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. È necessaria una valutazione medica completa prima di emettere qualsiasi prescrizione.

Posologia

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.

Effetti collaterali

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

Effetti collaterali comuni (possono interessare fino a 1 persona su 10)

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

Effetti collaterali non comuni ma gravi

• 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) è un farmaco soggetto a prescrizione medica in tutti gli stati membri dell’UE. Non può essere legalmente dispensato senza una prescrizione valida da parte di un professionista medico autorizzato.

Prescrivia opera come piattaforma intermediaria tecnologica: non prescriviamo farmaci, non impieghiamo medici né vendiamo medicinali. La nostra piattaforma mette in contatto i pazienti con medici indipendenti registrati nell’UE che possono condurre valutazioni sanitarie online riservate.

Il processo funziona come segue:

1. Completi una valutazione della salute: Risponda a un insieme strutturato di domande sulla salute covering your medical history, cardiovascular and gastrointestinal risk factors, current medications, and the nature of your pain or inflammatory condition.
2. Revisione medica: Un medico indipendente registrato nell’UE esamina la Sua valutazione. 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. Prescrizione e dispensazione: Se viene emessa una prescrizione, viene inoltrata a una farmacia partner autorizzata dell’UE, che dispensa e spedisce il farmaco direttamente a Lei.

Importante: Prescrivia non garantisce che venga emessa una prescrizione. Tutte le decisioni prescrittive vengono prese in modo indipendente da professionisti medici qualificati in base alle Sue circostanze cliniche individuali.

Informazioni importanti sulla sicurezza

Non utilizzi Voltaren se Lei:

• 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

Informi il Suo medico prima di 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

Interazioni farmacologiche: 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. Informi sempre il Suo medico di tutti i farmaci attualmente assunti.

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

Fonti

Le informazioni mediche presenti in questa pagina si basano sulle seguenti fonti:

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

Questo contenuto viene rivisto periodicamente per riflettere le linee guida cliniche aggiornate. Viene fornito esclusivamente a scopo informativo e non costituisce consulenza medica. Consulti sempre un professionista sanitario qualificato per consigli pertinenti alle Sue circostanze di salute individuali.