How long is it safe to use diclofenac? Understanding Duration and Risks

October 9, 2025 •

4 min read

Diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), carries a boxed warning from the FDA regarding the increased risk of serious cardiovascular and gastrointestinal events, which often increases with dosage and duration of use. Understanding how long is it safe to use diclofenac is critical for minimizing these potential health risks.

Quick Summary

The safe duration for using diclofenac depends on its form and purpose, with the lowest effective dose for the shortest period always recommended. Long-term oral use carries higher risks, while topical application is often safer for localized pain, though it still requires caution and monitoring.

Key Points

Duration Varies by Form: The safe duration for diclofenac depends on whether it is taken orally or applied topically, with different guidelines for each.
Lowest Dose for Shortest Time: All forms of diclofenac should be used at the lowest effective dose for the shortest possible duration to minimize risks.
High Oral Risks: Long-term and high-dose oral diclofenac carries an increased risk of serious cardiovascular events, such as heart attack and stroke, and dangerous gastrointestinal issues, like bleeding and ulcers.
Safer Topical Profile: Topical diclofenac (gels, patches) is generally safer for localized, long-term use due to low systemic absorption, but risks still exist, and overuse should be avoided.
Medical Supervision is Key: Any use beyond a short period, especially for chronic conditions, requires a doctor's supervision and regular health monitoring.
Alternatives Exist: For chronic pain, alternatives like other NSAIDs, acetaminophen, topical agents, and non-pharmacological therapies are available to reduce long-term risks.

Safe Use Guidelines for Diclofenac

Diclofenac is a powerful nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation from conditions like arthritis, migraines, and minor injuries. However, the duration of safe use varies significantly depending on the medication's form (oral vs. topical) and the condition being treated. To minimize the risk of serious side effects, healthcare providers universally recommend using the lowest effective dose for the shortest possible duration.

Oral Diclofenac (Tablets, Capsules)

Systemic diclofenac, taken orally, is associated with a greater risk of serious cardiovascular and gastrointestinal (GI) side effects, especially with high doses or prolonged use. The U.S. Food and Drug Administration (FDA) and other health authorities issue strong warnings, known as a boxed warning, for these risks.

Acute pain (e.g., injury, dental surgery): For temporary issues, such as a sprain or post-operative pain, diclofenac may only be needed for 1 to 2 days. For short-term use without a doctor's consultation, some guidance suggests no more than 3 days.
Chronic pain (e.g., arthritis): For long-term conditions like rheumatoid arthritis or osteoarthritis, a doctor may prescribe daily oral diclofenac. In these cases, regular medical monitoring is essential to review the treatment plan and test for potential side effects. This may include blood pressure checks and kidney and liver function tests. Your doctor may also prescribe a medication to protect your stomach.
General rule: For any ongoing use beyond a few days, a healthcare provider's guidance is necessary. The Mayo Clinic states that oral diclofenac is not for long-term use and that for severe or continuing arthritis, it must be taken daily as ordered by a doctor.

Topical Diclofenac (Gels, Patches)

Topical formulations, like diclofenac gel (Voltaren Arthritis Pain), deliver the medication directly to the site of pain, leading to much lower systemic absorption than oral versions. This significantly reduces the risk of systemic side effects, such as GI bleeding and cardiovascular events.

Over-the-counter arthritis pain: Non-prescription topical diclofenac gel is typically used for up to 21 days for arthritis pain, but if no relief is felt after 7 days, you should stop and contact a doctor. It should not be used on more than two painful joints at a time.
Prescription conditions (e.g., actinic keratosis): For specific skin conditions, a longer duration may be prescribed. For example, some topical gels for actinic keratosis are used for 60 to 90 days.

Risks of Prolonged Diclofenac Use

Taking diclofenac for extended periods, especially oral formulations, increases the potential for serious health problems. These risks are generally lower with topical versions but are not eliminated entirely.

