Indication for Aspercreme (Trolamine Salicylate)
Aspercreme (trolamine salicylate) is indicated for the temporary relief of minor aches and pain associated with simple backache, arthritis, strains, bruises, and sprains. 1
Mechanism and Formulation
Trolamine salicylate is a topical analgesic that works locally to provide pain relief. It is typically formulated as a 10% cream that can be applied directly to the affected area. Unlike other topical salicylates, Aspercreme has no strong odor or counter-irritating properties, making it more acceptable to patients 2.
Evidence for Effectiveness
The efficacy of trolamine salicylate has been demonstrated in several clinical contexts:
Osteoarthritis: Research has shown that trolamine salicylate cream is effective for temporary relief of minor pain and stiffness associated with osteoarthritis in the hands 2. The European League Against Rheumatism (EULAR) recognizes topical NSAIDs, including trolamine salicylate, as effective for pain relief in hand osteoarthritis with an effect size of 0.77 3.
Musculoskeletal Pain: Studies have demonstrated that trolamine salicylate cream can reduce the duration and severity of muscular soreness caused by exercise 4.
Tissue Penetration
Trolamine salicylate has been shown to penetrate into underlying tissues when applied topically:
- Research in pigs demonstrated that at least 82% of topically applied trolamine salicylate was absorbed over a 2-hour period 5.
- Muscle tissue directly under the application site showed salicylate concentrations 13 times higher than blood levels and 49 times higher than untreated muscle areas 5.
Clinical Application Guidelines
When using Aspercreme:
- Apply to affected areas by rubbing in thoroughly
- Can be applied up to 3-4 times daily
- Should not be bandaged or wrapped tightly after application
- Avoid application to broken or irritated skin
Safety Considerations and Contraindications
Contraindications:
- Known sensitivity to salicylates or any ingredients in the formulation 3, 6
- Should not be used in combination with oral salicylate drugs due to risk of systemic toxicity 3, 6
Special Populations:
- Pregnancy: Appears to be a safe choice for localized treatment (Pregnancy Category C) 3, 6
- Nursing mothers: Should discontinue nursing or the drug, or avoid applying to chest area if used while nursing 6
- Pediatric use: Should be avoided in children under 2 years of age and used with caution in children under 12 years due to increased risk of salicylate toxicity 6
Potential Drug Interactions:
- Acidifying agents, anticoagulants, antidiabetic agents, aspirin, corticosteroids, diuretics, methotrexate, pyrazinamide, sulfur, and uricosuric agents 3, 6
Monitoring and Precautions
- Systemic absorption, although rare, can occur, especially when applied to more than 20% of body surface area or in patients with abnormal hepatic or renal function 3, 6
- Should not be applied before UVB phototherapy due to filtering effect 3, 6
- If symptoms persist for more than 7 days or worsen, discontinue use and consult a healthcare provider
In summary, Aspercreme (trolamine salicylate) is indicated for temporary relief of minor musculoskeletal pain and is applied topically to affected areas. It offers a safe alternative to oral NSAIDs for localized pain relief with minimal systemic absorption when used as directed.