Flector

1 What is Flector?

Brand: Flector, Pennsaid, Rexaphenac, Solaraze, Voltaren

Generic: Diclofenac

Flector is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and other symptoms of arthritis of the joints such as inflammation, swelling, stiffness and joint pain.

This medication does not cure arthritis and will only help as long as you continue to use it. Flector topical 3% gel is also used to treat actinic keratosis, a skin problem that may turn cancerous if not treated.

Flector topical solution is used to treat pain and swelling caused by arthritis of the knees. Flector topical patch is used to treat acute pain caused by minor strains, sprains, and contusions (bruises).

This medication is only available with your doctor’s prescription. This medication is available in the following forms:

  • Gel/Jelly
  • Solution
  • Cream
  • Extended-Release Patch

2 What to Know Before Using

Before using Flector, you must know all about the risks and complications associated with it. This is a decision that you and your doctor will make together.

For this medication, there are many things that need to be considered:

  • Allergies: Inform your doctor if you have ever had an allergic reaction to any other medications. It is also important to inform your doctor of any non-medicine allergies such as foods, dyes, preservatives or animals.
  • Pediatric: No appropriate studies have been performed on the relationship of age to the effects of this medication in children. Safety and efficacy have not been established.
  • Geriatric: No appropriate studies have been performed on the relationship of age to the effects of this medication in elderly patients. Safety and efficacy have not been established.
  • Pregnancy: This medication is listed as Pregnancy Category C in the first and second trimesters. This means that animal studies have shown an adverse effect and no studies have been performed on pregnant women OR there are no adequate studies on pregnant animals and pregnant women. This medication is listed as Pregnancy Category D in the third trimester. This means that studies in pregnant women have demonstrated a risk to the unborn child. However, the benefits of this medication in a life-threatening situation or serious disease may outweigh the potential risk.
  • Breastfeeding: There are no up-to-date studies in women for determining infant risk when using this medication while breastfeeding. Weigh the potential risks with the benefits before taking this medication while breastfeeding.
  • Drug Interactions: Certain medications should not be used together. However, in certain cases, two medications may be used together, even if an interaction might occur. In these cases, your doctor may want to change your dose or take other precautions. When taking this medication, it is important that you inform your doctor if you are taking any of the medications listed below. The following interactions were selected on the basis of potential significance and are not all-inclusive. Using this medication with any of the following is not recommended.

Your doctor may decide not to treat you with this medication, or change some of the other medications you take:

  • Ketorolac

Using this medication with any of the following medication is not recommended, but may be unavoidable in some cases.

Your doctor may make the decision not to treat you with this medication or change some of the other medications you take:

  • Abciximab
  • Acenocoumarol
  • Amineptine
  • Amitriptyline
  • Amitriptylinoxide
  • Amoxapine
  • Anagrelide
  • Apixaban
  • Ardeparin
  • Argatroban
  • Beta Glucan
  • Bivalirudin
  • Ceritinib
  • Certoparin
  • Cilostazol
  • Citalopram
  • Clomipramine
  • Clopidogrel
  • Cyclosporine
  • Dabigatran Etexilate
  • Dabrafenib
  • Dalteparin
  • Danaparoid
  • Deferiprone
  • Desipramine
  • Desirudin
  • Desvenlafaxine
  • Dibenzepin
  • Dipyridamole
  • Dothiepin
  • Doxepin
  • Duloxetine
  • Edoxaban
  • Enoxaparin
  • Eptifibatide
  • Erlotinib
  • Escitalopram
  • Feverfew
  • Fluoxetine
  • Fluvoxamine
  • Fondaparinux
  • Ginkgo
  • Gossypol
  • Heparin
  • Imipramine
  • Lepirudin
  • Levomilnacipran
  • Lofepramine
  • Meadowsweet
  • Melitracen
  • Methotrexate
  • Milnacipran
  • Nadroparin
  • Nefazodone
  • Nortriptyline
  • Opipramol
  • Parnaparin
  • Paroxetine
  • Pemetrexed
  • Pentosan Polysulfate Sodium
  • Pentoxifylline
  • Phenindione
  • Phenprocoumon
  • Pralatrexate
  • Prasugrel
  • Protein C
  • Protriptyline
  • Reboxetine
  • Reviparin
  • Rivaroxaban
  • Sertraline
  • Sibutramine
  • Tacrolimus
  • Tianeptine
  • Ticlopidine
  • Tinzaparin
  • Tirofiban
  • Trimipramine
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Warfarin

Using this medication with any of the following medications may increase your risk of side effects. However, using both medications may be the best treatment for you.

