This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2021. For the original video go to https://www.youtube.com/watch?v=2YDmdrYbsd4&t=516s
Brad: Today the subject is, OTC or over the counter Voltaren gel. Pain reliever, versus the traditional Motrin, Advil, Aleve, or Tylenol. We're going to give you information on how to decide if Voltaren, the new over the counter pain med, is for you or not. And today we have an expert here that's going to help us out with the facts. Chris, the pharmacist.
Chris: Hey guys.
Brad: I'm looking at this from a therapist’s point of view. Pain management can be absolutely critical, whether therapy is successful or not. Particularly, an example is like a knee surgery. You have to get the knee moving.
Chris: Oh yeah.
Brad: You have break up scar tissue, and I think times like that, it's okay to have pain. So if we can decrease the pain, we can get more motion and get the therapy going on. But for the general public, if you just want to control a headache, or you want to control joint pain, arthritic pain, maybe a sprained ankle, or whatever it may be. This Voltaren gel is now over the counter, so anybody can use it, but let's get to the basics.
Chris: Sure.
Brad: Is it really new? Is Voltaren gel something that has been used or not?
Chris: Well, yeah. Voltaren gel has been around. It's diclofenac 1%. It's a topical gel. Diclofenac is the generic name of it.
Brad: Okay.
Chris: It's been around, as a prescription for quite a while. I mean.
Brad: For like a decade or more?
Chris: Yeah, I think 2009 is when it came out. So it's been around. It's definitely had its place in the orthopedic circles. I mean, it really goes right to your arena.
Brad: So when you say orthopedic, some people, you know, it's for joints.
Chris: Yeah. It's widely used for osteoarthritis, but it can be used for joint pain, muscle aches, you know there's just certain joints, you can't use it on real effectively. The hip joint. The hip is just too thick. I mean, it's too deep. You can't get this to penetrate into the hip directly. So it's going to be more for your, you know, your ankles, your elbows, hands, you had a back pain, sore ribs. I mean, people have used it for a little cartilage tear.
Brad: So, in the past doctors would prescribe the exact same thing?
Chris: Exact same thing. There is no difference between this and the prescription.
Brad: Why was it prescription, and then all of a sudden, now it's over the counter?
Chris: I think really what it comes down to is safety. And so they've had decades’ worth of experience showing that it was very safe and effective product. The biggest complaint for this, for patients that have side effects, is going to be kind of a rash or some itchy skin. So that's about it. The no-no’s are if you're on blood thinners, or if you were allergic to NSAIDs or aspirin. Those would be the things that you would not use it for. And of course, patients talking to the doctors, you know. It's very important to give them all that information, so they're imbibed with that, so that they can get you the right choices. When you walk into the pharmacy and you're like, “gosh I'm just looking for some pain relief, I've got a sore knee. It's just bugging me.” Voltaren gel is actually a really good thing that people can certainly try in the arena of pain relief. So whether it's going to be ibuprofen, whether it's going to be naproxen sodium, or acetaminophen.
Brad: I always get this confused. So naproxen sodium is the same as Aleve?
Chris: Yeah. Aleve. Yeah, we are talking ibuprofen would be Motrin or Advil. Aleve is going to be neproxin sodium, or acetaminophen is Tylenol.
Brad: Okay.
Chris: And then Voltaren is diclofenac.
Brad: Ok. Yep. So, it's whether, it's the manufacturer or the generic term.
Chris: Correct.
Brad: But it's the same active ingredient?
Chris: Yeah. Exact same thing. That's the business end.
Brad: Sure. So for diclofenac, is there other manufacturers that have it?
Chris: Well, GSK owns the patent that was on diclofenac gel. They actually, havea 3% prescription one also for a different process, or problem. So, but yeah, that's been around for years, and you know, it's effective good stuff. We've been using as a generic medication. So it's a lot more cost effective alternative for patients. And now, this is just really affordable stuff over the counter. So it's just nice because now it gives access to many. So you don't necessarily need to see a doctor. So if you have, you know, weekend wear kind of stuff. You were out in the yard, and you were raking, and you hurt your back, or you pulled something, or did something to your shoulder. You were playing catch with your kid and just did something to your rotator cuff, or labrum, or something silly, that maybe is minor. You know, maybe it doesn't need a doctor, or physical therapist yet. Now let's try and use something like this, you know, 3-4 times a day and see if it helps to relieve it and provide the pain relief that the patient needs.
