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Anemia has occurred in NSAID-treated patientsThis may be due to occult or gross blood lossfluid retentionor an incompletely described effect on erythropoiesisIf a patient treated with VOLTARENhas any signs or symptoms of anemiamonitor hemoglobin or hematocrit.

Diclofenac sodium did not show mutagenic activity in in vitro point mutation assays in mammalianmouse lymphomaand microbialyeastAmestest systems and was nonmutagenic in several mammalian in vitro and in vivo testsincluding dominant lethal and male germinal epithelial chromosomal studies in miceand nucleus anomaly and chromosomal aberration studies in Chinese hamsters.

Because serious GI bleedinghepatotoxicityand renal injury can occur without warning symptoms or signsconsider monitoring patients on long-term NSAID treatment with a CBC and a chemistry profile periodicallysee WARNINGSGastrointestinal BleedingUlceration And PerforationAnd Hepatotoxicity

Advise patients to be alert for the symptoms of congestive heart failure including shortness of breathunexplained weight gainor edema and to contact their healthcare provider if such symptoms occursee WARNINGSHeart Failure And Edema

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