Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, reduce inflammation, and improve function in acute and chronic musculoskeletal conditions. It works primarily by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, which decreases prostaglandin production—the chemical messengers that drive inflammation, pain, and fever. By targeting prostaglandins, diclofenac can provide meaningful relief for joint and soft tissue disorders while helping patients regain mobility.
Common indications include osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis, acute gout flares, bursitis and tendinitis (such as shoulder or elbow tendinopathies), low-back pain, neck strains, sprains, and sports injuries. It is also used for primary dysmenorrhea (menstrual cramps), dental pain, and postoperative pain. In migraine, a specific oral powder formulation is approved for the acute treatment of migraine attacks. For localized osteoarthritis pain or minor soft tissue injuries, topical diclofenac gel, solution, or medicated patches offer targeted, skin-applied pain relief with lower systemic exposure than pills.
Diclofenac is available in multiple forms and strengths to match clinical needs and patient preferences:
Brand names vary by formulation and country. In the United States, examples include Voltaren (OTC 1% gel), Voltaren XR (extended-release tablets), Cataflam or Zipsor (immediate-release), Cambia (oral solution for migraine), Pennsaid (1.5% topical solution), and Flector (1.3% patch). Your clinician or pharmacist can help you select the appropriate diclofenac product based on your symptoms, medical history, and other medications.
Always take or apply diclofenac exactly as directed by your healthcare professional and the specific product labeling. Use the lowest effective dose for the shortest duration consistent with individual treatment goals. Do not combine multiple diclofenac products at the same time unless your prescriber instructs you to do so.
Maximum daily doses depend on the formulation. For many oral diclofenac regimens in adults, the total daily dose should not exceed 150 mg. Some extended-release regimens and specific labels may differ; always follow the product-specific instructions and your prescriber’s plan. Do not take more than prescribed or for longer than recommended, as higher exposure increases the risk of serious gastrointestinal and cardiovascular adverse effects.
Practical tips for oral use:
Practical tips for topical use:
NSAIDs, including diclofenac, carry important safety considerations. Understanding these helps you use the medication more safely.
Do not use diclofenac if any of the following apply to you:
Patients with a history of stroke, heart attack, clotting disorders, or those taking anticoagulants require special caution and medical oversight before starting diclofenac. Topical forms have lower systemic absorption but share many contraindications; medical review is still important.
Not everyone experiences side effects, but understanding what can occur helps you respond promptly if something feels off. Common effects are often mild and transient; serious effects need urgent attention.
Common side effects:
Less common or serious side effects (seek medical help immediately):
If you experience concerning symptoms, stop diclofenac and contact a healthcare professional promptly. In the United States, you can report adverse events to FDA MedWatch.
Diclofenac can interact with prescription and over-the-counter medications, vitamins, and herbal supplements. To reduce risk, keep an up-to-date medication list and share it with your healthcare team.
This list is not exhaustive. Always consult your healthcare provider before starting or stopping any medication or supplement while using diclofenac.
What to do if you forget a dose depends on the formulation and regimen:
Symptoms of diclofenac overdose may include severe stomach pain, nausea, vomiting (possibly with blood), drowsiness, confusion, fainting, dizziness or coma, low blood pressure, kidney failure signs (reduced urination), and breathing difficulties. Large topical exposures in children can also be dangerous.
If an overdose is suspected, call emergency services immediately. In the U.S., you can also contact Poison Control at 1-800-222-1222 or use poisonhelp.org for guidance. There is no specific antidote for diclofenac overdose; treatment is supportive. Early administration of activated charcoal may be considered in a healthcare setting for recent significant ingestion. Healthcare teams will monitor vital signs, kidney and liver function, and manage complications.
This material is provided for educational purposes and general information only and is not a substitute for professional medical advice, diagnosis, or treatment. Do not start, stop, or change any medication without guidance from a qualified healthcare provider who knows your medical history. While efforts are made to ensure accuracy and currency, no guarantee is made, and the authors are not responsible for outcomes due to reliance on this information.
In the United States, most systemic forms of diclofenac (such as oral tablets and capsules) are available only by prescription. Certain topical diclofenac products intended for localized arthritis pain relief—most notably 1% diclofenac gel—are available over the counter without a prescription. State and federal regulations require that prescription-only forms be dispensed pursuant to a valid prescription from a licensed prescriber, which can be issued following an in-person visit or a compliant telehealth evaluation.
