Diclofenac+ misoprostol is indicated for symptomatic relief of-

• osteoarthritis
• rheumatoid arthritis

Osteoarthritis

Rheumatoid Arthritis

• Osteoarthritis: The recommended dosage for maximal GI mucosal protection is Diclofenac+ misoprostol 50 tid. For patients who experience intolerance, Diclofenac+ misoprostol 75 bid or Diclofenac+ misoprostol 50 bid can be used, but are less effective in preventing ulcers.
• Rheumatoid Arthritis: The recommended dosage is Diclofenac+ misoprostol 50 tid or qid. For patients who experience intolerance, Diclofenac+ misoprostol 75 bid or Diclofenac+ misoprostol 50 bid can be used, but are less effective in preventing ulcers. This fixed combination product, Diclofenac+ misoprostol, is not recommended for patients who would not receive the appropriate dose of both ingredients.

Diclofenac+ misoprostol may cause the following side effects-

• Abdominal pain 
• Diarrhea 
• Dyspepsia 
• Nausea 
• Flatulence 
• Asthenia

Abdominal Pain	Diarrhea	Dyspepsia
Nausea	Flatulence	Asthenia

• UTERINE RUPTURE HAS BEEN REPORTED WHEN MISOPROSTOL WAS ADMINISTERED IN PREGNANT WOMEN TO INDUCE LABOR OR TO INDUCE ABORTION BEYOND THE EIGHTH WEEK OF PREGNANCY
• Diclofenac+ misoprostol cannot be used to replace corticosteroids or to treat corticosteroid deficiency. Abrupt cessation of corticosteroids may result in disease exacerbation. If the decision is made to discontinue corticosteroids, patients on prolonged corticosteroid therapy should have their therapy tapered gradually.
• Anemia is sometimes seen in patients receiving NSAIDs, including Diclofenac+ misoprostol.
• Asthmatic patients may have aspirin-sensitive asthma. Aspirin use in patients with aspirin-sensitive asthma has been linked to severe bronchospasm, which can be fatal. Because cross reactivity between aspirin and other nonsteroidal anti-inflammatory drugs, including bronchospasm, has been reported in such aspirin-sensitive patients, Diclofenac+ misoprostol should not be administered to patients with this type of aspirin sensitivity and should be used with caution in patients with preexisting asthma.
• Misoprostol may cause abortion (sometimes incomplete), premature labor, or birth defects if given to pregnant women.
• NSAIDs cause an increased risk of serious gastrointestinal 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 are at greater risk for serious gastrointestinal events