diclofenac sodium
Diclofenac sodium topical gel (Voltaren gel) and diclofenac sodium topical solution (Pennsaid) can help ease arthritis pain from osteoarthritis. They're applied to the skin of the affected joints, typically 2-4 times daily, depending on which topical product you use. Some common side effects of topical diclofenac include dry skin, redness, and itching. Because diclofenac is a non-steroidal anti-inflammatory drug (NSAID), these topical products can also raise the risk for NSAID-related side effects, such as blood clots and high blood pressure. While the diclofenac sodium topical solutions are only available by prescription, you can get diclofenac sodium 1% topical gel over-the-counter or by prescription.
What is Diclofenac sodium topical gel (Voltaren gel)?
What is Diclofenac sodium topical gel (Voltaren gel) used for?
- Pain from osteoarthritis of the knees - topical solutions and 1% gel
- Pain from osteoarthritis of small joints, such as hands and wrists - 1% gel only
How Diclofenac sodium topical gel (Voltaren gel) works
Diclofenac sodium topical gel (Voltaren gel) is a non-steroidal anti-inflammatory drug (NSAID). It works by blocking proteins called cyclooxygenase 1 and 2 (COX-1 and COX-2) enzymes from making chemicals called prostaglandins. Prostaglandins play many roles in your body, including causing pain and swelling where you get injured. By blocking your body from making prostaglandins, diclofenac treats osteoarthritis by easing joint pain and swelling.
Drug facts
More on Diclofenac sodium topical gel (Voltaren gel) essentials
Side effects of Diclofenac sodium topical gel (Voltaren gel)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
1% gel
- Redness, rash, itchiness of the skin (contact dermatitis, 4%)
1.5% and 2% solution
- Dry skin (up to 32%)
- Contact dermatitis (9%)
- Acid reflux, bloating (8%)
- Stomach pain (6%)
Less Common Side Effects
1.5% and 2% solution
- Passing gas
- Itching
- Diarrhea
- Nausea
- Sore throat
Diclofenac sodium topical gel (Voltaren gel) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: dizziness, tiredness, cold sweat, trouble breathing, chest pain or tightness, anxiety
- Stroke: tiredness, lightheadedness, blurred vision, difficulty speaking, difficulty walking, weakness on one side of the body
- Stomach bleeds: blood in your vomit, stool that looks like black coffee grounds, pain in your stomach that doesn't go away
- Heart failure: trouble breathing, tiredness, swelling in your body, sudden weight gain
- Severe asthma attack: chest pain, cough, difficulty breathing, wheezing
- Serious allergic or skin reaction: fever, body aches, cough, peeling skin, rash, swelling of the face, painful blisters all over your body
The following Diclofenac sodium topical gel (Voltaren gel) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Burning, itching, redness, skin rash, swelling, or soreness at the application site
itching skin
Less common
Blood in the urine
dry, itching, or burning eyes
headaches, including migraines
increased sensitivity of the skin to sunlight
pain or tenderness around the eyes and cheekbones
redness of the skin
redness or swelling of the eyes
runny or stuffy nose
skin rash other than at the application site
tightness in the chest
troubled breathing
ulcers or sores on the skin, other than at the application site
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Chills
general feeling of discomfort or illness
joint pain
loss of appetite
muscle aches and pains
scaly, thick, or tingling skin
shivering
sweating
trouble sleeping
unusual tiredness or weakness
vomiting
Less common
back pain
belching
bleeding skin
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
dizziness
increase in body movements
indigestion
lack or loss of strength
loss of or change in taste
loss or thinning of the hair
neck pain
sleepiness or unusual drowsiness
stomach upset or pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Diclofenac sodium topical gel (Voltaren gel)
Pros
- Available as a less expensive generic medication
- Diclofenac sodium topical gel (Voltaren gel) 1% gel is available over the counter without a prescription
- Less serious side effects compared to oral diclofenac
- Can target specific areas of osteoarthritis pain
Cons
- Can cause skin irritation
- Can't be used for pain in other places, such as back or hip
- Can be inconvenient to use because you need to wait for the medication to dry before putting on clothing
- Not recommended for use during pregnancy
Pharmacist tips for Diclofenac sodium topical gel (Voltaren gel)
- Shower or clean your skin before applying topical diclofenac. If you want to shower after using this medication, wait about 30 minutes (solution) or 1 hour (gel) to give your body time to absorb the medication.