Brad: So I'm thinking in my head trying to separate all these different avenues out for pain relief, because, in my case I do best with ibuprofen.
Chris: Sure. Yeah.
Brad: Okay. I've tried Tylenol, doesn't seem to work, and everyone’s bodies have their own preferences.
Chris: Correct.
Brad: So if you know that I'm thinking, well, what about this? Now my understanding is, say I have a sore knee. If I take my ibuprofen, it goes throughout my whole system and it gets to that knee.
Chris: Yep
Brad: So if I take this, if I'm thinking right, and I put it directly on my skin, does that medication go through the skin to the point of the irritation?
Chris: It depends on the depth, but I mean that's why the hip joint is not the best place to put it.
Brad: Sure.
Chris: But let's say, we're talking to knee and ankle, you know people use it for arthritic hands all the time. And so, you know, it's important to get the correct product. So basically below the waist, we use 4 grams as the measuring tool. There's a measuring guide that's actually included within the box. Well, basically upper joint is going to be 2 inches, lower joint is going to be 4 inches. And so basically, it's just like squirting out toothpaste. So you just put it on the spreading blade, let's just pretend that I've got a sprained wrist. So we're going to put 2 grams on the wrist, and then you're just going to rub it in really well. Just wash your hands down. You don't really want to wash off the spot, but maybe wash the other hand with soap and water,
just so it doesn't irritate the skin. I mean, there's no point to it. The biggest complaint can be a little bit of skin irritation, but it's going to penetrate through the dermis, into the joint. It's not going to get all the way, deep into the joint, but it's going to help to where those pain receptors are, and hopefully help to kind of control some of the inflammation, that's creating some of the pain.
Brad: Sure.
Chris: So, then you'll apply every 6 hours, or 4 times a day max, 3-4 times a day. For lot of people it's going to be hard to go on a 24-hour schedule because we sleep somewhere in there, or we get busy, but 3-4 times a day, 4 to 6 hours apart, is a reasonable usage pattern for this particular product.
Brad: So upper body? So like Chris says, it's just so nice, because you can just squirt it out on there about that size. So you get an accurate dosage.
Chris: Exactly. And that's important.
Brad: You don't have to get a measuring cup.
Chris: No, you are not guessing. No. You'll get an idea, and then you just basically, let's say your elbow, you just kind of rub it in. Do that 4 times a day, and hopefully we're going to help to control the pain and inflammation, so you're more functional.
Brad: Have you heard a lot of people allergic, or break out from this or is that pretty weird?
Chris: No. I mean the biggest common side effect is a little bit of itchy, irritated skin. If you have an allergy to NSAIDs, which would be your ibuprofen, your Aleve, those types of things. Aspirin. You would want to avoid using the product because there's a higher chance, you know this is diclofenac, it is an NSAID. So it's, it's certainly something that is within that family, that umbrella. So you could see an allergic reaction. We don't want to tip the balance in the wrong direction.
Brad: Sure.
Chris: So if you know you're allergic to an NSAID, you should avoid it. And that's when we go to Tylenol.
Brad: Sure. And the other hand, if you have problems taking some of the other oral meds, because it upsets your stomach.
Chris: Yeah. And that's one of the advantages but while we're on it we'll just keep talking about it. So, when you take a traditional anti-inflammatory, so ibuprofen, naproxen sodium, aspirin, those products are going to have an increased risk of causing some stomach ulceration or some kidney damage. So, NSAIDS do have a risk. They can raise blood pressure, that can be damaging to the heart and kidneys. So there's a lot of things, that even though they do very good things for us and for many of us, we have to use it appropriately, under the doctor's guidance or at least make sure, you talk in your pharmacy about safe use, length of use, those types of things, because we don't want to create a new problem, in a different area of the body.
Brad: Right.
Chris: One of the distinct issues, that drives the bus with NSAIDs is stomach ulceration or irritated gut. So when you use something topical, like Voltaren gel or diclofenac gel, what that's going to do is you're not going to get, that whole amount of systemic absorption. So when we take the tablet, like you said it kind of goes all over. This acts right in the area. And so you're going to get some, that goes into the bloodstream. So you can see some prostaglandin inhibition. So there is still the remote, and I do mean remote possibility, that even though this is a topical gel, that it could cause stomach ulcerations, which is why we don't stack in on said NSAIDs. So if you're already taking a regimen of, let's just say, 600 milligrams of ibuprofen, 4 times a day. You're not going to use this, on top of that.
