What to Know About Voltaren Gel

Safety, side effects, dosage, and more

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Voltaren Gel (diclofenac 1%) is a topical nonsteroidal anti-inflammatory drug (NSAID) used to treat pain from joint health issues such as osteoarthritis (OA).

OA is the most common type of arthritis. It occurs over time due to wear and tear on joints. This can lead to joint pain, swelling, and stiffness.

The FDA-approved gel can help ease joint pain due to OA in the:

  • Knees
  • Feet
  • Ankles
  • Hands
  • Wrists
  • Elbows

Note that the gel has not been shown to work for:

  • Sports injuries
  • Sprains
  • Bruises
  • Strains

The FDA has also approved a 3% strength for over-the-counter (OTC) use in people with actinic keratosis, rough, scaly skin patches that can turn cancerous.

How to use voltaren gel safely

Verywell / JR Bee

Before Taking

Talk with your healthcare provider before using Voltaren Gel to be sure it's right for you. You may be able to switch to the gel if the oral form of diclofenac and other NSAIDs upset your stomach or you are at risk of side effects.

Most studies have shown that Voltaren Gel can ease pain just as well as its oral counterpart, but the risk of of serious side effects is much lower with the gel. That is because the gel is applied and absorbed through your skin, while the oral form affects your entire body.

The FDA approved Voltaren Gel for OTC use based on the results of studies on its effectiveness and safety. Since then, studies have supported the use of the NSAID gel as a first-line treatment option for knee OA and hand OA.

This is especially true for older adults or those at risk of harm from the effects of oral NSAIDs. This includes damage to organs such as the liver, kidneys, and heart.

Talk with your healthcare provider about all the medicines you take that might interact with this drug.

Medicines to discuss include your complete list of:

  • Prescriptions
  • OTC drugs
  • Dietary supplements
  • Herbal remedies
  • Essential oils

While some drugs may interact with the gel in a minor way, other interactions may be more risky.

You and your healthcare provider can discuss what this means to your health status and needs and decide on the best treatment for you.

Black Box Warnings

Drugs with black box warnings carry the highest level of caution. This is due to their high risk of serious side effects.

Warnings

Voltaren Gel has the following black box warnings:

Serious side effects can happen without warning. Your risk may be higher if you've been taking NSAIDs for a long time or at high doses.

Contraindications

Do not use Voltaren gel in the following circumstances:

  • If you have any heart issues or are at risk for adverse events such as heart attack and stroke
  • If you have allergies to this drug or other pain or fever aids such as aspirin
  • Before or after heart surgery

Talk with your healthcare provider before using the gel if you:

  • Have had problems or serious side effects from taking drugs for pain or fever
  • Are at risk for bleeding in your GI tract or have had stomach issues such as heartburn
  • Are pregnant or breastfeeding
  • Take a diuretic or ACE inhibitor
  • Are less than 18 years old, as the effects of this drug on children younger than age 18 is not known
  • Are age 60 or older

It is vital that you talk with your healthcare provider before using this drug if you have any serious health issues such as:

Dosage

Use the enclosed dosing card to measure the correct dose of Voltaren Gel. The card can be reused to measure to the 2-gram or 4-gram mark.

Apply 2 grams of the gel to each upper body part affected:

  • Hand
  • Wrist
  • Elbow

Apply 4 grams of the gel to each lower body part affected:

  • Foot
  • Ankle
  • Knee

The doses can be applied to the affected upper or lower body part up to four times per day as stated above.

Do not apply:

  • A higher dose than directed on the drug label or prescribed by your healthcare provider
  • More than 32 grams total per day
  • To more than two body parts at once
  • To your eyes, nose, or mouth
  • To open wounds or infected areas

How to Take and Store

Do:

  • Wash your hands before and after you apply the gel
  • Use the gel for up to 21 days unless your healthcare provider instructs you otherwise
  • Store at 68-77 degrees F (20-25 degrees C)

Do not:

  • Wash the gel off your hands if you apply it to the joints in this area
  • Freeze the gel

Precautions

  • Apply only on clean, dry skin without rashes, cuts, or infections.
  • Don't shower or rinse the treated area for at least an hour.
  • Do not place a bandage over the treated area.
  • Avoid sunlight and artificial sunlight after applying.
  • Do not combine the gel with another product.
  • Don't heat the treated joint(s).

Side Effects

Local reactions at the site where the gel was applied were the most common adverse reactions cited in clinical trials.

NSAIDs can also:

  • Raise your blood pressure
  • Cause you to retain fluid
  • Lead to edema (swelling in your tissues due to fluid build-up)

Watch your blood pressure and keep an eye out for these and other adverse effects while using this drug.

Stop using Voltaren Gel and let your healthcare provider know right away should any of these occur.

Also cease use of the drug if lab tests show a high eosinophil count, which can lead to symptoms such as:

  • Rash
  • Diarrhea
  • Stomach pain
  • Dark urine

Severe Adverse Reactions

Be sure to read the drug label and package insert that comes with Voltaren Gel. These will note the serious adverse reactions that can be caused by this drug.

Long-term NSAID use can lead to serious kidney issues such as renal papillary necrosis, a condition in which parts of the kidney die.

NSAIDs can also lead to severe and sometimes fatal skin conditions such as:

Long-term treatment with Voltaren can impact your liver enzymes. These may be higher than normal even before symptoms show up, and they can be a sign of serious liver issues that can be fatal or require a liver transplant.

Interactions

Voltaren Gel should not be used together with oral NSAIDs or aspirin because of an increased risk of adverse events.

Using these at the same time ups the total drug dose your body absorbs. This can amplify the risk of side effects.

Skin Products

Don't apply Voltaren Gel to areas of your face or body that have makeup or sunscreen on them. The combined use of these has not been tested. Therefore, it is not known whether this is safe to do.

Mixing use of skin products can also change how your body absorbs and reacts to the NSAID gel. 

Summary

Voltaren Gel is a topical pain aid prescribed by a healthcare provider to treat pain from OA in the knees, hands, and other joints. The gel may help ease joint pain just as well as oral forms of the NSAID.

Voltaren Gel should not used in people at risk for heart attack or stroke or who have had recent heart surgery. The drug should be used with caution in people in people with certain health issues such as kidney or liver disease.

Do not use the gel at the same time as other NSAIDs or aspirin as this can raise the risk of adverse events. These events can be serious and sometimes fatal.

Also, do not apply Voltaren Gel to areas of the skin with makeup or other products on them. Their combined use has not been tested.

A Word From Verywell

Voltaren Gel has expanded treatment options for OA. This has been key for people who can't use oral forms of the NSAID for various reasons.

Just be aware that all forms of NSAIDs carry risk. It doesn't matter if the drug is applied to your skin or taken in pill form.

Protect your health by taking the drug as stated on the drug label or prescribed by your healthcare provider.

And be sure to stop taking the drug and let your healthcare provider know if side effects do occur.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Javor S, Cozzani E, Parodi A. Topical treatment of actinic keratosis with 3.0% diclofenac in 2.5% hyaluronan gel: review of the literature about the cumulative evidence of its efficacy and safetyG Ital Dermatol Venereol. 2016;151(3):275-280.

  3. Tieppo Francio V, Davani S, Towery C, Brown TL. Oral versus topical diclofenac sodium in the treatment of osteoarthritisJ Pain Palliat Care Pharmacother. 2017;31(2):113-120. doi:10.1080/15360288.2017.1301616

  4. U.S. National Library of Medicine. Label: Voltaren arthritis pain-diclofenac sodium gel. Updated June 30, 2021.

  5. U.S. Food & Drug Administration. Voltaren gel. Updated February 2018.