diclofenac / capsaicin
Diclofenac/capsaicin is a prepackaged kit that comes with a bottle of diclofenac topical solution and a tube of capsaicin cream. They're applied directly to your skin on your knees to treat osteoarthritis of the knee. The kit is only available with a prescription.
What is Diclofenac/capsaicin?
What is Diclofenac/capsaicin used for?
- Treatment of aches and pains from osteoarthritis of the knee
How Diclofenac/capsaicin works
Diclofenac/capsaicin is a combination of two medications that work together to treat symptoms of knee arthritis:
- Diclofenac is a non-steroidal anti-inflammatory drug (NSAID). It works by blocking proteins in your body called cyclooxygenase 1 and 2 (COX-1 and COX-2) from making chemicals called prostaglandins. This helps treat pain and swelling in your knee.
- Capsaicin is a chemical that comes from chili peppers. It turns on certain proteins in your body to lower your sensitivity to pain over time. Activating these sensors in the skin causes them to be less sensitive to other pain signals.
Drug facts
Side effects of Diclofenac/capsaicin
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
Diclofenac topical solution
- Dry skin (32%)
- Skin irritation (9%)
- Indigestion (8%)
- Stomach pain (6%)
- Burning
- Stinging
- Redness
- Itching
Less Common Side Effects
Diclofenac topical solution
- Passing gas
- Itching at application site
- Diarrhea
- Nausea
- Sore throat
Diclofenac/capsaicin serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: chest pain or tightness, pain that radiates up to your shoulder, arm, neck, or jaw
- Stroke: trouble breathing, weakness in one part of your body or face, slurred speech
- Stomach bleeding: vomiting blood, bloody or dark stools, severe stomach pain or discomfort
- Heart failure: trouble breathing, tiredness, swelling in your body, sudden weight gain
- Liver problems: severe stomach pain, yellowing of the skin or whites of the eyes, nausea, vomiting, loss of appetite
- Kidney problems: tiredness, dry and itchy skin, low appetite, urinating less than usual, foamy or bloody urine, muscle cramps
- Severe asthma attack: chest pain, cough, difficulty breathing, wheezing
- Serious allergic or skin reaction: fever, body aches, cough, peeling skin, rash, trouble breathing, swelling of the face, painful blisters all over your body
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Pros and cons of Diclofenac/capsaicin
Pros
Cons
- Requires application of 40 drops (diclofenac) and a cream (capsaicin) 4 times per day
- Available as a brand name only, which can be expensive
- Can cause dry skin
- Only available with a prescription
Pharmacist tips for Diclofenac/capsaicin
- Make sure you know how to give yourself diclofenac/capsaicin to avoid hurting yourself or wasting the medication. Ask your provider or pharmacist if you have any questions on how to properly use the medication.
- How to use diclofenac solution: 1) Make sure your skin on your knees is clean and dry. Then, wash your hands with soap and water; 2) Put 10 drops of diclofenac either on your hand or directly on your knee. Don't give yourself all 40 drops at once because this might cause the medication to spill; 3) Spread the solution evenly on the front, back, and sides of your knee; 4) Repeat steps 2 and 3 three more times to receive the full dose of 40 drops; 5) If you were prescribed diclofenac/capsaicin for both knees, repeat steps 2, 3, and 4 for the other knee; 6) Wash your hands with soap and water.
- How to use capsaicin cream: 1) Rotate the pump's spout counter-clockwise slightly to unlock the medication; 2) Apply the capsaicin cream sparingly (small amount) to the affected area; 3) Gently massage the medication into your skin until it's fully absorbed; 4) Wash your hands with soap and water.
- After giving yourself the medication, don't apply other topical products (e.g., sunscreen, insect repellant, lotion) to your knees, don't wear clothing over your knees, and avoid skin-to-skin contact with another person until your skin where the medication was applied is completely dry.
- Don't apply diclofenac/capsaicin to open sores or wounds, infections, or inflammation on your skin because this will cause pain and possibly further damage your skin.
