Voltaren

introduction

Voltaren® is a drug from Novartis Pharma GmbH, which contains the active ingredient diclofenac. It belongs to the group of non-steroidal anti-rheumatic agents (NSAIDs), which includes ibuprofen, for example. So it's a pain reliever. Voltaren® comes in different versions, including tablets for systemic use or for local use as an ointment.

Its main characteristics are that anti-inflammatory (anti-inflammatory), pain reliever (analgesic), antipyretic (antipyretic) and anti-rheumatic Effects, which is why it is particularly in pain conditions (especially of the musculoskeletal system), inflammation or rheumatic diseases is used.

Next Diclofenac The Voltaren® preparations contain further, medically inactive ingredients: In Gels and Anoint For example, various alcohols and water also occur in Voltaren® Resinate include iron oxide and gelatin.

Launch

Diclofenac has been on the market since 1974 and is one of the most widely used pain relievers worldwide.
The active ingredient in Voltaren® unfolds its effect via an unselective inhibition of the Cyclooxygenase enzymes 1 and 2. These enzymes are responsible for the production of so-called prostaglandins, which are known as inflammation mediators. This name comes from the fact that a large number of its functions lead to the typical reactions of inflammation:

Prostaglandins can among other things fever cause the vessels to dilate and increase their permeability, leading to the one often observed in inflammation Redness, overheat and Swelling comes, they also increase the sensitivity to pain. Since the pro-inflammatory effect is mainly due to the function of the Cyclooxygenase 2 and the cyclooxygenase has other tasks and the cyclooxygenases are not only found in inflammatory cells, but also in many other areas of the body, certain side effects can occur when using diclofenac.

application

The area of ​​application for Voltaren® is broad. Voltaren® plays a particularly important role in the treatment of mild to moderate acute or chronic:

• Pain or.
• Inflammation,

especially if this is due to diseases or injuries to the musculoskeletal system (i.e. skeleton or Musculature) are due. Voltaren® is often used for diseases from:

• the rheumatic form circle
  • Rheumatoid arthritis
  • rheumatic fever
  • ankylosing spondylitis
  • Collagenoses
  • Vasculitis
• Sports injuries
  • Bruises
  • Sprains
• Soft tissue inflammation
  • Bursitis
  • Tendinitis
• degenerative diseases (osteoarthritis)
• Menstrual pain
  or
• gout

Application forms

A large number of preparations are available under the trade name Voltaren®, each of which is best suited for a specific indication.
There are:

• Tablets
• Capsules
• Suppositories
• drops
• Dragées and even
• Injection solutions

if internal or systemic therapy is to be used and there are for example local treatment:

• Anoint
• Gels
• band Aid and
• eye drop

Voltaren pain gel

Voltaren Pain Gel® is used for the local treatment of pain in the case of bruises, strains and sprains, which are often found in sports injuries. The main active ingredient is Voltaren®. Other ingredients include perfume cream and purified water. Voltaren Pain Gel® contains twice the concentration of active substances than a Voltaren tablet, which is why it is ideally applied to the intact skin every 12 hours, i.e. twice a day. Voltaren Pain Gel® is absorbed by the skin and thus reaches the deeper layers of the painful and inflamed tissue. There it unfolds its full effect.

Never apply Voltaren Pain Gel® to open injuries. Inflammation and skin irritation can be the result!

After using the pain gel, you should wash your hands thoroughly and let them dry. Voltaren Pain Gel® is recommended for adults and adolescents from 14 years of age, with an application period of up to three weeks at a time. However, if the pain persists or increases, you should consult a doctor!

Read more on the topic: Voltaren® pain gel.

Voltaren® Dispers

Voltaren® Dispers is the form of administration for producing a Suspension solutionby taking the tablets dissolved in a glass of water become.

It serves the Short-term use of a maximum of two weeks and is particularly suitable for patients with Problems swallowing tablets. If you have to take Voltaren® over a longer period of time, a different dosage form than Voltaren dispers® is recommended. The effects are also Pain and anti-inflammatory. Voltaren® Dispers is ideal for acute joint inflammation, Pain with joint wear, but also at Injuries.

Only take Voltaren® Dispers as directed by your doctor. The Daily dose of an adult usually amounts to one to three tablets.

Voltaren® Dispers may not under 18 years of age be taken. So keep it locked away from children. At intolerance from Voltaren® Dispers or Interactions with other medications, you should ask your doctor for advice!

Voltaren® resinate

Voltaren® resinate is swallowed whole in the form of hard capsules with at least one glass of water during or after a meal.

The maximum recommended daily dose is between 50 and 150 mg. It should not be exceeded!

