Yes. Diclofenac can cause peptic ulcers in the stomach or upper intestine. It belongs to a group of pain-relieving medicines called NSAIDs, which can weaken the stomach lining’s protection. Ulcers and bleeding can happen even without early warning signs, and risk rises with higher doses, longer use, older age, or certain other medicines. The chance is lower with skin gels than tablets, but not zero.

How Can Diclofenac Cause Peptic Ulcers?

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation. It is commonly prescribed for conditions such as arthritis and other painful conditions. Although it can provide effective relief, it can also damage the protective lining of the digestive tract.

The stomach has natural defenses that help protect its lining from digestive acids. NSAIDs interfere with these protective mechanisms, making the lining more vulnerable to injury. If the damage develops into an open sore in the stomach or the first part of the small intestine, called the duodenum, it is known as a peptic ulcer. According to MedlinePlus, diclofenac and other NSAIDs can cause ulcers, bleeding, or holes in the stomach or intestine, sometimes without warning symptoms.

Not everyone who takes diclofenac develops an ulcer. However, the risk is important to consider, particularly when the medicine is taken at higher doses, used for a long time, or combined with medicines that increase the chance of digestive bleeding.

Who Is More Likely to Develop an Ulcer While Taking Diclofenac?

The likelihood of an NSAID-related peptic ulcer depends on several factors, including a person's medical history, the dose and duration of treatment, and other medicines they take. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) identifies prolonged NSAID use, higher doses, taking more than one NSAID, and infection with Helicobacter pylori (H. pylori) as factors that increase ulcer risk.

Long-term use: Taking diclofenac over an extended period can increase the chance of damage to the stomach or intestinal lining.
Higher doses: Taking more diclofenac than prescribed can raise the risk of ulcers and bleeding.
A previous peptic ulcer: A history of stomach or intestinal ulcers, particularly an ulcer that has bled, is important for a prescriber to know.
Older age or poor general health: Older adults and people with poor overall health may be more vulnerable to serious digestive complications.
H. pylori infection: This stomach infection is another common cause of peptic ulcers and can increase the risk associated with NSAID use.
Other medicines: Aspirin, ibuprofen, naproxen, blood-thinning medicines, oral corticosteroids, and certain antidepressants can increase the risk of ulcers or bleeding, especially when combined with an NSAID.
Heavy alcohol consumption: Drinking large amounts of alcohol while taking diclofenac may increase the risk of serious stomach-related side effects.

These factors do not mean that an ulcer will necessarily develop. They help healthcare professionals assess whether diclofenac is appropriate and whether additional precautions may be needed.

Can Diclofenac Gel Also Cause Peptic Ulcers?

Yes. Diclofenac is available in oral forms, such as tablets and capsules, as well as topical forms, such as gels and solutions applied to the skin. Topical diclofenac generally results in less medicine entering the bloodstream than oral treatment, so some side effects are less likely. However, the risk of digestive complications is not completely absent. MedlinePlus guidance on topical diclofenac also warns of possible stomach or intestinal ulcers and bleeding.

Use topical products only as directed, and do not apply more than the recommended amount or use them more often than instructed. Tell your healthcare professional if you use topical diclofenac alongside oral painkillers, aspirin, or other medicines that may increase bleeding risk.

What Symptoms Can Occur With a Diclofenac-Related Ulcer?

A peptic ulcer may cause digestive symptoms, but some ulcers produce no noticeable symptoms until a complication occurs. The NIDDK's information on peptic ulcer symptoms describes several possible experiences, including:

Burning, aching, or discomfort in the upper abdomen
Indigestion or a sensation of fullness after eating
Nausea, and sometimes vomiting
Bloating or frequent belching
Discomfort that comes and goes or changes in relation to meals

These symptoms can have causes other than an ulcer. In addition, an NSAID-related ulcer may bleed without causing obvious stomach pain first. New or persistent stomach discomfort, heartburn, nausea, or other digestive changes while taking diclofenac should therefore be discussed with a healthcare professional.

When Does a Possible Ulcer Need Emergency Care?

Bleeding or a hole in the digestive tract can be serious complications of a peptic ulcer. Seek emergency medical care if you experience any of the following:

Vomiting blood or material that looks like coffee grounds
Black, sticky, or tar-like stools, or visible blood in the stool
Sudden, severe abdominal pain that does not go away
Fainting, marked dizziness, or symptoms suggesting significant blood loss

Do not wait for symptoms to become more pronounced if these warning signs occur. They can indicate bleeding or another serious digestive complication that needs urgent assessment.