- If you're using the diclofenac sodium topical gel (Voltaren gel), make sure to measure out the amount of medication you need with the plastic dosing card found inside the box.
- If you're using the diclofenac 1.5% solution for the knee, apply and rub in 10 drops of solution at a time to prevent spilling.
- If you're using a new bottle of diclofenac 2% solution (Pennsaid) for the first time, make sure to prime the bottle by holding it upright and pressing down on the pump 4 times. Priming the bottle makes sure that you get full doses of medication when you're ready to apply it to your skin. The bottle is ready to use after you prime it.
- Don't apply this medication to any open cuts or wounds on your skin. Also, don't use bandages or heat packs on your skin after you apply this medication. Doing so might affect how much medication gets absorbed.
- Wait until this medication dries or is completely rubbed into the skin before touching pets or other people. Otherwise, you might transfer some of this medication onto them.
- Avoid using other topical products, such as lotions, sunscreens, or bug repellants, on the same area of skin where you apply diclofenac sodium topical gel (Voltaren gel). These products might affect how your skin absorbs this medication. You can use these products on the same area of skin where you apply the diclofenac solution, but only after the medication dries.
Common questions about Diclofenac sodium topical gel (Voltaren gel)
You can't use diclofenac sodium topical gel (Voltaren gel) or diclofenac topical solutions on your back because they're not FDA-approved for pain relief in this area. There aren't enough research to know whether these medications are safe or will work well to treat back pain. Currently, topical diclofenac is only approved to treat pain in smaller joints, such as the hand, wrist, elbows, and knee. If you've back pain, talk with your provider. They can do an exam to learn more about what's causing your back pain, then recommend treatment options that are appropriate for you.
Because diclofenac sodium topical gel (Voltaren gel) is an NSAID, it can raise the risk for potentially dangerous NSAID-related side effects. For example, it carries a strong warning for risk of heart attack and stroke, as well as other side effects, like high blood pressure and serious skin reactions. Despite these warnings, topical diclofenac products are less likely to cause NSAID-related side effects compared with oral diclofenac (Cambia, Cataflam). But to minimize your risk of serious side effects, you should only use diclofenac sodium topical gel (Voltaren gel) as directed by your provider. Talk with your provider if you've any specific safety concerns about diclofenac sodium topical gel (Voltaren gel).
You can use diclofenac sodium topical gel (Voltaren gel) 4 times daily. If you're using the OTC version, don't apply to more than 2 body areas at the same time.
You might start to feel your pain ease a bit after a few days of using diclofenac sodium topical gel (Voltaren gel). But you'll need to keep using it regularly for about a week before you can expect more noticeable pain relief. Even still, some people might need to use diclofenac sodium topical gel (Voltaren gel) for a few more weeks to feel the full effect from the medication.
It's not recommended to use ibuprofen (Advil) tablets with diclofenac sodium topical gel (Voltaren gel), unless your provider instructs you to do so. Because both medications are NSAIDs, using them together puts you at higher risk for side effects, such as stomach bleeds, stroke, and kidney problems. If diclofenac sodium topical gel (Voltaren gel) alone isn't enough to treat your pain, discuss with your provider about other options for you. Please be aware that NSAIDs are found in many common over-the-counter and prescription pain medications. They sometimes appear in combination with other medications to treat different conditions, such as the common cold or trouble sleeping. Talk with your healthcare provider or pharmacist if you're not sure whether you're already taking an NSAID.
Talk with your provider if you're thinking about taking acetaminophen (Tylenol) tablets along with diclofenac sodium topical gel (Voltaren gel). These two medications work differently to relieve pain and they don't have any known interactions. But acetaminophen (Tylenol) might not be appropriate for you if you've certain health conditions, such as liver problems.
