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DIFLUNISAL 500MG FILM-COATED TABLETS
Active substance(s): DIFLUNISAL
145 mm x 260 mm
Headings: Helvetica bold 8 pt
Text: Helvetica 7 pt
PLEASE READ ALL OF THIS LEAFLET
CAREFULLY BEFORE YOU START TO TAKE
Keep this leaflet. You may want to read it again.
WHAT IS IN YOUR TABLETS?
The active ingredient in your Diflunisal Tablets is
diflunisal. Two strengths of Diflunisal Tablets are
available: peach-coloured, capsule-shaped,
film-coated tablets, marked 'MSD 675' containing
250 mg diflunisal; and orange-coloured,
capsule-shaped, film-coated tablets, marked 'MSD
697' containing 500 mg diflunisal.
Diflunisal 250 mg and 500 mg Tablets contain the
following inactive ingredients: microcrystalline
cellulose E460, hydroxypropylcellulose E463,
pregelatinised maize starch, magnesium stearate
E572, sunset yellow aluminum lake E110, talc,
titanium dioxide E171, methylhydroxypropylcellulose
E464. In addition, the peach-coloured 250 mg tablets
contain carnauba wax E903.
Diflunisal tablets are supplied in blister packs of 60
HOW DO YOUR TABLETS WORK?
The active ingredient in your tablets is diflunisal.
Diflunisal is one of a group of medicines known as
non-steroidal anti-inflammatory drugs or 'NSAIDs'.
NSAIDs work as painkillers and also reduce
inflammation in joints, muscles, and ligaments. These
medicines may do this by decreasing the production
of naturally occurring chemicals in your body, called
prostaglandins, which can cause inflammation.
WHO MAKES YOUR TABLETS?
Your tablets are made by Merck Manufacturing
Division, Merck Sharp & Dohme Limited, Shotton
Lane, Cramlington, Northumberland NE23 3JU, UK.
The Marketing Authorisation is held by Chemidex
Pharma Ltd, trading as Essential Generics, 7 Egham
Business Village, Crabtree Road, Egham, Surrey
WHY DO YOU NEED TO TAKE THESE
Your doctor has probably prescribed Diflunisal for you
for one of the following reasons which he will have
explained to you:
• to relieve pain
• to relieve pain and inflammation of joints or
tendons caused by a condition called rheumatoid
arthritis or osteoarthritis
• to relieve period pains.
ARE THERE PATIENTS WHO SHOULD NOT
TAKE THESE TABLETS?
Do not take the tablets if:
• you are in the last three months of pregnancy
• you are breast-feeding
• you have had a bad or allergic reaction to this or
similar medicines, or to any of the ingredients in
• you have had difficulty breathing, including
asthma, itchy rashes, localized swelling or
hay fever, after taking aspirin, ibuprofen or other
• you have, or have ever had an ulcer in your
stomach or intestine
• you have, or have ever had active bleeding in
your digestive system - symptoms of this would
be abdominal pain, vomiting blood, or if your
faeces are black or contain blood.
• you have severe liver, kidney or heart disease.
In addition, Diflunisal is not recommended for use in
If you think any of these apply to you, do not take the
tablets, go and talk to your doctor first and follow his
WHAT ELSE SHOULD YOU KNOW BEFORE
TAKING YOUR TABLETS?
You should check with your doctor before taking
• you have a problem with your blood clotting
• in the past you have had ulcers in your stomach
or intestine or had any bleeding from your
digestive system, or Crohn's disease.
• you suffer from heart, asthma, liver or
kidney problems, particularly if you are
• you suffer from high blood pressure, fluid
retention, or diabetes
• you are dehydrated
• you have a viral or bacterial infection.
Medicines such as Diflunisal may be associated with a
small increased risk of heart attack ("myocardial
infarction") or stroke. Any risk is more likely with high
doses and prolonged treatment. Do not exceed the
recommended dose or duration of treatment.
corticosteroid drugs, including anti-inflammatory
and replacement therapies
mifepristone, a treatment used in emergency
for termination of pregnancy
antibiotics from the quinolone group of antibiotics.
tacrolimus, used in treatment of
selective serotonin-reuptake inhibitors (SSRIs),
used to treat depression
HOW SHOULD YOU TAKE DIFLUNISAL?
Diflunisal tablets must be swallowed whole and must
not be crushed or chewed. You should preferably take
your tablets with or after food, exactly as advised by
your doctor or pharmacist. The number of tablets you
take each day will depend on your condition. The
usual doses are:
For relief of pain: an initial dose of 1000 mg followed
by 500 mg every 12 hours is recommended for most
patients. Following the first dose your doctor may tell
you to take 500 mg every 8 hours, if the pain is more
severe. After the first day the daily dose should not
exceed 1500 mg per day.
For osteoarthritis and rheumatoid arthritis: the
recommended dose is 500 mg to 1000 mg a day,
taken once or twice a day.
If you have heart problems, previous stroke or think
that you might be at risk of these conditions (for
example if you have high blood pressure, diabetes or
high cholesterol or are a smoker) you should discuss
your treatment with your doctor or pharmacist.
For period pain: the recommended dose is 1000 mg
at the start of cramps or bleeding, then 500 mg every
12 hours for as long as symptoms last. After the first
day the daily dose should not exceed 1500 mg per
day. The tablets should not usually be taken for more
than five days.
