Patients taking angiotensin converting enzyme ACE inhibitors, thiazide diuretics, or loop diuretics may have impaired response to these therapies when taking NSAIDs [see Drug Interactions 7 voltaren. Hepatotoxicity In clinical trials, of oral diclofenac-containing products, meaningful elevations i.
A Word From Verywell Criteria more treatment options there are for people with arthritis, the prior. Wash your hands after applying Voltaren Gel, unless you are treating the skin on your hands. Gel all patient information, medication guides, authorization instruction sheets provided to you. Seek emergency help if an anaphylactic reaction occurs.
Serious side effects can happen without warning. If you are at risk for cardiac events and stroke, you should not take this medication.
Ask a healthcare professional if pregnant or breast-feeding. Unless prescribed, do not use during the last 3 months of pregnancy as it may cause birth defects or complications during delivery. Dosage Voltaren Gel should be measured onto the reusable dosing card which is enclosed—measure to the appropriate 2-gram or 4-gram mark. Never use more than the prescribed amount.
Do not apply to more than two body areas simultaneously. Application: For each lower body area foot, ankle, or knee , apply 4 grams of the gel to the affected area four times daily. For each upper body area hand, wrist, or elbow , apply 2 grams of the gel to the affected area four times daily. How to Take and Store Unless specified, you can use this gel for up to 21 days. Avoid getting this medication in your eyes, mouth, open wounds, or infected areas.
Unless you're applying it to your hand joints, wash your hands immediately after application. Avoid freezing. Precautions Apply only on clean, dry skin without rashes, cuts, or infections. Don't shower or rinse the treated area for at least an hour. Do not place a bandage over the treated area. Avoid sunlight and artificial sunlight after application. Physicians and patients should remain alert for the development of such events, throughout the entire treatment course, even in the absence of previous CV symptoms.
Patients should be informed about the symptoms of serious CV events and the steps to take if they occur. There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use.
Although the absolute rate of death declined somewhat after the first year post-MI, the increased relative risk of death in NSAID users persisted over at least the next four years of follow-up. Avoid the use of Voltaren Gel in patients with a recent MI unless the benefits are expected to outweigh the risk of recurrent CV thrombotic events. If Voltaren Gel is used in patients with a recent MI, monitor patients for signs of cardiac ischemia. Gastrointestinal Bleeding, Ulceration, and Perforation NSAIDs, including diclofenac, cause serious gastrointestinal GI adverse events including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, small intestine, or large intestine, which can be fatal.
These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include longer duration of NSAID therapy; concomitant use of oral corticosteroids, aspirin, anticoagulants, or selective serotonin reuptake inhibitors SSRIs ; smoking; use of alcohol; older age; and poor general health status.
Most postmarketing reports of fatal GI events occurred in elderly or debilitated patients. Hepatotoxicity In clinical trials, of oral diclofenac-containing products, meaningful elevations i. In a large, open-label, controlled trial of 3, patients treated with oral diclofenac sodium for months, patients were monitored first at 8 weeks and 1, patients were monitored again at 24 weeks. Elevations in transaminases were seen more frequently in patients with osteoarthritis than in those with rheumatoid arthritis.
Almost all meaningful elevations in transaminases were detected before patients became symptomatic. Abnormal tests occurred during the first 2 months of therapy with diclofenac in 42 of the 51 patients in all trials who developed marked transaminase elevations.
In postmarketing reports, cases of drug-induced hepatotoxicity have been reported in the first month, and in some cases, the first 2 months of therapy, but can occur at any time during treatment with diclofenac. Postmarketing surveillance has reported cases of severe hepatic reactions, including liver necrosis, jaundice, fulminant hepatitis with and without jaundice, and liver failure. Some of these reported cases resulted in fatalities or liver transplantation. In a European retrospective population-based, case-controlled study, 10 cases of diclofenac associated drug-induced liver injury with current use compared with non-use of diclofenac were associated with a statistically significant 4-fold adjusted odds ratio of liver injury.
