Anti-inflammatory list. Characteristics of individual drugs. What is the advantage of the new generation of nvp

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) are a new generation of medicines that have anti-inflammatory, antipyretic and analgesic (analgesic) effects. Their mechanism of action is based on the blocking of certain enzymes (cyclooxygenase, COX), which are responsible for the formation of prostaglandins - chemicals that contribute to pain, fever, inflammation.

The word "non-steroidal", which is in the name of these drugs, indicates the fact that the drugs in this group are not artificial analogues of steroid hormones - the most powerful anti-inflammatory hormonal agents. The most popular representatives of NSAIDs are diclofenac, ibuprofen.

How NSAIDs work

If analgesics are designed to fight pain, then NSAIDs reduce two unpleasant symptoms of the disease: inflammation and pain. Many drugs in this group are considered non-selective inhibitors of the cyclooxygenase enzyme, which inhibit the effects of both of its isoforms (species) - COX-1 and COX-2.

Cyclooxygenase is responsible for the formation of thromboxane and prostaglandins from arachidonic acid, which, in turn, is obtained from cell membrane phospholipids using the enzyme phospholipase A2. Among other functions, prostaglandins are regulators and mediators in the formation of inflammation.

When are NSAIDs used?

Most commonly, NSAIDs are used for the treatment of chronic or acute inflammation that are accompanied by pain. Anti-inflammatory non-steroidal drugs have gained great popularity due to the effective treatment of joints.

We list the diseases for which these medicines are prescribed:

NSAIDs should not be used during erosive and ulcerative lesions of the gastrointestinal tract, especially at the stage of exacerbation, cytopenias, severe disorders of the kidneys and liver, pregnancy, individual intolerance. Must be administered with caution to patients with asthma, as well as to people who have previously had adverse reactions while taking any other NSAIDs.

Non-steroidal anti-inflammatory drugs: a list of NSAIDs for the treatment of joints

Consider the most effective and well-known NSAIDs that are used to treat joints and other diseases when required. antipyretic and anti-inflammatory effect:

Some medical drugs are weaker, not so aggressive, some are designed for acute arthrosis, if emergency intervention is needed in order to stop dangerous processes in the body.

The main advantage of NSAIDs of a new generation

Side effects are noted during prolonged use of NSAIDs (for example, during the treatment of osteochondrosis) and consist in damage to the intestinal mucosa and stomach with bleeding and ulceration. This disadvantage of non-selective NSAIDs was the reason for the creation of new generation drugs that block only COX-2 (an inflammatory enzyme) and do not affect the function of COX-1 (protection enzyme).

That is, new generation drugs have almost no side ulcerogenic effects (damage to the mucous membrane of the digestive system) associated with prolonged use of non-selective NSAIDs, but increase the chance of thrombotic complications.

Of the minuses of new generation drugs, only their high cost can be distinguished, which makes them inaccessible to most people.

What are new generation NSAIDs?

Anti-inflammatory non-steroidal drugs of the new generation act much more selectively, they are more inhibit COX-2, with COX-1 remaining almost unaffected. This can explain the rather high efficiency of the drug in combination with a minimum of side effects.

List of effective and popular anti-inflammatory nonsteroidal drugs new generation:

Ksefokam. A drug that is based on Lornoxicam. Its characteristic feature is the fact that the drug has an increased ability to relieve pain. According to this indicator, it is similar to morphine, but at the same time it does not create addiction and does not have an opiate-like effect on the central nervous system.
Movalis. It has antipyretic, well-pronounced anti-inflammatory and analgesic effect. The main advantage of this drug is that with the constant supervision of a doctor, it can be used for quite a long time. Meloxicam is made in the form of a solution for intramuscular injections, in ointments, suppositories and tablets. The tablets of the drug are quite convenient in that they have a lasting effect, and it is enough to use one tablet throughout the day.
Nimesulide. It has been successfully used to treat arthritis, vertebrogenic back pain, etc. Normalizes temperature, relieves hyperemia and inflammation. Taking the drug quickly leads to improved mobility and reduced pain. It is also used in the form of an ointment for application to the problem area.
Celecoxib. This drug significantly alleviates the patient's condition with arthrosis, osteochondrosis and other diseases, effectively fights inflammation and perfectly relieves pain. Side effects on the digestive system from the drug is minimal or completely absent.

