Diclofenac with Amiodarone Interaction Details

Brand Names Associated with Diclofenac

  • Cambia®
  • Cataflam®
  • Diclofenac
  • Voltaren XR®
  • Zipsor®
  • Zorvolex®

Brand Names Associated with Amiodarone

  • Amiodarone
  • Cordarone®
  • Pacerone®

Medical Content Editor
Last updated Feb 27, 2024

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Interaction Effect

Increased exposure of diclofenac

Interaction Summary

Concomitant use of diclofenac (a CYP2C9 substrate) with a CYP2C9 inhibitor may increase the exposure of diclofenac, increasing the risk of toxic effects. In a study, concurrent use of diclofenac and voriconazole (a CYP2C9 inhibitor) increased diclofenac Cmax by 114% and AUC by 78%. If coadministration of diclofenac and a CYP2C9 inhibitor is required, do not exceed the lowest recommended diclofenac sodium/misoprostol dose (50 mg of diclofenac twice daily)[1]. An increase in duration between doses of the oral solution may be required for subsequent migraine attacks [2], and dosage adjustments may be warranted for other uses of diclofenac [3][4].

Severity

Moderate

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

The concomitant use of diclofenac (a CYP2C9 substrate) with a CYP2C9 inhibitor may increase the exposure of diclofenac. If concomitant administration is required, do not exceed the lowest recommended diclofenac sodium/misoprostol dose (50 mg diclofenac twice daily)[1]. An increase in duration between doses of the oral solution may be required for subsequent migraine attacks [2], and dosage adjustments may be warranted for other uses of diclofenac [3][4].

Mechanism Of Interaction

Inhibition of CYP2C9-mediated metabolism of diclofenac

Literature Reports

A) In a study, a single dose of diclofenac 50 mg was administered concurrently with the last dose of the CYP2C9 inhibitor voriconazole (400 mg every 12 hours on day 1, followed by 200 mg every 12 hours on day 2). Compared with diclofenac administered alone, the mean Cmax and AUC of diclofenac increased by 114% and 78%, respectively [1].

References

    1 ) Product Information: ARTHROTEC(R) oral tablets, diclofenac sodium misoprostol oral tablets. Pfizer Labs (per FDA), New York, NY, 2016.

    2 ) Product Information: CAMBIA(R) oral solution, diclofenac potassium oral solution. Depomed, Inc. (per FDA), Newark, CA, 2016.

    3 ) Product Information: CATAFLAM(R) oral immediate-release tablets, diclofenac potassium oral immediate-release tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2016.

    4 ) Product Information: DYLOJECT(TM) intravenous injection, diclofenac sodium intravenous injection. Hospira, Inc. (per FDA), Lake Forest, IL, 2016.

Diclofenac Overview

  • Diclofenac capsules (Zipsor, Zorvolex) and tablets (Cataflam) are used to relieve mild to moderate pain. Diclofenac extended-release tablets (Voltaren XR), tablets (Cataflam), and delayed-release tablets (available generically) are used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints), and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints). Diclofenac extended-release tablets and delayed-release tablets are also used to treat ankylosing spondylitis (arthritis that mainly affects the spine). Diclofenac tablets (Cataflam) are also used to treat painful menstrual periods. Diclofenac solution (Cambia) is used to treat migraine headaches in adults, but cannot be used to prevent migraines or to treat other types of headaches. Diclofenac is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

See More information Regarding Diclofenac

Amiodarone Overview

  • Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles.

See More information Regarding Amiodarone

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.


Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.


Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.


Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.