Who Cannot Take Voltaren: Essential Safety Information for Diclofenac Users

Who Cannot Take Voltaren: Essential Safety Information for Diclofenac Users

Sarah was really struggling. Her back pain had been a constant companion for months, making even simple tasks feel like a marathon. Her doctor recommended Voltaren (diclofenac), a popular over-the-counter pain reliever. She grabbed a tube of the topical cream, eager for some relief. But as she read the leaflet, a knot of anxiety formed in her stomach. A long list of "do not take if" warnings stared back at her. Sarah wondered, "Who *cannot* take Voltaren?"

This is a question many people face. While Voltaren, containing the active ingredient diclofenac, can be a godsend for many experiencing pain and inflammation, it's absolutely crucial to understand that it's not for everyone. Taking a medication without understanding its contraindications can lead to serious health consequences. My own experience with a relative who experienced a severe reaction to an NSAID underscored the critical importance of this awareness. It’s not just about masking pain; it’s about ensuring the chosen relief doesn't inadvertently cause greater harm. This article aims to provide a comprehensive guide, delving deep into who should steer clear of Voltaren and why, drawing upon extensive research and offering practical advice for safe medication use.

Understanding Voltaren: What It Is and How It Works

Before we dive into who cannot take Voltaren, it's helpful to have a basic understanding of what it is. Voltaren is the brand name for diclofenac, a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs work by blocking the production of certain chemicals in the body called prostaglandins. Prostaglandins play a key role in the inflammatory process, causing pain, swelling, redness, and heat. By inhibiting their production, diclofenac helps to reduce these symptoms.

Voltaren comes in various forms, including topical creams, gels, and patches, as well as oral tablets and capsules. The topical formulations are designed to target localized pain and inflammation, like that associated with osteoarthritis of the knee or hand, or sprains and strains. Oral formulations are generally used for more widespread pain and inflammation, such as that seen in rheumatoid arthritis or ankylosing spondylitis. The absorption and potential side effects can differ depending on the delivery method.

Key Benefits of Voltaren (Diclofenac) Pain Relief: Effectively reduces mild to moderate pain. Inflammation Reduction: Helps to calm down swelling and redness associated with various conditions. Improved Mobility: By reducing pain and inflammation, it can significantly improve a person's ability to move freely. Targeted Relief (Topical): Topical forms offer localized treatment, minimizing systemic side effects for some individuals.

However, the very mechanism that makes NSAIDs effective – blocking prostaglandins – also means they can interfere with other bodily functions where prostaglandins are beneficial. This is where the contraindications come into play.

The Primary Groups Who Cannot Take Voltaren

So, let's get straight to the heart of the matter. Who absolutely should not take Voltaren? The list is significant, and understanding these conditions is paramount for personal safety. These aren't minor suggestions; they are critical warnings that, if ignored, can have severe health repercussions.

1. Individuals with a History of Allergic Reactions to Diclofenac or Other NSAIDs

This is perhaps the most immediate and obvious contraindication. If you've ever experienced any form of allergic reaction to Voltaren (diclofenac) or any other NSAID – such as ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin – you should not take Voltaren. Allergic reactions can range from mild skin rashes and itching to severe, life-threatening anaphylaxis, which involves difficulty breathing, swelling of the face and throat, and a sudden drop in blood pressure.

What to look out for:

Hives or a widespread rash Itching Swelling of the face, lips, tongue, or throat Wheezing or difficulty breathing Dizziness or fainting

If you’ve had even a mild reaction to one NSAID, it’s wise to assume you might react to others. It’s always best to discuss your medication history thoroughly with your doctor or pharmacist before starting any new NSAID, including Voltaren.

2. People with Active Peptic Ulcer Disease or a History of Gastrointestinal Bleeding

This is a major concern for NSAID use. Voltaren, like other NSAIDs, can irritate the lining of the stomach and intestines. Prostaglandins play a protective role in the gastrointestinal tract, helping to maintain the integrity of the stomach lining. By blocking these prostaglandins, NSAIDs can make the lining more vulnerable to damage, leading to ulcers, bleeding, and even perforation (a hole in the stomach or intestinal wall).

