The average peak plasma concentration with recommended use of VOLTAREN GEL (4 x 4 g per day applied to 1 knee) is 158 times lower than with the oral treatment. Diclofenac 3% gel may cause other side effects. Of these, 513 patients received diclofenac sodium topical gel for osteoarthritis of the knee and 400 were treated for osteoarthritis of the hand. To use the topical gel: Wash your hands before and after using this medicine. Additionally, patients with advanced liver disease and/or coagulopathy are at increased risk for GI bleeding.In clinical trials, of oral diclofenac-containing products, meaningful elevations (i.e., more than 3 times the ULN) of AST (SGOT) were observed in about 2% of approximately 5,700 patients at some time during diclofenac treatment (ALT was not measured in all studies).In a large, open-label, controlled trial of 3,700 patients treated with oral diclofenac sodium for 26 months, patients were monitored first at 8 weeks and 1,200 patients were monitored again at 24 weeks. Do not apply more than 16 g daily to any single joint of the lower extremities.Apply the gel (2 g) to the affected hand, wrist, or elbow 4 times daily. Elderly patients and patients with a prior history of peptic ulcer Exacerbation of Asthma Related to Aspirin SensitivityTo report SUSPECTED ADVERSE REACTIONS, contact Encube Ethicals Private Limited at Drugs that Interfere with Hemostasis (e.g. Instruct patients to avoid contact of diclofenac sodium topical gel with the eyes and mucosa, although not studied, should be avoided. "Avoid taking NSAIDs after a recent heart attack, unless your healthcare provider tells you to. All rights reserved. The dose for your feet, ankles, or knees is 4 grams of diclofenac sodium topical gel each time you apply it. Each tube contains diclofenac sodium in a gel base (10 mg of diclofenac sodium per gram of gel or 1%). Doctors give trusted answers on uses, effects, side-effects, and cautions: Dr. Ihle on can i use voltaren after using meloxicam: There is no interaction between the two drugs. How should I store diclofenac sodium topical gel? Keep from freezing.Do not keep outdated medicine or medicine no longer needed.Ask your healthcare professional how you should dispose of any medicine you do not use.After removing a used patch, fold the patch in half with the sticky sides together. In that open-label study, a higher incidence of borderline (less than 3 times the ULN), moderate (38 times the ULN), and marked (greater than 8 times the ULN) elevations of ALT or AST was observed in patients receiving diclofenac when compared to other NSAIDs. In this same cohort, the incidence of death in the first year post-MI was 20 per 100 person years in NSAID-treated patients compared to 12 per 100 person years in non-NSAID exposed patients. See 17 for PATIENT COUNSELING INFORMATION and Medication Guide.Diclofenac sodium topical gel is indicated for the relief of the pain of osteoarthritis of joints amenable to topical treatment, such as the knees and those of the hands. Additionally, 583 patients were exposed to diclofenac sodium topical gel in an uncontrolled, open-label, long-term safety trial in osteoarthritis of the knee. 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 150 mg or more, and duration of use for more than 90 days.Physicians should measure transaminases at baseline and periodically in patients receiving longterm therapy with diclofenac, because severe hepatotoxicity may develop without a prodrome of distinguishing symptoms. Some examples of diclofenac sodium topical gel application includeApplying 2 grams (2 g) of diclofenac sodium topical gel to hands, wrists, or elbows: Applying 4 grams (4 g) of diclofenac sodium topical gel to feet, ankles, or knees: What are the ingredients in diclofenac sodium topical gel? Based on clinical trial data and postmarketing experiences, transaminases should be monitored within 4 to 8 weeks after initiating treatment with diclofenac. 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. If it is almost time to put on your next patch, wait until then to apply a new patch and skip the one you missed. Follow the instructions on the medicine label if you are using this medicine without a prescription. These serious events may occur without warning. In the open-label, long-term safety study, distribution of adverse reactions was similar to that in the placebo-controlled studies. Adverse reactions that led to the discontinuation of the study drug were experienced in 12% of patients.