Mulitprofen CC

Multiprofen CC^™

Topical Usage

COMPOUNDING

HEALTH QUALITY ONTARIO | QUALITY STANDARDS

Testimonials

Multiprofen CC^™

The Multiprofen CC^™ Line of Compounded Topical Pain Creams.

M-Line Pharmacy makes topical creams for a wide range of conditions. The components of the Multiprofen CC™ Line of MULTIMODAL topical pain creams consist of an anti-inflammatory, an analgesic, an antispasmodic and a local anesthetic.

The Multiprofen CC^™ Line:

Multiprofen CC^™
Multiprofen CC Plus^™
Multiprofen CC Ultra^™
Multiprofen CC MU^™
Multiprofen CC UltraPlus^™
Multiprofen CC UltraMU^™

The Multiprofen CC™ Line was created to target specific issues and only uses ingredients necessary for treatment based on clinical data.

Application sites:

Where the pain persists
Where the original injury ocurred
The Dermatome
Trigger Points

Why Topical?

Topical delivery systems are used to control pain and act locally on damaged or dysfunctional soft tissues or peripheral nerves. They are not absorbed through the gastrointestinal system and do not undergo first pass hepatic metabolism. Less than 5% of the dose that is topically applied reaches the systemic circulation. (Osterwalder et al. Arzneim-Forsh 2002 52:822-827)

Pain signalling involves complex mechanisms. For neuropathic pain, peripheral activity of afferent nerves is an important contributor to pain. These conditions can benefit from a localized application of topical medications; combinations of agents targeting different pain mechanisms may be particularly useful. It is postulated that topical medications may play a role in desensitizing trigger zones and can reduce peripheral sensibility of areas affected by deafferentation and neuroma formation. (Safety and Efficacy of Topical Ketoprofen in Transfersome Gel in Knee Osteoarthritis: A Systematic Review. Sardana V1, Burzynski J2, Zalzal P1. 2017)

Optimal treatment may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, anti-arrhythmics, anesthetics, antiviral agents and NMDA (N-methyl-D-asparate) antagonists. NMDA-receptor antagonists such as Ketamine or Dextromethorphan can block pain transmission in the dorsal horn spinal neurons, reduce nociception, decrease tolerance to and the need for opioid analgesics (Anesth Analg 2001 Mar; 92(3): 739-44).

The American Academy of Orthopaedic Surgeons (AAOS) recommends nonsteroidal anti-inflammatories (NSAIDs; oral or topical) for patients with symptomatic osteoarthritis of the knee as the first option, with a grade of Strong recommendation.
Credit to: © American Academy of Orthopaedic Surgeons

Full report can be retrieved from: aaosorg/research/guidelines/treatmentofosteoarthritisofthekneeguideline.pdf

Ingredients Include:

Amitriptyline

Local release of adenosine and activation of adenosine A1 receptors is involved in the action of Amitriptyline, as analgesia is reduced by adenosine receptor antagonists and local administration of Amitriptyline enhances the peripheral availability of adenosine.
(Sawynok et al., Esser and Sawynok 2000)(Liu et al., 2006)

Baclofen

Baclofen is a GABA agonist myorelaxant possessing presynaptic depressant action at NMDA and non-NDMA receptors. Activation of GABAb receptors by local administration of Baclofen results in a uniform reduction in formalin-evoked behaviours (Zhou et al., 1998), and these receptors may represent a more promising target than GABAa receptors.
(Pharmacol Rev 55:1-20, 2003)

Ketoprofen

Topical drug delivery is an extremely useful therapeutic option in many treatment situations. Topical application of medications has proven to provide higher therapeutic drug concentrations, while reducing or eliminating the adverse effects of systematic administration.

The peripheral activity of afferent nerves is an important contributor to neuropathic pain. These conditions can benefit from a localized application of topical medications; combinations of agents targeting different pain mechanisms may be particularly useful. It is postulated that topical medications may play a role in desensitizing trigger zones and can reduce peripheral sensibility of areas affected by deafferentation and neuroma formation (Sardana et al., Musculoskeletal Care. 2017;15(2):114-121).

Ketoprofen has anti-inflammatory activities. It is well documented through numerous trials that Ketoprofen is effective topically.

Ketoprofen applied on the skin is able to enter tissues, reaching concentrations greater than in plasma, and producing the desired pharmacological activity, whereas plasma concentrations are too low to produce systemic activity or side effects. Studies in the literature have shown that by applying a 100 mg Ketoprofen patch daily directly to the focus of the painful condition, the concentration of Ketoprofen in the affected area was anywhere from 6 to 354 times higher than in the plasma. (Osterwalder et al., Arzneimittelforschung. 2002;52(11):822-7).

