Still

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Medically reviewed

Marina Burgos

Last updated on 10/01/2026

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Still

Property Description
Active Ingredient Diclofenac (as diclofenac sodium salt)
Form Ophthalmic solution (sterile eye drops)
Pharmacological Class Nonsteroidal Anti-Inflammatory Drug (NSAID)
General Purpose To alleviate discomfort and control inflammation in the eye
Origin Synthetic (a phenylacetic acid derivative)

What Type of Drug is Still and What is its Composition?

Still is a pharmaceutical preparation classified as a Nonsteroidal Anti-Inflammatory Drug (NSAID) intended for topical ophthalmic use. The core active ingredient is Diclofenac, formulated typically as diclofenac sodium salt, establishing it as a single-agent product concentrated in an aqueous solution. Diclofenac itself is a synthetic compound derived from phenylacetic acid, which defines its pharmacological classification as an anti-inflammatory agent. This mechanism of action targets the processes underlying inflammation.

Diclofenac acts as a potent inhibitor of cyclooxygenase, an enzyme critical to the inflammatory process. Consequently, the drug works by directly targeting the body's chemical signals that cause pain and swelling. Still is specifically designed to deliver this established NSAID directly to the surface of the eye, differentiating its application from oral NSAID forms.


Still: Ophthalmic Solution and Mechanism of Action

The distinctive physical form of Still is an ophthalmic solution administered as sterile eye drops. The general purpose of the medicine is to alleviate discomfort and control swelling related to inflammation within the eye. It achieves this fundamental function by acting as a cyclooxygenase inhibitor, effectively blocking the production of prostaglandins. These are the chemical messengers responsible for triggering and intensifying both pain signals and the inflammatory response. The principal function of ophthalmic NSAIDs is to manage inflammation localized to the anterior segment of the eye. Therefore, the drug is specifically designed to provide localized, anti-inflammatory and pain-relieving effects right where they are needed in the eye, such as minimizing discomfort following routine eye irritation.

What side effects are possible with Still?

Possible Side Effects and Safety Information

Still (Diclofenac Ophthalmic Solution) has a safety profile that is primarily characterized by localized ocular reactions, though systemic effects are also documented. This information is based on official government regulatory documents which classify and report adverse reactions by frequency and organ system.

Frequency-Classified Adverse Reactions

The most frequently documented events, classified in studies as Very Common, are localized reactions in the eye, including transient burning, stinging, increased tearing (lacrimation), and corneal inflammation (keratitis). Less frequently, but documented in clinical trials (typically le 3% of patients), are systemic effects such as headache, insomnia, nausea, vomiting, and abdominal pain. These effects are generally categorized across relevant System-Organ Classes (SOCs), including Eye Disorders, Nervous System Disorders, and Gastrointestinal Disorders.

Serious Ocular Risks and Safety Constraints

Official regulatory documentation identifies serious corneal adverse reactions reported through post-marketing surveillance, including corneal erosion, thinning, infiltration, and perforation. These severe events are associated with specific risk factors, such as underlying conditions like diabetes mellitus or rheumatoid arthritis, or complex ocular surgeries.

The safety constraints also highlight that use beyond 14 days post-surgery may increase the risk and severity of these corneal events. The drug is contraindicated in individuals with known hypersensitivity to diclofenac, aspirin, or other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), and its use must be avoided during late pregnancy due to the potential for fetal cardiovascular harm related to the NSAID class effect.

Overdose and Emergency Response

Overdose and when to seek help

Overdose Scope

Domain Official Regulatory Statement
Documented overdose presentations Overdose from excessive ocular instillation is unlikely to cause acute problems [FDA Labeling]. Acute systemic symptoms from accidental oral ingestion may include nausea, vomiting, epigastric pain, and gastrointestinal bleeding [SmPC].
Physiological systems affected Potential for systemic effects on the gastrointestinal, renal, and cardiopulmonary systems following significant accidental oral ingestion [SmPC].
Exposure-related factors The primary overdose risk is associated with accidental oral ingestion of the bottle's contents, not intended topical use [FDA Labeling].
Emergency-response statements The required management of overdose is defined as symptomatic and supportive [FDA Labeling]. Treatment must be initiated without delay as no specific antidote is known [SmPC].
When immediate medical help is required Seek immediate medical attention or contact a Poison Control Center (PCC) immediately if the product is accidentally swallowed [Health Canada Monograph].

