
diclofenac sodium
Topical diclofenac is a non-steroidal anti-inflammatory drug (NSAID). It helps temporarily relieve pain from osteoarthritis in adults. This medication comes as a %1 gel as generic and brand name (commonly Voltaren gel). It's available over the counter. There are also topical solutions of various strengths by prescription only. You apply the medication to the skin of the affected joints, up to 2 or 4 times daily. The exact dosage and number of times per day depends on which form you use. Side effects include dry skin, skin irritation, and itching. More serious risks include high blood pressure and stomach issues, but the potential is low.
What is Diclofenac sodium topical gel (Voltaren gel)?
What is Diclofenac sodium topical gel (Voltaren gel) used for?
- Pain from osteoarthritis of the knee - topical solutions and 1% gel
- Pain from osteoarthritis of small joints, such as hands, wrists, elbows, or feet - 1% gel only
How Diclofenac sodium topical gel (Voltaren gel) works
Diclofenac sodium is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking proteins in the body called cyclooxygenase (COX). These proteins make chemicals called prostaglandins, which cause pain and swelling.
By blocking COX proteins, diclofenac sodium topical gel (Voltaren gel) helps stop your body from making more prostaglandins. This helps ease pain and swelling from osteoarthritis.
Drug facts
| Common Brands | Voltaren Arthritis Pain, Aspercreme Arthritis Pain |
|---|---|
| Drug Class | NSAID |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription or over-the-counter |
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.
Diclofenac sodium topical gel (Voltaren gel) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: chest pain or tightness, dizziness, tiredness, cold sweat, trouble breathing, anxiety
- Stroke: weakness on one side of the body, blurred vision, trouble speaking, trouble walking
- Stomach bleeding: feel faint, bloody or black stools, bloody vomit, stomach pain that doesn't get better
- Fluid buildup or signs of heart failure: trouble breathing, tiredness, leg swelling, sudden weight gain
- Liver problems: fever, chills, fatigue, nausea, vomiting, yellowing of the skin or whites of the eyes, clay-colored stool, dark urine
- Kidney problems: urinating less than usual, nausea, muscle weakness
- High potassium levels: nausea, muscle weakness, numbness or tingling
- Severe asthma attack: chest pain, cough, trouble breathing, wheezing
- Serious allergic reaction or skin reaction: fever, rash, hives, skin reddening, blisters, peeling skin, body aches, cough, swelling of the face, trouble breathing
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
- Can help relieve specific areas of osteoarthritis pain
- 1% gel available over the counter without a prescription
- Less serious side effects than taking diclofenac pills by mouth
Cons
- Doesn't provide relief right away
- Can be inconvenient to use because you need to wait for the medication to dry before putting on clothing
- Not for minor sprains, bruises, or other joints (like the back or hip)
Pharmacist tips for Diclofenac sodium topical gel (Voltaren gel)
- Even though diclofenac sodium topical gel (Voltaren gel) is used on the skin, don't take other NSAIDs at the same time unless a healthcare professional says it's okay. This is because it can raise your risk of serious side effects, like stomach bleeding. A common NSAID is ibuprofen (Advil). Some can also be found in many over-the-counter pain and cold medications. Talk to a healthcare professional if you're not sure whether you're already taking an NSAID.
- Apply diclofenac sodium topical gel (Voltaren gel) onto clean, dry skin of the joints affected by osteoarthritis.
- Don't apply diclofenac sodium topical gel (Voltaren gel) to any open cuts, wounds, rashes, or infections on your skin. More medication than expected can absorb through these areas. This can raise the risk of serious side effects.
- For the diclofenac 1% gel (Voltaren Arthritis Pain): Use the plastic dosing card in the box to measure out the gel needed. This amount depends on if it's for joints in the hand, wrist, or elbow or joints in the foot, ankle, or knee. Apply the gel and gently rub in on up to 2 joints at the same time. If you don't feel any relief after using it 4 times a day for 7 days, stop and talk to your care team. Also stop using and talk to your care team if pain gets worse or lasts more than 3 weeks.
