Non Steroidal Anti Inflammatory Drugs (NSAIDs) reduce inflammation and are commonly used for short term pain relief. The most common way to take any NSAID is by mouth. While the effect is usually positive, regular use of NSAIDs can cause several side effects, including nausea, vomiting, dyspepsia (indigestion or heartburn), gastric ulceration, bleeding, and diarrhea. These problems are often associated with the amount of drug used – actual dose and frequency.

Many NSAIDs are also effective when applied as a cream or gel, directly to the painful joints or muscles. The doses are smaller and do not some in contact with the lining of the gut. While helpful, in lowering side effects, topical preparations are not perfectly safe, especially if the cream is swallowed.

Who the heck would eat a topical pain cream that contains a NSAID?

For one, children have an obvious propensity for putting things in their mouth. Also, household pets aren’t afraid to try a new “treat”. This can cause serious problems – and maybe even lead to death.

The FDA has issued a national alert that pets are at risk of illness and death when exposed to topical pain medications containing flurbiprofen (a propionic acid derivative*).

The warning was prompted by a fatal incident involving the cats of a patient who was using the topical cream. Two of the cats developed symptoms that included reluctance to eat, lethargy, vomiting, melena (refers to the black, “tarry” feces that are associated with upper gastrointestinal bleeding), anemia, and dilute urine. There was evidence in the kidneys and intestines consistent with NSAID toxicity.

NSAIDs are recommended for intermittent use to relieve acute pain. Most people understand the correlation between these drugs and stomach pain – even modest internal bleeding.

The topical versions seem a safer alternative to swallowing pills, and they are. The problem in this alert is grounded in the fact that the cats ate the cream.

*Propionic acid derivatives include Ibuprofen, Dexibuprofen, Naproxen, Fenoprofen, Ketoprofen, Flurbiprofen, and a few other rarely used products.