The People's Perspective on Medicine

How Can Topical Diclofenac (Voltaren Gel) Hurt Your Stomach?

Some people love topical diclofenac for sprains, strains or inflamed joints. Others find that it causes the same nasty stomach symptoms as oral NSAIDs.

Many people assume that if you rub a medication onto your skin it doesn’t go very far. That’s why there is little concern about side effects from gels or creams such as topical diclofenac. But the skin is not an impenetrable barrier.

Researchers have known for years that many medications can be absorbed through the skin and into the systemic circulation. They include nitroglycerin for the heart, fentanyl for pain, testosterone and estradiol for hormone replacement therapy, corticosteroids for inflammation and scopolamine for motion sickness.

Is Topical Diclofenac Safe for Everyone?

Over the years we have written that topical NSAIDs may be safer than oral versions of ibuprofen or diclofenac. That was based in part upon an overview by the Cochrane Collaboration (Cochrane Database of Systematic Reviews, June 11, 2015): 

“Topical NSAIDs provided good levels of pain relief in acute conditions such as sprains, strains and overuse injuries, probably similar to that provided by oral NSAIDs. Gel formulations of diclofenac (as Emugel), ibuprofen, and ketoprofen, and some diclofenac patches, provided the best effects. Adverse events were usually minimal.”

That said, some people are extremely sensitive to NSAID toxicity. Even topical diclofenac can cause harm to these individuals. Here are some examples:

Q. You’ve written about Voltaren gel for arthritis pain. I cannot use this drug, as it causes me severe stomach pain and acid reflux. I wish I could use it for my sore joints.

My aunt died from using an NSAID. It gave her an ulcer that led to infection and death.

I can’t believe we can buy NSAIDs without a prescription in this country. They can kill you and are known to cause ulcers even when people are unaware of the damage until it is too late.

A. You are correct that nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ibuprofen (Advil, Motrin IB), meloxicam and naproxen (Aleve) can cause stomach ulcers (Expert Review of Gastroenterology & Hepatology, June 2016).  Such complications can indeed be deadly.

Many people can apply topical NSAIDs without the complications associated with oral drugs like celecoxib, meloxicam or naproxen. Even so, there are some individuals who are super sensitive to NSAIDs in general and topical diclofenac in particular.

Stories from Other Readers:

Anonymous shared this story about Voltaren Gel:

“My doctor gave me Voltaren gel samples to try for joint pain. When I looked at the warnings (I cannot tolerate even tiny amounts of NSAIDs, due to other bad drug reactions that ruined my stomach) I asked about them. He waved them off, saying ‘They HAVE to say that because it’s an NSAID.’

“He said the gel was better because it wouldn’t affect my stomach. I did fine on the samples, and paid $167 for a prescription for several big tubes of Voltaren. As always, I was using a very low dose, less than half the recommended dose and only once or twice a day.

“After a couple weeks, I woke up with severe stomach pain. My stomach began to feel pretty awful in general. I asked my pharmacist and he said the gel gets into the bloodstream, and goes everywhere in the body. It causes all the side effects of any oral NSAID, i.e., everything listed on the box as a warning was true.

“Yes, it was causing my stomach pain and who knows what else.) That’s $167 down the drain. I can’t use the stuff. I tried a couple times later to just use a tiny dab or two of it, and it upset my stomach again”

Brenn reports a similar problem:

“I tried the Voltaren gel because oral NSAIDs cause extreme stomach distress, acid reflux, and most frightening, atrial fibrillation. My cardiologist said it was an inflammation in the lining of my heart. Using the gel caused the same problems in both me and my neighbor. If I only use a small amount, occasionally, the symptoms are mild, but it really doesn’t do much for relief.”

Diane has congestive heart failure. Topical diclofenac is not a good idea for her!

“I have a question: What about topical NSAIDs? I’ve been prescribed Voltaren gel for neuropathy in both feet. If I use it every day, I begin to get burning in my stomach. The prescription insert literature suggests that yes, it is absorbed. I also have edema in the extremities because I have congestive heart failure. I may be noticing an increase in this on the Voltaren gel. Does anyone know the answer to the gel vs. oral question?”

For most people, occasional use of oral ibuprofen or naproxen is not highly dangerous. Many people take these medicines daily, however, to ease the pain of arthritis. They are at risk for a range of serious side effects. The FDA has black box warnings on topical NSAIDs. Here is a link to learn more about this confusing subject:

How Safe Are Topical NSAIDs Like Voltaren Gel?

We discuss safer options to manage arthritis pain in our eGuide to Alternatives for Arthritis

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Oral Voltarin (diclofenac) causes me to break out in hives. That’s a listed side effect. Topical Voltarin jel does the same thing to me, it just takes a little longer. Yep, right through the skin.

Several doctors in the practice I go to were giving out samples of Voltaren Gel like it was candy. I read the inserts and never used it. Two years ago when I had terrible leg cramps all throughout the day, I was offered it yet again. I refused.

Turns out my leg cramps were due to an injection of a drug for my knees. I had asked the orthopedic doc if it would interfere with my Hashimoto’s. He said no. He was either extremely stupid or never bothered to read the interactions or both. It took me 5 doctor’s visits and lots of frightening days to get through it. Doctors never solved the riddle – I did!!!

The meds jump-started my thyroid and adrenals. I had a period/menstruation at 72 yrs. No, please don’t assume it was uterine cancer. I had that checked and had a scraping of the uterus (fun) and biopsied. The endocrinologist was the most useless doctor of the bunch. Now I am very busy researching Type 2 diabetes because I absolutely cannot rely on the doctors on this.

I used this product as well and got the same stomach ulcers I get with oral NSAIDS immediately. I also have tubes of the stuff left over. Should be sold in a smaller size tube for patients to try without wasting so much money.

The FDA is sure inconsistent. I see ads for Aleve all the time as though it were harmless yet they won’t approve Armour thyroid. I have no respect for them.

$167. for Voltaren gel? I bought some over the counter when I visited Toronto. It was on sale. $12 USD!!! Extra strength tube was $15. USD

Worth reading materials.Thank you

Years ago when I was given a prescription for Voltaren the doctor had a coupon as it wasn’t cheap. I read the side effects which I included blood clots and heart issues on it so I never had this prescription filled. I asked another doctor and he replied, “The drug company has to put it on there as those are the possible side effects in pill form, but this is topical so it won’t hurt you”. I didn’t believe what he said because topical, whether for the skin or ear or eye drops, are just as harmful so again I never filled the script.
If someone does get a heart attack or clots later after using these drugs I bet neither the doctor nor the patient would connect the dots!

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