- For the diclofenac 1.5% solution: Use the solution for the knee only. Apply and rub in 10 drops of solution at a time to prevent spilling. You can place the drops directly onto the knee or first in your hand and then onto your knee. Spread the solution evenly on the front, back, and sides of the knee. Apply 4 times a day.
- For the diclofenac 2% solution: Before using a pump for the first time, prime it to get the right amount of solution. Hold the bottle upright and press the pump down 4 times (don't use any medication that comes out). After priming, press the pump twice to get enough solution for one knee. Put the solution in your palm and spread it evenly on the front, back, and sides of your knee. Apply twice a day.
- Wash your hands after using diclofenac sodium topical gel (Voltaren gel). If you're treating your hands with the gel, wait at least 1 hour before washing. It's important to try not to get the medication near or in your eyes, nose, or mouth. This can cause irritation or be harmful. If you get it in your eye, rinse the eye well with water.
- Do your best to avoid skin-to-skin contact with other people or pets on the areas where you applied diclofenac sodium topical gel (Voltaren gel) until it's fully dry. Also wait until the area is dry before wearing clothes over it. This helps prevent the medication rubbing off onto other people, pets, or clothing.
- If you want to shower or bathe, wait at least 30 minutes after using the diclofenac solution or 1 hour after using the gel. This gives your body enough time to absorb the medication before it gets washed off.
- Don't use tight bandages or heat packs on the areas where you applied diclofenac sodium topical gel (Voltaren gel). It might cause more medication to get absorbed through the skin. This can raise your risk of serious side effects.
- Don't use other skin products, like lotions, sunscreen, or bug spray, on the treated area until diclofenac sodium topical gel (Voltaren gel) is fully dry. These products can affect how well your skin absorbs the medication. Wait until the medication dries before putting anything else on that area.
- If you're pregnant, don't use diclofenac sodium topical gel (Voltaren gel) until you've talked to a healthcare professional. NSAIDs like diclofenac can be harmful to an unborn baby when used at 20 weeks of pregnancy or later. These risks are possible even with diclofenac sodium topical gel (Voltaren gel). The healthcare professional can help you find a safe option.
- If you're breastfeeding, talk to a healthcare professional before using diclofenac sodium topical gel (Voltaren gel). It's not fully clear if it's safe to breastfeed while using this medication. The healthcare professional can help you choose a safe option for your osteoarthritis pain.
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.
Risk of heart attack and stroke
- Risk factors: History of heart problems, including a recent heart attack | Having risk factors for heart problems | Using more topical diclofenac than recommended | Using topical diclofenac for a long time | Recent or planned heart bypass surgery
Like all NSAIDs, diclofenac might raise your risk of blood clots. Some blood clots can lead to a serious heart attack or stroke. Some studies suggest that the risk can already go up as early as the first few weeks of starting NSAIDs.
Before starting diclofenac sodium topical gel (Voltaren gel), talk to a healthcare professional if you have heart problems. This includes a recent heart attack. Also talk to them first if you've had a recent heart bypass surgery or will have one soon. They can make sure diclofenac sodium topical gel (Voltaren gel) is safe for you to use.
If it's safe for you to use, be sure to use the smallest amount for the shortest possible time to relieve osteoarthritis pain. Follow your prescriber's directions or the instructions on the box carefully to make sure you're not using too much. This can help lower your risk.
Call 911 or get medical help right away if you have signs of a heart attack. Look out for chest pain that spreads to your arms or neck, shortness of breath, or sweating. Also get help right away if you have a severe headache, weakness on one side of your body, a droopy face, or trouble speaking or walking. These can be signs of a stroke.
Risk of stomach ulcers and stomach bleeding
- Risk factors: Older adults | History of stomach ulcers | History of stomach bleeding | Bleeding problems | Liver problems | Taking medications that can raise bleeding risk (e.g., aspirin, other NSAIDs, steroids, blood thinners) | Drinking alcohol | Smoking | Poor health | Using topical diclofenac for a long time | Using more topical diclofenac than recommended
NSAIDs like diclofenac can raise your risk of stomach problems. This can include stomach inflammation, stomach ulcers (sores), and stomach bleeding. These problems can happen at any time while using this medication. They can be dangerous and sometimes life-threatening.
