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VOLTAROL Tablets 25 and 50 mg

(diclofenac sodium)

What you need to know about Voltarol Tablets

Your doctor has decided that you need this medicine to help treat your condition.

Please read this leaflet carefully before you start to take your medicine. It contains important information. Keep the leaflet in a safe place because you may want to read it again.

If you have any other questions, or if there is something you don’t understand, please ask your doctor or pharmacist.

This medicine has been prescribed for you. Never give it to someone else. It may not be the right medicine for them even if their symptoms seem to be the same as yours.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

In this leaflet:

1. What Voltarol Tablets are, and what they are used for

2. Things to consider before you start to take Voltarol Tablets

3. How to take Voltarol Tablets

4. Possible side effects

5. How to store Voltarol Tablets

6. Further information

What Voltarol Tablets are, and what they are used for

Diclofenac sodium, the active ingredient in Voltarol Tablets, is one of a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce pain and inflammation.

Voltarol Tablets relieve pain, reduce swelling and ease inflammation in conditions affecting the joints, muscles and tendons including:
- Rheumatoid arthritis, osteoarthritis, acute gout, ankylosing spondylitis
- Backache, sprains and strains, soft tissue sports injuries, frozen shoulder, dislocations and fractures
- Tendonitis, tenosynovitis, bursitis.

They are also used to treat pain and inflammation associated with dental and minor surgery.

In children Voltarol Tablets are used to treat juvenile chronic arthritis.

Things to consider before you start to take Voltarol Tablets

Some people MUST NOT take Voltarol Tablets. Talk to your doctor if:

you think you may be allergic to diclofenac sodium, aspirin, ibuprofen or any other NSAID, or to any of the other ingredients of Voltarol Tablets. (These are listed at the end of the leaflet.) Signs of a hypersensitivity reaction include swelling of the face and mouth (angioedema), breathing problems, runny nose, skin rash or any other allergic type reaction

you have now, or have ever had, a stomach (gastric) or duodenal (peptic) ulcer, or bleeding in the digestive tract (this can include blood in vomit, bleeding when emptying bowels, fresh blood in faeces or black, tarry faeces)

you have had stomach or bowel problems after you have taken other NSAIDs

you have severe heart, kidney or liver failure

you are more than six months pregnant.

You should also ask yourself these questions before taking Voltarol Tablets:

Do you suffer from any stomach or bowel disorders including ulcerative colitis or Crohn's disease?

Do you have kidney or liver problems, or are you elderly?

Do you have a condition called porphyria?

Do you suffer from any blood or bleeding disorder? If you do, your doctor may ask you to go for regular check-ups while you are taking these tablets.

Have you ever had asthma?

Are you breast-feeding?

Do you have heart problems, or have you had a stroke, or do you think you might be at risk of these conditions (for example, if you have high blood pressure, diabetes or high cholesterol or are a smoker)?

Do you have Lupus (SLE) or any similar condition?

Do you have an inherited intolerance to some sugars such as lactose? (Voltarol Tablets contain a small amount of lactose.)

If the answer to any of these questions is YES, discuss your treatment with your doctor or pharmacist because Voltarol Tablets might not be the right medicine for you.

Are you taking other medicines?

Some medicines can interfere with your treatment. Tell your doctor or pharmacist if you are taking any of the following:

Medicines to treat diabetes

Anticoagulants (blood thinning tablets like warfarin)

Diuretics (water tablets)

Lithium (used to treat some mental problems)

Methotrexate (for some inflammatory diseases and some cancers)

Ciclosporin and tacrolimus (used to treat some inflammatory diseases and after transplants)

Quinolone antibiotics (for infections)

Any other NSAID or COX-2 (cyclo-oxgenase-2) inhibitor, for example aspirin or ibuprofen

Mifepristone (a medicine used to terminate pregnancy)

Cardiac glycosides (for example digoxin), used to treat heart problems

Medicines known as SSRIs used to treat depression

Oral steroids (an anti-inflammatory drug)

Medicines used to treat heart conditions or high blood pressure, for example beta-blockers or ACE inhibitors.

