What to Know About Voltaren (Diclofenac Sodium)

Voltaren (diclofenac sodium) is a nonsteroidal anti-inflammatory drug (NSAID) often used to manage pain associated with different arthritis conditions including rheumatoid arthritis (RA), osteoarthritis (OA), and ankylosing spondylitis (AS).

Your healthcare provider might also prescribe it to treat pain from a bone or joint injury or surgery, or for other types of mild-to-moderate pain, such as migraine headaches.

Formulations of Voltaren include oral tablets or capsules, eye drops, topical treatments, and powder for an oral solution. Oral Voltaren is a prescription drug; you can get topical gel and eye drops over-the-counter (OTC) without a prescription.

Keep reading to learn more about Voltaren, including its forms and uses, what to know before you start taking it, dosage, side effects, and more.

Uses

Voltaren comes in different forms, including oral tablets, ophthalmic solution (eye drops), as a topical gel, and as a powder for oral solution.

Oral

Oral Voltaren is used to treat pain and reduce inflammation from arthritis conditions like rheumatoid arthritis and ankylosing spondylitis. These tablets and capsules are only available as a prescription that your healthcare provider can write.        

Ophthalmic

Ophthalmic Voltaren is a sterile solution that contains 0.1% or 1 mg/mL (milligram per milliliter) diclofenac sodium. It is used to treat swelling after cataract eye surgery. It might also be prescribed after other types of eye surgery to manage eye pain and light sensitivity, or eye symptoms associated with seasonal allergies.

You can purchase these eye drops at a local retailer or online, or your healthcare provider can prescribe a higher strength.

Topical Gel

Voltaren gel is a topical gel. Much like oral Voltaren, it treats joint pain, stiffness, and swelling. It can also reduce inflammation and pain from inflammatory arthritis conditions like RA and AS.

The Food and Drug Administration (FDA) has approved Voltaren gel for arm and leg joints only. Do not use it on the spine, hips, or shoulders.

Oral Solution

Voltaren-XR (diclofenac potassium) powder for oral solution is prescribed for treating acute migraine (migraines not diagnosed as chronic) attacks in people over age 18. Sometimes, Voltaren-XR is used to treat arthritis pain and inflammation as well.

Before Taking

Before starting any new prescription, be sure you tell your healthcare provider about all the medications you use—prescription and non-prescription, herbal supplements, and vitamins. 

Oral Voltaren

Some people shouldn’t use oral Voltaren. An incomplete list includes:

• People with high blood pressure or conditions that cause water retention
• People who have ulcers or gastrointestinal bleeding
• People with a history of smoking or excessive alcohol use
• People with kidney disease
• People who use diuretics
• People with asthma
• People who experience allergic reactions to aspirin
• People who are pregnant or plan to become pregnant
• People who are breastfeeding

Your healthcare provider can tell you more about how oral Voltaren might affect you based on your current health status. You should let them know about all the health conditions you have and the treatments you take to manage them.

Ophthalmic

Before starting ophthalmic Voltaren, tell your healthcare provider about your medical history, including whether you have ever had an allergic reaction to aspirin or another NSAID. Your healthcare provider also needs to know if you have asthma, growths in the nose, bleeding or clotting problems, other eye problems, or diabetes.

If you are pregnant, trying to get pregnant, or breastfeeding, you should discuss with your healthcare provider the risks and benefits of using ophthalmic Voltaren.

Topical Gel

Much like other types of Voltaren, Voltaren gel is not for everyone. You should check with your healthcare provider if you have ever had an allergic reaction to aspirin or another NSAID, or have any of the following medical conditions:

• Asthma
• High blood pressure
• A heart condition or a history of heart attack or stroke
• A fluid retention condition
• Liver or kidney disease

According to the FDA’s labeling, people who are pregnant or plan to become pregnant shouldn’t use Voltaren gel. People who are breastfeeding should also avoid using it.

Oral Solution

Avoid using Voltaren-XR powder oral solution if you have an allergy to aspirin or another NSAID. Voltaren-XR should not be prescribed to children because there have not been appropriate studies showing that it is safe and effective for pediatric use.

Older adults should also avoid it due to the likelihood of side effects. People who are breastfeeding should not take Voltaren-XR as there have not been adequate studies about infant risk through breast milk.

