Brand Names of Topical NSAIDs
The FDA-approved topical NSAID formulations available in the United States include diclofenac sodium 1% gel (Voltaren Gel), diclofenac sodium topical solution 1.5% w/w in 45.5% dimethyl sulfoxide (PENNSAID), and diclofenac epolamine 1.3% patch (Flector Patch). 1
Available Topical NSAID Products
Diclofenac Formulations
- Diclofenac sodium 1% gel (Voltaren Gel) - approved for treatment of osteoarthritis pain 1
- Diclofenac sodium topical solution 1.5% w/w in 45.5% dimethyl sulfoxide (PENNSAID) - indicated for osteoarthritis knee pain 2, 3
- Diclofenac epolamine 1.3% patch (Flector Patch) - used for acute musculoskeletal conditions and osteoarthritis 4, 1
Efficacy of Topical NSAIDs
- Topical diclofenac formulations have demonstrated similar efficacy to oral NSAIDs for osteoarthritis pain with fewer systemic side effects 5, 3
- Clinical studies show topical diclofenac provides significant pain relief compared to placebo for knee osteoarthritis 6
- The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) recommend topical NSAIDs with or without menthol gel as first-line therapy for acute musculoskeletal injuries 7
Advantages of Topical NSAIDs
- Topical NSAIDs deliver medication directly to the affected area while minimizing systemic exposure 4, 5
- They provide a favorable safety profile compared to oral NSAIDs, particularly for patients at risk for gastrointestinal, renal, or cardiovascular complications 8, 5
- Only approximately 2% of the active ingredient is systemically absorbed when applied topically, reducing risk of systemic adverse effects 4
- Topical NSAIDs are particularly valuable for elderly patients (≥75 years) and those with increased risk of renal adverse events 7
Clinical Considerations
- Topical NSAIDs are primarily indicated for localized pain, particularly osteoarthritis of the knee 2, 6
- Local skin reactions (dry skin, rash) are the most common adverse effects with topical NSAIDs 3, 6
- When multiple joints are affected, systemic pharmacological treatment may be preferred over topical NSAIDs 7
- Topical NSAIDs should be used at the lowest effective dose and for a limited duration when possible 7
Cautions and Contraindications
- Despite lower systemic absorption, topical NSAIDs still carry the same boxed warnings regarding cardiovascular and renal toxicity as oral NSAIDs 1
- Patients should avoid applying topical NSAIDs to broken or irritated skin 5
- Patients should be advised to wash hands after application unless the hands are the treated area 1
- Concomitant use with oral NSAIDs should be avoided to prevent additive toxicity 5