There currently are no guidelines on the use of combination oral and topical NSAID therapy. Yet, we know that NSAIDs have been associated with an increased risk of gastrointestinal (GI) bleeding, heart attack and stroke. In the only study available, oral plus topical diclofenac was no better than either formulation used alone, and it increased the risk for GI bleeding. Given the lack of data and potential for increased risk, combining oral and topical NSAIDs “should not be routinely recommended,” according to Jenny Van Amburgh, Clinical Professor and Assistant Dean for Academic Affairs, School of Pharmacy, Northwestern University.

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