Diclofenac, Topical Gel

What are other names for this medicine?

Type of medicine: analgesic; nonsteroidal anti-inflammatory drug (NSAID)

Generic and brand names: diclofenac, topical gel; Voltaren Gel

What is this medicine used for?

This medicine is a painkiller that comes as a gel used on the skin. It is used to treat osteoarthritis pain in the arms and legs.

What should my healthcare provider know before I take this medicine?

Before you take this medicine, be sure to tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• a stroke
• asthma
• bleeding problems or blood disorders such as anemia
• heart failure
• high blood pressure
• kidney or liver disease
• nasal polyps
• problems urinating
• stomach or intestinal ulcers or bleeding

Tell your provider if you take steroids such as prednisone or medicine that reduces the chance of blood clots forming such as warfarin (Coumadin). Also tell your provider if you have recently had heart surgery or are scheduled for surgery.

Females of childbearing age: Talk with your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

Follow your healthcare provider's directions exactly. Using too much medicine may lead to harmful side effects. Check the label on the medicine for directions about your specific dose. Use the dosing card that comes with the medicine to measure the proper amount for each dose. Squeeze the proper amount of medicine onto the dosing card. You can use the dosing card to apply the medicine. After using the dosing card, fold it in half and throw it away in a safe place away from children and pets.

Wash your hands before using this medicine. Apply this medicine to clean, dry skin that does not have any cuts, infections or rashes. Do not use heating pads or put bandages on skin where you have applied the medicine. Avoid exposing skin where you apply the medicine to sunlight and artificial light, such as tanning booths. Do not use sunscreens, cosmetics, lotions, moisturizers, or insect repellants on the area where you apply this medicine.

Wash your hands after using the medicine, UNLESS the hands are the treated joints. In that case, wait at least 1 hour before washing your hands.

Do not shower or bathe for at least 1 hour after putting this medicine on your skin. Wait 10 minutes before covering the treated skin with clothing.

Keep this medicine away from your eyes. If some of the medicine gets into your eyes, rinse them with plenty of cool water.

What if I miss a dose?

If you miss a dose, use it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and use the next one as directed. Do not use double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

Symptoms of an acute overdose have not been reported.

What should I watch out for?

Warning: Occasionally, this medicine may cause bleeding, ulcers, or perforation of the stomach or intestines. These problems may occur without warning symptoms. Adults over the age of 65 may be at greater risk for side effects. If you have abdominal pain, a black tarry stool, or a bloody stool, stop taking this medicine and contact your healthcare provider right away.

Using this medicine for a long time may make it more likely that you will have a heart attack or stroke. Talk with your healthcare provider about this.

This medicine may cause an allergic reaction in people who have asthma or who have had allergic reactions to aspirin or other painkillers. If you develop hives, itching, a rash, tightness in your chest, or trouble breathing, stop taking this medicine and contact your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.

Do not take other pain relievers or drink alcohol while you are using this medicine unless your healthcare provider approves. They may increase the risk of stomach upset.

You may have swelling of the ankles, feet, or hands while taking this medicine. If this becomes bothersome, contact your healthcare provider.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are using this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Confusion; feeling faint; mouth or lip sores; hearing problems or ringing in your ears; vision changes; yellowing of your skin or eyes; bloody or black tarry stools; severe vomiting; blisters; swelling in ankles, feet, or hands.

Other: Redness and swelling at the site of application (which usually goes away in a short time), fever muscle pain, stomach pain, diarrhea, nausea, tiredness, gas, headache, dizziness, constipation

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik), and moexipril (Univasc)
• alcohol
• angiotensin II blockers such as candesartan (Atacand), losartan (Cozaar), and valsartan (Diovan)
• aspirin or other salicylates
• beta blockers such as metoprolol (Lopressor, Toprol XL), atenolol (Tenormin), bisoprolol (Zebeta), timolol, propranolol (Inderal, Inderal LA), and nadolol (Corgard)
• bile acid sequestrants such as cholestyramine (Questran), colesevelam (WelChol), and colestipol (Colestid)
• corticosteroids such as prednisone and methylprednisolone (Medrol, Solu-Medrol)
• diabetes medicines such as insulin, glyburide (DiaBeta, Glynase, Micronase), metformin (Glucophage, Glucovance), pioglitazone (Actos), and rosiglitazone (Avandia)
• diuretics such as chlorothiazide (Diuril), hydrochlorothiazide (Microzide), triamterene (Dyrenium, Dyazide, Maxzide), spironolactone (Aldactone), furosemide (Lasix), bumetanide (Bumex), and ethacrynic acid (Edecrin)
• immunosuppressants such as cyclosporine (Sandimmune, Neoral, Gengraf), and tacrolimus (Prograf)
• lithium (Lithobid, Eskalith)
• medicines to treat Alzheimer's such as galantamine (Razadyne ER, Razadyne) and tacrine (Cognex)
• medicines to treat or prevent blood clots such as warfarin (Coumadin), abciximab (ReoPro), argatroban, lepirudin (Refludan), bivalirudin (Angiomax), tirofiban (Aggrastat), pentosan polysulfate sodium (Elmiron), clopidogrel (Plavix), ticlopidine (Ticlid), and dipyridamole (Persantine)
• methotrexate
• natural remedies such as chaparral, comfrey, feverfew, flaxseed, fish oil, garlic, ginseng, ginkgo, kava, ma huang, pennyroyal, and valerian
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, Nuprin), naproxen (Aleve, Naprosyn), indomethacin (Indocin), nabumetone (Relafen), hydrocodone/ibuprofen (Vicoprofen), ketoprofen, ketorolac (Toradol), and celecoxib (Celebrex)
• pentosan polysulfate sodium (Elmiron)
• probenecid (Benemid)
• quinolone antibiotics such as levofloxacin (Levaquin), ofloxacin (Floxin), and ciprofloxacin (Cipro)
• SSRI antidepressants such as sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro)

Do not drink alcohol while taking this medicine. Also, do not take other painkillers while you are taking this medicine without your healthcare provider's approval.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.

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