Topical analgesic | Usual dose (adult) | Characteristics |
Topical nonsteroidal antiinflammatory drugs (NSAIDs)* | ||
Diclofenac topical gel (1%) | Knees: Rub in 4 g of gel to affected knee(s) 3 to 4 times daily. Hands: Rub in 2 g of gel to affected joint(s) 3 to 4 times daily. Maximum 16 g per joint per day; 32 g total per day. |
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Diclofenac topical patch (1.3%) | Apply one patch to most painful area 1 to 2 times daily (refer to product-specific instructions). | |
Diclofenac topical solution drops (1.5%) | Knees: Rub in 40 drops to affected knee(s) up to 4 times daily. | |
Diclofenac topical solution pump (2%) | Knees: Rub in 2 pump actions to affected knee(s) up to 2 times daily. | |
Ibuprofen topical gel (5, 10%); not available in United States | Knees or hands: Rub in dose (depends on joint size and location) up to 4 times daily; refer to product-specific information for detail. | |
Ketoprofen topical gel (2.5%); not available in United States | Knees or hands: Rub in 2 to 4 g of gel 2 to 4 times daily (maximum 15 g of gel per day); refer to product-specific information for detail. | |
Topical capsaicin¶ | ||
Capsaicin creams, gels, liquids, or lotions (0.025 to 0.1%) | Rub in a small amount (pea sized) 1 to 4 times daily; the preparation most often studied in osteoarthritis was 0.025% cream. |
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Capsaicin topical patches (0.025 to 0.05%) | Apply one patch to affected area for up to 8 hours (maximum 4 patches per day). | |
Capsaicin topical patch (high concentration 8%) | Postherpetic neuralgia (single treatment): Apply up to 4 patches to the most painful area for 60 minutes. Treatment may be repeated after 3 months. |
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Topical lidocaine | ||
Lidocaine topical patch (5%) | 1 to 3 patches applied for up to 12 hours in any 24-hour period. |
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Lidocaine topical creams, ointments, and gels (2 to 4%) | Apply a thin film 2 to 4 times daily (refer to product-specific instructions). |
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Lidocaine topical cream (5%) | Apply a thin film 3 to 4 times daily (maximum 6 times daily). |
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* For patients already on oral NSAIDs, topical therapies are generally not recommended because they are unlikely to provide additional pain relief. Gel measurements from tubes are approximate.
¶ Pain relief usually begins within the first week of treatment, and full effect is seen with regular application over approximately four weeks. Topical capsaicin should not come in contact with mucous membranes, abraded skin, eyes, or genital areas.