From the Guidelines
Voltaren gel (diclofenac sodium 1%) should be applied to the affected area 4 times daily in amounts of 2-4 grams per application, depending on the size of the area being treated, with a maximum total daily dose not exceeding 16 grams spread across all treated areas. For most joints like knees, ankles, or feet, use 2 grams (roughly the size of a quarter) per application. For larger areas like hips, shoulders, or elbows, use 4 grams per application. When applying, squeeze the gel onto your hand and gently rub it into the affected area until absorbed, then wash your hands unless they are the treatment area. Voltaren works by reducing inflammation and pain by blocking prostaglandin production through COX enzyme inhibition. This topical NSAID provides localized pain relief with less systemic absorption than oral NSAIDs, potentially reducing gastrointestinal side effects, as supported by studies such as 1. However, even with topical application, you should avoid using other oral NSAIDs simultaneously to prevent increased side effect risks, and discontinue use and consult your doctor if skin irritation occurs or if no improvement is seen after 7 days.
The evidence from studies like 1 suggests that topical NSAIDs, such as Voltaren gel, are a useful option in those unwilling or unable to take oral NSAIDs, with a positive effect size compared to placebo. It's also important to note that the use of Voltaren gel should be considered in the context of other treatment options for knee osteoarthritis, including paracetamol and intra-articular steroid injections, as outlined in guidelines such as 1.
In terms of specific dosing, the evidence from studies like 1 is not directly applicable to Voltaren gel, as it refers to oral doses of 500–750 mg twice daily. However, the recommended dosing for Voltaren gel is based on the principle of using the minimum effective dose to minimize side effects, while still providing adequate pain relief.
Key points to consider when using Voltaren gel include:
- Apply 2-4 grams to the affected area 4 times daily
- Maximum total daily dose: 16 grams
- Avoid using other oral NSAIDs simultaneously
- Discontinue use and consult your doctor if skin irritation occurs or if no improvement is seen after 7 days
- Consider alternative treatment options, such as paracetamol or intra-articular steroid injections, as needed.
From the FDA Drug Label
The recommended dose is 2 pump actuations on each painful knee, 2 times a day. Dispense 40 mg (2 pump actuations) directly onto the knee or first into the hand and then onto the knee. For relief of the pain of osteoarthritis (OA) of the knee(s), the recommended dose is 40 mg of diclofenac sodium (2 pump actuations) on each painful knee, 2 times a day.
The recommended dose of Voltaren gel is 40 mg (2 pump actuations) on each painful knee, 2 times a day.
- Apply the gel to clean, dry skin.
- Spread evenly around front, back, and sides of the knee.
- Wash hands completely after administering the product 2.
From the Research
Voltaren Gel Dose and Frequency
- The recommended dose of Voltaren gel is 4g applied four times daily to the affected knee 3, 4.
- The gel should be applied to the affected area, and the patient should wait at least 10 minutes before covering the treated area with clothing or applying other topical treatments.
- Studies have shown that topical diclofenac sodium 1% gel (Voltaren Gel) is effective in reducing pain and improving function in patients with knee osteoarthritis, with a low incidence of systemic adverse events 3, 5, 4.
- A novel diclofenac gel (AMZ001) applied once or twice daily has also been shown to be effective in reducing pain in patients with knee osteoarthritis, with a faster onset and longer duration of action compared to traditional topical NSAIDs 6.
Efficacy and Safety
- Topical diclofenac sodium 1% gel has been shown to be effective in reducing pain and improving function in patients with knee osteoarthritis, with significant improvements in WOMAC pain and physical function subscales, as well as global rating of benefit 3, 4.
- The safety profile of topical diclofenac sodium 1% gel is favorable, with a low incidence of systemic adverse events, including gastrointestinal and cardiovascular events 3, 5, 4.
- Application site dermatitis is the most common adverse event associated with topical diclofenac sodium 1% gel, but it is generally mild and transient 3, 4.
Comparison to Other Treatments
- Topical diclofenac sodium 1% gel has been compared to oral NSAIDs and other topical treatments, and has been shown to be effective and well-tolerated, with a lower risk of systemic adverse events 7, 5.
- The use of topical diclofenac sodium 1% gel may be preferred over oral NSAIDs in patients with mild to moderate knee osteoarthritis, particularly in those with a history of gastrointestinal or cardiovascular disease 7, 5.