Diclofenac – Voltaren, Voltaren-XR, Voltaren gel, Arthrotec, Flector patch

The following information is NOT meant to be used to treat yourself or patients

• Generic name = Diclofenac
• Trade name = Voltaren, Voltaren-XR, Voltaren gel, Arthrotec, Flector patch
• Class = anti-inflammatory
• MOA
  • Blocks cyclooxygenase (COX-1 & COX-2) and thus production of prostaglandins
• Advantages
  • Relatively inexpensive as generic
  • Comes in multiple formulations (pills, gel, patch)
• Dosing
  • 25, 50, 75-mg tablets
  • 100-mg extended release tablet
  • 25-mg capsule
  • 1% and 3% gel (Voltaren Gel)
    • Apply 2-grams (upper extremities) or 4-grams (lower extremities) to painful joint QID [no more than 8 or 16-gram/day to any single joint respectively]
    • How to measure and apply the gel
  • 1.5% topical solution
  • 180-mg patch (Flector patch)
    • One patch BID to most painful area (click here)
• Note:
  • COX-1 normally produces prostaglandins that are gastroprotective.  Thus, blocking it can lead to gastric ulcers/bleeds
    • Arthrotec is a combination with misoprostol (to protect the stomach)
  • Take with food or 8-oz of water
  • May increase risk of cardiovascular thrombotic events, MI, and stroke
    • Avoid in patients with cardiac history
    • The flector patch and topical formulations are great as alternatives for these patients
  • Flector patch– good for areas where local inflammatory relief is needed, but in patients who can’t take systemic NSAIDs
    • medium and large joints (examples: shoulder, sacroiliac, knee, ankle, elbow)
    • superficial painful tendons (examples: biceps tendon, DeQuervain’s, achilles)
  • Arthrotec gel
    • good for superficial, small joints and other small areas (ex: finger joints, tendonitis at wrist)
  • Absolute contraindication: ASA allergy