Diclofenac (Topical)

Overview

Diclofenac topical is an anti-inflammatory, nonsteroidal treatment that is commonly prescribed to patients who are suffering from the pain, stiffness, swelling and inflammation that is often caused by conditions such as arthritis in the joints, and osteoarthritis. Diclofenac will not cure your arthritis, but while you use the medication, it can help to relieve the troublesome symptoms these conditions cause.

The topical gel form of diclofenac is also used in the treatment of a condition called actinic keratosis, a skin ailment that can become cancerous if it is not promptly treated. Diclofenac solution is the preferred form of the drug that is used to tackle the swelling and discomfort caused by osteoarthritis affecting the knees. Diclofenac is also available as a topical patch. Patches are typically used to treat the severe, acute pain that is caused by minor contusions, sprains, and strains.

Diclofenac in its various forms is only available with a prescription from your GP. In the US, the drug is sold under the following brand names:

• Voltaren
• Solaraze
• Rexaphenac
• Pennsaid
• Flector

Conditions treated

• Arthritis of the joints
• Osteoarthritis
• Minor sprains, strains and contusions

Type of medicine

• Nonsteroidal anti-inflammatory
• Spray
• Solution
• Extended-release patch
• Gel
• Cream

Side effects

Together with the effects, it is designed to give, diclofenac can cause a few unwanted side effects in some patients. Not everyone will notice any adverse effects, but if they do occur you might need further medical assistance.

If your skin becomes painful, you experience a burning or tingling sensation or develop a rash affecting the application site immediately after applying the medication, you must stop using the medicine and consult your doctor immediately.

If any of the effects in the bulleted list below do occur, you should speak to your GP straight away:

• Tightness of the chest
• Tenderness or pain around the cheekbones and eyes
• Swelling or redness of the eyes
• Sore throat
• Skin rash, sores, or ulcers not at the application site
• Reddening of the skin
• Nasal congestion
• Itching skin
• Increased skin sensitivity
• Headaches, including migraines
• Eye pain
• Cough
• Burning, dry, or itching, eyes
• Breathing difficulties
• Blood in the urine
• Aches, headache, and fever, with or without chills

There are some side effects that diclofenac may cause that usually resolve themselves without the need for medical intervention. As your body gets used to the new drug, these effects generally disappear. Your GP may be able to offer some advice as to how you can best manage any temporary effects that you suffer. If any of the effects become especially bothersome or troubling and they persist, have a chat with your doctor.

• Tingling skin
• Thickened skin
• Stomach upset or discomfort
• Scaly skin
• Runny nose
• Neck pain
• Muscle pain
• Loss of or thinning hair
• Lack or loss of strength
• Joint pain
• Indigestion
• Heartburn
• Dry skin
• Diarrhea
• Chest pain
• Burning skin
• Bleeding skin
• Belching
• Back pain
• Acne

These are the most commonly experienced side effects seen by people taking diclofenac, but you may notice other effects not listed here. If you do, check with your GP.

Dosage

You should continue to use diclofenac for the full duration of your treatment. However, you should not keep using the drug for longer than you have been instructed to by your GP. Diclofenac is not designed to be used for prolonged periods.

When you pick up your prescription, you will be issued with a leaflet containing further information and instructions on how to use the drug. Be sure to read the leaflet, and ask your GP or pharmacist if there is anything that you do not understand.

Skin patches

Your doctor will explain how to use diclofenac patches. Note that the patches will only be effective if you apply them correctly.

• Make sure that your hands are clean and dry before and after handling a patch. Keep your fingers away from your eyes until you have washed and dried your hands. If you do get diclofenac in your eyes, rinse them out immediately with clean water or saline solution. If your eyes continue to be irritated for over an hour, ask your GP's advice.

• Put the patch on straight away after taking it out of the packaging. Do not cut the patch up and do not allow anything to come into contact with the sticky areas of the patch.

• Place the patch onto a dry, intact, clean patch of skin. Try to find a site that is free from hair, cuts, scars, or irritation. Try to choose areas where the patch will not be rubbed off by your clothes.

• Use your fingers to smooth the patch into position, ensuring that the edges are well stuck down.

• If the edges of the patch start to peel, you can stick them down with a piece of tape. Tubular elastic dressings and elasticated mesh can also help to keep the patch in place when applying to awkward areas such as the knees, elbows or ankles.

• When taking a shower or bath, remove the patch and replace it afterwards.

• For maximum effect, you should change your patch at the same time and on the same day of the week.

