Voltaren (Diclofenac)

What is Voltaren?

Voltaren is the brand name for diclofenac, a widely used non-steroidal anti-inflammatory drug (NSAID) approved by the European Medicines Agency (EMA) for the treatment of pain and inflammation. Available in multiple formulations — including oral tablets, modified-release capsules, topical gels, and suppositories — Voltaren is one of the most prescribed analgesic and anti-inflammatory medicines in Europe, indicated for a broad range of acute and chronic pain conditions.

How does Voltaren work?

Diclofenac udøver sine analgetiske, anti-inflammatoriske og antipyretiske virkninger gennem hæmning af cyclooxygenase (COX) enzymsystemet:

• COX enzyme inhibition: Diclofenac hæmmer både COX-1 og COX-2 enzymer, selvom det har en noget højere affinitet for COX-2 end traditionelle ikke-selektive NSAID’er såsom ibuprofen. This inhibition reduces the synthesis of prostaglandins and thromboxanes — lipid mediators central to pain signalling, inflammation, and fever.
• Reduced prostaglandin production: Ved at undertrykke produktionen af prostaglandin E2 på perifere steder med vævsskade og i centralnervesystemet, reducerer diclofenac sensibiliseringen af nociceptorer (smertereceptorer), sænker smerteintensiteten og følelsen af inflammation.
• Anti-oedema effects: Reduced prostaglandin synthesis limits vasodilation and oedema (fluid accumulation) at sites of inflammation, reducing swelling and joint stiffness.
• Topical penetration: In gel formulations, diclofenac penetrates through the skin into underlying muscle, tendon, and joint tissue, achieving therapeutic local concentrations while minimising systemic absorption — an important advantage for patients who cannot tolerate oral NSAIDs.

Onset of analgesic effect following oral administration typically occurs within 30 to 60 minutes, with peak plasma concentrations at one to two hours.

Who is Voltaren for?

Receptpligtig diclofenac er indiceret til voksne under følgende tilstande:

• Osteoarthritis and rheumatoid arthritis: Reduction of joint pain, stiffness, and inflammation
• Ankylosing spondylitis: Anti-inflammatory management of spinal inflammatory disease
• Acute musculoskeletal disorders: Sprains, strains, back pain, tendinitis, and bursitis
• Primary dysmenorrhoea: Relief of menstrual pain and cramping
• Acute gout: Anti-inflammatory treatment during gout flares
• Migraine: Diclofenac potassium tablets are specifically approved for acute migraine treatment in some EU markets
• Post-operative and post-traumatic pain: Short-term management of pain following injury or surgery

Diclofenac is not appropriate for patients with active peptic ulcer disease, severe heart failure, severe renal or hepatic impairment, established ischaemic heart disease or stroke, known hypersensitivity to NSAIDs, or those in the third trimester of pregnancy. En fuldstændig lægelig vurdering er påkrævet, før der udstedes en recept.

Dosage

Dosering varierer efter formulering og indikation. Følgende gælder for oral diclofenac:

Indication	Typical Dose	Frequency	Maximum Daily Dose
Osteoarthritis / Rheumatoid arthritis	50 mg	2–3 times daily	150 mg/day
Modified-release tablet	75–100 mg	Once or twice daily	150 mg/day
Ankylosing spondylitis	100–125 mg	Split doses	125 mg/day
Primary dysmenorrhoea	50–100 mg initially	Then 50 mg every 8h	200 mg on day 1
Acute migraine	50 mg (diclofenac-K)	Once, repeat if needed	200 mg/day

Diclofenac bør tages sammen med mad eller mælk for at reducere mave-tarm irritation. Tabletter med modificeret frigivelse skal sluges hele. Den laveste effektive dosis bør anvendes i den korteste varighed i overensstemmelse med behandlingsmålene.

Topiske geler (f.eks. Voltaren Gel) påføres direkte på det berørte led eller muskelområde. Doseringen for topiske præparater er angivet på produktetiketten og adskiller sig fra orale formuleringer.

Side effects

Bivirkningsprofilen for diclofenac afspejler dem, der er fælles for alle NSAID’er, med den kardiovaskulære risikoprofil for COX-2-foretrukne NSAID’er også relevant.