Voltaren-XR powder for oral solution should not be used with certain medications, including Ketorolac, an NSAID used for moderate-to-severe acute pain in adults. Voltaren-XR might interact with other drugs, much like Voltaren oral tablets and capsules.

Make sure you tell your healthcare provider about all of the medications you take to treat other conditions, including other NSAIDs.

People with certain medical conditions, including anemia, bleeding problems, heart problems, blood disorders, and liver disease, should let their healthcare providers know before starting Voltaren-XR.

Other NSAIDs

Other NSAIDs include:

• Celebrex (celecoxib)
• Ibuprofen
• Mobic (meloxicam)
• Nalfon (fenoprofen)
• Naproxen

Dosage

Voltaren comes in different formulations and brands. Each brand and formulation has a specific purpose and contains different amounts of the drug.

Oral

Oral Voltaren is available in standard tablets and extended-release oral capsules. Standard tablets come in three strengths—25 milligrams (mg), 50 mg, and 75 mg. The extended-release tablets are 100 mg (Voltaren XR).

Voltaren tablets and capsules should be taken by mouth with a full glass of water unless your healthcare provider tells you otherwise.

Capsules and tablets should be taken whole. They shouldn’t be crushed, chewed, or cut in half. Breaking down the tablets can destroy the outside coating and increase the potential for side effects.

The dosage your healthcare provider prescribes is based on the condition being treated, your treatment response, and other medicines you take. Because of the potential for side effects (such as stomach bleeding), your healthcare provider will prescribe Voltaren at the lowest effective dose for the shortest time possible.

Do not take more than your practitioner has prescribed. For chronic pain conditions and arthritis, take only as your healthcare provider has instructed. Make sure you discuss all the risks and benefits of taking oral Voltaren to manage your pain and inflammation.

Ophthalmic

Ophthalmic Voltaren is applied to an affected eye according to your healthcare provider’s instructions. The dosage and length of treatment will depend on what it is treating and how you respond to treatment. You should avoid wearing contact lenses unless your healthcare provider tells you otherwise.

Before applying drops, wash your hands. When applying, do not touch the tip of the dropper or let the tip touch the eye or another surface. Tilt your head back and while looking up, pull the lower eyelid to form a pouch. Place one drop into the pouch, then look down and gently close your eyes for a minute or two.

Topical

Voltaren gel contains a powerful anti-inflammatory ingredient that is absorbed into the joints from the skin. You should use the gel according to the dosing indicated on the packaging. Using too much can increase the risk of side effects.

The packaging for OTC Voltaren gel includes an information card showing how much to measure of the product. There are two dosage amounts—2 grams and 4 grams. The dosage will vary depending on which joint it is being applied to.

Do not apply the gel to more than two body areas at a time. Dosing for hands, wrists, and elbows is 2 grams to the affected joint, up to 4 times a day. For knees, feet, or ankles, apply 4 grams to the affected joints, up to 4 times daily. 

Do not wrap the affected joint with a bandage after applying the medicine. This could create heat and cause the body to absorb more of the medicine than what is safe. The FDA has approved Voltaren gel to be used daily for up to 21 days. If you have pain that persists after 21 days, consult your healthcare provider.

Wash your hands after applying Voltaren gel. If the gel was applied to the hands, wait at least one hour to wash your hands. Be careful not to touch your eyes or face.

Oral Solution

You should use the Voltaren-XR oral solution for the full length of time your healthcare provider has prescribed. Do not use it for longer than your practitioner orders.

To use the oral solution, open the powder packet and empty the contents into a cup. Add 1 to 2 ounces of water. No other liquid should be used for mixing the medicine. Mix well with the water and drink right away on an empty stomach.

The exact dosage of the medicine is based on the condition it is treating. Follow your healthcare provider’s orders or the label directions.

Missed Doses

If you miss a dose of your Voltaren treatment, take the missed dose as soon as you remember. If it’s almost time for your next dose, take the next scheduled dose; do not double doses.

If you think you have taken too much Voltaren, call your healthcare provider or the American Poison Control Hotline at 1-800-222-1222. If you might be experiencing an overdose, call 911 or have someone take you to the nearest emergency department.

Storage 

All formulations of Voltaren should be stored at room temperature away from heat or moisture. Keep bottles or medicine tubes sealed when not in use.

Side Effects

Each formulation of Voltaren has its own set of side effects that might occur with its use.

