Is Locoa stronger than Salonpas?

Yes, in the sense that matters. Locoa delivers 40mg of esflurbiprofen, a full NSAID, deep into the joint, and it beat a conventional flurbiprofen patch in a 633-patient trial. Salonpas relies mainly on menthol and methyl salicylate as counter-irritants for mild to moderate aches. The trade-off is that Locoa behaves much more like an oral NSAID in your bloodstream.

Can I buy Locoa patches in the US?

Not at a pharmacy. Locoa (spelled LOQOA on its English labeling) is made by Taisho Pharmaceutical and approved in Japan as a prescription drug for osteoarthritis pain. Esflurbiprofen does not appear in the FDA's drug approval database, so there is no US label and no US pharmacist checking it against your other medications.

Can I use Locoa and Salonpas together?

Not without asking your prescriber. Locoa's label says to avoid combining it with other anti-inflammatory drugs that have systemic effects, and the US Salonpas Pain Relief patch label classes its methyl salicylate as an NSAID and warns about stacking it with other NSAIDs.

Is there a pain patch that isn't an NSAID?

Yes. Lidocaine patches numb the skin, menthol-only patches are counter-irritants, and transdermal CBD patches like our 50mg isolate patch contain no NSAID or salicylate at all. A CBD patch is worn for 24 hours rather than 8 to 12. It is not an anti-inflammatory drug and is not a substitute for one, and CBD has its own liver-enzyme interactions, so tell your prescriber you're using it.

Can I use a CBD patch with Locoa?

Tell your prescriber first. Esflurbiprofen is cleared mainly by the liver enzyme CYP2C9, Locoa's label flags CYP2C9 inhibitors as raising esflurbiprofen levels, and CBD inhibits CYP2C9. That is a real pharmacokinetic overlap that whoever prescribed Locoa should know about.

Locoa patch vs Salonpas: a prescription NSAID against an OTC counter-irritant

Locoa and Salonpas look like the same kind of product: a thin adhesive sheet you stick over a sore knee or back. They are not. Locoa (sold in English as LOQOA tape) is a prescription NSAID patch from Japan’s Taisho Pharmaceutical, containing 40mg of esflurbiprofen per 10 x 14 cm sheet, approved for osteoarthritis pain. Salonpas, in the US, is an over-the-counter patch from Hisamitsu that mainly uses menthol and methyl salicylate as counter-irritants. So in the Locoa patch vs Salonpas question, Locoa is the more powerful drug by a wide margin. It is also the one that reaches your bloodstream at levels close to an oral anti-inflammatory, which rules a lot of people out. If that’s you, there’s a third kind of patch further down.

I’ve had rheumatoid arthritis since I was 15, more than 30 years now, and many years ago I took Celebrex and other NSAIDs for a long stretch. What follows is what the labels and the published trials actually say.

What each patch contains

	Locoa (LOQOA)	Salonpas Pain Relief (US)	Reclaim Labs 50mg CBD patch
Active ingredient	Esflurbiprofen 40mg, plus mentha oil	Methyl salicylate 10%, menthol 3%	CBD isolate 50mg, zero THC
Drug class	NSAID	Counter-irritant; label classes methyl salicylate as an NSAID	Not an NSAID; no salicylate, no menthol
Status	Prescription only, approved in Japan	OTC in the US (FDA NDA 022029)	OTC hemp product
Wear time	Once a day; max 2 patches at a time	8 to 12 hours; max 2 a day, 3 days in a row	One patch, 24 hours
Built for	Osteoarthritis pain, under a doctor	Mild to moderate muscle and joint aches	All-day, every-day pain; people who can’t add an NSAID

Salonpas also sells a camphor version and a 4% lidocaine line. For Salonpas against other US options, see our Icy Hot vs Salonpas comparison covers the shelf.

How well Locoa and Salonpas work

Locoa has the stronger evidence base, with the caveat that most of it was funded or run by Taisho.

In the phase III trial, Yataba et al. 2017 (PMID 27168463) randomized 633 knee osteoarthritis patients to the esflurbiprofen patch or an established flurbiprofen patch for two weeks, double-blind. Pain on rising from a chair improved by 40.9 mm on a 100 mm scale with esflurbiprofen versus 30.6 mm with the older patch. Against diclofenac gel, Tomatsu et al. 2022 (PMID 35199483) found the patch non-inferior in an open-label trial of 311 patients.

The reason is penetration. Yataba et al. 2016 (PMID 26438533) measured esflurbiprofen in knee tissue removed during joint replacement: synovial tissue levels were 14.8 times higher, and synovial fluid 32.7 times higher, than with a conventional flurbiprofen patch. Amemiya et al. 2021 (PMID 34529839) found synovial drug exposure from the patch in the same range as flurbiprofen tablets, in 38 patients awaiting knee replacement.

Salonpas has one solid placebo-controlled trial. Higashi et al. 2010 (PMID 20171409), from Hisamitsu, gave 208 adults with mild to moderate muscle strain the 10% methyl salicylate and 3% menthol patch or a placebo patch. Over 8 hours, the active patch produced roughly 40% more pain relief with movement, with adverse events similar to placebo.