Common side effects (may affect up to 1 in 10 people)

• Indigestion (dyspepsia) and heartburn
• Nausea
• Diarrhoea
• Abdominal pain
• Headache
• Dizziness
• Elevated liver enzymes (transaminases)

Less common but serious side effects

• Gastrointestinal bleeding and ulceration: NSAID’er kan forårsage mavesår, gastrointestinale blødninger og perforering. Risikoen er højere ved langvarig brug, hos ældre patienter og hos dem med tidligere GI-sygdom i anamnesen. Søg øjeblikkelig lægehjælp, hvis der opstår sort eller tjæreagtig afføring, blodopkastning eller stærke mavesmerter.
• Cardiovascular events: Diclofenac, particularly at higher doses and with prolonged use, is associated with an increased risk of heart attack and stroke. European regulatory authorities have emphasised that diclofenac’s cardiovascular risk profile is similar to selective COX-2 inhibitors and should be considered in prescribing decisions.
• Hepatotoxicity: Diclofenac is associated with a higher rate of drug-induced liver injury than some other NSAIDs. Elevated liver enzymes are common; serious hepatic reactions are rare but reported. Liver function should be monitored in long-term users.
• Renal impairment: NSAIDs reduce prostaglandin-mediated renal blood flow. Risk of acute kidney injury increases in elderly patients, those with pre-existing kidney disease, or those with hypovolaemia.
• Severe allergic reactions: Herunder anafylaksi og Stevens-Johnsons syndrom. Risikoen er højere hos patienter med tidligere NSAID-overfølsomhed eller aspirin-forværret luftvejssygdom.

Dette er ikke en komplet liste over bivirkninger. Se det EMA-godkendte produktresumé for fuldstændige ordinationsdetaljer.

How to get Voltaren online in Europe

Prescription-strength Voltaren (diclofenac) is a prescription-only medicine (POM) across all EU member states. It cannot be legally dispensed without a valid prescription from a licensed medical professional.

Prescrivia operates as a technology intermediary platform: we do not prescribe medicines, employ doctors, or sell medicines. Our platform connects patients with independent EU-registered doctors who can conduct confidential online health assessments.

The process works as follows:

1. Complete a health assessment: Besvar et struktureret sæt sundhedsspørgsmål, der dækker din sygehistorie, kardiovaskulære og gastrointestinale risikofaktorer, nuværende medicin og arten af din smerte eller inflammatoriske tilstand.
2. Doctor review: En uafhængig EU-registreret læge gennemgår din vurdering. Hvis diclofenac er klinisk passende for dine forhold, kan de udstede en recept. Hvis det ikke er hensigtsmæssigt, vil lægen rådgive om passende alternativer.
3. Prescription and fulfilment: Hvis en recept udstedes, videresendes den til en godkendt EU-apotekspartner, som udleverer og sender medicinen direkte til dig.

Important: Prescrivia garanterer ikke, at der vil blive udstedt en recept. Alle ordinationsbeslutninger træffes uafhængigt af kvalificerede læger baseret på dine individuelle kliniske forhold.

Important safety information

Do not use Voltaren if you:

• Have active peptic ulcer disease, gastrointestinal bleeding, or a prior history of NSAID-related GI complications
• Have established ischaemic heart disease, peripheral arterial disease, or cerebrovascular disease (including prior stroke or TIA)
• Have severe heart failure, severe hepatic impairment, or severe renal impairment
• Have had an allergic reaction (urticaria, asthma, rhinitis) after taking aspirin or any other NSAID
• Are in the third trimester of pregnancy or breastfeeding

Tell your doctor before starting Voltaren if you have:

• Cardiovascular risk factors (hypertension, high cholesterol, diabetes, smoking)
• A history of gastrointestinal ulcers or GI bleeding
• Liver or kidney disease
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Asthma or other respiratory conditions
• Fluid retention or oedema
• A bleeding disorder or are taking anticoagulants

Drug interactions: Diclofenac interagerer med antikoagulantia (warfarin, heparin, nyere antikoagulantia - øget blødningsrisiko), lithium (øgede lithiumniveauer), methotrexat (øget toksicitet), ACE-hæmmere og diuretika, øget N-nyre- og diuretika-risiko (reduceret N-nyre- og nyreeffekt) (øget GI-risiko), ciclosporin (øget nefrotoksicitet) og CYP2C9-hæmmere. Fortæl altid din læge om al nuværende medicin.

Diclofenac should not be used as a long-term treatment without regular medical review, including monitoring of liver function and cardiovascular and renal status.

Sources

Medicinsk information på denne side er baseret på følgende kilder:

• Det Europæiske Lægemiddelagentur (EMA). Diclofenac — Cardiovascular risk: updated restrictions on use. EMA/592685/2013.
• Det Europæiske Lægemiddelagentur (EMA). Voltaren — Summary of Product Characteristics. Tilgængelig på: ema.europa.eu
• World Health Organization (WHO). WHO Model List of Essential Medicines — Anti-inflammatory medicines. who.int
• McGettigan P, Henry D. Cardiovascular risk and inhibition of cyclooxygenase — A systematic review of the observational studies of selective and nonselective inhibitors of cyclooxygenase 2. JAMA. 2006;296(13):1633-1644.

Dette indhold gennemgås med jævne mellemrum for at afspejle opdateret klinisk vejledning. Den gives kun til informationsformål og udgør ikke medicinsk rådgivning. Rådfør dig altid med en kvalificeret sundhedsperson for rådgivning, der er relevant for dine individuelle helbredsforhold.