicated in the setting of CABG surgery. NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

Side effects requiring immediate medical attention

Along with its needed effects, diclofenac / misoprostol may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking diclofenac / misoprostol:

Less common

  • Black, tarry stools
  • bleeding or crusting sores on the lips
  • blood in the urine or stools
  • bruises or red spots on the skin
  • chest pain
  • chills
  • confusion
  • continuing thirst
  • convulsions (seizures)
  • cough or hoarseness
  • disorientation
  • drowsiness
  • fainting
  • fever with or without chills
  • fluid retention
  • general feeling of illness
  • heartburn or indigestion
  • increased heart rate
  • increased weight gain
  • irregular heartbeat
  • itching of the skin
  • large, flat, blue or purplish patches on the skin
  • lightheadedness or dizziness
  • lower back or side pain
  • mental depression
  • muscle cramps
  • nausea
  • painful or difficult urination
  • pounding heartbeat
  • psychotic reaction
  • rectal bleeding
  • seeing, hearing, or feeling things that are not there
  • severe headache
  • severe liver reactions
  • severe stomach pain, cramping, or burning
  • skin rash
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • stiff neck or back
  • sudden decrease in the amount of urine
  • swelling or tenderness in the upper stomach
  • swelling of the face, fingers, feet, or lower legs
  • troubled breathing, tightness in the chest
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting of material that looks like coffee grounds
  • yellow eyes or skin


  • Changes in facial skin color
  • fast or irregular breathing
  • puffiness or swelling of the eyelids or around the eyes

Get emergency help immediately if any of the following symptoms of overdose occur while taking diclofenac / misoprostol:

Symptoms of overdose

Side effects not requiring immediate medical attention

Some side effects of diclofenac / misoprostol may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Gas

Less common

  • Abnormal vision
  • acne
  • change in sense of taste
  • decreased appetite
  • decrease in sexual ability
  • dry mouth
  • irritability or nervousness
  • loss of hair
  • muscle pain
  • tingling, burning, or prickling sensations
  • trouble with swallowing
  • vaginal bleeding

For Healthcare Professionals

Applies to diclofenac / misoprostol: oral tablet


The highest reported incidences of adverse events for this drug were gastrointestinal and included abdominal pain, diarrhea, dyspepsia, nausea, and flatulence.[Ref]


NSAIDs including this drug, can cause serious gastrointestinal (GI) events which can occur at any time, with or without warning. For patients who develop a serious upper GI event, only about 20% were symptomatic. Upper GI ulcers, gross bleeding, or perforation occurred in approximately 1% of patients treated with NSAIDs for 3 to 6 months and 2% to 4% of patients treated for 1 year. Patients with a prior history of peptic ulcer disease and/or GI bleeding had a greater than 10-fold increased risk for developing a GI bleed than patients with neither of these risk factors.[Ref]


Very common (10% or more): Abdominal pain (21%), diarrhea (19%), dyspepsia (14%), nausea (11%)

Common (1% to 10%): Flatulence, gastritis, vomiting, eructation, constipation, peptic ulcer

Uncommon (0.1% to 1%): Stomatitis

Rare (less than 0.1%): Esophageal ulceration, esophagitis, gastroesophageal reflux, heartburn, hematemesis, melena, gall bladder disorder

Frequency not reported: Pancreatitis

Postmarketing reports: Gastrointestinal (GI) perforation, GI bleeding, melena, colitis, Crohn's disease, esophageal disorder, mouth ulceration, tongue edema, dry mouth


Very common (10% or more): Abdominal pain (15%), diarrhea (11%), dyspepsia (11%), nausea (11%)

Common (1% to 10%): Flatulence, nausea[Ref]


Uncommon (0.1% to 1%): Hypertension, chest pain, edema, palpitation, syncope

Rare (less than 0.1%): Arrhythmia, atrial fibrillation, hypotension, myocardial infarction, premature ventricular contractions, tachycardia, vasculitis, phlebitis

Frequency not reported: Cardiac failure, palpitations[Ref]

Clinical trials of several cyclooxygenase (COX)-2 selective and nonselective NSAIDs of up to 3 years duration have shown an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs appear to have a similar risk. There is no consistent evidence that concurrent use of aspirin mitigates this increased risk and may be associated with an increased risk of serious gastrointestinal events.[Ref]


Common (1% to 10%): Alanine aminotransferase increased, aspartate aminotransferase increased

Rare (less than 0.1%): Hepatitis, jaundice, abnormal hepatic function

Frequency not reported: Liver failure

Postmarketing reports: Hepatitis fulminant, blood bilirubin increased[Ref]