If you currently have an active peptic ulcer, taking Voltaren is a definite no-go. Even if you’ve had an ulcer or gastrointestinal bleeding in the past, you should exercise extreme caution. Your doctor might advise against NSAIDs altogether or may consider a very low dose for a short duration, perhaps with a protective medication like a proton pump inhibitor (PPI).

Signs of gastrointestinal bleeding include:

Black, tarry stools (melena) Vomiting blood or material that looks like coffee grounds Stomach pain that doesn't go away Unexplained weakness or fatigue (due to anemia from blood loss)

It's vital to report any of these symptoms immediately to your healthcare provider.

3. Individuals with Severe Heart Failure

NSAIDs, including Voltaren, can worsen heart failure. They can cause the body to retain fluid and salt, leading to increased blood volume and pressure on the heart. This can exacerbate symptoms of heart failure, such as shortness of breath, swelling in the legs and ankles, and fatigue.

For individuals with diagnosed severe heart failure, Voltaren is generally contraindicated. Even in those with milder heart failure, NSAID use should be approached with extreme caution and under close medical supervision. Doctors will often weigh the risks and benefits very carefully and may opt for alternative pain management strategies.

Symptoms of worsening heart failure include:

Increased shortness of breath, especially when lying down or with exertion Sudden weight gain (due to fluid retention) Swelling in the legs, ankles, or feet Increased fatigue and weakness A persistent cough, sometimes with pink, frothy mucus

If you have a history of heart failure, always consult your doctor before taking Voltaren. They will assess your specific condition and advise accordingly.

4. Patients with Severe Kidney Disease

The kidneys play a crucial role in filtering waste products from the blood and regulating fluid balance. NSAIDs can affect kidney function by reducing blood flow to the kidneys. In individuals with pre-existing kidney disease, this reduction in blood flow can be particularly damaging and lead to a further decline in kidney function, potentially resulting in acute kidney injury or worsening chronic kidney disease.

Therefore, if you have severe kidney disease, Voltaren is generally not recommended. Your doctor will likely monitor your kidney function regularly if you have any history of kidney problems and are considering or taking NSAIDs. It’s essential to be upfront about any kidney issues with your healthcare provider.

Signs that your kidney function might be affected include:

Changes in urination frequency (more or less than usual) Swelling in the legs, ankles, or feet Fatigue and weakness Nausea and vomiting Loss of appetite Itching

Regular blood tests (creatinine and BUN) are often used to monitor kidney function.

5. Those in the Third Trimester of Pregnancy

During the third trimester of pregnancy, NSAIDs, including diclofenac, are generally avoided. One of the main concerns is the potential for premature closure of a fetal blood vessel called the ductus arteriosus. This vessel is vital for fetal circulation but should close shortly after birth. Premature closure can lead to serious heart and lung problems in the newborn.

Furthermore, NSAIDs can interfere with labor and delivery by affecting blood clotting and potentially prolonging pregnancy. For these reasons, pregnant individuals in their third trimester should not take Voltaren. While use in earlier trimesters might be considered under strict medical guidance for specific indications, it's always best to err on the side of caution and discuss any medication use with your obstetrician.

Key considerations for pregnancy:

Consult your doctor immediately if you are pregnant and have pain. Avoid NSAIDs during the third trimester unless specifically directed by your doctor. Discuss all medications, including over-the-counter ones, with your healthcare provider. 6. Individuals with Severe Liver Disease

While less common than kidney or gastrointestinal issues, NSAIDs can also affect liver function. Diclofenac is metabolized by the liver, and in individuals with pre-existing severe liver disease, the liver may not be able to process the medication effectively. This can lead to a buildup of the drug in the body, potentially causing liver damage or exacerbating existing liver problems.

If you have severe liver disease, you should avoid Voltaren. For those with milder liver issues, your doctor might monitor liver function tests closely if NSAID use is deemed necessary.

Signs of liver problems can include:

Yellowing of the skin and whites of the eyes (jaundice) Dark urine Pale stools Abdominal pain, especially in the upper right side Nausea and vomiting Fatigue

Other Important Considerations and Relative Contraindications

Beyond the absolute contraindications, there are several other situations where Voltaren use needs to be carefully considered, often involving a risk-benefit analysis with a healthcare provider. These are sometimes referred to as relative contraindications, meaning the medication might be used, but with significant caution and monitoring.