- Don't shower or bathe for at least 30 minutes after using diclofenac and don't apply capsaicin within 1 hour of bathing or showering or anything that raises heat in your skin (e.g., heating pads, hot tub, sauna, intense exercise). Heat and occlusive dressings to your treated knees can raise the amount of diclofenac/capsaicin that's absorbed into your body, which can cause overdose and severe side effects.
- Stop using diclofenac/capsaicin and contact your provider if your pain worsens or if you get burning, pain, swelling, or blistering on your skin.
- Store diclofenac/capsaicin at room temperature in a cool, dry place and up and away out of children's reach and sight. This prevents them from accidentally swallowing medication that's left out. Always put medication away every time you use it. If you think that your child might’ve accidentally swallowed diclofenac/capsaicin, call your Poison Control Center at 1-800-222-1222 right away even if you aren't completely sure.
Common questions about Diclofenac/capsaicin
You might start to feel pain relief within 1 hour of using diclofenac/capsaicin. But it can take longer for you to feel the full effects of this medication.
Don't take a shower right away after you apply diclofenac/capsaicin. In fact, you shouldn't shower, take a bath, or exercise 1 hour before and after you apply capsaicin cream. Warm water, sweat, and open pores can make you more sensitive to capsaicin and put you at risk for burns. Also, it takes some time for your body to absorb the diclofenac topical solution (30 minutes). You should also wait to shower to give your body the chance to fully absorb both medications and to prevent burns.
When you're using diclofenac/capsaicin, protect the treated knee(s) from both natural and artificial sunlight (such as tanning beds). Animal studies suggest that the combination of ultraviolet (UV) light and topical diclofenac might raise your risk for skin tumors. You can protect yourself from the sun by staying in the shade, wearing loose clothing that covers your knees, or applying sunscreen. But make sure that you let your medications dry before putting on clothes or applying sunscreen, or else you might rub the medications off.
You're not recommended to take ibuprofen (Advil) tablets with diclofenac/capsaicin, 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/capsaicin 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.
The FDA recommends avoiding diclofenac and other NSAIDs at 20 weeks or later of pregnancy due to the risk of problems and complications (e.g., low amniotic fluid, kidney problems, and heart problems in the baby). Diclofenac/capsaicin should only be used by a pregnant female if it's clearly needed. If you're pregnant or thinking of becoming pregnant while taking diclofenac/capsaicin, talk to your provider about the risks and benefits of using this medication.
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Risks and warnings for Diclofenac/capsaicin
Diclofenac/capsaicin 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 | Using high doses of diclofenac/capsaicin | Using diclofenac/capsaicin for a long time | History of or planned heart surgery
NSAIDs, like diclofenac in diclofenac/capsaicin, can raise your risk of blood clots, heart attacks, or strokes. Use the lowest effective dose for the shortest time. To prevent heart attack or stroke, your provider will prescribe the lowest possible dose of diclofenac/capsaicin for the shortest amount of time that works well for you. If you have heart problems, talk to your healthcare provider before starting this medication. Don't use diclofenac/capsaicin if you've had or will be having heart bypass surgery. Call 911 or seek immediate help if you experience chest pain, shortness of breath, 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 other medications that can cause stomach problems | Drinking alcohol | Smoking | Having poor health | Bleeding problems | Liver problems | Using topical diclofenac for a long time | Using higher doses of topical diclofenac
Topical diclofenac in diclofenac/capsaicin can put you at risk for stomach ulcers (sores) and bleeds. Stomach bleeding is a dangerous condition that requires treatment right away. Make sure to tell your provider or pharmacist about all of your conditions and medications before starting diclofenac/capsaicin so they can determine your risk for stomach bleeding. Some medications, such as oral corticosteroids and blood thinners, can raise your risk of stomach bleeding. If you're feeling faint, vomiting blood, have bloody or dark stools, or have severe stomach pain or discomfort that doesn't go away while taking diclofenac/capsaicin, seek medical attention right away.
