Tolerability of topical NSAIDs in the elderly: do they really convey a safety advantage?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are very widely prescribed but they have a poor tolerability profile, with a range of potential adverse effects. NSAIDs that are used in topical formulations have been developed in the past 15 years and their use is increasing. The purpose is to achieve a high local concentration of the active ingredient at the affected site, with as low a plasma concentration as possible to minimise possible systemic adverse effects. The gastrointestinal and renal toxicity of topical NSAIDs has recently been highlighted in the medical literature. The elderly seem to be more sensitive to the adverse effects of NSAIDs than younger individuals, and this may also be true for topical NSAIDs. More formal epidemiological evaluation of the safety of topical NSAIDs is required in the postmarketing situation, as the main source of information regarding adverse drug reactions to topical NSAIDs in the UK has been spontaneous reporting data.