Recommended Dosing for Topical Diclofenac (Voltarin)
For topical diclofenac (Voltarin), the recommended dose is application of diclofenac 3% gel twice daily for 60-90 days for optimal efficacy. 1
Formulations and Application Guidelines
Topical diclofenac is available in several formulations:
- Diclofenac 3% in 2.5% hyaluronic gel: Apply twice daily for 60-90 days 1
- Diclofenac gel: Apply three times daily 1
- Diclofenac patch - 180 mg: Apply one patch daily or one patch twice daily 1
- Diclofenac sodium 2% topical solution: Apply twice daily 2
Efficacy and Evidence
Topical diclofenac has demonstrated significant efficacy in multiple clinical trials:
- Vehicle-controlled studies showed 70% clearance of target lesions after 60 days of treatment with diclofenac 3% gel compared to 44% with vehicle alone 1
- Another study showed 50% complete clearance after 90 days of treatment versus 20% with vehicle alone (p<0.001) 1
- Extending treatment from 90 to 180 days provides an additional 5% complete clearance without significant increase in adverse effects 1
Advantages of Topical Diclofenac
Topical diclofenac offers several benefits:
- Acts locally with minimal systemic absorption 1, 3
- Can be used as coanalgesic in combination with other pain medications 1
- Causes less intense local skin reactions than other topical treatments like 5-FU or imiquimod 5% cream 1
- Patient satisfaction is high (73%) despite somewhat lower efficacy compared to 5-FU (77%) 1
Application Technique
For optimal results:
- Apply to clean, dry skin
- Rub in gently until absorbed
- Wash hands after application unless treating hands
- For diclofenac patch, apply to the affected area and leave in place for the recommended duration
Potential Side Effects
Common side effects include:
- Pruritus (41% after 30 days of treatment) 1
- Rash (40% after 60 days) 1
- Generally well-tolerated with fewer systemic effects than oral NSAIDs 3
Special Considerations
- Percutaneous absorption of diclofenac is approximately 3-6% of the applied dose 3
- Upon daily topical administration, steady-state plasma levels are typically 20-40 nmol/L 3
- Topical diclofenac penetrates into target tissues, with concentrations in muscle tissue near the application site approximately 3 times higher than in distant muscle tissue 3
When to Consider Alternative Treatments
Consider alternative treatments when:
- Patient has inadequate response after 90 days of treatment
- Patient experiences intolerable side effects
- Treatment of more severe or thicker lesions is required (cryotherapy may be more effective) 1
Topical diclofenac offers an effective treatment option with a favorable side effect profile compared to other topical agents, making it a valuable choice for localized pain management.