Liver damage
- Risk factors: History of liver damage | Taking other medications that can cause liver damage
Rarely, diclofenac (an ingredient in diclofenac/capsaicin) taken by mouth has caused life-threatening liver damage. Your risk is higher if you use diclofenac/capsaicin with other medications that can also cause liver damage, such as acetaminophen (Tylenol). Liver damage can happen with or without symptoms, so it's best to use the lowest possible dose for the shortest possible time to minimize your risk. Your provider might order blood tests to check your liver function regularly. Stop diclofenac/capsaicin and talk to your 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, or dark urine.
Worsening 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
Diclofenac can raise your blood pressure by causing your body to hold onto more water. This can lead to new or worsening blood pressure problems, heart failure, and swelling of your arms and legs. Diclofenac/capsaicin can also cause some medications used to treat these conditions to work less well, such as furosemide (Lasix), lisinopril (Zestril), and losartan (Cozaar). Monitor your blood pressure closely while using diclofenac/capsaicin. Make sure to tell your provider about all your medical conditions before starting diclofenac/capsaicin. Let your provider know immediately 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 | Not enough fluids in the body (dehydration) | Using topical diclofenac for a long time
Diclofenac/capsaicin 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/capsaicin.
Diclofenac/capsaicin 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 and allergic reactions
- Risk factors: Asthma and stuffy nose with or without nasal polyps | History of allergic reaction to aspirin or other NSAIDs
Rarely, diclofenac/capsaicin can cause life-threatening allergic reactions. Diclofenac in diclofenac/capsaicin 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 or other NSAIDs in the past should avoid diclofenac/capsaicin. Get medical help right away if your throat tightens and you can't breathe.
Serious skin reactions
Diclofenac in diclofenac/capsaicin might cause sudden and serious skin reactions (e.g., DRESS). Symptoms can include fever, body aches, rash, peeling skin, painful blisters all over your body, and swelling of the face. Stop diclofenac/capsaicin and get medical attention right away if you experience these symptoms. Don't apply this medication to open wounds, skin infections, or inflamed skin as this can change how the medication gets absorbed or delay you from receiving the right medication in the meantime.
Anemia (low red blood cells count)
- Risk factors: History of blood problems | Taking blood thinners or certain antidepressants
Diclofenac/capsaicin can lower the level of red blood cells in your body (anemia). This might be due to stomach bleeding or swelling caused by diclofenac. Your provider will monitor your blood cell counts during treatment if you seem weaker than usual, have cold hands and feet, or shortness of breath. This is to make sure your red blood cell count doesn't drop too low. Please let your provider know if you have a history of blood problems or if you take certain medications that raise your risk of bleeding (e.g., blood thinners, SSRIs, SNRIs). Your provider can make sure diclofenac/capsaicin is safe for you.
Potential harm to unborn babies
- Risk factors: Currently in second or third trimester of pregnancy
Diclofenac and other NSAIDs should be avoided after 20 weeks of pregnancy because it might cause problems to your unborn baby (such as heart, lung, or kidney problems) or cause complications during delivery. If you're pregnant, talk to your provider first before using diclofenac/capsaicin to make sure it's safe for you.
For topical use only
Diclofenac/capsaicin should only be used on your skin. Don't take this medication by mouth, and never use it in your eyes, nose, or ears. If you think that your child might’ve accidentally swallowed this medication, call your Poison Control Center at 1-800-222-1222 right away.
Flammable
The capsaicin cream in diclofenac/capsaicin is flammable, meaning it can easily catch on fire. Avoid fire, flame, or smoking during and after using the medication. Store the capsaicin cream in a cool, well ventilated area away from heat.
Diclofenac/capsaicin dosage
Kit| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 150ml/60g of 1.5%/0.025% | 1 kit | $24.87 | $24.87 |
Typical dosage for Diclofenac/capsaicin
Diclofenac 1.5% solution: The typical dose is to apply 40 drops to the affected knee(s) 4 times per day.
Capsaicin 0.025% cream: The typical dose is to apply a small amount to affected area(s) up to 4 times per day.
How much does Diclofenac/capsaicin cost?
$24.87
Diclofenac/capsaicin 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/capsaicin will not be safe for you to take.
- Severe allergic reaction to a NSAID
- History of asthma, hives, or other allergic reactions after taking aspirin or another NSAID
- Major open heart surgery
