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.
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
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.
Source: DailyMed
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.
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
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
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.
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 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.
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.
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.
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.
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.
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.
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.
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).
Dosage | Quantity | Price as low as | Price per unit |
---|---|---|---|
100g of 1% | 1 tube | $59.54 | $59.54 |
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.
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.
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.
Asthma, hives, or allergic reactions after taking aspirin (Aspir-Low) or other NSAIDs
Heart bypass surgery
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
Short-term relief of minor aches and pains due to headache, muscle aches, minor arthritis pain, toothache, backache, the common cold, or menstrual cramps
Fever
Mild-to-moderate pain
Pain from rheumatoid arthritis (RA) or osteoarthritis (OA)
Pain from menstrual cramps
Ankylosing spondylitis (AS) (arthritis of the spine)
Polyarticular juvenile idiopathic arthritis (arthritis in children)
Tendonitis and bursitis
Pain
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Altman, R.D., et al. (2009). Diclofenac sodium gel in patients with primary hand osteoarthritis: A randomized, double-blind, placebo-controlled trial. The Journal of Rheumatology.
Bariguian Revel, F., et al. (2020). Topical diclofenac, an efficacious treatment for osteoarthritis: A narrative review. Rheumatology and Therapy.
Francio, V. T., et al. (2017). Oral versus topical diclofenac sodium in the treatment of osteoarthritis. Journal of Pain & Palliative Care Pharmacotherapy.
GlaxoSmithKline Consumer Healthcare Holdings (US) LLC. (2023). VOLTAREN ARTHRITIS PAIN- diclofenac sodium gel. VOLTAREN ARTHRITIS PAIN- diclofenac sodium kit [package insert]. DailyMed.
Horizon Therapeutics USA, Inc. (2022). PENNSAID- diclofenac sodium solution [package insert]. DailyMed.
Montford, J. R., et al. (2017). How dangerous is hyperkalemia? Journal of the American Society of Nephrology: JASN.
SOLA Pharmaceuticals. (2022). DICLOFENAC SODIUM 1.5%- diclofenac sodium topical solution [package insert]. DailyMed.
Sousa, A. G. P., et al. (2016). Hyporeninemic hypoaldosteronism and diabetes mellitus: Pathophysiology assumptions, clinical aspects and implications for management. World Journal of Diabetes.
Voltarengel.com. (n.d.). Frequently asked questions about arthritis & voltaren.
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