under-breast rash

People in Australia, New Zealand, Britain, Italy and many other countries have been able to buy topical NSAIDs for decades without a prescription. In the U.S. you can buy unlimited amounts of oral ibuprofen or naproxen without a doctor’s permission. We find that alarming. Why can’t Americans buy an NSAID gel like diclofenac or ibuprofen when they are in pain?

A Vacation Salvaged with an NSAID Gel:

Q. A few years ago while in Europe for vacation, I fell and bruised my ribs. Knowing there was not much I could do about it, I tried to tough out the rest of the two-week trip.

By the eighth day, I was in such misery that I booked a massage. After the massage, the masseuse applied ibuprofen gel to the painful area. I got instant relief.

I went to the nearest pharmacy and bought a tube. I now use it when my arthritis is bothering me and it works wonderfully. I have none of the stomach irritation that oral ibuprofen causes me. Yet the FDA refuses to approve it for OTC sale. Why is that?

A. Sometimes the FDA’s motives and rationales are mysterious to us. Back in 2009, the agency apparently cracked down on companies selling topical ibuprofen gel products without approval. So far as we can tell, no NSAID gel has been approved for OTC sale since then.

Topical NSAID Gel by Rx Only!

In the US, only diclofenac is available in topical formulations to treat inflamed joints. These include Pennsaid and Voltaren Gel. Flector patch is another topical application of diclofenac. All require a prescription.

Travel to Italy, though, and you can buy Voltaren Gel over the counter. They even advertise it on Italian television. By the way, they do NOT advertise prescription drugs on TV anywhere else in the world, except in New Zealand.

The Dangers of Oral NSAIDs:

We know we sound like cracked records when we talk about oral NSAID side effects. The trouble is, the research keeps accumulating about serious systemic side effects associated with such medications as diclofenac, ibuprofen, meloxicam and naproxen. Here is a link to an article we wrote this spring:

Really Bad News About Ibuprofen, Naproxen and Other NSAIDs

How Safe Is a Topical NSAID Gel?

Your doctor might consider prescribing ibuprofen or ketoprofen gel. You could then take the prescription to a compounding pharmacist.

Here is a link to answer the question about topical NSAID gel safety.

Dealing with Pain and Inflammation:

We know that arthritis and other inflammatory conditions can make life miserable. Doing nothing is not an option when you are in pain. You can learn more about the pros and cons of drugs used to treat arthritis and many nondrug approaches that can ease the pain from our Guide to Alternatives for Arthritis.

Share your own experience with topical NSAIDs or other approaches in the comment section below.

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  1. Jim

    I have been using Arnica Gel for several years for aches, pains, bruises and soreness. Small dab on your hand rub on skin and relief is quick, not a cure but gives relief.
    Not oily, stinky or messy, skin absorbs quicky. Comes in 7.5 FL OZ tube, looks like shampoo. It also available as a creme but I prefer the gel.
    Made from Arnica Montana, a mountain plant found in northwest US, and Sunflower Seed oil. Available from GNC, Amazon and other places for about $10.00.
    Lots of different product available but I prefer the Robert Research Laboratories version.
    Google “Arnica Gel”.

  2. Jen
    Central Virginia

    In May, our 90+ family member, who was living in assisted living, was prescribed by his PCP, prescription level naproxen for severe arthritic wrist pain despite his already taking a full strength aspirin due to having stents inserted many years ago. It took just 13 days until he was admitted to Emergency with “massive internal bleeding” for a ulcer that had developed. BP was 46/15 and he was unresponsive shortly after arriving.

    He received 5 units of blood that day. He nearly died, obviously, and was hospitalized for 6 days, then transferred to skilled nursing for over 3 weeks, where he developed a sore on his heel. (His diabetes complicates everything, including healing). Now he is in long term care. His days are spent in his wheelchair, a recliner, or napping in bed. He is frustrated, angry, and depressed. It seems unlikely that he will ever return to the assisted living experience that he did not especially like, but had adapted to and which he now misses a great deal. He has no control over his life.

    It is a tragic situation. We thought we were paying attention to his needs and his treatment. ALWAYS monitor what doctors prescribe!

    • Rick

      I guess the FDA knows that Ibuprofen kills enough people without adding a gel. Any of the NSAID’s that contain propanoic acid work by triggering your own adrenals, which releases endogenous opioids.

  3. Paul R

    I would think one could grind several tablets up and mix them into a tincture or body lotion jell and get the same effecy. Maybe there needs to be something like a surfactant or other convyance liquid or paste that activates the NSAID and facilitates its absorption through the skin.

  4. Morgan

    I’m on Medicare plus Aetna. Last week my internist prescribed Voltaren Gel for my bad knee. I just got my refusal letter. Two years ago, I was on Medicare plus Aetna and they OK’d the RX. It helped my knee tremendously! What changed in two years?

    naples fl

    I have taken liquid Advil capsules, mixed it with some penetrating hand cream and applied it to a sore joint with great success

  6. Suzanne

    Are topical NSAIDs really safer than oral. I know that you could avoid stomach problems with them, BUT what about the kidney damage. It’s still being absorbed into your blood stream isn’t it. Or will the delivery being topical be safer for kidneys or your liver?

