Early 2008, two non-steroidal anti-inflammatory drugs (NSAIDs) will finally become available commercially in a topical form; Voltaren Gel and the Flector Patch. Both of these preparations are different versions of the NSAID diclofenac. Over the years, NSAIDS have proven to be a valuable weapon in the arsenal against pain. Other examples of NSAIDS include medications like aspirin, ibuprofen and naproxen.

These drugs are especially helpful when inflammation is present and are used for a variety of painful conditions. Until now, NSAIDS were only available in pill form. This is unfortunate because NSAIDS that are given in a cream, ointment, gel or patch form are thought to be less likely to cause side effects like stomach ulcers. In the U.S., it was possible to get topical NSAID preparations, however, they had to be specially made by a pharmacist at a compounding pharmacy. Having these preparations commercially available will greatly increase the availability of these topical products.

Voltaren Gel is effective for osteoarthritis pain of the joints, particularly in the hands, elbows and knees. You can apply Volatren Gel up to four times a day. Generally, 2 to 4 grams of gel are used at each dose. One should not exceed 32 grams in one day. The amount of gel for each dose can be measured on a dosing card that comes with the medication. The gel should be massaged into the affected area. The area should not be washed for at least an hour after application to help ensure absorption.

The Flector Patch is probably more helpful for minor strains and sprains. It should be applied to the most painful area. It may not be as helpful for joint pain as it may be difficult to apply the patch directly to a joint. The old patch should be removed and a new patch should be applied every 12 hours. If irritation occurs, discontinue the use of the patch.
 
Remember that although it is thought that topical NSAIDS cause fewer side effects than the pill form, it is still possible for topical NSAIDS to cause side effects and drug interactions. Talk to your doctor before using these topical products with aspirin or oral NSAIDs. Also tell your doctor if you are taking blood thinners like warfarin (Coumadin). Topical NSAIDS may increase the risk of bleeding side effects when taken with blood thinners. Make sure your doctor and pharmacist have a list of all of your other medications. Topical NSAIDS have the potential to interact with many other medications including certain blood pressure medications.

Finally, never apply either topical product to an open wound. Generally, you should also not apply heat, such as a heating pad, to areas treated with these products. If you and your doctor decide that you require a different strength of diclofenac gel than is available in the commercial product, the pharmacy can prepare a diclofenac gel of a different strength. If you find that topical diclofenac products do not work well for you, there are a variety of other topical NSAIDS products that your pharmacist can compound for you, with a prescription. 

Author: Christi Larson, Pharm. D.

Dr. Larson is a Clinical Infusion Pharmacist, author of Empowered Medicine; A Guide for Consumers and creator of www.empoweredmedicine.com. You can read more about her by visiting www.EmpoweredMedicine.com and clicking on the 'About Us' tab.  EmpoweredMedicine.com is committed to providing evidence-based medical information.