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Question answered:19/03/08
Overall, we found little guidance on this topic.
The BNF has a section ‘..drugs to be avoided or used with caution in renal impairment’. This lists a number of NSAIDs and also states:
“Use lowest effective dose and monitor renal function; sodium and water retention; deterioration in renal function possibly leading to renal failure; deterioration also reported after topical use; avoid if possible creatinine clearance less than 20 mL/minute”
In 2002 the Annals of the Rheumatic Diseases looked at the safety of NSAIDs [1] reporting:
“Topical NSAIDs are popular with patients and account for a significant proportion of global analgesic sales. They achieve only low blood levels and are very safe compared with oral NSAIDs.”
We’ve had a look at the SPCs for some topical NSAIDs. The SPC for Voltarol Gel Patch [2] states:
“Although systemic effects should be low, the plaster should be used with caution in patients with renal, cardiac or hepatic impairment, history of peptic ulceration or inflammatory bowel disease or bleeding diathesis. Non-steroidal anti-inflammatory drugs should be used with particular caution in elderly patients who are more prone to adverse events.”
It also lists active peptic ulceration as a contraindication.
The SPC for Oruvail Gel [3], this reports:
“Although systemic effects are minimal, the gel should be used with caution in patients with severe renal impairment.”
Given this lack of clear guidance we recommend you seek specialist advice. We can forward your question to a specialist medicines information unit. If you would like us to do this can you let us know via ‘Contact us’ (http://www.clinicalanswers.nhs.uk/index.cfm?action=contact)
References
1) http://ard.bmj.com/cgi/content/full/61/9/767
2) http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=16903
3) http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=7496
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