Ketamine 10% | Cyclobenzaprine 2% | Diclofenac 3% | Gabapentin 6% | Lidocaine 5%

Route: Topical. Apply a small measured amount (as prescribed — typically 0.5–1 mL or 1–2 pump actuations) to the affected painful area(s) and massage gently until absorbed. Apply 2–4 times daily or as directed. Wash hands thoroughly after application. Avoid contact with eyes and mucous membranes. Do not apply to open wounds, rashes, or broken skin.

Dosing is entirely prescriber-determined based on pain location, intensity, and patient-specific clinical context:

• Typical application: small defined dose applied 2–4 times daily to the painful area.
• Quantity dispensed and per-application volume are specified by the prescriber.
• Prescribers may titrate application frequency based on response and tolerance.

• Ketamine 10%: Non-competitive antagonist at NMDA (N-methyl-D-aspartate) glutamate receptors expressed on peripheral nociceptors and central dorsal horn neurons; blocks calcium influx via the NMDA channel, reducing central sensitization, wind-up, and allodynia/hyperalgesia.
• Cyclobenzaprine 2%: Structurally related to tricyclic antidepressants; primarily acts in the brainstem and spinal cord to reduce tonic somatic motor efferent activity, reducing reflex muscle spasm; may also modulate norepinephrine and serotonin pain-modulating pathways.
• Diclofenac 3%: Inhibits COX-1 and COX-2 (cyclooxygenase enzymes) at the application site, reducing prostaglandin E2 and I2 synthesis and thereby reducing peripheral sensitization of nociceptors and local inflammation.
• Gabapentin 6%: Binds the α2-δ-1 and α2-δ-2 subunits of voltage-gated calcium channels on presynaptic terminals, inhibiting calcium influx and consequent release of excitatory neurotransmitters (glutamate, substance P) from sensitized peripheral and central nociceptors.
• Lidocaine 5%: Reversibly binds the intracellular pore of voltage-gated Na⁺ channels in sensory nerve axons, stabilizing the inactivated channel state, preventing action potential generation and conduction in nociceptive fibers (Aδ and C-fibers).

This five-ingredient topical is used prescriber-directed for patient-specific management of focal neuropathic pain syndromes (diabetic peripheral neuropathy, postherpetic neuralgia, complex regional pain syndrome), musculoskeletal pain with spasm, and refractory pain conditions where topical multi-mechanism therapy is clinically appropriate. Topical delivery limits systemic side effects compared to oral equivalents. Evidence for individual agents topically exists; clinical evidence for this specific compounded combination is limited to real-world practice and pharmacological rationale.

Monitoring: Pain scale assessment at 4–8 weeks; skin tolerance at application site; renal and hepatic function if prolonged NSAID topical use is anticipated; monitor for systemic effects in patients applying to large areas.

Contraindications:

• Known hypersensitivity to any component (lidocaine/amide anesthetics, NSAIDs, ketamine, cyclobenzaprine, gabapentin).
• NSAID allergy: diclofenac — contraindicated in NSAID-hypersensitive patients (aspirin-exacerbated respiratory disease).
• Application to large body surface areas in patients with renal or hepatic impairment.

Warnings & Precautions:

• Lidocaine: systemic toxicity if applied to large areas, under occlusion, or to broken skin.
• Diclofenac: topical NSAIDs carry lower systemic cardiovascular/GI risk than oral NSAIDs, but risk exists with extensive application.
• Cyclobenzaprine: may cause drowsiness if significantly absorbed systemically — though topical absorption is expected to be low.
• Avoid in pregnancy (diclofenac/NSAIDs: avoid third trimester; gabapentin: safety not established).

Drug Interactions:

• Topical application: systemic interactions are unlikely at low topical doses; however, inform prescriber of all concurrent medications.

Common Side Effects: Local skin reactions (erythema, pruritus, mild burning) at application site. Systemic effects are uncommon with proper topical application to limited areas.

Store at room temperature (15°C–25°C). Keep tightly sealed. Protect from excessive heat and light. Do not freeze. Use within the beyond-use date assigned by Genesis Compounding.

How does a topical ketamine cream work for pain?

Ketamine blocks NMDA receptors on peripheral sensory nerves and centrally in the dorsal horn, interrupting the sensitization process that underlies neuropathic pain, allodynia, and hyperalgesia. Topical delivery allows local NMDA antagonism at the site of pain without significant systemic psychoactive effects at therapeutic doses.

Why are five different ingredients used together?

Chronic and neuropathic pain involves multiple simultaneous pathways. Using agents that block different targets (NMDA channels, sodium channels, calcium channels, COX enzymes, and spinal motor pathways) provides broader multi-mechanism coverage than any single agent, potentially achieving pain control with lower doses of each individual agent.

Will this cream cause drowsiness or systemic effects?

Applied to a limited skin area as directed, systemic absorption is expected to be minimal. Potential for systemic effects increases if applied to large areas, damaged skin, or under occlusion. Report any dizziness, drowsiness, or unusual symptoms to your prescriber.

Is this FDA-approved?

No. This is a patient-specific, prescriber-directed 503A compounded preparation from Genesis Compounding, not FDA-approved as a compounded drug. Topical diclofenac 1–2% is FDA-approved; the other combinations at these concentrations are compounded patient-specifically.

How often should I apply this cream?

Application frequency is prescribed by your clinician — typically 2–4 times daily to the affected area. Follow the prescribed instructions precisely and do not exceed the directed dose or application area.