Topical applications of Ketoprofen allow the attainment of high intra-articular tissue concentrations, with limited systemic exposure (Rolf et al., Rheumatology (Oxford). 1999;38(6):564-7).

Lidocaine

Lidocaine is a local anesthetic which acts by blocking sodium channels, preventing nerve depolarization.
(Oral Surg Oral Med Oral Pathol Radiol Endod 2008; 105:466-9)

Thank you,
M-Line Pharmacy

Compounding is an activity that is regulated by the Ontario College Pharmacists. The Health Canada Drug Manufacturers approval process is intended for mass-produced drugs made by drug manufacturers. The Multiprofen CC™ Line of prescription medications are compounded for individual patients. Each ingredient in the Multiprofen CC™ family is approved by Health Canada.

Safety Considerations

For External Use Only
Do not prescribe the product if the patient had an anaphylactic reaction to ketoprofen, other non-steroidal anti-inflammatory drugs (NSAIDs), baclofen, amitriptyline, or lidocaine.
Contact the pharmacy to remove the active ingredients in question.
Do not prescribe for those who are pregnant or breast-feeding.
Do not apply to skin with conditions such as open wounds or cuts, or on skin that has a rash or eczema.
Do not wrap the skin with an airtight or occlusive dressing. If skin irritation occurs, contact our pharmacist or if not the prescribing practitioner.
Use with caution in patients with fluid retention or heart failure. Hypertension can occur with oral (tablet) NSAID treatment. Monitor blood pressure closely.
Use with caution in patients with liver and kidney failure. Monitor lab values.
Use with caution in patients on blood thinners. Monitor lab values.
As with all medications, side effects can occur, so please contact our pharmacist should your patient experience any irregular symptoms.

EXCERPT FROM Osteoarthritis, Care for Adults with Osteoarthritis of the Knee, Hip, or Hand

”What This Quality Statement Means For Patients If things like exercise and weight management are not working well enough to control your symptoms, your primary care provider should offer you options for pain-relieving medication. If you decide to use pain medication, it is important to continue using other nondrug treatments as well. One does not replace the other. Your primary care provider should work with you to make a plan to review your medication use after a certain time. However, if you experience any side effects from the medication, tell your primary care provider right away. Your primary care provider should first offer you a cream to rub over the joint. If this doesn’t work for you, they may recommend over-the-counter pills (such as low-dose analgesics and/or nonsteroidal anti-inflammatory drugs), prescription pills, or an injection into the joint. Your primary care provider should not offer you an opioid medication as the first or routine treatment for your osteoarthritis pain. These drugs have serious risks including addiction, overdose, and death. For more information, please see our patient reference guide Opioid Prescribing for Chronic Pain

Pain-relieving medication options • Stepped approach: #1 – Topical therapy for knee or hand; and/or low-dose analgesics and/ or nonsteroidal anti-inflammatory drugs (NSAIDs) for hip, knee, or hand, used as required to relieve symptoms”

Credit to:© Queen’s Printer for Ontario, 2018

To View Full Report

Title: Osteoarthritis, Care for Adults with Osteoarthritis of the Knee, Hip, or Hand

W: https://www.hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-osteoarthritis-clinician-guide-en.pdf

Zalzal Trial

This is a brief report of my clinical experience using a novel multi modal topical compound (MMTC) cream.
My name is Dr. Paul Zalzal, I am a Board Certified Orthopaedic Surgeon having received certification from the Royal College of Physicians and Surgeons of Canada. I hold a license to practice medicine within the Province of Ontario. I am the former Chief of the Division of Orthopaedics at the Oakville-Trafalgar Memorial Hospital and an Assistant Clinical Professor in the Department of Surgery, Faculty of Medicine at the McMaster University. I have post-graduate training in Orthopaedic Sub-specialties including Foot and Ankle Reconstruction, adult Hip and Knee Reconstruction and Revision Arthroplasty. I have research interests in lower extremity trauma, hip and knee reconstruction, biomechanics and tissue engineering. I have several peer review publications in these areas. I have a Master’s Degree in Biomedical Engineering from the University of Toronto.

I have been prescribing Multiprofen CC^™ in my clinical practice to assist with the management of patients with various musculoskeletal conditions. I prescribe Multiprofen CC^™ for patients to control pain and inflammation due to soft tissue trauma, arthritis, post-operative pain and chronic pain. I prescribe the topical cream to be used on various body parts including, the neck, back, shoulders, arms, wrists, hips, knees and ankles. In general, the clinical situations where I have found Multiprofen CC^™ useful include patients who are waiting a long time for surgery as a result of long waiting lists. It is useful in patients for whom surgery is contraindicated (advanced age, poor health etc). I have used it in the setting of acute pain following injury or exacerbation of underlying arthritis. It is effective in the management of post-operative pain and chronic pain. It is also useful in the management of post-operative stiffness after total knee replacement by enabling more aggressive physiotherapy.