Topical gel

• Make sure that your hands are clean and dry before and after using the gel. Keep your fingers away from your eyes until you have washed and dried your hands. If you do get diclofenac in your eyes, rinse them out immediately with clean water or saline solution. If your eyes continue to be irritated for over an hour, ask your GP's advice. Do not touch your mouth or nose until you have washed the medication off your fingers.

• If you are using Voltaren® 1% topical gel, measure the dose by using the dosing card enclosed with the medicine.

• Choose a clean, dry area as the application site. Avoid skin that is broken, infected or peeling.

• If possible, each application of the gel should cover the whole affected area.

• The treated area should be left open to the air. Do not cover the site with bandages or heating pads, unless your GP has told you otherwise.

• Sunscreen, makeup or other cosmetics should not be used on areas where diclofenac gel has been applied.

• Leave at least an hour after applying the gel before showering, bathing or washing the affected area. After applying the gel, leave at least 10 minutes before dressing and covering the skin.

Topical solution

• The topical solution form of diclofenac will only be effective if used as directed by your GP. Only use the medication as directed by your GP.

• Make sure that your hands are clean and dry before handling the solution. If you get any in your eyes, flush them immediately with a saline solution or clean water. If your eyes are still sore or irritated for over an hour, call your GP for advice.

• Make sure that the skin of the application site is clean, intact and dry, without irritation, cuts or scars.

• Place 10 drops of the medicine directly onto the application site or on your hand, being careful to spread the solution in an even layer across the back, sides and front of your knee.

• If you are using Pennsaid® solution, you should allow at least 30 minutes before you take a shower or bath.

• Allow the skin to dry completely before applying lotions, moisturizers, cosmetics or sunscreen. Do not place dressings or heat pads on the knee, and avoid sitting with the treated knee in direct sunlight.

• Keep the treated knee away from other people until the skin has dried completely.

The dose that you will be prescribed of diclofenac topical will vary between patients. You must keep to the instructions given to you by your GP or follow the directions on the product label. The information regarding dosage given here is based on the average. If you have been prescribed a different dose, you must not change it unless you are told to by your doctor.

The size of the dose that you use will depend on the strength of the preparation you have been prescribed. In addition, the number of daily doses that you use, the time you leave between treatments, and the duration of your treatment course will be dependent on the health problem you are using the drug to treat.

For actinic keratosis - Solaraze® 3% gel:

• Adults: apply the gel to the skin twice daily.
• Children: follow your GP's instructions.

For osteoarthritis - Voltaren® 1% gel:

• Adults: apply 2g to the skin over the affected area four times daily. Do not use more than 32g daily in total across all affected areas. Measure the correct dose by using the enclosed dosing card.
• Children: follow your GP's instructions.

For osteoarthritis affecting feet, ankles, or knees - Voltaren® 1% gel:

• Adults: apply 4 g to the skin over the affected area four times daily. Do not use more than 32g daily in total across all affected areas. Measure the correct dose by using the enclosed dosing card.
• Children: follow your GP's instructions.

For osteoarthritis affecting knee - solution:

• Adults: apply 10 drops to the skin over the affected area four times daily.
• Children: follow your GP's instructions.

For acute pain ' transdermal (skin) patches:

• Adults: place one patch on the target area, twice daily.
• Children: follow your GP's instructions.

If you forget to use one dose of diclofenac topical medication, you should endeavour to use it right away. However, if your next treatment time is due, miss out one dose and go back to your usual dosing regimen.

If you are using patches and you forget to change or wear one, use a fresh patch as soon as possible. If your next application time is almost due, miss out one patch and just apply a new one.

Do not use twice the quantity of gel or solution, or apply two patches at once to cover the missed dose.

If you do not notice any improvement in your condition after a few days of using the medication, or if you think that your pain is getting worse, you should arrange to see your GP. It may be that the dose or strength of the medication requires an adjustment in order to be fully effective.

Interactions

Some medication must never be used together because doing so could cause a serious interaction that may be harmful. However, sometimes it may be appropriate for your treatment to use two or more drugs at the same time, despite a possible interaction. In this case, your GP will probably change the dose rate of one or both of the drugs, or give precautionary advice on how you can prevent any side effects.

