The People's Perspective on Medicine

The Dangers of Diclofenac and Other NSAID Pain Relievers

A Danish study reviews the dangers of diclofenac and finds that it can harm the heart and digestive tract. Are topical NSAIDs like Voltaren Gel any safer?

Doctors love NSAIDs (nonsteroidal anti-inflammatory drugs). That’s largely because they don’t have a lot of other tools in the toolkit when it comes to treating pain and inflammation. Opioids have been demonized and doctors have been chastised if they prescribe hydrocodone or oxycodone for chronic pain. As a result, 60 million prescriptions are dispensed annually for drugs like meloxicam, naproxen, diclofenac, celecoxib, nabumetone and indomethacin. A large study from Denmark reports that diclofenac (Cataflam, Voltaren) is associated with serious cardiovascular complications (BMJ, September 4, 2018). What should you know about the dangers of diclofenac? Are topical diclofenac gels and creams (Pennsaid, Voltaren Gel) safer than oral formulations?

What Are the Dangers of Diclofenac?

Oral diclofenac is available without a prescription in most European countries. In the U.S. it is only available by prescription, though similar drugs (ibuprofen and naproxen) are sold over the counter.

Danish scientists wondered whether oral diclofenac carried risks similar to those of rofecoxib (Vioxx), which was pulled off the market in 2004 because it was linked to excess heart attacks and strokes. They analyzed data from the Danish National Health Service which keeps records on all Danish citizens.

The study included 1.4 million people who started taking diclofenac. They were compared to 3.9 million people starting on ibuprofen, 291,000 people on naproxen, 765,000 people starting on acetaminophen (paracetamol) and 1.3 million people taking no pain relievers. Such numbers are impressive.

Results:

The researchers found that people taking diclofenac were 50% more likely to experience a serious adverse event than those who were not taking any pain relievers. The complications included the heart rhythm disturbances (atrial fibrillation or flutter), clotting strokes, heart failure, heart attacks and cardiac death. They were also more likely to experience such side effects than people taking the other pain relievers.

The dangers of diclofenac began to show up within the first 30 days of treatment. Even low doses posed a risk. This contradicts the perception that short-term treatment is safe.

In their own words the researchers offer the following observations:

“In our study, we found that diclofenac initiators [when people start taking diclofenac] were at increased risk of major adverse cardiovascular events—both compared with no NSAID initiation, initiation of paracetamol [acetaminophen] as an analgesic alternative to NSAIDs, as well as initiation of other traditional NSAIDs. Risk estimates compared with no initiation, paracetamol initiation, and ibuprofen or naproxen initiation increased for almost all individual components of major adverse cardiovascular events (that is, atrial fibrillation or flutter, ischaemic stroke, heart failure, acute myocardial infarction [heart attack], and cardiac death). The risk increase applied to men and women of all ages.”

The Dangers of Diclofenac for the Digestive Tract:

It’s not just the heart and cardiovascular system that’s at risk from NSAIDs. Gastroenterologists have long recognized that drugs like diclofenac, ibuprofen, meloxicam and naproxen can cause serious ulceration and hemorrhage of the stomach and small intestine. The Danish investigators noted that diclofenac and naproxen were both associated with upper gastrointestinal bleeding at a rate 4.5 times higher than that of people not taking pain relievers.

Conclusions:

The authors concluded:

“It is time to acknowledge the potential health risk of diclofenac and to reduce its use…Our data support that initiation of diclofenac poses a cardiovascular health risk, both compared with no use, paracetamol use, and use of other traditional NSAIDs.”

Other Dangers of Diclofenac:

  • indigestion and heartburn
  • nausea and vomiting
  • stomachache
  • diarrhea
  • constipation
  • headache
  • dizziness
  • disorientation
  • rash
  • itching or hives
  • sensitivity to sunlight
  • elevated liver enzymes
  • swollen legs or feet
  • tinnitus (ringing in the ears)
  • delayed ovulation
  • digestive tract bleeding
  • perforated ulcer
  • atrial fibrillation or flutter
  • heart attack
  • stroke
  • blood clots
  • high blood pressure
  • congestive heart failure
  • kidney injury
  • liver damage
  • pancreatitis
  • anemia
  • elevated potassium levels
  • anemia
  • Stevens-Johnson syndrome

What About Topical Diclofenac?

Voltaren gel

CHONBURI, THAILAND-OCTOBER 11, 2018 : Voltaren Emulgel and Voltaren tablets. 1% diclofenac gel for topical anti-inflammatory and diclofenac sodium on white background. Painkiller, analgesic pills.

There is surprising controversy about the safety and effectiveness of topical NSAIDs. The Food and Drug Administration has a black box warning with Voltaren Gel:

WARNING: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS

Cardiovascular Thrombotic Events:

“Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use [see Warnings and Precautions.”