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Risks and warnings for Diclofenac sodium topical gel (Voltaren gel)
Diclofenac sodium topical gel (Voltaren gel) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart attack and stroke
- Risk factors: History of heart problems, including heart attack | Using high doses of diclofenac sodium topical gel (Voltaren gel) | Using diclofenac sodium topical gel (Voltaren gel) for a long time | History of heart bypass surgery
Diclofenac sodium topical gel (Voltaren gel) can raise your risk of having blood clots, heart attacks, or strokes. This can happen as early as within the first weeks of starting this medication. People with heart problems, those using high doses of diclofenac sodium topical gel (Voltaren gel), and those using diclofenac sodium topical gel (Voltaren gel) for a long time have a higher risk of this happening. That’s why it’s important to use the lowest possible dose for the shortest possible time. If you have heart problems, talk to your healthcare provider before starting this medication. Don't use diclofenac sodium topical gel (Voltaren gel) if you've had or will be having heart bypass surgery. Call 911 or seek immediate medical help if you experience chest pain, trouble breathing, weakness on one side of your body, or trouble speaking or walking.
Stomach bleeding and ulcers
- Risk factors: History of stomach bleeding or ulcers | Older adults | Taking aspirin (Aspir-Low), other NSAIDs, corticosteroids, blood thinners, or SSRIs | Drinking alcohol | Smoking | Having poor health | Liver problems | Bleeding problems | Using diclofenac sodium topical gel (Voltaren gel) for a long time | Using higher doses of diclofenac sodium topical gel (Voltaren gel)
Diclofenac sodium topical gel (Voltaren gel) can cause stomach bleeding and ulcers, which can be dangerous. There are many conditions and medications that raise your risk of this problem, so speak with your provider before starting this medication. Stomach bleeding and ulcers can occur without warning or symptoms, so it's best to use the lowest possible dose for the shortest possible time to minimize your risk. If you notice blood in your vomit, stool that looks like black coffee grounds, or if you have pain in your stomach that doesn't go away, stop using diclofenac sodium topical gel (Voltaren gel) and talk to your healthcare provider right away.
Liver damage
- Risk factors: History of liver damage | Taking other medications that can cause liver damage
Very rarely, diclofenac sodium topical gel (Voltaren gel) can cause life-threatening liver damage. This can happen as early as within the first month of starting this medication. Your risk is higher if you use diclofenac sodium topical gel (Voltaren gel) with other medications that can also cause liver damage, such as acetaminophen (Tylenol) and Augmentin (amoxicillin / clavulanate). Liver damage can happen with or without symptoms so if you use this medication for a long time, you might need to get lab work to check your liver regularly. Stop diclofenac sodium topical gel (Voltaren gel) and talk to your healthcare provider right away if you experience symptoms such as fever, chills, fatigue, nausea, vomiting, yellowing of the skin or whites of the eyes, clay-colored stool, and dark urine.
High blood pressure, heart failure, and swelling of your arms and legs
- Risk factors: High blood pressure | Heart failure | Taking certain high blood pressure medications, such as water pills, ACEIs, and ARBs
Diclofenac sodium topical gel (Voltaren gel) can raise your blood pressure, and it can also cause your body to hold onto more water. This can lead to new or worsen existing blood pressure problems, heart failure, and swelling of your arms and legs. Diclofenac sodium topical gel (Voltaren gel) can also cause some medications used to treat these conditions to be less effective, such as furosemide (Lasix), lisinopril (Zestril), and losartan (Cozaar). Monitor your blood pressure closely while using diclofenac sodium topical gel (Voltaren gel). Diclofenac sodium topical gel (Voltaren gel) isn't recommended if you have heart failure, so discuss with your provider before starting this medication. Let your provider know right away if you notice any changes in your blood pressure or experience symptoms, such as trouble breathing, tiredness, swelling in your body, or sudden weight gain.
