Arthrocare

A bicyclic monoterpene ketone found widely in plants, especially cinnamomum camphora. It is used topically as a skin antipruritic and as an anti-infective agent. [PubChem]

Menthol (Arthrocare) is a covalent organic compound made synthetically or obtained from peppermint or other mint oils. It is a waxy, crystalline substance, clear or white in color, which is solid at room temperature and melts slightly above. The main form of Menthol (Arthrocare) occurring in nature is (-)-Menthol (Arthrocare), which is assigned the (1R,2S,5R) configuration. Menthol (Arthrocare) has local anesthetic and counterirritant qualities, and it is widely used to relieve minor throat irritation.

Each 100 g of cream contains Methyl Salicylate (Arthrocare) 11 g, eugenol 1.4 g, Methyl Salicylate (Arthrocare) 5.6 g, cajuput oil 0.8 g and washable base.

Temporarily relieves discomfort due to minor irritations of the eye or exposure to wind or sun. For protection against further irritation or to relieve dryness of the eye

Eucalyptus Oil (Arthrocare) has been taken by mouth for catarrh and coughs and is an ingredient of many preparations. It has been used as an inhalation often in combination with other volatile substances. Eucalyptus Oil (Arthrocare) has also been applied as a rubefacient and is used as a flavour. It is also used in aromatherapy.

Positive Skin Test Control - Histamine (Arthrocare) is indicated as an adjunct in allergy skin test for diagnosis, as a positive control to test wheal-flare response of skin for evaluation of skin test response to allergenic extracts.

Oral

Nasal congestion; Throat irritation

Adult: As a loz (usually in combination with eucalyptus oil or cetylpyridinium chloride): 1 loz every 3 hr, to be sucked slowly.

Child: >6 yr: As a lozenge (usually in combination with eucalyptus oil or cetylpyridinium chloride): 1 lozenge every 3 hr, to be sucked slowly.

Topical/Cutaneous

Muscular aches and pains

Adult: As an ointment/cream (usually in combination with Menthol (Arthrocare), clove oil or methyl salicylate): Apply and rub gently onto the affected skin areas 2-3 times daily.

Methyl Salicylate (Arthrocare) cream is for the temporary relief of pain associated with strains of joints and muscles, arthritis, rheumatism, lumbago, and fibrositis. Methyl Salicylate (Arthrocare) cream can also be used for pre-sport warm-up and after sport as required.

Temporary relief of minor muscle and joint aches and pains caused by arthritis, simple backache, strains, sprains, and bruises. It may also be used for other conditions as determined by your doctor.

Camphor (Arthrocare) is a topical analgesic. It works by temporarily relieving minor pain.

Histamine (Arthrocare) is used to help diagnose problems or disease of the stomach. This test determines how much acid your stomach produces.

How the stomach test is done: Before Histamine (Arthrocare) is given, the stomach contents are emptied through a tube. Then the dose of Histamine (Arthrocare), which is based on body weight, is injected under the skin. Five minutes later, the stomach contents are emptied and tested for acidity. This procedure may be repeated several times. An antihistamine medicine may be given before the Histamine (Arthrocare) is injected to prevent a possible unwanted effect.

Histamine (Arthrocare) is to be used only under the supervision of a doctor.

Relieving minor pain caused by conditions such as arthritis, backache, bruising, bursitis, cramping, muscle strains or sprains, and tendonitis. It may also be used for other conditions as determined by your doctor.

Menthol (Arthrocare) lotion is a topical analgesic. It works by temporarily relieving minor pain.

Apply generously to clean affected area gently massaging into skin. Repeat if necessary. May be used with or without a wrap.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

For Prick, Puncture and Scratch Testing

Histamine (Arthrocare) base 1 mg/mL (Histamine (Arthrocare) Phosphate 2.75 mg/mL) should be used to give a reaction. (Refer to Interpretation Section.)

Prick, Puncture or Scratch Test Techniques

1. The skin in the test area should be cleansed with alcohol and air dried.

2. The Histamine (Arthrocare) control skin test solution should be placed at the same site with the other skin test antigens, either on the patient's back or on the volar surface of the forearm. The patient should be placed in a comfortable position before the testing is begun.

3. For the prick test, a sharp needle is used to puncture the skin, but not to draw blood. If the scratch test is used, carefully break or scratch the skin with a sterile scarifier. Do not draw blood. Each scratch should be about 2 mm - 4 mm in length.

4. A small drop of the Histamine (Arthrocare) base 1 mg/mL (Histamine (Arthrocare) Phosphate 2.75 mg/mL) is placed on the abraded skin site no closer than 4 or 5 cm from an adjacent test site. Some physicians prefer to place the solution on the test area and then prick through the drop with a sharp needle.