Gastrointestinal Bleeding, Ulceration, and Perforation:

“NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

In other words, the FDA makes little distinction between the dangers of diclofenac gel topical formulation and oral diclofenac. This differs dramatically from an overview published in the Journal of Pain and Palliative Care Pharmacotherapy (June, 2017):

“Oral Versus Topical Diclofenac Sodium in the Treatment of Osteoarthritis”

“…our narrative review suggests that the topical solution had a better tolerability property than oral Diclofenac sodium, especially due to side effects of gastrointestinal bleeding with the utilization of the oral format. In addition, the topical route may be considered a reasonable selection by clinicians for management of musculoskeletal pain in those patients with a history of potential risk and adverse side effects. Most studies reviewed comparing oral versus topical solution of Diclofenac sodium revealed comparable efficacy, with minimal side effects utilizing the topical route.”

People’s Pharmacy Perspective:

The Danish investigators recommend that oral diclofenac should not be available over the counter. Of course, in the US it is not, but both ibuprofen and naproxen are. The Danish study showed that the risks of gastrointestinal bleeding from naproxen are equivalent to those from diclofenac. And although the cardiovascular risks of diclofenac appeared slightly higher in this study than those of ibuprofen or naproxen, all NSAIDs can cause similar harms. We hope that people will use such medications only when absolutely necessary and treat them with the respect that is due potentially deadly drugs.

We think that topical NSAIDs in general and diclofenac in particular represent an interesting option. There are dangers of diclofenac with both the oral and the topical route. Some people are incredibly sensitive to NSAIDs. You can read more at this link:

“How Safe Are Topical NSAIDs Like Voltaren Gel?”

Readers React:

Linda reports on topical diclofenac:

“I have been taking Diclofenac Sodium Topical Gel 1% for two months on the side of my knee – it is working. I do not have any side effects from it.”

Mary also shares her experience:

“I use Voltaren gel for my knee pain and it has been a miracle drug for me. I assume the Danish study was done with oral medication. The gel applied topically would be a lot less dangerous I hope.”

You are quite right Mary. The Danish study involved oral NSAIDs. The FDA does not make a distinction, though.

Richard shares this insight:

“I was traveling in Italy this summer and my knees starting acting up. Slow walking in museums is hard on my legs. I am not supposed to take oral NSAIDs like ibuprofen, but my doctor said that it would be OK if I used topical diclofenac for a few days while traveling. I bought a large tube of Voltaren Gel over the counter for under $14. It worked great. I don’t understand why I can’t buy it the same way in the U.S.”

Topical NSAIDs Not Safe for Everyone!

Just because topical diclofenac does not cause as many serious side effects as oral diclofenac does not mean it is not without risk. Here is the other side of the coin:

Karen is super sensitive to NSAIDs:

“Recently I was prescribed topical Voltaren gel for pain in my midfoot area. I am unable to take NSAIDs because after a day or two my stomach hurts. I noticed within a day or so of applying the gel (twice a day as directed) I began to have similar GI symptoms. Do you think that’s a coincidence?”

Other readers have shared related reactions Here is a somewhat similar story from Rosanna:

“My orthopedic doctor prescribed diclofenac gel for my knee pain because I cannot tolerate NSAIDs. I have only applied it three times to my knees. Now I am suffering from acid reflux and a burning sensation in my digestive tract. I was told it was safe. I now know it is not and will stop using it. I am distressed that my physician thought this topical NSAID was safe for me.”

It is clear that some people do develop side effects from topical NSAIDs. The active ingredients can be absorbed into the blood stream. Here is a link to more such reports.

Even Topical NSAIDs Have Side Effects

That said, oral NSAIDs seem to us to be riskier because of greater systemic absorption. We’re not sure why topical diclofenac is not available without a prescription in the U.S. That is also true of other NSAIDS. The FDA works in strange and mysterious ways.

Share your own experience with oral vs. topical NSAIDs in the comment section. Have you ever tried Voltaren Gel or Pennsaid? How well did these products work? Did you experience any adverse reactions?

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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If someone can die from an aspirin overdose using A535, why would I think that any topical NSAID would be any safer?
People rarely follow instructions and often feel that topical is safer, therefore use more. WRONG, and often too late to reverse!

Oral and topical (gel) diclofenac (Voltaren) both give me hives. The gel just takes longer to get into my system. By the way, meloxicam (Mobic) and Celebrex both kick off my psoriasis. No strong anti-inflammatories for this guy!

I cannot use Voltaran gel as it causes severe GI pain and acid reflux. I wish I could use it.
My aunt died from using an NSAID. It gave her an ulcer which led to infection and death.
I can’t believe NSAIDs are OTC in this country when they can kill you and are known to cause ulcers even when people are unaware of the damage till it is to late.

I’m wondering if Arnicare is one of those NSAIDs? Several bicyclists use this, especially for long, multi-day rides. It does seem to work on the knee pain.

Arnicare is a homeopathic medicine with the herbal medicine Arnica montana. No NSAIDs.

To avoid these numerous NSAID complications, so many are turning to CBD oil, oral and topical. Have there been any in depth studies of this alternative and its ramifications on heart, liver, etc?

Sadly, there have been very few studies on CBD.