Elevations to greater than 3 x ULN of ALT occurred in about 1.6% (n=2184) of patients receiving diclofenac-misoprostol at some point during treatment. These increases were generally transient and returned to within normal range upon discontinuation of therapy. In an open-labeled trial among patients receiving NSAIDs, a higher incidence of transaminase elevations were observed in patients receiving diclofenac compared with other NSAIDs.[Ref]


Rare (less than 0.1%): Allergic reactions

Frequency not reported: Angioedema, laryngeal/pharyngeal edema, urticaria

Postmarketing reports: Anaphylaxis[Ref]


Common (1% to 10%): Erythema multiforme, rash, pruritus

Uncommon (0.1% to 1%): Purpura, urticaria

Rare (less than 0.1%): Angioedema, increased sweating, acne

Postmarketing reports: Toxic epidermal necrolysis, Stevens-Johnson syndrome, dermatitis exfoliative, dermatitis bullous, Henoch Schonlein purpura, mucocutaneous rash, rash vesicular, photosensitivity reaction, alopecia[Ref]


Frequency not reported: Renal failure, glomerulonephritis membranous, glomerulonephritis minimal lesion

Postmarketing reports: Acute renal failure, renal papillary necrosis, nephritis, interstitial nephrotic syndrome, proteinuria[Ref]


NSAIDs inhibit platelet aggregation and have been shown to prolong bleeding time in some patients. Unlike aspirin, the NSAID effect on platelet function is quantitatively less, of shorter duration, and reversible.[Ref]

Uncommon (0.1% to 1%): Thrombocytopenia

Rare (less than 0.1%): Agranulocytosis, anemia, aplastic anemia, coagulation time increased, ecchymosis, eosinophilia, hemolytic anemia, leukocytosis, leukopenia, lymphadenopathy, pancytopenia, decreased hematocrit[Ref]


Rare (less than 0.1%): Anorexia, appetite changes, dehydration, hyperglycemia, hypoglycemia, hyponatremia, weight changes, gout, hypercholesterolemia, porphyria[Ref]

Nervous system

Common (1% to 10%): Headache, dizziness

Rare (less than 0.1%): Drowsiness, headache, hyperesthesia, hypertonia, hypoesthesia, insomnia, meningitis, migraine, neuralgia, paresthesia, somnolence, stroke, tremor, confusion

Frequency not reported: Coma

Postmarketing reports: Convulsions, memory disturbance, taste disturbance[Ref]


Common (1% to 10%): Insomnia

Rare (less than 0.1%): Anxiety, impaired concentration, depression, dream abnormalities, hallucinations, irritability, nervousness, paranoia, psychotic reaction

Postmarketing reports: Mood changes, nightmares[Ref]


Rare (less than 0.1%): Asthenia, fatigue, fever, malaise, chills, hearing impairment, tinnitus, speech disorder[Ref]


Misoprostol may cause abortion. It has been used outside of its approved indications to ripen the cervix, to induce labor, and to treat postpartum hemorrhage, however a major adverse effect of these uses is hyperstimulation of the uterus. Uterine rupture, amniotic fluid embolism, and severe genital bleeding have been reported.[Ref]


Rare (less than 0.1%): Vaginitis, menstrual disorder, menorrhagia, dysmenorrhea, intermenstrual bleeding, cystitis, dysuria, nocturia

Frequency not reported: Impotence, perineal pain

Postmarketing reports: Intrauterine death, uterine rupture, incomplete abortion, abnormal uterine contractions, retained placenta, dysuria, urine abnormal


Frequency not reported: Hyperstimulation of the uterus, amniotic fluid embolism resulting in maternal and fetal death, severe vaginal bleeding, retained placenta, pelvic pain, uterine rupture[Ref]


Rare (less than 0.1%): Amblyopia, blurred vision, conjunctivitis, diplopia, glaucoma, iritis, lacrimation abnormal, night blindness, abnormal vision, eye pain[Ref]


Rare (less than 0.1%): Coughing, dyspnea, hyperventilation, pneumonia, respiratory depression, pharyngitis, increased sputum

Postmarketing reports: Asthma, pneumonitis, dyspnea[Ref]


Frequency not reported: Infection, sepsis

Postmarketing reports: Aseptic meningitis[Ref]


Rare (less than 0.1%): Arthralgia, myalgia, leg cramps[Ref]


1. "Product Information. Arthrotec (diclofenac-misoprostol)." Searle, Skokie, IL.

2. Cerner Multum, Inc. "Australian Product Information." O 0

3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.