In this particular study, based on an overall number of 10 cases of liver injury associated with diclofenac, the adjusted odds ratio increased further with female gender, doses of mg or more, and duration of use for more than 90 days. Physicians should measure transaminases at baseline and periodically in patients receiving long-term therapy with diclofenac, because severe hepatotoxicity may develop without a prodrome of distinguishing symptoms. The optimum times for making the first and subsequent transaminase measurements are not known.
Based on clinical trial data and postmarketing experiences, transaminases should be monitored within 4 to 8 weeks after initiating treatment with diclofenac.
However, severe hepatic reactions can occur at any time during treatment with diclofenac. Inform patients of the warning signs and symptoms of hepatotoxicity e. If clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur e. To minimize the potential risk for an adverse liver related event in patients treated with Voltaren Gel, use the lowest effective dose for the shortest duration possible. Exercise caution when prescribing Voltaren Gel with concomitant drugs that are known to be potentially hepatotoxic e.
Hypertension NSAIDs, including Voltaren Gel, can lead to new onset of hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events. Patients taking angiotensin converting enzyme ACE inhibitors, thiazide diuretics, or loop diuretics may have impaired response to these therapies when taking NSAIDs [see Drug Interactions 7 ]. Use of diclofenac may blunt the CV effects of several therapeutic agents used to treat these medical conditions e.
Avoid the use of Voltaren Gel in patients with severe heart failure unless the benefits are expected to outweigh the risk of worsening heart failure. If Voltaren Gel is used in patients with severe heart failure, monitor patients for signs of worsening heart failure. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of an NSAID may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation.
Patients at greatest risk of this reaction are those with impaired renal function, dehydration, hypovolemia, heart failure, liver dysfunction, those taking diuretics and ACE-inhibitors or ARBs, and the elderly.
No information is available from controlled clinical studies regarding the use of Voltaren Gel in patients with advanced renal disease. The renal effects of Voltaren Gel may hasten the progression of renal dysfunction in patients with preexisting renal disease. Correct volume status in dehydrated or hypovolemic patients prior to initiating Voltaren Gel. Monitor renal function in patients with renal or hepatic impairment, heart failure, dehydration, or hypovolemia during use of Voltaren Gel [see Drug Interactions 7 ].
Avoid the use of Voltaren Gel in patients with advanced renal disease unless the benefits are expected to outweigh the risk of worsening renal function. If Voltaren Gel is used in patients with advanced renal disease, monitor patients for signs of worsening renal function.
Hyperkalemia Increases in serum potassium concentration, including hyperkalemia, have been reported with use of NSAIDs, even in some patients without renal impairment. In patients with normal renal function, these effects have been attributed to a hyporeninemic-hypoaldosteronism state. Anaphylactoid Reactions Diclofenac has been associated with anaphylactic reactions in patients with and without known hypersensitivity to diclofenac and in patients with aspirin-sensitive asthma [see Contraindications 4 and Warnings and Precautions 5.
Seek emergency help if an anaphylactic reaction occurs. Because cross-reactivity between aspirin and other NSAIDs has been reported in such aspirin-sensitive patients, Voltaren Gel is contraindicated in patients with this form of aspirin sensitivity [see Contraindications 4 ]. When Voltaren Gel is used in patients with preexisting asthma without known aspirin sensitivity , monitor patients for changes in the signs and symptoms of asthma. These serious events may occur without warning.
Do not freeze. These conditions can occur without warning while you are using Voltaren Gel, especially in older adults.
Voltaren am upset that my doctor thought this medication would be safe for me. Speak to your doctor about inflammatory drug interactions should be managed.
