diethylamine salicylate: clinical use

Prescribing considerations

• Confirm that the pain is suitable for symptomatic topical treatment and investigate persistent symptoms.
• Review aspirin, salicylate or NSAID hypersensitivity, asthma history, pregnancy, breastfeeding and concurrent medicines.
• Avoid application over large areas or damaged skin because systemic adverse effects may occur if substantial amounts are absorbed.
• Counsel about local irritation and the serious fabric fire hazard.

Contraindications and cautions

• Hypersensitivity to diethylamine salicylate or formulation excipients.
• Known hypersensitivity to aspirin, other salicylates or other NSAIDs, particularly when associated with asthma.
• Application to cut, abraded or broken skin.
• For Algesal, use in children with a history of convulsions because terpene-containing excipients may lower the seizure threshold.

Monitoring

• Assess local skin tolerance and discontinue if excessive irritation develops.
• For a patient taking a coumarin anticoagulant, consider whether anticoagulation monitoring requires closer review.
• Assess urgently for salicylate toxicity after ingestion or clinically significant extensive exposure.

Clinical pharmacology

A cutaneous salicylate analgesic with local anti-inflammatory and counter-irritant activity. The Algesal SmPC reports detectable but small plasma amounts of salicylic acid after topical application.

Formulation and product differences

• Algesal is an off-white, lavender-scented cream containing a lavandin fragrance with d-limonene and linalool, which may cause allergic reactions.
• Odour Free Lloyds Cream contains cetostearyl alcohol and parahydroxybenzoate preservatives that may cause local or delayed allergic skin reactions.
• Advice for children under six differs: Algesal is not recommended, whereas Odour Free Lloyds Cream specifies use only on medical advice.
• Algesal is supplied in aluminium tubes; Odour Free Lloyds Cream is described in an amber glass jar.