Pain : NSAID Therapy
To avoid the risks of COX-2 inhibitors, our pharmacy can compound topically
applied NSAIDs such as ibuprofen and ketoprofen. Topical NSAIDs have a safety
profile which is superior to oral formulations. Topical NSAID administration
offers the advantage of local, enhanced delivery to painful sites with a reduced
incidence of systemic adverse effects.
Topical preparations can be customized to contain a combination of medications
to meet the specific needs of each patient.
Topical NSAIDs for Acute Pain
“Topical non-steroidal anti-inflammatory drugs have a lower incidence of
gastrointestinal adverse effects than the same drugs when they are taken orally.
The low incidence of systemic adverse effects for topical NSAIDs probably results
from the much lower plasma concentration from similar doses applied topically
to those administered orally. Topical application of ibuprofen resulted in measurable
tissue concentrations in deep tissue compartments, more than enough to inhibit
inflammatory enzymes.”1 Topical NSAIDs have not been associated with renal
failure.2
1 BMJ. 1995 Jul 1;311(6996):22-6
Topical non-steroidal anti-inflammatory drugs and admission to hospital for
upper gastrointestinal bleeding and perforation: a record linkage case-control
study.
Evans JM, McMahon AD, McGilchrist MM, White G, Murray FE, McDevitt DG, MacDonald
TM.
Department of Clinical Pharmacology, Ninewells Hospital and Medical School,
Dundee.
Free full text article available at bmj.com:
http://bmj.bmjjournals.com/cgi/content/full/311/6996/22
Click
here to access the PubMed abstract of this article.
The following article concludes: “Topical non-steroidal anti-inflammatory
drugs are effective in relieving pain in acute and chronic conditions.”
BMJ. 1998 Jan 31;316(7128):333-8
Quantitative systematic review of topically applied non-steroidal anti-inflammatory
drugs.
Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ.
University of Oxford, Oxford Radcliffe Hospital, Headington, UK
Click
here to access the PubMed abstract of this article.
Free full text article available at bmj.com:
http://bmj.bmjjournals.com/cgi/content/full/316/7128/333
The following article reports “The systemic concentrations of ketoprofen
have also been found to be 100 fold lower compared to tissue concentrations
below the application site in patients undergoing knee joint surgery. Topically
applied ketoprofen thus provides high local concentration below the site of
application but lower systemic exposure.”
Pharm Res. 1996 Jan;13(1):168-72
Percutaneous absorption of ketoprofen from different anatomical sites in man.
Shah AK, Wei G, Lanman RC, Bhargava VO, Weir SJ.
Pfizer Inc., Central Research Division, Groton, Connecticut 06340
Free full text article available at bmj.com:
www.bmj.bmjjournals.com/cgi/content/full/316/7128/333
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