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, not exceeding 16 grams total per day. When considering the treatment of pain associated with degenerative arthritis, the North of England evidence-based guideline development project recommends initial treatment with paracetamol, and if symptoms persist, ibuprofen or alternative drugs such as diclofenac may be considered 1. However, for the specific use of Voltaren gel, the dosage and frequency are crucial for effective pain management. The recommended application is for most joints, apply 2 grams (roughly the size of a cherry or a quarter) to cover a 4x4 inch area, and for larger joints like the knee, 4 grams (about the size of a walnut) may be needed 1. It's essential to gently rub the gel into the skin until it disappears, then wash your hands unless they're the treatment area, and allow the gel to dry before covering with clothing or bandages. Most patients should use Voltaren for no longer than 7-14 days for acute pain, though some conditions may require longer treatment under medical supervision. Key considerations include:
- Application amount: 2-4 grams per application
- Frequency: 4 times daily
- Maximum daily dose: 16 grams
- Duration for acute pain: 7-14 days
- Potential risks with prolonged use or in patients with certain medical conditions. Given the information from the studies, particularly the NSAID prescribing precautions 1, it's clear that the dosage and frequency of Voltaren gel are critical for balancing efficacy and safety.
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 and frequency of Voltaren gel, which contains diclofenac, can vary depending on the specific condition being treated and the individual patient's response to the medication 3, 4.
- For osteoarthritis, the typical dose is 2-4 grams of gel applied to the affected area 2-4 times a day 4.
- Studies have shown that topical diclofenac, such as Voltaren gel, can provide significant pain relief for patients with osteoarthritis, with a number needed to treat (NNT) of 9.8 for clinical success 3.
- The efficacy and safety of diclofenac in osteoarthritis have been demonstrated in several studies, including a network meta-analysis of unpublished legacy studies 5.
- While the exact dose and frequency of Voltaren gel may vary, it is generally recommended to apply the gel to the affected area 2-4 times a day, as needed, and to avoid applying more than 16 grams of gel per day 4, 6.
Potential Side Effects and Interactions
- Common side effects of Voltaren gel include mild skin irritation, such as redness, itching, and burning 3, 4.
- Less common side effects may include gastrointestinal upset, such as nausea and diarrhea, although these are generally less frequent than with oral NSAIDs 3, 5.
- Patients should be advised to avoid applying Voltaren gel to open wounds or broken skin, and to avoid using the gel in combination with other topical medications or oral NSAIDs without consulting a healthcare provider 4, 6.
Mechanism of Action and Efficacy
- Diclofenac, the active ingredient in Voltaren gel, works by inhibiting the production of prostaglandins, which are hormone-like substances that cause pain and inflammation 6.
- The gel formulation allows for targeted delivery of the medication to the affected area, reducing systemic absorption and minimizing the risk of side effects 3, 4.
- Studies have demonstrated the efficacy of topical diclofenac in reducing pain and inflammation in patients with osteoarthritis and other musculoskeletal conditions 3, 5.