Before you begin using diclofenac topical, you must tell your treating specialist if you are using any of the drugs listed below. It is not recommended to use this medication with any of the following:

• Zofenopril
• Xipamide
• Warfarin
• Vortioxetine
• Vorapaxar
• Vilazodone
• Venlafaxine
• Valsartan
• Valdecoxib
• Trolamine Salicylate
• Trimipramine
• Trichlormethiazide
• Triamterene
• Treprostinil
• Trandolapril
• Torsemide
• Tolmetin
• Tolfenamic Acid
• Tirofiban
• Tinzaparin
• Timolol
• Ticlopidine
• Ticagrelor
• Tiaprofenic Acid
• Tianeptine
• Tenoxicam
• Temocapril
• Telmisartan
• Tacrolimus
• Sulindac
• Sulfasalazine
• Spironolactone
• Spirapril
• Sotalol
• Sodium Salicylate
• Sibutramine
• Sertraline
• Salsalate
• Salicylic Acid
• Salicylamide
• Rofecoxib
• Rivaroxaban
• Reviparin
• Reboxetine
• Ramipril
• Quinapril
• Protriptyline
• Protein C
• Proquazone
• Propyphenazone
• Propranolol
• Proglumetacin
• Prednisone
• Prednisolone
• Prasugrel
• Pralatrexate
• Practolol
• Polythiazide
• Piroxicam
• Pindolol
• Piketoprofen
• Phenylbutazone
• Phenyl Salicylate
• Phenprocoumon
• Phenindione
• Perindopril
• Pentoxifylline
• Pentosan Polysulfate Sodium
• Pentopril
• Penbutolol
• Pemetrexed
• Paroxetine
• Parnaparin
• Parecoxib
• Paramethasone
• Oxyphenbutazone
• Oxprenolol
• Oxaprozin
• Opipramol
• Olsalazine
• Olmesartan
• Nortriptyline
• Nimesulide Beta Cyclodextrin
• Nimesulide
• Niflumic Acid
• Nepafenac
• Nefazodone
• Nebivolol
• Naproxen
• Nadroparin
• Nadolol
• Nabumetone
• Morniflumate
• Moexipril
• Milnacipran
• Metoprolol
• Metolazone
• Metipranolol
• Methylprednisolone
• Methyclothiazide
• Methotrexate
• Mesalamine
• Meloxicam
• Melitracen
• Mefenamic Acid
• Meclofenamate
• Meadowsweet
• Magnesium Salicylate
• Lumiracoxib
• Loxoprofen
• Losartan
• Lornoxicam
• Lofepramine
• Lithium
• Lisinopril
• Levomilnacipran
• Levobunolol
• Lepirudin
• Labetalol
• Ketorolac
• Ketoprofen
• Irbesartan
• Indapamide
• Imipramine
• Imidapril
• Iloprost
• Ibuprofen
• Hydroflumethiazide
• Hydrocortisone
• Hydrochlorothiazide
• Heparin
• Gossypol
• Ginkgo
• Furosemide
• Fosinopril
• Fondaparinux
• Fluvoxamine
• Flurbiprofen
• Fluoxetine
• Fluocortolone
• Flufenamic Acid
• Floctafenine
• Feverfew
• Feprazone
• Fepradinol
• Fenoprofen
• Felbinac
• Etoricoxib
• Etofenamate
• Etodolac
• Ethacrynic Acid
• Esmolol
• Escitalopram
• Eptifibatide
• Eprosartan
• Epoprostenol
• Eplerenone
• Enoxaparin
• Enalaprilat
• Enalapril
• Edoxaban
• Duloxetine
• Droxicam
• Doxepin
• Dothiepin
• Dipyrone
• Dipyridamole
• Digoxin
• Diflunisal
• Diclofenac
• Dibenzepin
• Diazoxide
• Dexketoprofen
• Dexibuprofen
• Dexamethasone
• Desvenlafaxine
• Desirudin
• Desipramine
• Delapril
• Deflazacort
• Deferiprone
• Danaparoid
• Dalteparin
• Dabigatran Etexilate
• Cyclosporine
• Cyclopenthiazide
• Cortisone
• Clopidogrel
• Clopamide
• Clonixin
• Clomipramine
• Citalopram
• Ciprofloxacin
• Cilostazol
• Cilazapril
• Choline Salicylate
• Choline Magnesium Trisalicylate
• Chlorthalidone
• Chlorothiazide
• Certoparin
• Ceritinib
• Celiprolol
• Celecoxib
• Carvedilol
• Carteolol
• Captopril
• Cangrelor
• Candesartan
• Bumetanide
• Bufexamac
• Budesonide
• Bromfenac
• Bivalirudin
• Bisoprolol
• Bismuth Subsalicylate
• Betaxolol
• Betamethasone
• Beta Glucan
• Benzthiazide
• Bendroflumethiazide
• Benazepril
• Bemiparin
• Balsalazide
• Azilsartan Medoxomil
• Azilsartan
• Atenolol
• Aspirin
• Argatroban
• Ardeparin
• Apixaban
• Anagrelide
• Amtolmetin Guacil
• Amoxapine
• Amitriptylinoxide
• Amitriptyline
• Amineptine
• Amiloride
• Alacepril
• Acenocoumarol
• Acemetacin
• Aceclofenac
• Acebutolol
• Abciximab