Diflunisal may make it more difficult to become
pregnant. You should inform your doctor if you are
planning to become pregnant or if you have problems
WHAT IF YOU FORGET TO TAKE A TABLET
OR TAKE TOO MANY?
In addition, if you have problems with your eyes, you
should inform your doctor.
WHAT ABOUT DRIVING AND OPERATING
Diflunisal can cause dizziness, drowsiness, fatigue
and visual disturbances in some people. If this
happens to you, avoid activities which require you to
be alert, for example, driving a car or operating
CAN YOU TAKE DIFLUNISAL TABLETS
WITH OTHER MEDICINES?
There are a few other medicines which may not mix
with Diflunisal. Your doctor knows about these and will
alter your treatment as needed. It is important that you
tell your doctor about all the medicines you are taking,
including any drugs you are taking without a doctor's
If you are taking any of the following medicines, you
should talk to your doctor about them before taking
• antiplatelet agents such as aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such
as indomethacin, sulindac, naproxen, or
• the following painkillers: paracetamol and codeine
• diuretics, sometimes known as water
tablets, called frusemide or
• aluminum hydroxide antacid suspension, or
• anti-clotting or blood thinning medicines - for
example, warfarin or nicoumalone
• ciclosporin, used in patients with transplants
• methotrexate, used in severe skin diseases,
severe rheumatoid arthritis and as anti-cancer
• gold salts, used in the treatment of arthritis
• cardiac glycosides such as digoxin, a medicine
used to treat heart failure and alterations of heart
• antihypertensive medicines for the treatment of
high blood pressure.
• lithium for treatment of mental disorders
If you miss a dose just carry on with the next one as
normal. Do not take an extra one to make up.
If you take too many tablets by mistake, contact
your doctor immediately.
WHAT UNWANTED EFFECTS COULD YOUR
Like all medicines, Diflunisal may occasionally cause
side effects in some patients. The most frequently
reported side effects are stomach or abdominal pain,
indigestion, nausea, diarrhoea, rash, headache.
Less frequent side effects that have occurred are
vomiting, constipation, wind, dizziness, sleepiness,
sleeplessness, ringing in the ears, tiredness.
The following rare side effects have also occurred:
Effects on the digestive system such as stomach or
intestinal ulcer, a hole in the lining of the intestines or
bleeding from the stomach or intestine, loss of
appetite, inflammation of the stomach.
Effects on the liver, the symptoms of which may be
pale faeces and dark urine, flu-like symptoms, and
yellowing of the skin and/or eyes.
Effects on the skin, such as a reaction to light,
itchiness, hives, sweating, dry and sore mouth, more
severe skin disorders, symptoms of which may include
redness, blisters, peeling skin, ulcerated mouth, eyes
Kidney problems including kidney damage, kidney
inflammation, changes in urine output, pain when
passing urine and blood stained urine.
Nervous system effects, including vertigo, lightheadedness, pins and needles, nervousness,
depression, confusion and hallucinations.
Eye disorders, including blurred vision and other
temporary disturbances in vision. If you develop eye
problems during treatment with Diflunisal, contact
your doctor immediately.
In addition, weakness and fluid retention have
occurred. Breathlessness, palpitation, fainting, chest
pain and muscle cramps have also been reported
Medicines such as Diflunisal may be associated with
a small increased risk of heart attack ("myocardial
infarction") or stroke.
If you notice any of the above effects, or you have any
other unusual symptoms or feelings, seek medical
Serious allergic reactions to Diflunisal have been
reported and include fever, chills, difficulty in breathing
and swallowing, collapse, swollen lips, face, tongue
and throat, rash, and swollen glands. This may also
include problems with liver, kidneys, or blood cells
(see above for symptoms of each). If you notice any of
these effects, stop taking the tablets and contact your
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or
nurse. This includes any possible side effects not listed in this
leaflet. You can also report side effects directly via the Yellow
Card Scheme at: www.mhra.gov.uk/yellowcard
By reporting side effects you can help provide more
information on the safety of this medicine.
HOW SHOULD YOUR TABLETS BE KEPT?
Do not take the tablets after the expiry date, which is
clearly marked on the pack.
Keep your tablets out of the reach and sight of
Do not store above 25°C. Store in the original
Do not put the tablets into another container as they
might get mixed up. If you have any tablets left over
when your doctor tells you to stop taking them, return
them to the pharmacist.
REMEMBER this medicine is for you. Do not share it
with anyone else. It may not suit them.
Date of revision: June 2015
HOW CAN YOU OBTAIN MORE
INFORMATION ABOUT DIFLUNISAL
This leaflet gives you some important patient
information about Diflunisal. If you have any questions
after you have read it, ask your doctor or pharmacist,
who will give you further information.
(Arthritis Care is an organisation which helps arthritis
patients and their relatives, and is not associated with
Chemidex Pharma Ltd.)
Patients requiring further independent information or
advice should contact Arthritis Care, the UK's largest
voluntary organisation working with people with
arthritis. Arthritis Care works with and for all people
with arthritis to promote their health, well-being and
independence, through services, support, self-help,
influence, and information.
Address: 18 Stephenson Way, London NW1 2HD.
Freephone Helpline: 0808 800 4050, 12 noon to
4 p.m., Monday to Friday.
Blood disorders, the symptoms of which could include
a combination of pallor, tiredness, fever, sore throat
and mouth, bruising and prolonged bleeding after