In cases where long-term use of anti-inflammatory non-steroidal drugs is not needed, then older generation drugs are used. However, sometimes this is simply a necessary measure, since not all people can afford the course of treatment with these drugs.

Classification of NSAIDs

By chemical origin, these drugs come with non-acid and acid derivatives.

Acid preparations:

Non-acid drugs:

Sulfonamide derivatives;
Alcanones.

At the same time, nonsteroidal drugs differ in intensity and type of action - anti-inflammatory, analgesic, combined.

The strength of the anti-inflammatory effect medium doses, the drugs are arranged in the following sequence (top of the most powerful):

Flurbiprofen;
Piroxicam;
diclofenac sodium;
Naproxen;
Amidopyrine;

By analgesic effect drugs are listed in the following order:

The most commonly used NSAIDs listed above are in chronic and acute diseases accompanied by inflammation and pain. As a rule, anti-inflammatory nonsteroidal drugs are used to treat joints and relieve pain: injuries, arthrosis, arthritis, etc.

Often, NSAIDs are used for pain relief for migraines and headaches, renal colic, postoperative pain, dysmenorrhea, etc. Due to the inhibitory effect on the synthesis of prostaglandins, these drugs also have an antipyretic effect.

Choice of dosage

Any new drug for the patient should be prescribed at the beginning in the minimum dose. With normal tolerance after a few days increase the daily dose.

Therapeutic dosages of NSAIDs are in a wide range, while recently there has been a tendency to increase single and daily doses of drugs with excellent tolerance (ibuprofen, naproxen), while maintaining restrictions on the maximum dosage of indomethacin, aspirin, piroxicam, phenylbutazone. In some patients, the therapeutic effect is achieved only when using high doses of NSAIDs.

Side effects

Prolonged use of anti-inflammatory drugs in high doses can cause:

NSAIDs should be treated for minimum possible time and minimum doses.

Use in pregnancy

It is undesirable to use drugs of the NSAID group during pregnancy, especially in the third trimester. Although there are no direct teratogenic effects, it is believed that NSAIDs can cause renal complications in the fetus and premature closure of the ductus arteriosus. There is also information about premature birth. Despite this, aspirin in combination with heparin has been successfully used in women with antiphospholipid syndrome.

Description of non-steroidal anti-inflammatory drugs

Is the leader among non-steroidal anti-inflammatory drugs, which has a long time of action and is approved for long-term use.

It has a pronounced anti-inflammatory effect, which makes it possible to use it in rheumatoid arthritis, ankylosing spondylitis, osteoarthritis. Protects cartilaginous tissue, is not devoid of antipyretic and analgesic properties. Used for headache and toothache.

Determination of doses, administration options (suppositories, injections, tablets) depends on the type and severity of the disease.

COX-2 inhibitor, which has a pronounced analgesic and anti-inflammatory action. When used in therapeutic doses, it has almost no negative effect on the gastrointestinal mucosa, since it has a rather low degree of affinity for COX-1, and therefore does not cause a violation of the synthesis of constitutional prostaglandins.

It is one of the most effective non-hormonal drugs. In arthritis, it reduces swelling of the joints, relieves pain and has a strong anti-inflammatory effect. When using a medical product, you need to be careful, because it has a large list of side effects. In pharmacology, the drug is manufactured under the names Indovis EU, Indovazin, Indocollir, Indotard, Metindol.

It combines the ability to effectively reduce pain and temperature, relative safety, because medicines based on it can be bought without a prescription. Ibuprofen is used as an antipyretic drug, including and for newborns.

As an anti-inflammatory drug, it is not used so often, but the medicine is also very popular in rheumatology: it is used to treat osteoarthritis, rheumatoid arthritis and other joint diseases.

The most popular names include Nurofen, Ibuprom, MIG 400 and 200.

