Erin’s Ageless-Essentials
Solutions for Better Aging and Care

Pain can significantly affect quality of life as we age. Arthritis, osteoarthritis, back pain, joint stiffness, injuries, and other musculoskeletal problems can make walking, sleeping, exercising, cooking, driving, and completing everyday activities more difficult.

One medication frequently used to relieve inflammatory pain is diclofenac.

Diclofenac can be very effective. But there is an important message for older adults:

Diclofenac is not simply another harmless pain reliever.

It belongs to a family of medicines called nonsteroidal anti-inflammatory drugs, or NSAIDs, and NSAIDs can affect the stomach and intestines, kidneys, heart, blood pressure, fluid balance, and other parts of the body.

The risks become particularly important for people who are older, take multiple medications, or have chronic health conditions.

The FDA-required prescribing information for systemic diclofenac carries a boxed warning concerning serious cardiovascular events such as heart attack and stroke and serious gastrointestinal complications including bleeding, ulceration, and perforation. Older adults and people with a history of ulcers or gastrointestinal bleeding are at greater risk for serious GI complications.

That does not mean that everyone over 60 should avoid diclofenac. It just means that we should understand the medication before using it.

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What Is Diclofenac?

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID).

Other medications in the broad NSAID family include:

• ibuprofen
• naproxen
• aspirin
• celecoxib
• meloxicam
• indomethacin
• ketorolac

Diclofenac reduces both pain and inflammation. It has been used for conditions involving the joints, muscles and bones, including arthritis and acute musculoskeletal pain.

Diclofenac is available in several formulations, depending upon the country and particular product, including oral tablets or capsules, topical gels, patches or plasters, suppositories, injections and certain eye drops.

For many older adults with osteoarthritis, one of the most familiar forms is:

diclofenac sodium topical gel 1%.

In the United States, topical diclofenac gel is commonly associated with products such as Voltaren Arthritis Pain Gel, although generic diclofenac products are also available.

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How Does Diclofenac Work?

Inflammation is partly controlled by substances called prostaglandins.

Your body produces prostaglandins through enzymes called cyclooxygenase enzymes, commonly shortened to:

COX-1 and COX-2.

Diclofenac inhibits these enzymes and thereby reduces the production of prostaglandins involved in inflammation and pain.

That can lead to:

less inflammation → less swelling → less pain → potentially better movement.

But prostaglandins perform other useful functions, too.

They help protect the stomach lining, support blood flow through the kidneys and participate in blood-vessel and platelet functions.

That is one reason NSAIDs can produce side effects in areas seemingly unrelated to the painful joint.

The same biological system that helps control inflammation also participates in protecting other organs.

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What Is Diclofenac Used For?

Depending upon the formulation, diclofenac may be used to manage inflammatory pain associated with conditions such as:

• osteoarthritis
• rheumatoid arthritis
• ankylosing spondylitis
• musculoskeletal injuries
• sprains and strains
• certain acute pain conditions

Prescription delayed-release diclofenac tablets are specifically indicated for symptoms of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Topical diclofenac gel 1%, however, has a more specific role.

Its prescribing information indicates it for osteoarthritis pain in joints suitable for topical treatment, particularly joints such as the:

knees and hands.

The prescribing information notes that the gel has not been evaluated for use on the spine, hip or shoulder.

That distinction is important.

A medication being sold as “arthritis pain gel” does not necessarily mean it has been studied for every painful joint in the body.

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Oral Diclofenac vs. Diclofenac Gel: A Very Important Difference

People sometimes hear the word “diclofenac” and assume every formulation carries exactly the same exposure.

They do not.

Oral diclofenac

When diclofenac is swallowed, it enters the bloodstream and produces effects throughout the body.

This is called systemic treatment.

Systemic exposure is one reason oral NSAIDs require particular attention to gastrointestinal, kidney, cardiovascular and blood-pressure risks.

Topical diclofenac

Topical diclofenac is placed directly on the skin over the painful joint.

The objective is to deliver medication primarily around the affected area while producing less systemic exposure than oral treatment.

This can make topical NSAID therapy particularly worth discussing when pain is localized to an accessible joint such as a hand or knee.

But there is a crucial misconception to avoid:

Topical does not mean zero systemic absorption.

Some diclofenac can still enter the bloodstream.

