In this analysis, we see an increase in irritation at the site of application, but a minimal increase in adverse events involving blood pressure, renal function, hepatic dysfunction, and gastrointestinal ulcer disease. Pharmacokinetic studies have demonstrated that systemic absorption of the topical diclofenac is 40 times less than oral diclofenac. This improved safety allows us to provide therapy to patients otherwise unable to receive anti-inflammatory drugs.
It will be no surprise if the guidelines for therapy of osteoarthritis from the United States will soon approximate those from Europe, where topical NSAIDs are part of the therapeutic algorithm for osteoarthritis. Are they completely safe? No. Is there no long-term cardiovascular risk? It has not been studied. Hence, the “black box” warning is applied to these agents that primarily list topical changes under adverse events.
Roy D. Altman, M.D., is professor of medicine in the division of rheumatology and immunology at the University of California, Los Angeles. He has been a consultant to Novartis, Eli Lilly, Ferring Pharmaceuticals, and Rottapharm/Madaus.
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