title: Toxicology and teratology of the active ingredients of professional therapy MuscleCare products during pregnancy and lactation: a systematic review.
abstract: BACKGROUND
  The rates of muscle aches, sprains, and inflammation are significantly increased during pregnancy. However, women are afraid to use systemic analgesics due to perceptions of fetal risks. Thus, topical products are important alternatives to consider for those women. Of interest, Professional Therapy MuscleCare (PTMC) has shown to be effective in alleviating the myofascial pain as reported in a randomized, placebo-controlled double-blinded comparative clinical study of five topical analgesics. However, to date, there is no complete review or long-term safety studies on the safety of these products during pregnancy and lactation. Thus, the aim of this article was to review toxicological, developmental, and reproductive effects associated with the use of PTMC products.
  
  
  METHODS
  We performed a systematic review on safety of PTMC from all toxicological articles investigating the effects of PTMC's ingredients. This search was conducted through medical and toxicological databases including, Web of Science, EMBASE, Medline, and Micromedix. Both reported and theoretical adverse effects were extensively reviewed.
  
  
  RESULTS
  Of the 1500 publications reviewed, 100 papers were retrieved and included in the review. Although some ingredients in PTMC products might cause adverse reproductive effects at high systemic doses, these doses are hundreds to thousands fold greater than those systemically available from topical use at the recommended maximum dose (i.e. 10 g/day).
  
  
  CONCLUSIONS
  This study provides evidence that, when used as indicated, PTMC is apparently safe for pregnant women and their unborn babies as well as for breastfed infants.
authors: Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada. abdulaziz.alsaad@mail.utoronto.ca.|Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College street, Toronto, ON, M5S 3M2, Canada. abdulaziz.alsaad@mail.utoronto.ca.|Department of Pharmacology & Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. abdulaziz.alsaad@mail.utoronto.ca.
authors: Abdulaziz M S
authors: AM
authors: Alsaad
authors: Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada. colleenfox_19@hotmail.com.
authors: Colleen
authors: C
authors: Fox
authors: Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada. gkoren@sickkids.ca.|Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College street, Toronto, ON, M5S 3M2, Canada. gkoren@sickkids.ca.
authors: Gideon
authors: G
authors: Koren
mesh_terms: D000287:Administration, Topical; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D001942:Breast Feeding; D005260:Female; D006801:Humans; D007774:Lactation; D059352:Musculoskeletal Pain / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D018600:Teratology; D014116:Toxicology
chemical_list: D000700:Analgesics