Can I apply lidocaine (5% topical anesthetic) ointment and Voltaren (diclofenac) gel at the same time to painful knees?

Applying Lidocaine 5% Ointment and Voltaren Gel Together for Knee Pain

You should not apply lidocaine 5% ointment and Voltaren (diclofenac) gel at the same time to painful knees due to potential drug interactions and safety concerns. 1, 2

Rationale for Not Using Together

Safety Concerns

• The international consensus statement on lidocaine specifically recommends that topical 5% lidocaine products should be removed before starting intravenous lidocaine infusions due to potential cumulative effects 1
• While this guideline addresses IV lidocaine specifically, the principle applies to combining topical local anesthetics with other medications
• Diclofenac sodium topical gel instructions specifically state to "wait until the treated area is dry before applying other topical medications to the same knee" 2

Proper Application Protocol

• Diclofenac gel requires clean, dry skin for application 2
• The medication needs to be absorbed properly without interference from other topical products
• After application, the area should remain uncovered until completely dry 2

Alternative Approaches

Sequential Application (If Both Are Needed)

1. Apply one medication first (e.g., diclofenac gel)
2. Allow it to dry completely (approximately 30 minutes)
3. Apply the second medication (e.g., lidocaine) at a different time of day
4. Ensure no skin-to-skin contact with others until the area is completely dry 2

Choose One Based on Pain Type

• For inflammatory osteoarthritis pain: Topical NSAIDs like diclofenac are conditionally recommended by the American College of Rheumatology 1
• For neuropathic or localized pain: Lidocaine 5% may be more appropriate 3

Evidence for Individual Efficacy

Diclofenac Gel

• Conditionally recommended by the American College of Rheumatology for knee osteoarthritis 1
• Shown to be effective regardless of age, with similar efficacy in both younger (25-64 years) and older (≥65 years) patients 4
• Provides targeted pain relief with less systemic exposure than oral NSAIDs 4

Lidocaine 5% Products

• Effective for localized pain relief without significant systemic effects 3
• Studies show significant improvement in pain qualities associated with osteoarthritis when used as monotherapy or add-on therapy 5
• Optimal anesthetic effects typically observed between 35-40 minutes after application 6

Monitoring and Precautions

Watch For

• Local skin reactions (redness, irritation) at application sites
• For diclofenac: avoid showering/bathing for at least 30 minutes after application 2
• For lidocaine: monitor for signs of systemic absorption (dizziness, numbness around mouth) 3

Best Practices

• Always wash hands thoroughly after application 2
• Do not apply to open wounds or damaged skin 2
• Do not use external heat or occlusive dressings over treated areas 2
• Avoid sun exposure to treated areas 2

Alternative Pain Management Approaches

If you need additional pain control beyond what a single topical agent provides, consider:

• Physical therapy and exercise programs 1
• Weight loss if overweight 1
• Oral acetaminophen (if not contraindicated) 1
• Intra-articular corticosteroid injections for acute flares 1
• Self-management programs and psychosocial interventions 1

Remember that topical treatments are just one component of comprehensive osteoarthritis management, and combining them inappropriately may reduce their effectiveness or increase risk of adverse effects.