For that reason, topical diclofenac products still carry important NSAID warnings, including warnings concerning cardiovascular and gastrointestinal complications.

Think of it this way:

Oral diclofenac: medicine travels through the body to reach the painful area.

Topical diclofenac: medicine is applied near the painful area, with less of the medication generally reaching the rest of the body.

Less exposure does not mean no exposure.

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Why Diclofenac Deserves Special Attention After Age 60

A healthy 25-year-old and an 80-year-old with hypertension, diabetes, kidney disease and eight daily medications are not starting from the same medical baseline.

Aging may bring changes in:

• kidney function
• cardiovascular health
• liver function
• gastrointestinal vulnerability
• medication metabolism
• hydration
• blood pressure regulation
• the number of prescription medications being taken

Older adults are also more likely to take medications that can interact with NSAIDs.

The FDA labeling specifically identifies older adults as being at greater risk for serious gastrointestinal events associated with NSAIDs.

Therefore, the question for an older adult shouldn’t simply be:

“Does diclofenac relieve arthritis pain?”

It should also be:

“Is this particular form of diclofenac appropriate for me considering my other health conditions and medications?”

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The Six Major Safety Areas Older Adults Should Understand

1. Stomach and Intestinal Bleeding

NSAIDs can damage the gastrointestinal tract.

Potential complications include:

• stomach irritation
• ulcers
• gastrointestinal bleeding
• perforation of the stomach or intestines

Serious events can sometimes occur without warning symptoms.

Risk may be particularly concerning in people with a history of:

• stomach ulcers
• gastrointestinal bleeding
• advanced age
• anticoagulant or antiplatelet therapy
• corticosteroid treatment
• other NSAID use

Warning symptoms requiring prompt medical attention can include:

black, tarry stools; vomiting blood or material resembling coffee grounds; significant abdominal pain; fainting; or unexplained weakness.

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2. Heart Attack and Stroke

This is one of the most important diclofenac warnings.

NSAIDs can increase the risk of serious cardiovascular thrombotic events, including:

heart attack and stroke.

The risk can occur relatively early during treatment and may increase with longer use.

European regulators have also concluded that systemic diclofenac’s cardiovascular risk deserves particular attention, especially with high-dose and long-term treatment.

People with cardiovascular disease or major cardiovascular risk factors therefore need an individualized discussion with their healthcare professional.

Those risk factors can include:

• previous heart attack
• previous stroke
• heart disease
• high blood pressure
• diabetes
• high cholesterol
• smoking
• peripheral vascular disease
• heart failure

The general principle used with NSAIDs is:

Use the lowest effective dose for the shortest duration necessary.

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3. Blood Pressure

NSAIDs can make blood-pressure management more complicated.

That matters tremendously in the aging population because hypertension is common.

A person might reasonably think:

“My medicine is for my knee. What does that have to do with my blood pressure?”

The answer involves the kidneys, blood vessels and sodium/fluid regulation.

NSAIDs can affect renal prostaglandins and kidney blood flow, which can contribute to:

• sodium retention
• fluid retention
• worsening hypertension
• swelling
• kidney problems

Therefore, someone beginning regular NSAID therapy may need blood-pressure monitoring, particularly if hypertension is already present.

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4. Kidneys

The kidneys deserve special attention when discussing NSAIDs.

The kidneys continuously filter the blood, regulate electrolytes, manage fluid balance and help control blood pressure.

Prostaglandins help maintain blood flow through the kidneys under certain circumstances.

Because NSAIDs reduce prostaglandin production, kidney blood flow can become impaired in susceptible individuals.

This becomes more concerning in people who:

• already have kidney disease
• are dehydrated
• have heart failure
• take certain blood-pressure medicines
• take diuretics or “water pills”
• are older
• have multiple chronic diseases

A medication intended to improve knee pain therefore has the potential, in susceptible people, to affect an entirely different organ system.

Signs of possible kidney or fluid problems that should prompt medical attention can include:

• significantly decreased urination
• unusual swelling
• sudden weight gain
• worsening ankle or leg swelling
• unusual weakness
• shortness of breath

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5. Fluid Retention and Heart Failure

This deserves its own section because it is particularly important for the older-adult population.

NSAIDs can contribute to sodium and fluid retention.

