Colonic Ulceration and Bleeding during Diclofenac Therapy

To the Editor: Diclofenac (Voltaren) is a recently introduced anti-inflammatory agent that is formulated as an enteric-coated product. We report the development of colonic ulcerations after the initiation of diclofenac therapy in two patients who were also taking other drugs. A 60-year-old woman was prescribed diclofenac (50 mg three times daily) for osteoarthritis. Her other medications were chlorpropamide, triamterene—hydrochlorothiazide, clonidine, amitriptyline, and ferrous sulfate. After four months of diclofenac therapy, she was noted to have positive stool tests for occult blood, and her hematocrit had decreased from 0.37 to 0.29. Esophagogastroduodenoscopy revealed minimal antral gastritis. Colonoscopy showed an ulcer in . . .