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Pain Management «
Atlas Drug & Nutrition
8416 Kennedy Boulevard
North Bergen, NJ 07047
Local Phone 201-869-5990
Toll-free 888-449-5990
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8:30PM
Saturday: 10:00AM to
5:00PM
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http://www.atlasdrugandnutrition.com/painmanagement.html
Compounding - Pain Management
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"Effective Topical Anti-Inflammatory and Pain Reliever
Without All The Systemic Effects. "
Medications that relieve inflammation and pain and relax muscles
« can cause undesirable side effects, including cardio-vascular
complications, drowsiness, gastric irritation and unwanted
systemic side effects. Topical administration (e.g., cream, gel
«
and Ointment), on the other hand, delivers the drug directly to the
disease site and produces high local drug concentration, while
reducing unwanted side effects.2
« Ketoprofen (Orudis) andlor Piroxicam (Feldene) topical gels
have anti-inflammatory and analgesic effects and are used in the
local and symptomatic treatment of:
These gels are often prescribed by Arthritis Specialists,
Orthopaedic Surgeons, Sports Medicine Specialists and
Rehabilitation Therapists. They are often used in combination
with ultrasound for added deep-tissue effectiveness.
For example, in a 1992 study on the treatment of gonarthroses
(inflammation of the knee joint), the application of Piroxicam gel
(even at a low level of 5mg/gm) resulted in more than 90%
improvement of all evaluated criteria, including pain, mobility and
required assistance during change of position (sitting, standing
up, and climbing stairs). The gel was applied to the joint area 3
times daily for 2 weeks. Tolerance level was 97.5%. The
conclusion to this study states that Piroxicam gel is an important
asset to local treatment in rheumatology and will be a valuable
asset to orthopedic surgery and sports medicine.5
For additional anti-inlammatory effects a prescription for
Ketoprofen with Piroxicam can be prepared and Ketoprofen with
Lidocaine for anti-inflammatory and numbing effects. Ketoprofen
and Piroxicam are both non-steroidal anti-inflammatory drugs
(NSAIDs).
The following article reports "The systemic concentrations of
ketoprofen have also been found to be 100 fold lower compared
to tissue concentrations below the application site in patients
undergoing knee joint surgery. Topically applied ketoprofen thus
provides high local concentration below the site of application but
lower systemic exposure."
2 Chi SC, Jun HW, Release rates of ketoprofen from poloxamer gels in a
membraneless diffusion cell. J Pharm ScL 1991; 80(3);280-283.
5 Vachtenheim J. Feldene in local therapy of deforming gonarthroses. Vnitmi Lekarstvi
(Czech). 1992; 38(2):155-159.
NSAID Therapy
The following article concludes: "Topical non-steroidal anti-
inflammatory drugs are effective in relieving pain in acute and
chronic conditions." BMJ. 1998 Jan 31;316(7128):333-8
Quantitative systematic review of topically applied non-
steroidal anti-inflammatory drugs. Moore RA, Tramer MR,
Carroll D, Wiffen PJ, McQuay HJ.
University of Oxford, Oxford Radcliffe Hospital, Headington.
The abstract of this article can be viewed online. Go to PubMed:
www.ncbi.nlm.nih.gov/PubMed
In the search box, enter the following PMID: 9487165
BASE USED
These gels are prepared in a Pluronic Lecithin Organogel (PLO
gel) vehicle for enhanced penetration. PLO is an antipyretic gel
20/07/20109:12:45 PM
Atlas Drug Page 2

which becomes more viscous as it warms up by body heat. This

gel is easily removed with water. In general, we dispense these
compounds in calibrated syringes for ease of measurement.

HOW TO ORDER
Prescription details could be as such:
Ketoprofen 10% or 20%, in PLO gel Apply TID PRN
Ketoprofen 15%, Piroxicam 2%, in PLO gel Apply TID PRN
Ketoprofen 15%, Lidocaine 5%, in PLO gel Apply TID PRN

Ketoprofen 10%, Ketamine HCL 2%, Capsaicin 0.075%, in PLO

gel

Gabapentin (Neurontin), Ketamine (Ketalar), Misoprostal

(Cytotec). Capsaicin, Amitriptyline (Elavil), Baclofen and many
other active drugs could be added to the above for neurological
(e.g., Shingles and diabetic neuropathy) and other types of pain
relief.

Neuropathic Pain
Possible Uses: Neuropathy & Neuropathic Pain, Skeletal Muscle
Spasticity, Post-Herpetic Neuralgia (oncology-related), Bone
Pain (oncology-related), oral contraindications to NSAID use,
Muscle pain
- Nifedipine 0.5-15% transdermal PLO gel
- Lipoic Acid 0.5-3% transdermal PLO gel
- Pentoxifylline 5-10% transdermal PLO gel
- Gabapentin 6-10% transdermal PLO gel
- Topical ketoprofen 0.5-10% transdermal PLO gel
- Baclofen 2% + Amitriptyline 2% + Lidocaine 2% + Gabapentin
2% in PLOgel
- Ketoprofen 10% + Lidocaine 5% + Amitriptyline 2% in Lecithin-
organogel Trans. Gel
- Ketoprofen 10% + Amitriptyline 2% in PLO transdermal gel
- Ketoprofen 10% + Gabapentin 3% PLO Transdermal Gel
- Ketoprofen 10% + Cyclobenzaprine 2% PLO Transdermal Gel
- Ketamine 10% + Capsaicin 0.025% PLO Transdermal Gel
- Ketamine 5% + Ketoprofen 10% + Lidocaine 5% in PLO
Transdermal Gel
- Ketoprofen 10% or 20% in DMSO 5% transdermal Gel
- Deoxy-d-glucose(2) 0.2% / Gabapentin 5% or 10% /
Ketoprofen 5% / Amitriptyline 2% I Tetracaine 1% in PLO gel
- Clonidine HCI 0.2% + Gabapentin 6% + Ketoprofen 10% in
PLOgel
- Capsaicin 0.025-0.1 % transdermal PLO gel
- Ketoprofen 5% + Acyclovir 5% + Lidocaine 1% Transdermal

P~

.·~op'a~~ \
The following artic~di~cusses the use of topical ketamine
0.5% (5 mg/ml) gel, IPplied as a thin film two to three times
daily over the skin ere pain was severe. Topical ketamine
reduced pain for ients with postherpetic neuralgia with no
systemic sid ects.
003;60:1391-1392

Topical ketamine treatment of postherpetic neuralgia

Dianna Quan, MD, Mary Wellish, as and Donald H. Gilden,

MD
Departments of Neurology (Drs. Quan and Gilden, M. Wellish)
and Microbiology (Dr. Gilden), University of Colorado Health
Sciences Center, Denver.

Post-herpetic Neuralgia (shingles)

Alpha lipoic acid 100mg p.o. lid x 4 months

Amitriptyline 2%, Ketoprofen 10% PLO for face

Iontophoresis & Phonophoresis

Iontophoresis facilitates delivery of medications into the tissues
beneath the skin by electronic transport of ionized drugs in
solution. Acetic acid iontophoresis is effective in the treatment of
heel pain. Iontophoresis of dexamethasone for plantar fasciitis
should be considered when more immediate results are needed.
Iontophoresis has also been used to successfully treat plantar
hyperhidrosis.

http://www.atlasdrugandnutrition.com/painmanagement.html 20/07/2010 9:12:45 PM