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 exerts its analgesic, anti-inflammatory, and antipyretic effects through inhibition of the cyclooxygenase (COX) enzyme system:

• COX enzyme inhibition: Diclofenac inhibits both COX-1 and COX-2 enzymes, though it has a somewhat higher affinity for COX-2 than traditional non-selective NSAIDs such as ibuprofen. This inhibition reduces the synthesis of prostaglandins and thromboxanes — lipid mediators central to pain signalling, inflammation, and fever.
• Reduced prostaglandin production: By suppressing prostaglandin E2 production at peripheral sites of tissue injury and in the central nervous system, diclofenac reduces the sensitisation of nociceptors (pain receptors), lowering pain intensity and the sensation of 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?

Prescription-strength diclofenac is indicated for adults in the following conditions:

• 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. Se requiere una evaluación médica completa antes de emitir cualquier receta.

Posología

Dosing varies by formulation and indication. The following applies to 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 should be taken with food or milk to reduce gastrointestinal irritation. Modified-release tablets should be swallowed whole. The lowest effective dose should be used for the shortest duration consistent with treatment goals.

Topical gels (e.g., Voltaren Gel) are applied directly to the affected joint or muscle area. The dosing for topical preparations is specified on the product label and differs from oral formulations.

Efectos secundarios

The side effect profile of diclofenac reflects those common to all NSAIDs, with the cardiovascular risk profile of COX-2-preferring NSAIDs also relevant.

Efectos secundarios frecuentes (pueden afectar hasta a 1 de cada 10 personas)

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

Efectos secundarios poco frecuentes pero graves

• Gastrointestinal bleeding and ulceration: NSAIDs can cause peptic ulcers, gastrointestinal bleeding, and perforation. Risk is higher with prolonged use, in elderly patients, and in those with a prior history of GI disease. Seek immediate medical attention if black or tarry stools, vomiting blood, or severe abdominal pain occur.
• 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: Including anaphylaxis and Stevens-Johnson syndrome. Risk is higher in patients with prior NSAID hypersensitivity or aspirin-exacerbated respiratory disease.

This is not a complete list of side effects. Refer to the EMA-approved Summary of Product Characteristics for full prescribing details.

How to get Voltaren online in Europe

Prescription-strength Voltaren (diclofenac) es un medicamento sujeto a prescripción médica en todos los estados miembros de la UE. No puede dispensarse legalmente sin una receta válida de un profesional médico autorizado.

Prescrivia opera como plataforma intermediaria tecnológica: no prescribimos medicamentos, no empleamos médicos ni vendemos medicamentos. Nuestra plataforma conecta a los pacientes con médicos independientes registrados en la UE que pueden realizar evaluaciones de salud en línea confidenciales.

El proceso funciona de la siguiente manera:

1. Complete una evaluación de salud: Responda a un conjunto estructurado de preguntas de salud covering your medical history, cardiovascular and gastrointestinal risk factors, current medications, and the nature of your pain or inflammatory condition.
2. Revisión médica: Un médico independiente registrado en la UE revisa su evaluación. If diclofenac is clinically appropriate for your circumstances, they may issue a prescription. If it is not appropriate, the doctor will advise on suitable alternatives.
3. Prescripción y dispensación: Si se emite una receta, se remite a una farmacia asociada autorizada de la UE, que dispensa y envía el medicamento directamente a usted.

Importante: Prescrivia no garantiza que se emita una receta. Todas las decisiones de prescripción son tomadas de forma independiente por profesionales médicos cualificados en función de sus circunstancias clínicas individuales.

Información importante de seguridad

No utilice Voltaren si usted:

• 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

Informe a su médico antes de 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

Interacciones medicamentosas: Diclofenac interacts with anticoagulants (warfarin, heparin, newer anticoagulants — increased bleeding risk), lithium (increased lithium levels), methotrexate (increased toxicity), ACE inhibitors and diuretics (reduced efficacy, increased renal risk), other NSAIDs and aspirin (increased GI risk), ciclosporin (increased nephrotoxicity), and CYP2C9 inhibitors. Informe siempre a su médico de todos los medicamentos que toma actualmente.

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

Fuentes

La información médica de esta página se basa en las siguientes fuentes:

• European Medicines Agency (EMA). Diclofenac — Cardiovascular risk: updated restrictions on use. EMA/592685/2013.
• European Medicines Agency (EMA). Voltaren — Summary of Product Characteristics. Disponible en: 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.

Este contenido se revisa periódicamente para reflejar las directrices clínicas actualizadas. Se proporciona únicamente con fines informativos y no constituye asesoramiento médico. Consulte siempre a un profesional sanitario cualificado para obtener asesoramiento relevante para sus circunstancias de salud individuales.