How does this medication work? What will it do for me?

Diclofenac belongs to the class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing pain, swelling, and inflammation. Diclofenac topical gel (applied to the skin) is used to relieve pain associated with recent muscle or joint injuries such as sprains, strains, or sports injuries. It is generally used in addition to other non-medication measures (such as getting enough rest) to relieve these discomforts.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Voltaren® Emulgel
Each tube of whitish, soft, homogenous, cream-like oil-in-water topical emulsion contains diclofenac diethylamine 1.16% w/w. Nonmedicinal ingredients: carbomer, cocoyl caprylocaprate, diethylamine, isopropyl alcohol, liquid paraffin, macrogol cetostearyl ether, perfume, propylene glycol, and purified water.

Voltaren® Emulgel - Joint Pain
Each tube of whitish, soft, homogenous, cream-like oil-in-water topical emulsion contains diclofenac diethylamine 1.16% w/w. Nonmedicinal ingredients: carbomer, cocoyl caprylocaprate, diethylamine, isopropyl alcohol, liquid paraffin, macrogol cetostearyl ether, perfume, propylene glycol, and purified water.

Voltaren® Emulgel Extra Strength
Each tube of whitish, soft, homogenous, cream-like oil-in-water topical emulsion contains diclofenac diethylamine 2.32% w/w. Nonmedicinal ingredients: butylhydroxytoluene, carbomers, cocoyl caprylocaprate, diethylamine, isopropyl alcohol, liquid paraffin, macrogol cetostearyl ether, oleyl alcohol, perfume, propylene glycol, and purified water.

How should I use this medication?

Diclofenac topical gel is applied over the affected area 3 or 4 times a day and gently rubbed into the skin. The amount needed will depend on the size of the area being treated. Usually, a strip of about 2 cm long will be enough to cover a 200 cm² area.

Diclofenac extra strength topical gel is measured to give an accurate dose. Use the dosing card supplied with the medication to measure 2 gram doses and apply the gel to the affected area 2 times a day only. Gently rub the gel into the skin.

After applying the gel, wash your hands, unless the area being treated is part of the hand.Do not apply this medication to infected, abraded, or open skin. Do not apply to skin rashes or eczema. Do not use dressings that do not breathe on top of this medication. This medication is for external use only and should not be taken by mouth.

Avoid getting this medication into the eyes or other mucous membranes (e.g., nose, mouth, vagina, anus). If you accidentally get this medication in your eyes, rinse your eyes well with clean water and contact your doctor or pharmacist.

Diclofenac topical gel should not be used for longer than 7 days for muscle or joint injuries unless recommended by your doctor. If the condition does not improve within 7 days, or if it gets worse, contact your doctor.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, apply it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not apply a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from direct sunlight, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to diclofenac or any ingredients of the medication
  • are allergic to acetylsalicylic acid or other NSAIDs (e.g., ibuprofen, naproxen, ketorolac)
  • are taking another NSAID
  • are using or taking other products containing diclofenac
  • experience asthma attacks, itchiness, or runny nose after taking acetylsalicylic acid or other NSAIDs

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who uses this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people using this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • application site irritation (e.g., redness, itching)
  • increased sensitivity of the skin to sunlight

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • blistering skin at the application site
  • heartburn
  • stomach discomfort

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a serious allergic reaction (e.g., hives, difficulty breathing, or swelling of the face and throat)
  • symptoms of bleeding in the stomach or intestines (black, tarry stools; stomach pain; vomit with a coffee-grind appearance or vomiting blood; weakness or fainting)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Absorption: Diclofenac gel is intended to be used on the surface of intact, uninfected skin. This minimizes the amount of diclofenac that may be absorbed into your body. However, when it is used for a longer than recommended length of time, or applied to a large area of the body, enough medication may be absorbed to cause side effects similar to diclofenac that is taken by mouth.

Asthma: As with other anti-inflammatory medications, rarely, diclofenac gel can cause difficulty breathing. If you have asthma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you have any unusual difficulty breathing while using this medication, contact your doctor immediately.

Drowsiness/reduced alertness: Some people have reported headache, dizziness, lightheadedness, and confusion while using this medication. Avoid operating motor vehicles and doing other potentially hazardous activities until you have determined the effect this medication has on you.

Infection: This medication may mask some of the signs of infection, such as fever.

Peptic ulcers: If you have stomach or intestinal ulcers or a history of them, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Sun sensitivity: This medication may make your skin more sensitive to the sun. While you are using this medication, avoid excessive sun exposure, including tanning beds and sun lamps. If you experience sunburn with itching, swelling, and blistering, stop using this medication and contact your doctor.

Vision: Other medications in the same family as diclofenac may cause vision changes such as blurred or decreased vision. If you notice vision changes, stop using the medication and check with your doctor.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while using this medication, contact your doctor immediately.

Breast-feeding: It is not known if diclofenac topical gel passes into breast milk. If you are a breast-feeding mother and are using this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children less than 16 years of age.

What other drugs could interact with this medication?

There may be an interaction between diclofenac topical gel and any of the following:

  • acetaminophen
  • acetylsalicylic acid (ASA)
  • alcohol
  • aliskiren
  • angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
  • angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • bisphosphonates (e.g., alendronate, etidronate, pamidronate, risedronate, zoledronic acid)
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • corticosteroids (e.g., prednisone, hydrocortisone, methylprednisolone)
  • cyclosporine
  • desmopressin
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone)
  • digoxin
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
  • fluoroquinolone antibiotics (e.g., ofloxacin, ciprofloxacin)
  • herbal medications that affect blood clotting (e.g., ginkgo biloba, garlic, ginger, ginseng, glucosamine)
  • lithium
  • medications that affect blood clotting (e.g., acetylsalicylic acid (ASA, aspirin), clopidogrel, enoxaparin, dalteparin, heparin, lepirudin, tinzaparin, or warfarin)
  • medications used to treat stomach or intestinal ulcers, reflux, or excessive acidity (e.g., ranitidine, omeprazole, esomeprazole, pantoprazole)
  • mesalamine
  • methotrexate
  • other nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen, ketorolac)
  • other products containing diclofenac
  • pemetrexed
  • pentoxifylline
  • phenytoin
  • probenecid
  • selective serotonin reuptake inhibitors (SSRIs e.g., paroxetine, fluoxetine, citalopram, sertraline)
  • sulfasalazine
  • tacrolimus
  • tenofovir
  • tricyclic antidepressants (e.g., amitriptyline, doxepin, imipramine)
  • voriconazole

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.