Overdose Classifications (High-Level)

Classification Official Regulatory Statement
Severity classification Classified as low risk from intended ocular use; Potential for severe systemic NSAID toxicity from accidental oral ingestion [SmPC].

Connection to the overall overdose profile:

Regulatory documents define the overdose profile by contrasting the low risk from intended topical use with the higher risk of accidental systemic ingestion. Due to the potential for severe symptoms related to systemic NSAID toxicity, the labeling mandates that patients must seek immediate medical attention when accidental ingestion is suspected. Since no specific antidote is known, the official guidance requires initiating immediate supportive care.

Therapeutic Uses of Still

What Still Treats: Main Uses and Benefits

The medication is commonly used for addressing symptom patterns characteristic of chronic angina, which are conditions involving episodic or fluctuating manifestations of chest discomfort. Still is applied across domains where additional symptomatic support is needed on a regular schedule to help prevent the symptomatic manifestations of chronic heart-related circulation issues.

Still is commonly used to help with addressing symptom patterns characteristic of chronic angina associated with coronary artery disease. Still is relevant for easing symptoms related to physical discomfort and systemic imbalance that tend to arise with predictable exertion. It provides support that helps ease the overall symptom burden.

Still is relevant for easing symptoms associated with recurrent manifestations of stable angina pectoris and related symptoms of predictable chest pressure or pain. It is commonly used when supportive symptom management is appropriate to address periods of increased distress or discomfort. It provides supportive relief when symptoms interfere with routine activities.

Quick Fact: Support for Predictable Angina Symptoms
Still plays a role in managing symptoms that become more disruptive during flare-ups associated with physical discomfort.

Regulatory References

  1. NIH DailyMed overview

Eligibility and Restrictions for Use

Still is officially designated for use in adult patients aged 18 and older. Safety and effectiveness have not been established in pediatric patients under the age of 18, and use is generally not indicated for this group. Older adult (geriatric) patients may use the medicine without general dosage modification, as no overall differences in safety were observed compared to younger adults.

The medicine is contraindicated in several population groups. It must not be used by patients with a known allergy or hypersensitivity to Diclofenac Sodium or any component of the eye drops, or by individuals who experience allergic reactions, such as asthma or hives, precipitated by aspirin or other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Use is also contraindicated in women during the third trimester of pregnancy.

Certain populations require restricted use or special consideration. These include patients with known bleeding tendencies or those with pre-existing risk factors for corneal complications, such as Diabetes Mellitus, Rheumatoid Arthritis, or corneal epithelial defects. Furthermore, the product must not be used by individuals wearing soft contact lenses. Use during breastfeeding or for women attempting conception is generally not recommended.

What should I know about interactions with other medicines?

Still Interactions with other medicines and products

The official regulatory documents define the interaction profile of Still (Diclofenac Ophthalmic Solution) based on co-administration with other local and systemic agents.

Interacting Substance Category Official Regulatory Classification
Systemic Products Prolonging Bleeding Time Increased risk of ocular tissue bleeding
Topical Ophthalmic Corticosteroids Risk of delayed corneal wound healing
Other Ophthalmic Preparations Mandatory timing separation of 5 to 10 minutes

Pharmacodynamic and Procedural Constraints

Co-administration with medicinal products which may prolong bleeding time, such as systemic anti-platelet agents or anticoagulants, is associated with a documented increased risk of bleeding of ocular tissues, including hyphemas. This effect stems from the potential for the product to interfere with thrombocyte aggregation. Use in patients with known bleeding tendencies requires explicit caution, as the risk is heightened in this population.

The label also identifies a pharmacodynamic interaction with Topical Ophthalmic Corticosteroids, where concomitant use may increase the potential for problems with corneal healing or cause the process to be delayed. This consideration is particularly relevant for patients with pre-existing corneal complications.

