TRANSDERMAL NONSTEROIDAL ANTIINFLAMMATORY AGENTS

Concern over the scale of morbidity associated with the use of oral no n-steroidal anti-inflammatory drugs (NSAIDs), particularly in the elde rly, has led to the development of alternative strategies for the reli ef of musculoskeletal and joint pain. One such is to explore the possi bility of formulations that bypass the gastrointestinal tract that has proved so vulnerable to the prostaglandin inhibitory effects of NSAID s. The success of transdermal absorption of such drugs as nicotine, oe strogens, nitrates, clonidine and hyoscine into the bloodstream has ad ded a new dimension to drug therapy. Over the past 15 years some six t opical non-steroidals (T/NSAIDs) have been licensed in the UK, and a n umber of others are available in other countries or are under investig ation. Unlike the case with the drugs mentioned above, where the aim i s to achieve a high blood level, comparable to that obtained with the oral formulation, with T/NSAIDs the desired goal is a high local conce ntration at the site of the lesion with, al the same time, as low a pl asma concentration as possible, in order to minimise adverse GI tract or systemic effects. This paper reviews the pharmacokinetic data and t he evidence for efficacy and safety, and attempts to assess the place of T/NSAIDs in current medical practice.