So: Locoa is a genuine anti-inflammatory delivered into the joint. Salonpas makes a sore muscle feel better for a working day. If you have an occasional muscle ache, buy the cheap Salonpas box. You don’t need anything stronger, and you don’t need us.

Why Locoa is closer to a pill than it looks

A patch that gets the drug into the joint as well as a tablet also gets it into your blood.

Otsuka et al. 2017 (PMID 28378068) states that systemic exposure from two Locoa patches a day was estimated as comparable to 120mg a day of oral flurbiprofen. Over 52 weeks in 201 osteoarthritis patients, creatinine and blood urea nitrogen rose by small but statistically significant amounts. In the same cohort, Yataba et al. 2016 (PMID 27229525) reported mild skin reactions at 46.8% of patch sites, systemic adverse events in 9.0% of patients, and one serious gastric ulcer hemorrhage.

That’s why Locoa’s label reads like an oral NSAID label. It contraindicates peptic ulcer, severe kidney, liver or heart disease, severe hypertension, aspirin-induced asthma and late pregnancy. Salonpas isn’t free of this either: the US label carries a stomach bleeding warning and says to ask a doctor first if you take a blood thinner, a steroid or a diuretic, or have high blood pressure.

Interactions, if you take other medications

Locoa’s label lists interactions that land squarely on people with autoimmune conditions. A Locoa prescribed in Japan won’t show up in a US pharmacy’s interaction check, so you have to raise it yourself.

You take	What Locoa’s label says
Warfarin	Esflurbiprofen may displace warfarin from plasma proteins and increase its effect
Methotrexate	Reduced kidney clearance may raise methotrexate levels
Corticosteroids (prednisone, methylprednisolone)	Increased risk of stomach ulcer and GI bleeding
SSRIs, SNRIs, tricyclics	Increased bleeding risk
Thiazide or loop diuretics	Diuretic effect may decrease
CYP2C9 inhibitors	Esflurbiprofen levels may rise
Certain quinolone antibiotics	Seizure risk; four are contraindicated outright

Our CBD and NSAIDs page covers the same overlap with ibuprofen, naproxen and diclofenac, and the methotrexate and prednisone pages go deeper on those two.

If you can’t add another NSAID patch

Read that table again and picture who it describes: someone on methotrexate or prednisone, an SSRI, a blood pressure pill. That’s a typical RA medication list, and close to mine over the years. For a lot of us, the strongest patch in this comparison is the one we’re least able to use, and Salonpas is an NSAID-class patch too.

That’s the gap our 50mg CBD patch is built for. It’s a transdermal isolate patch: one patch, worn for 24 hours, instead of re-sticking every 8 to 12. It contains no NSAID, no salicylate and no menthol, so it adds nothing to an NSAID load you’re already carrying. It’s THC-free, so it’s safe for drug tests, and it’s waterproof enough to shower and swim in.

What it isn’t: esflurbiprofen. Nobody has run a head-to-head trial of a CBD patch against Locoa or Salonpas, and I won’t pretend one exists. It’s a different tool for pain that never really switches off, not a stronger version of the same drug. CBD also inhibits the liver enzyme CYP2C9. In Bansal et al. 2023 (PMID 37313955), a 640mg CBD extract raised exposure to a CYP2C9-cleared probe drug by 77% in 18 healthy adults. That dose is many times a single patch, but it’s why your prescriber should know you’re using it, and why I wouldn’t wear it alongside Locoa without asking.

How I navigate this

I take Prozac, lisinopril and metoprolol every day, alongside CBD. Prozac is on Locoa’s bleeding-risk list and hypertension is on its caution list. I was on prednisone for 23 years and on methotrexate earlier in my disease history, both on the same list. If someone handed me Locoa, my prescriber would see the whole list before the first patch went on. A strong NSAID in patch form still counts as a strong NSAID.

So I keep my everyday options outside the NSAID family. For one sore spot, the NANO roll-on is the localized option. For the 2800mg oil, the protocol is half a dropper a day for the first two weeks, then a full 1ml dropper from week three.

What this means if you’re choosing

Occasional muscle ache, no other medications: Salonpas. Cheap, OTC, a placebo-controlled trial behind it. Follow the 3-day limit.
Osteoarthritis pain a counter-irritant doesn’t touch, and NSAIDs are fine for you: a real topical NSAID. In the US that usually means diclofenac gel or a prescription diclofenac patch; our Flector patch alternatives page compares them.
You already have Locoa from a Japanese prescriber: keep to the label, no more than 2 at once, and show your US doctor the box.
You take methotrexate, steroids, an SSRI or SNRI, warfarin, or blood pressure medication, or you’re already on an oral NSAID: don’t stack another NSAID patch. That’s the case for a 24-hour CBD patch, with your prescriber in the loop.

The patch format makes Locoa feel gentler than a pill. The pharmacology says otherwise, so pick your patch by your medication list, not just its strength.