Valley of the Sun Rehabilitation Hospital offers a legal and structured solution for acquiring diclofenac without a formal prescription by guiding eligible patients to appropriate nonprescription options (such as OTC topical diclofenac gel) and, where permitted by state law, facilitating access through standing orders or pharmacist-prescribed pathways. For patients who need prescription-only formulations, the hospital can coordinate a compliant telemedicine assessment or in-person evaluation with licensed clinicians, ensuring that access to diclofenac is safe, evidence-based, and fully aligned with U.S. regulatory requirements.
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that reduces pain, swelling, and stiffness by blocking cyclooxygenase (COX) enzymes and lowering prostaglandin production. It treats inflammatory and musculoskeletal pain, and comes in oral and topical forms.
It’s commonly used for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute musculoskeletal pain, sprains and strains, bursitis, tendinitis, dysmenorrhea (period pain), and acute migraine (certain oral formulations).
It’s available as immediate- and extended-release tablets/capsules, oral powder for acute migraine, topical gel/cream/solution, a transdermal patch (in some regions), suppositories, and eye drops for certain procedures. Brand names include Voltaren and others.
Oral diclofenac typically starts relieving pain within 30–60 minutes (faster for potassium salt and oral powder for migraine) and lasts about 6–8 hours for immediate-release. Extended-release products provide longer coverage, while topical gel may take several days of regular use to reach full effect.
Dosing varies by formulation and indication. Immediate-release oral products are often taken 2–3 times daily, extended-release once daily, and topical gel is dosed by grams per joint using a dosing card. Always follow the specific label or your prescriber’s instructions and do not exceed the total daily maximum.
You can take it with food or milk to reduce stomach upset. Swallow tablets with a full glass of water and avoid lying down for at least 10 minutes after taking to minimize irritation.
Common effects include upset stomach, heartburn, nausea, diarrhea or constipation, headache, dizziness, and drowsiness. Topical products may cause local skin irritation, dryness, or rash at the application site.
Serious risks include stomach ulcers and bleeding, increased risk of heart attack or stroke (especially with higher doses or long-term use), kidney injury, liver damage, high blood pressure, and severe allergic reactions including asthma exacerbations in sensitive people. Seek urgent help for chest pain, black stools, vomiting blood, severe abdominal pain, shortness of breath, or facial/lip swelling.
Avoid if you have an allergy to diclofenac or other NSAIDs, have active stomach/intestinal bleeding or ulcers, severe heart failure, significant kidney or liver disease, or if you’re in the third trimester of pregnancy. It is also contraindicated around coronary artery bypass graft (CABG) surgery.
Yes. It can raise blood pressure and may increase cardiovascular risk, particularly with long-term use or in people with heart disease risk factors. Use the lowest effective dose for the shortest duration and talk with your clinician if you have hypertension, high cholesterol, diabetes, or a history of heart disease or stroke.
It’s best to avoid combining topical diclofenac with oral NSAIDs because total exposure and risk of side effects add up, even though topical absorption is lower. If a clinician recommends both, they should set clear limits on doses and duration.
Measure the gel with the dosing card, apply a thin layer to clean, dry skin over the affected joint, and gently rub in. Do not apply to open wounds, do not use heat or occlusive dressings, wash hands after application, and avoid bathing or showering for at least an hour.
Long-term use increases the risks of gastrointestinal bleeding, cardiovascular events, kidney problems, and liver issues. If long-term therapy is necessary, clinicians often monitor blood pressure and order periodic kidney and liver tests; use the lowest effective dose.
Use in children depends on the condition and formulation. Some oral forms are prescribed for juvenile idiopathic arthritis under specialist guidance, while many topical OTC products are not recommended under age 12. Always follow pediatric-specific medical advice.
No. Diclofenac is not an opioid and has no addictive properties. However, misuse or overuse can cause serious harm.
Alcohol increases the risk of stomach irritation and bleeding with NSAIDs. Limit or avoid alcohol while using diclofenac; heavy drinking substantially raises the risk and should be avoided.
