What Are the Dangers of Using Voltaren Gel?

Voltaren (diclofenac) gel is generally safe when used as directed. In some people, however, Voltaren gel can lead to dangerous side effects, such as heart attack, stroke, and gastrointestinal (GI) bleeding. Milder side effects have also been reported, including skin dryness and irritation.

Using Voltaren gel as directed reduces the risk of side effects. Still, this nonsteroidal anti-inflammatory drug (NSAID) may not be right for you if you have a history of certain medical conditions, including kidney or liver disease, heart problems, or peptic ulcers.

While some formulations of Voltaren gel can be available without a prescription, it's best to consult with your healthcare provider before using it.

Risks of Using Voltaren Gel

As with any drug, Voltaren gel can cause side effects. The most common side effects reported by users include skin irritation and dryness, the symptoms of which are generally mild.

On rare occasions, people have been known to experience disruptive or intolerable side effects while using Voltaren gel, including:

• Pimples
• Skin cysts
• Hives or swelling
• Numbness and tingling
• Nausea or vomiting
• Stomach pain
• Upset stomach
• Diarrhea
• Bloating

Call your healthcare provider if you experience these or any other unusual side effects while using Voltaren gel.

Dangerous Side Effects

The FDA has issued a black box warning advising consumers of the following dangers of Voltaren gel in some users:

• Cardiovascular events: Voltaren gel may increase the risk of potentially fatal cardiovascular events such as a heart attack or stroke, especially in people at risk of these events.
  
• GI bleeding: Voltaren gel may increase the risk of severe gastrointestinal bleeding, ulcers, and stomach or intestinal perforation in older adults with a history of GI bleeding.

While rare, Voltaren gel has been known to cause anaphylaxis, a potentially deadly, whole-body allergic reaction.

Signs of Voltaren Gel Overdose

Using more than the normal or recommended amount of Voltaren gel can lead to overdose. The most common signs of diclofenac overdose are:

• Nausea
• Vomiting, sometimes with blood
• Dizziness
• Drowsiness
• Blurred vision

Other signs of diclofenac overdose include:

• Wheezing or trouble breathing
• Ringing in the ears
• Peeing very little or not at all
• Diarrhea
• Bleeding in stomach and intestines
• Stomach pain
• Chest pain
• High or low blood pressure
• Increased heart rate
• Swelling in body or legs (edema)
• Agitation
• Confusion
• Decreased consciousness or lack of responsiveness
• Seizures
• Delirium (person is not making sense)
• Abnormal movements
• Numbness and tingling
• Unsteadiness
• Headache
• Rash

The exact symptoms of Voltaren gel overdose depend on how much Voltaren gel was used and how quickly the person experiencing overdose gets medical attention.

Whereas a very mild overdose may only cause nausea, vomiting, and stomach pain, larger overdoses can be fatal. It's critical to note, though, that mild stomach pain can still indicate massive—and potentially deadly—internal bleeding.

Who Should Not Use Voltaren Gel?

Due to the risks of cardiovascular events and GI bleeding, Voltaren should not be used if you have had coronary artery bypass surgery or a history of peptic ulcer disease.

Voltaren also needs to be used with caution in people with the following pre-existing conditions:

• Liver disease: Voltaren can increase liver enzymes, causing liver inflammation and damage if overused. People with advanced liver disease are at high risk. Signs of liver injury include severe fatigue, dark urine, pale stools, and jaundice (yellow skin and eyes)
• High blood pressure: Voltaren can increase blood pressure and make blood pressure more difficult to control in people with untreated or uncontrolled hypertension.
• Heart failure: Voltaren must be avoided in people with severe heart failure unless the benefits outweigh the risks. Signs of worsening heart failure include fatigue, shortness of breath, swollen ankles or feet, and sudden weight gain.
• Kidney disease: Voltaren must be avoided in people with severe kidney disease unless the benefits outweigh the risks. Overuse of the drug can lead to kidney toxicity and failure. Signs of kidney failure include shortness of breath, nausea, dark urine, and low urine output.

Voltaren Gel Interactions

Voltaren gel should never be used with any other NSAID in any form. Doing so further suppresses prostaglandins, which not only mediate pain and inflammation but also facilitate blood clotting. This can increase the risk of severe GI bleeding and cardiovascular events.

