Ibuprofen gel: topical relief for muscle and joint pain

The NHS lists gels and sprays among the forms of ibuprofen and says you are less likely to get side effects from them than from tablets. The UK product information for Ibuleve gel describes fast local relief of pain and inflammation in musculoskeletal conditions including backache, rheumatic and muscular pain, sprains, strains, lumbago and fibrositis, and neuralgia. It works directly in inflamed tissue under the skin where it is applied.

The aqueous alcoholic base also gives a cooling, soothing effect. Gel is a reasonable fit for a single sore area; it is not designed for widespread or whole-body pain.

Apply the gel to the painful area and rub it gently into the skin, using the amount on the leaflet. The product information gives 1.0 to 2.5g up to three times a day, at least 4 hours apart, or as directed by a doctor, and the NHS says not to exceed 4 applications in 24 hours. The same schedule applies across age groups, though the gel is not normally recommended for children under 12 unless a doctor instructs.

Wash your hands afterwards, and avoid getting it in your eyes, mouth or on broken skin. Treatment should not normally continue for more than a few weeks unless a doctor recommends it, and the NHS says to see a GP if your pain gets worse or does not go away.

• Do not smoke or go near naked flames: clothes that have been in contact with ibuprofen gel burn more easily.

• External use only, and keep out of the sight and reach of children.

• If the gel is accidentally swallowed and you feel unwell, the NHS says to seek medical advice.

Skin reactions are the usual concern: rash, itching and skin irritation are listed, along with photosensitivity reactions. Very rarely, severe cutaneous adverse reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis, and drug reaction with eosinophilia (DRESS), can occur, and the product information says ibuprofen should be withdrawn immediately and alternative treatment considered if signs appear.

Stop using the gel and seek medical advice for a spreading rash, blistering, swelling of the face or lips, or wheezing. Propylene glycol in the gel may irritate the skin in some people.

The product information says not to use it if allergic to any ingredient, or if you have hypersensitivity to aspirin, ibuprofen or related painkillers (including by mouth), especially where associated with asthma, and not on broken or damaged skin. Oral NSAIDs, including ibuprofen, can sometimes be associated with kidney impairment, worsening of active stomach ulcers and allergic bronchial reactions in susceptible asthmatic patients, and these cautions are the reason people with such histories are asked to check first.

The NHS lists asthma, stomach ulcers, heart, liver or kidney conditions, clotting problems and previous stroke among reasons ibuprofen in general may not suit you.

The product information for this gel says it should not be used during pregnancy or lactation, noting that no teratogenic effects have been demonstrated but ibuprofen should be avoided in pregnancy because the onset of labour may be delayed and its duration increased. The NHS says to avoid using ibuprofen in pregnancy unless advised by a doctor or pharmacist, and that when breastfeeding you should check with a pharmacist or doctor; if using gel or spray, use it on the smallest area and try to keep your baby's skin from touching it.

NSAIDs may interact with blood-pressure-lowering medicines and may enhance anticoagulant effects, though absorption from gel is much lower than from tablets. Do not take other NSAIDs such as naproxen or aspirin at the same time without advice.