PHARMACOTHERAPY
NSAIDs are so notorious? Topical diclofenac
would seem to be the solution; however, the
product information contains the same strict
boxed warnings as do oral NSAIDs about
cardiovascular (CV) and gastrointestinal
(GI) risks. A close look at the data indicates
that the topical preparations available for diclofenac have less than 5% of the bioavailability of an oral 50-mg tablet. Does this
mean that the adverse events are lessened
as well? Studies have not given us concrete
answers for this, so each clinician is left to
make choices for individual patients based
on the patient’s risk profile. Given our limited choices for anti-inflammatory options
in patients with risk factors, using topical
NSAIDs may be an option with careful monitoring in low-risk patients to provide relief.
However, there is not currently any clinical
data to support that claim. It remains to be
seen whether topical NSAIDs will allow safer
use of anti-inflammatory agents in patients
with CV disease, peptic ulcer disease, a history of NSAID-induced upper GI bleeding, or
in those on concurrent antiplatelet or anticoagulation therapy.
GiVe 8)=UH