is Diclofenac , 1% solution, 4 mg. 4 times a day OK to use while on prednisone?
I’m currently on 9 mg.
My GP says it’s fine because it’s topical, not systemic. I’ve tried it 3 times and it really helped my shoulder pain. I have osteoarthritis and possibly other causes for the pain.
I’m a little hesitant, I struggle with heartburn.
Diclofenac is an NSAID. It is normally recommended not to mix NSAIDs with steroids. Did your doctor mention that Diclofenac really should not be taken long term like steroids, as you could have some quite nasty results? Perhaps taking it occasionally for aches and pains might be OK.
If it is topical it shouldn't be too much of a problem with the heartburn. And you also shouldn't absorb too much to interact with the pred - the main reason for not taking NSAIDs and pred is because both can irritate the stomach and result in bleeding if too bad.
Otherwise even oral diclofenac can be taken with paracetamol. They are different types of painkiller so you can use the to get a double effect. My own rheumy positively encourages the use of NSAIDs when required despite being on pred but I MUST take a PPI to protect my stomach. I don't take one otherwise - they don't dish them out automatically here like they tend to in the UK.
What are you using? Is it a spray? Rather than a cream?
I’m not too sure they dish them out based on my experience. Prior to PMR my doc switched me from Diclofenac to Naproxin because of reported risk of heart issues. I now take Naproxen sparingly for osteoarthritis (ages since I had the last tab) and ibuprofen if required, but again sparingly given it too isn’t good for the heart on a long term basis. (Not sure why it’s not good for the heart, I just follow the advice given.)
No NSAID is really particularly good for the heart - apparently they increase the risk of clots (so why is aspirin given post MI?) but also are bad for the kidneys and tend to raise BP which is also bad for the heart.
Most UK doctors seem to have pred plus a PPI on speed dial for patients with PMR!
I’m on Aspirin since developing angina and having a Stent inserted. Now on Aspirin for life which thins the blood. Downside I bruise without knowing I’ve knocked myself.
It is a platelet inhibitor so reduces clot risk - just doesn't fit with the Harvard Medical comment.
I have wonderful bruises on my shins - pred and Pradaxa (anticoagulant). One at present is about 3in diameter and I have no idea why it is so big!!
I was on Clopidogrel and Aspirin for 6 months after the procedure and bled from tiny cuts, some of which could bleed for 12 hours or more. Nowhere near as bad now I’m on Aspirin on its own.
Blimey - they were checking your platelets I trust? You'd have thought one of the more modern approaches could be used.
No they didn’t check platelets, but that’s history for me I suppose now that I’m off Clopidogrel. So reading one of your replies on this topic, I’ve now learnt that Aspirin is an anti platelet also. No wonder I’m a bleeder.
As an aside, I was told to pre-load on Aspirin and Clopidogrel before the stent procedure taking 8 of each the night before. The nurse practitioner said make sure you shave before taking the 16 tablets.
It’s a gel. Dose is 4.mg 4 times a day as needed. I rubbed it on my shoulder and it helped immediately. I’ve never taken a PPI, just relying on Tums.
That's great if it helps. And safer than a tablet if you are using it for a limited area and relatively short term.
My opinion is that a topical NSAID is better. I use it on my fingers and always use less then what's recommended, only once a day and on the days when the pain is really bad. Try it and see what works for you. Check out this article: detroitnews.com/story/life/...
My rheumatologist suggested it for my osteoarthritis. Like kulina I use less than recommended (for my fingers) and once a day if the pain is bad. I use oral ibuprofen when my hip arthritis gets bad. Just one 200mg tablet dials down the pain. I’m lucky it works at such a low dose.
Thanks Susan. Yes that seems to be working for me. I use ibuprofen that way too. I think I’m just paranoid about the interaction with prednisone.
GCA early signs , not sure
What should I expect?
Incontinence and Prednisolone 
Update on my shingles