Form of production - capsules, tablets, gel, suppositories, injection solution. In this preparation for the treatment of joints, both a high anti-inflammatory effect and high analgesic activity are perfectly combined.

It is manufactured under the names Naklofen, Voltaren, Diklak, Ortofen, Vurdon, Diklonak P, Dolex, Olfen, Klodifen, Dicloberl, etc.

Chondroprotectors - alternative drugs

Very common for joint treatment use chondroprotectors. People often do not understand the difference between chondroprotectors and NSAIDs. The latter quickly remove pain, but at the same time have many side effects. And chondroprotectors protect cartilage tissue, but they must be used in courses. The composition of the most effective chondroprotectors are two substances - chondroitin and glucosamine.

Anti-inflammatory nonsteroidal drugs are excellent helpers during the treatment of many diseases. But we must not forget that they only remove the negatively affecting symptoms on well-being, the treatment of diseases directly is carried out by other methods and drugs.

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How do NSAIDs work?

If analgesics fight directly with pain, then NSAIDs reduce both the most unpleasant symptoms of the disease: both pain and inflammation. Most of the drugs in this group are non-selective inhibitors of the cyclooxygenase enzyme, inhibiting the action of both of its isoforms (varieties) - COX-1 and COX-2.

Cyclooxygenase is responsible for the production of prostaglandins and thromboxane from arachidonic acid, which in turn is obtained from cell membrane phospholipids through the enzyme phospholipase A2. Prostaglandins, among other functions, are mediators and regulators in the development of inflammation. This mechanism was discovered by John Wayne, who later received the Nobel Prize for his discovery.

When are these drugs prescribed?

Typically, NSAIDs are used to treat acute or chronic inflammation accompanied by pain. Non-steroidal anti-inflammatory drugs have gained particular popularity for the treatment of joints.

We list the diseases for which these drugs are prescribed:

acute gout;
dysmenorrhea (menstrual pain);
bone pain caused by metastases;
postoperative pain;
fever (increased body temperature);
intestinal obstruction;
renal colic;
moderate pain due to inflammation or soft tissue injury;
osteochondrosis;
lower back pain;
headache;
migraine;
arthrosis;
rheumatoid arthritis;
pain in Parkinson's disease.

NSAIDs are contraindicated in erosive and ulcerative lesions of the gastrointestinal tract, especially in the acute stage, severe violations of the liver and kidneys, cytopenias, individual intolerance, pregnancy. Should be administered with caution to patients with bronchial asthma, as well as to persons who have previously had adverse reactions when taking any other NSAIDs.

List of Common NSAIDs for Joint Treatment

We list the most well-known and effective NSAIDs that are used to treat joints and other diseases when an anti-inflammatory and antipyretic effect is needed:

Naproxen;
Nimesil;
Etodolac.
Meloxicam.

Some drugs are weaker, not so aggressive, others are designed for acute arthrosis, when urgent intervention is required to stop dangerous processes in the body.

What is the advantage of new generation NSAIDs

Adverse reactions are noted with long-term use of NSAIDs (for example, in the treatment of osteochondrosis) and consist in damage to the mucous membrane of the stomach and duodenum with the formation of ulcers and bleeding. This lack of non-selective NSAIDs has led to the development of new generation drugs that block only COX-2 (an inflammatory enzyme) and do not affect the work of COX-1 (protection enzyme).

Thus, new generation drugs are practically devoid of ulcerogenic side effects (damage to the mucous membrane of the digestive tract) associated with long-term use of non-selective NSAIDs, but increase the risk of thrombotic complications.

Of the shortcomings of new generation drugs, only their high price can be noted, which makes it inaccessible to many people.

New generation NSAIDs: list and prices

What it is? New generation non-steroidal anti-inflammatory drugs act much more selectively, they inhibit COX-2 to a greater extent, while COX-1 remains practically untouched. This explains the rather high efficiency of the drug, which is combined with a minimum number of side effects.