If both medications are prescribed together, your doctor may change the dose or how often you take one or both medications:

  • Acebutolol
  • Alacepril
  • Alprenolol
  • Amiloride
  • Arotinolol
  • Atenolol
  • Azosemide
  • Befunolol
  • Bemetizide
  • Benazepril
  • Bendroflumethiazide
  • Benzthiazide
  • Betaxolol
  • Bevantolol
  • Bisoprolol
  • Bopindolol
  • Bucindolol
  • Bumetanide
  • Bupranolol
  • Buthiazide
  • Canrenoate
  • Captopril
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Chlorothiazide
  • Chlorthalidone
  • Cilazapril
  • Ciprofloxacin
  • Clopamide
  • Cyclopenthiazide
  • Delapril
  • Dilevalol
  • Enalapril
  • Enalaprilat
  • Esmolol
  • Ethacrynic Acid
  • Fosinopril
  • Furosemide
  • Hydrochlorothiazide
  • Hydroflumethiazide
  • Imidapril
  • Indapamide
  • Labetalol
  • Landiolol
  • Levobunolol
  • Lisinopril
  • Lithium
  • Mepindolol
  • Methyclothiazide
  • Metipranolol
  • Metolazone
  • Metoprolol
  • Moexipril
  • Nadolol
  • Nebivolol
  • Nipradilol
  • Oxprenolol
  • Penbutolol
  • Pentopril
  • Perindopril
  • Pindolol
  • Piretanide
  • Polythiazide
  • Propranolol
  • Quinapril
  • Ramipril
  • Sotalol
  • Spirapril
  • Spironolactone
  • Talinolol
  • Temocapril
  • Tertatolol
  • Timolol
  • Torsemide
  • Trandolapril
  • Triamterene
  • Trichlormethiazide
  • Xipamide
  • Zofenopril

Other Interactions

Certain medications should not be used while eating, or while eating certain foods in the case of negative interactions. Using alcohol or tobacco with certain medications may also cause negative interactions. Talk with your doctor about the use of your medication with food, alcohol or tobacco.

Other Medical Problems 

Pre-existing medical problems may affect the use of this medication.

Be sure to tell your doctor if you have any other medical problems, especially:

  • Anemia
  • Bleeding problems
  • Blood clots
  • Congestive heart failure
  • Edema (fluid retention or body swelling)
  • Heart attack
  • Heart disease
  • Hypertension (high blood pressure)
  • Kidney disease
  • Stomach ulcers or bleeding
  • Stroke - Use with caution. May make these conditions worse.
  • Aspirin-sensitive asthma
  • Aspirin (or other NSAIDs) sensitivity
  • Kidney disease - Should not be used in patients with these conditions.
  • Damaged or non-intact skin caused by skin diseases (i.e. exudative dermatitis, eczema, infection lesions), burns, or wounds (for skin patch only) - Should not be used in patients with this condition.
  • Heart surgery (i.e. coronary artery bypass graft [CABG] surgery) - Should not be used to relieve pain right before or after the surgery.
  • Liver disease - Use with caution. The effects may be increased because of slower removal of the medicine from the body.

3 Proper Usage

Proper usage of Flector requires strict adherence to your doctor’s orders. Do not take more, less or for a longer or shorter period of time than your doctor tells you.

This medication comes with a patient information brochure. It is very important that your read this information. Ask your doctor if you have any questions.

To use the skin patch:

  • Wash your hands with water before and after applying the patch. Do not touch your eyes, nose or mouth until you have washed your hands. If it gets into your water, wash the eyes immediately with water or saline. If eye irritation persists for more than an hour, call your doctor.
  • Apply the patch immediately after removing it from the pouch. Do not cut it into smaller pieces and do not touch the sticky surface of the patch.
  • Apply the patch to a clean, dry skin area of skin. Choose an area with little or no hair and free of cuts, scars or irritation. Avoid putting the patch on an area where it could be rubbed off by clothing.
  • Press the patch firmly onto the skin. If the edges of the patch begin to peel off, the edges can be taped down.
  • Do not use the patch when you take a bath or shower. Use the patch at regular times to help you remember your doses.

To use the topical gel:

  • Wash your hands with water before and after using this medication. Use the enclosed dosing card to measure the correct dose. The gel should be applied within the oblong area of the dosing card up to the 2-4g line (2g for each elbow, wrist or hand and 4g for each knee, ankle or foot).
  • Apply the medication to clean, dry skin and avoid getting any in your eyes, nose or mouth. Do not apply this medication to broken skin, open wounds, infection or severely peeling skin. Do not use cosmetics or skin care products on the same areas that you have applied the medication. Do not shower, bathe or wash the area for at least 1 hour after application. Wait 10 minutes before covering the area with gloves or clothing.

To use the topical solution:

  • Wash your hands with water before and after applying the patch. Do not touch your eyes, nose or mouth until you have washed your hands. If it gets into your water, wash the eyes immediately with water or saline. If eye irritation persists for more than an hour, call your doctor.
  • Apply the solution to a clean and dry area of skin. Do not apply this medication to broken skin, open wounds, infection or severely peeling skin.
  • Put 10 drops of the solution at a time on your hand to directly on your knee. Apply the solution on the front, back and sides of your knee. Wait at least 30 minutes before showering or bathing.
  • Avoid skin-to-skin contact with other people and the treated knee until the skin is completely dry. Do not expose the treated area to sunlight.

Dosing: Different patients will be given a different dose of this medication based on the strength of the medication. The number of doses you take each day, the time between doses and the length of time you take this medication depends on the reason you are taking this medication.

The following information only includes the average dose of this medication. If your dose is different, do not change it without first speaking to your doctor.

