Can an adult or geriatric patient with no known allergies to Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or significant medical history use Voltaren (diclofenac) gel on their knees after removing a lidocaine patch?

Can You Use Voltaren Gel on Your Knees After Moving a Lidocaine Patch?

Yes, you can safely apply Voltaren (diclofenac) gel to your knees immediately after removing a lidocaine patch, as there are no known drug interactions between topical lidocaine and topical diclofenac, and both medications work through different mechanisms at the application site. 1

Why This Combination is Safe

Different Mechanisms of Action

• Lidocaine works as a local anesthetic by blocking sodium ion channels in nerve fibers, providing numbness and pain relief through a completely different pathway than NSAIDs 2
• Diclofenac functions as an anti-inflammatory agent by inhibiting prostaglandin synthesis, reducing inflammation and pain at the tissue level 1, 3
• These distinct mechanisms mean no pharmacological interaction occurs when applied sequentially to the same area 2, 1

No Documented Drug Interactions

• Multiple clinical guidelines recommend both topical NSAIDs and topical lidocaine as treatment options for musculoskeletal pain without any warnings about combining them 2
• The American College of Rheumatology guidelines for osteoarthritis management list both topical NSAIDs and topical anesthetics as acceptable therapies without contraindications for sequential use 2

Practical Application Guidelines

Timing and Technique

• Remove the lidocaine patch completely and ensure the skin is clean and dry before applying Voltaren gel 1
• Apply 4 grams of diclofenac gel (approximately the size of a cherry or walnut) to each affected knee, four times daily 4
• Gently massage the gel into the skin until fully absorbed 1, 5
• Wash hands thoroughly after application unless treating the hands 1

Expected Benefits

• Voltaren gel provides superior pain relief compared to placebo, with a reduction of approximately 1.08 cm on a 10-cm pain scale within 1-7 days 1
• The combination approach may provide complementary pain relief: immediate numbing from residual lidocaine effects plus anti-inflammatory benefits from diclofenac 2, 1
• Topical diclofenac achieves therapeutic concentrations in underlying muscle and joint tissues while maintaining low systemic absorption 5

Safety Considerations

Skin Assessment

• Ensure the skin where the lidocaine patch was applied shows no irritation, redness, or breakdown before applying Voltaren gel 1
• If any skin irritation exists from the lidocaine patch, wait until the skin has fully recovered before applying diclofenac 1

Common Side Effects

• Local skin reactions occur in approximately 5-10% of patients using topical diclofenac but are generally mild and transient 1, 4
• Application site dermatitis is the most common adverse effect (4-6% incidence) but rarely requires discontinuation 4
• Gastrointestinal side effects are extremely rare with topical formulations compared to oral NSAIDs 1, 4

Special Populations Requiring Caution

• Patients ≥75 years old should preferentially use topical rather than oral NSAIDs, making Voltaren gel an excellent choice 2
• Avoid topical diclofenac on non-intact skin or open wounds 1
• Patients with aspirin allergy or NSAID hypersensitivity should not use Voltaren gel 2

Optimal Treatment Strategy

Comprehensive Knee Pain Management

• Continue Voltaren gel application for at least 1-2 weeks to assess full therapeutic benefit 1
• Consider alternating or combining with the lidocaine patch if pain control remains inadequate, as both can be used as part of multimodal analgesia 2
• If applying both products on the same day, space applications by several hours and apply to clean, dry skin each time 1

When to Seek Additional Treatment

• If pain persists after 2 weeks of consistent Voltaren gel use, consider adding oral acetaminophen or consulting a healthcare provider for alternative therapies 2
• Intra-articular corticosteroid injections may be indicated for acute exacerbations with joint effusion 2
• Physical therapy and strengthening exercises should be initiated as first-line non-pharmacologic treatment alongside topical therapies 2