Voltaren Gel (Diclofenac)

In the United States, yes. The 1% gel was prescription-only from 2007 until February 2020, when the FDA approved an Rx-to-OTC switch; it is now sold as Voltaren Arthritis Pain in pharmacies and supermarkets without a prescription. In Canada, the UK and most of Europe, Voltaren Emulgel 1% has been available without prescription for many years, while the 2% strength is sold over the counter in some countries and prescription-only in others. Your pharmacist can confirm the local status and check that the gel is appropriate for you.

Measure each dose on the dosing card that comes in the box: squeeze a line of gel along the 2 g mark for the hands, wrists or elbows, or the 4 g mark for the knees, ankles or feet. Apply four times a day, evenly spaced, and rub it in gently. The daily limit is 8 g per upper-body joint, 16 g per lower-body joint and 32 g in total. Using more than directed does not add relief but increases the amount absorbed into the body. If you need the gel for more than 21 days, speak to a doctor.

Not without advice from a doctor or pharmacist. Although only a few percent of the applied dose reaches the bloodstream, it still adds to the diclofenac, ibuprofen, naproxen or aspirin already circulating from tablets, raising the overall risk of stomach bleeding, kidney strain and cardiovascular events. The same applies to combining the gel with other topical NSAIDs on the same area. Low-dose aspirin taken for heart protection is usually acceptable, but confirm this with your pharmacist.

Keep the gel away from the eyes, nostrils, mouth and genitals, and never apply it to cuts, grazes, eczema, infected skin or open wounds, since absorption and irritation both rise on damaged skin. Do not use it on the back, neck, hips or shoulders, where it has not been shown to work. Avoid covering the treated area with airtight dressings or heat wraps, and protect it from direct sunlight and sunbeds, as diclofenac can cause photosensitivity reactions. Wash your hands after each application unless your hands are the treated joint.

Do not use the gel if you have had asthma, hives or an allergic reaction after taking aspirin or any other NSAID. It should not be used in the last three months of pregnancy, and earlier in pregnancy or while breastfeeding only on medical advice. People with heart disease, high blood pressure, kidney disease, a history of stomach ulcers, or who have recently had heart bypass surgery should talk to a doctor before using it, because NSAID class warnings still apply to the small amount that is absorbed. It is not recommended for children under 12 without a doctor's guidance.

For sprains, strains and bruises, many people notice easing of pain within the first few hours and clear improvement over two to three days. Osteoarthritis pain responds more slowly: according to the clinical trials behind the US approval, the benefit builds over the first week of regular application four times a day, so the gel should be used consistently rather than only when pain flares. If there is no improvement after seven days, or if the joint becomes red, hot or swollen, stop and see a doctor.

Both contain diclofenac diethylamine, but the 2% version, sold as Voltaren Emulgel 2% or Forte, holds twice the concentration and is formulated for twice-daily rather than four-times-daily application, which many users find easier to keep up. The total daily diclofenac dose is similar. The 2% strength is used mainly for acute injuries and localised joint pain in adults, and in some countries it is sold only with a prescription. It is not available in the US, where the OTC product is the 1% gel. A pharmacist can advise which strength suits your situation.