What Happens in a Diclofenac Overdose?

A small diclofenac overdose usually brings an upset stomach and vomiting rather than lasting harm.1MedlinePlus. Diclofenac sodium overdose A large one can reach well beyond the stomach, affecting blood pressure, the kidneys and, at the extreme, the brain.2MedlinePlus. Diclofenac sodium overdose3MedlinePlus. Diclofenac sodium overdose There is no antidote, so how dangerous it becomes depends mainly on how much was taken and how quickly help arrives, and anyone who took too much should call poison control.

Why Too Much Diclofenac Causes Harm

Diclofenac is an NSAID, part of the family of anti-inflammatory painkillers that includes ibuprofen and naproxen. Like the others, it relieves pain by blocking enzymes that make prostaglandins, the chemical messengers behind pain and swelling. But prostaglandins also protect the stomach lining, keep blood flowing to the kidneys, and help blood clot. In an overdose, most of the harm comes from blocking this system far too strongly.4PubMed Central. The patterns of toxicity and management of acute nonsteroidal anti-inflammatory drug (NSAID) overdose

In the stomach, less prostaglandin means less protective mucus and less blood flow to the lining, so acid can wear away the surface and cause sores. In the kidneys, prostaglandins keep small blood vessels open, so blocking them can cut blood flow and reduce how well the kidneys filter. Platelets also rely on this system to clump properly, so a heavy dose can make any bleeding that starts harder to stop.

The liver breaks down about 70% of a dose, and about 30% leaves through bile into the gut.5Deranged Physiology. Pharmacology of non-steroidal anti-inflammatory agents Some of that drug is then reabsorbed from the gut and circulates again, which keeps it in the body longer.6Deranged Physiology. Pharmacology of non-steroidal anti-inflammatory agents A breakdown product in bile can also directly injure the small intestine, at least in animals.7PubMed. Diclofenac acyl glucuronide, a major biliary metabolite, is directly involved in small intestinal injury in rats

Usual adult tablets are 25 to 75 mg, so a pack can hold several grams. Combining diclofenac with another NSAID such as ibuprofen adds to the same effects.

Symptoms to Expect and When to Get Help

A mild overdose does not usually cause serious problems.8MedlinePlus. Diclofenac sodium overdose Stomach pain and vomiting are common.9MedlinePlus. Diclofenac sodium overdose The vomit may contain blood, though, which is a sign of bleeding in the stomach.10MedlinePlus. Diclofenac sodium overdose

Other signs involve the heart and circulation:

In a very severe overdose, seizures can occur.15MedlinePlus. Diclofenac sodium overdose So can coma, where the person cannot be woken or respond.16MedlinePlus. Diclofenac sodium overdose Any seizure, fainting or unresponsiveness means calling emergency services at once.

For anything less dramatic, call poison control right away. In the US the number is 1-800-222-1222, and it’s worth calling even if the person feels fine. Have the bottle ready, along with the strength, the number of pills and the time they were taken. Mention any other pills or alcohol, plus the person’s age and weight. Don’t make the person vomit unless you’re told to.

Bleeding from a damaged stomach lining can continue quietly for a day or more. Kidney strain doesn’t hurt in its early stage, so the first sign may be only a drop in urine or a blood test result. Peeing much less than usual is a warning sign. Being checked is better than waiting for symptoms.

Bleeding can also show up in ways other than vomited blood. Black, sticky, tar-like stools can mean blood that has been digested on its way through the gut, so bleeding may be happening even with no vomiting. Vomit that looks like coffee grounds is another sign, since stomach acid darkens blood. Dizziness on standing, unusual paleness or a racing heart can mean blood loss and need urgent assessment.

Stomach Bleeding and Kidney Damage

Stomach damage starts17MedlinePlus. Diclofenac sodium overdose The bleeding can be slow and hidden, showing up only as tiredness, paleness or dark stools, or it can be heavy with vomited blood. When it’s heavy, a blood transfusion may be needed.18MedlinePlus. Diclofenac sodium overdose

Doctors judge how serious it is using blood counts, which can fall hours after the bleeding starts rather than right away. They may also pass a camera tube into the stomach to stop the bleeding.19MedlinePlus. Diclofenac sodium overdose It lets the doctor see the bleeding point and treat it directly, for example with clips or heat. Stomach-protecting medicines then help sores heal and reduce further bleeding once the drug has been cleared.

The kidneys are the other main target. In animals, one large dose of diclofenac caused sudden kidney injury, with inflammation and damage to kidney cells.20Scientific Reports. Renoprotective effects of dapagliflozin and montelukast for diclofenac induced acute kidney injury through network pharmacology and experimental validation In animal kidneys already under strain, a 200 mg dose worsened damage markedly while 100 mg did little.21PubMed Central. A Single Oral Dose of Diclofenac Causes Transition of Experimental Subclinical Acute Kidney Injury to Chronic Kidney Disease

People with kidney disease, dehydration or heart failure are likely more vulnerable, since strained kidneys rely on prostaglandins to keep blood flowing. Older people and those with long-term kidney, heart or liver disease have less reserve and can be hurt by smaller amounts. Some blood pressure and water pills add to the strain, so the full medicine list matters.

In a person, kidney trouble typically looks like low urine output, swelling and lower back pain. Doctors follow kidney function with creatinine blood tests. Creatinine is a waste product the kidneys remove, so a rising level on repeat tests shows they’re filtering less well. One normal result soon after the overdose doesn’t rule out later injury, which is why the test is repeated over time.

Kidney injury after an NSAID overdose is usually temporary. Once the drug is cleared and fluids and monitoring are provided, function often returns over days to weeks, though some people need dialysis for a while.