I surveyed over 60 consecutive patients who were using Multiprofen CC^™ to determine if they experienced any pain relief, and if so what percentage of pain relief they experienced. My results showed that 80% of the patients surveyed experienced some form of relief. Of those who experienced relief, the average pain relief they reported was 67%. The only side effect reported was a rash in 3 % of the patients surveyed. The rash resolved when they discontinued use.

Sincerely,
Paul Zalzal, BASc, MASc, MD, FRCSC
Assistant Clinical Professor

Patient 1

Patient is a 55 year-old woman with knee Osteoarthritis.
By using Visco-supplementation injections in conjunction with Multiprofen CC^™, patient reports significant pain reduction.

“After two applications to my knees I felt relief. I am so happy. I had been using Voltaren for two years without much results. Multiprofen is the best!”

Joanna

Oakville, Ontario

“I am doing very well using this cream and happy that it works. I’m going to the cottage for the summer and taking an extra with me.”

Susan

Oakville, Ontario

“I’ve had pain in my knee for 10 years. Multiprofen works very well and the pain in my knee is gone. I am going to continue using it.”

Mark

Burlington, Ontario

“After many years of shoulder pain I am doing very well using Multiprofen. I can now perform my daily farming tasks. I will continue to use it.”

Frank

Dufferin County, Ontario

“This is unbelievable! I play a lot of sports and I have tried everything for my shoulder pain… I love this cream! Thank you.”

Wayne

Burlington, Ontario

“Multiprofen has been working very well. I’m using less of my narcotics and I’m very happy about it.”

David

Hamilton, Ontario

Multiprofen CC^™

Multiprofen CC^™ inflammation et douleurs articulaires? Neuropathie douloureuse?

Multiprofen CC^™ est une crème topique MULTIMODALE qui aide à soulager les douleurs musculo-squelettiques et neuropathiques, qu’elles soient aigües ou chroniques.

Conçu pour: Les traumatismes des tissus mous comme les entorses ou les foulures. Les blessures sportives. Les maladies articulaires dégénératives comme l’arthrose. Les affections inflammatoires comme l’arthrite rhumatoïde dans les mains, les poignets, les coudes, les épaules, les hanches, les genoux, les chevilles et les pieds. Les conditions de surutilisation comme la tendinite de la coiffe des rotateurs, la tendinite du tendon d’Achille, la tendinite pattelaire ou l’épicondylite latérale et médial. Fasciite plantaire, éperons du talon. Douleurs dorsales mécaniques. Maladie de Osgood-Schlatter. Situations de stress comme la douleur post-chirurgicale après remplacement du genou ou les soins post-fracture. Douleur chronique. Maladie du Zona et neuropathie douloureuse. La Migraine.

Utilisé seul ou en association avec d’autres médicaments administrés par voie orale, Multiprofen CC^™ a été créé pour cibler des problémes spécifiques. Il ne contient que des ingrédients actifs nécessaires au traitement, sur la base de données cliniques.

Les commandes de prescriptions et d’échantillons téléchargées sur internet puis envoyées par télécopie ou demandées par téléphone sont prises en comptes exclusivement chez Concession Medical Pharmacy.

Multiprofen CC^™ Famille comprend:

Multiprofen CC^™
Multiprofen CC Plus^™
Multiprofen CC Ultra^™
Multiprofen CC MU^™

N’hésitez pas à nous contacter pour nous faire part de vos questions ou commentaires, nous serons heureux de vous aider à obtenir le meilleur résultat pour votre patient.

orders@multiprofencc.ca

Tel: 844.832.9102
Fax: 844.832.9329

Livraison gratuite au Canada

Multiprofen CC^™ et produits connexes sont des marques déposées utilisés sous licences et appartiennent à leurs propriétaires respectifs. Tous droits réservés.
Ce contenu est destiné aux professionnels de la santé.

Documentation à propos des crèmes contre la douleur:

Cette notice résume plusieurs travaux démontrant l’éfficacité des médicaments topiques comme moyen efficace pour aider à traiter la douleur.

Les systèmes d’administration topiques sont utilisés pour contrôler la douleur et agissent localement sur les tissus mous endommagés ou dysfonctionnels ainsi que sur les nerfs périphériques. Ils ne sont pas absorbés via le système digestif et ne passent pas le métabolisme hépatique. Moins de 5% de la dose appliquée atteint la circulation systémique, ce qui explique nos observations cliniques : elles n’ont répertoriés ni effets secondaires systémiques ni interactions médicamenteuses significatives (Osterwalder et al., Arzneim-Forsch 2002 52:822-827).

