Taking NSAIDs may cause serious and possibly life-threatening cardiovascular events such as heart attack and stroke. This risk can occur with short-term use and may increase with long-term use of NSAIDs.
Taking NSAIDs may cause serious and potentially fatal bleeding in the stomach or intestines, also known as gastrointestinal (GI) bleeding. Some people are at higher risk for GI bleeding while taking NSAIDs, including older adults (age 65 years and older) and people with a history of GI bleeding or peptic ulcer disease.
Cambia should not be used in people right before or after heart bypass surgery (coronary artery bypass graft, or CABG), due to the risk of serious cardiovascular events.
As an NSAID, diclofenac potassium blocks an enzyme called cyclooxygenase (COX) that helps produce chemicals called prostaglandins. Prostaglandins are thought to contribute to the inflammation that causes painful symptoms. Decreasing prostaglandins may help relieve this inflammation.
Similar to other NSAIDs, diclofenac potassium carries a boxed warning due to the risk of serious cardiovascular events (e.g., heart attack) and gastrointestinal bleeding. Talk to your healthcare provider about these potential safety concerns before starting treatment.
Cambia is a powdered form of diclofenac potassium that comes in single-dose packets. It is dissolved into water and taken as an oral solution. Cambia is indicated for use in acute migraine treatment. Diclofenac potassium is also approved in a tablet (Cataflam) and liquid-filled capsule (Zipsor) for mild to moderate pain relief.
You can get diclofenac potassium products only with a prescription from a healthcare provider.
What Is Cambia Used For?
The Food and Drug Administration (FDA) approved Cambia for the acute treatment of migraine attacks, with or without aura, in adults.
Brand Name(s): Cambia, Cataflam, Zipsor
Drug Availability: Prescription
Administration Route: Oral
Therapeutic Classification: Analgesic
Available Generically: No
Controlled Substance: N/A
Active Ingredient: Diclofenac potassium
Dosage Form(s): Powder for solution, tablet, capsule
Migraine is a common headache disorder that involves recurring migraine attacks or episodes. Attacks usually consist of moderate to severe pain on one side of the head. Other symptoms may include nausea, vomiting, and sensitivity to light and sound.
Before or during a migraine attack, about one-third of people get warning symptoms known as an aura. Aura symptoms involve sensory disturbances like seeing sparks or flashes of light or temporary vision loss. If untreated, migraine attacks typically last four to 72 hours.
Cambia does not work to prevent migraine episodes. Neither is it used to treat other types of headaches like cluster headaches.
Diclofenac potassium’s other formulations, Cataflam and Zipsor, are also used to treat mild and moderate pain associated with inflammatory conditions involving the musculoskeletal system. Some examples of uses include primary dysmenorrhea (painful menstrual cramps), osteoarthritis, and rheumatoid arthritis.
How to Take Cambia
Cambia is a medication that you take only as needed for migraine attacks. Take one dose during a migraine attack or as directed by your healthcare provider.
Cambia comes in packets of powder. Each packet contains one dose of 50 milligrams (mg). The active ingredient is diclofenac potassium.
To take Cambia, empty the contents of one packet into a cup that contains 1 to 2 ounces of water only. Do not use any other type of liquid or beverage. Mix well, and then drink the mixture immediately.
It may work better if you take it on an empty stomach. Since migraine attacks aren’t always predictable, you can still take the medication with food or after you’ve eaten.
If you are taking diclofenac potassium for other types of mild to moderate pain, take it as prescribed by your healthcare provider. Dosages may vary depending on your health condition and pain severity.
Keep in mind that the different formulations are not interchangeable. The oral solution is rapidly absorbed and starts working much faster than the oral tablet form of diclofenac. Follow the instructions for the formulation you have been prescribed.
Storage
Cambia comes in single-dose packets of powder. Store the packets at room temperature (between 67 F and 78 F), away from moisture. Do not keep them in the bathroom. Don’t open a packet until you are ready to take a dose.
The tablet and liquid-filled capsule formulations should be kept at room temperature and should not be stored above 86 F.
What Are the Side Effects of Cambia?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.