The drug is available over the counter in low doses, in a higher dose, however prescription only. The Voltaren® Resinat hard capsules contain the active ingredient Diclofenac among other things, for example medicinal charcoal, iron oxide and gelatin. The elongated hard capsules made of gelatin mass contain the named active ingredient in their cavity. Voltaren® Resinat is not crushed or pulled apart before ingestion in order not to impair the delayed release of the active ingredient.

The specialty of Voltaren® Resinat lies in one increased risk of hypersensitivity reactions. These can take the form of Swelling of the face, tongue, or airways noticeable and left untreated over shortness of breath up to shock to lead. These reactions occur more frequently in patients with Neurodermatitis or hay fever on.

There is also a Danger of poisoning when taking certain medications at the same time due to high drug concentrations in the blood. These include, among other things: the rheumatism and cancer used Methotrexate, the Heart drug digoxin and lithium, which at depressions Is used.
There are also interactions with blood sugar lowering drugs in the Diabetes therapy known. Because of the high concentration of active ingredients, Voltaren® Resinat is only on the market from 18 years available.

If you notice any undesirable side effects or one of the reactions described above, it is imperative that you consult a doctor in order to initiate suitable countermeasures!

dosage

While all available Medication pharmacy only, the fact whether they require a prescription or not depends on the dosage form and which one dosage the active ingredient diclofenac is.

As a rule, the recommended dose for systemic treatment with Voltaren® (Diclofenac) in adults between 50 and 150 milligrams per day. After ingestion, the effect unfolds relatively quickly:

for normal tablets on average within one hour. The effect then usually lasts for about 3 or 4 hours, only with the Retard preparationswhich only gradually release their active ingredient into the body, it takes about 12 hoursuntil the effect wears off. For local use of Voltaren®, for example for that Voltaren pain gel, the rule of thumb applies that a lot of 1 to 4g (which is roughly the size of a walnut for this gel) up to four times should be applied thinly to the affected area daily. Apart from the active ingredient Diclofenac The locally applied remedies also help because they contain alcohol and water, soothing and cooling and thus in turn pain relieving.

Side effects

As with the use of any drug, it can also be with the use of Voltaren®/ Diclofenac various side effects arise.
These range from General complaints how:

• fatigue
• dizziness
• Malaise or
• a headache

to local symptoms such as skin rashes when applied locally to more severe diseases and impairments. The Cyclooxygenase is also localized in the gastric mucosa, among other things. There the manufactured prostaglandins provide protection against the destructive power of the Stomach acid. However, since the production of these prostaglandins is reduced by diclofenac, this can balance get messed up and the acid become harmful. That is why Voltaren® leads just like everyone else Cyclooxygenase inhibitors) frequently to side effects in the gastrointestinal area.

These include:

• stomach pain
• diarrhea
• nausea
• Vomit
• Stomach cramps
• Loss of appetite
• Stomach ulcers
• Bleeding in the stomach
• Flatulence, or
• Inflammation of the gastric mucosa

Since Voltaren® is used internally in the liver has to be broken down, it can, especially with long-term or high-dose intake of this drug, in combination with other preparations that are metabolized in the liver or can potentially damage it for other reasons, or with a high Consumption of alcohol also to inflammation of the liver, partly included Jaundice and malfunctions.

Some of the rarer side effects of Voltaren® are Anemia, Cramping of the airways with resulting Shortness of breath, Bleeding tendency, high blood pressure, Heart attacks or malfunction of the Kidneys.
It is therefore important to pay attention to possible undesirable effects when using Voltaren® and to regularly check the functions of when using it over a longer period of time liver, kidney and the Blood pressure have it checked. If side effects are noticed, you should always consult a doctor with whom you can then initiate appropriate countermeasures or discuss whether it makes sense to discontinue the drug or replace it with another.

Liver side effects

Voltaren® is almost completely metabolized by the liver. Long-term and repeated use can lead to liver damage.
The increased activity of the liver can show in the laboratory values. The so-called transaminases can rise.
This increase can manifest itself with no or with noticeable discomfort. Liver disease can manifest itself in rashes and inflammation of the liver.
In the case of existing liver damage, the use of Voltaren® must be strictly monitored. The active substance diclofenac is contraindicated in patients who have a certain blood formation disorder that affects the functioning of the liver.
It also applies here that drugs that are also broken down by the liver increase the risk of liver damage.
The additional consumption of alcohol can also lead to faster and more severe liver damage. Since the liver is an important detoxification organ in our body, liver damage can affect many different organs and parts of the body.