    • Janet
      Washington State

      5 years ago I developed an ulcer from too much ibuprofen. Now due to an injury I am using diclofenac gel. Can this cause any stomach ulcer problems? Is there a difference between using a diclofenac patch vs the gel?

      I am getting an MRI next week. Lumbar spine, pelvis and hip pointer sprain. This makes for a big area to be covering with any medication, but swelling in left thigh and groin is considerable.

      I guess I’m just scared.

  7. karlyn

    Might there be an FDA address or email where people could petition, beg, for topical nsaid approval?

    • Rick

      I guess the FDA knows that Ibuprofen kills enough people without adding a gel. Any of the NSAID’s that contain propanoic acid work by triggering your own adrenals which releases endogenous opioids. They may help you with the pain but your kidneys will suffer. I have a friend who is a nephrologist and she told me of the amount of people who are on dialysis due to the effects of these medications.

  8. Michele M.

    Recently helped elderly neighbor concerned about $50 per tube cost of Volteran gel. Fast web search revealed alternative local pharmacies with $25 price. Comparison shop.

  9. Lloyd
    Los Angeles

    I doubt that topical intake of NSAIDs, as opposed to oral intake, will avoid the dangers to your heart. I was using a NSAID for over two decades and now have a premature heartbeat (PVC), My cardiologist wants to implant a pacemaker and start me on a new medication.

    No study has shown the causal connection between NSAIDS and PVC, but that does not mean there is no causal connection, only that this particular heart abnormality has not been studied. It seems that every prescription that I have taken has resulted in my needing a second or third medication to counteract the prior medication. I am off all now, but I do use aspirin cream, available without prescription, to relieve arthritis and muscular pain.

    • Karen
      Washington state

      The difference in dosage between topical and oral NSAIDS is great. A much smaller dose is needed for topical preps because they are used right on the targeted area. (Knees,other joints).
      Using topical NSAIDS avoids “the first pass effect” that results when an oral medicine travels thru the blood stream to your targeted area. It passes thru the liver and is partly metabolized so you need a larger original dose to get the same effect and other organ systems are also exposed. So maybe your topical med also gets somewhat absorbed into your blood stream, but that amount is much much lower than the oral dose.

  10. Wendy

    I have tendon problems with my right foot that flare up from time to time. My podiatrist prescribes Pennsaid for me. A compound pharmacy delivers it when needed and it works great. It is expensive, but so far it outweighs the complications of taking the OTC NSAIDS orally.

  11. Sally
    Seattle, WA

    I first learned of Voltaren Gel three years ago while in Canada after I had a knee/ ankle sprain from a fall…amazing relief from pain. I always buy it when we travel to Canada but, I recently learned that Amazon sells it on line. They have warehouses in Canada and perhaps this is how they are able to ship to the US.

  12. Lorrie

    How about just opening the liquid capsule and adding to skin cream. Is there a safe Canadian pharmacy to order on line? Will try my cream and let you know.

  13. Mary
    Culver City California

    I really think the pharmaceutical industry is very dialed in with doctors, who often want to put you on a prescription rather than finding the cause of your discomfort.

    If ibuprofen gives you stomach problems, then you can get another prescription for stomach issues, which might give you side effects, and then there’s another prescription for that.

  14. Sherrie

    Voltaren Gel is very good. But it’s also very expensive even in the generic and even if my insurance pays part. I still have a copay that I can’t afford. I have a friend that gets through her military insurance and she gave me a tube to try and it really does help. Her copay is very cheap and she gets five tubes at a time. If it is prescription only, they could at least make it affordable. The oral form in generic is very affordable but I could not take it. I had an issue with my stomach and had to stop. I take meloxicam orally but my feet are still really stiff. The gel does help.

  15. Ken

    Why not buy gel ibuprofen capsules and break them open?

  16. Joan

    You don’t have to go overseas to purchase topical Voltaren. It is available over the counter in Canada and Mexico. Since we live close to Canada, we go once a year to replenish our supply. Both my husband and I have been able to avoid surgery (back surgery for him and knee replacements for me) with the use of this drug,
    We have no difficulty in bringing up to eight 150 g tubes back through customs.

  17. Brooke

    I asked my Dr about the Gel and he stated something about kidney damage. I do take 200 mg of Celecoxib daily so that was his reasoning behind that statement. I see no reason why it couldn’t be one or the other but he didn’t suggest that. I may revisit that idea. I take the Celecoxib for ongoing chronic lower back pain and it does nothing more than take the edge off. No great pain relief.

  18. Mary
    Barrie ON Canada

    Voltarin is available over the counter in Canada.

  19. MarciaB

    What prevents anyone from making it themselves?

  20. Paul
    New Hampshire

    I worked in a retail pharmacy in Bermuda for 15 years where we sold Voltaren Gel brought in from England along with some other products that made sense such as neosporin polymyxin eye drops for pinkeye and many topical antifungals. Acyclovir topical for cold sores and a few others. These were all sold OTC. We basically copied what Canada allowed. Sometimes there is no rational for what the government allows in our health care system.

  21. Mare

    So, anyone try to make their own NSAID gel? Perhaps finely crushing some tablets, putting the powder into aloe vera gel to try to dissolve, liquid lecithin is a good base for home remedy applications. If I were in pain, it would be worth trying.

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