Regarding local administration, the official instructions establish a procedural constraint: Still must be separated by an interval of at least five to ten minutes from any other applied topical ocular preparation (eye drops or ointments).

There are no known clinically significant systemic pharmacokinetic interactions documented for the ophthalmic solution. Use is contraindicated in patients with a history of hypersensitivity to Aspirin or other Nonsteroidal Anti-Inflammatory Drugs.

Mechanism of Action

Core Mechanism: Inhibition of the Cyclooxygenase Enzyme System

The fundamental action of the molecule is the non-selective inhibition of the Cyclooxygenase (COX) enzymes, specifically COX-1 and COX-2. This mechanism acts on the Arachidonic Acid Cascade to prevent the biosynthesis of various prostaglandins, which are key local chemical messengers in physiological responses. This molecular interaction suppresses the biosynthesis of these mediators at an early step in the cascade.


Modulation of Local Ocular Vascular and Tissue Responses

By severely limiting the availability of prostaglandins, the molecule exerts control over the resulting tissue-level responses. Prostanoids normally trigger vasodilation and increase vascular permeability in the eye's anterior segment; therefore, their suppression decreases these vascular changes. This physiological change reflects the mechanism's control over the processes of vascular permeability and cell migration, which results in decreased influx of fluid and cells into the anterior segment.


Inhibition of Peripheral Nociceptor Sensitization

The mechanism of COX inhibition alters the peripheral sensitization of nociceptors. Prostaglandins act to lower the threshold for nerve ending activation; reducing their concentration helps raise this threshold. This targeted action modifies the chemical process by which localized stimuli are transmitted, which results in an altered threshold for nociceptor activation.

Dosage and Administration Information

Official Administration Instructions for Still

This section outlines the instructions for the use of the drug Still. These instructions govern the dosage, route, frequency, and specific conditions for administration for the medication in adult patients.

Administration Details

Feature Requirement
Route of Administration Oral (by mouth)
Dosing Schedule One (1) 1 mg tablet per day
Timing Relative to Meals May be taken with or without food
Age Group Indicated for use in adult patients only

Procedural Steps

Still is administered once daily as a whole tablet, without any preparation steps such as crushing or dilution. The daily dose should be taken consistently at the same time each day to maintain the prescribed schedule. The defined steps are as follows:

  1. Select the Tablet: Take one 1 mg tablet from the product container.
  2. Swallow: Swallow the entire tablet whole, accompanied by liquid.
  3. Repeat: Administer the next dose after approximately 24 hours.

Missed Dose Instructions

If a dose of Still is missed, it is instructed to skip that dose entirely. The patient should then resume the dosing schedule by taking the next dose at its regularly scheduled time. It is explicitly prohibited to take two doses at the same time to compensate for a missed dose, as this could lead to an excessive intake of the drug.

Recent Clinical Evidence

Research Evidence / Overview of Studies for Still's Disease

Evidence for Use in Systemic Juvenile Idiopathic Arthritis (SJIA)

Research for Systemic Juvenile Idiopathic Arthritis (SJIA) has been conducted using short-to-intermediate term Randomized Controlled Trials (RCTs), which are considered a structured research design, alongside numerous prospective and retrospective longitudinal observational studies that follow patient groups over time. These studies were used in research exploring how symptoms change over time in children and adolescents under 16 with active SJIA.

The studies was studied for outcomes related to physical discomfort and systemic or functional imbalance. Researchers examined standardized measures of disease activity and studies monitored patterns in inflammatory biomarkers like C-Reactive Protein (CRP) and ferritin. Studies also monitored patterns related to corticosteroid dose changes over the course of the study.

Evidence for Use in Adult-Onset Still's Disease (AOSD)

Evidence for Adult-Onset Still's Disease (AOSD) is often derived from a blend of research scenarios. It includes a smaller number of controlled trials and more reliance on retrospective and prospective observational cohort studies, as well as reports from individual centers. These studies explored how symptoms are measured in adults over age 16 presenting with conditions characterized by fluctuating or episodic manifestations.