For someone already struggling with edema or heart failure, additional fluid retention may be clinically significant.

Watch for:

• increasing ankle swelling
• increasing leg swelling
• rapid weight gain
• abdominal swelling
• increasing shortness of breath
• difficulty breathing when lying down
• sudden decline in exercise tolerance

People with heart failure or a history of significant edema should discuss NSAID use with their healthcare professional rather than assuming an OTC topical product is automatically appropriate.

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6. Liver Effects

Diclofenac can also affect the liver.

Mild elevations of liver enzymes can occur with oral diclofenac, while clinically significant liver injury is uncommon but well documented.

Possible warning symptoms of liver injury include:

• unusual fatigue
• persistent nausea
• poor appetite
• pain in the upper-right abdomen
• dark urine
• unusually pale stools
• yellowing of the skin or whites of the eyes

Anyone experiencing symptoms suggesting liver injury should contact a healthcare professional promptly.

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Diclofenac and Other Pain Relievers: Beware of “NSAID Stacking”

This is one of the most practical lessons we can teach older adults and caregivers.

Suppose someone applies diclofenac gel to an arthritic knee.

Later that day, the person develops back pain and takes ibuprofen.

Then, because another joint hurts, they take naproxen.

They may not realize that they have used multiple NSAIDs.

Diclofenac + ibuprofen + naproxen does not simply equal “more pain relief.”

It can mean greater exposure to NSAID-related risks.

Before combining diclofenac with another NSAID, ask a pharmacist or healthcare professional.

This includes seemingly ordinary OTC medicines.

Always check the active ingredients.

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What About Aspirin?

This is particularly important for older adults.

Many people take low-dose aspirin because a healthcare professional prescribed it for cardiovascular reasons.

Do not automatically stop prescribed aspirin because you begin using diclofenac.

Instead, tell your healthcare professional or pharmacist:

“I take aspirin every day. Is diclofenac appropriate for me?”

The combination can affect bleeding risk and requires individualized consideration.

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Diclofenac and Blood Thinners

People taking anticoagulants or other medicines affecting clotting deserve particular caution.

Examples may include medications such as:

• warfarin
• apixaban
• rivaroxaban
• dabigatran
• clopidogrel

Combining medications that affect clotting or gastrointestinal integrity can increase bleeding concerns.

A pharmacist should review the complete medication list rather than looking at diclofenac in isolation.

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The “Medication Triangle” Older Adults Should Know

One particularly important combination involves:

NSAID + diuretic + ACE inhibitor or ARB

These medications are common among older adults with hypertension, heart disease or kidney problems.

Examples include:

Diuretics

• furosemide
• hydrochlorothiazide
• bumetanide
• torsemide

ACE inhibitors

• lisinopril
• enalapril
• benazepril

ARBs

• losartan
• valsartan
• irbesartan

When an NSAID is added to certain blood-pressure medicines and a diuretic, kidney function can become more vulnerable, especially during dehydration or illness.

This does not mean everyone taking these medications will develop kidney injury.

It means the combination deserves professional review and, when appropriate, monitoring.

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Other Important Medication Interactions

Before starting diclofenac, make sure the doctor or pharmacist knows about all:

prescription medicines + OTC medicines + vitamins + supplements + herbal products.

Particularly important medications can include:

• other NSAIDs
• aspirin
• anticoagulants
• antiplatelet medicines
• corticosteroids
• certain antidepressants
• diuretics
• ACE inhibitors
• ARBs
• lithium
• methotrexate

Drug interactions can vary according to the diclofenac formulation, dose, duration and individual health conditions.

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How to Use Topical Diclofenac More Safely

Follow the instructions for the specific product you purchased or were prescribed, because formulations are not necessarily interchangeable.

General principles include:

Apply only as directed.

More gel does not necessarily mean better pain relief.

Use the dosing card or measuring guide if your product provides one.

Correct dosing matters.

Apply to clean, dry, intact skin.

Do not routinely place topical diclofenac on:

• cuts
• open wounds
• infected skin
• severely irritated skin

unless specifically instructed by a healthcare professional.

Wash your hands appropriately afterward.

Follow the specific product directions, particularly when treating the hands themselves.

Avoid the eyes, mouth and mucous membranes.

Diclofenac gel is intended for external use.