I remember reading in a professional publication in 2015 that topical diclofenac gel was going to OTC status in January of 2016. So far that has not happened, and I have Canadian patients who visit Florida in the winter asking me for it (I am a pharmacist). They are puzzled that they cannot obtain it. As systemic absorption is generally less with topical products & often they are just as effective, why has this product not appeared on the shelves of our pharmacies? I too use the gel on my aching knee. Very effective, no adverse events experienced, and I do not have to take any oral NSAIDs.

I was given a prescription for topical Voltaren for arthritis pain in my knee. My doctor assured me that the side effects warnings applied only to the oral meds. I used less than the amount allowed (a plastic “ruler” comes with the topical gel) but still got excellent pain relief. Then, after three weeks of using the gel, my ankle suddenly became very swollen, and when I went to Urgent Care, my blood pressure was 220/110. They sent me to the ER where they monitored me until my bp returned to normal, which took about 7 hours.

Now, I take oral ibuprofen, but I am careful to take it with food and milk as well as a dose of Pepcid.

When they do these studies, how much of the medication are people actually taking per day? Are certain people more susceptible to the side effects? Are occasional doses dangerous? I have had chronic back pain for years. I do Pilates, yoga other exercises, get acupuncture and massages but sometimes the only thing that works is naproxen. Living with pain Is not fun and sometimes I think the side effects which I don’t seem to have are preferable to the pain.

I tried topical Voltaren for arthritis in my hands. I had used oral naproxen for years but became convinced it was the cause of my tinnitus and hearing loss. I never had GI side effects from naproxen or ibuprofen. Within 2 days of starting the gel I started having horrible reflux which only abated after I stopped the gel. No more reflux since. I have gotten relief from curcumin, which I don’t think is causing any side effects.

I tried the Voltaren gel because NSAIDs cause extreme stomach distress, acid reflux, and most frightening, atrial fibrillation. My cardiologist said it was an inflammation in the lining of my heart. However, using the gel caused the same problems in both me and my neighbor. If I only use a small amount, occasionally, the symptoms are mild, but it really doesn’t do much for relief.

I have had extremely extended, very long-term use of generic Excedrin for pain relief as well as Naproxen, with no ill effects. I no longer take either but not for reasons of side effects or bad reactions.
I have found that the use of CBD cream is a very effective way of dealing with joint pain. I have used it for three years, and it is a veritable life (reduced pain)-saver.

I would be VERY sceptical about using the gel form if the FDA has a warning on it already, as the FDA isn’t so quick to put warnings on topical drugs.

I was given a prescription for the Voltaran Gel but after reading the side effects I chose not to have it filled, as I already have gotten very ill from Fluoroquinolone (Cipro, Levaquin,Floxin) ear drops that the FDA refuses to put warnings on. I also was in the hospital for a week for a small stomach blockage after using Erthyromycin eye ointment.

I believe that whether it’s ear or eye drops or topical ointment used on the skin, they are just as harmful and should be used with great care and should NOT be an OTC drug.

Diclofenac gel. brand name Pennsaid was $2,900 on Medicare’s Drug Plan D. Now it is out as a generic and about $79. The info that comes with both says the dangers of the drug are the same for the topical as for oral. Dangerous side effects!!

A couple of years ago I took Diclofenac, and within a few weeks had severe esophagus pain, and I was told never to take it again. It didn’t help my knee much anyway. CBD cream was useless, as was arnica, raisins and gin, and even DMSO didn’t help although it helps some people and horses!

My knee has torn menisci, damaged ligament/tendon, and arthritis. Knee replacement is radical, painful, not always successful and won’t help the ligament/tendon problem, an honest orthopedic doctor told me. My knee used to pop, lock and drop me to the floor. I fell several times and was in danger and had to use a walker. He told me physical therapy was the best help for me. I am 80.

I have been having excellent physical therapy 3 x week for 4 months now, massage, ultrasound, heat and do physical therapy at home the days I don’t go to the clinic. After two weeks, I had no more pop, drop and lock, although I have to walk carefully. I don’t even use a cane now unless I have to walk over uneven ground. I will never have the mobility and strength I had when younger, but this disability is apparently what comes with age for some of us.

My doctors tell me all meds are “dangerous” and “poison” and if we can exercise and keep moving, be careful not to fall, that is usually the best treatment. No matter what, if you can exercise and not fall, you will enjoy better health and less pain. And if you need to lose weight, do so.
I don’t expect you to print this, but I feel I should tell the truth in hopes of encouraging others in case you do print it.

I agree. Our bodies were designed brilliantly never to just quit working or fall apart. Enter Western Medicine with their potions and lotions. A quick fix brings side effects which works well for a health-scared world. It guarantees return patients. Why on earth would we suggest clean eating, exercise, and prayer? I will share this article. It is yet another wonderful wake up call, especially to those living in denial that the only solution to pain is a synthetic chemical.