Studies explored clinical response criteria specific to AOSD and outcomes related to systemic or functional imbalance. Reported outcomes were short-term and often based on small populations documented in observational data. Findings describe patterns observed in the studies related to symptom evolution over defined time intervals.

Gaps in the Research and Areas of Uncertainty

The research landscape for Still's disease, while growing, has several areas where more information is needed. Comparative evidence is lacking, meaning few studies have directly compared all available treatment options against each other to see how they perform in an observational setting. Sample sizes were modest in many of the controlled trials due to the rarity of the condition. The long-term effects are not fully established regarding the sustained absence of symptoms and the overall management strategy over many years. Research provides context but not individual predictions, and findings describe group patterns, not personal outcomes.

Frequently Asked Questions (FAQ)

Common questions about Still (FAQ)

Q: How quickly should I expect to feel the effects of Still?

According to official regulatory documents, the active ingredient in Still is quickly absorbed by the eye's tissues after application. Detectable levels are usually found in the aqueous humor (the fluid in the eye) within one to four hours. However, this pharmacokinetic information does not specify the precise time required to feel relief from pain or swelling.

Q: Is it normal to feel a bit drowsy when first starting Still?

Official reports list systemic side effects associated with the drug class, such as insomnia (difficulty sleeping) and headache. While drowsiness itself is not usually listed as a very common side effect, some reports mention dizziness. The product is designed to have minimal absorption into the rest of the body, which is consistent with the limited systemic side effects reported.

Q: Can Still be taken with over-the-counter pain relievers like ibuprofen?

Official product information cautions against using Still with systemic medications that can prolong bleeding time, such as certain anti-platelet agents or anticoagulants. The concurrent use of systemic NSAIDs (like Ibuprofen) with Still has the potential to increase the risk of bleeding in ocular tissues.

Q: Does Still interact with common supplements like multivitamins or fish oil?

Still is an eye drop solution, meaning it has minimal absorption into the rest of the body. Regulatory documents state there are no known clinically significant systemic pharmacokinetic interactions. Official labeling does not typically provide specific data for every supplement, such as multivitamins or fish oil, given the drug's minimal systemic absorption.

Q: Why do doctors prescribe Still instead of other options?

Official product information indicates that Still (Diclofenac Ophthalmic) is approved for specific uses related to eye surgery. It is officially sanctioned for reducing inflammation and relieving pain following procedures like cataract extraction. The drug's use is localized to the eye, providing a targeted effect.

Q: What kind of research has been done on the long-term use of Still?

Regulatory warnings indicate that the medication is generally intended for short-term use. Official safety information specifies that using the eye drops for longer than 14 days after certain surgeries may increase the risk and severity of serious corneal complications. For this reason, official safety information recommends against use beyond this short duration due to increased risk.

Q: Is there a generic version of Still available?

Yes, the active ingredient in Still is Diclofenac Sodium. This compound is available from multiple manufacturers and can be found on the market as a generic ophthalmic solution.

Q: What are the documented benefits of Still according to clinical studies?

Clinical studies supporting the drug's approval demonstrate its effectiveness in reducing postoperative inflammation and providing temporary relief from pain and light sensitivity. The official benefits are linked to specific uses following procedures like cataract extraction or corneal refractive surgery.

Q: Does Still interact with birth control pills?

Because Still is an eye drop solution, its absorption into the bloodstream is minimal. Regulatory documents generally state there are no known clinically significant systemic pharmacokinetic interactions. Specific interaction data with oral contraceptives is generally not provided due to the drug's minimal systemic exposure.

Q: Does Still interact with common cold or flu medicines?

Regulatory information advises caution when using Still alongside any systemic medication that may prolong bleeding time. This caution is advised because some cold or flu medicines contain systemic NSAIDs, which can potentially affect bleeding time.

Q: What is the evidence supporting the efficacy of Still?

The efficacy (effectiveness) of Still is supported by controlled clinical studies that were submitted to regulatory bodies like the FDA. These studies confirmed the drug's ability to manage inflammation and pain specifically in the anterior segment of the eye following certain types of surgery, leading to its official indications for use.

Q: Can Still be crushed or split if a person has trouble swallowing pills?