Side effects on the kidney

Prolonged or repeated use of Voltaren® can damage the kidney functions. This can be explained by the mechanisms of action.
By inhibiting a certain enzyme, the enlargements in certain kidney vessels are inhibited. This slows down the kidney blood flow. If the kidney is not supplied with enough blood, its filtering function can decrease. In addition, inhibiting the other enzyme can cause poor blood flow in the renal arteries. In particular, people with previously damaged kidneys or kidney diseases are at risk of further damaging their kidneys from taking Voltaren®. Here, too, other drugs can increase the risk of side effects on the kidneys. If Voltaren® is taken continuously or frequently, kidney functions must be checked regularly. Since the kidneys have a very important filter function in our body, damage can result in certain toxins no longer being able to be sufficiently removed from our body. The kidneys also play an important role in regulating blood pressure. In the event of damage, this can also lead to increased blood pressure, either directly or as a reflex.

Side effects on the stomach

The inhibition of one enzyme leads to a reduced synthesis of prostaglandins. As a result, fewer bicarbonate ions are released. As a result, gastric mucus formation can be restricted.
This can lead to an imbalance between gastric mucus and acid build-up. The stomach acid can attack the stomach. Stomach damage and a gastric ulcer, a so-called gastric ulcer, can develop. With the active ingredient diclofenac, however, the risk of gastric ulcer development is theoretically relatively lower than with other active ingredients of the same class of active ingredients. However, when diclofenac is combined with glucocorticoids, the risk adds up.
This is justified by the properties of the two active ingredients. If the Voltaren® has already caused gastric damage, the glucocorticoids ensure that this damage heals more poorly. The risk of developing a stomach ulcer increases accordingly. Medical advice can reduce side effects. If necessary, prophylactic, gastro-protective medication is helpful.

Read more on the subject under: Glucocorticoids and Ulcus Ventriculi (gastric ulcer)

Rash

Serious skin reactions are very rare during treatment with Voltaren®.
In these rare cases, redness and blistering will occur. A fatal outcome has been reported in isolated cases.
These reactions mainly occurred at the beginning of treatment. If there are signs of a rash or changes in the mucous membranes, a doctor should be contacted.

high blood pressure

The high blood pressure can also be explained by the mechanism of action of Dicolfenac.
The inhibition of one enzyme prevents the formation of certain substances in the kidney. This minimizes the excretion of sodium and thus water.
More sodium and water are then retained. This eventually leads to an increase in blood pressure. In addition, the inhibition of the other enzyme can contribute to increased blood pressure by a possible narrowing of the renal arteries. Taking other drugs that increase blood pressure increases the risk of this side effect. In addition, certain risk factors for high blood pressure in combination with Voltaren® can increase it.

Therapy with Voltaren®

There are a number of points to be observed during therapy with Voltaren®.
On the one hand, it is advisable to ask a doctor or pharmacist for help with non-prescription preparations, even with non-prescription preparations, and to read the package insert carefully.

Voltaren® is only to be used in the manner and dosage described there, unless the doctor has expressly prescribed otherwise!
While using Voltaren® one should refrain from taking other drugs from the group of NSAIDs (for example Ibuprofen) as they increase both the effects and the side effects of Voltaren®.
Also taking steroidal pain relievers, such as Cortisol, increases the side effects in the gastrointestinal area and should therefore be avoided if possible.

Interactions

In addition, certain interactions can also occur when taking other medications. For example, taking certain anti-epileptic drugs (e.g. phenytoin), lithium or cardiac glycosides can increase the level of diclofenac in the blood. On the other hand, diclofenac can also make some medications less effective than normal, including some antihypertensive and diuretic agents.
Since the systemic use of diclofenac can lead to undesirable effects that can impair general performance, such as dizziness or tiredness, you should avoid driving heavy machinery or actively participating in road traffic during therapy or only with special caution be performed.

There are certain people who should rather refrain from using Voltaren. A distinction is made here between absolute contraindications and relative contraindications, in which a potential hazard from the drug must be weighed against its benefit and the possibility of use if, then only after consultation with a doctor.
The absolute contraindications include hypersensitivity to the active ingredient diclofenac itself or to similar active ingredients (hypersensitivity reactions include asthma attacks, narrowing of the airways and rashes).

In addition, Voltaren® must not be used in the presence of stomach or intestinal ulcers, blood clotting or blood formation disorders or severe weakness of the heart muscles. In children up to the age of 15 years, at least the systemic intake of diclofenac is strongly discouraged, as there are no sufficiently informative studies for the therapy in this group of patients.
The relative contraindications to the use of Voltaren® include asthma, inflammatory bowel disease (Crohn's disease and ulcerative colitis), asthma, chronic respiratory infections, tendency to allergic reactions, hay fever, metabolic diseases and functional disorders of the liver, immunological skin diseases (e.g. lupus) , High blood pressure, heart failure and kidney dysfunction.