I’m surprised not to have seen any comments about the use of topical DMSO (70% solution) for arthritic pain. I have used it for years with much gratitude to Dr. Stanley Jacob, who years ago was much criticized for discovering its usefulness for arthritic pain. Its effect on atopic dermatitis is evident in two minutes. Sometimes I have been awakened by pain on a finger joint, and all I do is rub it with a small DMSO- soaked cotton pad, and in minutes I go back to sleep. You may search for this product in OR state if you wish. Best of health to you !

I tried 1% diclofenac for osteoarthritis with no noticeable side effects. But, I didn’t think it worked as well as my homemade topical, 6 tablespoons of MSM powder dissolved in 12 ounces of aloe vera jel.

Last year my surgeon put me on Naproxen before it became necessary for him to do neck surgery on me. On day 21 of taking Naproxen my blood pressure spiked to 234/180 and I went to the ER. I will never take NSAIDS again.

I had back surgery 2 1/2 months ago and was put on 10 mg Percoset 4 times a day. My BP was high the whole time. I started tapering off after 2 weeks. After 2 months my BP went up to 225/112 and I went to the ER twice. I managed to completely taper off 2 weeks later and my doctor managed to save me from a stroke and get my BP back down to normal.

Needless to say, I’m afraid of all pain meds now. I’ve just started physical therapy and am in pain. Doctor said I can take Extra Strength 500 mg Tylenol, one every 4 hrs if needed. So far I have taken just one on 2 occasions with no scary side effects. I have decided to face the pain rather than risk a stroke.

I was using Diclofenac for a month or more when I started feeling like my heart was going to stop. then I did a little research and found that it was Aleve. the little blue pill. I had the same problem with it. now I have 2 and a half tubes of Diclofenac and I can’t use it. I do better with ibuprofen but try not to use it often. This leaves me with Tylenol and thankfully, Deep Blue essential oil cream. It really helps. and oddly enough, Rosemary oil seems to help. I just rub it on my knees. Maybe different things work for different people. I saw the post above where all the person uses is Aleve.

Why do they even make pain relief meds when they all cause other things to go wrong that is more dangerous than the pain???
All pain meds make me sick so I don’t take any. But sometimes I still take an aspirin which is also bad, and me being on Warfarin makes it worse. I live with horrible pain every day, but what can I do, NOTHING……‼️😭😭😭

I took Vioxx for several years until they took it off the market. I was an RN and stood long hours at my job. I eventually had my knees replaced but continued taking Aleve at that time. I was diagnosed with A.Fib a few years later but never connected the dots. Neither did my PCP. Eventually I had a spinal fusion and was prescribed Diclofenac, and it was great for all my arthritis aches and pains. Eventually I had to start on blood thinners so had to go off all NSAIDS. Every area of arthritis was so intense. However my GI upset was gone, and A. Fib was less frequent (but the damage was done). If only my doctors would have told me what I know now. I have pain every day.

Does diclofenac in a topical cream or gel pose a threat as well?

Thankfully I can’t handle any kind of opioid. But I need Advil for pain relief. I don’t take a lot of it, but it’s the only thing that will work for me. I think it’s a shame that people who really need pain relief from opioids are having a harder time getting their prescriptions. Makes me want to stock up on Advil just in case.

My Dr warned me of the dangers of these painkillers over 20 years ago so why they needed to do such a big clinical trial is beyond me.
I control my own inflammation with regular cups of ginger tea, ice packs, and massage and for the pain I take paracetamol.
I have found from past experience the more painkillers you take the more you need as the body gets used to them.
Pain is the bodies way of warning you something is injured or wrong and stops you in your tracks which helps rest the affected part, diet also plays a big roll in inflammation so cutting down or better still cutting out wheat, sugar, and dairy will also ease inflammation

I had a foot crushed in a head-on collision in 1992 about the time Voltaren came out. I have been taking Diclofenac since it became the generic. I can take 1-2 per day but get by with one. I might take 2 a couple times a year. I am 68 and that is the only drug I have to take. All my stats are perfect. I do excercise 2 days a week and dance 2 days a week. I keep my own yard up and do a lot of digging and planting. I would hate to give up Diclofenac I always eat when I take it at break

Of course it made no sense to take Vioxx of the market and leave Diclofenac and other NSAIDs on as well as Ibuprofen and naproxen OTC. They all have the same side effect profile. Vioxx had the largest pocket for lawyers to pick.

I don’t know what you are talking about. I have had painful “shingles” (including seizures until at full Rx dose) since early spring and my doctor has prescribed Acetaminophen COD #3 (2 capsules) with 3 of Gabapentin 300 MC Capsules). This is on the left side of my face and head, down to my breast and shoulder, front and rear and I SEE NO RELIEF. What do you offer as a solution to my daily pain. Is there a “Doctor prescribed end to a case of shingles.” Or do I have to wait for the “Shingles Gods” to decide for them selves.?????