5. Use a separate sterile scarifier or needle for each patient.

6. The test should be read at 15 minutes; if a large wheal reaction occurs before that time the test site should be wiped free of Histamine (Arthrocare).

Interpretation

The patient's response is based on the size of: erythema (degree of redness) and/or size of wheal (smooth, slightly elevated area) which appear after 10 minutes.

For percutaneous testing, different devices and/or techniques influence the size of the reaction. Therefore, it is important to refer to the device manufacturer's or distributor's instructions when grading reactions.

For prick, puncture and scratch testing, Histamine (Arthrocare) base 1 mg/mL (Histamine (Arthrocare) Phosphate 2.75 mg/mL) should be used to give a positive reaction. In a large population, the NHANES II survey reports a mean diameter (average of length and width) wheal of 4.4 mm ± 1.65 mm (± standard deviation) and a mean erythema of 18.4 mm ± 8.55 mm (± standard deviation) when using 25 gauge B-D needle by prick puncture (Pepys) technique.7 All positive reactions should be interpreted against an appropriate negative control.

For Intradermal Skin Testing

Histamine (Arthrocare) base 0.1 mg/mL (Histamine (Arthrocare) Phosphate 0.275 mg/mL) or 0.01 mg/mL should be used to give a reaction. (Refer to Interpretation Section.)

Intracutaneously (Intradermal) Test Techniques

1. The skin should be cleansed with alcohol and air dried.

2. A sterile one milliliter tuberculin syringe with 26 or 27 gauge needle should be used. A single sterile syringe should be used for each solution to assure sterility. Only the Histamine (Arthrocare) base 0.1 mg/mL (Histamine (Arthrocare) Phosphate, 0.275 mg/mL) or greater dilution solution should be used.

3. The Histamine (Arthrocare) base skin test solution should be injected at the same site with the other skin test allergens, either on the patient's back or on the arm. The patient should be placed in a comfortable position before the testing is begun.

4. The skin is held tense and the needle is inserted almost parallel to the skin, bevel side up, far enough to cover the beveled portion. Slowly inject 0.01 mL or 0.02 mL, making a small bleb approximately 3 mm - 5 mm in diameter.

5. The test should be read in 15 minutes.

Interpretation

The patient's response is based on the size of: erythema (degree of redness) and/or size of wheal (smooth, slightly elevated area) which appear after 10 minutes.

For intradermal skin testing, Histamine (Arthrocare) base 0.1 mg/mL (Histamine (Arthrocare) Phosphate 0.275 mg/mL) or 0.01 mg/mL should be used to give a positive reaction. The available 0.1 mg/mL concentration must be diluted ten-fold to achieve this dose. All positive reactions should be interpreted against an appropriate negative control. In two successive years of testing, the Committee on Standardization of the American College of Allergy reported positive reactions at Histamine (Arthrocare) base doses of 0.01 mg/mL and higher. Mean sum of wheal diameters was approximately 14 mm ± 4.8 mm and sum of erythema diameter was approximately 52 mm ± 21.6 mm following 0.01 mL intradermal doses of 0.01 mg/mL Histamine (Arthrocare) base. When 0.01 mL of 0.1 mg/mL Histamine (Arthrocare) base was injected, the sum of cross-diameters of wheal ranged from 15-20 mm and the sum of cross-diameters of erythema ranged from 60-80 mm.8

Oral

Nasal congestion; Throat irritation

Adult: As a loz (usually in combination with eucalyptus oil or cetylpyridinium chloride): 1 loz every 3 hr, to be sucked slowly.

Child: >6 yr: As a lozenge (usually in combination with eucalyptus oil or cetylpyridinium chloride): 1 lozenge every 3 hr, to be sucked slowly.

Topical/Cutaneous

Muscular aches and pains

Adult: As an ointment/cream (usually in combination with Menthol (Arthrocare), clove oil or methyl salicylate): Apply and rub gently onto the affected skin areas 2-3 times daily.

Apply generously on the affected area 2-3 times daily or whenever necessary.

See also:
What is the most important information I should know about Camphor (Arthrocare)?

Children under 30 months.

- Skin oozing.

- Skin superinfected.

- Do not use on mucous membranes.

- Connected to the presence of terpene derivatives:

. infants under 30 months

. children with a history of seizures (febrile or not).

- Do not apply to the breasts when breastfeeding.

Do not apply to sensitive skin. Do not expose to temp >50°C.

Positive Skin Test Control - Histamine (Arthrocare) is contraindicated in patients with a history of hypersensitivity to Histamine (Arthrocare) products, and in patients with hypotension, severe hypertension, vasomotor instability, severe cardiac, pulmonary or renal disease.