1. Individuals Taking Certain Medications

The interaction between medications can be complex and potentially dangerous. Voltaren can interact with several classes of drugs, increasing the risk of side effects or reducing the effectiveness of other medications. It is crucial to inform your doctor and pharmacist about ALL medications you are taking, including prescription drugs, over-the-counter medicines, herbal supplements, and vitamins.

Key drug interactions to be aware of:

Blood Thinners (Anticoagulants): Medications like warfarin (Coumadin), rivaroxaban (Xarelto), and apixaban (Eliquis). NSAIDs can increase the risk of bleeding when taken with these drugs. Other NSAIDs: Taking Voltaren with other NSAIDs, even in combination products (like some cold remedies), significantly increases the risk of gastrointestinal bleeding and other side effects. Aspirin: Low-dose aspirin for heart protection can be affected by Voltaren. While sometimes co-prescribed with careful timing and monitoring, it increases bleeding risk. Corticosteroids: Medications like prednisone. Combining these with NSAIDs significantly elevates the risk of gastrointestinal ulcers and bleeding. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Antidepressants like fluoxetine (Prozac) and venlafaxine (Effexor). These can also increase the risk of bleeding. Diuretics ("Water Pills"): Medications like furosemide (Lasix) and hydrochlorothiazide. NSAIDs can reduce the effectiveness of diuretics and increase the risk of kidney damage. ACE Inhibitors and Angiotensin II Receptor Blockers (ARBs): Blood pressure medications like lisinopril (Prinivil) and losartan (Cozaar). NSAIDs can reduce their blood pressure-lowering effect and increase the risk of kidney problems, particularly in older adults or those with existing kidney issues. Lithium: A medication used to treat bipolar disorder. NSAIDs can increase lithium levels in the blood, potentially leading to toxicity. Methotrexate: A medication used to treat cancer and autoimmune diseases. NSAIDs can increase methotrexate levels, leading to toxicity.

This is not an exhaustive list. Always discuss your full medication regimen with your healthcare provider.

2. Individuals with a History of Asthma, Especially Aspirin-Sensitive Asthma

Some individuals with asthma, particularly those whose asthma is triggered or worsened by aspirin, can experience similar reactions to other NSAIDs, including Voltaren. This condition is known as aspirin-exacerbated respiratory disease (AERD) or Samter's Triad. It typically involves asthma, nasal polyps, and a sensitivity to aspirin and other NSAIDs. Reactions can include bronchospasm (wheezing and difficulty breathing) shortly after taking the medication.

If you have asthma and have ever experienced breathing difficulties after taking aspirin or another NSAID, you should avoid Voltaren and discuss alternative pain relief with your doctor.

3. Elderly Patients

Older adults are generally at a higher risk for adverse effects from NSAIDs, including Voltaren. Their bodies may process medications differently, and they are often more likely to have underlying health conditions (like heart, kidney, or gastrointestinal issues) that can be exacerbated by NSAIDs. The risk of gastrointestinal bleeding, kidney problems, and cardiovascular events is significantly increased in this age group.

If you are an older adult, it is especially important to:

Discuss any potential Voltaren use with your doctor. Start with the lowest effective dose for the shortest possible duration. Be vigilant for any new or worsening symptoms and report them immediately. Consider alternative pain management options. 4. Individuals with Inflammatory Bowel Disease (IBD) - Crohn's Disease and Ulcerative Colitis

While NSAIDs are not a direct cause of IBD, they can sometimes trigger or worsen flares in individuals who have Crohn's disease or ulcerative colitis. The exact mechanism isn't fully understood, but it's thought that NSAIDs can disrupt the protective lining of the gut, making it more susceptible to inflammation, or they may alter the gut microbiome.

If you have IBD, it's generally advisable to avoid NSAIDs like Voltaren unless your doctor specifically recommends it and monitors you closely. Acetaminophen (Tylenol) is often considered a safer alternative for pain relief in these individuals, though it doesn't have anti-inflammatory properties.

5. Individuals with Certain Cardiovascular Risk Factors

Beyond severe heart failure, NSAIDs have been linked to an increased risk of cardiovascular events such as heart attack and stroke. This risk appears to be higher with long-term use and at higher doses, but it can occur even with short-term use in susceptible individuals. People with existing cardiovascular disease, high blood pressure, high cholesterol, diabetes, or who smoke are at greater risk.