Always tell your doctor or pharmacist about all the medicines you are taking. This means medicines you have bought yourself as well as medicines on prescription from your doctor.

Pregnancy

Are you pregnant or planning to become pregnant? Although not common, abnormalities have been reported in babies whose mothers have taken NSAIDs during pregnancy. You should not take Voltarol Tablets during the last 3 months of pregnancy as it may affect the baby’s circulation.

Are you trying for a baby? Taking Voltarol Tablets may make it more difficult to conceive. You should talk to your doctor if you are planning to become pregnant, or if you have problems getting pregnant.

Will there be any problems with driving or using machinery?

Very occasionally people have reported that Voltarol Tablets have made them feel dizzy, tired or sleepy. Problems with eyesight have also been reported. If you are affected in this way, you should not drive or operate machinery.

Other special warnings

You should take the lowest dose of Voltarol for the shortest possible time, particularly if you are underweight or elderly.

There is a small increased risk of heart attack or stroke when you are taking any medicine like Voltarol. The risk is higher if you are taking high doses for a long time. Always follow the doctor’s instructions on how much to take and how long to take it for.

Whilst you are taking these medicines your doctor may want to give you a check-up from time to time.

If you have a history of stomach problems when you are taking NSAIDs, particularly if you are elderly, you must tell your doctor straight away if you notice any unusual symptoms.

Because it is an anti-inflammatory medicine, Voltarol may reduce the symptoms of infection, for example, headache and high temperature. If you feel unwell and need to see a doctor, remember to tell him or her that you are taking Voltarol.

The 50 mg tablets are not suitable for children aged under 12.

How to take Voltarol Tablets

The doctor will tell you how many Voltarol Tablets to take and when to take them. Always follow his/her instructions carefully. The dose will be on the pharmacist’s label. Check the label carefully. If you are not sure, ask your doctor or pharmacist. Keep taking your tablets for as long as you have been told, unless you have any problems. In that case, check with your doctor.

Take the tablets before or with food.

Swallow the tablets whole with a drink of water. Do not crush or chew the tablets.

The usual doses are:

Adults and children over 12

75 mg to 150 mg daily divided into two or three doses. The number of tablets which you take will depend on the strength the doctor has given you.

Elderly

Your doctor may advise you to take a dose that is lower than the usual adult dose if you are elderly. Your doctor may also want to check closely that the Voltarol Tablets are not affecting your stomach.

Children aged 1-12 years

Doses vary with the age and weight of the child. The usual dose is 1 mg to 3 mg per kilogram of body weight a day. This is usually divided into two or three separate doses.

The doctor may also prescribe another drug to protect the stomach to be taken at the same time, particularly if you have had stomach problems before, or if you are elderly, or taking certain other drugs as well.

What if you forget to take a dose?

If you forget to take a dose, take one as soon as you remember. If it is nearly time for your next dose, though, just take the next dose and forget about the one you missed. Do not double up on the next dose to make up for the one missed. Do not take more than 150 mg (three 50 mg tablets or six 25 mg tablets) in 24 hours.

What if you take too many tablets?

If you, or anyone else, accidentally takes too much, tell your doctor or your nearest hospital casualty department. Take your medicine pack with you so that people can see what you have taken.

Voltarol Tablets Side Effects

Voltarol Tablets are suitable for most people, but, like all medicines, they can sometimes cause side effects.

Some side effects can be serious

Stop taking Voltarol Tablets and tell your doctor straight away if you notice:

Stomach pain, indigestion, heartburn, wind, nausea (feeling sick) or vomiting (being sick)

Any sign of bleeding in the stomach or intestine, for example, when emptying your bowels, blood in vomit or black, tarry faeces

Allergic reactions which can include skin rash, itching, bruising, painful red areas, peeling or blistering

Wheezing or shortness of breath (bronchospasm)

Swollen face, lips, hands or fingers

Yellowing of your skin or the whites of your eyes

Persistent sore throat or high temperature

An unexpected change in the amount of urine produced and/or its appearance.