I was drywall installer, very hard on body. I’ve had 2 back surgeries 20 some years ago. I took a few very bad falls, broken elbow, broken ribs. My back is so bad now, it’s hard to explain. Had to sale my beautiful home, buy a very small one. I cannot make plans, as I never know if I can walk or drive. I have horrible insomnia, can last for days, times I can’t even shower. I have tried everything. From all reading and studying, majority of deaths are from illegal fentanyl and fake opioids from China and other places. They will add meth or fake fentanyl because THEY WANT an OD, better for their business. Sick and sad that real patients, in need, are lumped in with people trying to get high. Not to mention the thousands of law abiding citizens turned into criminals, so they can work, take care of their children, etc. I was on very potent pain meds, I CHOSE to detox, to see if I could find another way. Now, they wont help me, hands are tied, doctors are afraid to treat their patients. Horrible

Because NSAIDs by mouth cause me serious painful reflux and because I have post-tibial tendonitis in one foot and plantar fasciitis in the other; I was prescribed Diclofenac GEL for my feet. I use about half the amount prescribed once to twice a day , instead of 4 times a day as prescribed and have been doing so since the end of May. It works like a dream and I have no reflux. My gastroenterologist said use on the feet should be OK. Are you saying I am still in danger of serious illness? Please respond! Thank you.

Is the research the same for Diclofenac in topical gel (1%) form? It seems unlikely to me that this form as found in Voltaren Gel would have the same side effects as the pill form. I find Voltaren Gel somewhat effective on arthritic thumbs as well as sore muscles, hip and back pain.

Have any studies been done on topical diclofenac? How much is absorbed into the system? That is what was prescribed for my chronic shoulder pain.

Does this apply to Voltaren gel? Any studies about it? What are people in chronic pain to do?

What about Voltaren/Diclofenac CREAM?? Nothing was mentioned
or did I miss it? Is it not less harmful to apply meds directly to the
pain site? I buy it in Germany without prescription at the Pharmacy, a very big seller over there with monthly “specials” in
pricing, each Pharmacy different offers. Since last year available
in Forte, i,e, extra strength.

I have been using diclofenac for 3 years. Before I started using it I had sever lower back pain. I use VOLTAREN gel 100g (Diclofenac) I can’t take the pills for other health reasons. I only use this gel when my lower back starts to act up by rubbing on the Voltaren gel 3 to 4 times a day for 2 to 3 days really helps with the pain. Now I am very concerned about the list of dangers with the use of Diclofenac. After reading this articular I will ask my prescribing doctor about this medication and the more serious problems it causes. GELL vs PILL is it the same and does it have the same dangerous problems.

Curious about cardio effects of topical application (such as diclofenac – Solaraze) for actinic keratosis…

I am fearful that the reactive attempts of the Federal government to micro manage pain relief for millions who truly need it may make a bad situation worse. The public needs to know the risks of all pain medications, whether prescription or OTC. Ask your pharmacist if you have questions. This is their arena of knowledge.

I have a rheumatiod arthritis diagnosis. I always used distraction as first line of defense against pain. When things got bad enough for this to be ineffective, I started taking Ibuprophen. Then it wasn’t enough so I started on Naprosyn. All this was prior to NSAIDS becoming generic. After about a year, I gave up on NSAIDS because I started having allergic reactions to each one prescribed. These included things like the usual rash, hives and later progressed to angioedema. At this point my rheumatologist stated I should NEVER take any NSAID again except aspirin or tylenol. Eventually this didn’t work and I started taking Darvocet N 100 prn a couple times a week. Suddenly this was pulled from the market. Other opiods make me drowsy and non functional. 3 Grams of Omega 3’s help tremendously, but often it is back to “Distraction” as first line of defense. I finally gave in and started taking methotrexate which turned out to be my saving grace. But, I have been on it for 20+ years now and am concerned the day may come when I might not be able to continue with it. I will not likely see the day when a new class of pain medication is developed, and becomes inexpensive enough that I can afford it.

Development of safe, non-addictive, pain meds must become a priority for the health and well being worldwide!

A few years ago I was getting a cortisone shot in my left knee every 5 months for pain. The knee had “advanced arthritis.” After several shots, I started taking a good quality brand of curcumin with black pepper extract for greater absorption — 1330 mg of turmeric root extract a day, standardized to provide a minimum of 95% curcuminoids. The pain and swelling started decreasing almost immediately, and I haven’t had a shot since. I hope to continue to avoid knee surgery.

I’ve said it before and I’ll say it again; I wish people could try medical marijuana BEFORE they start on these potentially harmful and addictive drugs. CBD is the part of marijuana that DOES NOT GET YOU HIGH. But it is used very successfully for pain control for many conditions. You need to find a reputable dispensary from which to get it. I’m not against pharmaceuticals, but it’s safer to start with something non-addictive and that won’t harm you. And advocate for the Federal law to change.

If I take one single diclofenac I’ll have a rectal bleed in 24 hours. Bright red blood. Same thing with over the counter Naproxen. Severe abdominal pain followed by rectal bleeding as though a knife were stabbing my gut and I will bleed quite profusely. The drug did this. Because my colonoscopy was entirely normal once those drugs left my system. Everything else about my blood chemistries including liver are normal.

