Voltaren (Diclofenac) Tablets and Gel: Safe Use and Risks to the Stomach, Heart and Kidneys

Voltaren (diclofenac) is a non-steroidal anti-inflammatory drug (NSAID) that relieves pain and inflammation. It comes as tablets and as a gel. Tablets are stronger but carry risks to the stomach, heart and kidneys. The gel is absorbed less and is often less harmful. The basic rule is the lowest effective dose for the shortest possible time, avoiding combination with another anti-inflammatory painkiller, and consulting a doctor if you are pregnant or an older adult.

What is Voltaren and when is it used?

Voltaren is the brand name for the active ingredient diclofenac, an NSAID that reduces swelling and pain [2]. It is used for pain in the joints, muscles and bones, including arthritis, sprains, back pain, and pain after dental surgery [2].

According to the ClinicsJo guide to Voltaren 50 mg tablets, it is also used for knee osteoarthritis, acute gout attacks, severe menstrual pain, and renal colic. Other products from the same family have their own pages, such as Cataflam (diclofenac potassium), diclofenac patch, and Voltaren eye drops. Each has a different use, so do not substitute one for another without asking your pharmacist.

Painkillers do not treat the cause of pain. If joint or back pain recurs, it is better to get it diagnosed and treat its cause rather than relying permanently on painkillers.

What is the difference between Voltaren tablets and Voltaren gel?

Tablets are swallowed, absorbed into the blood, and act throughout the body, so they are faster and stronger, but their side effects are broader. The gel is applied to the skin and works on the painful area, and much less medicine enters the body [4].

The gel is milder, but it is not free of warnings. The prescribing information for topical anti-inflammatories, including diclofenac gel, warns of a possible increased risk of heart attack and stroke [1]. Systemic effects are more likely when it is used excessively over a large area of skin [4].

How do I use Voltaren safely?

With tablets

The golden rule is the lowest dose that controls symptoms for the shortest possible time [2]. The usual dose for adults, as set by the doctor or pharmacist, ranges between 75 and 150 mg per day at most [3], which matches our guide's figure of 150 mg as the maximum daily dose.

• Take the tablet with food or a light snack, or immediately after eating, as this reduces stomach irritation [3].
• Swallow extended-release tablets whole. Do not crush or chew them [3].
• If you miss a dose, take it when you remember, unless the next dose is almost due. Never double the dose [3]. For details, see What should I do if I miss a dose of a painkiller?
• One or two days may be enough for back pain, injury, or after dental surgery. Use may last longer in chronic conditions such as rheumatoid arthritis, under medical supervision [3].

Children should only be given Voltaren on a doctor's prescription or a pharmacist's instructions, and the dose is set according to body weight [3].

With the gel

• Apply an amount the size of a cherry or a nut (about 2 to 4 grams) to the painful area and rub gently, then wash your hands [3].
• If the gel is 1% for arthritis, the leaflet specifies application to a maximum of two areas of the body, 4 times daily for up to 21 days, or as recommended by the doctor [1].
• Apply it to clean, dry skin, not to skin that is wounded, peeling, inflamed, or has a rash [1].
• Do not cover the area with a tight dressing or apply heat to it, and avoid bathing for at least one hour after application [1].
• Avoid the eyes, mouth and nose, and stay away from strong sunlight, as the skin may become more sensitive to it [1].
• If you do not feel improvement after 7 days, stop using it and consult your doctor [1].

Does Voltaren harm the stomach?

Yes, it can. Common symptoms are stomach pain, nausea, and rash, which affect more than 1 in 100 people taking the tablets [4]. Ulcers appear with long-term use or high doses, or in older people whose health is weak [4].

The leaflet warns that anti-inflammatories may cause swelling, ulcers, bleeding, or perforation of the stomach or intestines, and that this can happen without warning symptoms [1]. The risk increases with smoking, alcohol consumption, and age 60 years or older [1].

Those who have previously had an ulcer may not be suited to Voltaren tablets, and the doctor may prescribe an alternative [4]. If you need the tablets for a long time, the doctor may add a medicine that protects the stomach [3]. Do not start a protective medicine or stop a medicine on your own, as this is the doctor's decision. For more, read Stomach and duodenal ulcers: H. pylori, painkillers and bleeding.

Does Voltaren harm the heart and kidneys?