Common Side Effects
More common side effects of diclofenac potassium may include:
NauseaDizzines
Severe Side Effects
Like other NSAIDs, diclofenac potassium may cause serious side effects. However, severe side effects are not expected when the medication is used short-term and only as prescribed. Some people may have conditions or factors that increase the risk of specific severe side effects.
The FDA has issued three boxed warnings regarding this medication:
Taking NSAIDs may cause serious and possibly life-threatening cardiovascular events such as heart attack and stroke. This risk can occur with short-term use and may increase with long-term use of NSAIDs. Taking NSAIDs may cause serious and potentially fatal bleeding in the stomach or intestines, also known as GI bleeding. Some people are at higher risk for GI bleeding while taking NSAIDs, including older adults (65 years and older) and people with a history of GI bleeding or peptic ulcer disease. Diclofenac potassium should not be used in people right before or after heart bypass surgery (coronary artery bypass graft, or CABG) due to the risk of serious cardiovascular events.
Potentially severe side effects and their symptoms include:
Medication overuse headaches, which are worse-than-usual headaches caused by overutilization of acute headache medications like diclofenac potassium High blood pressure (hypertension), which doesn’t typically cause symptoms Heart failure: Weakness, fluid retention that may cause swelling in your lower legs and rapid weight gain, trouble breathing during physical activity, or heart palpitations GI bleeding or ulcers in the stomach or intestines: Vomit that’s bright or dark red or looks like coffee grounds; stool that’s bright red, maroon, or black; abdominal pain; rapid pulse; dizziness; fainting Kidney problems, such as kidney failure: Low energy, loss of appetite, nausea or vomiting, muscle weakness, confusion, changes in your heart rhythm or rate Liver damage, such as liver failure: Fatigue, stomach upset, fever, chills, dark-colored urine, and yellowing of your skin or the whites of your eyes (jaundice). A blood test showing raised liver enzyme levels can also be a sign of liver damage. Anemia (low red blood cells): Fatigue, dizziness, fast heart rate, chest pain Asthma attacks in people with asthma: Sudden episodes of shortness of breath, coughing, and wheezing Serious allergic reactions, including anaphylaxis and severe skin reactions: Swelling of the tongue, throat, or face; trouble breathing; or skin inflammation or peeling.
If you notice the symptoms described above, don’t wait to see if they go away. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.
Long-Term Side Effects
Diclofenac potassium can cause side effects that continue to affect you even after stopping treatment with the medication. Several of these serious side effects, also described above, may require long-term treatment. These side effects include:
High blood pressureHeart failureKidney or liver problems
Dosage: How Much Cambia Should I Take?
Modifications
In certain cases, you may need to adjust how you take diclofenac potassium. Talk to your healthcare provider about your treatment if any of the following apply to you:
If you experience a serious side effect, you or your healthcare provider may send a report to the FDA’s MedWatch Adverse Event Reporting Program online or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (Zipsor® capsules): For acute pain: Adults and children 12 years of age and older—25 milligrams (mg) 4 times a day. Children younger than 12 years of age—Use and dose must be determined by your doctor. For oral dosage form (Zorvolex® capsules): For acute pain: Adults—18 or 35 milligrams (mg) 3 times a day. Children—Use and dose must be determined by your doctor. For osteoarthritis: Adults—35 milligrams (mg) 3 times a day. Children—Use and dose must be determined by your doctor. For oral dosage forms (delayed-release tablets, enteric-coated tablets): For ankylosing spondylitis: Adults—25 milligrams (mg) 4 times a day, with an extra 25 mg dose at bedtime if necessary. Children—Use and dose must be determined by your doctor. For osteoarthritis: Adults—50 milligrams (mg) 2 or 3 times a day, or 75 mg two times a day. Children—Use and dose must be determined by your doctor. For rheumatoid arthritis: Adults—50 milligrams (mg)3 or 4 times a day, or 75 mg two times a day. Children—Use and dose must be determined by your doctor. For oral dosage form (immediate-release tablets): For osteoarthritis: Adults—50 milligrams (mg) 2 or 3 times a day. Children—Use and dose must be determined by your doctor. For pain or menstrual cramps: Adults—50 milligrams (mg) 3 times a day. Your doctor may direct you to take 100 mg for the first dose only. Children—Use and dose must be determined by your doctor. For rheumatoid arthritis: Adults—50 milligrams (mg) 3 or 4 times a day. Children—Use and dose must be determined by your doctor. For oral dosage form (solution): For migraine headaches: Adults—One packet (50 milligrams) as a single, one time dose. Children—Use and dose must be determined by your doctor.
