PMID- 22367354
OWN - NLM
STAT- MEDLINE
DCOM- 20160609
LR  - 20150909
IS  - 1536-3686 (Electronic)
IS  - 1075-2765 (Linking)
VI  - 22
IP  - 5
DP  - 2015 Sep-Oct
TI  - Topical Nonsteroidal Anti-Inflammatory Drugs: The Importance of Drug, Delivery, 
      and Therapeutic Outcome.
PG  - 388-407
LID - 10.1097/MJT.0b013e3182459abd [doi]
AB  - Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of 
      pain associated with a variety of indications, including arthritic conditions, 
      but their usefulness is often limited by dose-dependent adverse events (AEs), 
      such as gastrointestinal disturbances, cardiovascular events, and renal toxicity. 
      The risk of such effects could be reduced by the use of topical formulations, 
      which offer the potential to deliver analgesic concentrations locally, at the 
      site of inflammation, while minimizing systemic concentrations. The topical 
      preparations currently approved in the United States are diclofenac sodium 1.5% 
      topical solution (containing dimethyl sulfoxide as a penetration enhancer), 
      diclofenac sodium gel 1%, and a diclofenac hydroxyethylpyrrolidine 1.3% patch. 
      Each of these topical NSAIDs provide drug delivery to subcutaneous tissues for 
      the management of pain associated with osteoarthritis or soft-tissue injuries. 
      Furthermore, these formulations are not significantly associated with the 
      systemic AEs associated with oral NSAIDs; the most common AEs associated with 
      topical formulations are local skin reactions, which are usually mild and 
      self-limiting. Other topical NSAID preparations approved in the European Union 
      include ibuprofen creams and gels, ketoprofen gel, felbinac gel and cutaneous 
      foam, and piroxicam gel. Meta-analyses have confirmed the efficacy and safety of 
      these preparations. However, it is important to recognize that pharmacokinetic 
      absorption from topical formulations can vary markedly, even between different 
      formulations of the same drug, depending on the agent, the underlying disorder, 
      and the site of application. It is therefore essential to consider the patient, 
      the drug, and the drug delivery mechanism when selecting a topical NSAID 
      preparation.
FAU - Barkin, Robert L
AU  - Barkin RL
AD  - Departments of Anesthesiology; Family Medicine; and Pharmacology, Rush University 
      Medical Center, Chicago, IL; and Department of Anesthesiology, North Shore 
      University Health System, Pain Centers Skokie and Evanston Hospital, Skokie, IL.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Ther
JT  - American journal of therapeutics
JID - 9441347
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Phenylacetates)
RN  - 13T4O6VMAM (Piroxicam)
RN  - 144O8QL0L1 (Diclofenac)
RN  - 51317-25-0 (biphenylylacetic acid)
RN  - 90Y4QC304K (Ketoprofen)
RN  - WK2XYI10QM (Ibuprofen)
SB  - IM
MH  - Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/adverse 
      effects/*therapeutic use
MH  - Diclofenac/therapeutic use
MH  - Drug Delivery Systems
MH  - Humans
MH  - Ibuprofen/therapeutic use
MH  - Ketoprofen/therapeutic use
MH  - Pain/*drug therapy
MH  - Phenylacetates/therapeutic use
MH  - Piroxicam/therapeutic use
MH  - Skin Absorption
MH  - United States
EDAT- 2012/03/01 06:00
MHDA- 2016/06/10 06:00
CRDT- 2012/02/28 06:00
PHST- 2012/02/28 06:00 [entrez]
PHST- 2012/03/01 06:00 [pubmed]
PHST- 2016/06/10 06:00 [medline]
AID - 10.1097/MJT.0b013e3182459abd [doi]
PST - ppublish
SO  - Am J Ther. 2015 Sep-Oct;22(5):388-407. doi: 10.1097/MJT.0b013e3182459abd.