Can you use Voltaren gel with blood thinners?

October 8, 2025 •

3 min read

According to the U.S. National Library of Medicine, using topical diclofenac, the active ingredient in Voltaren, with a blood thinner like warfarin may increase the risk of bleeding. While topical gels have lower systemic absorption than oral medications, the combination is not without risk, and caution is strongly advised. Always consult a healthcare provider to determine if you can use Voltaren gel with blood thinners safely.

Quick Summary

Combining Voltaren gel and blood thinners significantly increases bleeding risk, even with topical application. This is because both medications interfere with blood clotting. A healthcare provider must assess the risks versus benefits for each patient.

Key Points

Significant Bleeding Risk: Combining Voltaren gel (diclofenac) with blood thinners substantially increases the risk of serious bleeding events, even though the gel is applied topically.
Consult a Doctor First: Always consult your healthcare provider before using Voltaren gel if you are taking any anticoagulant, such as warfarin, Eliquis, or Xarelto.
Topical Still Carries Risk: While systemic absorption from the gel is lower than with oral NSAIDs, it is not zero and is still enough to increase bleeding risk, especially with higher doses or prolonged use.
Recognize Bleeding Signs: Patients should monitor for and immediately report unusual signs of bleeding, including unexplained bruising, bloody stools, or weakness.
Safer Alternatives Exist: In many cases, alternative pain relief medications like acetaminophen are a safer option for those on blood thinners.
Synergistic Effect: Both NSAIDs and blood thinners interfere with the body’s clotting process, and their combined effect is a synergistic increase in bleeding risk.

Understanding the Interaction Between Voltaren Gel and Blood Thinners

Voltaren gel contains diclofenac, a nonsteroidal anti-inflammatory drug (NSAID). While it's applied topically to provide localized pain relief, a small amount is absorbed into the bloodstream. NSAIDs, including topical ones, can affect platelet function, which is crucial for blood clotting. This creates a significant interaction risk when combined with blood thinners, or anticoagulants, which are designed to prevent blood clots.

How NSAIDs and Anticoagulants Affect Bleeding

NSAID Mechanism: NSAIDs, like diclofenac, inhibit cyclooxygenase enzymes, which reduces inflammation and pain. A side effect of this action is the inhibition of platelet aggregation and adhesion, which are key steps in forming a blood clot. This prolongs bleeding time.
Anticoagulant Mechanism: Blood thinners, such as warfarin (Coumadin), apixaban (Eliquis), and rivaroxaban (Xarelto), work by disrupting the body's clotting cascade. Their primary function is to prevent harmful blood clots from forming or growing larger, which is critical for conditions like atrial fibrillation or deep vein thrombosis.
Synergistic Bleeding Effect: When an NSAID and an anticoagulant are used together, their blood-thinning effects are synergistic, meaning the combined effect is greater than the sum of their individual effects. This dramatically increases the risk of serious bleeding events.

Comparing Risks: Oral vs. Topical Diclofenac

The most significant factor in this discussion is the route of administration. While oral diclofenac carries a very high risk of bleeding in patients on anticoagulants, topical application carries a lower, but still present, risk.

Oral Diclofenac

Systemic exposure is high, meaning a large amount of the drug enters the bloodstream.
Increases the risk of major gastrointestinal (GI) bleeding and other hemorrhagic events.

Voltaren Gel (Topical Diclofenac)

Systemic absorption is limited, so less diclofenac reaches the bloodstream.
While the risk is lower, it is not zero. The FDA and medical literature still warn of a potential increased bleeding risk, especially with regular or prolonged use over large body areas.
Particular caution is advised for patients with existing risk factors, such as advanced age, a history of GI bleeding, or kidney issues.

Key Considerations Before Combining Medications

Even with topical application, a physician's consultation is non-negotiable for anyone on a blood thinner. The following steps are crucial for safe pain management:

Inform your doctor: Always disclose all medications, including topical ones and over-the-counter products, to your healthcare provider.
Consider alternatives: Discuss safer alternatives with your doctor. Acetaminophen (Tylenol) is often a safer option for pain relief in patients taking blood thinners.
Monitor for signs of bleeding: Learn to recognize the signs of internal or unusual bleeding. These can include unexplained bruising, nosebleeds, blood in urine or stool, dizziness, or weakness. Report any of these symptoms to your doctor immediately.

Table of Bleeding Risk with Common Blood Thinners


Blood Thinner (Anticoagulant)	Type	Interaction with Voltaren Gel	Important Notes
Warfarin (Coumadin)	Vitamin K Antagonist	Increased risk of serious bleeding events.	Requires regular INR monitoring. Use of Voltaren gel complicates management.
Apixaban (Eliquis)	Direct Oral Anticoagulant (DOAC)	Increased bleeding risk, particularly GI bleeding.	While topical risk is lower than oral NSAIDs, it is still a concern, especially with long-term use.
Rivaroxaban (Xarelto)	Direct Oral Anticoagulant (DOAC)	Increased bleeding risk.	Studies show NSAID use with DOACs increases bleeding risk.
Clopidogrel (Plavix)	Antiplatelet	Increased bleeding risk.	This drug also affects platelets, so the combination with an NSAID like diclofenac is particularly risky.

Conclusion: A Decision Made With Caution

While the systemic absorption of Voltaren gel is minimal, its combination with blood thinners like warfarin, Eliquis, or Xarelto is a serious matter. The potential for increased bleeding risk, even from a topical application, requires careful medical supervision. The safest approach is to consult your prescribing physician or pharmacist to discuss your specific medication list and health history. They can help you weigh the benefits of localized pain relief against the potential for severe bleeding complications, and identify a safe, effective pain management plan. Avoid self-medicating and always seek professional advice before combining these drug types. For detailed prescribing information, refer to official sources such as the FDA's document on Voltaren Gel.

Frequently Asked Questions

No, it is not safe to use Voltaren gel with warfarin without strict medical supervision. The combination significantly increases the risk of serious bleeding because both medications have synergistic effects that interfere with blood clotting.

Using Voltaren gel with Eliquis is not recommended without consulting your doctor. The topical diclofenac in Voltaren can increase the bleeding risk that is already elevated by the anticoagulant effect of Eliquis.

Voltaren gel interacts with blood thinners by inhibiting platelet function, which is essential for clotting, while blood thinners disrupt the clotting cascade. The combined effect leads to a higher risk of bleeding than with either medication alone.

Signs of a bleeding problem include unusual bruising, nosebleeds, red or black tarry stools, red or brown urine, prolonged bleeding from cuts, severe headaches, or unusual weakness.

Yes, the bleeding risk with Voltaren gel is lower than with oral NSAIDs because less of the drug is absorbed into the bloodstream. However, the risk is not eliminated and still requires careful consideration and medical advice.

You should discuss safer alternatives with your doctor. Acetaminophen (Tylenol) is often a suitable alternative for pain relief, but you should still confirm its use with your healthcare provider.

Yes, even short-term use of Voltaren gel with blood thinners significantly increases bleeding risk. The length of use does not negate the potential for serious complications.