Gel:

For actinic keratosis (Solareze 3% gel):

  • Adults - Apply to the affected area twice per day.
  • Children - Use and dose must be determined by your doctor.

For osteoarthritis of the hands or wrists (Voltaren 1% gel):

  • Adults - Apply 2g to the affected area 4 times per day (8g each day). The dose should not exceed 32g per day over all affected joints.
  • Children - Use and dose must be determined by your doctor.

For osteoarthritis of the hands or wrists (Voltaren 1% gel):

  • Adults - Apply 4g to the affected area 4 times per day (16g each day). The dose should not exceed 32g per day over all affected joints.
  • Children - Use and dose must be determined by your doctor.

Solution:

For osteoarthritis of the knee:

  • Adults - 40 drops (10 drops at a time) on each affected knee 4 times per day.
  • Children - Use and dose must be determined by your doctor.

Skin patch:

For acute pain:

  • Adults - 1 patch applied to the painful area twice a day.
  • Children - Use and dose must be determined by your doctor.

Missed dose: If you miss a dose of this medication, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and resume your normal dosing schedule. Do not double dose.

Storage: Store this medication in a closed container at room temperature. Keep it away from heat, moisture, and direct light. Do not freeze.

Keep our of the reach of children. Do not keep expired medication or medication you no longer need. Ask your doctor how to dispose of any medication you do not use.

After removing a used patch, fold the patch in half, with the sticky sides together. Dispose of the used patch out of the reach of pets and children.

4 Precautions to Take

In using Flector, you must be careful and take some precautions as advised by your doctor. It is very important that your doctor checks in with you often while you are receiving this medication to make sure that it is working properly.

Do not take other prescription or over-the-counter medications without asking your doctor. This medication may cause bleeding in the stomach or intestines. These problems may happen without any warning signs.

This is more likely if you have had a stomach ulcer in the past, if you smoke or drink alcohol regularly, are over 60 years old, are in poor health or are using certain other medications such as steroids or a blood thinner.

Serious skin reactions may occur with this medication. Inform your doctor immediately if you have to blister, peeling, loosening of the skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin or fevers or chills while using this medication.

This medication may cause a serious type of allergic reaction called anaphylaxis, which is life-threatening and requires immediate emergency medical help. This is more likely in people with an aspirin allergy or an allergy to any non-steroidal anti-inflammatory drugs (NSAIDs).

Inform your doctor immediately if you have fast or irregular breathing, gasping for breath, fainting (syncope), changes in the colour of the skin, fast and irregular heartbeat (tachycardia and arrhythmias), hive-like swelling on the skin and puffiness or swelling around the eyes.

Possible warning signs of serious side effects that may occur during your treatment may include black, tarry stool, decreased urination, severe stomach pain, skin rash, swelling of the face, fingers, feet or lower legs, unusual bleeding or bruising, unusual weight gain, vomiting blood or material that looks like coffee grounds or yellow skin or eyes (jaundice).

Signs of a serious heart problem may occur such as chest pain, tightness in the chest, fast or irregular heartbeat (tachycardia, arrhythmias), unusual flushing or warmth of the skin, weakness or slurring of speech. If you notice any of these signs, call your doctor immediately.

Using this medication while pregnant can harm your unborn child. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant, inform your doctor immediately.

While using this medication, your skin may become more sensitive to sunlight than normal (photosensitivity) and too much sunlight may increase the effects of this medication. During your treatment:

  • Discuss the use of sun block with your doctor.
  • Do not use a sunlamp or tanning equipment.
  • Wear protective clothing, including a hat and sunglasses.
  • Stay out of direct sunlight, especially between the hours of 10am and 3pm.

Inform the doctor in charge that you are using this medication before any surgery or medical tests. It may be necessary to stop treatment for a while, or to change to a different NSAID medication before your treatment.

5 Potential Side Effects

As with many medications, there are several potential side effects associated with Flector. Although not all of these side-effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if you experience any of the following side-effects:

More common:

  • Application site reactions, including skin rash, pain, tingling or burning sensation
  • Flu-like syndrome (body ache, headache, fever, with or without chills)
  • Itching skin

Less common or rare:

  • Blood in the urine
  • Cough
  • Dry, itching, or burning eyes
  • Eye pain
  • Headaches, including migraines
  • Increased sensitivity of the skin
  • Nasal congestion
  • Pain or tenderness around the eyes and cheekbones
  • Redness of the skin
  • Redness or swelling of the eyes
  • Skin rash other than at the application site
  • Sore throat
  • Tightness in the chest
  • Troubled breathing
  • Ulcers or sores on the skin, other than at the application site

Some side effects that may occur do not normally need medical attention. These may leave as your body becomes accustomed to treatment. Ask your doctor about ways to prevent or reduce some of these side effects.

Talk to your doctor if any of the following side effects continue or are bothersome, or if you have questions:

More common:

  • Burning skin
  • Dry skin
  • Scaly skin
  • Thickening of the skin
  • Tingling sensation in the skin

Less common:

Some patients may experience other side effects that are not listed. Check with your doctor if you notice any other side effects. Ask your doctor for medical advice about side effects.

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