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PLO gels and creams: A prescription option for those who have difficulty taking oral medications

Have trouble swallowing a pill? Have adverse effects to oral pain medications? Several agents in medications taken for pain or muscle spasms can often interfere with or prevent daily activities because of their unpleasant side effects. These medications can cause drowsiness, dizziness, lightheadedness, euphoria (feeling high) and impaired judgment. Often, people also complain of nausea, vomiting and constipation while taking most of these medications. These side effects can prevent people from working, attending classes, driving or performing their daily routine. 

Fortunately, there is a new option to control muscle spasms and pain without taking any pills. These new agents, known as PLO gels or creams, are wonderful for those people who have trouble swallowing medications or who cannot tolerate oral drugs.            

Invented in the early 1990s as an alternative to oral medications, PLO stands for Pluronic Lecithin Organogel, a mixture of oil and water that thickens to form a gel.  The PLO gel can be applied to the skin at the site of the pain or to the inside of the wrist for a full-body effect. They are a great option because they can treat pain or muscle spasms in a local area while minimizing the effects on the rest of the body.  

PLO gels are applied directly to the skin and can take effect immediately. They are unique because of their transdermal (through the skin) method of delivering medication. Usually only a small, pea-size amount of the PLO gel is needed for each dose. The gel can thoroughly pass the medication through the skin because the lecithin in the PLO base works to pull the medications through all the different layers of the skin. PLO preparations allow the medications to reach deeper layers of the skin where they can take effect.  

PLO gels are made with a variety of medications and can treat multiple medical problems. These gels often contain agents such as Ketamine, Ketoprofen, Gabapentin, Cyclobenazaprine and Lidocaine. PLO gels can treat other medical conditions by adding drugs such as Prochlorperazine or Scopolamine for motion sickness, Chlorpromazine for nausea, or Testosterone for hormone replacement. Additionally, they commonly are used on pets. For example, the gel can be applied inside the ear of cats where the medications will pass quickly into the bloodstream and cannot easily be rubbed or licked off.  

PLO gels require a prescription and must be prepared at a compounding pharmacy.  Once they are prepared, the gels should be stored at room temperature and are good for up to six months. Talk to your local compounding pharmacy for more information about PLO gels.  
Geremi Boom, BS, C.PhT, is a certified pharmacy technician at Flagstaff Pharmacy, a division of Flagstaff Medical Center. Debbie Doehnert, is a pharmacist intern at Flagstaff Pharmacy and is a student at the University of Arizona College of Pharmacy.