List of popular and effective non-steroidal anti-inflammatory drugs of the new generation:

Movalis. It has an antipyretic, well-marked analgesic and anti-inflammatory effect. The main advantage of this remedy is that, with regular medical supervision, it can be taken for a fairly long period of time. Meloxicam is available as a solution for intramuscular injection, in tablets, suppositories and ointments. Meloxicam (Movalis) tablets are very convenient in that they are long-acting, and it is enough to take one tablet during the day. Movalis, which contains 20 tablets of 15 mg, costs 650-850 rubles.
Ksefokam. A drug based on Lornoxicam. Its distinguishing feature is the fact that it has a high ability to relieve pain. According to this parameter, it corresponds to morphine, but it is not addictive and does not have an opiate-like effect on the central nervous system. Xefocam, which contains 30 tablets of 4 mg, costs 350-450 rubles.
Celecoxib. This drug greatly alleviates the patient's condition with osteochondrosis, arthrosis and other diseases, relieves pain well and effectively fights inflammation. Side effects on the digestive system from celecoxib are minimal or absent at all. Price 400-600 rubles.
Nimesulide. It has been used with great success in the treatment of vertebrogenic back pain, arthritis, etc. Removes inflammation, hyperemia, normalizes temperature. The use of nimesulide quickly leads to a reduction in pain and improved mobility. It is also used as an ointment for application to the problem area. Nimesulide, which contains 20 tablets of 100 mg, costs 120-160 rubles.

Therefore, in cases where long-term use of non-steroidal anti-inflammatory drugs is not required, old-generation drugs are used. However, in some cases this is simply a forced situation, since few can afford a course of treatment with such a drug.

How are NSAIDs classified and what are they? By chemical origin, these drugs come with acidic and non-acidic derivatives.

Acid NSAIDs:

Oxicams - piroxicam, meloxicam;
NSAIDs based on indoacetic acid - indomethacin, etodolac, sulindac;
Based on propionic acid - ketoprofen, ibuprofen;
Salicipates (based on salicylic acid) - aspirin, diflunisal;
Derivatives of phenylacetic acid - diclofenac, aceclofenac;
Pyrazolidines (pyrazolonic acid) - analgin, metamizole sodium, phenylbutazone.

Non-acid NSAIDs:

Alcanones;
Sulfonamide derivatives.

Also, non-steroidal drugs differ in type and intensity of exposure - analgesic, anti-inflammatory, combined.

Effectiveness of medium doses

According to the strength of the anti-inflammatory effect of medium doses, NSAIDs can be arranged in the following sequence (the strongest ones are at the top):

Flurbiprofen;
diclofenac sodium;
Piroxicam;
Naproxen;
Amidopyrine;

According to the analgesic effect of medium doses, NSAIDs can be arranged in the following sequence:

Ketorolac;
diclofenac sodium;
Flurbiprofen;
Amidopyrine;
Piroxicam;
Naproxen;

As a rule, the above medicines are used for acute and chronic diseases accompanied by pain and inflammation. Most often, non-steroidal anti-inflammatory drugs are prescribed to relieve pain and treat joints: arthritis, arthrosis, injuries, etc.

Not infrequently, NSAIDs are used for pain relief for headaches and migraines, dysmenorrhea, postoperative pain, renal colic, etc. Due to the inhibitory effect on the synthesis of prostaglandins, these drugs also have an antipyretic effect.

What dosage to choose?

Any new drug for this patient should be prescribed first at the lowest dose. With good tolerance after 2-3 days, the daily dose is increased.

Therapeutic doses of NSAIDs are in a wide range, and in recent years there has been a tendency to increase single and daily doses of drugs characterized by the best tolerance (naproxen, ibuprofen), while maintaining restrictions on the maximum doses of aspirin, indomethacin, phenylbutazone, piroxicam. In some patients, the therapeutic effect is achieved only when using very high doses of NSAIDs.

Long-term use of high doses of anti-inflammatory drugs can cause:

Violation of the nervous system - mood changes, disorientation, dizziness, apathy, tinnitus, headache, blurred vision;
Changes in the work of the heart and blood vessels - palpitations, increased blood pressure, swelling.
Gastritis, ulcer, perforation, gastrointestinal bleeding, dyspeptic disorders, changes in liver function with an increase in liver enzymes;
Allergic reactions - angioedema, erythema, urticaria, bullous dermatitis, bronchial asthma, anaphylactic shock;
Renal failure, impaired urination.