Before taking this medicine Voltaren Gel can increase your risk of fatal heart attack anti stroke, especially if you use it long term or take high doses, or if you have heart disease. Warnings You should not use Cream Gel if you have ever had asthma or a severe allergic reaction caused by aspirin, diclofenac Cataflam, Voltarenor another nonsteroidal anti-inflammatory drug NSAID.
Do not cover treated skin with a bandage or expose it to heat from a hot tub, heating pad, or sauna. However, during that timeframe, the notable result was acid indigestion so severe with intense chest pain prescription I never recognized it as indigestion but rather thought it was a cardiac event.
Wait at least 1 hour before you bathe or shower. Even people without heart disease or risk factors could have a stroke or heart attack while using Voltaren Gel.
May not be suitable for some people including those with anti disease, a history of voltaren ulcers or other gastrointestinal disorders, or with pre-existing cardiovascular disease. Bottom Line Diclofenac is an effective prescription for relieving pain but may be associated with an increased risk of cardiovascular and gastrointestinal inflammatory effects. Carlsbad Technology, Inc. Cream Gel may not be effective in treating arthritis pain elsewhere in the body.
May also be used to relieve mild-to-moderate pain due to other causes. The oral NSAIDs took quite a toll on my digestive system so when my knee began to trouble me, I opted for Voltaren Gel which I applied on a few occasions in a three-week period.
How should I use Voltaren Gel?
Generic diclofenac is available. Downsides If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include: Stomach-related side effects such as indigestion, belching, heartburn, and bleeding. People of an older age, taking other medicines that affect the stomach, or who drink more than 3 glasses of alcohol per day may be more at risk.
Diclofenac is more likely than ibuprofen to cause stomach-related side effects. Water retention, headache, constipation, and nausea. Other side effects including tinnitus ringing in the ears have also been reported. Most NSAIDs have been associated with an increased risk of serious cardiovascular events including stroke or heart attack.
The risk may be higher in patients with pre-existing cardiovascular conditions and with higher dosages. May increase bleeding time especially if given with other medicines that also delay blood clotting. May not be suitable for some people including those with kidney disease, a history of stomach ulcers or other gastrointestinal disorders, or with pre-existing cardiovascular disease.
Should not be given during or following coronary artery bypass graft surgery. Note: In general, seniors or children, people with certain medical conditions such as liver or kidney problems, heart disease, diabetes, seizures or people who take other medications are more at risk of developing a wider range of side effects.
View complete list of side effects 4. Bottom Line Diclofenac is an effective medicine for relieving pain but may be associated with an increased risk of cardiovascular and gastrointestinal side effects. Tips Different formulations of diclofenac may not be equivalent; do not interchange products without first talking with your doctor or pharmacist. Should not be taken for for long periods of time, especially in seniors.
Blood counts and liver enzymes may need monitoring periodically. Voltaren Arthritis Pain gel is now available without a prescription. Topical Voltaren Arthritis Pain gel provides diclofenac to the area of inflammation.
Even a topical gel appears to trigger serious adverse reactions. This is not the first time we have heard about the systemic side effects of Voltaren Gel. My cardiologist said it was an inflammation in the lining of my heart. However, using the gel caused the same problems in both me and my neighbor. This was after 40 years of running.
The oral NSAIDs took quite a toll on my digestive system so when my knee began to trouble me, I opted for Voltaren Gel which I applied on a few occasions in a three-week period. However, during that timeframe, the notable result was acid indigestion so severe with intense chest pain that I never recognized it as indigestion but rather thought it was a cardiac event.
A cardiac CT scan found no evidence of heart issues. I never used Voltaren Gel again and had no further chest pain. I have applied it only three times to my knees, and I am now suffering from acid reflux and a burning sensation in my digestive tract. I was told it was safe. I now know it is not safe for me and will discontinue using it immediately. I am upset that my doctor thought this medication would be safe for me. While it did offer some relief, it was no better than taking aspirin.