See also:
What is the most important information I should know about Menthol (Arthrocare)?

Not to be used in

No known conditions.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

All NSAIDs are contra-indicated in patients with active peptic ulceration; in addition, the non-selective NSAIDs should be used with caution, if at all, in patients with a history of such disorders. To reduce the risk of gastrointestinal effects, NSAIDs may be taken with or after food or milk

Use Camphor (Arthrocare) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Camphor (Arthrocare) is only to be used on intact, clean, dry skin. Do not apply Camphor (Arthrocare) to wounds or damaged skin.
• Open pouch and remove patch. If needed, cut patch to size. Peel off protective backing and apply the sticky side to the affected area.
• Wash your hands immediately after using Camphor (Arthrocare).
• Do not bandage tightly after applying Camphor (Arthrocare).
• Do not use Camphor (Arthrocare) more often than 3 to 4 times per day.
• If you miss a dose of Camphor (Arthrocare) and you are using it regularly, use it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your health care provider. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Camphor (Arthrocare).

Use Menthol (Arthrocare) spray as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Wash your hands before and right after using Menthol (Arthrocare) spray.
• Spray Menthol (Arthrocare) spray directly onto the affected area. Do not rub or massage the medicine into the skin.
• Do not wrap, bandage, or use a heating pad on the treated area.
• Do not apply Menthol (Arthrocare) spray more than 4 times daily.
• If you miss a dose of Menthol (Arthrocare) spray, use it as soon as you remember. Continue to use it as directed by your doctor or on the package label.

Ask your health care provider any questions you may have about how to use Menthol (Arthrocare) spray.

Camphor (Arthrocare) is used to relieve minor pain and itching, to treat fungal infection of the toenail and to have temporary relief from cough associated with common cold.

Histamine (Arthrocare) is a solution for skin prick testing. Histamine (Arthrocare) Positive and negative control are fordiagnostic use only. They are used as a reference with other skin prick tests to determine which substances cause allergic reaction.

Pharmaceutical Aid

Methyl Salicylate (Arthrocare) is used as an anti-pain topical medication, as cream, gel, ointment, lotion or spray. It is used to temporarily relieve muscle or joint pain caused by strains, pains, arthritis, bruising or backaches.

If you are currently being treated with any of the following medications, you should not use eucalyptus without first talking to your health care provider.

* 5-Fluorouracil (5-FU) -- In an animal study, topical Eucalyptus Oil (Arthrocare) enhanced the absorption of topical 5-fluorouracil (5-FU), a medication used to treat cancer.

* Other Possible Interactions -- Eucalyptus may increase how quickly the body eliminates some medications, including pentobarbital, a barbiturate used as an anesthetic, and amphetamine, a stimulant used for narcolepsy and attention deficit hyperactivity disorder.

Tell your doctor of any over-the-counter or prescription medication you may take including: blood thinners.

Do not start or stop any medicine without doctor or pharmacist approval.

Absorption of Methyl Salicylate (Arthrocare) through the skin can occur after excessive topical application, and interactions would be expected to be as for other salicylates

See also:
What are the possible side effects of Camphor (Arthrocare)?

Camphor (Arthrocare) is LIKELY SAFE for most adults when applied to the skin in a cream or lotion in low concentrations. Camphor (Arthrocare) can cause some minor side effects such as skin redness and irritation. Don’t use undiluted Camphor (Arthrocare) products or products containing more than 11% Camphor (Arthrocare). These can be irritating and unsafe.

Camphor (Arthrocare)-containing products are LIKELY UNSAFE when applied to broken or injured skin. Camphor (Arthrocare) is easily absorbed through broken skin and can reach toxic levels in the body.

Camphor (Arthrocare) is also LIKELY SAFE for most adults when inhaled as vapor in small amounts as a part of aromatherapy. Don’t use more than 1 tablespoon Camphor (Arthrocare) solution per quart of water.

Do not heat Camphor (Arthrocare)-containing products (Vicks VapoRub, BenGay, Heet, many others) in the microwave. The product can explode and cause severe burns.

Camphor (Arthrocare) is UNSAFE when taken by mouth by adults or children. Ingesting Camphor (Arthrocare) can cause severe side effects, including death. The first symptoms of Camphor (Arthrocare) toxicity occur quickly (within 5 to 90 minutes), and can include burning of the mouth and throat, nausea, and vomiting.

epigastric burning, nausea and vomiting, and CNS depression, including coma. Cyanosis, ataxia, miosis, pulmonary damage, delirium, and convulsions may occur. Deaths have been reported.

See also:
What are the possible side effects of Histamine (Arthrocare)?

