VOLTAREN ARTHRITIS PAIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VOLTAREN ARTHRITIS PAIN (VOLTAREN ARTHRITIS PAIN).
Non-selective cyclooxygenase (COX-1 and COX-2) inhibitor, reducing prostaglandin synthesis.
| Metabolism | Hepatic metabolism via CYP2C9; also undergoes conjugation (glucuronidation) and hydroxylation. |
| Excretion | Renal (65% as metabolites, <1% unchanged); biliary/fecal (35% as metabolites). |
| Half-life | Approximately 2 hours; terminal half-life may be prolonged in elderly (up to 4 hours) or hepatic impairment. |
| Protein binding | >99% bound to albumin. |
| Volume of Distribution | 0.1–0.2 L/kg; primarily distributes to synovial fluid (concentrations up to 50% of plasma). |
| Bioavailability | Oral: 100% (immediate-release); topical: approximately 6% systemic absorption. |
| Onset of Action | Oral: 30 minutes; topical: 2–4 hours. |
| Duration of Action | Oral: 4–6 hours; topical: 6–8 hours; clinical effect may persist longer with regular dosing. |
Oral: 50 mg twice daily or 75 mg twice daily for osteoarthritis; immediate-release: 50 mg three times daily for rheumatoid arthritis. Maximum daily dose: 150 mg.
| Dosage form | GEL |
| Renal impairment | GFR >30 mL/min: no adjustment. GFR 10-30 mL/min: dose reduction to 50 mg once daily or avoid use. GFR <10 mL/min: contraindicated. |
| Liver impairment | Child-Pugh A: no adjustment. Child-Pugh B: reduce dose by 50% (maximum 75 mg/day). Child-Pugh C: contraindicated. |
| Pediatric use | For juvenile idiopathic arthritis: 1-2 mg/kg/day in 2-3 divided doses, maximum 3 mg/kg/day or 150 mg/day. For children <1 year: not recommended. |
| Geriatric use | Start at lowest effective dose (e.g., 50 mg once daily). Increase cautiously; maximum 100 mg/day. Monitor renal function and GI bleeding risk. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for VOLTAREN ARTHRITIS PAIN (VOLTAREN ARTHRITIS PAIN).
| Breastfeeding | Limited excretion into breast milk (M/P ratio approximately 0.02-0.04). Considered compatible with breastfeeding due to low infant dose (<0.1% of maternal weight-adjusted dose); monitor infant for gastrointestinal effects. |
| Teratogenic Risk | First trimester: Risk of miscarriage and congenital malformations (cardiac, gastroschisis) increased; avoid use. Second trimester: Possible oligohydramnios and fetal renal impairment. Third trimester: High risk of premature closure of ductus arteriosus, persistent pulmonary hypertension, oligohydramnios; contraindicated after 30 weeks gestation. |
■ FDA Black Box Warning
Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk. NSAIDs are contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
| Serious Effects |
History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs; perioperative pain in the setting of coronary artery bypass graft (CABG) surgery; advanced renal disease; pregnancy (third trimester); history of gastrointestinal bleeding or perforation related to previous NSAID therapy; active peptic ulcer disease; severe heart failure; known hypersensitivity to diclofenac or any component of the product.
| Precautions | Cardiovascular thrombotic events; gastrointestinal bleeding, ulceration, and perforation; hypertension; congestive heart failure and edema; renal toxicity; anaphylactoid reactions; serious skin reactions; hematologic toxicity; ophthalmic effects; hepatic effects; asthma; masking of inflammation and fever. |
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| Fetal Monitoring | Monitor fetal ultrasound for oligohydramnios and ductus arteriosus patency if used beyond 20 weeks. Maternal monitoring of blood pressure, renal function, and gastrointestinal symptoms. Discontinue if oligohydramnios or ductal constriction detected. |
| Fertility Effects | Reversible inhibition of ovulation via cyclooxygenase inhibition affecting prostaglandin synthesis; may delay or prevent conception. Use in women attempting to conceive should be limited. |