Diclofenac, Topical Gel

This drug has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

• Serious stomach bleeding, ulceration, and perforation: NSAIDs can cause an increased risk of serious bleeding, sores (ulcers), and holes (perforation) in the stomach or intestines, which can be fatal. These reactions can occur at any time during use and without warning symptoms. Older people and people with a prior history of peptic ulcer disease or GI bleeding have a greater risk for serious GI events.
• Risk of heart disease: Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). All NSAIDs can increase your risk of heart attack, heart failure, or stroke. This risk can go up the longer you use NSAIDs, and if you use high doses. Your risk may be higher if you have risk factors for heart disease, such as high blood pressure. If you have heart disease, talk to your doctor before using diclofenac.
• Surgery: You shouldn’t use diclofenac before you have surgery, especially heart bypass surgery. Talk to your doctor if you use diclofenac and will have surgery soon.

1. Diclofenac topical gel is available as a brand-name drug and a generic drug. Brand names: Solaraze, Voltaren.
2. Diclofenac also comes in other forms, including oral tablets and capsules, eye drops, powder packets for oral solution, a transdermal patch, and a topical solution.
3. Diclofenac topical gel is used to treat osteoarthritis pain in certain joints. It’s also used to treat actinic keratosis (AK).

Diclofenac is a prescription drug. It comes as a topical gel, oral capsule, oral tablet, eye drops, transdermal patch, topical solution, and powder packets for oral solution.

Diclofenac topical gel is available as the brand-name drugs Solaraze and Voltaren. It’s also available as a generic drug. Generic drugs usually cost less than brand-name versions. In some cases, they may not be available in every strength or form as a brand-name drug.

Voltaren (diclofenac 1%) is now available OTC as Voltaren Arthritis Pain in the U.S.

Why it’s used

Diclofenac topical gel is used to help relieve osteoarthritis pain in joints that can benefit from treatment through the skin. These joints include those in your hands and knees.

Diclofenac topical gel is also used to treat actinic keratosis (AK). This condition causes rough, scaly spots on the skin of older adults.

How it works

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID).

The drug works by blocking a particular enzyme in your body. When the enzyme is blocked, your body decreases the amount of inflammatory chemicals it makes. This helps to reduce inflammation and pain.

Diclofenac topical gel may cause drowsiness. Don’t drive or use machinery until you know how this drug affects you.

Diclofenac can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Diclofenac. This list does not include all possible side effects. For more information on the possible side effects of Diclofenac, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

Diclofenac can also cause other side effects.

More common side effects

The more common side effects that can occur with diclofenac gel include:

• itching or rash at application site
• stomach pain
• constipation
• diarrhea
• gas
• heartburn
• nausea
• vomiting
• sleepiness

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Allergic reaction. Symptoms can include:
  • itching
  • rash
  • breathing problems
  • hives
• Edema. Symptoms can include:
  • swelling of the feet or ankles
  • increased blood pressure
  • increased weight
• Stomach ulcer or stomach bleeding. Symptoms can include:
  • very dark stools
  • blood in your stool
• Bruising more easily.

The Diclofenac dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using Diclofenac to treat
• your age
• the form of Diclofenac you take
• other medical conditions you may have

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

All possible dosages and forms may not be included here.

Dosage for actinic keratoses (AK)

Generic: Diclofenac

• Form: topical gel
• Strengths: 3%

Brand: Solaraze

• Form: topical gel
• Strengths: 3%

Adult dosage (ages 18 years and older)

Apply diclofenac gel to AK lesions twice per day. Usually, 0.5 grams (gm) of gel is used for each site that’s 2 inches by 2 inches (5 centimeters by 5 centimeters). The recommended length of treatment is 60 to 90 days.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years hasn’t been established.

Dosage for osteoarthritis

Generic: Diclofenac

• Form: topical gel
• Strengths: 1%

Brand: Voltaren

• Form: topical gel
• Strengths: 1%

Adult dosage (ages 18 years and older)

• Diclofenac gel is usually applied four times per day to the affected area. The dosing card included in the drug package should be used to measure the proper amount of gel to apply to painful joints.
  • No more than 8 gm per day should be used for any single joint of the hand, wrist, elbow.
  • No more than 16 gm per day should be used for any single joint of the knee, ankle or foot.
  • The total dosage of diclofenac gel shouldn’t be more than 32 gm per day, over all affected joints.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years hasn’t been established.

Special dosage considerations

Seniors: If you are age 65 years or older, your body may process this drug more slowly. Your doctor may start you on a lowered dose so that too much of this drug doesn’t build up in your body. Too much of the drug in your body can be dangerous.

Diclofenac is used for short-term treatment. It should be used for the shortest possible time to treat the problem. If your doctor wants you to use it for a longer time, your doctor should check your liver function, kidney function, and blood pressure periodically.

This drug comes with risks if you don’t use it as prescribed.

If you stop taking the drug or don’t take it at all: If you stop using diclofenac and still have swelling and pain, you could have joint or muscle damage that doesn’t heal.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you use too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

• stomach ulcer
• stomach bleeding
• headache

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Apply your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: Your symptoms should improve.

This drug comes with several warnings.

