Drug vs. Drug

Diclofenac vs. ibuprofen: Differences, similarities, and which is better for you

Avatar By | January 8, 2020

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

With so many treatment options for arthritis, it can be overwhelming to choose the best medication for you. If you experience pain from arthritis on a regular basis, you may be recommended a nonsteroidal anti-inflammatory drug (NSAID) like diclofenac or ibuprofen. These drugs work by decreasing the production of prostaglandins, or chemicals responsible for inflammation.

Diclofenac and ibuprofen are commonly used NSAIDs that can treat inflammation and pain from osteoarthritis and rheumatoid arthritis. Both drugs are nonselective NSAIDs which means they block the COX-2 and COX-1 enzymes responsible for prostaglandin production. Because the COX-1 enzyme also has protective effects on the lining of the stomach, blocking this enzyme can cause gastrointestinal side effects.

What are the main differences between diclofenac vs. ibuprofen?

Diclofenac is a prescription drug that also goes by the brand name, Voltaren. It is available as a generic medication used to treat osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, or arthritis that affects the spine. Diclofenac sodium comes as a delayed-release tablet, extended-release tablet, and topical gel or solution. It is FDA approved for adults 18 years and older.

Ibuprofen is a commonly taken NSAID that can be purchased over-the-counter (OTC) or with a prescription. Ibuprofen can be found by its brand name, Advil or Motrin. OTC ibuprofen can be used for mild pain and fever while the prescription-strength ibuprofen can be used for more severe pain from arthritis. It is FDA approved to treat pain in adults and children 6 months and older.

Diclofenac Ibuprofen
Drug class Nonsteroidal anti-inflammatory drugs (NSAID) Nonsteroidal anti-inflammatory drugs (NSAID)
Brand/generic status Brand and generic available Brand and generic available
What is the generic name?
What is the brand name?
Diclofenac
Voltaren
Ibuprofen
Advil, Motrin
What form(s) does the drug come in? Oral tablet, enteric-coated Oral tablet, extended-release
Topical gel
Topical solution
Oral tablet
Oral capsule
Oral suspension
What is the standard dosage? 50 mg two to three times per day 400 to 800 mg every six to eight hours
How long is the typical treatment? Daily as instructed by your doctor Not longer than 10 days or as instructed by your doctor
Who typically uses the medication? Adults Adults

Conditions treated by diclofenac and ibuprofen

Diclofenac is used to treat osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.  It can also help treat dysmenorrhea or pain from menstrual cramps and migraines. Ibuprofen can also treat osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. As an NSAID painkiller, ibuprofen can also treat dysmenorrhea and migraines as well as mild pain and fever in non-prescription doses.

Condition Diclofenac Ibuprofen
Osteoarthritis Yes Yes
Rheumatoid arthritis Yes Yes
Ankylosing spondylitis Yes Off-label
Dysmenorrhea Yes Yes
Migraine Yes Yes

Is diclofenac or ibuprofen more effective?

Diclofenac needs a prescription by your healthcare provider and is considered a more potent NSAID than ibuprofen. For arthritis, diclofenac is usually dosed as 25 to 50 mg up to a daily dose of 150 mg. Ibuprofen is prescribed at higher doses of 800 mg up to a daily dose of 3200 mg.

In a meta-analysis from the Journal of Arthritis Research and Therapy, diclofenac was found to be more effective than ibuprofen for arthritic pain relief. The study reviewed data from 176 studies with over 146,524 patients. The risk of stomach-related effects were also found to be lower with diclofenac compared to ibuprofen. Diclofenac was found to be more effective when compared to other NSAIDs like celecoxib and naproxen.

Both diclofenac and ibuprofen are comparable in appropriate doses. Discuss your treatment options with your doctor as one might work better for you.

Coverage and cost comparison of diclofenac vs. ibuprofen

Most medicare and health insurance plans cover the generic version of diclofenac. The average retail cost of diclofenac can be around $60. This cost can be lowered to $20-30 with a SingleCare coupon card.

For generic ibuprofen, the cost is often covered by most medicare and insurance plans. Without insurance, the average retail cost can range from $3 to almost $7 per bottle. However, with an ibuprofen coupon, the price can be as low as $3.

  Diclofenac Ibuprofen
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage 50 mg 400-800 mg
Typical Medicare copay $3-$46 $0-$22
SingleCare cost $20-30 $3

Side effects of diclofenac and ibuprofen

Common side effects of diclofenac and ibuprofen include gastrointestinal side effects such as diarrhea, indigestion, flatulence or gas, stomach pain or cramps, heartburn, and constipation. These medications can also affect the central nervous system (CNS) and cause side effects such as dizziness and headache. Other side effects include pruritus (itching) and edema (swelling in the hands, arms, legs, or feet).

More serious adverse effects include stomach ulcers and renal or liver problems. These side effects are more likely to occur if you have a history of them or are taking other medications that can interact with NSAIDs.

