The People’s Pharmacy: Ibuprofen gel saved European vacation

Q. A few years ago while in Europe for vacation, I fell and bruised my ribs. Knowing there was not much I could do about it, I tried to tough out the rest of the two-week trip.

By the eighth day, I was in such misery that I booked a massage. After the massage, the masseuse applied ibuprofen gel to the painful area. I got instant relief.

I went to the nearest pharmacy and bought a tube. I now use it when my arthritis is bothering me, and it works wonderfully. I have none of the stomach irritation that oral ibuprofen causes me. Yet the Food and Drug Administration refuses to approve it for over-the-counter sale. Why is that?

A. Sometimes the FDA’s motives and rationales are mysterious. Back in 2009, the agency apparently cracked down on companies selling topical ibuprofen products without approval. So far as we can tell, none have been approved since then.

In the U.S., only diclofenac is available in topical formulations to treat inflamed joints. These include Pennsaid and Voltaren Gel. Flector patch is another topical application of diclofenac. All require a prescription.

Your doctor might consider prescribing ibuprofen or ketoprofen gel. You could then take the prescription to a compounding pharmacist.

You can learn more about the pros and cons of drugs used to treat arthritis and many nondrug approaches that can ease the pain from our “Guide to Alternatives for Arthritis.” Access to this online resource may be purchased at www.PeoplesPharmacy.com.

Q. I’ve had cold sores since I was young. I have spoken with doctors about them innumerable times.

In your column, you often recommend taking L-lysine. This product has not shown efficacy in peer-reviewed clinical trials, as far as I’ve heard. It is just one of the home-remedy folk “cures” that show up in your columns. Even acyclovir and valacyclovir are of limited efficacy.

A. Cold sores are caused by herpes simplex virus type 1. It hides out in the body and appears in the form of a cold sore lesion on the lips or face in the event of a drop in immunity, exposure to intense sunlight or increased stress (BMJ Clinical Evidence, online, Sept. 23, 2009).

A comprehensive Cochrane review supports your stance on L-lysine (Cochrane Database of Systematic Reviews, Aug. 7, 2015). That could be due to a lack of studies rather than a lack of efficacy, however. Long-term use of the antiviral drugs acyclovir or valacyclovir was modestly effective in preventing cold sores.

Despite such negative news, we continue to hear from readers that L-lysine works for many people. Here is one testimonial:

“Lysine tablets work for me. At the first tingle of a beginning cold sore, I take a 500-mg tablet. Then I take another 500-mg tablet later on that day.

“I try to take 1,000 mg a day for several days. By then, there is either a small cold sore that goes away early or no cold sore at all. Usually it’s the latter.”

Q. Do any of your readers have an idea for helping with interstitial cystitis? It is extremely painful.

A. Interstitial cystitis is caused by inflammation of the bladder or nerves connected to it. Although urination often is painful, specialists recommend adequate hydration to dilute toxins or irritants that could aggravate the condition (Reviews in Urology, 2014).

Some people who suffer from interstitial cystitis or painful bladder syndrome may get relief from a warm sitz bath. Alternatively, sitting on an ice pack helps others.

Over-the-counter medicines such as calcium glycerophosphate (Prelief) or the flavonoid quercetin also may be helpful.