While doctors may prescribe Voltaren even to some individuals with cardiovascular risk factors if the benefits outweigh the risks, it's a decision that requires careful medical evaluation. Patients should be aware of the symptoms of heart attack and stroke and seek immediate medical attention if they occur.

Symptoms of heart attack include:

Chest pain or discomfort Pain or discomfort in one or both arms, the back, neck, jaw, or stomach Shortness of breath Cold sweat, nausea, or lightheadedness

Symptoms of stroke include:

Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body Sudden confusion, trouble speaking, or difficulty understanding speech Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance, or coordination Sudden severe headache with no known cause

Choosing Safer Alternatives: What to Do If You Cannot Take Voltaren

If you fall into any of the categories above, the good news is that there are often alternative ways to manage pain and inflammation. It's always best to consult with your healthcare provider to determine the safest and most effective options for your specific situation.

1. Acetaminophen (Tylenol)

Acetaminophen is a pain reliever and fever reducer but does not have significant anti-inflammatory effects. It is generally considered safer for individuals with gastrointestinal issues, heart problems, or kidney disease compared to NSAIDs. However, it's crucial not to exceed the recommended dosage, as overdose can cause severe liver damage.

2. Topical Non-NSAID Pain Relievers

For localized pain, such as in the knees or hands, topical treatments that don't contain NSAIDs might be an option. These can include capsaicin creams or menthol-based rubs. While they work differently than NSAIDs, they can provide some relief for certain types of pain.

3. Physical Therapy and Exercise

For many chronic pain conditions, physical therapy can be incredibly beneficial. A physical therapist can design a personalized exercise program to strengthen muscles, improve flexibility, and reduce pain without medication. Low-impact exercises like swimming, walking, and cycling can also be helpful.

4. Lifestyle Modifications

Depending on the source of your pain, lifestyle changes can make a big difference. This might include weight management to reduce stress on joints, improving posture, using ergonomic tools, or adopting stress-reduction techniques like mindfulness or meditation.

5. Prescription Medications (Non-NSAID)

In some cases, your doctor might prescribe other types of medications that are not NSAIDs but can help manage pain and inflammation, depending on the underlying cause. These could include certain muscle relaxants, nerve pain medications, or other specialized drugs.

6. Heat and Cold Therapy

Simple applications of heat (like a warm compress or bath) or cold (like an ice pack) can be effective for temporary pain relief and reducing swelling. Experiment to see which works best for your specific type of pain.

Understanding the Different Forms of Voltaren and Their Specific Warnings

It's important to note that the risks and warnings can sometimes vary slightly depending on whether you are using topical Voltaren (cream, gel, patch) or oral Voltaren (tablets, capsules).

Topical Voltaren (Diclofenac Gel, Cream, Patch)

Topical diclofenac is absorbed through the skin, leading to lower systemic levels of the drug compared to oral formulations. This generally means a lower risk of serious gastrointestinal and cardiovascular side effects. However, it's not risk-free.

Who should still be cautious or avoid topical Voltaren:

Individuals with known allergies to diclofenac or other NSAIDs. A skin reaction is still possible. Those with a history of skin reactions to topical medications. People with asthma (especially aspirin-sensitive asthma), as systemic absorption, though low, can still trigger reactions in sensitive individuals. Pregnant individuals – particularly in the third trimester, though general advice is to avoid unless medically indicated and supervised. Individuals with severe kidney, liver, or heart disease should still consult their doctor, as some systemic absorption does occur. Do not apply to broken or infected skin. Avoid contact with eyes and mucous membranes. Wash hands after application to prevent accidental transfer to sensitive areas or other people.

While topical Voltaren is often considered a safer alternative for localized pain, it's crucial to read the specific product labeling and consult your doctor.

Oral Voltaren (Diclofenac Tablets, Capsules)

Oral diclofenac carries a higher risk of systemic side effects because the drug enters the bloodstream directly. Therefore, all the contraindications and precautions mentioned earlier are particularly relevant and strongly emphasized for oral formulations.

