Diclofenac Topical

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and other symptoms of arthritis of the joints (eg, osteoarthritis), such as inflammation, swelling, stiffness, and joint pain. However, diclofenac does not cure osteoarthritis and will help you only as long as you continue to use it.

Diclofenac topical 3% gel is also used to treat actinic keratosis, a skin problem that may become cancerous if not treated. The exact way that topical diclofenac helps this condition is unknown.

Diclofenac topical solution is used to treat pain and swelling caused by osteoarthritis of the knees.

Diclofenac topical patch is used to treat acute pain caused by minor strains, sprains, and contusions (bruises).

diclofenac is available only with your doctor's prescription.

• Nonsteroidal Anti-inflammatory Drug (NSAID)
• Nonsteroidal Anti-inflammatory Drug (NSAID), Topical

Hypersensitivity to diclofenac (eg, anaphylactic reaction, serious skin reactions) or any component of the formulation; history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs; use in the setting of coronary artery bypass graft (CABG) surgery; use on nonintact or damaged skin, including exudative dermatitis, eczema, infected lesions, burns, or wounds.

Documentation of allergenic cross-reactivity for NSAIDs is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Canadian labeling: Additional contraindications (not in US labeling):

Pennsaid: Concomitant use with other diclofenac containing products or other NSAIDS; active peptic ulcer; history of recurrent GI ulceration; active GI inflammatory disease; significant hepatic impairment or active hepatic disease; severely impaired or deteriorating renal function (CrCl <30 mL/minute); use in children; pregnancy; breast-feeding

Voltaren Emulgel: Concomitant use with other diclofenac-containing products or other NSAIDS

Start at lower end of dosing range. Refer to adult dosing.

Gel: Store between 20°C to 25°C (68°F to 77°F); do not freeze. Protect from heat. Avoid freezing.

Voltaren Emulgel [Canadian product]: Store at 15°C to 30°C (59°F to 86°F).

Solution: Store between 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F).

Patch: Store between 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Keep envelope sealed when not being used.

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience skin irritation. Have patient report immediately to prescriber signs of signs of abdominal ulcers (severe abdominal or back pain; black, tarry, or bloody stools; vomiting blood or vomit that looks like coffee grounds; or weight gain or abnormal swelling), signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; hematuria; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding), signs of severe cerebrovascular disease (change in strength on one side is greater than the other, difficulty speaking or thinking, change in balance, or vision changes), signs of kidney problems (urinary retention, hematuria, change in amount of urine passed, or weight gain), signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of high potassium (abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, numbness or tingling feeling), signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes), burning or numbness feeling, angina, shortness of breath, tachycardia, severe abdominal pain, severe back pain, excessive weight gain, swelling of arm or leg, severe dizziness, passing out, severe headache, vision changes, flu-like symptoms, or loss of strength and energy (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating, and advising patients.

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing substances in the body that cause pain and inflammation.

Diclofenac topical (for the skin) is used to treat joint pain caused by osteoarthritis. Pennsaid is for use on the knees. Voltaren Topical is for use on the hands, wrists, elbows, knees, ankles, or feet. This medicine may not be effective in treating arthritis pain elsewhere in the body.

Solaraze is used to treat warty overgrowths of skin (actinic keratoses) on sun-exposed areas of the body.

Diclofenac topical may also be used for purposes not listed in this medication guide.

Do not use cosmetics, sunscreen, lotions, insect repellant, or other medicated skin products on the same area you treat with diclofenac topical.

Avoid exposing treated skin to heat, sunlight, or tanning beds.

Avoid getting this medicine near your eyes, nose, or mouth. If this does happen, rinse with water. Call your doctor if you have eye irritation that lasts longer than 1 hour.

Avoid drinking alcohol. It may increase your risk of stomach bleeding.

Avoid taking aspirin or other NSAIDs while you are using diclofenac topical.

Ask a doctor or pharmacist before using any cold, allergy, or pain medication. Many medicines available over the counter contain aspirin or other medicines similar to diclofenac. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.

Usual Adult Dose for Actinic Keratosis:

3% Gel:
-Apply an amount sufficient to cover each lesion twice a day and rub in gently
-Duration of therapy: 60 to 90 days; complete healing of lesions may not be evident for up to 30 days following cessation of therapy

Comments:
-Normally, 0.5 g is used on each 5 cm x 5 cm lesion site.
-Lesions that do not respond to therapy should be carefully reevaluated and management reconsidered.
-Sun exposure should be avoided during therapy.

Use: For the topical treatment of actinic keratosis

Usual Adult Dose for Osteoarthritis:

1% Gel:
Lower Extremities: Apply 4 g to the affected foot, knee, or ankle 4 times a day and rub in gently; not to exceed 16 g/day to any single joint of the lower extremities

Upper Extremities: Apply 2 g to the affected hand, wrist, or elbow 4 times a day and rub in gently; not to exceed 8 g/day to any single joint of the upper extremities

Maximum dose: 32 g/day over all affected joints

Comments:
-When used on the lower extremities, this drug should be applied to the entire affected foot, knee, or ankle; the entire foot includes the sole, the top of the foot, and the toes.
-When used on the upper extremities, apply to the entire affected hand, wrist, or elbow; the entire hand includes the palm, the back of the hands, and the fingers.
-The accompanying dosing card should be used for application; consult manufacturer product information for instructions.

Use: For the relief of pain associated with osteoarthritis of the joints amenable to topical treatment, such as the knees and those of the hands; this drug has not been evaluated for use on the spine, hip, or shoulder

1.5% Topical Solution: Apply 40 drops to each affected knee 4 times a day

2% Topical Solution: Apply 40 mg (2 pump actuations) to each affected knee 2 times a day

Use: For the relief of signs and symptoms of osteoarthritis of the knee(s)

Usual Adult Dose for Pain:

1.3% Topical Patch:
-Apply 1 patch to the most painful area twice a day

Use: For the topical treatment of acute pain due to minor strains, sprains, and contusions

Ask your doctor before using diclofenac topical if you take an antidepressant such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed easily.

Tell your doctor about all your current medicines and any you start or stop using, especially:

• cyclosporine;

• lithium;

• methotrexate;

• a blood thinner (warfarin, Coumadin, Jantoven);

• heart or blood pressure medication, including a diuretic or "water pill"; or

• steroid medicine (prednisone and others).

This list is not complete. Other drugs may interact with diclofenac topical, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.