Effects on the Liver and Heart

Liver injury is uncommon, even with long-term use. Among arthritis patients taking diclofenac for a long time, about 3 in 100 had levels of ALT and AST, enzymes that leak out of liver cells when they are irritated, above three times normal.22PubMed. How common is diclofenac-associated liver injury? Analysis of 17,289 arthritis patients in a long-term prospective clinical trial Only about 1 in 4,000 needed hospital care for the liver, and none had liver failure.23PubMed. How common is diclofenac-associated liver injury? Analysis of 17,289 arthritis patients in a long-term prospective clinical trial

A high enzyme level is a sign of strain, not proof of failure. These figures come from people taking normal doses for a long time, so they show how common liver irritation is, not what happens after a single overdose. A mild rise often settles on its own, which is why doctors usually repeat the test before deciding what to do.

Early liver trouble can feel vague: tiredness, nausea, loss of appetite, or discomfort in the upper right of the belly. Yellow skin or eyes, dark urine and pale stools mean the liver isn’t clearing bile properly and need prompt medical review. Diclofenac liver problems tend to appear weeks or months into regular use, so someone with a single overdose is unlikely to have symptoms at first. Blood tests can show a rise before any symptoms, which is why checks may be repeated after a large overdose.

In rats, high doses sped up the heart and changed its electrical rhythm on ECG for at least 24 hours.24PubMed. The effect of diclofenac sodium intoxication on the cardiovascular system in rats Hospitals therefore usually monitor heart rhythm after a large overdose. Chest pain, fainting or a pounding, irregular heartbeat after an overdose should be treated as an emergency.

What Happens at the Hospital

Treatment of NSAID overdose is entirely supportive.25PubMed. Toxic effects of nonsteroidal anti-inflammatory drugs in overdose. An overview of recent evidence on clinical effects and dose-response relationships Doctors manage problems such as bleeding, low blood pressure or seizures as they appear.

A typical ER visit starts with blood tests that check the kidneys, liver, blood count and acid levels. IV fluids support blood pressure and the kidneys, and stomach-protecting medicine may be given. Activated charcoal may be offered if the person arrives soon after swallowing. It binds drug left in the gut so less reaches the blood, and it works best early, which is why timing matters and why it isn’t useful hours later. It’s given only if the person is alert enough to protect their airway.

Many people go home after several hours of observation if tests stay normal. The decision rests on the amount taken, how long ago, symptoms, and repeat blood tests. Someone who took a small amount and feels well may be discharged, while those with bleeding, kidney changes or an abnormal rhythm are admitted. Discharge advice usually lists signs to return for, such as black stools, vomiting blood or low urine.

When the overdose was intentional, a mental health assessment is routine and part of care. In the US, the 988 line offers support any time.

Children, Suppositories and Gels

Diclofenac is among the painkillers young children most often swallow by accident, and in almost all such cases the medicine was left within reach.26Arhiv za higijenu rada i toksikologiju. Characteristics of unintentional ingestion of oral nonsteroidal anti-inflammatory drugs and analgesics in preschool children Suppositories have caused accidental poisonings in children too.27Barind Medical College Journal. Clinical and Epidemiological Profile of Acute Poisoning in Pediatric Patients: Patterns, Causes, and Outcomes One child died of severe muscle breakdown after an accidental injected overdose.28Balkan Medical Journal. Fatal Acute Diclofenac-Induced Rhabdomyolysis in A Pediatric Patient Dark, cola-colored urine with muscle pain or weakness is the warning sign; it can overload the kidneys and needs emergency care.

A child’s small body weight means an amount that is harmless for an adult can be a significant dose for them. Store every form locked away, and call poison control for any amount a child takes, since they can work out whether it’s a concern based on the child’s weight.

If a child swallowed something, stay calm and take the product away. Don’t make the child vomit or give anything to drink unless poison control says so. Note the time it was taken, because that affects whether treatment such as charcoal will help.

Gel is different. It puts up to 150 times less drug into the blood than tablets.29PubMed. Two Phase I, Randomized, Open-Label, Multiple-Dose, Crossover Studies Investigating the Systemic Bioavailability of Topical Diclofenac Diethylamine Gels Compared With Oral Diclofenac Tablets It’s meant to act at the sore spot, so ordinary overuse is rarely an overdose. Still, one person developed liver injury from topical diclofenac.30PubMed Central. Topical Diclofenate-Induced Hepatotoxicity Swallowing gel, or putting large amounts over wide areas or broken skin, is a reason to call poison control. Gel can also irritate skin, so rash or redness is a reason to stop using it.

Alcohol and Other Medicines

Mixing makes an overdose more dangerous. In one reported case, a man who took diclofenac with 60 other painkiller tablets and alcohol arrived in deep coma, shock and severe blood acid buildup.31Medical Toxicology. Severe Metabolic Acidosis After Diclofenac and Alcohol Overdose: A Case Study Alcohol, blood thinners, steroids and other NSAIDs all add to stomach-bleeding risk. Alcohol irritates the stomach on its own, and blood thinners and steroids raise the chance that a stomach sore will bleed heavily.

Extra doses often hide in other products. Many cold, flu and headache remedies contain ibuprofen, aspirin or acetaminophen, so the active ingredients on every label matter. Acetaminophen harms the liver and may not cause symptoms early, but it has its own antidote, so reporting it can change treatment.

Tell poison control or the ER everything taken: every medicine, supplement and drink from the last day, with approximate amounts and times. Include products that seem harmless, like cold remedies or herbal products.