Avoid Voltaren if using other NSAIDs such as:

• Aspirin
• Advil, Motrin (ibuprofen)
• Aleve (naproxen)
• Celebrex (celecoxib)
• Ponstel (mefenamic acid)
• Arcoxia (etoricoxib)
• Indocin, Tiborex (indomethacin)
• Oral diclofenac

It is important to be aware of other potentially serious drug interactions:

• Anticoagulants (blood thinners) like Coumadin (warfarin) or Plavix (clopidogrel) are used with caution with Voltaren as their combined use can further promote bleeding.
• High blood pressure medications like ACE inhibitors, angiotensin receptor blockers (ARBs), diuretics, or beta-blockers are also used with caution as their combined use with Voltaren can decrease their effectiveness.

When to Get Medical Attention

Call 911 if you develop signs of stroke or heart attack, including:

• Slurring
• Confusion
• Loss of balance
• Sudden numbness or weakness of one side of the face, arm, or leg
• Sudden chest pain or pressure
• Cold sweat
• Shortness of breath
• Lightheadedness
• Spreading pain to the shoulder, arm, back, neck, or jaw

Call 911 if you develop signs of GI bleeding or intestinal performation, including:

• Black or tarry stool
• Bright red blood in vomit
• Cramps or severe pain in the abdomen
• Dark or bright red blood in stool
• Dizziness or faintness
• Feeling tired
• Paleness
• Shortness of breath
• Vomit that looks like coffee grounds
• Weakness
• Fever and chills
• Shock

Call 911 if you experience symptoms of anaphylaxis, including:

• Dizziness
• Fainting
• Sudden rash or hives
• Irregular heartbeats
• Shortness of breath
• Wheezing
• Swelling of the face, lips, or throat

You should also call 911 immediately if you have any signs of diclofenac overdose, or believe you may have used too much Voltaren Gel.

How to Use Voltaren Gel Properly

Voltaren is a topical medicine applied to the skin. It is only meant for the local treatment of OA or actinic keratosis. It is not used for application on large areas of skin; doing so can lead to an overdose.

Apply the medication to clean, dry skin. Do not use on skin that has been broken or is peeling, infected, swollen, or covered with rash. Wash your hands after application.

After application, do not shower or bathe for at least 30 minutes.

Osteoarthritis

OTC Voltaren gel and the stronger 1.5% and 2% diclofenac formulations have specific dosing instructions to ensure safety:

• OTC Voltaren (1% diclofenac) gel: Apply to no more than two body parts (such as the knee and ankle, or the hand and ankle) four times daily for up to 21 days. A dosing card included in the packaging has a cut-out opening that you place on the skin to limit the area of exposure.
• Diclofenac 1.5% liquid solution: This formulation comes in a drop bottle. Apply 10 drops at a time, rubbing to absorb, and continue applying 10 drops at a time until 40 drops have been delivered. Use four times daily as directed by your healthcare provider.
• Diclofenac 2% liquid solution: This formulation comes in a pump bottle. Pump two squirts into your palm and rub into your knee. Use four times daily as directed by your healthcare provider.

To achieve better relief, apply the medication on the same schedule every day. It may take up to seven days to feel the full benefits of treatment.

Actinic Keratosis

The 3% diclofenac formulation is used only for actinic keratosis. It is available as a topical gel and sold under the brand name Solaraze.

• Diclofenac 3% gel: Apply enough gel to lightly cover each lesion, rubbing to absorb. Apply twice daily for 60 to 90 days.

Signs of improvement may not be seen until 30 days after the completion of therapy.

Summary

Voltaren is generally safe when used as prescribed but may be unsafe for people with a history of peptic ulcers or serious heart disease. Taking it with other NSAIDs can increase the risk of gastrointestinal bleeding and stomach ulcers. Cardiovascular events like heart attack and stroke have also been reported.

If you want to try Voltaren Gel, speak with a healthcare provider to ensure that it is safe for you. The exact amount of Voltaren Gel you can safely use depends on where you are applying it and the strength of the drug. Follow your provider's directions meticulously to ensure you use the correct amount.