The synovial fluid elimination half-life is at least 3 times greater than that for plasma.Biotransformation: Diclofenac undergoes single and multiple hydroxylation and methoxylation, producing 3′-, 4′-, 5-hydroxy, 4′-5-hydroxy and 3′-hydroxy-4′-methoxy derivatives of diclofenac. Isolated: acute renal failure, nephrotic syndrome, urinary abnormalities (e.g., hematuria and proteinuria), interstitial nephritis, papillary necrosis.Hematologic: Isolated: thrombocytopenia, leukopenia, agranulocytosis, hemolytic anemia, aplastic anemia, anemia secondary to gastrointestinal bleeding.Hepatic: Occasional: elevations (³3 times the upper normal limit) of serum aminotransferase enzymes (AST, ALT). Synovial fluid concentrations exceed plasma levels within 4 to 6 hours of administration. The dosage should be reduced to the lowest level that will provide control of symptoms adjusted when necessary and closely supervised.Children: Diclofenac sodium is not recommended in children under 16 years of age. It is an inhibitor of prostaglandin synthetase, (cyclo-oxygenase). 2010 Caution is called for when using diclofenac sodium in patients with hepatic porphyria, since diclofenac sodium may trigger an attack.Infection: The anti-inflammatory, antipyretic, and analgesic effects of diclofenac sodium may mask the usual signs of infection. Urine output, serum urea, and serum creatinine should be carefully monitored.During long-term therapy, kidney function should be monitored periodically.Hepatic Function: As with other NSAIDs, borderline elevations of one or more liver tests may occur. Voltaren and Lithium interaction Voltaren Ophthalmic and Lithium interaction Voltaren SR and Lithium interaction Zaroxolyn and Lithium interaction About medication causes: Another misdiagnosis possibility is that a particular medication or substance may be the real cause of the disease. voltaren-ophthalmic-diclofenac-ophthalmic-343643 Voltaren Patient w/ established heart disease, uncontrolled HTN, or significant risk factors for CV disease Max: 100 mg daily if treated for >4 wk. In these cases lower doses of diclofenac should be considered. These reactions can occur at any time during treatment, without warning symptoms or signs. If you log out, you will be required to enter your username and password the next time you visit. Patients experiencing these symptoms should be made aware that these side effects may occur, and be cautioned against operating machinery or motor vehicles should they experience any of these.Gastrointestinal: If, during therapy, peptic ulceration is suspected or confirmed, or if gastrointestinal bleeding or perforation occurs, diclofenac sodium should be withdrawn immediately. Statistically significant changes in prothrombin and partial thromboplastin times have been reported in normal volunteers. Sukkarto SR,Glucophage SR,View more Related Help & Advice. Voltarol is a nonsteroidal agent with marked analgesic/anti- inflammatory properties. Liver function should be monitored during long-term treatment with this drug. The mean peak plasma concentration of 1.5 g/mL (5 mol/L) is attained, on average, 2 hours after ingestion of one 50 mg enteric-coated tablet.Following administration of slow-release (SR) diclofenac sodium, Cmax is reached at approximately 4 hours or later. VOLTAREN® Novartis Pharmaceuticals . As with other prostaglandin inhibitors, this applies particularly to the last 3 months of pregnancy, because of the possibility of uterine inertia and/or premature closing of the ductus arteriosus.The highest diclofenac level observed in the breast milk of 6 patients receiving oral diclofenac sodium doses of 3´50 mg day 1, followed by 2´50 mg day 2, was smaller than 5 ng/g. Rare: urticaria. The plasma concentrations show a linear relationship to the amount of drug administered. The mean changes were observed to be less than 1 second in both instances, and are unlikely to be clinically important.Persistently abnormal or worsening renal, hepatic or hematological test values should be followed up carefully since they may be related to therapy.Information to be Provided to the Patient. Losartan allows the smooth flow of blood and the heart to pump blood more efficiently. Concomitant treatment with potassium-sparing diuretics may be associated with increased serum potassium, thus making it necessary to monitor levels.Glucocorticoids: Concomitant administration may aggravate gastrointestinal side effects.NSAIDs: Concurrent oral treatment with two or more NSAIDs may promote the occurrence of side effects (see Warnings).Methotrexate: Caution should be exercised when NSAIDs are administered less than 24 hours before or after treatment with methotrexate.