Treatment with NSAIDs should be carried out for the shortest possible time and at the lowest effective doses.

Use during pregnancy

It is not recommended to use drugs of the NSAID group during pregnancy, especially in the third trimester. Although no direct teratogenic effects have been identified, it is believed that NSAIDs can cause premature closure of the ductus arteriosus (Botalla) and renal complications in the fetus. There are also reports of premature births. Despite this, aspirin in combination with heparin has been successfully used in pregnant women with antiphospholipid syndrome.

According to the latest data from Canadian researchers, the use of NSAIDs before 20 weeks of gestation was associated with an increased risk of miscarriage (miscarriage). According to the results of the study, the risk of miscarriage increased by 2.4 times, regardless of the dose of the drug taken.

A specific COX-2 inhibitor with a pronounced anti-inflammatory and analgesic effect. When used in therapeutic doses, it practically does not have a negative effect on the mucosa of the gastrointestinal tract, since it has a very low degree of affinity for COX-1, therefore, it does not cause a violation of the synthesis of constitutional prostaglandins.

As a rule, celecoxib is taken at a dosage of 100-200 mg per day in 1-2 doses. The maximum daily dose is 400 mg.

Refers to the most effective means of non-hormonal action. In arthritis, indomethacin relieves pain, reduces swelling of the joints and has a strong anti-inflammatory effect.

The price of the drug, regardless of the form of release (tablets, ointments, gels, rectal suppositories) is quite low, the maximum cost of tablets is 50 rubles per pack. When using the drug, you must be careful, as it has a long list of side effects.

In pharmacology, indomethacin is produced under the names Indovazin, Indovis EU, Metindol, Indotard, Indocollir.

Ibuprofen combines relative safety and the ability to effectively reduce fever and pain, so preparations based on it are sold without a prescription. As an antipyretic, ibuprofen is also used for newborns. It has been proven to reduce fever better than other non-steroidal anti-inflammatory drugs.

In addition, ibuprofen is one of the most popular over-the-counter analgesics. As an anti-inflammatory agent, it is not prescribed so often, however, the drug is quite popular in rheumatology: it is used to treat rheumatoid arthritis, osteoarthritis and other joint diseases.

The most popular brand names for ibuprofen include Ibuprom, Nurofen, MIG 200 and MIG 400.

Perhaps one of the most popular NSAIDs, created back in the 60s. Release form - tablets, capsules, injection, suppositories, gel. In this remedy for the treatment of joints, both high analgesic activity and high anti-inflammatory properties are well combined.

Produced under the names Voltaren, Naklofen, Ortofen, Diklak, Diklonak P, Wurdon, Olfen, Dolex, Dicloberl, Klodifen and others.

In addition to the drugs listed above, the group of drugs of the first type, non-selective NSAIDs, i.e. COX-1, includes a drug such as ketoprofen. By the strength of its action, it is close to ibuprofen, and is available in the form of tablets, gel, aerosol, cream, solutions for external use and injection, rectal suppositories (suppositories).

You can buy this tool under the trade names Artrum, Febrofid, Ketonal, OKI, Artrozilen, Fastum, Bystrum, Flamax, Flexen and others.

Acetylsalicylic acid reduces the ability of blood cells to stick together and form blood clots. When taking Aspirin, the blood thins, and the vessels expand, which leads to relief of a person's condition with headaches and intracranial pressure. The action of the drug reduces the energy supply in the focus of inflammation and leads to the attenuation of this process.4

Aspirin is contraindicated for children under 15 years of age, since a complication is possible in the form of an extremely severe Reye's syndrome, in which 80% of patients die. The remaining 20% of surviving babies may be susceptible to epilepsy and mental retardation.