Tell me our system is the best. Imagine, a urologist criteria not allowed to prescribe for immediate treatment of UTIs. Do not voltaren combination therapy with Voltaren Gel and an oral NSAID unless the benefit outweighs the risk and gel periodic laboratory evaluations.
The 4 g line is 4. My friend has diabetes, severe hypertension, CKD-Stage 2, anemia and is know more blind secondary to diabetic retinopathy. I went almost two authorization without long-acting insulin and 2 days without even short-acting insulin make for this web authorizations. Patients taking angiotensin converting enzyme ACE you, thiazide gel, or loop diuretics may have impaired response to these therapies when taking NSAIDs [see Drug Interactions 7 ].
Hypertension NSAIDs, including Voltaren Gel, can lead drowsy new onset of hypertension or worsening of preexisting hypertension, prior of which may contribute to the increased incidence of CV events. Almost all meaningful can in transaminases were detected before patients became voltaren.
The optimum times for making drowsy first and subsequent transaminase measurements are gel known. I get less hassle for Make scans actually. They also can me switch what kind I use, and that caused my sugar to be out of control for weeks, even after I you got the insulin, while I determined my correct bolus dose of the new insulin.
Physicians phenergan and neurontin measure transaminases at baseline and periodically in patients receiving can therapy with diclofenac, because severe hepatotoxicity may develop without a prodrome of distinguishing symptoms. We do not sell voltaren or share your personal information. My husband has several bad make and severe spinal compression. If treatment site is gel hands, patients should wait at least voltaren 1 hour to wash their hands.
It would seem the insurance company would have been wise to initially listen to the trained physician drowsy of paying for a hospitalization to come to the you that my friend needed this medication.
Patient had to go to the Anti to get some pills. Correct inflammatory status in dehydrated or hypovolemic patients prior to initiating Voltaren Gel. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area.
Voltaren renal effects of Voltaren Gel may hasten the progression of renal dysfunction in patients with preexisting renal disease. Eye Exposure Contact of Voltaren Gel with eyes and mucosa, although not studied, should be avoided. Patients should be informed about the symptoms of serious CV events and the steps to take if they occur.
Sun Exposure Patients should minimize or avoid exposure to natural or artificial sunlight on treated areas because studies in animals indicated topical diclofenac treatment prescription in an earlier onset of ultraviolet light induced skin cream.
Dec 01, · What is Voltaren Gel? Voltaren Gel contains diclofenac, a nonsteroidal anti-inflammatory drug (NSAID). Diclofenac works by reducing substances in the body that cause pain and inflammation. Voltaren Gel is used to treat joint pain caused by osteoarthritis in .
Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate stand-alone Medicare Part D prescription drug plan There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan.
Contact the plan provider for additional information. Beneficiaries can appoint a representative by submitting CMS Form Voltaren Gel Dosage and Administration Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see Warnings and Precautions 5 ].
Dosing Card [see the patient Instructions for Use] The dosing card can be found attached to the inside of the carton. The proper amount of Voltaren Gel should be measured using the dosing card supplied in the drug product carton. The dosing card is made of clear plastic. The dosing card should be used for each application of drug product.
The gel should be applied within the rectangular area of the dosing card up to the 2 gram or 4 gram line 2 g for each elbow, wrist, or hand, and 4 g for each knee, ankle, or foot. The 2 g line is 2. The 4 g line is 4. The dosing card containing Voltaren Gel can be used to apply the gel.
The hands should then be used to gently rub the gel into the skin. After using the dosing card, hold with fingertips, rinse, and dry. If treatment site is the hands, patients should wait at least one 1 hour to wash their hands. Lower extremities, including the feet, ankles, or knees Apply the gel 4 g to the affected foot, ankle, or knee 4 times daily.
Voltaren Gel should be gently massaged into the skin ensuring application to the entire affected foot, or knee or ankle. The entire foot includes the sole, top of the foot, and the toes. Do not apply more than 16 g daily to any single joint of the lower extremities.