Although the chance is small with diclofenac sodium topical gel (Voltaren gel), it's important to know about this risk. Before using diclofenac sodium topical gel (Voltaren gel), speak to a healthcare professional about your health conditions. Also tell them about the medications you take. Many conditions and medications can raise your risk of these stomach issues. So, a healthcare professional can check your risk to be safe.
Stomach ulcers can feel like a gnawing pain in the stomach, acid reflux, or fullness. If this happens, let your care team know.
People who have stomach bleeds might not have any symptoms since the bleed can happen over time. But get medical help right away if you feel faint, have severe stomach pain that doesn't go away, vomit blood, or have bloody or dark stools. These can be signs of stomach bleeding.
Liver damage
- Risk factors: History of liver damage | Taking other medications that can cause liver damage | Using more topical diclofenac than recommended | Using topical diclofenac for a longer time than recommended | Taking other medications containing diclofenac
Although rare, some people taking diclofenac pills had higher liver enzyme levels. This can be a sign of liver damage. And in rare cases, it's led to serious problems like liver failure.
While you're using diclofenac sodium topical gel (Voltaren gel), be aware of this risk to be safe. Your healthcare professional might have you get lab work done regularly to check your liver, especially if you need to use this medication for a long time. Stop using this medication and tell your care team right away if you notice yellow skin or eyes, nausea, vomiting, clay-colored stool, or dark urine. These could be signs of liver damage.
High blood pressure
NSAIDs like diclofenac can raise your blood pressure. Before using diclofenac sodium topical gel (Voltaren gel), ask your primary care provider if you can use it if you have high blood pressure. Also let them know if you take any blood pressure medications. This is because diclofenac might make them work less well. Your care team can make sure diclofenac sodium topical gel (Voltaren gel) is right for you.
Ask your primary care provider if you need to check your blood pressure regularly at home while using diclofenac sodium topical gel (Voltaren gel). If so, let them know if your blood pressure stays higher than usual.
Swelling and risk of heart failure
- Risk factors: Heart failure | Other heart problems | Using more topical diclofenac than recommended | Using topical diclofenac for a longer time than recommended
NSAIDs like diclofenac can cause your body to hold onto more water. This can cause swelling in your legs or feet. Also, too much fluid buildup in the body can put you at risk of heart failure. If you have heart failure or edema (swelling from fluid buildup), talk to a healthcare professional first to see if diclofenac sodium topical gel (Voltaren gel) is safe for you to use.
Let your care team know if you notice swelling in your legs or ankles. Watch for other signs of heart failure like trouble breathing, chest pain with physical activity, sudden weight gain, or tiredness.
Kidney damage
- Risk factors: Older adults | Kidney or liver problems | Heart failure | Dehydration | Loss of body fluid through conditions like severe vomiting, bleeding, or diarrhea | Taking diuretics (water pills), ACEIs, or ARBs | Using diclofenac sodium topical gel (Voltaren gel) for a long time
NSAIDs like diclofenac can slow blood flow to the kidneys. This can damage the kidneys if you use NSAIDs for a long time. In most cases, kidney issues got better over time after stopping the medication.
To be safe, ask a healthcare professional before using diclofenac sodium topical gel (Voltaren gel) if you have kidney problems. Also tell them about your medications. They can see if you're taking any other medications that can harm the kidneys. The healthcare professional can check it's safe for you to use diclofenac sodium topical gel (Voltaren gel).
Tell your care team if you notice that you're urinating less than usual while using diclofenac sodium topical gel (Voltaren gel). Your care team can check if there's something going on with your kidneys.
High potassium levels
Some people taking NSAIDs like diclofenac have had high potassium levels. This is possible in people with or without kidney problems. Watch for signs of high potassium levels while using diclofenac sodium topical gel (Voltaren gel). This can include nausea, muscle weakness, or numbness or tingling. If this happens, let your care team know so they can see what's going on and manage this if needed.
