NSAID + prostaglandin analogue (gastroprotective)

Diclofenac sodium with misoprostol

Brand names: Arthrotec

Adult dose

Dose: 1 tablet (50/200mg) BD–TDS

Route: Oral

Frequency: BD–TDS

Clinical pearls

Largely superseded by NSAID + PPI co-prescription (NICE NG100/CKS)
Misoprostol component reduces NSAID-induced ulceration
MHRA: avoid in women of childbearing age — pregnancy risk

Contraindications

Established CV disease (diclofenac contraindication)
Pregnancy / women of childbearing potential without contraception (misoprostol abortifacient)
Active GI bleeding
Severe renal/hepatic impairment
NSAID hypersensitivity

Side effects

Diarrhoea (misoprostol)
Abdominal pain
GI bleeding (still possible)
Renal impairment
CV events
Pregnancy loss (misoprostol)

Interactions

As for diclofenac

Monitoring

BP
Renal function
Pregnancy status
GI symptoms

Reference: BNF; NICE CKS NSAIDs; MHRA Drug Safety Update; https://bnf.nice.org.uk/drugs/diclofenac-sodium-with-misoprostol/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways