What are the effects of combining Diclofenac (Nonsteroidal Anti-Inflammatory Drug (NSAID)) and Lidocaine (Local Anesthetic) ointments?

From the Guidelines

Combining diclofenac and lidocaine ointments is not recommended due to potential interactions and altered effectiveness. When considering pain management options, it's essential to prioritize the patient's morbidity, mortality, and quality of life. According to the study published in the Journal of the National Comprehensive Cancer Network 1, topical agents like lidocaine patch and diclofenac gel can be used as coanalgesics in combination with other medications, but there is no direct evidence to support combining diclofenac and lidocaine ointments.

Key Considerations

• Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation and pain, while lidocaine is a local anesthetic that numbs the area by blocking nerve signals.
• The chemical properties of these medications differ, and mixing them could potentially alter their effectiveness, stability, or absorption rates.
• Combining them might increase the risk of side effects such as skin irritation or systemic absorption.

Recommended Approach

• If pain management requires both anti-inflammatory and anesthetic effects, it's better to apply them sequentially rather than mixing them together.
• For example, you might apply lidocaine first to numb the area, wait 15-30 minutes for it to take effect, and then apply diclofenac.
• This approach preserves the integrity of each medication and allows them to work as intended.

Important Notes

• The study 1 suggests that topical agents can be used in combination with other medications, but it does not provide guidance on combining diclofenac and lidocaine ointments specifically.
• It's crucial to consult with a healthcare provider for personalized advice on proper application timing and potential interactions before using both medications for pain management.

From the Research

Combining Diclofenac and Lidocaine Ointments

• The combination of diclofenac and lidocaine ointments is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, the individual components have been studied for their efficacy in pain management:
  • Diclofenac has been shown to be effective in treating acute and chronic pain conditions, including musculoskeletal pain and osteoarthritis 2, 4.
  • Lidocaine has been found to be effective in treating chronic pain conditions, including postherpetic neuralgia, diabetic peripheral neuropathy, and osteoarthritis 5, 6.
• The studies suggest that topical NSAIDs, such as diclofenac, and topical lidocaine can be effective in providing pain relief for various conditions 2, 3, 4, 5, 6.
• However, there is no direct evidence to support the combination of diclofenac and lidocaine ointments, and further research would be needed to determine the efficacy and safety of such a combination.

Efficacy of Individual Components

• Diclofenac:
  • Effective in treating acute musculoskeletal pain, with a number needed to treat (NNT) of 1.8 for diclofenac Emulgel 2.
  • Effective in treating chronic musculoskeletal pain, with an NNT of 5.0 for topical diclofenac preparations 2.
• Lidocaine:
  • Effective in treating postherpetic neuralgia, with a significant reduction in pain intensity 5.
  • May be effective in treating other chronic pain conditions, including diabetic peripheral neuropathy and osteoarthritis 5, 6.

Safety and Adverse Events

• Topical NSAIDs, such as diclofenac, have been shown to have a low risk of systemic adverse events and local skin reactions 2, 4.
• Lidocaine has been found to have a low risk of systemic adverse events and local skin reactions, making it a relatively safe treatment option 5.