Therapy with Voltaren® is also not recommended during pregnancy, although it is important how far it has progressed: While it is advisable not to take it in the first six months of pregnancy, as there is still insufficient experience with potential If there are effects on mother and unborn child, use in the last three months of pregnancy is really strictly forbidden, as it can cause severe damage to the unborn child on the one hand and premature labor and thus cause premature birth on the other. You should also not use Voltaren® while breastfeeding, as diclofenac and its breakdown products can pass into breast milk and are then absorbed by the baby.

Voltaren and alcohol

In principle, drugs should not be taken with alcohol! Take tablets with enough water. A glass of 250 ml is recommended here.

Long-term use of Voltaren® is potentially liver and kidney damaging. This means that the damage to these organs can, but does not have to be, caused by Voltaren®. Diclofenac is broken down and detoxified via a special metabolism system in the liver and then excreted via the kidneys.

The process of breaking down alcohol also takes place in the liver, which puts additional strain on our detoxification system. The simultaneous consumption of alcohol and Voltaren® therefore harbors the risk of an increase in the effectiveness of the alcohol. Even small amounts of alcohol can result in reduced responsiveness.

Elderly people from the age of 65 represent a special group: with increasing age, the metabolism slows down, which is why the duration of alcohol and voltarenes can increase enormously. Signs of undesirable side effects of Voltaren® or an overdose can be headache, dizziness, drowsiness, nausea, vomiting or abdominal pain. If this is the case, be sure to consult a doctor so that he can initiate suitable measures!

However, if you have had a glass of wine or beer, don't be alarmed! Simply no additional alcohol during your voltaren therapy!

Read much more information on this topic at: Voltaren and alcohol - are they compatible?

Voltaren® in pregnancy

In general, as little medication as possible should be taken during pregnancy (Please refer: Medication during pregnancy). In the case of Voltaren®, ingestion or external use is possible in the first and second trimester of pregnancy after consultation with your doctor. Extensive studies have shown that there is no connection between the consumption of Voltaren and a risk of malformations for the child.

In the third trimester of pregnancy, however, you are no longer allowed to take Voltaren®!

With increasing gestational age and the simultaneous use of Voltaren®, the risk of premature closure of the so-called ductus arteriosus botalli in the unborn increases. The ductus is a short-circuit connection between the main artery and the pulmonary arteries of the fetus. This creates an economical bypassing of the as yet unventilated pulmonary circulation. The natural closure of the duct takes place around two to ten days after birth. In addition, Voltaren® can inhibit fetal kidney function.

Taking Voltaren® in the last trimester of pregnancy therefore carries high risks and in the worst case can even be fatal for your unborn child. If you still take Voltaren within the prohibited period, see a doctor as soon as possible! He will perform an ultrasound scan of your child to determine any changes in blood flow properties in the ductus arteriosus Botalli.

However, if you are dependent on pain medication during pregnancy, paracetamol is available in all phases of pregnancy in consultation with your doctor. The following application risks apply to pregnant women to the same extent as before.

Read more on the topic: Paracetamol in pregnancy

Bleeding under Voltaren®

The commercial preparation Voltaren® contains the active ingredient diclofenac.
Its mode of action can explain a relatively increased risk of bleeding. Voltaren® inhibits two enzymes. By inhibiting one of the enzymes, hemostasis is inhibited.
This leads to colloquial blood thinning. This results in a relatively increased risk of bleeding. This bleeding tendency can affect the skin and mucous membranes as well as internal organs such as the stomach and intestines. However, the active ingredient diclofenac inhibits. less hemostasis compared to other active substances from the same substance class. Accordingly, the risk of bleeding is lower. However, if other drugs are taken in addition, which can trigger an increased bleeding tendency, the risk of bleeding increases.
For example, a combination with active ingredients from the same substance group or with so-called anticoagulants such as Marcumar® can increase the risk of bleeding. A combination with selective serotonin reuptake inhibitors (SSRIs) can also increase the risk of side effects of bleeding.

Summary

The active ingredient is in the pain medication Voltaren® Diclofenac contain. He belongs to the group of so-called "Non - steroidal - anti-inflammatory drugs", short NSAIDs.

The spectrum of activity of Voltaren® includes Pain relief, anti-inflammatory and lowering of fever. The main areas of application are above all Pain, bruises, or strains by violations of the Musculoskeletal system or Sports accidents and rheumatic diseases. Depending on the form of administration, it can be used internally or externally, as well as for mild to moderately acute, i.e. sudden to chronic, i.e. permanent pain.