Still is formulated as an ophthalmic solution, meaning it is a liquid administered as eye drops. It is not a tablet or a capsule that is taken orally. It must be administered only to the eye as directed.

Q: Can Still cause lightheadedness or dizziness?

Dizziness has been reported as an adverse reaction following the use of Diclofenac ophthalmic solution. Additionally, temporary blurring of vision can occur after administration, which may indirectly lead to a feeling of unsteadiness.

Q: Does Still interact with anti-depressant medications?

As an eye drop solution, Still has very minimal systemic absorption. Regulatory documents state there are no known clinically significant systemic pharmacokinetic interactions. Specific interaction data with all antidepressant classes is usually not provided due to the drug's minimal systemic absorption.

Q: What happens if I miss several doses of Still?

Official instructions for a single missed dose advise skipping it and resuming the regular schedule at the next scheduled time. The instructions explicitly prohibit taking two doses at the same time. The product information does not specify a separate procedure for missing multiple doses; patients are instructed to skip the missed dose(s) and continue with the regularly scheduled dose.

Q: How long does Still stay in your system after you stop taking it?

Regulatory pharmacokinetic data for the active ingredient, Diclofenac, show a systemic elimination half-life of about 1.2 to 2 hours. However, since this drug is applied topically as eye drops, its concentration in the bloodstream is minimal and quickly cleared.

Q: Can people with kidney problems use Still safely?

Still is an eye drop with very low systemic exposure. Due to the drug's low systemic exposure, significant risks to the kidneys are considered minimal, although general caution for the NSAID class is noted for patients with severe renal impairment.

Q: Is Still commonly prescribed for a short time, or is it a long-term treatment?

The drug is officially indicated and prescribed for short-term use. This is to treat conditions following specific eye surgeries. The product information carries a safety constraint warning against use beyond 14 days post-surgery due to increased risks of serious corneal complications.

Q: Can Still affect your ability to drive or operate machinery?

Regulatory information warns that using the eye drops may cause temporary blurring of vision or other visual disturbances immediately after application. Patients are advised not to drive or operate machinery until their vision has returned to normal.

Q: What happens if you take an alcoholic drink while on Still?

Still is an eye drop, which means minimal drug reaches the rest of your body. However, the systemic forms of this drug class (NSAIDs) carry a warning that alcohol consumption may increase the risk of gastrointestinal side effects, such as stomach bleeding.

Q: Does Still affect liver function?

Still is an ophthalmic solution with minimal systemic absorption, so it is unlikely to affect the liver. While systemic NSAIDs have warnings related to potential hepatotoxicity, the minimal systemic absorption from the eye drops means these risks are significantly lower compared to oral NSAIDs.

Q: Is Still an addictive drug?

No, Still (Diclofenac Ophthalmic) is classified as a Nonsteroidal Anti-Inflammatory Drug (NSAID). It is not a controlled substance or a narcotic and does not carry a risk of addiction or physical dependence.

Q: Do people with heart conditions need to avoid Still?

Systemic NSAIDs carry warnings for an increased risk of serious cardiovascular events. Although the eye drops have minimal systemic absorption, the general class warning advises that patients with existing heart conditions should be cautious regarding NSAIDs.

Q: Is it okay to take Still if you have high blood pressure?

Systemic NSAIDs, which belong to the same drug class as Still, may cause new onset or worsening of existing hypertension and could interfere with blood pressure medications. Patients with high blood pressure are generally cautioned regarding the NSAID class.

How should Still be stored and disposed of?

How to Store and Dispose of Still?

The official storage and disposal requirements for Still are based on authoritative regulatory documentation to ensure product integrity and safety.

Storage Requirements

Still must be stored in its original container, kept tightly closed, at a temperature range of 2 C to 25 C (36 F to 77 F). The medicine must be stored out of the sight and reach of children.

Handling and Stability

To prevent contamination, do not allow the dispensing container tip to contact any surface. Single-use applicators must be disposed of immediately after one use. The solution must be discarded 4 weeks after first opening the container.

Disposal Instructions

Any unused medicinal product or waste material, including the container, must be disposed of in accordance with local requirements, typically through an approved waste disposal plant.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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