Systemic effect of topical diclofenac
Topical diclofenac (as Voltaren gel, for example) is a popular choice for quite a few things, from osteoarthritis to sports injuries.
Diclofenac itself can be hard on the body, especially the stomach, but not just because it's taken orally. How much systemic effect does topical diclofenac retain? Is there any rough "dosage equivalency", like "x grams of topical gel a day equals one 15mg tablet in terms of the systemic effect"?
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Not a lot, it seems, which reduces side effects, but of course also makes the effect more local instead of systemic.
The pharmacological study
Systemic Bioavailability of Topical Diclofenac Sodium Gel 1% Versus Oral Diclofenac Sodium in Healthy Volunteers concludes
Systemic exposure with diclofenac sodium gel 1% was 5- to 17-fold lower than with oral diclofenac. Systemic effects with topical diclofenac were less pronounced.
Which is conclusive with an earlier study In vivo bioavailability and metabolism of topical diclofenac lotion in human volunteers, which measured a systemic absorption of around 7 percent (around a 15-fold decrease).
Most side effects from topical diclofenac affect the skin, gastrointestinal system are much lower than when a comparable oral dose is given. For example, in a study on 200 elderly patients, no gastrointestinal issues were reported. A meta analysis of 14 studies concludes that it has a low incidence of gastrointestinal issues, with the main complaints being nausea.
However, as the first referenced study also says, topical diclofenac
inhibited COX-1 and COX-2 less than oral diclofenac
And therefore
Systemic effects with topical diclofenac were less pronounced
So in terms of effect, topical application is not quite the same as taking it orally.
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