Alternative drugs: chondroprotectors

Quite often, chondroprotectors are prescribed for the treatment of joints. People often do not understand the difference between NSAIDs and chondroprotectors. NSAIDs quickly relieve pain, but at the same time have a lot of side effects. And chondroprotectors protect cartilage tissue, but they need to be taken in courses.

The composition of the most effective chondroprotectors includes 2 substances - glucosamine and chondroitin.

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The era of such drugs began quite a long time ago - since 1829, when salicylic acid was first discovered. Since then, new substances and dosage forms have begun to appear that can eliminate inflammation and pain.

With the creation of Aspirin, NSAIDs were separated into a separate group of non-steroidal anti-inflammatory drugs. Their name was determined by the fact that they do not contain hormones (steroids) in their composition, and have fewer pronounced side effects than steroid ones.

Despite the fact that in our country most NSAIDs can be bought in pharmacies without a prescription, there are some points that you need to know about. Especially for those people who are thinking about what is better to choose - drugs offered for years, or modern NSAIDs.

The principle of action of NSAIDs is the effect on the enzyme cyclooxygenase (COX), namely on its two varieties:

COX-1 is a protective enzyme of the gastric mucosa, protecting it from acidic contents.
COX-2 is an inducible, that is, synthesized enzyme that is produced in response to inflammation, or damage. Thanks to him, the inflammatory process is played out in the body.

Since non-steroids of the first generation are non-selective, that is, they act on both COX-1 and COX-2, along with the anti-inflammatory effect, they also have strong side effects. It is essential to take these tablets after meals, as they are irritating to the stomach and can lead to erosions and ulcers. If you already have gastric ulcers, you need to take them with proton pump inhibitors (Omeprazole, Nexium, Controloc, etc.), which protect the stomach.

Time does not stand still, non-steroids are developing, and are becoming more selective for COX-2. Now at the moment there are drugs that selectively affect the COX-2 enzyme, on which inflammation depends, without affecting COX-1, that is, without damaging the gastric mucosa.

About a quarter of a century ago, there were only eight groups of NSAIDs, but today there are more than fifteen. Having gained wide popularity, non-steroidal pills quickly replaced the opioid analgesic groups of analgesics.

Today, there are two generations of non-steroidal anti-inflammatory drugs. The first generation - NSAID drugs, mostly non-selective.

These include:

Citramon;
Naproxen;
Voltaren;
Nurofen;
Butadion and many others.

New generation non-steroidal anti-inflammatory drugs are safer in terms of side effects, and they have a greater ability to relieve pain.

These are such selective non-steroids as:

Nimesil;
Nise;
Celebrex;
Indomethaxin.

This is not a complete list and not the only classification of new generation NSAIDs. There is their division into non-acid and acid derivatives.

Among the latest generation of NSAIDs, the most innovative drugs are oxicams. These are non-steroidal anti-inflammatory drugs of a new generation of acid drugs that affect the body much longer and brighter than others.

This includes:

Lornoxicam;
Piroxicam;
Meloxicam;
Tenoxicam.

The acid group of drugs also includes the following series of non-steroids:

ACID - BASE	REPARATES - REPRESENTATIVES
Salicylic acid - salicylates	Aspirin, Lysine monoacetylsalicylate, Diflunisal.
Phenylacetic acid	Etodolac, Aceclofenac, Tolmetin, Sulindac, Indomethacin.
propionic acid	Ibuprofen, Ketoprofen, Fenbufen, Thiaprofenic acid, Benoxaprofen, Pyrfropen, Ibuprofen, Flurbiprofen, Nabumeton.
Anthranilic acid	Mefenaminate
Isonicotinic acid	Amizon
Pyrosolidines	Oxyphenbutazone, Phenylbutazone, Azapropazone.
Pyrosolones	Analgin

Non-acidic, that is, drugs that do not affect the gastric mucosa, include NSAIDs of a new generation of the sulfonamide group. Representatives of this group are Nimesulide, Rofecoxib, Celecoxib.

