Studies, including a large meta-analysis, have described the advantages of topical vs. oral NSAID therapy. These include high tissue levels of medication at the site of injury, with minimized systemic side effects, such as stomach upset and drowsiness.
J Pain Symptom Manage. 2007 Mar;33(3):342-55.
Topical agents for the management of musculoskeletal pain.
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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.” Topical NSAIDs have not been associated with renal failure.
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.
Free full text article available at bmj.com: QJM 1995;88:551–557
Non-steroidal anti-inflammatory drugs and hospitalization for acute renal failure.
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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.
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Free full text article available at bmj.com: 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.
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Findings of this study demonstrate that “following topical application in a patch, ketoprofen shows rapid and sustained delivery to the underlying tissues without a significant increase of the plasma drug concentration.”
AAPS PharmSciTech. 2010 Mar;11(1):154-8. Epub 2010 Jan 20.
Ketoprofen absorption by muscle and tendon after topical or oral administration in patients undergoing anterior cruciate ligament reconstruction.
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Reduction of spontaneous pain and pain on active movement in the topical ketoprofen spray group was significantly greater than in the oral ketoprofen treatment group, irrespective of sprain severity. Regarding mobility impairment and ankle swelling, topically-applied ketoprofen treatment turned out to be significantly superior to orally administered ketoprofen treatment. Additionally, the topical preparation was well tolerated, whereas ketoprofen tablets caused gastrointestinal side effects in some patients.
Minerva Cardioangiol. 2008 Oct;56(5 Suppl):47-53.
Management of uncomplicated ankle sprains with topical or oral ketoprofen treatment. A registry study.
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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 higher tissue levels beneath the site of application and a reduced incidence of systemic (such as gastrointestinal) adverse effects.
Advanced Studies in Medicine, Johns Hopkins University, Volume 3 (7A), July 2003
This study concluded that topical NSAIDs, when used for treatment of pain resulting from strains, sprains or sports or overuse-type injuries, can provide good levels of pain relief without the systemic adverse events associated with oral NSAIDs.
Cochrane Database Syst Rev. 2010 Jun 16; 6: CD007402.
Topical NSAIDs for acute pain in adults.
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