Be sure to tell your doctor how you are feeling so that the doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects. Your doctor will monitor your symptoms carefully and will probably take your blood pressure and order certain tests to check your body's response to topical diclofenac (Pennsaid, Voltaren). Keep all appointments with your doctor and the laboratory. If you experience any of the following symptoms, stop using topical diclofenac and call your doctor: stomach pain, heartburn, vomiting a substance that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools. Tell your doctor if you take any of the following medications: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven) aspirin other NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos) selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft) or serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR). Tell your doctor if you have any of these risk factors and if you have or have ever had ulcers or bleeding in your stomach or intestines, or other bleeding disorders. The risk may be higher for people who use NSAIDs for a long time, are 60 years of age or older, have poor health, smoke, or drink alcohol while using topical diclofenac. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. NSAIDs such as topical diclofenac (Pennsaid, Voltaren) may cause swelling, ulcers, bleeding, or holes in the stomach or intestine. If you will be undergoing a coronary artery bypass graft (CABG a type of heart surgery), you should not use topical diclofenac (Pennsaid, Voltaren) right before or right after the surgery. Get emergency medical help right away if you experience any of the following symptoms: chest pain, shortness of breath, weakness in one part or side of your body, or slurred speech. Tell your doctor if you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke if you smoke and if you have or have ever had high cholesterol, high blood pressure, or diabetes. Do not use an NSAID such as topical diclofenac if you have recently had a heart attack, unless directed to do so by your doctor. This risk may be higher for people who use NSAIDs for a long time. These events may happen without warning and may cause death. People who use nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as topical diclofenac (Pennsaid, Voltaren) may have a higher risk of having a heart attack or a stroke than people who do not use these medications.
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