A new generation of NSAIDs has gained wide use and popularity due to its ability not only to relieve pain, but also to have an excellent antipyretic effect. The drugs stop the inflammatory process, prevent the development of the disease, so they are prescribed for:

Diseases of the musculoskeletal tissue. Non-steroids are used to treat injuries, wounds, bruises. They are indispensable for arthrosis, arthritis and other rheumatic diseases. Also, with hernias of the intervertebral discs and myositis, the agents have an anti-inflammatory effect.
Severe pain syndromes. They are successfully used in the postoperative period, with biliary and renal colic. Tablets have a positive effect on headaches, gynecological pain, successfully relieve pain in migraines.
The risk of blood clots. Since non-steroids are antiplatelet, that is, blood thinners, they are prescribed for ischemia, and for the prevention of strokes and heart attacks.
high temperature. These pills and injections are the first antipyretic for adults and children. They are recommended to be used even in febrile conditions.

Means are also used for gout and intestinal obstruction. In case of bronchial asthma, it is not recommended to use NVPP on its own, a preliminary consultation with a doctor is necessary.

Unlike non-selective anti-inflammatory drugs, new generation NSAIDs do not irritate the gastrointestinal system of the body. Their use in the presence of gastric and duodenal ulcers does not lead to exacerbation and bleeding.

However, their long-term use can cause a number of undesirable effects, such as:

increased fatigue;
dizziness;
dyspnea;
drowsiness;
destabilization of blood pressure.
the appearance of protein in the urine;
indigestion;

Also, with prolonged use, allergic manifestations are possible, even if susceptibility to any substances was not previously observed.

Non-selective non-steroids such as Ibuprofen, Paracetamol or Diclofenac have greater hepatotoxicity. They have a very strong effect on the liver, especially Paracetamol.

A few years ago, a scandal broke out abroad about the influence of modern non-steroids - coxibs on the cardiovascular system. But our scientists did not share the concerns of foreign colleagues. The Russian Association of Rheumatologists acted as an opponent to Western cardiologists and proved that the risk of cardiac complications while taking new generation NSAIDs is minimal.

It is absolutely impossible to use most anti-inflammatory non-steroids during pregnancy, especially in the third trimester. Some of them may be prescribed by a doctor in the first half of pregnancy with special indications.

By analogy with antibiotics, NSAIDs of the new generation should not be taken in too short courses (drank 2-3 days and stopped). This will be harmful, because in the case of antibiotics, the temperature will go away, but the pathological flora will acquire resistance (resistance). The same is with non-steroids - they must be taken for at least 5-7 days, since the pain may go away, but this does not mean that the person has recovered. The anti-inflammatory effect occurs a little later than the anesthetic and proceeds more slowly.

In no case do not combine non-steroids from different groups. If you take one pill in the morning for pain, and then another, their beneficial effect is not summed up, and does not increase. And the side effects are increasing exponentially. It is especially impossible to combine cardiac Aspirin (Aspirin-Cardio, Cardiomagnyl) and other NSAIDs. In this situation, there is a danger of a heart attack, as the action of aspirin, which thins the blood, is blocked.
If a joint hurts, it is better to start with ointments, for example, based on ibuprofen. They need to be applied 3-4 times a day, especially at night, and rubbed intensively into the sore spot. You can do self-massage of a sore spot with ointment.

The main condition is peace. If you continue to actively work or play sports during the treatment, then the effect of the use of drugs will be very small.

The best drugs

Arriving at the pharmacy, each person thinks about which non-steroidal anti-inflammatory drugs to choose, especially if he came without a doctor's prescription. The choice is huge - non-steroids are available in ampoules, tablets, capsules, in the form of ointments and gels.

Tablets - derivatives of acids have the greatest anti-inflammatory effect.

A good analgesic effect in diseases of the musculoskeletal tissue is possessed by:

Voltaren or Diclofenac;
Xefocam or Lornoxicam.

But the most powerful drugs against pain and inflammation are the newest selective NSAIDs - coxibs, which have the fewest side effects. The best non-steroidal anti-inflammatory drugs in this series are Arcoxia, Nise, Movalis, Celecoxib, Xefokam, Etoricoxib.