Pregnancy: NSAIDs, such as diclofenac potassium, should be avoided during pregnancy starting at 30 weeks gestation, as NSAID use can lead to a problem called premature closure of the ductus arteriosus in the fetus. Breastfeeding: It is unknown whether diclofenac potassium passes into human breast milk. However, diclofenac potassium does have the potential to cause adverse effects in nursing babies. Therefore, you and your healthcare provider should make a decision whether to stop taking the drug or stop nursing. 65 years or older: Older adults are at an increased risk of serious side effects and complications related to NSAID use. You and your healthcare provider should monitor closely for any severe side effects related to cardiovascular events, GI bleeds, or kidney problems. Liver disease: People with liver impairment may be prescribed diclofenac potassium only if the benefit outweighs the potential risk.
Missed Dose
Cambia is usually taken as needed for migraines. Therefore, you will not need to worry about missing a dose.
For other diclofenac potassium products, take the missed dose as soon as you remember. If it is closer to your next scheduled dose, skip the missed dose and continue with your regular schedule. Do not take more doses to make up for a missed dose.
Overdose: What Happens If I Take Too Much Cambia?
You should not take more diclofenac potassium than prescribed by your healthcare provider. Taking too much may cause serious side effects.
Overdose symptoms may include extreme drowsiness, nausea, vomiting, belly pain, or bleeding in your stomach or intestines. Rarely, an overdose may cause kidney failure, trouble breathing, or coma.
Precautions
What Are Reasons I Shouldn’t Take Cambia?
You should not take this medication if:
If someone collapses or isn’t breathing after taking diclofenac potassium, call 911 immediately.
This medicine may raise your risk of having a heart attack or stroke. This is more likely in people who already have heart disease or in people who use this medicine for a long time.
This medicine may cause bleeding in your stomach or intestines. These problems can happen without 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 of age, are in poor health, or are using certain medicines (eg, steroid medicine, blood thinner).
Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.
Serious skin reactions, including Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) can occur during treatment with this medicine. Check with your doctor right away if you have black, tarry stools, blistering, peeling, or loosening of the skin, chest pain, chills, cough, diarrhea, fever, itching, joint or muscle pain, painful or difficult urination, red irritated eyes, red skin lesions, sore throat, sores, ulcers, or white spots in the mouth or on the lips, swollen glands, unusual bleeding or bruising, or unusual tiredness or weakness.
Some possible warning signs of serious side effects that can occur during treatment with this medicine may include black, tarry stools, decreased urination, severe stomach pain, skin rash, swelling of the face, fingers, feet, or lower legs, unusual bleeding or bruising, unusual weight gain, vomiting of blood or material that looks like coffee grounds, or yellow skin or eyes. Also, signs of serious heart problems could occur, including chest pain or tightness, fast or irregular heartbeat, unusual flushing or warmth of the skin, weakness, or slurring of speech. Check with your doctor right away if you notice any of these warning signs.
Check with your doctor right away if you have bloody urine, a decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.
Hyperkalemia (high potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you have stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, or weakness or heaviness of the legs.
This medicine may cause a serious allergic reaction called anaphylaxis, which can be life-threatening and requires immediate medical attention. It may occur often in patients who are allergic to aspirin or other nonsteroidal anti-inflammatory drugs. Call your doctor right away if you have a rash, itching, trouble breathing or swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.
Using this medicine during the later part of pregnancy can harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.
