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1840891 tn?1431551393

Topical NSAID?

All the regulars here know me, but a brief intro for others: I 'm 58, have had HCV since 1984 and was dx'd with compensated cirrhosis around 2004. I'm now near the end of my third tx, a 48-week bout of triple tx with Incivek. I've been UND and had normal liver enzymes since week 8 and I'm now on week 46.

Here's my new question: I've had autoimmune arthritis for decades now, but in just the last year I've also developed osteoarthritis in both thumbs. It's very painful and quite debilitating. I complained to my PCP about how I couldn't take NSAID's, and she suggested I try Voltaren gel, a topically applied NSAID. She said if used as directed only very minute amounts would be absorbed into the general circulation. I googled the drug and immediately found an alarming FDA safety report at http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm193047.htm, which notes post-marketing reports of drug- induced hepatoxicity, some leading to complete failure of the liver. I decided to ask my hepatologist before trying this medication. I truly expected him to say no, but instead his email reply was simply "okay to use."

I've since tried this gel cautiously, in about half the recommended amount and only 1-2 times per day rather than every 4 hours. Even in such small doses I can definitely note some pain relief and improved mobility, so I really want to be able to continue using it, however, in spite of my hepatologist's okay, I keep worrying about whether I might add to my existing liver damage. I would love to hear from anyone who can offer some info such as how most hepatologists feel about the use of this gel (or any other topical NSAID) in cirrhotics. I just have this lingering doubt that my hepatologist tends to be a little bit too relaxed about some things – it does seem to take quite a lot to actually alarm him. Thanks!
19 Responses
Avatar universal
Hi, I don´t know much on this topic, but this questions was already made before:

http://healthquestions.medhelp.org/diclofenac-hepatitis

Maybe one of the guys that answered it can help you.

Best regards,
163305 tn?1333672171
I wish I could help you with this one.

The only experience I can relate is about when I had decompensated cirrhosis.
The ascites showed up while I was swimming a lot in the ocean. None of my doctors thought the salt water would affect my ascites, even when they put me on a low salt diet. They were wrong. If I got in the ocean, my belly swelled up. Our skin is porous and it does absorb. That is my observation. Obviously it's not as potent as taking something orally but it still can affect you.
This would be my concern about the topical ointment you're using.

Since your hepatologist thinks it's fine, maybe doing what you're doing, using it in the smallest amounts and only when needed, would be fine.
2147300 tn?1369693288
Funny thing, on my first tx in 2003 my GI was adamant about taking Tylanol. No acetaminophen.  

Today, my same GI says ok for the tylanol. He is more relaxed, more experienced.  Maybe the warning is standard like acetaminophen was in the day?

Got to say the nasty.......What about the roid tx?
766573 tn?1365170066
Yes!
http://www.cks.nhs.uk/osteoarthritis/evidence/supporting_evidence/pharmacological_treatments/topical_nsaids


I used to love Volteran but it strung when I applied it. I use the 5% Ibuleve gel on my hands and knees. I have been buying it on eBay.UK for years. I was stunned when I moved back to the states and no one had ever heard of it. Products like Deep Heat (Mentholatum) smell good and the heating sensation feels OK for about five minutes but I never (ever) experienced functional relief with concoctions like that.


(The gel & the mousse are great: don't hassle with the spray)

http://www.ebay.co.uk/sch/i.html?_trksid=p5197.m570.l1313&_nkw=Ibuleve&_sacat=0
Plus there are some other places that sell it.

http://www.netdoctor.co.uk/seniors-health/medicines/ibuleve.html
http://www.medicine.ox.ac.uk/bandolier/booth/painpag/topical/topkin.html
http://www.ncbi.nlm.nih.gov/pubmed/8361400
253566 tn?1219683299
After reading all the warnings I was also VERY concerned about Voltaren gel (I got the !%).

I also started with a very small amount for shoulder pain and only during strenuous use (such as taking a full bath with a fear of my shoulder giving out while I tried to get in and out of the bath...).

But Boy! some of those warnings were pretty scary - like internal bleeding in the elderly!!! WTF!!!

I do keep it on my shelf for stock-when needed (but really hope that my condition doesnt get worse and I wont need anything.

Best of luck,
frank
223152 tn?1346981971
I wish I could help but I have never used the product.  When I drank, and I was never a big drinker, but when I had over 2 beers or glasses of wine, which was overdoing for me, I could feel the sluggishness the next morning -- I would not call it a hangover, but a foggy feeling.  I attributed it to my liver not being able to process the toxins.  Is it possible that you can observe how you feel the day after you have used the voraten gel?  Perhaps you can gauge how much you can use it.

I am glad you are so close to completion and get these drugs out of your system.

Note to OH -- I find that very interesting about your swimming in the ocean and the salts coming thru the pores.  There is a new place in my town that offers a salt wellness therapy.  I guess the room is filled with salt and you breathe in the salt airs and it is healing.  I was curious about it because I know salt does heal wounds, but I guess I won't be trying that!

bean
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