Creating Unique
Topical Solutions
Creating Unique
Topical Solutions
Multiprofen CC™
Multiprofen CC™
Application sites:
Where the pain persists
Where the original injury occurred
The Dermatome
Click to see dermatome chart
Trigger Points
Click to see trigger point chart
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., 2002) 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. (Sardana et al., 2017)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., 1999), (Esser & Sawynok, 2000), (Liu et al., 2000)
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. (Sawynok, 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.,
2017).
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., 2002).
Topical applications of
Ketoprofen allow the
attainment of high
intra-articular tissue
concentrations, with limited
systemic exposure (Rolf et
al., 1999).
Topical application
delivered Ketoprofen to the
target tissues at a similar
concentration to that
observed after oral
administration without a
high plasma concentration.
Topical application rapidly
achieved effective tissue
levels and was maintained
for at least 20 hours
(Sekiya et al., 2010).
LIDOCAINE
Lidocaine is a local
anesthetic which acts by
blocking sodium channels,
preventing nerve
depolarization and stopping
nerve signals (Heir et al.,
2008).
A randomized, double-blind,
vehicle-controlled study
demonstrated that topical
Lidocaine reduces the
intensity of all common
neuropathic pain qualities
and thus may be of potential
benefit for nonallodynic
neuropathic pain states
(Galer et al., 2002).
Compounding is an activity that is regulated by the Ontario College of 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.
- 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.
What This Quality Statement Means
For Patients
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.Title: Osteoarthritis, Care for Adults with Osteoarthritis of the Knee, Hip, or Hand
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., 2002) 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. (Sardana et al., 2017)
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., 1999), (Esser & Sawynok, 2000), (Liu et al., 2000)
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. (Sawynok, 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.,
2017).
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., 2002).
Topical applications of
Ketoprofen allow the
attainment of high
intra-articular tissue
concentrations, with limited
systemic exposure (Rolf et
al., 1999).
Topical application
delivered Ketoprofen to the
target tissues at a similar
concentration to that
observed after oral
administration without a
high plasma concentration.
Topical application rapidly
achieved effective tissue
levels and was maintained
for at least 20 hours
(Sekiya et al., 2010).
LIDOCAINE
Lidocaine is a local
anesthetic which acts by
blocking sodium channels,
preventing nerve
depolarization and stopping
nerve signals (Heir et al.,
2008).
A randomized, double-blind,
vehicle-controlled study
demonstrated that topical
Lidocaine reduces the
intensity of all common
neuropathic pain qualities
and thus may be of potential
benefit for nonallodynic
neuropathic pain states
(Galer et al., 2002).
Compounding is an activity that is regulated by the Ontario College of 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.
- 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.
What This Quality Statement Means
For Patients
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. Title: Osteoarthritis, Care for Adults with Osteoarthritis of the Knee, Hip, or Hand