Drugs for the relief of soft-tissue inflammation

Enzymes

Hyaluronidase is used to render the tissues more readily permeable to injected fluids, e.g. for introduction of fluids by subcutaneous infusion (termed hypodermoclysis).

HYALURONIDASE:

Indications: enhance permeation of subcutaneous or intramuscular injections, local anaesthetics and subcutaneous infusions; promote resorption of excess fluids and blood.

Contraindications: do not apply direct to cornea; avoid sites where infection or malignancy; not for anaesthesia in unexplained premature labour; not to be used to reduce swelling of bites or stings; not for intravenous administration.

Dose and Administration: With subcutaneous or intramuscular injection, 1500 units dissolved directly in solution to be injected (ensure compatibility). With local anaesthetics, 1500 units mixed with local anaesthetic solution (ophthalmology, 15 units/mL). Hypodermoclysis, 1500 units dissolved in 1 mL water for injections or 0.9% sodium chloride injection, administered before start of 500–1000 mL infusion fluid. Extravasation or haematoma, 1500 units dissolved in 1 mL water for injections or 0.9% sodium chloride injection, infiltrated into affected area (as soon as possible after extravasation).

HYALURONIC ACID SODIUM SALT (Hyalectin):

Indications: Traumatic and degenerative joint disease. Adjuvant in orthopaedic surgery.

Contraindications: do not apply direct to cornea; avoid sites where infection or malignancy; not for anaesthesia in unexplained premature labour; not to be used to reduce swelling of bites or stings; not for intravenous administration.

Dose and Administration: 2ml syring (20mg Hylacetin) to be administered intra-articularly once a week for 5 weeks.

Rubefacients and other topical  antirheumatics

The use of a NSAID by mouth is effective for relieving musculoskeletal pain. Topical NSAIDs may provide some slight relief of pain in musculoskeletal conditions.Rubefacients act by counter-irritation. Pain, whether superficial or deep-seated, is relieved by any method which itself produces irritation of the skin. Counter-irritation is comforting in painful lesions of the muscles, tendons, and joints, and in non-articular rheumatism. Rubefacients probably all act through the same essential mechanism and differ mainly in intensity and duration of action.

DIETHYLAMINE SALICYLATE-CHLORBUTOL-MENTHOL:

Indications: symptomatic relief of muscular pain and stiffness including backache, lumago and fibrosis. Useful in relieving rheumatic pain and in injuries such as cramps, sprain and stress related to sport activity.

Contraindications: in broken skin, lips or near to eyes.

Dose and Administration: apply 1 to 4cm strip of the cream into the affected area with gentle massage 3-4 times daily.

AESCIN-DIETHYLAMINE SALICYLATE:

Indications: contusions, crush injuries, sprains, bruises, haematoma and tenosynovitis. Painful conditions of the vertebral column. In superficial thrombophlebitis, varicose veins. For care of the veins after injections or infusions.

Contraindications: should not be applied to broken skin, mucous membranes or skin areas exposed to radiotherapy.

Dose and Administration: spread a thin layer of the gel onto the skin of the affected area once daily or more frequently.

DICLOFENAC SODIUM (as Diclofenc diethylamine):

Indications: For the local symptomatic relief of pain and inflammation in: – trauma of the tendons, ligaments, muscles and joints, e.g. due to sprains, strains and bruises – localised forms of soft tissue rheumatism It is recommended that treatment be reviewed after 14 days in these indications. For the treatment of osteoarthritis of superficial joints such as the knee. In the treatment of osteoarthritis, therapy should be reviewed after 4 weeks.

Contraindications: Patients with or without chronic asthma in whom attacks of asthma, urticaria or acute rhinitis are precipitated by aspirin or other non-steroidal anti-inflammatory agents (NSAIDs). Hypersensitivity to the active substance or any of the excipients. Hypersensitivity to propylene glycol, isopropanol or other components of the gel base.

Dose and Administration: should be rubbed gently into the skin. Depending on the size of the affected site to be treated 2-4g (a circular shaped mass approximately 2.0-2.5cm in diameter) should be applied 3 – 4 times a daily. After application, the hands should be washed unless they are the site being treated.