Voltaren (diclofenac) is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation. It works by blocking cyclooxygenase enzymes, which helps decrease prostaglandins that cause inflammation and pain. While Voltaren is generally safe when used as directed, there are some medications that should not be taken with Voltaren due to potential drug interactions. Knowing what medications to avoid while taking Voltaren is important to reduce the risk of side effects.
NSAIDs
Voltaren should not be used with other NSAIDs as this increases the risk of side effects. Some examples of NSAIDs that should be avoided while taking Voltaren include:
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve, Naprosyn)
- Ketoprofen
- Indomethacin
- Celecoxib (Celebrex)
Using two NSAIDs together can increase the risk of gastrointestinal issues like ulcers and bleeding. It also does not provide any additional pain relief benefit.
Anticoagulants/Antiplatelets
Voltaren may interact with blood thinners, increasing the risk of bleeding and bruising. Anticoagulants and antiplatelets that should not be used with Voltaren include:
- Warfarin (Coumadin)
- Heparin
- Enoxaparin (Lovenox)
- Clopidogrel (Plavix)
- Dabigatran (Pradaxa)
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
If you need to take Voltaren, your doctor may recommend stopping the anticoagulant temporarily or may monitor you more closely.
Diuretics
Voltaren can reduce the effects of diuretics, which are medications that help the body get rid of extra fluid. Examples of diuretics that may interact with Voltaren include:
- Furosemide (Lasix)
- Hydrochlorothiazide
- Spironolactone (Aldactone)
- Triamterene (Dyrenium)
Voltaren can decrease the diuretic effects by reducing prostaglandin synthesis in the kidneys. Your doctor may recommend monitoring fluid levels more closely if taking both medications.
Corticosteroids
Using Voltaren with oral or injected corticosteroids like prednisone can increase the risk of gastrointestinal bleeding and ulcers. Topical corticosteroids applied to the skin are less likely to interact with Voltaren but should still be used cautiously. Examples of systemic corticosteroids to avoid include:
- Prednisone
- Prednisolone
- Methylprednisolone (Medrol)
- Dexamethasone (Decadron)
Methotrexate
Voltaren can increase levels of methotrexate in the body, resulting in increased side effects. Methotrexate is commonly used to treat cancers like leukemia as well as some autoimmune diseases. The interaction occurs because Voltaren reduces the clearance of methotrexate by the kidneys. If you need to take both medications, your doctor will likely monitor your blood cell counts and kidney function more frequently.
Cyclosporine
Cyclosporine is an immunosuppressant medication often used after organ transplants. Voltaren can increase cyclosporine levels, resulting in more side effects like kidney damage and high blood pressure. If you take both medications, your doctor will monitor blood levels of cyclosporine and kidney function. The dose of cyclosporine may need to be reduced.
Lithium
Voltaren can increase blood levels of lithium, resulting in lithium toxicity. Lithium is used to treat bipolar disorder. Signs of lithium toxicity include nausea, vomiting, diarrhea, drowsiness, muscle weakness, and confusion. Doctors will monitor lithium blood levels closely if Voltaren is needed.
ACE Inhibitors & ARBs
Voltaren can reduce the blood pressure lowering effects of ACE inhibitors like lisinopril or ARBs like losartan. Examples include:
- Captopril (Capoten)
- Enalapril (Vasotec)
- Lisinopril (Prinivil, Zestril)
- Losartan (Cozaar)
- Valsartan (Diovan)
Your doctor may monitor your blood pressure more closely if you need to take both types of medications.
Furosemide
Furosemide is a loop diuretic that helps the body get rid of extra fluid. Voltaren can reduce furosemide’s diuretic effects. Your doctor may monitor fluid levels more closely if taking both medications.
Digoxin
Voltaren can increase blood levels of the heart medication digoxin (Lanoxin). This can lead to digoxin toxicity with symptoms like nausea, vomiting, and abnormal heart rhythms. If taking both medications, your digoxin levels will need to be monitored closely.
Probenecid
Probenecid is used to treat gout and increase uric acid excretion. It can increase Voltaren levels in the body, resulting in more side effects. Your doctor may consider monitoring kidney function and reducing the Voltaren dosage if needed.
Oral Hypoglycemics
Voltaren may reduce the glucose-lowering effects of some diabetes medications. Examples include:
- Glipizide
- Glyburide
- Metformin
- Pioglitazone
Blood glucose should be monitored closely in diabetics taking Voltaren, and medication adjustments may be needed.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs used to treat depression may increase the risk of bleeding when combined with Voltaren. This includes medications like:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
Your doctor will assess your risk factors for bleeding if taking both types of medications.
Bone Health Medications
Voltaren can interfere with bone health medications like:
- Alendronate (Fosamax) – used to treat osteoporosis
- Risedronate (Actonel) – used to treat osteoporosis
It is recommended to separate dosing of these bone medications and Voltaren by at least 2 hours. The interaction involves reduced absorption of the bone medications when taken close together.
Angiotensin II Receptor Blockers (ARBs)
Voltaren can reduce the blood pressure lowering effects of ARBs like losartan and valsartan. Examples include:
- Losartan (Cozaar)
- Valsartan (Diovan)
- Irbesartan (Avapro)
- Olmesartan (Benicar)
Your doctor may monitor your blood pressure more closely if you need to take both medications.
Herbal Supplements
Some herbal supplements may interact with Voltaren and increase the risk of bleeding, including:
- Garlic
- Ginkgo
- Fish oil
- Vitamin E
Let your doctor know if you take any herbal supplements with Voltaren.
Acetaminophen
While acetaminophen (Tylenol) on its own is safe to take with Voltaren, combination products containing acetaminophen and other pain relievers like oxycodone should be avoided. Too much acetaminophen can cause liver damage.
Mifepristone
Mifepristone is used for medical abortions and termination of pregnancy. Voltaren can decrease the effects of mifepristone and should not be taken for 8-12 days after using mifepristone.
Conclusion
Voltaren is an effective and commonly used NSAID for treating pain, but it does come with some potential medication interactions to be aware of. Avoid combining Voltaren with other NSAIDs, blood thinners, steroids, diuretics, methotrexate, lithium, and certain arthritis medications. Be sure to discuss all your medications with your doctor and pharmacist to prevent any problematic interactions with Voltaren. Your doctor may adjust medication dosages or monitor you more closely if Voltaren needs to be taken with certain high-risk medications. Pay close attention to any new side effects that develop after starting Voltaren or adding a new medication to your regimen. Promptly reporting any issues to your doctor can prevent more serious complications from drug interactions. With some caution and awareness, Voltaren can typically be used safely along with other needed medications.
