Topical NSAIDs and counter-irritants (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

There is some evidence that topical NSAIDs have an effect in acute conditions like strains and sprains and in chronic conditions like arthritis and rheumatism.  Simple analgesics or topical rubefacients may provide symptomatic relief and may be considered as an alternative. Generally unsuitable for children.  Patient packs carry a warning to avoid during pregnancy or breast-feeding.  A range of topical NSAIDs and rubefacients, including ibuprofen gel, is available to the public for self-medication from pharmacies and retail outlets. The cooling effect of levomenthol on the skin may be helpful.

IBUPROFEN

Therapy notes

  • Topical application of large amounts of NSAIDs may result in systemic effects including hypersensitivity and asthma (renal disease has also been reported).
  • Giving NSAIDs by multiple routes has an additive effect, eg oral and topical.
  • Review therapy after 14 days (or after 28 days for osteoarthritis).

Formulation and dosage details

Formulation:

Topical gel 5%OTC

Dosage:

Apply up to 3 times daily.

CAPSAICIN

Therapy notes

  • Caution; wash hands immediately after use. Avoid contact with eyes and inflamed or broken skin.
  • Watch carefully for broken skin and pressure sores in the feet and advise patients to stop treatment and seek help if there is any break in the skin or increasing irritation.

Formulation and dosage details

Formulation:

Cream 0·025%, 0·075% unlicensed (licensed products have become discontinued)

Dosage:

0·025%, for symptomatic relief in osteoarthritis, apply a small amount 4 times daily.

0·075%, for post-herpetic neuralgia (important: after lesions have healed) apply sparingly 3 to 4 times daily for 8 weeks then review. 

LEVOMENTHOL

Therapy notes

Formulation and dosage details

Formulation:

Cream, menthol 1% in aqueous cream (Arjun®)

Dosage:

Apply 1 to 2 times daily. 

Editorial Information

Document Id: F286