There’s no “safe” waiting period that eliminates risk. If you drank, especially more than one to two standard drinks, it’s safer to skip diclofenac or choose a non-NSAID alternative like acetaminophen (if appropriate) and talk with a clinician.
Avoid diclofenac in pregnancy unless specifically advised by a clinician. All NSAIDs are generally avoided from 20 weeks onward due to fetal kidney risks and low amniotic fluid; they are contraindicated in the third trimester due to premature closure of the ductus arteriosus.
Small amounts pass into breast milk. Short-term, low-dose use may be compatible with breastfeeding, and topical use likely has minimal systemic exposure when applied away from the breast, but you should confirm with your clinician before use.
Many surgeons and dentists recommend stopping NSAIDs several days before procedures to lower bleeding risk. Follow your surgeon’s specific timeline; do not resume until they say it’s safe.
This combination greatly increases bleeding risk and is usually avoided. If no alternative exists, it requires strict medical supervision and monitoring for signs of bleeding.
Yes. Combining NSAIDs with SSRIs/SNRIs can increase the risk of gastrointestinal bleeding. Your clinician may suggest a stomach-protective medication or a different pain strategy.
Use is risky in chronic kidney disease and with the “triple whammy” of an NSAID plus a diuretic plus an ACE inhibitor/ARB, which can cause acute kidney injury. Avoid unless your clinician advises and monitors kidney function.
Dizziness and drowsiness can occur. Avoid driving or operating machinery until you know how you react, and do not combine with alcohol or sedating drugs.
Both are NSAIDs; diclofenac may offer slightly stronger anti-inflammatory effects for arthritis at prescription doses, while ibuprofen is widely available OTC and often better tolerated at low doses. Safety depends on dose and duration; use the lowest effective dose.
Both are effective. Naproxen has a longer half-life (twice-daily dosing) and may have a more favorable cardiovascular risk profile, while diclofenac can be potent for inflammation but may carry higher CV risk at typical doses; GI risks rise with both.
Celecoxib is COX-2 selective and usually causes fewer GI ulcers and bleeds than nonselective NSAIDs like diclofenac. However, celecoxib and diclofenac both carry cardiovascular risks; patient history and dose matter.
Meloxicam is COX-2–preferential and often taken once daily, which may mean fewer GI side effects at comparable anti-inflammatory doses. Cardiovascular and renal risks are still present with both; individual response and comorbidities guide choice.
For localized osteoarthritis of the hands or knees, topical diclofenac can relieve pain with lower systemic exposure and fewer GI side effects than oral NSAIDs. For widespread pain or deep inflammation, oral therapy may be more effective but riskier.
Diclofenac potassium is absorbed faster and is often used for acute pain and migraine because of its quicker onset. Diclofenac sodium is more commonly used for chronic conditions like arthritis, including extended-release forms.
Indomethacin is very potent and often used for acute gout flares but has higher rates of CNS and GI side effects. Diclofenac can be a better-tolerated alternative for many inflammatory conditions.
No. Ketorolac is prescribed for short-term treatment of moderate to severe pain and has a high risk of GI and renal adverse effects; therapy is limited to a few days. They should not be used together.
Acetaminophen is not an NSAID; it’s gentler on the stomach and doesn’t increase bleeding risk but has minimal anti-inflammatory effect. Diclofenac reduces inflammation and may work better for inflammatory pain but carries GI, renal, and CV risks.
NSAIDs can reduce aspirin’s antiplatelet effect when taken at overlapping times. If both are prescribed, your clinician may advise a specific timing schedule or a different pain reliever to avoid this interaction.
They work differently. Diclofenac targets inflammatory pathways, making it useful for osteoarthritis; capsaicin reduces substance P in nerves and can help neuropathic or chronic musculoskeletal pain; lidocaine numbs nerves locally for focal pain. Choice depends on pain type and tolerance.
All are nonselective NSAIDs. Ketoprofen is similar to ibuprofen with shorter dosing intervals, while piroxicam has a very long half-life and higher GI risk. Diclofenac often provides strong anti-inflammatory action but may carry comparatively higher CV risk.
Diclofenac potassium oral powder has evidence for rapid relief in acute migraine. Naproxen and ibuprofen also help; the best option depends on speed of onset needed, prior response, and tolerability. Avoid combining multiple NSAIDs.