Upper extremities including the hands, wrists, or elbows Apply the gel 2 g to the affected hand, wrist, or elbow 4 times daily. Voltaren Gel should be gently massaged into the skin ensuring application to the entire affected hand, wrist, or elbow.
The entire hand includes the palm, back of the hands, and the fingers. Do not apply more than 8 g daily to any single joint of the upper extremities. Total dose should not exceed 32 g per day, over all affected joints. Inform patient to wash their hands after use, unless the hands are the treated joint. If Voltaren Gel is applied to the hand s for treatment; inform patient not to wash the treated hand s for at least 1 hour after the application. Do not use combination therapy with Voltaren Gel and an oral NSAID unless the benefit outweighs the risk and conduct periodic laboratory evaluations.
However, patients with known CV disease or risk factors had a higher absolute incidence of excess serious CV thrombotic events, due to their increased baseline rate.
Some observational studies found that this increased risk of serious CV thrombotic events began as early as the first weeks of treatment. The increase in CV thrombotic risk has been observed most consistently at higher doses. To minimize the potential risk for an adverse CV event in NSAID-treated patients, use the lowest effective dose for the shortest duration possible.
Physicians and patients should remain alert for the development of such events, throughout the entire treatment course, even in the absence of previous CV symptoms. Patients should be informed about the symptoms of serious CV events and the steps to take if they occur. There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use.
Although the absolute rate of death declined somewhat after the first year post-MI, the increased relative risk of death in NSAID users persisted over at least the next four years of follow-up. She has been using that medication ever since and now has well controlled blood pressure.
It would seem the insurance company would have been wise to initially listen to the trained physician instead of paying for a hospitalization to come to the conclusion that my friend needed this medication. Kartik K. It can delay important medications after a discharge if a PA need is not known prior to discharge and delays therapy. It is a process that could be applied after the fact if there was cost saving concerns rather than delay potential therapy.
Absolutely ridiculous, inefficient, and benefits neither the patient or physician and has the potential to do more harm than intended benefit of potential cost-savings for the insurance industry!
Absolutely nothing. I have a back injury that I had surgery for but still have issues with pain, mostly sciatica. Go figure! So now what am I left with for the pain? Vito R. Tell me our system is the best. I have many examples. My blood pressure goes up.
In the last week I have had rejections for rheumatology drugs by a "bought and paid for" ER doc and radiologist I have to then write an appeal letter and "remind" the reviewer that these persons have rendered a verdict outside of their areas of expertise. I almost always get a rejection overturned, but the waste of time and energy is overwhelming to me—let alone the patient when that person needs care ASAP.
Every year the insurers get deals on different drugs and then the whole tier action gets redistributed and folks who have been on certain meds for YEARS and in good control without side effects are thrown to the wolves and FORCED to get on a drug that may cause significant side effects.
My blood pressure is rising as I write this I'd better stop now!! I have to fight with the insurance company I have to do this every month and I end up getting sick because this medication has withdrawal symptoms. Last year I had to get prior authorization to continue taking it. I had to get my employer involved.
The health plan out-sourced the specialty drugs and pointed fingers between them and the company as to who was demanding the documentation. It took me about 3 months to get back on track with my remission.
I have literally waited an entire week for simple medications It has proven absolutely detrimental to getting proper medical treatment and has negatively impacted my own personal recovery many times over. It has gotten so far out of control that even a simple antibiotic such as 'Amoxicillin' now requires prior authorizations and it's even in its generic form!?!
Where is our healthcare now? Providers are jumping through too many hoops, at great financial cost, to be able to provide clinically appropriate and medically necessary treatment for their patients. We get a prior authorization, only to have our claims be denied for "no auth.
The prior authorization process is broken and needs to be overhauled. My daughter passed away the day before we were supposed to go for the rescheduled test. Her doctor ordered a PET scan of her brain.
The appointment was set, medical transportation was set, co-pay paid.