What the article does not mention is whether the topical form of Voltaren carries the same risk as the oral form.

I’m wondering if Voltaren gel applied to the specific joints will have similar side effects?

I wonder if the risks are the same with topical diclofenac vs. oral administration?

I wonder if this study was an oral version of diclofenac or the gel, which we use (Voltaren?)

How about just plain aspirin? Is that deadly too?

I’ve been taking diclofenac for 5 or six years with no adverse affects other than it relieves my joint pain and makes it so I can function normally. I guess you have to do what you think is best for you. Everybody is different. I had a friend that ate right never smoked or drank and died of cancer at 52. My grandma smoked cigars and drank beer and had 450 cholesterol and lived to be 105yrs old.

Diclofenac gel (Voltaren) is sold over-the-counter overseas, but requires a prescription in the U.S. I use it for Osteoarthritis in my neck, fingers, and knees. It works great without many of the side effects from taking it orally.

Could someone comment on the use of Voltarin Gel? Is the danger of gastric and other damage still there when Voltarin is applied externally?

The report of the study does not clarify if the harmful results of using diclofenac are from use of oral tablets, topical ointment, or both. Reference to internal bleeding make me believe the comparisons would be from oral ingestion. The topical ointment works well for my arthritis but I do have atrial fib. So the risk to me seems lower with the ointment.

Meditation helps tremendously and is easy to learn to do.Many places offer instruction for free, or very low cost. It requires no equipment, can be done any place (no, you don’t need to sit cross-legged on the floor or think of nothing, the major complaints). There are also guided meditations on the web. I have knees that trouble me, so I take naproxen if I have a lot to do, but I find if I take two a day for a couple of days it staysin my system, so I don’t use it regularly.The herb Devil’s Claw is also useful, and has no side effects according to the literature. A combo of natural remedies plus meditation for relaxation can be very effective, saving the “drugs” for tough times.

Any thoughts on topical use when prescribed for actinic keratosis or other skin lesions?

Just one pill, one Aleve or ibuprofen, even Tylenol, and I feel like I am having a heart attack. A cardiologist finally diagnosed it as an infection in the lining of my heart due to NSAIDs I was using for DDD. The only thing I can take for pain is Tramadol and now my pain management doc is reluctant to give me even that. Nothing but endless pain and agony.

Does diclofenac ointment have the same warnings as taking it orally?

Question that is not addressed in the article; is diclofenac sodium topical gel, 1%, as dangerous as oral versions? I have been prescribed this version for very painful hand pain from RA. I’m also developing some facet RA in my lower spine that I have considered using it for. Everything seems to carry serious risk. Except CBD marijuana extract. Not cheap, but not really expensive either and I know a number of people who swear by it.

Is there any danger to using Voltaren Gel? Unable to tolerate oral pain meds, I have used Gel for fibromyalgia pain for about ten years now. Have not been able to get info re risks but need something to take the edge off chronic pain. Any info out there?

Is there any information regarding the use of Diclofenac gel & correlation to heart problems?

I use diclofenac cream on my knees twice a day I do no take pills The cream does not cause any side effects I need an rx for itI think its generic for voltarin

I have used the Declofenac gel on my shoulders knees and elbows as needed, sometimes twice a day for several weeks. I learned that my doctor now must get special authorization to prescribe it to me. I’m wondering if the gel version is as dangerous as the tablet. I have assumed not but I must be more vigilant.

As I had a stomach bleed a few years prior while taking taking aspirin, I began taking Vioxx in 2000 when I was diagnosed with osteoarthritis and lupus. After Vioxx was taken off the market, I was prescribed Mobic. When I went to the gastroenterologist for a routine colonoscopy, he discovered increased pancreatic lipase and ? After lowering the Mobic dose, the pancreatic problem did not resolve. Only after discontinuing Mobic did the pancreatic enzyme levels return to normal.

In the interim when I took naproxen for a couple of months, the insurance would not cover Celebrex. So now I have been taking diclofenac for about 10 years and last year lowered the dose to 50 mg two times daily – my PC is concerned about my kidneys; the rheumatologist says it is ok.

Frankly, without an anti-inflammatory like Diclofenac, I am at risk for other complications, joint destruction (both hips have been replaced) and immobility. Sad to say, there don’t appear to be any other choices.

I use the Flector Patch on my lower back. This patch is topical diclofenac. Are the risks the same as the oral administration of diclofenac? I assume that because this medicine does not pass through the GI tract , there are no GI side affects . As to the other side affects, I’d like to know whether those risks are also reduced. And I also assume that using diclofenac in a topical gel, cream or ointment carries less of a risk of GI and other side affects.

I am assuming this article refers to oral diclofenac and not topical??? I was diagnosed with a drug induced intestinal ulcer last winter from my NSAID [Lodine-X]L that I had taken for 20+ years. I have osteoarthritis and inflammatory arthritis and had just routinely taken the NSAID. My primary care physician and the GI doc who did the 1st colonoscopy/endoscopy agreed on the diagnosis prior to the colonoscopy. The results of that one showed gastritis, and the intestinal ulcer.