Using too much of Cambia® or any other migraine medicines (eg, ergotamine, triptans, opioids, NSAIDs, or a combination treatment for 10 or more days per month) may worsen your headache. Talk to your doctor about this risk. It may also be helpful to note of how often your migraine attacks occur and how much medicines you use.
Call your doctor right away if you have confusion, drowsiness, fever, general feeling of illness, headache, loss of appetite, nausea, stiff neck or back, or vomiting. These could be symptoms of meningitis.
Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after your treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
This medicine may cause a delay in ovulation for women and may affect their ability to have children. If you plan to have children, talk with your doctor before using this medicine.
Before having any kind of surgery or medical tests, tell your doctor that you are using this medicine. It may be necessary for you to stop treatment for awhile, or to change to a different nonsteroidal antiinflammatory drug before your procedure.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
You are allergic to NSAIDs, diclofenac potassium, or any of the product’s ingredients. You had an asthma attack, hives, or other severe reaction after taking aspirin or another NSAID in the past. You are recovering from or getting ready to have heart bypass surgery (also known as CABG).
What Other Medications Interact With Cambia?
Diclofenac potassium can interact with other medications. Drug interactions may increase the risk of certain side effects. However, some drug interactions can be managed by close monitoring by your healthcare provider.
Before taking diclofenac potassium, tell your healthcare provider about all of your current medications, including prescription drugs, over-the-counter (OTC) medications, vitamins, and herbal supplements. Some of the most important interactions to be aware of while taking this medication include:
Certain blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and diuretics (e. g. , Lasix (furosemide) and thiazides) Certain antidepressant drugs like selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) Lanoxin (digoxin), a heart medication Lithium, a drug used to treat mania related to bipolar disorder Drugs with blood-thinning effects, such as Jantoven (warfarin), aspirin, and other NSAIDs
What Medications Are Similar?
Cambia, Cataflam, and Zipsor contain the active ingredient diclofenac potassium. They are prescription drugs that belong to a group of medications called NSAIDs. Other types of NSAIDs are available both by prescription and OTC.
You should not take more than one NSAID drug at the same time. Doing so could increase your risk of severe side effects. Some examples of other drugs in the same class as diclofenac potassium include:
Advil, Motrin (ibuprofen) Aleve, Anaprox, Naprosyn (naproxen) Flurbiprofen Nabumetone Diclofenac sodium
Other acute migraine medications are available by prescription besides NSAIDs, such as triptans. Additionally, some medications are available to prevent migraine attacks, such as Topamax (topiramate) and amitriptyline.
Different formulations of diclofenac exist in oral and topical forms of diclofenac sodium (the sodium salt formulation). These formulations are not the same as diclofenac potassium. Diclofenac potassium has been shown to absorb faster in the body and have a more rapid onset of pain relief.
How Can I Stay Healthy While Taking Cambia?
Managing migraine attacks or other pain episodes can be challenging. Particularly for migraine, there are steps you can take day-to-day to prevent episodes from striking. When possible, try to avoid or minimize exposure to the following migraine triggers:
Frequent use of NSAIDs, such as Cambia, can increase your chances of getting rebound headaches. This side effect is also called a medication overuse headache and can worsen your headache pain.
Alcohol, especially red wine Dietary triggers, such as chocolate, soft cheeses, artificial sweeteners like aspartame, and monosodium glutamate (MSG), a food additive Sleep disturbances like insomnia Skipping or delaying meals. Life can get busy, but do your best to stick to a consistent meal schedule. Excessive caffeine or caffeine withdrawal. If you’re used to having caffeine every morning, skipping it may trigger a migraine. Stress. Behavioral therapy like relaxation training and cognitive-behavioral therapy (CBT) may help manage stress and prevent related migraines.
Besides reducing how often you have migraine attacks, trigger avoidance offers another advantage: potentially taking less migraine medication. This may help to reduce your risk of developing drug-related side effects.
For other types of mild to moderate pain, physical activity is a healthy way to relieve certain types of pain, such as arthritis pain. It can also aid in improving your functioning, mood, and overall quality of life.
Talk to your healthcare provider about other strategies for reducing pain, whether related to migraines or other types of inflammatory conditions.
