Monday, September 01, 2008

Voltaren Gel

This is a great idea, but the logistics are awkward.

Voltaren is an non-steroidal anti-inflammatory (NSAID) pain reliever, and a rather effective one at that. It is available in pill form as the generic diclofenac. The downside of any NSAID is its adverse effect on the stomach and intestinal tract, causing pain, gastritis, ulcers, and diarrhea. In addition, the drugs can increase the risk of stroke and heart attack, and, in susceptible individuals, can decrease blood flow to the kidneys thus increasing the risk over years of use of decreased kidney function. Specific to Voltaren is the risk of "severe hepatic reactions, including liver necrosis, jaundice, fulminant hepatitis with and without jaundice, and liver failure" per www.voltarengel.com. Well shoot, who wants any of that?

We do, however, want arthritis pain relief, and Voltaren does that well. So Novartis minced it up and put it in an alcohol-based gel so that we could smear it right on our throbbing joints. Once absorbed through the skin, it reduces arthritic hand pain 46% after 6 weeks of use, and pain levels plunge 51% after 3 months of slathering it on arthritic knees. Drug levels reaching your stomach, kidneys, and liver are 6% that of an oral dose so, while the risks are not nothing, they're a whole lot less than the pill delivers.

The problem is in the how much cream how often department. The web site recommends 2 gm four times daily to upper extremity sites and 4 gm four times daily for the lower extremity. A tube of toothpaste is 170 gms so that amount of Voltaren Gel would get you through just over ten days of knee treatment. The stuff is definitely gooey, lightly but pleasantly scented, and dries within 4-5 minutes leaving a light sheen but no residual sticky stuff. I cannot imagine using it during the workday if I wore pantyhose. Pulling them back up again after gelling your hip would be like getting a wet bathing suit back on a small child. But then again, who wears pantyhose anymore? What about for one throbbing , chronically hyperextended index finger swollen from years of writing chart notes and prescriptions? The very thing I think, but you can't wash the area for 1 hour after each application.

The other problem is cost. By my calculations, you would apply your way through $172 worth of gel to service one bum knee for a month. Does insurance pay? Dunno, but I kind of think not.

10 comments:

Eric, AKA CubsterSEA said...

Compounding pharmacy. Ketoprofen in an alcohol/DMSO liquid base.

There's also a diclofenac patch that is modestly impressive.

Ruth said...

Several of our local pharmacies prepare customized anti-inflammatory creams on site that are cheaper than the prices you state. Our physicians do use them on our geriatric unit mainly because of the renal and hepatic benefits. Nearly all our patients who are admitted suffer the effects of polypharmacy.

Dr. Smak said...

Interesting - not used this at all. The crooked finger will be sure to be a difficult problem, with all that pesky hand hygiene, but ditch the hose.

Anonymous said...

The doctor mentions that it is a hassle to put the gel on and is not even sure of insurance coverage? Whats more important ? Providing releif,or worrying about the gelgetting on your pantyhose? Or GI bleeds with oral fomulations ? The patch doesnt adhere to joints unless you use masking tape! And the patch is more exspensive than the gel without coverage. I know people who have used the gel and love it. It is covered on some insurance plans, however today its tough to get branded on tier 1.

femail doc said...

Anon: Thanks for your comment. I've not heard from anyone who likes this product but the drug rep, so I appreciate your input! I'll reconsider its use.

Anonymous said...

I love the cream. I am 34 and have knee bursitis. The max dose of oral inflammatory meds couldn't touch the pain nor did they decrease swelling. Voltaren did.

Anonymous said...

My doctor gave me a sample of this for arthritis in my ankle. It's great!

Anonymous said...

If you use this cream for awhile can you ween off it or are you stuck with it or the pain?

femail doc said...

Dear Last Anon commenter:
This cream is solely for symptom control. If you have an ongoing orthopedic problem, once you discontinue the cream it will be just as uncomfortable as it was before the cream use. If you have an acute problem, say an ankle sprain, that will heal, there is nothing about using this cream to alleviate the pain that creates an ongoing need for its use.

Russ said...

I wonder if you took the pill form and crushed it and mixed it with alcohol/DMSO/aloe gel, would you have an affordable option or a mess???