I immediately stopped the Lodine [February] and have had nothing for the pain except acetominophen since then. I do have problems with inflammatory arthritis in one of my feet and my primary doc prescribed diclophenac sodium 1% gel to be used on that foot. The max dosage for a day is 4 times [16 grams total] but I have never used it more than once. I had a 2d colonoscopy last month which showed the ulcer having healed and the gastritis having resolved; I do realize that I will never be able to take an NSAID again. Do I need to worry about the topical since the route of administration is different?

What about diclofenac cream? It seems like the risks would be reduced.

My wife was prescribed a large tube of Diclofenac topical cream. Should she stop using it?

I have been applying Diclofenac Sodium Topical Gel 1% and Diclofenac Sodium Gel 3% for ankle pain. Is this as harmful as taking the tablets?

I am a retired MD. I prescribed Darvocet for 30+ years as well as occasionally taking it myself for pain. I never learned of any of my patients’ having a complication and considered it safe and effective when taken as prescribed. You can overdose on even aspirin and have severe complications including death. The hysteria over Darvocet added to the neolithic approach to opioids has made many drug pushers very, very rich. We cannot control every addiction prone person. You are responsible for you, first, last and always. A realistic and not a save the world approach would be too logical ever to be enacted.

Henry, excellent reply. I am so tired of crippling, unrelenting pain, it would be OK with me if every dr. who denies opioids to patients who need them would suffer from Complex Regional Pain Syndrome so they could learn the value of opioids for their patients.

Darvocet is the best pain reliever ever for moderate pain. All this hoopla about its side effects..total BS

What is the difference using voltaren gel instead of diclofenac for vascular problems, I use the gel and my legs swell and ache bad, could it be the gel?

I would prefer more meaningful statistics. Statements such as “50% more likely” or “rate 4.5 times higher” are personally meaningless. I would prefer statements such as “x people out of y people experienced a serious adverse event”, so I can ascertain the statistical probability as it applies to me.

The FDA is a joke!
Why do they approve drugs and allow over the counter meds to be sold to the unsuspecting public that are so harmful to them???
My Mom ended up on dialysis due to high use of Motrin 800= ibuprofen
Her Dr never told her it damaged her kidneys so badly!
He just told her after some lab work to stop taking it!

Do the warnings about Voltaren apply to the topical Voltaren cream?

After reading about the above drug, Diclofenac, you just wonder if it is really worth taking the drug. Also when a person is looking at the TV or reading a magazine advertising a drug and hear what the side effect are. You think you might be better off in just taking the Ibuprofen. Yes, you have to be your own detective when taking all of these drugs. Goggle all the names of the drugs. Also if you have too go on the WEBMD website.

What are thoughts on the gel?

I recentky began using voltaren gel. Is that better than taking the pill form??

Diclofenac caused my gums to start disintegrating. I woke up with a mouth full of tissue. Stopped taking that right away and everything healed up over the coming weeks

what about diclofenaco Gel? Same dangers??

My understating and experience is with Diclofenac as a gel. It was ordered by my Integrative Medicine doctor and applied topically.

I apply voltarin topically to a knee transplant area when red, warm, or hurting. I’ve been using several years as needed, currently up to 2 days/wk once or twice. I have experienced no side effects that I’m aware of. I am aware there is some in the blood even when applied topically. Does anyone have info on topical use.

I have used Voltaren Gel occasionally on my knee and shoulder for pain. I wonder if this is a safer alternative.

Everything I see for this medication involves a pill taken orally. What about the Diclofenac gel? I voiced these same concerns with my family physician (for use on my arthritic knee). Her take was that the tissue around this site was quite thin, so there would be little actual medication going into the blood stream. I don’t use it often, but still concerned about its use

I was just prescribed the Diclofenac GEL to use on my neck, spine, and hips 4 times a day. I have been a little leery of the gel as it seems to have the same side effects as the tablets. I have had Ulcerative Colitis for about 54-years but is in remission right now. I am concerned about continuing it.

I have connective tissue disease/rheumatoid arthritis. I took ibuprofen years ago but when I realized the connection with a compromised gastrointestinal tract and autoimmune disease and inflammation, I discontinued its use. I worked diligently to heal my gut and still do my best to keep it healthy. I have consciously changed my food choices, which were considered healthy at that time. I have found when I have a flare up or arthritic symptoms, I take a quality brand of Boswellia (Indian Frankincense). There are other herbs as well for pain and inflammation.

Boswellia happens to work for me. Just like prescription medication, you may not tolerate an herb. There may be side effects. You need to be knowledgeable. I have also used homeopathy and found positive results with pain and a sleep disorder. I encourage those with pain that there are options that can provide relief that do not come from a pharmacy. There is acupuncture, massage, working on better sleep, tweaking a healthy diet, etc. I encourage anyone to explore other therapies that may work as well as a prescription, perhaps help the whole body as well (acupuncture), or at the very least enable you to take less medication or fewer medications which is the ultimate goal.

