Topical nonsteroidal anti-inflammatory drugs the importance of drug delivery and therapeutic outcome

In studies lasting 6 to 12 weeks, topical diclofenac and topical ketoprofen were significantly more effective than carrier for reducing pain; about 60% of participants had much reduced pain. With topical diclofenac, the NNT for clinical success in six trials (2343 participants) was (95% confidence interval ( CI ) to 16) (moderate quality evidence). With topical ketoprofen, the NNT for clinical success in four trials (2573 participants) was ( to ) (moderate quality evidence). There was too little information for analysis of other individual topical NSAIDs compared with carrier. Few trials compared a topical NSAID to an oral NSAID , but overall they showed similar efficacy (low quality evidence). These efficacy results were almost completely derived from people with knee osteoarthritis.

US BOXED WARNINGS: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS :
-Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.
-This drug is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.
-NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at a greater risk for serious GI events.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

CAPSAICIN
Capsaicin is the chemical found in chili peppers that gives them their hot, spicy taste. It's also the active ingredient in several over-the-counter pain products, including Capzasin HP, Sloan's Liniment, and Zostrix. The burning sensation from capsaicin is supposed to do more than just get your mind off the pain, although it does that quite well. In theory, neurons shut down after they've been stimulated by the chemical, so the burning and other unrelated sensations -- including pain -- cease. We say "in theory" because the results from studies testing the low concentrations of capsaicin present in most over-the-counter products ( percent or less) haven't been impressive.

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  • Citation tools Download this article to citation manager Lin Jinying , Zhang Weiya , Jones Adrian , Doherty Michael . Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials BMJ 2004; 329 :324
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    Topical nonsteroidal anti-inflammatory drugs the importance of drug delivery and therapeutic outcome

    topical nonsteroidal anti-inflammatory drugs the importance of drug delivery and therapeutic outcome

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  • Citation tools Download this article to citation manager Lin Jinying , Zhang Weiya , Jones Adrian , Doherty Michael . Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials BMJ 2004; 329 :324
    • BibTeX (win & mac) Download
    • EndNote (tagged) Download
    • EndNote 8 (xml) Download
    • RefWorks Tagged (win & mac) Download
    • RIS (win only) Download
    • Medlars Download
    Help If you are unable to import citations, please contact technical support for your product directly (links go to external sites):

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