Don’t automatically cover the treated area tightly.

Occlusive coverings can potentially alter absorption.

Be careful with heat.

Do not assume that applying a heating pad over medication is safe. Follow the manufacturer’s directions.

Don’t assume sunscreen, cosmetics or another topical medication can simply be layered over the same area.

Check the label or ask your pharmacist.

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Does Diclofenac Cure Arthritis?

No.

This distinction matters.

Diclofenac can help control:

pain + inflammation + stiffness

but it does not reverse the underlying aging of cartilage or permanently cure osteoarthritis.

Pain reduction should ideally help support a broader mobility strategy that may include, when medically appropriate:

• strengthening
• flexibility exercises
• physical therapy
• appropriate physical activity
• weight management when relevant
• assistive devices
• joint protection
• heat or cold therapy
• treatment of the underlying condition

Medication should be viewed as one tool rather than the entire pain-management plan.

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What Side Effects Are More Common?

Depending upon formulation, side effects can include gastrointestinal discomfort, nausea, indigestion, abdominal pain, diarrhea, constipation, dizziness, headache or skin reactions where topical medication is applied.

Topical products may produce:

• dryness
• itching
• redness
• rash
• irritation at the application site

Mild irritation is very different from symptoms suggesting a serious allergic reaction.

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When Is Diclofenac an Emergency?

Seek emergency medical attention for symptoms suggesting a severe allergic reaction, heart attack, stroke, major gastrointestinal bleeding or another serious reaction.

Examples include:

Possible allergic reaction

• swelling of the lips, tongue, face or throat
• difficulty breathing
• severe wheezing
• widespread hives

Possible heart attack

• chest pressure or pain
• unexplained shortness of breath
• pain spreading to the arm, jaw, back or shoulder
• sudden sweating or severe weakness

Possible stroke

• facial drooping
• sudden weakness or numbness, especially on one side
• difficulty speaking
• sudden confusion
• sudden severe balance or vision problems

Possible gastrointestinal bleeding

• vomiting blood
• vomit resembling coffee grounds
• black or tarry stools
• significant unexplained weakness or fainting

Do not wait for a routine appointment when symptoms suggest a medical emergency.

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Who Should Speak With a Healthcare Professional Before Using Diclofenac?

Extra caution is appropriate for someone with:

• kidney disease
• heart failure
• coronary artery disease
• previous heart attack
• previous stroke
• uncontrolled or difficult-to-control hypertension
• significant edema
• liver disease
• previous stomach ulcer
• previous gastrointestinal bleeding
• asthma triggered by aspirin or NSAIDs
• previous serious NSAID allergy
• anticoagulant therapy
• multiple medications
• dehydration
• upcoming surgery

Diclofenac is contraindicated in certain situations, including people with previous allergic-type reactions to diclofenac and certain reactions to aspirin or other NSAIDs, and around coronary artery bypass graft surgery.

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Pregnancy Warning

Although Erin’s Ageless-Essentials focuses primarily on older adults, many readers are caregivers, daughters, granddaughters and other family members, so this warning is worth including.

The FDA recommends avoiding NSAIDs such as diclofenac at approximately 20 weeks of pregnancy or later unless specifically advised by a healthcare professional, because they can cause fetal kidney problems and reduced amniotic fluid.

At approximately 30 weeks and later, additional fetal cardiovascular concerns arise.

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Oral Diclofenac Should Not Be Treated Like an Ordinary OTC Pain Pill

Prescription oral diclofenac deserves particular respect.

The official prescribing information contains an FDA boxed warning concerning:

serious cardiovascular events

and

serious gastrointestinal bleeding, ulceration and perforation.

Systemic diclofenac has also drawn regulatory attention because of cardiovascular risk, particularly with higher doses and prolonged treatment.

For someone who needs oral diclofenac for an extended period, the clinician may consider monitoring factors such as:

• blood pressure
• kidney function
• liver tests
• blood counts
• gastrointestinal symptoms
• swelling/fluid retention
• overall cardiovascular status

Monitoring needs should be individualized.

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Topical Diclofenac May Be an Important Option for Localized Osteoarthritis Pain

There is an important balance here.

We do not want readers to become unnecessarily frightened of useful medication.

