It is one of the most used anti-inflammatories against pain, however the diclofenac found in the famous Voltarène is not without risk.
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) widely used to relieve pain, notably under the brand name Voltarène. But its oral form is the subject of warnings due to an increased cardiovascular risk, with more heart attacks, heart failures and deaths of cardiovascular origin compared to other NSAIDs considered as effective.
What is diclofenac used for?
Diclofenac is a medicine from the family of non-steroidal anti-inflammatory drugs (without cortisone) used to relieve pain and reduce inflammation, for example in cases of muscle pain, joint pain, dental pain or painful periods. “It inhibits the synthesis of prostaglandins which are molecules that maintain or promote inflammation” informs us the rheumatologist Pascal Chazerain. It is found in treatments such as Voltarène. It exists in several forms: tablets, gels to apply to the skin, patches or even suppositories. “Apart from the fact that it is a little less effective in migraine than ketoprofen, it is the twin brother of ketoprofen“, continues the specialist.
In what medicines is diclofenac found?
In France, diclofenac is present in several medications, in different forms (gel, tablets, patches, etc.). The best known is Voltarène, but it is not the only one. Here are the main medications that contain it:
- Voltarene: available in gel (topical application), tablets or patches
- Flector: often in the form of a patch or powder for oral solution
- Diclofenac Biogaran: generic tablets
- Diclofenac Mylan: generic tablets
- Diclofenac EG: generic tablets
Local forms (gel, patch) are generally used for targeted muscle or joint pain. Oral forms (tablets, sachets) are more general but also more closely monitored due to their potential side effects.
What are the indications for gel?
Topical forms based on diclofenac, such as Voltarene gel, are used to treat targeted and superficial pain. They are indicated in cases of osteoarthritis, tendinitis or after minor trauma (blow, mild sprain). Their action remains localized, with penetration limited to a few millimeters, which explains why they are generally better tolerated than tablets. But they are not completely risk-free. “There is a quantity of diclofenac that can pass into the blood and we can have general effects like those found with tablets” warns the pharmacist. Excessive use, on large surfaces or under occlusive dressing, increases this passage into the body. Furthermore, the gel can weaken the skin: “the gel dries the skin and removes the lipid film, which increases the risk of skin problems”. It is also recommended to avoid any exposure to the sun on the treated area.
What are the side effects of diclofenac?
“There are twice as many side effects with diclofenac as with some other nonsteroidal anti-inflammatory drugs” warns pharmacist Martial Fraysse. “Of the heartburnof the skin rashes signs of allergy, if we see blood in the stools or that one has a hemorrhoidal crisis which becomes more complicated, You should talk to your doctor or pharmacist about it. explains the specialist. Voltarène® can also increase blood pressure even on a short take and “exacerbate asthma“. These side effects explain why diclofenac cannot be given sustainably and/or in too large doses.
What are the side effects of diclofenac?
Diclofenac has several side effects that you should be aware of. Its action on prostaglandins explains part of the risks: “Prostaglandins are involved in the process of inflammation, argues Martial Fraysse. The big difficulty is that there are prostaglandins which protect the mucous membranes such as the stomach and others which participate in inflammation. However, medications are not always selective, some act on both types of prostaglandins in question, some only affect one. Result, the medication can weaken the digestive mucosa and sometimes cause early side effects: “Medicines based on diclofenac such as Voltarène® reduce the prostaglandins which protect the stomach, so we are likely to develop digestive bleeding even in the short term, after ten days” he warns. But the main point of vigilance concerns cardiovascular risk. The Medicines Agency mentions a “well-known cardiovascular risk”confirmed by studies showing an increase in events likeheart attack or stroke, even at low doses. “If you take diclofenac, especially for months, you can have thromboses, strokes, confirms the pharmacist. It has this paradoxical effect: instead of thinning the blood like all nonsteroidal anti-inflammatories (…) it can cause it to clot more quickly when taken over the long term.” This phenomenon promotes the formation of clots and explains why this medication is contraindicated in patients who already have cardiovascular disease.
Can you get it without a prescription?
Local forms (gel, patch) such as Voltarène gel are available without a prescription in pharmacies, for mild to moderate pain (sprain, tendinitis, blow, etc.). On the other hand, oral forms (tablets, sachets) are subject to medical prescription. They are more dosed and present more risks, particularly cardiovascular and digestive.
What are the contraindications of diclofenac?
- Pregnant and breastfeeding women, even in gel.
- Patients with cardiovascular diseases (proven congestive heart failure, ischemic heart disease, peripheral arteriopathy and/or cerebrovascular disease).
- “Someone who is renal failure should not take them, especially in tablets because they are quite toxic to the kidneys like all NSAIDs. recalls Martial Fraysse.
- “The anti-inflammatory increases the risk of bleeding and so if there is already a digestive ulcerlikely to bleed, this will make it worse and if there is already anticoagulant treatment, this is likely to increase the risk of a complication“, specifies Doctor Chazerain.
What precautions for use?
You must carefully follow the dosage indicated by the doctor and the duration of treatment with diclofenac. In gel, the pharmacist can advise you. For Martial Fraysse “the patient must always look at what the medicine does to him. If it has more side effects than therapeutic effects, it is obvious that he must inform his pharmacist or doctor to stop it.” An NSAID should always be taken in the middle of the meal.
Can we give diclofenac to children?
“Voltarène® can be given a few times in cases of ankylosing spondylitis in young children with dose adjustments” indicates our interlocutor. This is then Voltarène25® which is authorized for use in over 6 years oldApart from this case, diclofenac-based medicines are not authorized for children under less than 35 kilos.
Thanks to Martial Fraysse, doctor of pharmacy and doctor Pascal Chazerain, head of the rheumatology department Groupe Hospitalier Diaconesses Croix Saint-Simon in Paris
