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Even Topical NSAIDs Have Side Effects

Q. My doctor gave me Voltaren Gel samples for joint pain. I cannot tolerate even tiny amounts of NSAIDs any more, so when I read the warnings, I asked about them. He dismissed them, saying the gel was better than pills because it wouldn’t get into my stomach to cause trouble.

I did fine on his samples and then paid $167 for a prescription for several tubes of Voltaren. One day I woke up with severe stomach pain. I asked my pharmacist about this, and he said the gel goes through the skin into the bloodstream and then everywhere in the body. That’s why it causes side effects like any oral NSAID.

I don’t know why my rheumatologist assumed this would be safe for me. I can’t use the stuff. I tried a couple times later to use just a tiny dab or two of it, and it upset my stomach again.

A. NSAIDs (nonsteroidal anti-inflammatory drugs) are a mainstay of arthritis treatment. Oral medications such as ibuprofen (Advil, Motrin IB, etc), naproxen (Aleve, Naprosyn) and diclofenac (Cataflam, Voltaren) can ease joint pain but may cause bleeding ulcers, increase blood pressure, damage kidneys and raise the risk for heart attacks.

Topical NSAIDs such as Voltaren Gel offer a way to target the anti-inflammatory benefits to the affected joint. Such formulations reduce the total dose of medicine absorbed. One study showed that oral diclofenac resulted in blood levels 5 to 17 times higher than applying topical gel (Journal of Clinical Pharmacology, Jan. 2010).

Despite this difference, some people experience digestive tract upset with topical diclofenac. It is worth noting that blood levels accumulate over time. Perhaps that is why the FDA requires a strong warning regarding bleeding ulcers, which can be fatal.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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