What about Gabapentin? I use it at night to help with the pain from post-herpetic permanent nerve damage.

I assume the warnings herein have to do with taking Diclofenac internally. What about Voltaren used topically? Just the other day you published information about Voltaren used topically to relieve joint, patella, etc pain?

What about the topical Voltaren? Does it have the same affects?

What about Gabapentin? I take it at night to ease the pain from post herpetic nerve damage.

What about diclofenac Sodium Topical Gel (Voltaren Gel)? Does it have the same dangers? I use it sparingly and occasionally for arthritic pain in wrists and feet. It sure does help.

I occasionally use topical diclofenac – you haven’t addressed this iteration of the drug. Thoughts? Suggestions?

I’m wondering if Voltaren Gel that is applied topically carries the same risks as the pill?

I am curious to know if the topical gel form of Voltaren also can cause side effects? It is not passing through the digestive system and presumably only a small amount would be systemically absorbed when rubbed onto the knee, or shoulder, or wherever needed. I have had hip replacement and tried all of the above NSAIDs, and now am just on Aleve. However, my diverticulitis has recurred so I will discontinue all NSAIDs.

Any information on Voltaren used topically as a salve rather than taken orally as a tablet?

Have been taking 50 mg diclofenac sodium for 25 years for arthritis and am pain free. I have well controlled high blood pressure which may or may not be caused by diclofenac. Unless something else on the adverse reactions list occurs, I’m not willing to deal with arthritis pain. I do have regular checkups with primary care and cardiologist.

CANNABIS IS LOOKING BETTER AND BETTER, SAFER AND SAFER.

Great news, NOT. For those of us who suffer from arthritis and cannot move without pain, these drugs are a necessity. What are we supposed to do? I agree with Coreen. Alternative therapies do not work when you have arthritis in multiple places and cannot manage the pain other ways. I hope there is research going on which will lead to safer drugs.

Not to mention the emerging knowledge of a “new” type of colitis (microscopic / immunologic) resulting from taking an NSAID at the same time as a PPI (acid reflux drug proton pump inhibitor) for chronic problems over the years.

Does this also apply to topical Voltaren?

I had a doctor that told me that I had to make “friends” with my pain, but with pain like this who needs enemies! I go on the Naproxen and off it until I can’t function. Then I go back on it to work and accomplish a few necessary tasks. It has been a see-saw like that since they found degenerative disc disease when I had just turned 30 years old. I am 67 now, and I credit my excellent gastroenterologist for saving my stomach, intestines and kidneys. It is a balancing act but it can be done. And, yes, Pain and I are dear old friends.

my rheumatologist prescribed Diclofenac for lower back pain due to degenerative disc disease in lower back. About a year later I was finally accepted into a pain management clinic and the Dr. there immediately took me off the pills and told me to use the Voltaren gel only along with Tylenol if needed. They also assigned a physiotheripist. The pills did a much better job I have to admit and were just 1 a day.

No one mentioned Voltaren gel. Does it have side effects?

I have been using a combination of diclofenac / misoprostol for eighteen years as proscribed by my doctor. The misoprostol first coats the interior of the stomach to prevent irritation; then the diclofenac starts working to combat the pain. This time-release version is known as Arthrotec 75 although it is available in 50’s too. The proportions are diclofenac 75 mg with misoprostol at 20 mcg and the lower dosage is diclofenac at 50 mg /misoprostol 20 mcg. My doc gave it to me because the sodium naproxin (sp?) was irritating my stomach. Arthrotec 75 has been a godsend.

After an unskillful operation on my foot, I took aspirin (thinking it was safer than other pain killers and without consulting my doctor) for six years. I came down then with microscopic colitis, which took 18 months to diagnose, as it is a somewhat rare condition.

When I stopped the aspirin, the symptoms stopped completely for two years. After that, I discovered that I had also become intolerant of artificial sugars. I will likely discover other sensitivities as the years go by. Somewhere in the middle of all this, I was also diagnosed with pulmonary hypertension, which some researchers think may be linked to gastrointestinal problems. So much trouble, all linked to aspirin. It is a powerful drug and should be used with care.

I was prescribed Diclofenac cream for a shoulder injury. Imagine my surprise when, after using this medication for a few days, my vision became blurred. Upon investigation I found that blurred vision can be one of the side effects of this medication. It was only when I stopped using the medication that things returned to normal after approximately two weeks!

I have a question: What about topical NSAIDs? I’ve been prescribed Voltaren gel for neuropathy in both feet. If I use it every day, I begin to get burning in my stomach. The prescription insert literature suggests that yes, it is absorbed. I also have edema in the extremities because I have congestive heart failure. I may be noticing an increase in this on the Voltaren gel. Does anyone know the answer to the gel vs. oral question? Thanks.

We haven’t seen research that addresses this question. We suspect that the gel or patch is safer; we don’t know if that means it is safe.

I know people who have been on gabapentin 5 or more years after breast surgery and after shingles nerve damage. Anyone out there have any input on the newest shingles vaccine re:side effects???

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