Japan’s green Vantelin Kowa boxes contain more than one patch. Start by distinguishing パップS (Pap S) from パットEX (Pat EX). The red パットEXホット box has a warming formula with additional timing and bathing precautions.
I’m Irene, a Taiwan-born, Japan-licensed pharmacist working in a Japanese drugstore. This guide focuses on three patch families, using size, feel and restrictions to narrow the choice without mixing in gels or support braces. Sources checked: 13 October 2026, Japanese-market products.
Compare the three at the shelf
| Name on the box | Form and feel | Indomethacin concentration | Dimensions |
|---|---|---|---|
| パップS (Pap S) | Water-containing poultice patch; cooling feel, stretches both ways | 0.5g per 100g patch base | 10×14cm |
| パットEX (Pat EX) | Thin water-containing patch; cooling formula | 1g per 100g patch base | 7×10, 10×14, 14×20cm |
| パットEXホット (Pat EX Hot) | Thin water-containing patch; warming formula | 1g per 100g patch base | 7×10, 10×14cm |
All three are Class 2 topical pain-relief/anti-inflammatory medicines for ages 15 and over. Despite its thin, close-fitting design, Pat EX is officially a thin water-containing patch, not a tape formulation. Double the concentration does not establish double the pain relief.
Pap S: a 10×14cm water-containing patch
Match バンテリンコーワパップS, available in 12- and 24-patch packs. Each 100g of patch base contains indomethacin 0.5g; l-menthol is among the additives. The box identifies the 14×10cm size, two-way stretch and cooling feel.
Consider this when its water-containing patch format and size suit your preference. A cooling sensation does not replace assessment or appropriate care for an injury.
Pat EX: choose the thin format, then the size
Match バンテリンコーワパットEX. Each 100g of patch base contains indomethacin 1g, arnica tincture 1mL (equivalent to arnica 0.2g) and l-menthol 1.2g. All three are active ingredients; this is a different formula from Pap S.
The regular patch measures 7×10cm, 大判 (large) 10×14cm and 超大判 (extra-large) 14×20cm. Choose a size for the painful area rather than comparing pack counts alone. A larger patch is not a reason to cover more unaffected skin.
Pat EX Hot: consider bathing plans before choosing warmth
The red box says バンテリンコーワパットEXホット. Each 100g of patch base contains indomethacin 1g, arnica tincture 1mL (equivalent to arnica 0.2g) and capsicum extract 0.4g (equivalent to capsicum 5g). Regular is 7×10cm and large is 10×14cm. Although l-menthol is an additive, this is the warming option.
For bruises or sprains, wait until heat and related symptoms at the affected area have subsided before using Hot. Sweating may increase irritation. Do not heat the covered area with a heated table, electric blanket or similar source. After handling the medicated surface, avoid touching the eyes, inside the nose, lips or other mucous membranes.
Remove Hot at least one hour before bathing, and wait about 30 minutes after bathing before applying it. These rules matter more than simply choosing a red box for winter.
Shared directions and restrictions
Labelled uses include shoulder pain associated with stiffness, lower-back pain, joint and muscle pain, tenosynovitis (hand/wrist pain), elbow pain such as tennis elbow, bruises and sprains. These medicines relieve symptoms such as pain and swelling; they do not treat every underlying cause. Use them only while symptoms are present.
Remove the plastic film and apply to the affected area no more than twice daily. This is the application frequency, not a statement that the limit is two patches per day or permission to cover the body. Wipe away sweat or water first and follow the box’s step-by-step film-removal diagram.
Pat EX application example: peel off the centre section of film, place that exposed section over the centre of the affected area, then peel the remaining film from one side at a time while smoothing the patch into place. The diagram below is for Pat EX. Pap S has a different film design; follow its own two-step diagram.
Do not use under 15, after previous allergy to the product/ingredients, or if you have ever had asthma. Do not apply around the eyes, on mucous membranes, eczema, contact dermatitis, wounds, ringworm/athlete’s foot or pus-producing areas. Consult before use if receiving medical treatment, pregnant or possibly pregnant, or with a history of allergy to medicines or other substances.
For sensitive skin, the maker advises testing a roughly 1–2cm square piece on the inner arm for at least half a day and checking for rash or itching before use. This does not guarantee that later reactions cannot occur.
Stop and consult with the box for rash, redness, itching, swelling, contact dermatitis, stinging, heat or dryness. Pap S also lists bleeding under the skin; Hot lists pain. Stop and consult if symptoms have not improved after five or six days. Do not use continuously for two weeks or longer; you do not need to wait two weeks to seek help.
Irene’s order of choice
Check age, asthma history, skin site and pregnancy-related precautions first, then the format and size. For Hot, include bathing and external-heat habits in the decision. Hotter, cooler or larger does not automatically mean more effective.
Keep unused patches in the original pouch, reseal the zipper firmly and store cool, dry, away from direct light and out of children’s reach. Do not transfer them to another container or use expired patches. Store stock varies, so match the full name and dimensions.