The risk is small but real, and it is linked to high doses and long duration. The British health authority notes a small possibility of heart or kidney failure when the maximum dose (150 mg daily) is taken for a long time [4]. The US prescribing information warns of a possible increased risk of heart attack and stroke, which may rise with long-term use [1].

According to our guide, the drug may raise blood pressure and cause fluid retention and ankle swelling, and it may affect kidney function, especially in older people and those who are dehydrated. Therefore, tell your doctor about the following [1]:

• Any heart disease, previous blood clot, high blood pressure, diabetes, or high cholesterol.
• Smoking.
• Kidney disease, liver disease, or heart failure.
• Severe diarrhea, vomiting, or dehydration.

Examples of those requiring extreme caution include patients with severe heart failure or advanced kidney failure, in whom Voltaren is usually prohibited according to our guide. If you are going to undergo heart bypass surgery (coronary artery bypass graft), the drug should not be used before or immediately after it [1].

Which medicines and painkillers should not be combined with Voltaren?

The most serious common mistake is combining Voltaren with another anti-inflammatory painkiller such as ibuprofen, naproxen, or aspirin. Sources classify these medicines within the same family [5]. Combining them does not increase the benefit, while the harm multiplies, as our guide notes.

The leaflet stresses the need to inform your doctor about these medicines [1]:

• Blood thinners such as warfarin and aspirin.
• Other anti-inflammatory painkillers such as ibuprofen and naproxen.
• Oral steroids such as dexamethasone and prednisone.
• Antidepressants from the SSRI and SNRI classes.

Our guide adds that combining it with blood thinners greatly increases the risk of bleeding, and with corticosteroids it doubles the risk of ulcers. The drug may also weaken the effect of blood pressure medicines and diuretics, and the risk of kidney damage rises when a diuretic, an ACE inhibitor (ACEI), and an anti-inflammatory are combined. It may also raise levels of lithium, digoxin, and methotrexate.

Also read about blood thinners and their safe handling, and the answer to Can I take ibuprofen with blood thinners? When buying without a prescription, read Over-the-counter medicines: safe use and limits.

If a rash, facial swelling, or wheezing in the chest appears after taking the drug, it may be a drug allergy and requires urgent medical evaluation. Those with asthma and aspirin sensitivity are usually not given the drug, according to our guide.

Is Voltaren suitable during pregnancy and for older adults?

During pregnancy and breastfeeding

Voltaren is prohibited in the last trimester of pregnancy due to its risk to the fetal heart, according to our guide, and this also includes the gel. The US prescribing information goes further: it may harm the fetus and cause delivery problems if used from week 20 onward, and the gel should not be used after that week except on the doctor's instruction [1]. The drug may also reduce fertility in women [1].

Therefore, if you are pregnant, planning a pregnancy, or breastfeeding, ask your doctor before any use. If you become pregnant while using it, contact your doctor [1]. For more on painkillers and pregnancy, read Painkillers: safe use, doses and avoiding complications.

For older adults

Older adults are more prone to ulcers and bleeding [4] and to kidney effects, especially with dehydration or multiple medications. Our guide recommends that those over 60 or with a history of ulcers ask their doctor about stomach protection or a safer alternative. People with high blood pressure and diabetes also need extra caution.

Before resorting to tablets, other approaches may help depending on the cause of pain, such as hot or cold compresses and physiotherapy [5]. Sources describe paracetamol as generally safer than other painkillers, but its daily dose should not be exceeded and products containing it should not be combined [5]. Read more in Painkillers: safe use, doses and avoiding complications.

When should I see a doctor, and when should I go to the emergency room?

See a doctor or pharmacist promptly if

• Black stools appear, or you have severe stomach pain, heartburn, vomiting, or diarrhea, as this may indicate an ulcer or bleeding [4].
• Your eyes or skin turn yellow, as this may be a sign of liver problems [4].
• Shortness of breath appears with fatigue and swelling in the legs or ankles, as this may indicate heart failure [4].
• You gain weight without a reason, or unusual bruising or bleeding appears [1].
• The pain has not improved within 7 days of using the gel, or it has worsened [1].

