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Diclofenac, Topical Gel

Highlights for diclofenac

  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, 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).
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Important warnings

Important warnings

FDA warning: Nonsteroidal anti-inflammatory drug (NSAID)
  • This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • 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.

    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.

    NSAIDs such as diclofenac can increase your risk of serious side effects, including stomach bleeding or ulcers.

Other warnings

  • High blood pressure warning: This drug can cause high blood pressure, or worsen high blood pressure if you already have it. Your doctor will likely monitor your blood pressure while you use this drug.
  • Water retention warning: This drug can cause your body to retain water, leading to edema (swelling or puffiness).
  • Liver function warning: Using diclofenac may affect some of your liver function tests.Your doctor should monitor your liver function while you use diclofenac.
  • Allergic reaction warning: If you have an allergy to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), talk to your doctor before using diclofenac. Wash your hands well after using the gel so you don’t get it in your eyes or transfer it to someone else.

About

What is diclofenac?

Diclofenac is a prescription drug. It comes as a topical gel, oral capsule, oral tablet, eye drops, transdermal patch, transdermal 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.

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.

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Side effects

Diclofenac side effects

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

Diclofenac can also cause other side effects.

More common side effects

The more common side effects that occur with diclofenac gel include itching or rash where you apply the gel. Other common side effects that occur with diclofenac include:

  • 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

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Interactions

Diclofenac may interact with other medications

Diclofenac topical gel can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with diclofenac are listed below.

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 blood pressure drugs include:

  • angiotensin-converting enzyme (ACE) inhibitors
  • angiotensin II receptor blockers
  • beta blockers
  • diuretics (water pills) such as furosemide or hydrochlorothiazide

Cancer drug

Using diclofenac with the cancer drug pemetrexed 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). Do not combine it with other NSAIDs unless directed by your doctor.Examples of other NSAIDs include:

  • ketorolac
  • ibuprofen
  • naproxen
  • aspirin
  • celecoxib (Celebrex)

Drugs that affect the flow of blood

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

  • warfarin
  • aspirin
  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin norepinephrine reuptake inhibitors (SNRIs)

Drugs that are slower to clear from your body

Diclofenac reduces pain, but it also affects chemicals that keep your kidneys running well. This effect may make your kidneys take longer to filter out some drugs. This may increase the levels of these drugs in your body, as well as their side effects.

Examples of these drugs include:

  • anticoagulants, such as warfarin
  • enalapril
  • cyclosporine
  • digoxin
  • furosemide
  • lithium
  • methotrexate

Other drugs

Certain drugs may increase the levels of diclofenac in your body. Examples of these drugs include:

  • enalapril or captopril (angiotensin-converting enzyme inhibitors)
  • losartan (Diovan) or other angiotensin II receptor blockers
  • cyclosporine

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we can not guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

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Other warnings

Diclofenac warnings

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 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 a history of smoking or alcohol use: Smokers and those who drink alcohol regularly have an increased risk of ulcer from NSAIDs such as diclofenac.

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 is diclofenac is the right drug for you.

For people with asthma and aspirin reaction: 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 usingdiclofenac 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.

When to call the doctor
If your pain doesn’t improve, or if the swelling, redness, and stiffness of your joint(s) don’t improve, call your doctor. This drug may not be working for you.

Breastfeeding isn’t recommended if you’re using diclofenac.

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.

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Dosage

How to use diclofenac

All possible dosages and forms may not be included here. Your dose, form, and how often you use it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Dosage for actinic keratoses (AK)

Generic: Diclofenac

  • Form: transdermal gel
  • Strengths: 3% transdermal diclofenac sodium gel, 100 g

Brand: Solaraze

  • Form: transdermal gel
  • Strengths: 3% transdermal diclofenac sodium gel, 100 g

Adult dosage (ages 18 years and older)

Apply diclofenac gel is applied to AK lesions twice per day. Usually, 0.5 grams of gel is used for each 5 cm by 5 cm site. The recommended duration of therapy is 60–90 days.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years has not been established.

Dosage for osteoarthritis

Generic: Diclofenac

  • Form: transdermal gel
  • Strengths: 1% transdermal diclofenac sodium gel, 100 g

Brand: Voltaren

  • Form: transdermal gel
  • Strengths: 1% transdermal diclofenac sodium gel, 100 g

Adult dosage (ages 18 years and older)

  • Diclofenac gel is usually applied 4 times per day to the affected area. The included dosing card should be used to measure the proper amount of gel to apply to painful joints.
    • No more than 8 grams per day should be used for any single joint of the hand, wrist, elbow.
    • No more than 16 grams per day should be used for any single joint of the knee, ankle or foot.
    • The total dosage of diclofenac gel should not be more than 32 grams per day, over all affected joints.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years has not been established.

Special dosage considerations

Seniors: If you are aged 65 years and 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 does not build up in your body. Too much of the drug in your body can be dangerous.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

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Use as directed

Use as directed

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

If you don’t use it on schedule: If you forget to use it on time, you may have more pain. However, you can still benefit from applying the next dose on schedule.

If you miss a dose: If you miss a dose of diclofenac, and if it’s nearly time for the next dose, wait until then and use a single dose.

Don’t try to double a dose to catch up. You could have much worse side effects or greater risk of a stomach ulcer or stomach bleeding.

How to tell if the drug is working: You should experience reduced pain and swelling.

Important considerations

Important considerations for using diclofenac

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

General

  • Always take diclofenac with food.
  • Start eating, take your diclofenac, and then finish your food. Eat something that coats your stomach, such as a meal or at least a glass of milk.

Refills

A prescription for this medication is not refillable. You or your pharmacy will have to contact your doctor for a new prescription if you need this medication refilled.

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 occasionally.

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. You may be able to order it. Call ahead first. The pharmacist may need to submit your claim to insurance to see if the drug is covered.

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.

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Alternatives

Are there any alternatives?

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). There are many NSAIDs available both over-the-counter and by prescription.

If desired, ask your pharmacist or doctor to recommend alternatives. If you can’t take NSAIDS due to stomach or water retention issues, there may be other kinds of treatment that can help 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 here in 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.

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