How does this medication work? What will it do for me? Diclofenac belongs to the class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). It works by reducing pain, swelling, and inflammation. The topical solution (a lotion applied to the skin) is used to relieve symptoms such as pain associated with osteoarthritis of the knee. This medication should be used continuously for no more than three months. Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor. How should I use this medication? The usual dose of diclofenac topical solution is 40 drops applied to the knee four times daily at evenly spaced time intervals. Apply it only to clean, dry skin. Squeeze 10 drops of diclofenac topical solution into the hand or directly onto the knee. Spread the solution evenly around the front, back, and sides of the knee. Repeat this procedure until 40 drops have been applied and the knee is completely covered. To treat the other knee, repeat the procedure. Allow several minutes for the medication to dry. Wash hands after applying the medication, and avoid contact with eyes or mucous membranes. Do not apply the medication to infected, abraded, or open skin. Do not use dressings that do not breathe on top of this medication. This medication is for external use only, and should not be taken by mouth. The topical solution should not be used for longer than three months. Many things can affect the dose of medication that a person needs, such as the severity of the condition, body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor. It is very important that this medication be used on a regular schedule exactly as prescribed by your doctor. If you miss a dose of this medication, apply it as soon as you remember it. If it is almost time for your next dose, skip the missed dose and carry on with your regular schedule. Do not take a double dose to make up for a missed one. What form(s) does this medication come in? Pennsaid® is available as a clear, odourless topical solution containing diclofenac 1.5%. Nonmedicinal ingredients: dimethyl sulfoxide, glycerine, propylene glycol, ethanol, and purified water. Who should NOT take this medication? Diclofenac topical solution should not be used by: anyone who currently has or has recently had inflammatory diseases of the stomach and intestines, such as stomach or intestinal ulcer or ulcerative colitis people with significant liver impairment or liver disease people with severely impaired or deteriorating kidney function anyone who is currently taking other NSAIDs (e.g., ibuprofen, naproxen) anyone who is or may be allergic to diclofenac or any of the ingredients of the medication anyone who has had an allergic reaction to ASA or other anti-inflammatory medications children pregnant or breast-feeding women

Pennsaid Side Effects:

The following side effects may go away as your body becomes used to the medication; check with your doctor if they continue or become bothersome. More common burning, dry, red, itchy, scaly, thickened, or tingling skin at application site Less common acne back pain belching chest pain heartburn or indigestion joint pain lack or loss of strength loss or thinning of hair muscle pain or neck pain nausea runny nose stomach upset or pain Contact your doctor as soon as possible if any of the following side effects occur: More common abnormal burning, pain, or prickling feeling on skin at application site flu-like syndrome that may include bodyache, headache, and fever with or without chills itching skin joint pain Less common or rare abnormal burning or prickling feeling blood in the urine change in sense of taste cough decrease in body movement dry, itching, or burning eyes eye pain headaches, including migraine high blood pressure increased sensitivity of eyes to light infection nasal congestion pain or tenderness around eyes or cheekbones redness or swelling of eyes shortness of breath skin rash other than at the application site sore throat stomach upset or pain swelling, increased skin sensitivity, skin rash or skin pain caused by exposure to sun at application site tightness in chest troubled breathing ulcers or sores on skin other than at the application site wheezing Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication. Are there any other precautions or warnings for this medication? Hepatic porphyria: People with hepatic porphyria should use this medication with caution, as it may trigger an attack. Infection: This medication may mask some of the signs of infection. Kidney function: People with reduced kidney function may need lower doses and more frequent medical check-ups while using this medication. Occupational hazards: Some people have reported headache, dizziness, lightheadedness, and confusion while taking this medication. Avoid operating motor vehicles and doing other potentially hazardous activities until you have determined the effect this medication has on you. Stomach: Stomach ulcers and bleeding from the stomach have been known to occur when diclofenac is taken by mouth. These complications can occur at any time and are sometimes severe enough to require immediate medical attention. Although these reactions have not been seen with diclofenac topical solution, you should seek medical attention right away if you notice any signs of bleeding (such as dark, tarry stools, blood in the stools, or vomiting of material that looks like coffee grounds). Vision: Other medications in the same family as diclofenac may cause vision changes such as blurred or decreased vision. If you notice vision changes, stop using the medication and check with your doctor. Pregnancy: This medication is not recommended for use during pregnancy, as its safety has not been established. Breast-feeding: This medication should not be used by nursing mothers. Children: Diclofenac is not recommended for children. The safety, effectiveness, and dosage of this medication for this age group have not been established. Seniors: Seniors may have a higher risk of side effects with this medication. Seniors may need lower doses of this medication and more frequent medical check-ups. What other drugs could interact with this medication? The following medications may affect the way that diclofenac works or increase the risk of side effects: acetaminophen ASA alcohol corticosteroids (e.g., prednisone) heparin other NSAIDs (e.g., naproxen, indomethacin) quinolone antibiotics (e.g., ciprofloxacin, levofloxacin, gatifloxacin) warfarin Diclofenac may affect the way that the following medications work or increase the risk of side effects: beta-adrenergic blockers (e.g., metoprolol, atenolol) cyclosporine digoxin diuretics (water pills; e.g., spironolactone) heparin lithium methotrexate medications for diabetes (e.g., glyburide, metformin) probenecid warfarin If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to: stop taking one of the medications, change one of the medications to another, change how you are taking one or both of the medications, or leave everything as is. An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed. Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them