Voltaren (diclofenac) is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation. It comes in different forms, including as a pill to swallow and as a gel to rub on the skin. Both the gel and pill forms contain the same active ingredient, diclofenac. However, there are some differences between Voltaren gel and Voltaren pills when it comes to safety.
How Voltaren gel and pills work
Voltaren works by blocking the production of prostaglandins, chemicals in the body that promote inflammation, pain, and fever. When you rub Voltaren gel on the skin over a painful area, the diclofenac is absorbed through the skin into the underlying tissues. This provides localized pain relief by reducing inflammation right where the gel is applied.
Swallowing a Voltaren tablet releases the diclofenac to travel through the bloodstream. It can then exert an anti-inflammatory effect throughout the body, not just in one localized area. Both the gel and oral tablet provide effective pain relief by reducing inflammation, just in different ways.
Safety concerns with oral NSAIDs like Voltaren
While oral NSAIDs like Voltaren are effective pain medications, they do come with more potential side effects and safety concerns compared to topical diclofenac gel. Some of the main safety issues associated with oral NSAIDs include:
Gastrointestinal bleeding and ulcers
One of the most worrying side effects of oral NSAIDs like Voltaren is that they can cause bleeding and ulcers in the stomach and intestines. This occurs because the medications inhibit prostaglandins that normally help protect the lining of the digestive tract. Taking an oral NSAID daily for more than a few weeks significantly increases the risk of developing a potentially serious GI bleed.
Kidney problems
NSAID medications are filtered through the kidneys, so high doses taken over long periods can reduce kidney function. People who already have kidney impairment are especially susceptible to further kidney damage when using NSAIDs. Reduced kidney function increases the risk of fluid retention, salt imbalance, and heart problems.
Increased risk of heart attack and stroke
Research shows that oral diclofenac and other NSAIDs can raise the risk of having a heart attack or stroke. Diclofenac has also been associated specifically with an increased rate of cardiovascular death. The risk goes up the longer someone takes oral NSAIDs.
Medication interactions
Oral NSAIDs like Voltaren can potentially interact with several other medications, including blood thinners, steroids, diuretics, lithium, methotrexate, and ACE inhibitors for blood pressure. This could lead to adverse effects. By contrast, topical NSAIDs have very little systemic absorption and thus minimal drug interactions.
Safety profile of topical Voltaren gel
Voltaren gel applied on the skin avoids many of the safety issues associated with oral NSAID use because only a small amount of the medication gets absorbed into the bloodstream. Less than 10% of the diclofenac in the gel penetrates through the skin, compared to almost 100% absorption for the tablets. This localized absorption directly at the site of pain provides good efficacy with far fewer systemic effects throughout the body.
Benefits of using topical rather than oral diclofenac include:
Minimal gastrointestinal effects
Numerous studies have shown very low rates of GI side effects with topical NSAIDs compared to oral NSAIDs. In fact, diclofenac gel has not been shown to irritate, ulcerate, or perforate the GI tract, unlike oral diclofenac. For those at risk of NSAID-induced stomach ulcers or bleeding, Voltaren gel avoids this serious complication.
Kidney safety
Clinical studies found no evidence of kidney toxicity or reduction in kidney function with use of diclofenac gel. Because only small amounts get absorbed into the bloodstream, Voltaren gel does not cause systemic kidney issues seen with oral NSAID use. It is considered generally safe to use topical diclofenac even if you have pre-existing kidney disease.
No increased cardiovascular risks
Voltaren gel has not been linked to any increased rate of heart attacks, strokes, or cardiovascular deaths. The very low systemic absorption avoids the cardiovascular risks proven in studies of oral diclofenac tablets. Topical NSAIDs are not associated with the same heart and blood vessel safety issues as oral NSAIDs.
Minimal drug interactions
There are no significant interactions between Voltaren gel and other medications, given its localized skin absorption. The gel can typically be used safely with other prescription or over-the-counter medications, unlike oral NSAIDs that can interact with many drugs. Exceptions could include blood thinners and other topical products applied to the same area.
Well-tolerated on the skin
Voltaren gel is generally well-tolerated when applied to intact skin. Mild skin irritation is possible at the application site. Some people experience rashes or itching where the gel is applied. Allergic reactions are rare but can occur. It is meant to be applied to the skin on a short-term basis. Oral NSAIDs are more likely to cause systemic allergic reactions.
Safety precautions with Voltaren gel
Voltaren gel does not produce the extent of adverse effects caused by oral NSAIDs, but some precautions are still needed when using the topical medication:
– Avoid applying gel to broken or irritated skin as increased absorption may occur. Use on intact skin only.
