Diclofenac gel can be a beneficial tool in the management of localized osteoarthritis pain. There are many situations where acetaminophen is not effective and oral NSAIDs are intolerable or inappropriate. This is a type of situation where diclofenac gel may be appropriate to consider. Here are a few mistakes and clinical pearls that you should know regarding this medication.
Where Can We Use Diclofenac Gel?
The location of the pain is critical when it comes to the use of diclofenac gel. The knee, elbow, hand, and wrist are all appropriate joints to use this localized therapy on. Many patients will have osteoarthritis of the hip. The hip is not a good place to utilize this medication.
How Much Do I Put On?
Below is an image of the dosing card that comes with Voltaren gel. This is really helpful when educating patients or healthcare professionals about how much a patient should utilize. A helpful tip to remember is that we are going to typically use 2 grams for an upper extremity joint and 4 grams for a lower extremity joint.
What About Systemic Absorption?
It has a relatively low amount of drug systemically absorbed. From the package insert, there is about 6% of the drug absorbed compared to the oral formulation. This means that the renal, GI, and other potential negative risks from topical diclofenac should be very low compared to oral dosage forms. Compare this to a drug like fentanyl which has a very high level of systemic absorption and is going to have the typical opioid adverse effect profile.
This is one of the big downsides of the drug. Cost concerns are a legitimate issue with diclofenac gel and prior authorizations are often the norm. It is important to recognize whether your patient can afford the medication if you are going to prescribe it.
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