Large doses of Histamine (Arthrocare) may precipitate systemic reactions. These reactions may include flushing, dizziness, headache, bronchial constriction, urticaria, asthma, marked hypotension or hypertension, abdominal cramps, vomiting, metallic taste, local or generalized allergic manifestations.

An antihistamine preparation may be given orally, I.M. or I.V. to prevent or ameliorate systemic reactions to the drug.

If a systemic or anaphylactic reaction does occur, apply a tourniquet above the site of injection and inject 1:1000 epinephrine-hydrochloride intramuscularly or subcutaneously into the opposite arm. Loosen the tourniquet at least every 10 minutes. Do not obstruct arterial blood flow with the tourniquet.

Epinephrine

Dosage:

Adult: 0.3 to 0.5 mL should be injected. Repeat in 5 to 10 minutes if necessary.

PEDIATRIC: The usual initial dose is 0.01 mg (mL) per kg body weight or 0.3 mg(mL) per square meter of body surface area. Suggested dosage for infants to 2 years of age is 0.05 mL to 0.1 mL; for children 2 to 6 years, 0.15 mL; and children 6 to 12 years, 0.2 mL. Single pediatric doses should not exceed 0.3 mg (mL). Doses may be repeated as frequently as every 20 minutes, depending on the severity of the condition and the response of the patient.

After administration of epinephrine, profound shock or vasomotor collapse should be treated with intravenous fluids, and possibly vasoactive drugs. Oxygen should be given by mask. Aminophylline or adrenal corticosteroids may be used if necessary after adequate epinephrine and circulatory support has been given.

Emergency resuscitation measures and personnel trained in their use should be available immediately in the event of a serious systemic or anaphylactic reaction not responsive to the above measures (Ref. J. ALLERGY AND CLINICAL IMMUNOLOGY 77s (2): p. 271-273, 1986).16

Rarely are all of the above measures necessary, the tourniquet and epinephrine usually producing prompt responses. However, the physician should be prepared in advance for all contingencies. Promptness in beginning emergency treatment measures is of utmost importance.

Adverse Event Reporting

Report all adverse events to Jubilant HollisterStier LLC Customer Technical Services Department at 1 (800) 992-1120. A voluntary adverse event reporting system for health professionals is available through the FDA MEDWATCH program. Preprinted forms (FDA Form 3500) are available from the FDA by calling 1 (800) FDA-1088. Completed forms should be mailed to MEDWATCH, 5600 Fisher Lane, Rockville, MD 20852-9787 or Fax to: 1 (800) FDA-0178.

See also:
What are the possible side effects of Menthol (Arthrocare)?

May cause hypersensitivity reactions such as cutaneous dermatitis. Ingestion of large amount of Menthol (Arthrocare) may cause GI effects such as severe abdominal pain, nausea, vomiting, vertigo, ataxia, drowsiness and coma.

See also:
What are the possible side effects of Methyl Salicylate (Arthrocare)?

As aspirin, The most common adverse effects of therapeutic doses of aspirin are gastrointestinal disturbances such as nausea, dyspepsia, and vomiting. Gastrointestinal symptoms may be minimised by giving aspirin with food. Irritation of the gastric mucosa with erosion, ulceration, haematemesis, and melaena may occur. Methyl Salicylate (Arthrocare) H2-antagonists, proton pump inhibitors, and prostaglandin analogues such as misoprostol may be used in the management of aspirin-induced mucosal damage. Slight blood loss, which is often asymptomatic, may occur in about 70% of patients; it is not usually of clinical significance but may, in a few patients, cause iron-deficiency anaemia during long-term therapy. Such occult blood loss is not affected by giving aspirin with food but may be reduced by use of enteric-coated or other modified-release tablets, H2-antagonists, or high doses of antacids. Major upper gastrointestinal bleeding occurs rarely.

Some persons, especially those with asthma, chronic urticaria, or chronic rhinitis, exhibit notable hypersensitivity to aspirin, which may provoke reactions including urticaria and other skin eruptions, angioedema, rhinitis, and severe, even fatal, paroxysmal bronchospasm and dyspnoea. Persons sensitive to aspirin often exhibit cross-sensitivity to other NSAIDs.

Aspirin increases bleeding time, decreases platelet adhesiveness, and, in large doses, can cause hypoprothrombinaemia. It may cause other blood disorders, including thrombocytopenia.

Aspirin and other salicylates may cause hepatotoxicity, particularly in patients with juvenile idiopathic arthritis or other connective tissue disorders. In children the use of aspirin has been implicated in some cases of Reye’s syndrome, leading to severe restrictions on the indications for aspirin therapy in children. For further details see under Reye’s Syndrome,.

Aspirin given rectally may cause local irritation; anorectal stenosis has been reported.