Voltaren (diclofenac) gel is a topical medicine that is used to reduce pain and swelling from osteoarthritis in certain joints. For years it was only available as a prescription medicine. But since 2020, Voltaren gel has also been available as an over-the-counter (OTC) product.
How Does Voltaren Gel Work?
Voltaren gel belongs to a group of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs). When your body is injured, as with cartilage breakdown in your joints from osteoarthritis, it makes substances called prostaglandins that cause warmth, pain, and swelling. Voltaren gel works by blocking an enzyme called cyclooxygenase (COX). This enzyme helps make prostaglandins. There are two main types of this enzyme, COX-1 and COX-2. Voltaren gel blocks both of them. By reducing the activity of these enzymes, Voltaren gel lowers prostaglandin levels in the area where it is applied. This helps decrease pain and inflammation in the muscles, joints, or tissues beneath the skin to make the painful or swollen area feel better and move more comfortably. Unlike other topical medicines that seem to provide quick relief, it may take a few days before you start to feel relief from Voltaren gel.
How Was Voltaren Gel Studied?
At least two studies looked at how Voltaren gel compared to a placebo (a dummy medicine that has no effect) applied to the skin four times daily for osteoarthritis pain of the knee (study 1) or hand (study 2). Study 1 used the pain score from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), where lower scores mean less pain, to see how well the medicine worked. Study 2 used a pain intensity visual analog scale ranging from 0 (best) to 100 (worst) to measure how well it worked.
What Are the Main Benefits of Voltaren Gel?
For people using Voltaren gel four times a day for their knee pain, the WOMAC pain index score was lower after 12 weeks, compared to the placebo. This means that the patients using the Voltaren gel rated their pain as less intense compared to people using the placebo. These results are summarized in the table below.
Study 1:
Voltaren gel (127 people) | Placebo (119 people) | |
| Knee pain using the WOMAC pain index at 12 weeks | 28 | 37 |
For people using Voltaren gel four times a day for their hand pain, the pain scores were lower after four and six weeks, compared to the placebo. This means that the patients using the Voltaren gel rated their pain as less intense compared to people using the placebo. These results are summarized in the table below.
Study 2:
Voltaren gel (198 people) | Placebo (187 people) | |
| Hand pain using a 0-to-100 pain index at four weeks | 43 | 50 |
| Hand pain using a 0-to-100 pain index at six weeks | 40 | 47 |
Is Voltaren Gel Right for Me?
You should only use Voltaren gel according to the package labeling or as your health care provider recommends. You should not use it if you are allergic to any of the ingredients in the product or to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. You should not use it to treat pain in other or larger joints, such as the spine, hip, or shoulder joints. It is not known if Voltaren gel is safe or effective for pain in these areas. Voltaren gel should not be used right before or after certain heart surgery, such as coronary artery bypass graft (CABG), because it could increase your risk of having a heart attack or stroke. It should also not be applied to damaged skin. Doing so may cause irritation or increase the amount of medicine that is absorbed, increasing your risk of side effects. Voltaren gel may not be right for you if you have certain health conditions or take certain medicines. Before using Voltaren gel, tell your health care provider about all of your health conditions and any medicines that you take, including over-the-counter medicines.
How Should I Use Voltaren Gel?
Voltaren gel comes with a dosing card to help you measure the right amount of medicine to treat your pain. Use 2 grams of medicine, 2.25 inches on the dosing card, for smaller joints, such as your hands, wrists, or elbows. Use 4 grams of medicine, 4.5 inches on the dosing card, for larger joints, such as your feet, ankles, or knees. After measuring the correct amount of medicine, you should gently rub it onto the affected joints. You can do this up to four times each day. You should not use Voltaren gel on more than two body parts at the same time. Doing so could expose you to too much medicine, which could increase your risk of side effects.
How Can I Prevent and Manage Side Effects?
The most common side effect of Voltaren gel is redness, itching, a rash, dry skin, scaling, or peeling where you apply it. More serious side effects are possible with it, but these are much less common. Some of these more serious side effects may include heart, bleeding, or blood pressure problems.
Using Voltaren gel may increase the risk of heart attacks and strokes in some people, especially those who already have heart problems or who recently had a heart attack. If you have heart problems, talk to your health care provider before using Voltaren gel.
Using Voltaren gel may increase your risk of bleeding, including stomach bleeding or ulcers. Other things, like drinking alcohol, smoking, and taking certain medicines, can add to this risk. To reduce your risk of bleeding while using Voltaren gel, it is best to avoid drinking alcohol and smoking. If you are not sure if any of your medicines can increase your risk of bleeding, check with your pharmacist or other health care provider.
Using Voltaren gel may increase your blood pressure. To lessen the risk of high blood pressure from using Voltaren gel, you can practice some simple healthy habits to control your risk factors for high blood pressure.
Do not smoke. Smoking temporarily increases your blood pressure. Over time, regular smoking can damage and harden your blood vessels.
Maintain a healthy weight. Being overweight can affect your heart and blood vessels.
Stay active. People who do not exercise seem to have a higher heart rate.
Limit salt. Salt causes your body to hold onto water. This increases the amount of blood being pushed through your arteries.
Is Prescription Voltaren Gel Stronger Than the Over-the-Counter (OTC) Version?
No, over-the-counter Voltaren gel is 1% diclofenac, which is the exact same strength as the prescription version that is approved for adults with arthritis pain in certain joints. There is a higher-strength version available as a prescription medicine, diclofenac 3% gel (Solaraze). This higher-strength diclofenac gel is not used for arthritis pain. Instead, it is used for a particular skin condition known as actinic keratosis.
What Is the Bottom Line?
Voltaren gel is an OTC topical medicine for relief from arthritis-related pain in certain joints. You can apply it to the affected joints up to four times per day. Unlike other topical pain products, Voltaren gel may take a few days before you notice relief. It is generally well-tolerated. Before using Voltaren gel, tell your health care provider about all of your health conditions and any medicines that you take, including over-the-counter medicines.