Some types of medicine should not be used when you are eating particular food groups, using alcohol, or using tobacco, as to do so could cause interactions to occur. Remember to discuss this aspect of your lifestyle with your GP before you begin using diclofenac.

Warnings

When you decide to use a medicine, you must consider the risks against the benefits of doing so. You should discuss this with your GP.

Allergies

If you have ever suffered an allergic or otherwise unusual reaction when taking diclofenac or other any form of prescription or non-prescription drug, you must tell your GP. In addition, mention to your doctor if you have allergies to certain food groups, food preservatives, food colorant or animal derivatives.

Geriatric patients

Studies to date have not highlighted any specific problems that are experienced by geriatric patients using diclofenac. However, older people can often have age-related health problems such as stomach, kidney, or heart problems, all of which may necessitate caution and a varied dose for patients who are using this medication.

Pregnancy

Studies have not shown any risk to the unborn baby in patients who are using diclofenac topical during the first two trimesters of their pregnancy. However, research has shown that this medication poses a definite risk to the fetus during the third trimester. If you are in the latter stages of pregnancy, or if you considering becoming pregnant during the time that you will be using diclofenac topical, you must tell your doctor. There may be an alternative medication that you could use that is safer for your unborn baby.

Breastfeeding

There have been no studies carried out that show whether diclofenac topical can pass into a mother's breast milk. However, if you are breastfeeding, you should tell your doctor. It may be safer for your nursing infant to discontinue breastfeeding until you have completed your course of diclofenac. In the meantime, you should consider using an alternative form of nutrition for your infant.

Medical history

Some medical problems can interfere with the effectiveness of this medication. In addition, in some health conditions, diclofenac can cause unpleasant or dangerous side effects.

If you have a history of the following health conditions, you must tell your GP before you start using diclofenac.

Diclofenac should be used with caution in patients who are suffering from any of the conditions listed below. This medicine can make these conditions worse:

• Mild to moderate kidney disease
• Hypertension (high blood pressure)
• Hyperkalemia (high potassium in the blood)
• History of stroke
• History of stomach ulcers or bleeding
• Historical or recent heart attack
• Heart disease
• Edema (fluid retention or body swelling)
• Congestive heart failure
• Blood clots
• Bleeding problems
• Anemia

Diclofenac topical should not be used to treat patients who have the following conditions:

• Severe kidney diseases
• History of sensitivity to aspirin or other NSAIDS
• Aspirin-sensitive asthma

Diclofenac skin patches should not be used if you have the following conditions:

• Exudative dermatitis
• Infection lesions
• Eczema
• Wounds or burns

This medication should not be used to treat pain immediately before or after heart surgery, including coronary artery bypass graft surgery.

Diclofenac topical must only be used with caution in patients who have a history of liver disease. This is because the drug's effects may be amplified due to the slower removal of the medication from the body.

While you are using diclofenac, you must attend your doctor or specialist for regular check-ups. Your doctor will monitor your body's response to the medication in order to make sure that it is working properly and to help manage any side effects that you may be experiencing. You may also be asked to have urine and blood tests taken to look for any side effects.

Using diclofenac can increase the risk of you suffering a heart attack or having a stroke. However, this eventuality is more likely to occur in patients who have a history of these conditions or in those who are prescribed the medicine for long-term use.

Diclofenac can cause bleeding in the intestines or stomach, suddenly and without warning. This complication is more likely to occur if you have a history of stomach ulcers, if you drink alcohol on a regular basis, or if you smoke. Patients over 60 years of age, those who are in poor health, and people who are using some other medications such as blood thinners and steroids are also at risk of bleeding while taking diclofenac.

Some people experience nasty skin reactions when using diclofenac topical preparations. If you begin to notice loosening, blistering, or peeling of the skin, reddened lesions, skin rashes, severe acne, ulcers or sores on the skin, or if you develop chills or a fever, you should stop taking the medication and contact your GP without delay.