  Diclofenac Ibuprofen
Side Effect Applicable? Frequency Applicable? Frequency
Diarrhea Yes 1%-10% Yes 1%-3%
Indigestion Yes 1%-10% Yes 1%-3%
Flatulence Yes 1%-10% Yes 1%-3%
Stomach cramps Yes 1%-10% Yes 1%-3%
Constipation Yes 1%-10% Yes 1%-3%
Heartburn Yes 1%-10% Yes 3%-9%
Nausea Yes 1%-10% Yes 3%-9%
Vomiting Yes 1%-10% Yes 1%-3%
Headache Yes 1%-10% Yes 1%-3%
Dizziness Yes 1%-10% Yes 3%-9%
Itching Yes 1%-10% Yes 1%-3%
Edema Yes 1%-10% Yes 1%-3%

This may not be a complete list. Consult your doctor or pharmacist for other side effects.
Source: DailyMed (Diclofenac), DailyMed (Ibuprofen)

Drug interactions of diclofenac vs. ibuprofen

Diclofenac and ibuprofen are NSAIDs that can interact with blood pressure medications like angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, and diuretics. NSAIDs may reduce the blood pressure lowering effects of these antihypertensive medications.

Taking NSAIDs with blood thinners like aspirin or warfarin can increase the risk of bleeding. These medications can interact and increase the risk of stomach ulcers. Taking NSAIDs with SSRI antidepressants can also increase the risk of bleeding.

NSAIDs can also interact with other medications and increase their levels in the body. Taking NSAIDs with drugs like lithium, digoxin, and methotrexate can increase the risk of adverse side effects.

Consult a doctor or pharmacist if you are taking any medications before starting an NSAID.

Drug Drug Class Diclofenac Ibuprofen
Aspirin Antiplatelet Yes Yes
Warfarin Anticoagulant Yes Yes
Paroxetine
Sertraline
Escitalopram
Fluoxetine
Selective serotonin reuptake inhibitor (SSRI) antidepressant Yes Yes
Venlafaxine
Desvenlafaxine
Serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant Yes Yes
Enalapril
Lisinopril
Benazepril
Angiotensin-converting enzyme (ACE) inhibitors Yes Yes
Losartan
Valsartan
Irbesartan
Candesartan
Angiotensin receptor blockers (ARBs) Yes Yes
Metoprolol
Carvedilol
Atenolol
Beta-blockers Yes Yes
Hydrochlorothiazide
Furosemide
Diuretics Yes Yes
Lithium Mood stabilizer Yes Yes
Methotrexate Antimetabolite Yes Yes
Digoxin Cardiac glycoside Yes Yes

This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.

Warnings of diclofenac and ibuprofen

Using NSAIDs can lead to an increased risk of cardiovascular events such as heart attack and stroke, especially if you have a medical history of them. NSAIDs may worsen heart failure or alter the effects of blood pressure medications. NSAIDs can also increase the risk of gastrointestinal events such as bleeding or ulcers in the stomach and intestines.

Diclofenac and ibuprofen should be avoided or monitored in people with liver or kidney problems. Taking NSAIDs can increase the risk of toxicity in the liver and kidneys.

NSAIDs should not be used during late pregnancy. Taking NSAIDs after 30 weeks of gestation can cause premature closure of the ductus arteriosus, a blood vessel in the fetal heart. Talk to your doctor about using NSAIDs during early stages of pregnancy as they should only be taken if the potential benefits outweigh the risks.

Frequently asked questions about diclofenac vs. ibuprofen

What is diclofenac?

Diclofenac is an NSAID used to treat arthritis in adults. It is FDA approved for osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. Diclofenac often comes as a prescription oral tablet or topical gel and is used two or three times a day.

What is ibuprofen?

Ibuprofen is an NSAID used to treat pain and inflammation from arthritis. It is available over the counter to treat pain and fever in adults and children. Prescription-strength ibuprofen is also available and is usually taken every 6 to 8 hours.

Are diclofenac and ibuprofen the same?

No, diclofenac and ibuprofen are not the same. Diclofenac is a prescription NSAID while ibuprofen can be purchased over-the-counter or with a prescription. Diclofenac is only prescribed for adults while ibuprofen can be used in children.

Is diclofenac vs. ibuprofen better?

Diclofenac is considered more potent than ibuprofen and needs to be taken two or three times per day. Ibuprofen often needs to be taken in higher doses to treat pain from arthritis.

Can I use diclofenac vs. ibuprofen while pregnant?

NSAIDs like diclofenac and ibuprofen should be avoided during pregnancy. Taking NSAIDs during the latter part of pregnancy may cause fetal heart problems. Consult a doctor if you are pregnant.

Can I use diclofenac vs. ibuprofen with alcohol?

Diclofenac and ibuprofen should be avoided with alcohol. Drinking alcohol with NSAIDs can lead to an increased risk of bleeding and other side effects such as dizziness and headache.

Is diclofenac better than ibuprofen for back pain?

Diclofenac is FDA-approved for arthritis that affects the spine. It may be more effective in lower doses compared to ibuprofen. Diclofenac and ibuprofen, like most NSAIDs, can help with pain management and inflammation.

Is diclofenac safer than ibuprofen?

Diclofenac needs a doctor’s assessment and prescription to use. Ibuprofen is over the counter and is therefore deemed safer for general ailments like pain or fever.

Can I take diclofenac and ibuprofen?

No. Diclofenac and ibuprofen should not be taken together since they work in a similar way. Taking them together can increase the risk of adverse events and side effects.