Long-term pain and inflammation in osteoarthritis and rheumatoid arthritis, in people at higher risk of NSAID-related stomach ulcers or bleeding, such as older adults or those with a past ulcer.

Diclofenac blocks the COX enzymes to cut the prostaglandins that cause pain and swelling. The problem is that the stomach uses one of those same prostaglandins to protect its own lining. Misoprostol is a synthetic stand-in for it, restoring the mucus and bicarbonate barrier that the diclofenac would otherwise strip away.

Diarrhoea and abdominal cramps, which come mostly from the misoprostol and often settle after the first weeks, plus the usual NSAID effects of indigestion, nausea and headache.

Misoprostol causes the womb to contract, so this combination must not be taken in pregnancy or by anyone who could become pregnant without reliable contraception. All the diclofenac cautions still apply: stomach bleeding, heart attack and stroke risk, and care with heart, kidney or liver disease. Do not take another NSAID alongside it. It is a prescription medicine in Pakistan.