Diclofenac can cause some very serious side effects in a small number of patient who are using this drug. You must contact your GP as a matter of urgency if you begin to experience any of the following signs:

• Black, tarry stools
• A decrease in urine production
• Severe stomach pains
• Skin rashes
• Swelling of the lower legs, feet, fingers, or face
• Unusual and unexpected bruising or bleeding
• Unexpected weight gain
• Yellowing of the eyes or skin
• Vomiting up blood or matter that resembles coffee grounds

In some patients, diclofenac can cause serious heart problems. If you begin to notice any of the following side effects, you must contact your doctor for advice straight away:

• Pain in the chest
• Feeling of tightness in your chest
• Irregular or rapid heartbeat
• Unexpected warmth of the skin or flushes
• Feeling of weakness
• Slurring of speech

A very few people can suffer from a serious allergy called anaphylaxis when they begin using this medicine. Anaphylaxis occurs more frequently in patients who have an allergy to aspirin or to any anti-inflammatory, nonsteroidal drugs. This condition is extremely dangerous if not treated promptly. If you notice any of the following signs, call 911 immediately. Note that anaphylaxis usually occurs within a few minutes of using the medication:

• Irregular or very rapid breathing
• Struggling for breath
• Fainting
• Changes in facial skin color
• Irregular, rapid heartbeat
• Hives or swellings on the skin
• Swelling or puffiness of the area around the eyes or of the eyelids

Sometimes, diclofenac can cause skin reactions, including soreness, scaling, redness, and peeling of the application site. Try to tolerate the reaction for a day or two to see if it settles down, and do not stop using the drug. If the problem becomes very troublesome and does not begin to settle down, ask your GP for advice.

While you are using diclofenac, you may find that your skin becomes more sensitive to the sun that it usually is. You should be aware that too much exposure to sunlight can make the side effects of the medication worse. Take the following precautions during the time that you are using diclofenac:

• Where possible, keep the treated areas of your skin out of direct sunshine, particularly between 10am and 3pm when the sun is at its strongest.

• Equip yourself with sunglasses and a hat, and keep treated areas covered with cotton clothing when you go outside in the sun.

• Avoid using sunlamps or tanning beds.

• Ask your doctor for advice on the best sunscreen or sunblock product that you could use during your course of treatment with diclofenac. If you do have a very bad reaction to the sun, check with your GP for advice.

If you are due to attend hospital or your GP clinic for any form of surgery or medical testing, tell the medical attendant that you are taking diclofenac. You may need to discontinue using the medication for a short time, or perhaps change to another form of anti-inflammatory, nonsteroidal medicine prior to undergoing your procedure.

While you are using diclofenac topical, you must not use any other medication, unless you have cleared their use with your doctor first. This includes both over the counter and prescription drugs, vitamins, and herbal supplements.

If you think that your symptoms are becoming worse, you should talk to your doctor.

Storage

Keep all forms of diclofenac topical medicines in a sealed container and at room temperature. Do not leave the medicines in direct sunlight or close to a source of heat. Keep the medicines dry. Do not refrigerate or freeze the medicines.

Keep the medicines in a secure place where they cannot be accessed by children or pets. If a pet does consume any of your drugs, you should contact your vet straight away for advice.

Do not use any medication that has gone out of date. Do not keep any medicine that you no longer need.

Dispose of unwanted diclofenac responsibly. Do not throw it down the drain or toilet or discard it with your garbage where children or animals could easily find it. When you have removed a spent patch, fold it with the adhesive sides together and dispose of it where pets and children cannot find it.

Summary

Diclofenac topical is an anti-inflammatory, nonsteroidal treatment that is used by patients who are suffering from the painful symptoms that are often caused by conditions such as arthritis and osteoarthritis. Diclofenac can also be used to treat a skin condition actinic keratosis that can become cancerous if not caught in time and treated appropriately.

Diclofenac cannot provide a cure with your arthritis, but while you are using the drug, it can go a long way to relieving the bothersome symptoms these conditions can cause.

There are a great many medicines that you should not take at the same time as using diclofenac because they can cause interactions and make side effects worse. In addition, there are a number of medical disorders and conditions that can be exacerbated by the use of diclofenac. For these reasons, you should be sure to fully disclose all your medical history to your doctor before you begin using this medicine. You will also need to attend your GP for regular appointments to ensure that the medicine is working correctly and to discuss any problems you may be experiencing while using it.

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