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diclofenac topical (Solaraze, Voltaren gel)

Indications: - topical NSAID for treatment of actinic keratosis (about 50% effective) - treatment of osteoarthritis of the knee, ankle, elbow, wrist, & hand [4,7] - inflammatory conditions of the elbow (lateral epicondylitis) Contraindications: - not useful for osteoarthritis of the hip [7] Caution: - avoid exposure to sunlight & sunlamps - avoid applying to broken skin Dosage: - apply twice daily for 60-90 days - in DMSO, Voltaren Gel, apply QID - may take up to 7 days to work - Flector patch BID - Pennsaid, topical solution for osteoarthritis of the knee (Diclofenac Sodium Topical Solution 1.5%) - 1% Gel - each upper body area (hand, wrist, or elbow) 2.25 inches (2 grams) - each lower body area (foot, ankle, or knee) 4.5 inches (4 grams) Gel: contains 1-3% diclofenac. 1% dispensed in 100 g tubes. Pharmacokinetics: - 10% of dose is absorbed through the skin Adverse effects: 1) better tolerated than 5-fluorouracil (Effudex), but less effective 2) gastrointestinal effects are uncommon 3) hepatotoxicity with 1% topical gel can occur at any time during treatment with diclofenac [5] 4) localized skin rash [6] Notes: cost about $112/month (2004) [3]

Interactions

drug adverse effects of NSAIDs monitor with non steroidal anti-inflammatory agents (NSIADs)

Related

actinic (solar) keratosis (AK)

General

diclofenac (Voltaren, Cataflam, Flector patch, Cambia, Pennsaid, Zipsor, Zorvolex) topical anti-inflammatory agent

References

  1. Prescriber's Letter 8(2):supplement 2001
  2. Prescriber's Letter 9(2):11 2002
  3. Prescriber's Letter 11(5):28 2004
  4. Barthel HR1, Axford-Gatley RA. Topical nonsteroidal anti-inflammatory drugs for osteoarthritis. Postgrad Med. 2010 Nov;122(6):98-106 PMID: 21084786
  5. FDA MedWatch Voltaren Gel (diclofenac sodium topical gel) 1% - Hepatic Effects Labeling Changes http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm193047.htm
  6. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  7. a Costa BR, Pereira TV, Saadat P et al. Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: Network meta-analysis. BMJ 2021 Oct 12; 375:n2321. PMID: 34642179 PMCID: PMC8506236 Free PMC article https://www.bmj.com/content/375/bmj.n2321
  8. Bariguian Revel F, Fayet M, Hagen M. Topical diclofenac, an efficacious treatment for osteoarthritis: a narrative review. Rheumatol Ther. 2020;7(2):217-236 PMID: 32086778 PMCID: PMC7211216 Free PMC article https://link.springer.com/article/10.1007/s40744-020-00196-6

Components

diclofenac (Voltaren, Cataflam, Flector patch, Cambia, Pennsaid, Zipsor, Zorvolex)