10.3 DRUGS FOR THE RELIEF OF SOFT-TISSUE INFLAMMATION
10.3.1 Enzymes
[Collagenase clostridium hystolyticum Discontinued by manufacturer]
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Collagenase Clostridium histolyticum 900mcg (Xiapex®) *
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| * Xiapex® - Sobi has discontinued commercialisation of this product at the end of 2019 - see attached information |
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Hyaluronidase
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Used to render tissues more easily permeable to injected fluids i.e. in hypodermoclysis.
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AMBER Hyaluronidase injection 1500 unit
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10.3.2 Rubefacients and other topical anti-rheumatics
Topical non-steroidal anti-inflammatory drugs (NSAIDs) are recommended by NICE as a first line treatment with or without regular paracetamol for | the management of osteoarthritis. |
GREEN Ibuprofen gel 5%
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GREEN Ketoprofen gel 2.5% (licensed for up to 7 days use only)
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Prescribers are reminded that photosensitivity reactions are an important side effect of Ketoprofen gel. Before prescribing
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| > verify that the patient does not have any phototoxicity- or photoallergy-related contraindications. |
| > explain to patients the steps they need to take to minimise the risk of photosensitivity reactions |
| > check that patients understand the risk of photosensitivity and the steps they need to take to minimise this risk. |
| A prescriber checklist is available here |
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Capsaicin
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If above agent/s are ineffective or insufficient then alongside other options (such as oral NSAIDs, oral opioids or intra-articular injections) consider
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substitution or addition of topical capsaicin for hand/knee osteoarthritis.
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| Cautions Avoid contact with eyes, and inflamed or broken skin. Hands should be washed immediately after use. Not for use under tight bandages. Avoid taking a hot shower or bath just before or after applying capsaicin—burning sensation enhanced. |
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| Side-effects |
Transient burning sensation can occur during initial treatment, particularly if too much cream is used, or if the frequency of administration
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| is less than 3–4 times daily. |
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GREEN Capsaicin cream 0.025% [Zacin®] (for osteoarthritis of the hand and knee only- NOT for back pain)
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| For general musculoskeletal pain advise to purchase a rubefacient product] [Consider OTC/Self care] |
AMBER Capsaicin cream 0.075% [Axsain®] (for post herpetic neuralgia & painful diabetic neuropathy)
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For the use in specialist services, Transvasin® cream has been approved for off-licence use to improve the blood flow of the ear lobe prior to
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measuring capillary ear lobe blood gases.
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| RED Transvasin® cream |
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Information about changes to medicines or treatments on the NHS: Changes to rubefacients prescribing: Patient Information Leaflet
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