– Do not apply to open wounds or infected skin.
– Avoid sun exposure after applying gel to reduce any risk of photosensitivity.
– Use the minimum effective dose for the shortest time needed.
– Avoid wearing occlusive dressings over the treated area.
– Use extra care when applying to larger skin areas or using larger amounts of gel.
– Discontinue use if a rash develops at the application site.
– Avoid getting the gel in your mouth or eyes after applying.
– Consult your doctor before using if pregnant or breastfeeding.
– Check with your doctor about any other medical conditions before using.
Risk factors that favor topical diclofenac
Evidence clearly shows that Voltaren gel is the safer option compared to oral diclofenac for certain groups of people at higher risk for side effects:
Older adults
The elderly are more susceptible to NSAID-induced kidney impairment, cardiovascular effects, and GI bleeding. Voltaren gel bypasses the systemic effects of oral NSAIDs that are of greatest concern in older people.
Pre-existing kidney disease
For patients with reduced kidney function, topical NSAIDs like Voltaren gel avoid the potential kidney toxicity posed by oral NSAIDs. Kidney disease patients can use the gel safely with minimal systemic absorption.
History of stomach ulcers or GI bleeding
People with a history of GI ulcers, gastritis, or bleeding in the stomach or intestines are much more prone to these same complications when taking oral NSAIDs. Voltaren gel offers effective relief without irritating the GI tract.
Cardiovascular disease
Those with a history of heart disease or stroke are at even greater risk of cardiovascular death when using oral diclofenac or other NSAIDs. The topical gel eliminates the cardiovascular risks while still providing anti-inflammatory activity.
Osteoarthritis treatment with Voltaren gel vs pills
Many people use NSAIDs like diclofenac to manage the pain, stiffness, and swelling of osteoarthritis. For treating osteoarthritis in specific joints, evidence suggests Voltaren gel may be a wiser choice than oral NSAIDs:
Hand osteoarthritis
Osteoarthritis commonly affects the small joints of the hands. Rubbing Voltaren gel directly onto painful hand joints allows a targeted effect to reduce hand arthritis inflammation. Oral NSAIDs would expose the whole body to risks.
Knee osteoarthritis
Voltaren gel absorbs through the skin to penetrate osteoarthritic knee joints right at the source of pain. This site-specific delivery of diclofenac maximizes local anti-inflammatory effects in the knees while minimizing systemic adverse reactions compared to oral NSAIDs.
Shoulder osteoarthritis
Applying topical diclofenac on and around osteoarthritic shoulder joints provides more direct treatment effects. Oral NSAID use could lead to unnecessary and harmful GI, kidney, heart and blood vessel effects for shoulder osteoarthritis.
| Form of Diclofenac | Safety Pros | Safety Cons |
|---|---|---|
| Oral Tablets | – Provides systemic effects | – GI bleeding / ulcers |
| – Convenient dosing | – Kidney toxicity | |
| – Familiar medication | – Increased cardiac risk | |
| Topical Gel | – Minimal GI effects | – Localized to one area |
| – No kidney toxicity | – Potential skin irritation | |
| – No increased cardiac risk | – Avoid sun exposure after applying |
Is Voltaren gel ultimately safer?
Based on all current evidence and clinical research, experts agree that Voltaren gel is clearly the safer choice compared to oral diclofenac, especially for long-term use. The main advantages of using topical rather than oral diclofenac include:
– Greatly reduced systemic absorption and fewer whole-body adverse effects
– Minimal safety concerns related to cardiovascular, kidney, or GI complications
– Ability to apply directly to painful osteoarthritic joints for a targeted effect
– Avoiding the serious GI and cardiovascular risks proven with oral NSAID use
– No need to worry about drug-drug interactions or dose adjustments
Of course, oral NSAIDs do have a role for short-term use or widespread pain relief. But for chronic usage or localized pain problems, Voltaren gel provides the benefits of topical diclofenac with much less safety risk. Work closely with your doctor, but Voltaren gel is generally the preferred route for ongoing diclofenac therapy.
Conclusion
Voltaren gel allows people to reduce pain, swelling and stiffness in a targeted way while avoiding the considerable safety concerns associated with systemic oral NSAID use. Applying topical diclofenac directly over joints affected by osteoarthritis or injury offers site-specific anti-inflammatory activity without increased risk of cardiovascular events, kidney disease, stomach ulcers, or dangerous bleeding. For many people, Voltaren gel provides a much safer choice than oral NSAID pills – one that still relieves pain without all the accompanying risks of therapy. It is especially favorable for regular, long-term use in older adults and those with pre-existing medical conditions that make oral NSAIDs too risky to take on an ongoing basis.