Cardiovascular risks: The FDA has issued a boxed warning for increased risk of serious cardiovascular thrombotic events, including myocardial infarction (heart attack) and stroke. This risk can increase with higher doses and longer duration of use, even in people without pre-existing heart conditions.
Gastrointestinal risks: Prolonged use increases the likelihood of GI adverse events, such as bleeding, ulceration, and perforation of the stomach or intestines. These can occur without warning symptoms and can be fatal.
Other risks: Long-term diclofenac use has also been linked to issues such as liver damage, kidney problems, fluid retention (edema), and elevated blood pressure.

Comparison: Oral vs. Topical Diclofenac


Aspect	Oral Diclofenac (Tablets, Capsules)	Topical Diclofenac (Gel, Patches)
Recommended Duration	Shortest possible time for acute pain; long-term only with strict medical supervision.	Up to 21 days for OTC arthritis pain; longer for some prescribed conditions (60-90 days for AK).
Systemic Absorption	High, affecting the entire body.	Very low, concentrating the effect at the application site.
Cardiovascular Risk	Higher risk of heart attack and stroke, especially at high doses and for long periods.	Considerably lower risk due to reduced systemic absorption.
Gastrointestinal Risk	Higher risk of bleeding, ulcers, and perforation.	Significantly lower risk, though still a possibility, particularly with overuse.
Primary Use	Widespread pain and inflammation, and chronic conditions.	Localized pain relief, such as in the joints for osteoarthritis.

Alternatives to Long-Term Diclofenac Use

For chronic pain management, especially if long-term diclofenac poses too great a risk, several alternatives are available:

Other NSAIDs: Alternatives like ibuprofen or naproxen may be recommended by a doctor or pharmacist, as some studies suggest they may have a better cardiovascular risk profile than diclofenac, although risks still exist.
COX-2 inhibitors: For patients with GI concerns, a COX-2 inhibitor like celecoxib may be an option, as they are specifically designed to reduce GI side effects compared to traditional NSAIDs.
Acetaminophen: Over-the-counter acetaminophen (Tylenol) can provide pain relief without the same GI or cardiovascular risks, making it a safer long-term option for many patients.
Topical alternatives: Topical treatments containing capsaicin or other analgesics can provide localized pain relief.
Non-pharmacological therapies: Physical therapy, exercise, weight management, and massage can be highly effective in managing chronic pain with minimal side effects.

Conclusion

How long you can safely use diclofenac depends heavily on the form and the underlying condition. For acute, short-term issues, it can be effective for a few days, while chronic conditions require a more cautious approach. Oral diclofenac, particularly at high doses, carries significantly higher cardiovascular and GI risks than topical applications, making the topical form a preferred choice for localized, long-term use in some patients. Crucially, any long-term treatment plan involving diclofenac must be managed and monitored by a healthcare professional to ensure the benefits outweigh the risks. Always discuss your symptoms and alternative options with your doctor to create the safest and most effective pain management plan for you. For more detailed information on managing pain without opioids, consult resources like the CDC website on Nonopioid Therapies for Pain Management.

Frequently Asked Questions

For over-the-counter diclofenac gel (Voltaren), it is recommended to stop use and contact your doctor if you do not feel arthritis pain relief after 7 days. The maximum duration without a doctor's direction for arthritis pain is up to 21 days.

Oral diclofenac is not intended for long-term use due to increased risks of heart attack, stroke, and gastrointestinal bleeding. For chronic conditions like arthritis, it should only be used long-term under strict medical supervision at the lowest effective dose.

The most significant risks include serious cardiovascular events (heart attack, stroke) and gastrointestinal complications (bleeding, ulcers, perforation). Long-term use can also negatively affect liver and kidney function.

Yes, safer alternatives exist, such as topical diclofenac for localized pain, non-NSAID pain relievers like acetaminophen, and other NSAIDs like naproxen, which some studies suggest may carry a lower cardiovascular risk profile.

Topical diclofenac is generally safer because it has much lower systemic absorption, which reduces the risk of serious side effects on the heart and stomach that are more common with oral forms.

While topical gel has fewer systemic side effects, it is recommended to consult a doctor if you need to use it for more than 21 days for arthritis pain. A doctor's guidance is always prudent for any prolonged medication use.

If you are on long-term diclofenac therapy, your doctor will likely monitor your blood pressure and regularly perform kidney and liver function tests to check for potential adverse effects.