Allergy warning

If you have an allergy to aspirin or other similar NSAIDs, such as ibuprofen or naproxen, you could have an allergic reaction to diclofenac. Call your doctor right away if you have any signs of:

• wheezing
• trouble breathing
• hives
• itchy rash

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t use this drug again if you’ve ever had an allergic reaction to it. Using it again could be fatal (cause death).

Alcohol interaction warning

Avoid drinking alcohol when using this drug. Alcohol can increase your risk of stomach ulcers from using diclofenac.

Contact with drug warning

Diclofenac gel can transfer to others. Make sure the gel has dried on your skin before you touch anyone else.

Warnings for people with certain health conditions

For people with high blood pressure or water retention: Tell your doctor before using diclofenac. Your heart may already be working hard, and adding an NSAID can increase this workload.

For people with ulcer or digestive bleeding: If you’ve had an ulcer or bleeding from your digestive system, ask your doctor before using diclofenac. You’re at increased risk for another bleed.

For people with kidney disease or taking diuretics: If you have kidney disease or take diuretics (water pills), there’s a risk this drug can affect your kidneys’ ability to remove excess water from your body. Ask your doctor if diclofenac is the right drug for you.

For people with asthma and aspirin reactions: If you have asthma and you react to aspirin, you could have a bad reaction to diclofenac. Talk to your doctor before using the drug.

Warnings for other groups

For pregnant women: Before 30 weeks of pregnancy, this drug is a pregnancy category C drug. After 30 weeks of pregnancy, it’s a pregnancy category D drug.

A category C drug means that means that studies have shown that the drug can be a risk to the offspring of lab animals. However, not enough studies have been done to show risk in humans.

Category D means two things:

1. Studies show a risk of adverse effects to the fetus when the mother uses the drug.
2. The benefits of using diclofenac during pregnancy may outweigh the potential risks in certain cases.

Do not use diclofenac if you’re pregnant, unless your doctor advises you to. Be especially sure to avoid using diclofenac at 30 weeks of pregnancy and later.

For women who are breastfeeding: This drug may pass into the breast milk, which means it may pass to a child who is breastfed. This may lead to dangerous effects for the child.

Talk to your doctor regarding whether breastfeeding is a good choice for you.

For seniors: Seniors are at higher risk for stomach problems, bleeding, water retention, and other side effects from diclofenac. Seniors may also have kidneys that aren’t working at peak levels, so the drug can build up and cause more side effects.

Diclofenac can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Below is a list of medications that can interact with Diclofenac. This list does not contain all drugs that may interact with Diclofenac.

Before taking Diclofenac, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Blood pressure drugs

Diclofenac may decrease the blood pressure-lowering effects of some drugs used to control blood pressure. Using diclofenac with certain blood pressure medications may also increase your risk of kidney damage.

Examples of these blood pressure drugs include:

• angiotensin-converting enzyme (ACE) inhibitors, such as benazepril, captopril, enalapril, and lisinopril
• angiotensin II receptor blockers, such as candesartan, irbesartan, losartan, and olmesartan
• beta-blockers, such as acebutolol, atenolol, metoprolol, and propranolol
• diuretics (water pills), such as furosemide and hydrochlorothiazide

Cancer drug

Using the cancer drug pemetrexed with diclofenac may increase the effects of pemetrexed. Symptoms may include fever, chills, body aches, mouth sores, and severe diarrhea.

Other NSAIDs

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). Don’t combine it with other NSAIDs unless directed by your doctor, as this may increase your risk of stomach and bleeding issues. Examples of other NSAIDs include:

• ketorolac
• ibuprofen
• naproxen
• celecoxib
• aspirin

Drugs that affect the flow of blood

Taking diclofenac with other drugs that affect the flow of blood through your body can increase your risk of bleeding. Examples of these drugs include:

• warfarin
• aspirin
• selective serotonin reuptake inhibitors (SSRIs), such as escitalopram, fluoxetine, paroxetine, and sertraline
• serotonin-norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine, duloxetine, venlafaxine, and levomilnacipran

Bipolar disorder drug

If you take lithium with diclofenac, it may increase the lithium in your body to harmful levels. Your doctor may monitor your lithium levels closely.

Immunosuppressant drug

Taking cyclosporine, a drug that weakens your immune system, with diclofenac may increase your risk for kidney problems.

Methotrexate

Taking methotrexate with diclofenac can lead to harmful levels of methotrexate in your body. This can raise your risk of infection and kidney issues.

Digoxin

Taking digoxin with diclofenac can lead to increased levels of digoxin in your body and increased side effects. Your doctor may monitor your digoxin levels closely.

Keep these considerations in mind if your doctor prescribes diclofenac for you.

Refills

A prescription for this medication is refillable. You shouldn’t need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

If you use diclofenac for a long time, your doctor should do blood tests to check your kidney and liver function at least once a year.

You should check your own blood pressure from time to time. Home blood pressure monitors are available at most pharmacies and online.

Shop online for blood pressure monitors.

Sun sensitivity

You may have increased sensitivity to the sun while using diclofenac. To protect your skin, use sunscreen with SPF 30 or greater.

Availability

Not every pharmacy stocks this drug. However, you may be able to order it. When filling your prescription, be sure to call the pharmacy first to make sure they stock this drug or can order it for you.

Prior authorization

Many insurance companies require a prior authorization for this form of this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

If your insurance company won’t cover this form, you may consider checking whether it will cover the tablet or capsule form instead.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.