Absolute contraindications for oral Voltaren:

History of allergic reaction to diclofenac or other NSAIDs Active peptic ulcer disease or history of GI bleeding Severe heart failure Severe kidney disease Severe liver disease Third trimester of pregnancy

The risk of cardiovascular events (heart attack, stroke) and serious gastrointestinal complications (bleeding, perforation) is more pronounced with oral NSAIDs. They should generally be used at the lowest effective dose for the shortest duration necessary.

A Checklist for Safety: Before You Take Voltaren

To help you navigate this important decision, here's a checklist. If you answer "yes" to any of the following questions, you MUST speak with your doctor or pharmacist before taking Voltaren, regardless of its formulation.

Voltaren Safety Checklist

Have you ever experienced any of the following after taking aspirin or another NSAID (like ibuprofen or naproxen)?

Rash, itching, hives? (Yes/No) Wheezing or difficulty breathing? (Yes/No) Swelling of your face, lips, tongue, or throat? (Yes/No) Anaphylaxis or other severe allergic reaction? (Yes/No)

Do you currently have or have you ever had any of the following conditions?

Stomach ulcers or bleeding? (Yes/No) Severe heart problems (heart failure)? (Yes/No) Severe kidney problems? (Yes/No) Severe liver problems? (Yes/No) Asthma? (Yes/No) Have you ever had breathing problems after taking aspirin or an NSAID (aspirin-sensitive asthma)? (Yes/No) Inflammatory Bowel Disease (Crohn's disease or Ulcerative Colitis)? (Yes/No) High blood pressure? (Yes/No) Heart disease, history of heart attack, or stroke? (Yes/No)

Are you currently pregnant or breastfeeding?

Pregnant (especially third trimester)? (Yes/No) Breastfeeding? (Yes/No - consult doctor as caution is advised)

What other medications are you currently taking? (List ALL, including prescriptions, OTCs, supplements, and herbals)

Blood thinners (e.g., warfarin, Eliquis)? (Yes/No) Other NSAIDs (e.g., ibuprofen, naproxen, aspirin)? (Yes/No) Corticosteroids (e.g., prednisone)? (Yes/No) SSRIs or SNRIs (antidepressants)? (Yes/No) Diuretics ("water pills")? (Yes/No) Blood pressure medications (ACE inhibitors, ARBs)? (Yes/No) Lithium? (Yes/No) Methotrexate? (Yes/No) Any other prescription or over-the-counter medications? (Please list)

Are you over the age of 65?

Yes (Increased caution needed) (Yes/No)

If you marked "Yes" to any of the critical contraindications (e.g., severe heart failure, active ulcers, severe kidney/liver disease, allergy) or have significant interactions, you likely cannot take Voltaren. For other "Yes" answers, it means you need to have a detailed discussion with your healthcare provider to assess your individual risk and determine if Voltaren is appropriate for you, or if safer alternatives exist.

Frequently Asked Questions About Who Cannot Take Voltaren

Q: I have mild knee pain and osteoarthritis. My doctor suggested Voltaren gel. I've had heartburn in the past, but no ulcers. Can I use it?

A: This is a common scenario, and it highlights the importance of understanding relative vs. absolute contraindications. While you don't have an active ulcer or a history of bleeding, having experienced heartburn suggests a sensitivity in your gastrointestinal tract. Topical Voltaren generally has lower systemic absorption than oral forms, meaning a reduced risk of stomach issues. However, it's still crucial to discuss this with your doctor. They will likely advise you to:

Start with the lowest available strength of the Voltaren gel. Apply it precisely to the affected knee and avoid widespread application. Be extremely vigilant for any signs of gastrointestinal upset, such as worsening heartburn, stomach pain, nausea, or changes in bowel habits. Report any such symptoms immediately to your doctor. They might also recommend taking Voltaren gel in conjunction with an over-the-counter antacid if needed, or even consider a short course of a proton pump inhibitor (PPI) for added stomach protection, especially if you plan to use it regularly.

It’s also worth exploring other options for osteoarthritis pain, such as acetaminophen, physical therapy, or other topical agents, to see if they can provide adequate relief with fewer potential risks for your specific situation.

Q: I have high blood pressure and take Lisinopril. My doctor prescribed Voltaren tablets for my back pain. Is this safe?

