Axcel Diclofenac-50 Drug Interactions

Care should be taken in patients treated with any of the drugs mentioned as follows because, as with other NSAIDs, diclofenac has the potential to induce the following reactions.
Lithium: Diclofenac may raise plasma concentrations of lithium (by the impairment of its excretion from the kidneys).
Methotrexate: Methotrexate should not be administered within 24 hours of each other if given with extreme caution. NSAIDs are reported to increase the plasma levels of methotrexate resulting in increase toxicity.
Other Analgesics: If other systemic NSAIDs or aspirin are given concomitantly with diclofenac sodium the frequency side effects may be increased.
Cyclosporin: NSAIDs may increase cyclosporin nephrotoxicity as a result of their effect on renal prostaglandins. Cyclosporin may increase the bioavailability of diclofenac.
Quinolone Antibiotics: There is an increased risk of convulsions if quinolone antibiotics are given while NSAIDs are being taken. Caution is advised when considering their use because patients taking NSAIDs and quinolones may have an increased risk of developing convulsion.
Diuretics: The activity of diuretics may be inhibited by some NSAIDs. Increased serum potassium levels may result when diclofenac is given concomitantly with potassium-sparing diuretics. Serum potassium levels should therefore be monitored.
Anticoagulants: Care is required when giving anticoagulants with NSAIDs as diclofenac may reversibly inhibit platelet aggregation. Monitoring is recommended to ensure the desired response to the anticoagulants is maintained, as there are rare reports of increase risk of haemorrhage with combined diclofenac and anticoagulant therapy.
Oral Hypoglycaemic Agents: It has been reported hypo and hyperglycaemic effects have occurred rarely when diclofenac and oral antidiabetic agents have been given together and adjustment of hypoglycaemic may be required. Inhibition of metabolism of sulfonylurea drugs, prolonged half-life and increased risk of hypoglycaemia have also been reported.
Aminoglycosides: Reduction in renal function in susceptible individuals, decreased elimination of aminoglycosides and increased plasma concentrations have been reported.
Probenecid: Reduction in metabolism and elimination of NSAIDs and metabolites occurs with probenecid.
Anti-hypertensives: There may be a reduction in the effect of anti-hypertensives.
Cardiac Glycosides: NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma cardiac glycosides (e.g. digoxin) levels.
Mifepristone: In common with other NSAIDs, diclofenac should be avoided for at least 8 to 12 days following mifepristone administration as NSAIDs can reduce the effect of mifepristone.
Corticosteroids: There is increased risk of gastrointestinal bleeding with corticosteroids.