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Topical analgesia is generally recommended to avoid systemic side-effects. Painful joints, for example, may be treated with an ibuprofen- or diclofenac-containing gel (The labeling for topical diclofenac has been updated to warn about drug-induced hepatotoxicity. [41]); capsaicin also is used topically.
Ibuprofen is a weaker anti-inflammatory agent than other NSAIDs. [10] Ibuprofen was discovered in 1961 by Stewart Adams and John Nicholson [12] while working at Boots UK Limited and initially marketed as Brufen. [13] It is available under a number of brand names including Advil, Motrin, and Nurofen.
Diclofenac, sold under the brand name Voltaren among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammatory diseases such as gout. [6] [9] It can be taken orally (swallowed by mouth), inserted rectally as a suppository, injected intramuscularly, injected intravenously, applied to the skin topically, or through eye drops.
In people with heart failure, NSAIDs increase mortality risk (hazard ratio) by approximately 1.2–1.3 for naproxen and ibuprofen, 1.7 for rofecoxib and celecoxib, and 2.1 for diclofenac. [ 68 ] On 9 July 2015, the Food and Drug Administration (FDA) toughened warnings of increased heart attack and stroke risk associated with nonsteroidal anti ...
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[8] A 2017 Cochrane systematic review investigating ketoprofen as a single-dose by mouth in acute, moderate-to-severe postoperative pain concluded that its efficacy is equivalent to drugs such as ibuprofen and diclofenac. [9] There is evidence supporting topical ketoprofen for osteoarthritis but not other chronic musculoskeletal pain. [10]
The effectiveness of acetaminophen alone as an antipyretic in children is uncertain, with some evidence showing it is no better than physical methods. [14] Therapies involving alternating doses of acetaminophen and ibuprofen have shown greater antipyretic effect than either drug alone. [15]
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