Clinical Information
Use as directed by your healthcare provider. Apply a thin layer to the affected skin as instructed. If you miss a dose, apply it when you remember unless it is almost time for your next scheduled dose. Do not apply extra cream to make up for a missed dose. Your healthcare provider will decide how often and how long you should use this medicine.
Each ingredient works in a different but complementary way. Ketoprofen blocks enzymes (COX-1 and COX-2) that create substances causing swelling and pain, easing inflammation within 30–60 minutes and lasting 4–6 hours. Gabapentin calms overactive nerve signals by reducing calcium flow in nerve cells; this can lower burning or shooting pain within a few days, with best relief after 1–2 weeks of steady use. Baclofen activates GABA-B receptors in muscles and the spinal cord to relax tight muscles and cut down spasms; relief often starts in 1 hour and lasts about 6–8 hours. Lidocaine blocks sodium channels in skin nerves, numbing the area in 5–15 minutes for 1–2 hours. Together, the cream gives quick numbness from lidocaine, short-term inflammation control from ketoprofen, and longer nerve and muscle pain relief from gabapentin and baclofen.
Do not use if you are allergic to ketoprofen, gabapentin, baclofen, lidocaine, other NSAIDs (such as ibuprofen or naproxen), or local anesthetics of the amide type. Do not apply to broken, infected, or irritated skin. Avoid use in the third trimester of pregnancy (may harm unborn baby) and while breastfeeding unless your provider approves. Do not use if you have a history of aspirin-sensitive asthma, severe liver or kidney disease, certain heart rhythm problems, or active stomach ulcers or bleeding. Not for children under 12 without medical advice.
Tell your provider about all medicines and supplements you use. Using other NSAIDs (like aspirin, ibuprofen, or naproxen) or blood thinners (warfarin, apixaban) can raise bleeding risk. Medicines that depress the nervous system (opioids, sleep aids, alcohol, benzodiazepines) may add to dizziness or drowsiness from gabapentin or baclofen. Other topical anesthetics or large amounts of lidocaine patches may increase numbness or rare heart rhythm effects. Alcohol can worsen stomach irritation from ketoprofen and increase sedation. Report all herbal products, especially ginkgo, garlic, or high-dose omega-3, which may also thin blood.
Very common (more than 1 in 10 users): mild skin redness, itching, or burning where applied; temporary numbness from lidocaine that fades within 2 hours. Common (1–10 in 100 users): dry skin, peeling, mild headache, dizziness, feeling sleepy. Uncommon (1–10 in 1,000 users): stomach upset, nausea, muscle weakness, blurred vision. Rare but serious: severe skin rash or blisters, wheezing or shortness of breath, stomach bleeding (black or bloody stools), confusion, irregular heartbeat. Most local skin effects improve after washing the area or stopping the cream. Seek medical help right away for signs of allergic reaction (rash, swelling of lips or face, trouble breathing) or stomach bleeding.
Store tightly closed at room temperature (68-77°F, 20-25°C). Keep away from moisture, heat, and direct sunlight. Do not freeze. Keep out of reach of children and pets. Do not store in the bathroom. Stable for 180 days from the compounding date when kept in its original container. Dispose of unused or expired cream through a pharmacy take-back program or mix it with coffee grounds in a sealed plastic bag before throwing it in the trash.
Frequently Asked Questions
Q:How much cream should I apply each time?
A:Use just enough to cover the painful area with a thin film. Rub it in gently until it disappears. Your healthcare provider will tell you if you need more or less.
Q:When will I start to feel relief?
A:You may feel numbness from lidocaine in about 10 minutes. Inflammation and muscle pain usually improve within an hour. Nerve pain can take several days of regular use to calm down fully.
Q:Can I use this cream with my other pain medicines?
A:Often yes, but you need to ask your doctor first. Using too many NSAIDs or other medicines that make you drowsy can increase side effects. Always share a full list of your drugs and supplements with your provider.
Q:Is it safe to wrap or bandage the area after applying the cream?
A:Do not tightly bandage, heat, or cover the area unless your provider instructs you. Extra heat or pressure can push more medicine into your body and raise the chance of side effects.
Q:What should I do if the cream irritates my skin?
A:Wash the area with mild soap and cool water, then pat dry. If redness or burning lasts more than a few hours or gets worse, stop using the cream and call your healthcare provider.
Q:Can I drive or operate machinery after using the cream?
A:Most people can, but some feel dizzy or sleepy, especially at first. If you feel light-headed, avoid driving or using machines until you know how the cream affects you.
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This compounded cream combines five active drugs that work together to help ease nerve and muscle pain when applied to the skin. It is made for patients who have chronic pain that has not improved with single-drug treatments. Because the medicine stays mostly in the skin and tissues where it is applied, it may lower the chance of whole-body side effects seen with oral pain pills.
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This compounded rectal cream combines nifedipine, lidocaine, and hydrocortisone to ease pain, itch, and swelling caused by anal fissures or hemorrhoids. Nifedipine relaxes the tight muscles around the anus to improve blood flow and speed healing. Lidocaine numbs the area for quick pain relief. Hydrocortisone lessens redness, swelling, and itching.
Nitroglycerin Ointment
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