Brad: I see.
Chris: Because there is a synergistic or additive effect, that when we're talking about swinging things to the negative. So kidneys, stomach, heart. So we need to be careful with all of those things.
Brad: All right. So if you've got arthritis and I'm thinking of my mother right now, she's got a knee that bothers her, on and off, it's an arthritic problem. She's not a good candidate for surgery, so to manage the pain, she could put this on that knee. Say there's no skin irritation. She could put that dosage on there.
Chris: Yep, that should be a 4 inch. So yeah. And then, it's really neat for your mom. I mean, you know, one of the easiest ways, you know, a lot of times it's like, are you really looking at your clock? Has it been six hours? I'll tell people just go breakfast, lunch, dinner, bed. Those are intervals that are somewhat, just through our lives, we've kind of naturally spaced those apart.
Brad: Right. So let's say you put it on there to. Do you notice the effect? Is it typically within an hour? Or is it kind of take a day?
Chris: Yeah, it's going to take a day or 2 with some consistent use. I mean, you might get some pain relief right out of the gates, but it needs to be kind of an additive effect, because there's a lot of things going on with inflammation, that's causing pain.
Brad: Sure.
Chris: And so we have to calm down all those chemotaxis, and healing factors, to give the relief to the patient. So it does require repeated dosing, to get adequate drug response.
Brad: So a typical scenario, my mom's got knee pain. She uses this for a couple of days. The knee pains getting better, or maybe it's back to normal again. Then you can stop?
Chris: Yeah. Usually we're not going to want people to use this longer than 7 days, without at least discussing with their doctor. Just because there could be something more potentially wrong with that knee. Let's say she tore some cartilage, or you know, and there's a litany of things that you're going to see in there. So we want to make sure, that we're not overlooking something. So, 7 days is kind of the max, unless your doctor says, “Oh yeah, you can use, as long as you need to kind of thing,” but make sure your doctor's involved. I mean, that's, the quarterback of the team. I mean, you're very important with your own healthcare, but your doctor should be involved or at least ask a pharmacist or one of the other healthcare professionals.
Brad: To make sure there's no red flags.
Chris: Exactly.
Brad: If you're on other medications.
Chris: Yeah, blood thinners would be the big no-no.
Brad: Okay. So any other side effects or things to be?
Chris: No, it's actually some pretty slick innocuous stuff. I mean, not much bad with that, simply because it acts locally, so you don't get as much into the system.
Brad: Yeah.
Chris: So it doesn't create all the systemic onset side effects. It's pretty impressive stuff. There's a lot of orthopedic surgeons and doctors out there, that routinely prescribe it still, even though it is over the counter because sometimes your co-payment might be a little bit cheaper.
Brad: Sure.
Chris: But I mean, you can get a tube of that for about 9 bucks, over the counter. It's affordable stuff
Brad: And that'll last you the 7 days?
Chris: Oh yeah, easily. I mean the, depending upon the size of the tube. They actually make a larger tube too, so it's a little bit more economical, I just grabbed a small one.
Brad: It depends on what size area you're covering.
Chris: Exactly. And how frequently, hopefully it's just going to be kind of a short-term thing anyways, but it's available to you if you need it.
Brad: Yeah. Well, that's great. I think it's a great alternative, especially when you don't have to take pills, if you've got digestive irritants.
Chris: Yeah. Just remember guys, it takes about 5 minutes for this to absorb. So let's say you're treating a shoulder, while you rub it in, give it about 5 minutes to dry, otherwise you’ll put it on your shirt, your shirt kind of stick to it.
Brad: Oh, I see.
Chris: I'll get a little slimy, so. Just, that'd be just one of the other negative things. That's not really an overt side effect, but it's definitely a cause and effect kind of scenario. You want to keep your clothing looking nice.
Brad Yes, exactly. All right. That answered a lot of information for me. I'm thinking this is going to be a go to. I'm going to at least try it with my mother's knee.
Chris: Yeah. Give it a go.
Brad: See how she responds.
Chris: I bet she'd appreciate it.
Brad: All right. Very good. Take care and enjoy your pain-free way of life. All right.
Chris: Thanks guys.
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