Worsening asthma in certain people
- Risk factors: Asthma, including aspirin-sensitive asthma | Stuffy nose with or without nasal polyps | Allergic reaction to aspirin or other NSAIDs
If you have asthma, ask a healthcare professional first before using diclofenac sodium topical gel (Voltaren gel). Also don't use this medication if you've ever had trouble breathing after taking aspirin or other NSAIDs. NSAIDs like diclofenac can make your airways tighten. This can lead to a serious asthma attack or trouble breathing. Get medical help right away if your throat tightens and you can't breathe.
Severe allergic reaction or skin reaction
Diclofenac sodium topical gel (Voltaren gel) might cause an allergic reaction or a skin reaction. This can be sudden, very serious, and sometimes life-threatening, such as with anaphylaxis. Symptoms include fever, body aches, rash, peeling skin, or painful blisters. It can also include swelling of the face or throat, throat tightness, and trouble breathing. Stop using the medication and get help right away if this happens.
Risk of general bleeding and anemia
- Risk factors: Taking blood thinners, like aspirin or warfarin | Blood-clotting problems
NSAIDs like diclofenac can raise your risk of bleeding. Be careful if you also take other medications that raise bleeding risk, like blood thinners. Tell your care team if you notice easy bruising or bleeding that's hard to stop while using diclofenac sodium topical gel (Voltaren gel).
Some people can also have anemia (low red blood cell count) while using NSAIDs. Let your care team know if you feel very weak, dizzy, or short of breath or have skin that's paler than usual. These could be signs of anemia.
Higher risk of serious side effects when used together with oral NSAIDs
Don't use diclofenac sodium topical gel (Voltaren gel) with other NSAIDs unless a healthcare professional says it's okay. This includes aspirin, ibuprofen (Advil), or naproxen (Aleve).
Using more than one NSAID at the same time – even if one is a gel used on your skin and the other is a pill you swallow – can raise your risk of serious side effects. These can include stomach bleeding, kidney damage, and higher bleeding risk.
To be safe, ask a healthcare professional if you're not sure whether any of your other medications are NSAIDs.
Harm to an unborn baby
- Risk factors: Currently pregnant
NSAIDs like diclofenac can cause harm to an unborn baby, especially if used during the second half of pregnancy (after week 20). It can raise the risk of serious health issues, like heart or kidney problems in your unborn baby.
If you're pregnant, talk to your obstetrician-gynecologist (OB-GYN) about the risks and benefits of using diclofenac sodium topical gel (Voltaren gel). Ask if there are other safer options for you.
Diclofenac sodium topical gel (Voltaren gel) dosage
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 100g of 1% | 1 tube | $15.65 | $15.65 |
Typical dosage for Diclofenac sodium topical gel (Voltaren gel)
-
Diclofenac 1% gel (Voltaren Arthritis Pain)
- Apply to the affected area(s) of your body up to 4 times a day. Don't use on more than 2 joints at the same time. The amount of gel you use for each dose depends on where the affected area is.
- Joints on upper body (e.g., hands, wrists, elbows): Use 2 grams of gel, measured using the provided plastic dosing card. Don't use more than 8 grams per day on any single joint.
- Joints on lower body (e.g., feet, ankles, knees): Use 4 grams of gel, measured using the provided plastic dosing card. Don't use more than 16 grams per day on any single joint.
- Apply to the affected area(s) of your body up to 4 times a day. Don't use on more than 2 joints at the same time. The amount of gel you use for each dose depends on where the affected area is.
-
Diclofenac 1.5% topical solution
- The typical dose is 40 drops of the solution to each affected knee 4 times a day.
-
Diclofenac 2% topical solution
- The typical dose is 2 pumps (40 mg) of the solution 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.
- Known allergy to diclofenac products
- History of asthma, hives, or other allergic reactions after taking aspirin or another NSAID
- Using right before or after open heart surgery
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