How Can You Reduce the Risk of Ulcers While Taking Diclofenac?

The aim is to use diclofenac only when appropriate, at the lowest effective dose, and for the shortest necessary duration. The UK National Health Service (NHS) advises using the lowest dose that works for the shortest possible time, as prolonged use and high doses can increase the risk of stomach ulcers.

Practical steps that may help reduce risk include:

Follow the prescribed dose. Do not increase the dose or extend the treatment period without discussing it with your prescriber.
Avoid combining NSAIDs without medical advice. Diclofenac combined with ibuprofen, naproxen, or other NSAIDs can raise the risk of digestive complications.
Share your medical history. Tell your healthcare professional about previous ulcers, digestive bleeding, H. pylori infection, and other significant health conditions.
Review all your medicines. Include prescription medicines, over-the-counter painkillers, aspirin, and supplements when discussing your treatment.
Ask about stomach protection if you are at higher risk. A prescriber may recommend a medicine that reduces stomach acid, depending on your individual circumstances.

If you have had a peptic ulcer or digestive bleeding before, seek medical advice before starting or restarting diclofenac. Your healthcare professional may recommend a different pain medicine, a lower dose, a shorter course, or additional protection for the stomach.

How Do Doctors Assess a Possible Diclofenac-Related Ulcer?

Healthcare professionals consider the nature and timing of symptoms, the dose and duration of diclofenac use, previous digestive problems, and other medicines. According to the NIDDK's guidance on diagnosing peptic ulcers, an assessment may include a medical history, a physical examination, tests for H. pylori, and an upper gastrointestinal endoscopy when appropriate.

An endoscopy allows a clinician to examine the lining of the upper digestive tract. Other tests may be needed to assess suspected bleeding or related complications. The choice of tests depends on the symptoms, examination findings, and clinical circumstances.

What Happens if Diclofenac Is Causing an Ulcer?

Management depends on the suspected cause, the extent of the injury, and whether bleeding or another complication is present. A healthcare professional may recommend stopping diclofenac, changing to another pain-relief option, or reducing the dose if ongoing NSAID treatment is necessary. Medicines that reduce stomach acid, including proton pump inhibitors (PPIs), may be prescribed to help an ulcer heal or to lower risk in people who need to continue NSAID treatment.

The NIDDK's treatment guidance for peptic ulcers explains that treatment addresses both the ulcer and its underlying cause. If H. pylori infection is present, it may require a combination of medicines, including antibiotics. Do not start acid-reducing medicines or change your prescribed treatment on your own; seek advice tailored to your medical history and other medicines.

If you develop stomach pain or heartburn while taking diclofenac, stop taking it and contact your healthcare professional promptly. If you have signs of digestive bleeding or sudden severe abdominal pain, seek emergency care rather than waiting for a routine appointment.

Frequently Asked Questions

Answers to common questions about diclofenac, peptic ulcers, and digestive safety.

How quickly can diclofenac cause a stomach ulcer?

There is no single timeframe. Diclofenac-related ulcers and bleeding can occur at different points during treatment, sometimes without warning symptoms. Risk generally increases with higher doses and longer use, but serious complications are not limited to long-term treatment.

Can I take diclofenac if I have had a stomach ulcer before?

A previous stomach or intestinal ulcer, especially one associated with bleeding, is an important risk factor. Speak with your healthcare professional before taking diclofenac. They may recommend an alternative medicine or, if diclofenac is necessary, a plan to reduce digestive risks.

Can diclofenac cause an ulcer without stomach pain?

Yes. Some peptic ulcers cause few or no noticeable symptoms, and NSAID-related bleeding can occur without early warning. Black, tarry stools, vomiting blood, or sudden severe abdominal pain require emergency medical assessment.

Is diclofenac gel safer for the stomach than tablets?

Topical diclofenac generally leads to less medicine entering the bloodstream than oral diclofenac, making some side effects less likely. However, ulcers and digestive bleeding remain possible. Use the product as directed and discuss your other medicines and ulcer history with a healthcare professional.

Citations

Medical disclaimer: This article is for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified clinician regarding your specific health situation.

Back to all articles