Compounded Topical Analgesics



Compounded Topical Analgesics


Amode Tembhekar, BS

Christopher Migdal, BS

Martin AC Manoukian, BS



FAST FACTS



  • Topical analgesics and anesthetics may include patches, creams, ointments, or gels prepared for local delivery to the skin, targeting sensory nerve endings and tissues after dermal penetration.


  • Topical administration allows effective delivery of medications while reducing systemic side effects.


  • Topical analgesics can improve patient adherence and acceptance.


INTRODUCTION

The use of compounded pain medications has long been used in pain management to increase drug efficacy while simultaneously decreasing toxicity. Recently, this method of pharmaceutical delivery has gained increasing popularity owing to a greater understanding of the adverse effects, addiction potential, and abuse of currently prescribed oral analgesics. Many physicians prefer to use compounded topical medications owing to perceived improvements in efficacy and a resultant decreased narcotic prescribing.1 In particular, compounded topical analgesics have been demonstrated to be effective tools for treating various types of pain, including musculoskeletal pain, fibromyalgia, peripheral neuropathic pain, diabetic neuropathy, postherpetic neuralgia, and vulvyodynia.2 Although there are a plethora of options and formulations, this chapter will provide a concise summary of commonly used compounding medications and the principles behind their use. There are numerous advantages to using compounding medications, chief among them their ability to produce local, targeted effects while avoiding the undesirable systemic effects of oral dosing, thereby resulting in improved patient adherence2,3.




FORMULATIONS

Multiple formulations of compounded analgesics exist, and selection should be based on the etiology of a particular pain condition. For example, for a patient with neuropathic pain a regimen may include Ketamine 10%, Gabapentin 6%, and Clonidine 0.2%.9 Baclofen 2% and Amitriptyline 2% may be supplemented as deemed appropriate. For mechanical or inflammatory pain associated with muscle spasms, another analgesic compounded combination of Ketoprofen, Lidocaine, and Cyclobenzaprine would be favorable. Capsaicin is another promising topical analgesic that has been effective in treating postherpetic neurlagia.10 The mechanisms of action of these drugs are summarized in Table 35-1. These analgesics are delivered in the form of creams, gels, and ointments that may have limited efficacy when used alone. Thus, compounded topical analgesics are usually delivered with transdermal bases such as Pluronic lecithin organogel, Speed Gel, VanPen, DemiGel, Lipoderm, or LipodermActiveMax to enhance permeation and absorption.3,11,12 Keep in mind that multiple mechanisms and potential targets exist for therapeutic pharmacologic intervention for both acute and chronic pain. Careful assessment should guide treatment strategy.

Only gold members can continue reading. Log In or Register to continue

Mar 10, 2020 | Posted by in PAIN MEDICINE | Comments Off on Compounded Topical Analgesics
Premium Wordpress Themes by UFO Themes