Kidney damage and high potassium levels
- Risk factors: Kidney or liver problems | Heart failure | Taking certain high blood pressure medications, such as water pills, ACEIs, or ARBs | Older adults | Loss of body fluid through conditions such as severe vomiting, bleeding, or diarrhea | Using diclofenac sodium topical gel (Voltaren gel) for a long time
Diclofenac sodium topical gel (Voltaren gel) can damage your kidneys by slowing down blood flow to the kidneys. The risk is higher if you're taking certain blood pressure medications (like ACEIs, ARBs, or water pills), or have certain conditions (like kidney or liver problems and heart failure). Kidney damage is usually reversible once you stop taking this medication. If you have very severe kidney problems, don't use this medication unless the benefit is greater than the risk of side effects. Let your provider know if you notice a change in how often you urinate after starting diclofenac sodium topical gel (Voltaren gel).
Diclofenac sodium topical gel (Voltaren gel) can also lead to high potassium levels, even in people with healthy kidneys. If you experience signs of high potassium levels, such as nausea, muscle weakness, or tingling sensations in your muscles, tell your healthcare provider right away because it might be dangerous.
Severe asthma attack
- Risk factors: Asthma and stuffy nose with or without nasal polyps | Allergic reaction to aspirin or other NSAIDs
Diclofenac sodium topical gel (Voltaren gel) can cause your airways to tighten, which might lead to severe asthma attacks. Be careful using this medication if you have asthma. People who've experienced asthma attacks triggered by aspirin (Aspir-Low) or other NSAIDs in the past should avoid diclofenac sodium topical gel (Voltaren gel). Get medical help right away if your throat tightens and you can't breathe.
Severe allergic or skin reaction
Diclofenac sodium topical gel (Voltaren gel) might cause sudden, very serious, and sometimes life-threatening allergic and skin reactions. Symptoms include fever, body aches, rash, peeling skin, painful blisters all over your body, and swelling of the face. Stop the medication and get help right away if you experience these symptoms.
Harm to unborn babies
- Risk factors: Currently pregnant
If diclofenac sodium topical gel (Voltaren gel) is used during or after the second trimester of pregnancy, it can lower the amniotic fluid (the fluid that surrounds the baby in the womb). This can occur as soon as 2 days after starting the medication and result in serious kidney problems in your unborn baby. Babies born to mothers who use diclofenac sodium topical gel (Voltaren gel) starting in the third trimester of pregnancy or later can also develop heart problems. If you're thinking of getting pregnant or become pregnant, talk to your provider about the risks and benefits of using diclofenac sodium topical gel (Voltaren gel).
Diclofenac sodium topical gel (Voltaren gel) dosage
Tube of gel| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 100g of 1% | 1 tube | $14.41 | $14.41 |
Typical dosage for Diclofenac sodium topical gel (Voltaren gel)
Diclofenac 1% (Voltaren Arthritis Pain) gel: Use the plastic dosing card found inside your box to measure out the amount of gel needed. Apply to the affected area(s) of your body 4 times a day. Don't use on more than 2 body areas at the same time.
- Joints on lower body (e.g., feet, ankles, knees): Use up to 4 grams of gel for each dose. Don't use more than 16 grams per day on any single joint.
- Joints on upper body (e.g., hands, wrists, elbows): Use up to 2 grams of gel for each dose. Don't use more than 8 grams per day on any single joint.
Diclofenac 1.5% topical solution: The typical dose is to apply 40 drops to each affected knee 4 times a day.
Diclofenac 2% (Pennsaid) topical solution: The typical dose is to apply 2 pumps (40 mg total) to each affected knee 2 times a day.
