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Diflunisal is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation. However, there are several important safety considerations and warnings you need to be aware of before using this medication. Below is a detailed guide to help you understand the potential risks and necessary precautions.

• Heart Attack and Stroke Risk: Diflunisal can elevate the risk of heart attacks, strokes, and blood clots, particularly if you have pre-existing heart conditions or use the drug in higher doses or for extended periods. Avoid using diflunisal if you have undergone or will undergo heart bypass surgery. Seek immediate medical help if you experience chest pain, difficulty breathing, weakness on one side of your body, or trouble speaking.

• Stomach Bleeding and Ulcers: There is a risk of serious stomach bleeding and ulcers, which can occur without warning. This is particularly concerning for older adults and those with a history of stomach issues, or who are taking medications like aspirin, corticosteroids, or blood thinners. Signs of bleeding include persistent stomach pain, black or tarry stools, and vomit resembling coffee grounds. Consult your healthcare provider immediately if you notice any of these symptoms.

• High Blood Pressure, Heart Failure, and Swelling: Diflunisal may cause high blood pressure, fluid retention, and swelling, especially in individuals with kidney issues or heart failure. It can also interact with medications for these conditions, such as ACE inhibitors and diuretics. Monitor your blood pressure closely and report symptoms like breathing difficulties, fatigue, swelling, or sudden weight gain to your healthcare provider.

• Kidney Damage: Prolonged use of diflunisal can lead to kidney damage, particularly if you have pre-existing kidney or liver issues or are taking certain blood pressure medications. Notify your healthcare provider if you experience changes in urination frequency; kidney damage can often be reversed by discontinuing the medication.

• Liver Damage: Rarely, diflunisal can cause severe liver damage, especially when taken with acetaminophen. Symptoms to watch for include fever, fatigue, nausea, jaundice, clay-colored stools, and dark urine. Consult your healthcare provider immediately if you experience these symptoms.

• Anemia: Diflunisal might cause anemia due to its potential to cause stomach bleeding or kidney damage. Regular blood tests may be required if you are on long-term treatment.

• Asthma Attacks: Individuals with asthma should use diflunisal cautiously, as it can cause severe asthma attacks. Avoid using this medication if you have had asthma attacks triggered by aspirin or other NSAIDs in the past.

• Allergic Reactions and Skin Issues: Severe skin reactions, such as Stevens-Johnson syndrome, can occur. Symptoms include fever, body aches, peeling skin, and painful blisters. Discontinue use and seek immediate medical attention if you experience these symptoms.

• Pregnancy Risks: Using diflunisal during or after the second trimester can harm the unborn baby by reducing amniotic fluid and leading to kidney and heart problems. Discuss the risks with your healthcare provider if you are pregnant or planning to become pregnant.

• Reye's Syndrome: Rarely, diflunisal can cause Reye's syndrome, particularly in children or teenagers recovering from viral infections. Symptoms include confusion, sleepiness, and seizures. Contact your healthcare provider immediately if these symptoms occur.

• Contraindications: Do not use diflunisal if you have asthma, hives, or allergic reactions to aspirin or other NSAIDs, or if you have recently had heart bypass surgery.

Always discuss the potential benefits and risks of diflunisal with your doctor or pharmacist, and follow their guidance closely to ensure safe use of this medication.

Common side effects:

• Nausea
• Heartburn
• Stomach pain
• Diarrhea
• Rash
• Headache

Less common but important to monitor:

• Vomiting
• Constipation
• Passing gas
• Sleepiness
• Tiredness
• Difficulty falling asleep
• Dizziness
• Ringing in the ears

Serious side effects:

• Heart attack symptoms (dizziness, tiredness, cold sweat, trouble breathing, chest pain)
• Stroke symptoms (lightheadedness, blurred vision, difficulty speaking or walking, weakness on one side of the body)
• Stomach bleeds (blood in vomit or stool resembling black coffee grounds, persistent stomach pain)
• Heart failure symptoms (breathing difficulties, swelling, sudden weight gain)
• Liver damage (fever, chills, fatigue, nausea, vomiting, yellowing of the skin or eyes, clay-colored stool, dark urine)
• Severe asthma attack (chest pain, cough, difficulty breathing, wheezing)
• Serious allergic reaction (fever, rash, body aches, facial swelling, peeling skin, painful blisters)

Interactions with high risk of serious adverse effects and should be avoided:

• Ketorolac

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• abciximab
• apixaban
• Clopidogrel
• Enoxaparin
• Warfarin
• ACE inhibitors (such as Captopril, Lisinopril)
• angiotensin II receptor blockers (such as Losartan, Valsartan)
• diuretics (such as Furosemide, Hydrochlorothiazide, Triamterene)
• corticosteroids (such as Prednisone)
• Methotrexate
• pemetrexed
• Lithium
• NSAIDs (such as Ibuprofen, Aspirin)