Call 911 or go to the nearest emergency department if

• You vomit blood or a substance resembling coffee grounds [1].
• You feel chest pain, shortness of breath, or faint, as this may be a heart attack [4].
• Weakness appears on one side of the body, slurred speech, loss of balance, or blurred vision, as this may be a stroke [4].
• Your lips, tongue, or throat swell, or you have difficulty breathing or swallowing, as this may be a severe allergic reaction [4].
• You take an overdose or a child swallows the gel. Seek urgent medical advice, and take with you the box, the leaflet, and any other medicines [3].

In these situations, do not drive yourself to the emergency department. Ask someone else to take you or call an ambulance [4].

How do I find the right doctor or clinic in Jordan?

If pain is recurring, or if you need anti-inflammatory painkillers for more than a few days, it is best to be examined by a doctor. Clinics are spread across the governorates of the Kingdom, and you can filter on ClinicsJo by specialty and governorate.

• Joint, muscle and back pain: start from the musculoskeletal pain or back pain page, and look for orthopedic or rheumatology doctors.
• Stomach symptoms after painkillers: see stomach pain treatment to find gastroenterology doctors.
• What to check in the listing: specialty, governorate, working hours, and available contact or booking methods.

Bring a list of all your medicines and supplements, including painkillers bought without a prescription. These are useful questions to ask your doctor:

1. Do I need tablets, or is the gel sufficient?
2. What is the appropriate duration for me?
3. Do I need a medicine to protect my stomach?
4. Does Voltaren interact with my medicines for blood pressure, diabetes, or blood thinners?
5. Is there a more suitable alternative for my condition, age, or pregnancy?

The Jordan Food and Drug Administration (JFDA) regulates medicines and their general prices in Jordan, so buy from a licensed pharmacy and ask the pharmacist about the registered product. You can find broader guidance in Medication safety: a consumer guide. The information here is educational and does not replace consulting a doctor or pharmacist.

Frequently asked questions

Can I take Voltaren on an empty stomach?

It is best to take Voltaren tablets with food, a light snack, or immediately after eating, as this reduces stomach irritation. Avoid taking them on an empty stomach. If heartburn or persistent stomach pain appears, speak with your doctor or pharmacist instead of increasing the dose or repeating it.

Can I combine Voltaren tablets and Voltaren gel?

Do not combine the tablets and the gel to treat the same pain unless your doctor tells you to, as this combination is usually unnecessary. The topical painkiller works at the site of pain, while the tablets enter the whole body, and each carries its own specific warnings, so ask your doctor or pharmacist first.

Can Voltaren be used with ibuprofen or aspirin?

It is not recommended to combine it with another anti-inflammatory such as ibuprofen, naproxen, or aspirin, because they belong to the same family. Combining them does not increase the benefit, while the risk of ulcers, bleeding, and kidney harm multiplies. If you take aspirin on prescription for heart protection, do not stop it, and ask your doctor.

Can Voltaren harm the kidneys?

It may affect kidney function, especially in older adults, in people who are dehydrated or have kidney disease, and when taken with a diuretic and a blood pressure medicine. Long-term use at high doses carries a small risk. Tell your doctor about your kidney condition and your medicines before starting.

Is Voltaren gel safer than tablets?

Usually yes, because a much smaller amount of the drug enters the body, so effects on the stomach, heart, and kidneys are reduced. However, it is not risk-free: its warnings include heart risk, and excessive use over a large area for a long time may lead to effects similar to tablets. Stick to the specified amount and duration.

Can someone with high blood pressure or heart disease use Voltaren?

Voltaren may raise blood pressure and cause fluid retention, and it is prohibited in severe heart failure and, in some cases, after heart attacks. If you have high blood pressure, diabetes, or heart disease, do not use it on your own. Consult your doctor to decide what is most suitable for you and for how long.

Sources and references

1. Diclofenac Topical (arthritis pain): MedlinePlus Drug Information — MedlinePlus — U.S. National Library of Medicine. Accessed: 2026-10-26.
2. About diclofenac — NHS (UK National Health Service). Accessed: 2026-10-26.
3. How and when to take or use diclofenac — NHS (UK National Health Service). Accessed: 2026-10-26.
4. Side effects of diclofenac — NHS (UK National Health Service). Accessed: 2026-10-26.
5. Pain Relievers | Analgesics | Painkillers — MedlinePlus — U.S. National Library of Medicine. Accessed: 2026-10-26.