ATC Group: M02A Topical products for joint and muscular pain

Aceclofenac is a non-steroidal agent with marked anti-inflammatory and analgesic properties. The mode of action of aceclofenac is largely based on the inhibition to prostaglandin synthesis. Aceclofenac is a potent inhibitor of the enzyme cyclo-oxygenase, which is involved in the production of prostaglandins.

Benzydamine exerts an anti-inflammatory and analgesic action by stabilising the cellular membrane and inhibiting prostaglandin synthesis.

Capsaicin, or 6-nonenamide, N-[(4-hydroxy-3-methoxyphenyl) methyl]-8-methyl, (6E), is a highly selective agonist for the transient receptor potential vanilloid 1 receptor (TRPV1). The initial effect of capsaicin is the activation of TRPV1-expressing cutaneous nociceptors, which results in pungency and erythema due to the release of vasoactive neuropeptides.

Dexketoprofen belongs to the non-steroidal anti-inflammatory group of drugs. The mechanism of action of Dexketoprofen is related to the reduction of prostaglandin synthesis by the inhibition of cyclooxygenase pathway. Furthermore, the inhibition of the synthesis of prostaglandins could affect other inflammation mediators such as kinins, causing an indirect action which would be additional to the direct action.

Diclofenac is a non-steroidal anti-inflammatory drug. The mechanism of action of diclofenac in AK may be related to the inhibition of the cycloxygenase pathway leading to reduced prostaglandin E₂ (PGE₂) synthesis. In addition, immunohistochemistry (IHC) from skin biopsies ac revealed that the clinical effects of diclofenac in AK are primarily due to anti-inflammatory, anti-angiogenic and possibly anti-proliferative effects and apoptosis-inducing mechanisms.

Dimethyl sulfoxide is used for the symptomatic relief of patients with interstitial cystitis. There is no clinical evidence of effectiveness of dimethyl sulfoxide in the treatment of bacterial infections of the urinary tract.

Etofenamate is a flufenamic acid derivative, which is readily transported through the skin and concentrated in inflamed tissue, where it exerts anti-inflammatory and analgesic effects by inhibiting the release of histamine, lysosomal enzymes and prostaglandin.

Felbinac is an active metabolite of fenbufen, belonging to the family of medicines known as nonsteroidal anti-inflammatory drugs (NSAIDs). It is used as a gel for local treatment of pain and inflammation associated with conditions of the musculo-skeletal system.

Flurbiprofen is a propionic acid derivative NSAID which acts through inhibition of prostaglandin synthesis. In humans flurbiprofen has potent analgesic, antipyretic and anti-inflammatory properties.

Ibuprofen is a propionic acid derivative NSAID that has demonstrated its efficacy by inhibition of prostaglandin synthesis. In humans ibuprofen reduces inflammatory pain, swellings and fever. Furthermore, ibuprofen reversibly inhibits platelet aggregation.

Indometacin has anti-inflammatory, antipyretic, and analgesic effects, it is an inhibitor of prostaglandin synthetase.

Ketoprofen is a non-steroidal anti-inflammatory drug. It has anti-inflammatory and analgesic actions.

Loxoprofen has excellent analgesic, anti-inflammatory and antipyretic properties, with particularly potent pain-relieving activity. This drug is a prodrug which is biotransformed into an active metabolite trans-OH form (SRS coordination) to exert its actions. Inhibition of prostaglandin biosynthesis constitutes the mechanism of action of loxoprofen, the site of action being cyclo-oxygenase.

Naproxen is a non-steroidal anti-inflammatory analgesic compound with antipyretic properties as has been demonstrated in classical animal test systems. Naproxen exhibits its anti-inflammatory effect even in adrenalectomised animals, indicating that its action is not mediated through the pituitary-adrenal axis.

Niflumic acid is an analgesic and anti-inflammatory agent used in the treatment of rheumatoid arthritis.

Nimesulide is a non-steroidal anti-inflammatory drug with analgesic and antipyretic properties which acts as an inhibitor of prostaglandin synthesis enzyme cyclo-oxygenase. Cyclo-oxygenase produces prostaglandins, some of them being implicated in the development and maintenance of inflammation.

Piroxicam is a non-steroidal anti-inflammatory agent with analgesic and antipyretic activity. It is effective regardless of the aetiology of the inflammation.

As a skeletal muscle relaxant whose prototype is mephenesine, tolperisone induces ataxia and muscle weakness in animal models by acting on the central nervous system at the spinal level. In fact it inhibits polysynaptic and monosynaptic reflexes with little action on non-reflex muscle response and without potentiating the phenobarbital sleep.