Can I use Voltaren (diclofenac) gel topical and naproxen pill at the same time?

Using Voltaren Gel and Naproxen Together: Safety Considerations

Using topical diclofenac (Voltaren gel) and oral naproxen together is not recommended due to increased risk of adverse effects, particularly gastrointestinal bleeding, cardiovascular events, and renal complications.

Rationale for This Recommendation

Drug Interaction Concerns

The FDA drug label for topical diclofenac explicitly warns against combination therapy with oral NSAIDs, stating:

• Concomitant use of oral NSAIDs with diclofenac sodium topical solution resulted in higher rates of rectal hemorrhage (3% vs. <1%) and more frequent abnormal laboratory values for creatinine, urea, and hemoglobin 1
• The combination of diclofenac with other NSAIDs increases the risk of gastrointestinal toxicity with little or no increase in efficacy 1

Cardiovascular Risks

Both medications carry cardiovascular risks:

• Diclofenac is associated with increased risk of cardiovascular thrombotic events (RR 1.63) compared to placebo 2
• All NSAIDs, including naproxen, carry cardiovascular risks including myocardial infarction, stroke, heart failure, and hypertension 2
• Using multiple NSAIDs simultaneously can compound these risks 3

Gastrointestinal Risks

The combination significantly increases gastrointestinal risks:

• NSAIDs cause an increased risk of serious gastrointestinal adverse events including inflammation, bleeding, ulceration, and perforation 2
• The risk of gastrointestinal bleeding is increased with chronic use of NSAIDs 2
• Using multiple NSAIDs enhances antiplatelet effects, leading to increased bleeding risk 3

Renal Considerations

Both medications can affect kidney function:

• NSAIDs can cause volume-dependent renal failure and other renal complications 3
• The risk of kidney damage is doubled when using multiple NSAIDs 3

Alternative Approaches

If you need pain relief, consider these safer alternatives:

1. Use only one NSAID at a time:

   • Either topical diclofenac OR oral naproxen, not both together
   • Topical diclofenac has shown comparable efficacy to oral NSAIDs with fewer systemic side effects 4

2. Consider topical diclofenac alone:

   • Long-term studies show topical diclofenac is well-tolerated even in elderly patients and those with comorbidities like hypertension, diabetes, and cardiovascular disease 5
   • Topical application provides localized pain relief with minimal systemic absorption 2

3. Consider acetaminophen with a single NSAID:

   • Acetaminophen can provide complementary pain relief with fewer GI side effects 3
   • Acetaminophen can be nearly as efficacious as NSAIDs for some types of pain 3

Special Considerations

• If you must use both: If your healthcare provider determines the benefits outweigh the risks, regular laboratory monitoring is essential to check for signs of bleeding, kidney dysfunction, or other complications 1

• For elderly patients: The risk of adverse effects is higher; topical NSAIDs are generally safer than oral formulations 2

• For patients with existing conditions:

  • Cardiovascular disease: Both medications increase risk; consider non-NSAID alternatives
  • GI issues: Use of multiple NSAIDs significantly increases bleeding risk
  • Renal impairment: Both medications can worsen kidney function

Common Pitfalls to Avoid

• Using multiple NSAID formulations simultaneously without medical supervision
• Failing to recognize that topical NSAIDs still have some systemic absorption
• Ignoring early warning signs of GI bleeding, cardiovascular issues, or kidney problems

Remember that optimizing the dose of a single NSAID is generally safer and often just as effective as combining multiple NSAIDs. Always consult with your healthcare provider before making changes to your medication regimen.