Close medical surveillance and caution should be exercised in patients with ulcerative colitis, or with Crohn's disease as these conditions may be exacerbated (see section 4.8 Undesirable effects). Methotrexate: Diclofenac can inhibit the tubular renal clearance of methotrexate hereby increasing methotrexate levels. Caution is recommended when NSAIDs, including diclofenac, are administered less than 24 hours before treatment with methotrexate, since blood concentrations of methotrexate may rise and the toxicity of this substance be increase. Cases of serious toxicity have been reported when methotrexate and NSAIDs, including diclofenac are given within 24 hours of each other. This interaction is mediated through accumulation of methotrexate resulting from impairment of renal excretion in the presence of the NSAID.

Drugs known to cause hyperkalemia: Concomitant treatment with potassium-sparing diuretics, ciclosporin, tacrolimus or trimethoprim may be associated with increased serum potassium levels, which should therefore be monitored frequently (see section 4.4 Special warnings and precautions for use). This medicine is only for use on your skin. Do not use it in the mouth. Do not swallow it. Wash your hands after use unless they are the area to be treated. Be careful not to get Diclofenac diethylammonium in your eyes. If this happens, rinse your eyes well with clean water. See your doctor or pharmacist if any discomfort persists. If your medicine becomes discoloured or shows any sign of deterioration, return it to your pharmacist.As fluid retention and oedema have been reported in association with NSAIDs therapy, including diclofenac, particular caution is called for in patients with impaired cardiac or renal function, history of hypertension, the elderly, patients receiving concomitant treatment with diuretics or medicinal products that can significantly impact renal function, and those patients with substantial extracellular volume depletion from any cause, e.g. before or after major surgery (see section 4.3 Contraindications). Monitoring of renal function is recommended as a precautionary measure when using diclofenac in such cases. Discontinuation therapy is usually followed by recovery to the pre-treatment state. Diclofenac is contraindicated in patients with established congestive heart failure (NYHA II-IV), ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease (see section 4.3 Contraindications).

Other side effects which may occur are usually mild, passing and harmless (if you are concerned, tell a doctor or pharmacist). Repeated oral administration of Voltarol Rapid for 8 days in daily doses of 50 mg t i d does not lead to accumulation of diclofenac in the plasma.This medicine is available without prescription. However, you still need to use Diclofenac diethylammonium carefully to get the best results from it. Note that this leaflet is revised on a regular basis with the latest information on your medicine. Please refer to the date at the end of the leaflet. Children (aged 1-12 years) with juvenile chronic arthritis: 1-3mg/kg per day divided into 2 or 3 doses (12.5mg and 25mg suppositories only). In 15 clinical studies involving the use of rectal diclofenac in the treatment of postoperative pain in children with an overall mean age of 8 years, the use of rescue analgesia (particularly opiates) was reduced. (12.5mg and 25mg suppositories only)