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What is Diclofenac (Voltaren)?

Diclofenac Sodium label
A label for Diclofenac Sodium extended-release tablets.
Credit: NIH.

Diclofenac is a pain reliever in the drug class NSAID (non-steroidal anti-inflammatory drug). It is available both over-the-counter and by prescription in the United States. Its common brand names are Voltaren, Cataflam and Zipsor.

Diclofenac is often used to treat pain, tenderness, swelling and stillness resulting from osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis. Short-acting (Cataflam and Zipsor) diclofenac may be used to treat menstrual or other pains. Diclofenac gel or cream is sometimes used to treat actinic keratosis, a skin condition that may become cancerous if not treated. Diclofenac oral tablets or liquids may be prescribed to help with gout, joint inflammatory disease in children or young adults, and bursitis.

Forms of diclofenac

Diclofenac is available in the following oral-route forms:

  • Capsule
  • Powder for solution
  • Liquid-filled capsule
  • Tablet
  • Tablet, enteric coated
  • Tablet, extended release

It is available in the following topical-route forms:

  • Gel or cream
  • Solution
  • Patch, extended release

Side effects

The NIH lists the following side effects of diclofenac oral as less severe, though a doctor should be consulted if they persist:

  • diarrhea
  • constipation
  • gas or bloating
  • headache
  • dizziness
  • ringing in the ears

The following are more severe side effects, and if experienced, a doctor should be consulted immediately, and use of the drug stopped:

  • unexplained weight gain
  • excessive tiredness
  • lack of energy
  • nausea
  • loss of appetite
  • itching
  • pain in the upper right part of the stomach
  • yellowing of the skin or eyes
  • flu-like symptoms
  • fever
  • blisters
  • rash
  • hives
  • swelling of the eyes, face, tongue, lips, throat, arms, hands, feet, ankles, or lower legs
  • difficulty breathing or swallowing
  • hoarseness
  • pale skin
  • fast heartbeat
  • cloudy, discolored, or bloody urine
  • back pain
  • difficult or painful urination

The NIH lists the following side effects of diclofenac topical gel or cream as less serious, though a doctor should be consulted if they persist:

  • dryness, redness, itching, swelling, pain, hardness, irritation, swelling, scaling, or numbness at application site
  • acne
  • stomach pain
  • constipation
  • gas
  • dizziness
  • numbness, burning, or tingling in the hands, arms, feet, or legs

The following are more serious and, if experienced, should receive immediate doctor consultation:

  • hives
  • itching
  • difficulty breathing or swallowing
  • swelling of the face, throat, arms, hands, feet, ankles, or lower legs
  • unexplained weight gain
  • wheezing
  • worsening of asthma
  • yellowing of the skin or eyes
  • nausea
  • extreme tiredness
  • unusual bleeding or bruising
  • lack of energy
  • loss of appetite
  • pain in the upper right part of the stomach
  • flu-like symptoms
  • dark-colored urine
  • rash
  • blisters on skin
  • fever
  • pale skin
  • fast heartbeat
  • excessive tiredness

The NIH warns that patients who take diclofenac or other NSAIDs besides than aspirin may have an increased risk of heart attack, stroke, ulcers, bleeding, or holes in the stomach or intestine. It is important for patients to tell their doctors if there is a family history of heart disease, heart attack, or stroke. Patients should also inform their doctors if they smoke, have or have had high cholesterol, high blood pressure, or diabetes.

Diclofenac sodium and diclofenac potassium

There are two main forms of diclofenac: diclofenac sodium and diclofenac potassium.

The body absorbs diclofenac sodium more slowly, which is useful when patients need to reduce inflammation. Diclofenac sodium’s brand name is Voltaren.

The body absorbs diclofenac potassium more quickly, which is useful when immediate pain-relief is required. Forms of diclofenac potassium may be available over-the-counter in lower doses. Its brand names are Cataflam and Zipsor.

Voltaren (diclofenac sodium)

Voltaren is a prescription brand-name form of diclofenac sodium that is available as a gel, as standard and extended release oral tablets, and as a suppository.

Voltaren Gel

Voltaren Gel is FDA-approved for treating osteoarthritis pain in joints amenable to topical treatment, such as knees, hands, wrists, feet, and elbows. It has not been studied for use on hips, spine, or shoulders.

Voltaren Gel comes with a polypropylene dosing card that should be used for application. Typical dosage is 2 grams for each elbow, wrist, or hand and four grams for each knee, ankle, or foot. Voltaren Gel is typically applied four times a day. Total usage should not exceed 32 grams per day for all affected joints.

Patients should wash their hands after application of Voltaren Gel, unless the drug is used on the hands, in which case patients should wait one hour before washing their hands. All patients should not shower or bathe for at least one hour after drug application.

Voltaren Oral

Voltaren Oral should be taken with water, and can be taken with food, milk, or an antacid if patients experience stomach pain. Taking it with anything but water may slow absorption and delay pain relief, however. It is important that patients do not lie down or crush, chew, or break the tablets. This can increase side effects.

Voltaren Oral can be taken on an as-needed basis or on a regular schedule, which is the more common approach to arthritis treatment. If taking it on an as needed basis, patients should use the lowest effective dose for the shortest possible length of time, in order to minimize side effects and other risks. If taking it regularly for arthritis, patients may not experience full benefits for up to two weeks.

Recreational use of diclofenac

It is not possible to get high off of diclofenac or other NSAIDs, and abuse of the drug is likely to cause serious side effects.

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