More on Diclofenac sodium topical gel (Voltaren gel) dosage
Interactions between Diclofenac sodium topical gel (Voltaren gel) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abciximab
- Acenocoumarol
- Amiloride
- Amineptine
- Amitriptyline
- Amitriptylinoxide
- Amoxapine
- Anagrelide
- Apixaban
- Ardeparin
- Argatroban
- Aspirin
- Bemiparin
- Bendroflumethiazide
- Benzthiazide
- Betamethasone
- Betrixaban
- Bivalirudin
- Budesonide
- Bumetanide
- Cangrelor
- Ceritinib
- Certoparin
- Chlorothiazide
- Chlorthalidone
- Cilostazol
- Citalopram
- Clomipramine
- Clopamide
- Clopidogrel
- Cortisone
- Cyclopenthiazide
- Cyclosporine
- Dabigatran Etexilate
- Dalteparin
- Danaparoid
- Deferiprone
- Deflazacort
- Desipramine
- Desirudin
- Desmopressin
- Desvenlafaxine
- Dexamethasone
- Dexketoprofen
- Diazoxide
- Dibenzepin
- Diflunisal
- Digoxin
- Dipyridamole
- Dipyrone
- Dothiepin
- Doxepin
- Droxicam
- Duloxetine
- Edoxaban
- Enoxaparin
- Eplerenone
- Epoprostenol
- Eptifibatide
- Escitalopram
- Ethacrynic Acid
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Feverfew
- Floctafenine
- Flufenamic Acid
- Fluocortolone
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Furosemide
- Ginkgo
- Gossypol
- Heparin
- Hydrochlorothiazide
- Hydrocortisone
- Hydroflumethiazide
- Ibuprofen
- Iloprost
- Imipramine
- Indapamide
- Inotersen
- Ketoprofen
- Lepirudin
- Levomilnacipran
- Lithium
- Lofepramine
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Magnesium Salicylate
- Meadowsweet
- Meclofenamate
- Mefenamic Acid
- Melitracen
- Meloxicam
- Mesalamine
- Methotrexate
- Methyclothiazide
- Methylprednisolone
- Metolazone
- Milnacipran
- Morniflumate
- Nabumetone
- Nadroparin
- Naproxen
- Nefazodone
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Nortriptyline
- Olsalazine
- Opipramol
- Oxaprozin
- Oxyphenbutazone
- Paramethasone
- Parecoxib
- Parnaparin
- Paroxetine
- Pemetrexed
- Pentosan Polysulfate Sodium
- Pentoxifylline
- Phenindione
- Phenprocoumon
- Phenylbutazone
- Phenyl Salicylate
- Piketoprofen
- Piroxicam
- Polythiazide
- Prasugrel
- Prednisolone
- Prednisone
- Proglumetacin
- Propyphenazone
- Proquazone
- Protein C
- Protriptyline
- Reboxetine
- Reviparin
- Rivaroxaban
- Rofecoxib
- Salicylamide
- Salicylic Acid
- Salsalate
- Sertraline
- Sibutramine
- Sodium Salicylate
- Spironolactone
- Sulfasalazine
- Sulindac
- Tacrolimus
- Tenofovir Disoproxil Fumarate
- Tenoxicam
- Tianeptine
- Tiaprofenic Acid
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Torsemide
- Trazodone
- Treprostinil
- Triamterene
- Trichlormethiazide
- Trimipramine
- Trolamine Salicylate
- Valdecoxib
- Venlafaxine
- Vilazodone
- Vorapaxar
- Vortioxetine
- Warfarin
- Xipamide
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acebutolol
- Alacepril
- Atenolol
- Azilsartan
- Azilsartan Medoxomil
- Benazepril
- Betaxolol
- Bisoprolol
- Candesartan Cilexetil
- Captopril
- Carteolol
- Carvedilol
- Celiprolol
- Ciprofloxacin
- Enalapril
- Enalaprilat
- Eprosartan
- Esmolol
- Fosinopril
- Irbesartan
- Labetalol
- Levobunolol
- Lisinopril
- Losartan
- Metipranolol
- Metoprolol
- Moexipril
- Nadolol
- Nebivolol
- Olmesartan Medoxomil
- Oxprenolol
- Penbutolol
- Perindopril Erbumine
- Pindolol
- Practolol
- Propranolol
- Quinapril
- Ramipril
- Sotalol
- Spirapril
- Telmisartan
- Timolol
- Trandolapril
- Valsartan
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Diclofenac sodium topical gel (Voltaren gel) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Diclofenac sodium topical gel (Voltaren gel) will not be safe for you to take.
- Asthma, hives, or allergic reactions after taking aspirin (Aspir-Low) or other NSAIDs
- Heart bypass surgery
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