La transmission de la douleur implique des mécanismes complexes. L’activité périphérique des nerfs afférents est un contributeur important de la douleur neuropathique. Une amélioration de l’état peut être obtenu avec l’application localisée de médicaments topiques en combinant plusieurs agents qui visent différents mécanismes de douleur. On affirme que les médicaments topiques peuvent jouer un rôle dans la désensibilisation des zones de déclenchement et peuvent réduire la sensibilité périphérique des zones affectées par la désafférentation et la formation de neuroma.
(Oral Surg Oral Med Pathol Radiol Endod 2008;105:466-9)

Un traitement optimal de la douleur peut comporter l’utilisation de médicaments qui possèdent des propriétés anti-douleur, y compris des antidépresseurs, des anticonvulsivants, des antiarythmiques, des anesthésiques, des agents antiviraux et des antagonistes du NMDA (N-méthyl-D-aspartate).
Les antagonistes des récepteurs de NMDA tels que la kétamine ou le dextrométhorphane peuvent bloquer la transmission de la douleur dans les neurones de la corne dorsale de la moelle épinière, réduire la nociception et diminuer la tolérance et le besoin d’analgésiques opioïdes (Anesth Analog 2001 Mar;92(3):739-44).
Les médécins ont constatés qu’en combinant plusieurs agents avec différents mécanismes d’action pour diminuer la nociception, il est possible d’utiliser de plus petites concentrations de chaque médicament.

Amitriptyline:

L’amitriptyline est responsable de la libération locale d’adénosine et l’activation des récepteurs A1 de l’adénosine. L’analgésie est réduite par les antagonistes des récepteurs de l’adénosine et l’administration locale d’amitriptyline augmente la disponibilité périphérique d’adénosine.
(Sawynok et al., Esser et Sawynok 2000)(Liu et al., 2006)

Baclofène:

Le baclofène est un myorelaxant agoniste de GABA possédant une action dépresseur présynaptique au niveau des récepteurs NMDA et non NMDA. L’activation des récepteurs GABAb par administration locale de baclofène a pour résultat une réduction uniforme des comportements évoqués par le test à la formaline.
(Zhou et al., 1998) et ces récepteurs peuvent représenter une cible plus prometteuse que les récepteurs GABAa (Pharmacol Rev 55:1-20, 2003).

Kétoprofène:

Le kétoprofène a des activités anti-inflammatoires. Des nombreux essais ont montrés que le kétoprofène est efficace topiquement. Les résultats des essais cliniques ont prouvé qu’en appliquant un patch de 100 mg de kétoprofène quotidiennement directement sur l’endroit douloureux, la concentration de kétoprofèn dans la zone touchée était de 6 à 354 fois supérieure à celle du plasma.

L’administration topique de médicaments est une option thérapeutique extrêmement utile dans beaucoup de traitements et permet d’atteindre des concentrations thérapeutiques plus élevees, tout en réduisant ou éliminant les effets indésirables de l’administration systémique (A.Rheumatology, Oxford, 1999).

Lidocaïne

Lidocaïne, un anethésique local, agit en bloquant les canaux sodium en en évitant la dépolarisation des nerfs (Oral Surg Oral Med Oral Pathol Radiol Endod 2008;105:466-9).

Nous continuerons à aider nos patients en travaillant directement avec eux et leurs médecins dans la triade de soins, pour améliorer le soulagement de la douleur avec des crèmes efficaces.
Merci, L’equipe Multiprofen CC^™

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Multiprofen CC™

Topical Usage

Compounding

Health Quality Ontario | Quality Standards

Multiprofen CC™

Topical Usage

Safety Info

Clinical Results

Français

Multiprofen CC™

Topical Usage

COMPOUNDING

HEALTH QUALITY ONTARIO | QUALITY STANDARDS

Testimonials

Multiprofen CC™

The Multiprofen CC™ Line of Compounded Topical Pain Creams.

Application sites:

Why Topical?

Ingredients Include:

Amitriptyline

Baclofen

Ketoprofen

Lidocaine

Zalzal Trial

Patient 1

Joanna

Oakville, Ontario

Susan

Oakville, Ontario

Mark

Burlington, Ontario

Frank

Dufferin County, Ontario

Wayne

Burlington, Ontario

David

Hamilton, Ontario

Multiprofen CC™

Multiprofen CC™ Famille comprend:

Documentation à propos des crèmes contre la douleur:

Amitriptyline:

Baclofène:

Kétoprofène:

Lidocaïne

How to Prescribe

Multiprofen CC™ and family can only be filled at Concession Medical Pharmacy

Steps:

Sample Request

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Multiprofen CC^™

Multiprofen CC^™

Multiprofen CC^™

Multiprofen CC^™

The Multiprofen CC^™ Line of Compounded Topical Pain Creams.

Multiprofen CC^™

Multiprofen CC^™ Famille comprend:

Multiprofen CC^™ and family can only be filled at Concession Medical Pharmacy