If you notice that you are bruising more easily than usual or have frequent sore throats or infections, tell your doctor.

The side effects listed below have also been reported.

Up to 1 in 10 people have experienced:

Stomach pain, heartburn, nausea, vomiting, diarrhoea, indigestion, wind, loss of appetite

Headache, dizziness, vertigo

Skin rash or spots

Raised levels of liver enzymes in the blood.

Between 1 in 100,000 and 1 in 100 people have experienced:

Stomach ulcers or bleeding (there have been very rare reported cases resulting in death, particularly in the elderly)

Drowsiness, tiredness

Hypotension (low blood pressure, symptoms of which may include faintness, giddiness or light headedness)

Skin rash and itching

Fluid retention, symptoms of which include swollen ankles

Liver function disorders, including hepatitis and jaundice.

Isolated side-effects, reported in less than 1 in 100,000 people include:

Effects on the nervous system:

Tingling or numbness in the fingers, tremor, blurred or double vision, hearing loss or impairment, tinnitus (ringing in the ears), sleeplessness, nightmares, mood changes, depression, anxiety, mental disorders, confusion, hallucinations, malaise, disorientation and loss of memory, fits, headaches together with a dislike of bright lights, fever and a stiff neck, disturbances in sensation.

Effects on the stomach and digestive system:

Constipation, inflammation of the tongue, mouth ulcers, taste changes, lower gut disorders (including inflammation of the colon).

Effects on the heart, chest or blood:

Palpitations (fast or irregular heart beat), chest pain, hypertension (high blood pressure), inflammation of blood vessels (vasculitis), inflammation of the lung (pneumonitis), congestive heart failure, blood disorders (including anaemia).

Effects on the liver or kidneys:

Kidney or liver disorders, presence of blood or protein in the urine.

Effects on skin or hair:

Serious skin rashes including Stevens-Johnson syndrome and Lyell’s syndrome and other skin rashes which may be made worse by exposure to sunlight.

Hair loss.

Other effects:

Inflammation of the pancreas, impotence.

Medicines such as diclofenac may be associated with a small increased risk of heart attack or stroke.

Do not be alarmed by this list - most people take Voltarol Tablets without any problems.

If any of the symptoms become troublesome, or if you notice anything else not mentioned here, please go and see your doctor. He/she may want to give you a different medicine.

How to store Voltarol Tablets

Store in a dry place, below 30°C. Keep the tablets in their original pack.

Keep out of the reach and sight of children.

Do not take Voltarol Tablets after the expiry date which is printed on the outside of the pack.

If your doctor tells you to stop taking the tablets, please take any unused tablets back to your pharmacist to be destroyed. Do not throw them away with your normal household water or waste. This will help to protect the environment.

Further information

The tablets come in two strengths containing either 25 mg or 50 mg of the active ingredient, diclofenac sodium. The tablets are enteric-coated. This special coating prevents absorption of diclofenac sodium in the stomach, reducing the risk of stomach irritation. It is absorbed when it reaches the intestine.

The tablets also contain the inactive ingredients silicon dioxide, lactose, maize starch, sodium starch glycollate, povidone, microcrystalline cellulose, magnesium stearate, hydroxypropylmethylcellulose, polyethoxylated castor oil, talc, titanium dioxide, methacrylic acid copolymer, polyethylene glycol, silicone, yellow iron oxide, red iron oxide (50mg tablets only).

The 25 mg tablets come in blister packs containing 84 tablets. The 50 mg tablets come in blister packs containing 14 or 84 tablets.

The Product licence holder is

Novartis Pharmaceuticals UK Limited

trading as Geigy Pharmaceuticals

Frimley Business Park

Frimley

Camberley

Surrey

GU16 7SR

England

Voltarol Tablets are released on to the market by

Novartis Pharmaceuticals UK Limited

Horsham

West Sussex

RH12 5AB