Tolerability of topical NSAIDs in the elderly - Do they really convey a safety advantage?

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are very widely prescribed but they have a poor safety profile, with a range of potential adverse effects. NSAIDs that are used in topical formulation have been developed in the last fifteen years and their use is increasing. The purpose is to achieve a high local concentration of the active ingredient at the affected site, with as low a plasma concentration as possible to minimise possible systemic side-effects. This paper reviews the evidence available regarding the safety of topical NSAIDs, with particular reference to gastrointestinal and renal toxicity which have recently been highlighted in the medical press. The effects on the elderly are also discussed. The authors conclude that more formal epidemiological evaluation of the safety of topical NSAIDs is required in the post-marketing situation.