Low Dose Oral Minoxidil for Hair Loss

Recently there have been many studies that support the use of low dose oral minoxidil for managing alopecia. It is a promising alternative compared to traditional treatments that have been used in the past. Minoxidil is known to induce hypertrichosis, prolong anagen duration, and increase hair diameter. Several ways in which minoxidil could stimulate hair growth include increasing the linear growth rate of hair, increasing the diameter of the hair fiber, altering the hair cycle by either shortening of telogen or prolonging anagen, or a combination
of these.”  (click to read more)

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Why is a Topical Treatment Plan Preferred?
Topical preparations have a good safety profile, which may decrease systemic side effects and are beneficial for patients who are intolerant or want an alternative to oral medication. To achieve the benefits and results of topical preparations it is important to follow the exact instructions of the physician, since “favorable treatment outcomes are strongly dependent on medication adherence rate.”  (click to read more)

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Topical Diclofenac 

Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of therapeutic agents that have analgesic, antipyretic and in high doses anti-inflammatory actions (1). Diclofenac is available today as various topical formulations in the form of gels, gel patches, sprays, foams, creams, ointment etc (1). They are effective and at the same time well tolerated by the patient.  (click to read more)

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Topical Cyclobenzaprine
Cyclobenzaprine is a skeletal muscle relaxant pharmacologically related to tricyclic antidepressants (1). It acts centrally to reduce somatic motor activity by influencing both alpha and gamma motor neurons (1). Cyclobenzaprine is often compounded into topical analgesics (off-label use) for musculoskeletal conditions because it is highly effective in muscle tissue at the site of pain, allowing for effective dosing without the systemic adverse effect of somnolence (4). A potential advantage of topical agents is avoidance of the systemic side
effects often associated with oral medications.  (click to read more)

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Topical Amitriptyline in Neuropathic Pain
There are several articles that support the use of topical amitriptyline. Topical amitriptyline acts mainly locally in tissues through receptors and/or ion channels.1 Analgesics administered topically have a much better profile for adverse effects as they relieve local pain with minimal systemic effects.  Indications for a local administration of tricyclic antidepressants are the following pain syndromes: carpal tunnel syndrome, neuralgia of intercostal nerves, postherpetic neuralgia, complex regional pain syndrome, painful diabetic neuropathy, meralgia paraesthetica, coccydynia, costochondritis, mucositis after chemotherapy and intractable itch.  (click to read more)

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Topical Tramadol 
Opioids are the most powerful pain relievers, and therefore, traditional opioid analgesics remain the drug of choice for the medical treatment of severe acute pain syndromes and for progressive severe chronic illnesses (4). As a molecule, based on its physicochemical properties (5), tramadol appears to be a suitable transdermal agent. Also, its pKa is about 9.41; therefore, it is ionized and soluble over the pH range of interest (4). Topical approaches have the advantage of local pain control with minimal systemic side effects and good patient
acceptability.  (click to read more)

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Cascade with GI Prostaglandin and Use of Topical NSAIDs vs Oral NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for their anti-inflammatory, analgesic, and antipyretic effects.1 NSAIDs generally work by blocking the production of prostaglandins (PGs) through the inhibition of two cyclooxygenase enzymes. 1 However, their use has been associated with potentially serious dose-dependent gastrointestinal (GI) complications such as upper GI bleeding.2 GI complications resulting from NSAID use are among the most common drug side effects in the United States, due to the widespread use of
NSAIDs.2 Topical products were developed to provide well tolerated, effective targeted therapies, based on the drug’s pharmacokinetics and penetration to the site of action.  (click to read more)

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Topical Gabapentin
Topical Gabapentin is used for the treatment of chronic pain conditions including but not limited to postherpetic neuralgia (PHN), complex regional pain syndrome (CRPS) and vulvodynia (VVD). Multiple studies have already demonstrated the efficacy of oral gabapentin in treating chronic neuropathic pain.5 However, oral gabapentin is limited by dose-dependent toxicity which can cause systemic adverse effects. Boardman noted, “topical application seemed to largely circumvent the more common systemic adverse effect of oral therapy, such as
sedation, fatigue, dizziness, and confusion.”The use of topical analgesic therapy allowed for higher concentrations of medication locally while reducing the likelihood of systemic side effects common to the drugs used. It has also been noted that topical gabapentin is a good and effective option for chronic pain condition.  (click to read more)

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Topical Ketoprofen
Ketoprofen, a nonsteroidal anti-inflammatory drug (NSAID), possesses analgesic, antipyretic and anti-inflammatory properties. Oral Ketoprofen is widely used in musculoskeletal pain and inflammation in muscles and joints, including arthritis pain, osteoarthritis, stiffness of the joints, soft tissue rheumatism, and sports injuries. (1). Topical formulations of NSAIDs have analgesic effects similar to that of oral formulations, but are associated with less systemic exposure and, therefore, with fewer serious adverse events (2). In one study the results revealed that Ketoprofen cream formulation caused a significant reduction in the pain scale, removed the
redness and swelling and improved the walking ability in rheumatoid arthritis patients (3). In another trial it was revealed that ketoprofen cream provided good level of pain relief, removed swelling and tenderness and improved functional impairment in volunteers suffering with rheumatoid arthritis (7).  (click to read more)

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