Oral

Mild side effects of oral Voltaren include upset stomach, nausea, diarrhea, constipation, bloating, headache, dizziness, and drowsiness. If side effects persist or get worse, let your healthcare provider know right away.

Oral Voltaren can raise your blood pressure. Be sure to check your blood pressure regularly and let your healthcare provider know if your blood pressure is persistently elevated.

Serious side effects are rare but can occur. Tell your healthcare provider right away if you experience serious side effects, such as ringing in the ears or other hearing changes, mood changes, problems with swallowing, and signs of heart failure—ankle or foot swelling, breathing problems, extreme fatigue, or unusual or sudden weakness.

You should get medical help if you experience signs of a kidney problem, such as changes in the urine output and fluid retention in the ankles or feet. Like other NSAIDs, Voltaren oral can cause serious liver problems. Get medical help for signs of a liver problem, such as dark urine, abdominal pain, or yellowing skin or eyes.

While rare, some people might experience a serious allergic reaction to Voltaren oral. You should get medical help if you experience signs of an allergic reaction, including swelling of the face, tongue, or throat; rash or itching; trouble breathing; and severe dizziness.

The above-mentioned side effects aren’t the only possible side effects. If you experience additional side effects, you should let your healthcare provider know.

Black box warnings for oral Voltaren include:

• An increased risk for serious and potentially fatal cardiovascular events, including heart attack and stroke
• An increased risk for serious gastrointestinal (GI) events, including stomach bleeding, ulcers, or perforations of the stomach or intestines. Serious GI events are more common in older people or those with a history of peptic ulcers or previous GI bleeding.
• Potential contradictions after coronary artery bypass graft (CABG) surgery

Ophthalmic

The common side effects of ophthalmic Voltaren include stinging, burning, or itching of the eyes and temporary blurred vision after the medication is applied. 

Up to 3% of people who use ophthalmic Voltaren will experience systemic (affecting the entire body) side effects. Systemic side effects might include abdominal pain, decreased muscle strength, chills or fever, dizziness, facial swelling, headache, nausea and/or vomiting, insomnia, stuffy nose, or viral infection.

Topical

The most common side effects associated with Voltaren gel are application site reactions, including itching, dryness, redness, and scaling. If you experience an allergic reaction with serious skin symptoms, you should stop using the gel and call your healthcare provider.

Systemic side effects of Voltaren gel might include:

• Nausea and/or vomiting
• Abdominal pain and bloating
• Upset stomach
• Stomach ulcers
• Numbness and tingling
• Cysts
• Pimples
• Other skin irritation
• Elevated blood pressure
• Fluid retention
• Swelling of feet or ankles

Oral Solution

Mild side effects of the powder solution are similar to those of the oral tablets and capsules. More serious side effects include fainting, fast or pounding heart, hearing changes like ringing in the ears, a persistent or severe headache, sudden or unexplained weight gain, vision changes, and unusual fatigue. 

The powder solution carries the same black box warnings as the oral tablets and capsules.

Warnings and Interactions

You should avoid drinking alcohol when taking Voltaren oral. This might increase your risk for stomach bleeding. You should also avoid taking other NSAIDs or aspirin with Voltaren unless your healthcare provider tells you you can.

Ask your practitioner if it is safe for you to use other pain relief medicines with oral or powder solution Voltaren, including those for pain and swelling, fever, or cold and flu symptoms. These products might contain ingredients similar to those in Voltaren that could increase your risk for side effects and adverse reactions.

Ophthalmic Voltaren may cause your vision to be blurred. You should avoid driving, using heavy machinery, or any activity that requires clear vision. Wait until you are sure it is safe to perform these types of activities.

Avoid using Voltaren gel in higher doses than recommended. Applying more than indicated can increase the risk for serious complications, including sudden GI bleeding, stroke, or heart attack.

Some drugs may interact with Voltaren, regardless of the formulation. These might include:

• Antidepressants: taking NSAIDs with certain antidepressants may cause bruising or bleeding
• Heart or blood medications, including diuretics
• Other formulations of diclofenac (including other brand names or generics)
• Blood thinners such as warfarin or coumadin
• Other NSAIDs, including aspirin, naproxen, meloxicam, and others

Other drugs might interact with Voltaren as well, including prescription drugs, OTC medicines, vitamins, and herbal supplements. Check with your healthcare provider before starting Voltaren to manage pain from arthritis or another condition.