Understanding the Availability of Diclofenac
For many years, the nonsteroidal anti-inflammatory drug (NSAID) diclofenac was only available via prescription in the United States. However, this changed in February 2020 when the FDA approved the transition of a specific formulation, diclofenac sodium 1% topical gel, to over-the-counter (OTC) status. Now widely available under the brand name Voltaren Arthritis Pain, this topical gel provides convenient access to a potent pain reliever for those with certain types of arthritis pain. It is crucial, however, to understand that this OTC availability applies only to the 1% topical gel. Other formulations, such as oral tablets, solutions, and stronger 3% topical gels, remain prescription-only.
How Topical Diclofenac Works
Diclofenac is an NSAID that functions by blocking the body's production of chemicals called prostaglandins, which are responsible for causing pain and inflammation. Unlike oral NSAIDs that circulate throughout the body, the topical gel delivers the active ingredient directly to the site of pain, such as the hands, wrists, elbows, knees, feet, and ankles. This localized application significantly limits systemic exposure, leading to a much lower risk of the systemic side effects associated with oral NSAIDs, such as gastrointestinal bleeding and cardiovascular complications. The gel's formula is designed to penetrate the skin and reach the inflamed joints below, providing targeted relief where it is needed most.
Proper Use of OTC Diclofenac Gel
Using OTC diclofenac gel correctly is essential for both effectiveness and safety. Adhering to the manufacturer's instructions ensures you get the most benefit while minimizing risks. The following are key steps for proper application:
- Use the dosing card provided in the package to measure the correct amount of gel for the affected joint.
- For joints in the upper body (hands, wrists, elbows), apply 2 grams of gel. For joints in the lower body (knees, ankles, feet), apply 4 grams.
- Gently rub the gel into the affected area, ensuring it is fully absorbed.
- Apply the gel four times a day, but do not exceed two treatment areas at the same time.
- Do not wash the treated area for at least one hour after application.
- Do not cover the area with clothing or gloves for at least 10 minutes.
- It may take up to 7 days of consistent use to feel the full pain-relieving effects.
- Avoid applying the gel to open wounds, infected areas, or rashes.
Potential Risks and Side Effects
Despite its lower risk profile compared to oral NSAIDs, topical diclofenac still carries potential risks and side effects, especially with prolonged use. The following is a list of potential issues:
- Local Skin Reactions: These are the most common side effects and include dryness, redness, itching, swelling, or irritation at the application site.
- Systemic Risks: While minimized, there is still a risk of systemic side effects, including serious cardiovascular issues like heart attack and stroke, and gastrointestinal problems like stomach bleeding and ulcers.
- Severe Allergic Reactions: A severe allergic reaction is possible, particularly in individuals with an aspirin allergy.
- Other Side Effects: Less common side effects may include stomach pain, nausea, and dizziness.
Consulting a healthcare provider is recommended before starting treatment, especially if you have a history of heart disease, high blood pressure, ulcers, or kidney disease.
Comparison: Topical vs. Oral Diclofenac
| Feature | OTC Diclofenac (Topical Gel 1%) | Prescription Diclofenac (Oral Tablet) |
|---|---|---|
| Availability | Over-the-Counter | Prescription Only |
| Application | Applied directly to the skin on affected joints | Taken by mouth |
| Absorption | Localized and minimal systemic absorption | Systemic absorption throughout the body |
| Primary Use | Temporary relief of osteoarthritis joint pain | Broader pain management for various conditions (e.g., arthritis, migraines, menstrual cramps) |
| Systemic Side Effects | Lower risk of systemic effects (cardiovascular, GI) | Higher risk of systemic side effects (cardiovascular, GI, liver) |
| Local Side Effects | Higher risk of skin reactions at the application site (e.g., dryness, irritation) | No local skin reactions |
Other Considerations Before Use
- Avoid Other NSAIDs: Do not combine topical diclofenac with other oral NSAIDs like ibuprofen (Advil) or naproxen (Aleve) without consulting a doctor, as this increases the risk of serious side effects.
- Pregnancy and Breastfeeding: Pregnant or breastfeeding individuals should consult a healthcare professional before use, especially after 20 weeks of pregnancy, as NSAIDs can harm the fetus.
- Duration of Use: Do not use the gel for more than 21 days at a time for arthritis pain without speaking to a doctor. If pain persists after 7 days, discontinue use and consult a healthcare provider.
- Off-Label Use: The FDA-approved OTC formulation is specifically for arthritis pain in certain joints. Using it for back pain, muscle soreness, or other conditions is considered off-label and not recommended.
Conclusion
In summary, the question of "Can diclofenac be bought at OTC?" has a clear answer: yes, but only in its 1% topical gel form under the brand Voltaren Arthritis Pain and its generic counterparts. This option provides a targeted, effective way to manage localized arthritis pain with a lower risk of systemic side effects compared to oral NSAIDs. However, it is not without risks and requires careful use, especially regarding dosage, duration, and potential interactions with other medications. For broader pain management or for individuals with underlying health concerns, oral formulations of diclofenac and other NSAIDs remain prescription-only and should be discussed with a healthcare provider.
For additional information on diclofenac, consult the comprehensive monograph on MedlinePlus: Diclofenac Topical (arthritis pain): MedlinePlus Drug Information.