For an older adult with localized osteoarthritis—particularly of the hand or knee—a topical NSAID can be worth discussing because medication can be delivered locally rather than relying entirely on systemic treatment.

But the correct conclusion is not:

“The gel is completely safe.”

A better conclusion is:

“Topical diclofenac generally reduces systemic exposure compared with oral treatment, but it is still an NSAID and still requires appropriate precautions.”

That distinction is especially valuable for seniors.

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A Caregiver’s Diclofenac Checklist

Before an older adult starts diclofenac, ask:

☐ Is this oral diclofenac or topical diclofenac?

☐ What condition are we treating?

☐ Is inflammation actually contributing to the pain?

☐ Is there kidney disease?

☐ Is there heart disease or heart failure?

☐ Is there significant swelling or edema?

☐ Is blood pressure controlled?

☐ Is there a history of stomach ulcers or GI bleeding?

☐ Has the person ever reacted to aspirin, ibuprofen, naproxen or another NSAID?

☐ Are they taking aspirin?

☐ Are they taking a blood thinner?

☐ Are they taking another NSAID?

☐ Are they taking a diuretic?

☐ Are they taking an ACE inhibitor or ARB?

☐ Does the pharmacist have the person’s complete medication list?

☐ What is the lowest effective dose?

☐ How long should the medication be used?

☐ What side effects should cause us to stop and call the doctor?

☐ What symptoms require emergency care?

☐ If long-term therapy is planned, what laboratory or blood-pressure monitoring is needed?

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Five Questions to Ask Your Pharmacist

Your pharmacist can be one of the most valuable members of your healthy-aging team.

Bring your medication list and ask:

1. “Does diclofenac interact with anything I’m already taking?”

2. “Am I taking another medication that is also an NSAID?”

3. “Considering my kidneys, blood pressure and heart history, should I discuss diclofenac with my doctor before using it?”

4. “Would topical diclofenac be appropriate for this particular joint?”

5. “How much should I use, how often, and for how long?”

Those five questions can prevent a surprising number of medication mistakes.

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The Erin’s Ageless-Essentials Bottom Line

Diclofenac is an effective anti-inflammatory pain medication used for arthritis and other painful inflammatory conditions.

For older adults, however, the form of diclofenac matters.

Topical diclofenac and oral diclofenac should not automatically be viewed as equivalent choices.

Oral diclofenac produces systemic exposure and carries important gastrointestinal, cardiovascular, kidney, blood-pressure and other considerations.

Topical diclofenac delivers medication primarily to the treated area and can be useful for localized osteoarthritis pain, particularly in joints such as the hands and knees. However, some medication still enters the bloodstream, so topical diclofenac is not risk-free.

Perhaps the most important lesson for adults over 60 is this:

Do not evaluate a pain medication only by whether it stops the pain.

Also ask:

What else is this medication doing inside my body?

A medication that helps your knee can potentially affect your stomach, kidneys, blood pressure, fluid balance or heart.

That doesn’t necessarily make the medication a bad choice.

It makes informed use the better choice.

For older adults—particularly those living with several chronic conditions or taking multiple medications—the safest approach is often to involve the pharmacist and healthcare provider in choosing the right medication, the right formulation, the lowest effective dose and the shortest appropriate duration.

At Erin’s Ageless-Essentials, we believe knowledge gives older adults and caregivers a stronger voice in their healthcare decisions.

Healthy aging isn’t simply about living longer. It is about understanding the choices that can help us live those years as safely, independently and comfortably as possible.

Stay Informed. Join our newsletter at newsletter@erinsagelessessentials.com for updates and information on topics that impact our elder and senior communities.

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Educational Disclaimer

The information provided by Erin’s Ageless-Essentials is intended for general educational and informational purposes only. It is not medical advice and should not be used to diagnose, treat, cure or prevent a medical condition or as a substitute for individualized advice from a physician, pharmacist or other qualified healthcare professional.

Medication risks and benefits vary according to age, medical history, kidney and liver function, cardiovascular health, other medications and many other factors. Never start, stop or change a prescription medication solely on the basis of information presented here. If you believe you are experiencing a medical emergency or a serious medication reaction, seek emergency medical care.

Sources consulted: U.S. FDA/DailyMed prescribing information and Drug Safety Communications, National Library of Medicine LiverTox, NHS medication information, and European Medicines Agency safety reviews.