Topical Analgesics

Over-the-counter analgesics are a class of medicines that relieve pain, and depending on the dosage form, some analgesics may also help to reduce things like fever.

There are two different categories of analgesics: internal and external.

• Internal analgesics are pain relievers and fever reducers. These medicines are intended for internal use and are either taken by mouth in the form of pills and liquids, or inserted into the rectum in suppository form. • External analgesics are topical pain relievers and are not intended to reduce fever. These medicines are for external use only and are applied directly to the outer body surface in lotions, sprays, and other forms. Before selecting an OTC analgesic medicine, the type of symptoms a customer is experiencing helps determine the best treatment suited to them.

The Market

Analgesics make up a large proportion of the total self medication market in Ireland, the market worth ¤273 million is estimated in total. Patients often use OTC topical analgesics for the treatment and management of musculoskeletal injuries and disorders. Following the introduction of the codeine regulations, pharmacists now encourage the use of acetaminophen as first in line choice of pain relief, followed by ibuprofen, before codeine-based analgesics. In addition, patients must be made aware of how to use the medication properly and must be informed by pharmacists of the possible side effects that can occur when a product is used after the recommended period of three days. Products may have local analgesic, anaesthetic, antipruritic, and/or counterirritant effects. Topical pain killers, or analgesics, are sprayed on or rubbed into the skin over painful muscles or joints. Although all are designed to relieve pain, different products are made up different ingredients. Counterirritants are approved for the topical treatment of minor aches and pains of muscles and joints. They are often employed for the treatment of acute musculoskeletal injuries and as an adjunct therapy in the treatment of chronic musculoskeletal disorders.

Counterirritants differ from other external analgesics in that pain relief results more from nerve stimulation than depression. Topical analgesics for musculoskeletal pain can be used alone or in conjunction with oral analgesics when appropriate and warranted. External analgesic products may contain or more of the following ingredients: methyl salicylate, camphor, menthol, methyl nicotinate, capsicum, and trolamine salicylate. Salicylates: These same ingredients that give aspirin its pain-relieving quality are found in some creams. When absorbed into the skin, they may help with pain, particularly in joints close to the skin, such as the fingers, knees, and elbows. Capsaicin: The main ingredient of hot chili peppers, capsaicin is also one of the most effective ingredients for topical pain relief. When first applied, capsaicin creams cause a warm tingling or burning sensation. This gets better over time. Users may need to apply these creams for a few days up to a couple of weeks before they will notice relief from pain. Topical analgesic products are available in a variety of formulations, including gels, ointments, creams, lotions, and patches in single-entity or combination formulations. Topical heat therapy patches are also available in various sizes for treating joint and muscle pain and provide 8 to 12 hours of continual, portable heat therapy. OTC topical analgesics are intended to be used for mild to-moderate pain for no longer than 7 days. The factors that a pharmacist may consider when recommending a topical analgesic include dosage form, cost, ease of use of product, as well as the patient’s medical history, including possible allergies.

WWho? Anyone suffering from pain, musculoskeletal problems or fever

WWhat are the symptoms? Dependent on the condition suffered

HHow long has the patient had the symptoms? Dependent on the

condition suffered

AAction already taken? Pain relief

MMedication? Apply topical products only to intact skin. Areas treated

with counterirritants should not be covered with tight bandages or occlusive dressings. Patients on anticoagulation therapy should be advised not to use topical products that contain salicylates, because concomitant use has been associated with prolonged prothrombin time

Otrivine® Adult Mucus Relief Menthol 0.1%w/v Nasal Spray is for relief of nasal congestion.

Product Information: Please refer to Summary of Product Characteristics for full prescribing information. Otrivine Adult 0.1%w/v Nasal Drops, solution; Otrivine Adult 0.1%w/v Nasal Spray, solution; Otrivine Adult Measured Dose Sinusitis 0.1%w/v Nasal Spray, solution; Otrivine Adult Mucus Relief 0.1%w/v Nasal Spray, solution (xylometazoline hydrochloride 0.1% w/v). Uses: Nasal decongestant for relief of symptoms of acute rhinitis in allergic or upper respiratory tract infections, including the common cold or in uenza and relief of sinusitis. Dosage and method of use: Adults, elderly and children over 12 years: Adult Drops: Two to four drops in each nostril, up to 3 times daily as needed. Spray: One to two sprays into each nostril, up to 3 times daily as needed. Measured Dose Sinusitis Spray: One application in each nostril, up to 3 times daily as needed. Mucus Relief Menthol Spray: One application in each nostril, 3 times daily as needed. Children under 12 years: Do not use. Contraindications: Hypersensitivity to ingredients. Concomitant use with MAOIs or ceased treatment within the last 2 weeks. Recent trans-nasal surgery, acute coronary disease, hyperthyroidism, narrow angle glaucoma, rhinitis sicca and atrophic rhinitis. Precautions: Do not exceed the recommended dose or use for more than 7 consecutive days as excessive or prolonged use may cause rebound congestion and drug induced rhinitis. Use with caution in those showing a strong reaction to adrenergic agents, or with cardiovascular disease, hypertension, prostatic enlargement or diabetes, pregnancy and breast feeding. Otrivine Menthol: Extra caution is advised in patients with hyperthyroidism. All of the products contain: benzalkonium chloride which can cause irritation or bronchospasm. Otrivine Menthol also contains: polyoxl hydrogenated castor oil, which may cause skin reactions. To prevent cross infection, each pack should be used by one person only. Side E ects: Common: headache, nasal dryness or nasal discomfort, burning sensation, nausea, application site burning; Very rare: Hypersensitivity reaction (angioedema, rash, pruritus), visual impairment/disturbance, heart rate irregular and heart rate increased. Legal Category: Pharmacy only. Product Authorisation Number: Otrivine Adult Nasal Drops: PA 0678/120/001; Otrivine Adult Nasal Spray: PA 0678/120/002; Otrivine Adult Measured Dose Sinusitis Spray: PA 0678/120/003; Otrivine Adult Mucus Relief Menthol Nasal Spray PA0678/120/005 PA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. Date of last revision: 02 June 2017. Further information is available on request.