Topcial Therapies Reviewed- Chad Robertson - CSTS- March 2011

© 2011 Zanagen Limited Education

Chad Robertson B.Sc. (Kin) B.Sc. (Pharm)Zanagen Limited maintains ownership of all content and/or images contained in this presentation


Learning Objectives

Session I: Background – Benefits of Topical Therapy for the Management of Pain and

Connective Tissue Disorders– Old and New Concept “Pain Models”– Acute and Chronic Pain Conditions

Session 2: Treating Pain from the Outside– History of Transdermal Therapy– Evolving Transdermal Products– Strategies for Optimizing Skin Penetration– Key Points to Consider when Recommending Topical Therapy


In the News – Drug RecallsPopular Arthritis Drug May DisruptHeart RhythmsScience Daily – Celebrex, a popular arthritis drug that blocks pain byinhibiting the enzyme COX-2, hasbeen shown in laboratory studies toinduce arrhythmia, or irregularbeating of the heart, via a novelpathway unrelated to its COX-2inhibition. Pfizer manufacturersCelebrex and in 2004 sales were $3.3 Billion Worldwide.


In the News – Drug Recalls

Vioxx Side-Effects: Possible

Explanation

Science Daily 2007 – Vioxx and

related pain medications were taken

off the market in 2004 because they

caused dangerous heart conditions in

some people. A group of scientists,

led by Timothy Hla at the University of

Connecticut, may now have figured

out how these drugs trigger life

threatening side-effects.


In the News – Drug RecallsBextra Recall and Withdrawal News

ScienceDaily – Health Canada asked

Pfizer to immediately suspend sales

of its drug after the drugmaker has

been forced to remove Bextra from

the U.S. and European markets. The

manufacturer continued to stand

behind the safety of the drug in spite

of adding a warning in October 2004

that the drug increased the

occurrence of heart problems in high

risk patients


What If?

• You could avoid taking pills for acute & chronic pain• There was an all natural pain relief solution that worked• You could avoid side effects such as; gastritis, dizziness, cardio

vascular, liver & kidney related issues• You were able to control your acute and chronic pain easily• You could possibly deactivate the enzyme that converts acute• Pain to chronic pain prior to chronic pain setting in


Why Topical Creams – Why Now?

• Pain relief pharmaceuticals** are being taken off the market by the FDA & Health Canada due to severe side effects – eg.

NSAID’s*: Vioxx, Bextra & Prexige (and possibly Celebrex)• Consumers excessive reliance on oral medication (pills)• An aging population with higher incidences of chronic pain• Escalating worldwide health care costs• Prescription drugs abuse and misuse

* NSAID – Non-Steroidal Anti-Inflammatory Drug

** Nutraceuticals are natural food components that provide health benefits or reduce the risk of chronic disease


Trandermal Delivery Has Expansion Potential

• Acts Quicker than Ingestibles

• Maintains Efficacy of Active Molecules

• Diffusion through the skin avoids internal organs

• Reduces potential side effects such as gastritis, dizziness, cardiovascular, liver & renal related issues

• Avoid interaction of active molecules in the formulation with food and liquids

• Less frequent application

• Time saved & personal control over administration

• Ease of removal to terminate therapy

• Controlled release property


Classical Theory of Pain


Trandermal Rubs Have Not Changed in 100 Years

• Dr Bengué created Bengay in France in the 1890’s

• He used Menthol’s palliative qualities to help manage pain topically

• Fundamentally all current mass products use the same ingredients and have the same drawbacks

– The Menthol burn feels unpleasant

– Menthol cannot be used everywhere on the body


Evolving Transdermal Therapies• Alternative natural-based topical therapies

are emerging in the market• Focusing on targeting inflammatory and

pain pathways in the body• Incorporating transdermal vehicles to

enhance the absorption of active ingredients

Livrelief– Distributed by LivDerma Inc.– Claim “blocks 5 pain pathways”– All natural ingredients

Traumeel– Distributed by Heel– Excessive dilution of homeopathic

ingredients– Poor Clinical Testing Guidelines


Evolving Transdermal Therapies

• Multiple mechanisms of action

• Targets a variety of biochemical pathways:

– Inflammation

– Regeneration

– Remodeling

– Incorporates penetration enhancers to improve absorption

– Clinically Tested


Prescription Based Transdermal Therapies

Pennsaid

• Prescription Topical

• Launched in 2003

• Contains 1.50% w/w diclofenac sodium; 16mg/ml

• Indicated for OA of the knees only

• Contains DMSO (dimethyl sulfoxide) as a penetration enhancer

• 40 drops, four times per day

• Incidence of local side-effects is high


Other Palliatives Have Emerged as an Alternative

• Alternatives are emerging as wraps and patches

• Avoiding menthol, but only use heat and cold


Penetration Enhancement Techniques


Factors to Consider When Recommending a Topical AnalgesicFactors to Consider are:

• Medical history, including possible allergies and medication history• Dosage form• Active ingredient• Ease of use• Odour of the product• Cost, and options available


• Topical analgesics should only be applied on intact skin• The use of topical analgesics should be discontinued if patient

complains of excessive redness or blistering of the skin• Patients should be advised not to use heating devices in conjunction

with topical counter-irritants• Patient education, provide clear instructions, express empathy and

believe in your patient• Encourage patients to seek medical care if pain worsens or persists

after 7 days of self-treatment

Factors to Consider When Recommending a Topical Analgesic

Thank you for your time and consideration

Chad Robertson B.Sc. (Kin) B.Sc. (Pharm)


Topcial Therapies Reviewed- Chad Robertson - CSTS- March 2011

Health & Medicine

Transcript of Topcial Therapies Reviewed- Chad Robertson - CSTS- March 2011