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:
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.
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.