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During the last three days of diclofenac treatment, he became anorexic and complained of nausea, epigastric pain and developed erythematous pruritic eruptions over his back, abdomen, chest, face and scalp. Serum CPK levels peaked at 83,770 units/L 11 days following diclofenac cessation. Six months following cessation of diclofenac, the patient was asymptomatic and strength was normal. Agranulocytosis and aplastic anemia during diclofenac therapy are reported as well, and have resulted in patient death despite proper management. In one review of 26 cases of diclofenac-induced hepatitis, the authors found a correlation between the cumulative diclofenac dose and severity of liver damage as well as the logarithm of the peak and mean transaminase levels. The events, which have been chosen for inclusion due to either their seriousness, frequency of reporting, possible causal connection to topical diclofenac sodium ophthalmic solution, 0. Diclofenac-induced hepatitis may be a result of a hypersensitivity reaction in some cases. RenalDiclofenac may impair the ability of the kidney to cope with low renal blood flow states due to inhibition of prostaglandin-dependent afferent arteriolar vasodilation. In one case, diclofenac-induced thrombocytopenic purpura was accompanied by renal and hepatic toxicity. Fatal cases of fulminant hepatitis during diclofenac therapy are reported in the literature. OtherOther diclofenac side effects include tinnitus, blurred vision, taste disturbance, reversible hearing loss, dry eyes, scotoma, night blindness, and amblyopia. I really like that fact that very little of the diclofenac goes systemic. 17% of patients following short-term (duration not defined) and long-term (up to 58 weeks) treatment with diclofenac, respectively. In addition, blood pressure may be elevated by diclofenac which may have clinical relevance in patients with comorbid illnesses. Autoimmune hemolytic anemia and thrombocytopenia during diclofenac therapy have been associated with the development of autoantibodies as well as drug- or metabolite-dependent antibodies, implicating a drug hypersensitivity. Additional risk factors for diclofenac-induced renal insufficiency are advanced age and concomitant use of diuretics or ACE inhibitors. Colonic strictures, ulcerations, and bleeding associated with diclofenac use have been reported in the literature. Nervous systemAseptic meningitis was reported in a 42-year-old female following two weeks of therapy with diclofenac 50 mg three times a day. A disproportionate amount of postoperative hemorrhage requiring operative intervention has been reported with the use of diclofenac when used for analgesia after adenotonsillectomy. The patient was diagnosed with erythema multiforme and rhabdomyolysis due to diclofenac. Elevations in serum transaminases are generally reversible upon cessation of diclofenac therapy. The patient's symptoms spontaneously resolved over 48 hours following the discontinuation of diclofenac. A 44-year-old man with recurring knee pain treated himself with diclofenac 75 mg intramuscularly for 6 days followed by 75 mg orally three times a day for seven days. Blood dyscrasias are usually reversible upon cessation of diclofenac, although rare fatalities are reported. Several authors have speculated that the enteric, or "delayed release", form of diclofenac may be at fault, as tablet fragments have been found at the site of the pathology. These events were generally minor, but led to discontinuation of therapy in 9% of patients on Arthrotec and 5% of patients on diclofenac. PsychiatricPsychiatric side effects of diclofenac include rare reports of depression, anxiety, irritability, nightmares, and psychotic reactions. Comparison of the antiinflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. HepaticElevations in serum transaminases three times normal values are reported in up to 2% of patients during the first 2 months of diclofenac therapy.

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