The authors warned that although topical lidocaine products are safe, some patients may experience unpredictably high absorption, leading to elevated blood levels. Castro and Dent conducted a double-blind placebo-controlled trial involving 87 patients with back pain or arthritis who were administered either an OTC transdermal patch containing 3. The OTC product was found to be noninferior to the prescription lidocaine transdermal patch in terms of efficacy, side effects, and impact on quality of life.
Both lidocaine patches were manufactured by JAR Laboratories, which partially funded this research. The treatment duration for OTC lidocaine patches is up to 7 days. The patches can be used every 6 to 8 hours as needed, not to exceed three applications within 24 hours.
Due to their good safety profile, low incidence of systemic effects, and lack of drug-drug interactions during topical exposure, lidocaine patches may be especially useful for the management of focal neuropathic pain with or without allodynia [heightened pain sensitivity to otherwise innocuous stimulation] in older adults. Capsaicin is a resin derived from hot chili peppers of the Capsicum family.
Commercially available preparations contain either capsaicin or capsicum oleoresin. Capsaicin is thought to work via several mechanisms of action. Capsaicin interacts with sensory afferents via vanilloid receptors, which are cation channels from the transient receptor potential TRP family.
Capsaicin depletes substance P at nerve afferent endings and temporarily reduces the density of nerve fibers in the skin. Trials involving capsaicin are difficult to conduct because it is nearly impossible to disguise its unique burning sensation. A systematic review of topical capsaicin for the treatment of chronic pain found that while topical capsaicin was better than placebo for the management of neuropathic and musculoskeletal pain, its efficacy was moderate to poor.
Nonetheless, the investigators recommended that topical capsaicin may be useful as an adjunct or as sole therapy for patients who are unresponsive or intolerant to other treatment modalities. No details are provided about the capsaicin patch employed.
An early phase 2, multicenter, randomized, semi—double-blind controlled study comparing the efficacy and safety of 0. The 1. Capsaicin patches 0. Beside the stinging, burning, and erythematous reaction that is associated with capsaicin therapy, inhalation of the drug can produce respiratory irritation and cough. Due to its half-life of about 2 hours, the four-times-a-day application of capsaicin cream makes this form of therapy inconvenient; the capsaicin patch helps to ameliorate this problem.
MS is also referred to as oil of wintergreen, sweet birch oil, gaultheria oil, teaberry oil, and mountain tea. It is by this mechanism that MS acts as a rubefacient. A systematic review found that while topically applied rubefacients containing salicylates may be effective for acute pain NNT 2.
The drug is lipophilic. There is appreciable dermal absorption via direct local tissue penetration when MS is applied topically. Acute salicylate poisoning has occurred following dermal application of MS. Exercise and heat exposure i. Absorption is also directly proportional to the amount of skin in contact with the drug.
Topical exposure of salicylates has been associated with fatalities from salicylism, especially in children. MS demonstrates zero-order kinetics following dermal absorption. Severe urticaria, angioedema, and contact dermatitis have been reported with the use of MS. Menthol, which is a natural product from the peppermint plant, Mentha piperita, is a cyclic terpene alcohol.
Menthol increases cutaneous blood flow. Activation of TRPM8 channels on sensory neurons of the trigeminal and dorsal root ganglia and on C unmyelinated axons and A thinly myelinated axons nociceptors reduce pain transmission. Although concentrations of menthol peak in the skin within 30 minutes, vasoactive effects are seen within 15 minutes.
The effects disappear after 45 minutes with the drug cleared from the skin by 60 minutes. There is a paucity of studies evaluating menthol patches. The heat wraps increased skin temperature by Further, whereas ThermaCare HeatWraps caused a However, since this was not an efficacy study, the clinical implications of these findings for patients with pain are unclear.
There are very limited published clinical data on the use of MS in conjunction with menthol, despite the widespread use of this analgesic combination. Pain relief was present during the 8 hours in which the patch was in contact with the skin; after removal of the patch, pain control dissipated. Salonpas patches are the first and only topically applied medication to receive FDA approval for the temporary relief of mild-to-moderate aches and pains of muscles and joints associated with arthritis, back pain, strains, bruises, and sprains.
Despite their widespread use, studies involving OTC analgesic patches are both lacking and are of poor quality. These trials, when available, vary in design and typically include small numbers of patients. For rubefacients, such as MS, there is a paucity of information supporting their use in either acute or chronic pain. There is conflicting evidence for the benefit of low-dose capsaicin in treating chronic neuropathic pain, but it may be useful for low back pain and osteoarthritis of the knees and hands.
Pharmacists need to be familiar with both the efficacy data and adverse effects associated with topical OTC analgesics in order to help ensure their safe use, especially since these medications are often used as first-line therapy in the management of acute and chronic pain. Prevalence of chronic pain and high-impact chronic pain among adults — United States, Accessed December 20, Department of Health and Human Services. Food and Drug Administration. Accessed November 29, Transdermal drug delivery in pain management.
Accessed December 15, Optimizing transdermal drug therapy. DailyMed will deliver this notification to your desktop, Web browser, or e-mail depending on the RSS Reader you select to use. Due to inconsistencies between the drug labels on DailyMed and the pill images provided by RxImage , we no longer display the RxImage pill images associated with drug labels.
We anticipate reposting the images once we are able identify and filter out images that do not match the information provided in the drug labels. View Package Photos. Drug Label Info. Drug Label Information Updated January 31, If you are a consumer or patient please visit this version. Uses temporarily relieves minor pain associated with: arthritis simple backache bursitis tendonitis muscle strains muscle sprains bruises cramps.
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