A: This situation requires careful consideration due to potential drug interactions. Lisinopril is an ACE inhibitor, and as mentioned, NSAIDs like Voltaren can interfere with the effectiveness of ACE inhibitors and increase the risk of kidney problems, especially in individuals with pre-existing kidney issues or older adults. However, the decision to prescribe Voltaren tablets in this case likely means your doctor has weighed the benefits against the risks for your specific medical profile.

Here's what you should expect and do:

Close Monitoring: Your doctor will likely want to monitor your blood pressure regularly and may order kidney function tests (blood work) to ensure your kidneys are handling the medication well. Lowest Dose, Shortest Duration: You should be instructed to take the lowest possible dose of Voltaren that effectively manages your pain and to use it for the shortest duration possible. Be Aware of Symptoms: Pay close attention to any signs of elevated blood pressure (headaches, dizziness), fluid retention (swelling in ankles or legs), or changes in urination. Report these to your doctor promptly. Communicate: If you feel your back pain is not well-controlled or if you experience any new or worsening symptoms, don't hesitate to contact your doctor. They may need to adjust your treatment plan.

It’s always a good idea to confirm with your doctor why they believe Voltaren is the best choice for you in this context and what specific signs they want you to watch for.

Q: I have a history of stomach ulcers, but they are healed now. Can I take Voltaren?

A: This is a situation where caution is paramount. While healed ulcers may seem like a non-issue, the stomach lining can still be more vulnerable. NSAIDs, including Voltaren, work by reducing protective prostaglandins in the stomach lining, which can make it susceptible to damage again. Taking Voltaren, even if your ulcer is healed, significantly increases your risk of developing a new ulcer or experiencing a recurrence of bleeding.

In such cases:

Avoidance is Generally Recommended: Most healthcare providers would strongly advise against using Voltaren (especially oral forms) if you have a history of peptic ulcer disease. Discuss Alternatives: Safer alternatives for pain and inflammation management will likely be recommended. These could include acetaminophen, other classes of pain relievers, or non-pharmacological approaches. If Absolutely Necessary: In very rare circumstances, if the benefits of Voltaren are deemed to outweigh the significant risks, a doctor might prescribe it at the lowest possible dose for the shortest duration, always coupled with a gastroprotective medication like a proton pump inhibitor (PPI). However, this is usually a last resort, and strict monitoring is essential.

It is far better to err on the side of caution and explore all other possible pain relief options before considering Voltaren with a history of ulcers.

Q: I am allergic to penicillin. Does this mean I'm allergic to Voltaren?

A: No, an allergy to penicillin does not automatically mean you are allergic to Voltaren (diclofenac). Penicillin is a type of antibiotic, and its allergic reactions are due to its specific chemical structure, which is very different from NSAIDs like diclofenac. Allergic reactions are highly specific to the substance that triggers them.

However, this does not mean you can disregard safety. If you have a history of drug allergies in general, it's always a good practice to:

Inform your doctor or pharmacist about ALL your known drug allergies. When starting Voltaren, be aware of the signs of an allergic reaction (rash, itching, swelling, breathing difficulties) and discontinue use immediately if you experience any.

Your penicillin allergy itself does not preclude you from taking Voltaren, but general caution with new medications is always advised.

Concluding Thoughts on Safe Voltaren Use

Navigating the world of pain relief medication can be complex. Voltaren, a potent NSAID, offers significant benefits for many, but its use is not without risks. Understanding "who cannot take Voltaren" is not just a matter of reading a leaflet; it's about taking an active role in your health and safety. The key takeaway is that if you have a history of allergies to NSAIDs, active gastrointestinal bleeding, severe heart, kidney, or liver disease, or are in the third trimester of pregnancy, you should avoid Voltaren.

Furthermore, individuals with certain chronic conditions, those taking specific medications, and older adults need to exercise extreme caution and always consult with a healthcare professional. The risk of serious side effects, including gastrointestinal bleeding, cardiovascular events, and kidney damage, is real and should not be underestimated. By being informed, asking the right questions, and working closely with your doctor or pharmacist, you can make the safest and most effective choices for managing your pain.

Remember, the goal is relief without causing further harm. Never hesitate to seek professional medical advice – it’s your best defense in ensuring that the medications you take contribute positively to your well-being.