Methyl salicylate, menthol, camphor, capsaicin.
Each gram contains Methyl Salicylate 100 mg (10% w/w), Menthol 40 mg (4% w/w), Camphor 40 mg (4% w/w), Capsaicin 0.75 mg (0.075% w/w).
Pharmacology: Pharmacodynamics: Methyl salicylate: Methyl salicylate is a salicylic acid derivative. It inhibits cyclooxygenase, thereby reducing the formation of prostaglandins and cause platelet dysfunction. It is used topically as a counter irritant. It is absorbed through skin upon application for the relief of rheumatic, joint or muscle pain.
Menthol: Menthol dilated blood vessels causing cold sensation, followed by analgesic effect. It acts as penetration enhancer to give faster onset of action.
Camphor: Camphor is a stimulant, rubefacient, antipruritic, and feebly antiseptic. It becomes ideal for neuralgia and other painful area when combine with ingredient like menthol, and methyl salicylate.
Capsaicin: Capsaicin possesses the same action with camphor but perform more slowly and less completely. However, it is more effective than camphor.
Pharmacokinetics: Methyl salicylate: Methyl salicylate can be absorbed through skin. It is metabolized to salicylic acid in the dermal and subcutaneous tissues after topical application. The half-life of salicylates is 2-4 hours at therapeutic levels. As salicylate level increase into the toxic range, the half-life can be greater than 18 hours.
Menthol: Menthol is excreted in the urine and bile as a glucuronide.
Camphor: Camphor is readily absorbed from all administration sites. It is hydroxylated in the liver to yield hydroxycamphor metabolites which are then conjugated with glucuronic acid and excreted in the urine. It can cross the placenta.
Capsaicin: Capsaicin is absorbed through skin and metabolized by microsomes. Capsaicin is mainly eliminated through kidneys with a small untransformed proportion excreted in faeces and urine.
Relief of joint and muscle pain, sprains, strains, pain associated with rheumatism and arthritis. Temporary relief of pain associated with musculoskeletal soreness and discomfort.
Apply to affected area 2 to 3 times daily.
Symptoms of methyl salicylate overdose: Salicylate intoxication may occur following excessive topical application of salicylates. Symptoms include dizziness, tinnitus, deafness, sweating, nausea and vomiting, headache and confusion and may be controlled by reducing dosage. Severe intoxication following overdose include hyperventilation, fever, restlessness, ketosis and respiratory alkalosis and metabolic acidosis. CNS depression may lead to coma, cardiovascular collapse and respiratory failure may also occur.
Symptoms of camphor/menthol overdose: Ingestion of significant quantities is reported to cause severe abdominal pain, nausea, vomiting, vertigo, drowsiness and coma; instant collapse in infants after the local application of camphor/menthol to their nostrils. Severe toxicity of camphor is characterized by seizures, delirium, visual hallucinations, celebral edema and status epilepticus. Systemic toxicity may include hypotension, tachycardia, respiratory failure and death.
Symptoms of capsaicin overdose: Capsaicin overdose can cause burning or stinging pain to the skin. If ingested, can cause nausea, vomiting, abdominal pain and burning diarrhea. Exposure to eye can produce intense tearing, pain and conjunctivitis.
Treatment: For methyl salicylate, menthol and camphor intoxication, the stomach should be emptied by gastric lavage or administration of oral activated charcoal. Fluid and electrolyte management is the mainstay of treatment with the immediate aim of correction of acidosis, hyperpyrexia, hypokalaemia and dehydration if present. Any convulsions must be controlled through supportive care including anticonvulsant therapy.
For capsaicin overdose, the primary treatment is removal of exposure by bathing the contacted surface with oily compound e.g. vegetable oil or petroleum jelly. Cold milk or water may be used to treat burning sensation.
This product is contraindicated in patients who have shown hypersensitivity to any of the ingredients without doctor's consultation.
Can cause convulsion.
Contraindicated in children below 2 years of age.
Caution must be exercised when older children are treated.
Avoid direct application into the nostrils.
For external use ONLY; not to be taken.
Do not apply to wounds, damaged skin, over large body areas, under occlusion or use with heating pad.
Avoid contact with eyes, nose, mouth, rectum or genitals.
Special precaution should be taken for usage during pregnancy or lactation.
This product contains methyl salicylate and when applied or rub onto the skin, can be absorbed through the skin into the blood. For patients taking warfarin, excessive application onto the skin for muscle or joint pains may increase the chances of bleeding.
This product is contraindicated in children below 2 years of age. Caution must be exercised when older children are treated.
It is dangerous to place any camphor containing product into the nostril of children. A small amount applied this way may cause immediate collapse.
Safety for use in pregnancy had not been established. Potential benefit of the product should be weighed against the possible risks to the mother and child prior to usage.
Possible temporary burning or stinging sensation. Possible skin sensitivity reactions e.g. irritation, redness and swelling of the skin.
Methyl salicylate should not be used with anticoagulants e.g. warfarin as it may potentiate the side effects of warfarin. Methyl Salicylate, camphor and capsaicin combination shall not be used with anti-anginal drugs e.g. captopril, ramipril, amlodipine, etc. Capsaicin may increase stomach acid and reduce the effect of stomach acid reducers like cimetidine, omeprazole, etc. Capsaicin may also decrease the pain relieving effect of aspirin and increase the risk of bleeding associated with aspirin.
Keep in an airtight container. Store at temperature below 30°C. Protect from light and moisture.
Shelf-Life: 2 Years.
M02AC - Preparations with salicylic acid derivatives ; Used in the topical treatment of joint and muscular pains.