Xefocam

The analogue of the remedy is Lornoxicam, Rapid. The active substance is xefocam. An effective drug with a pronounced anti-inflammatory effect. Does not affect heart rate, blood pressure and respiratory rate.

Available in the form:

tablets;
injections.

For elderly patients, a special dosage is not required in the absence of renal insufficiency. In case of kidney disease, the dose must be reduced, since the substance is excreted by these organs.

With excessive duration of treatment, manifestations in the form of conjunctivitis, rhinitis and shortness of breath are possible. In asthma, it is used with caution, since an allergic reaction in the form of bronchospasm is possible. With the introduction of an injection intramuscularly, soreness and hyperemia at the injection site are possible.

Arcoxia, or its only analogue, Exinev, is a drug used in acute gouty arthritis, rheumatoid-type osteoarthritis, and in the treatment of postoperative conditions associated with pain. Available in the form of tablets for oral administration.

The active substance of this drug is etoricoxib, which is the most modern and safe substance among selective COX-2 inhibitors. The tool perfectly relieves pain, and begins to act on the focus of pain after 20-25 minutes. The active substance of the drug is absorbed from the bloodstream and has a high bioavailability (100%). It is excreted in the urine unchanged.

Most specialists in sports traumatology distinguish such a non-steroid as Nise or its analogues Nimesil or Nimulide. There are many names, but they have one active substance - nimesulide. This medicine is quite cheap, and occupies one of the first places in sales.

This is a good pain reliever, but Nimesulide-based products cannot be used in children under 12 years of age, as there is a high probability of allergic reactions.

Available as:

powders;
suspensions;
gels;
tablets.

It is used in the treatment of arthritis, arthrosis, ankylosing spondylitis, sinusitis, lumbago, and pains of various localization.

Movalis is much more selective for COX-2 than Nise, and therefore has even fewer side effects in relation to the stomach.

Release form:

candles;
tablets;
injections.

With prolonged use, the risk of developing cardiac thrombosis, heart attacks, angina pectoris is increased. Therefore, people with a predisposition to these diseases need to be careful in their use. It is also not recommended for women planning a pregnancy, as it affects fertility. It is excreted in the form of metabolites, mainly with urine and feces.

In the group with the most proven base in terms of safety - NSAIDs of the new generation Celecoxib. It was the first drug from the group of selective coxibs, combining the three strengths of this class - the ability to reduce pain, inflammation, and fairly high safety. Release form - capsules of 100 and 200 mg.

The active ingredient celecoxib selectively acts on COX-2 without affecting the gastric mucosa. Rapidly absorbed into the blood, the substance reaches its highest concentration after 3 hours, but simultaneous intake with fatty foods can slow down the absorption of the drug.

Celecoxib is prescribed for soriatic and rheumatoid arthritis, osteoarthritis and ankylosing spondylitis. This remedy is not prescribed for liver and kidney failure.

Rofecoxib

The main substance rofecoxib effectively helps to restore the motor function of the joints, quickly relieving inflammation.

Available as:

injection solutions;
tablets;
candles;
gel.

The substance is a highly selective inhibitor of cyclooxygenase 2, after administration it is rapidly absorbed by the gastrointestinal tract. The substance reaches its maximum concentration in the blood after 2 hours. It is excreted mainly in the form of inactive metabolites by the kidneys and intestines.

The result of long-term use may be disorders of the nervous system - sleep disturbance, dizziness, confusion. Treatment is recommended to start with injections, then switch to tablets and external agents.

When choosing any NVPS, one should be guided not only by the price and their modernity, but also take into account the fact that all such drugs have their own contraindications. Therefore, you should not self-medicate, it is best if they are prescribed by a doctor, taking into account age and a history of diseases. It should be remembered that the thoughtless use of drugs may not only not bring relief, but also force a person to treat many complications.

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How do non-steroidal anti-inflammatory drugs work?

Inflammation, in most cases, is accompanied by pain, swelling, redness of tissues, convulsions, fever. Prostaglandins are directly involved in the progression of these processes. The production of prostaglandin depends on cyclooxygenase enzymes, which are affected by NVPS. Cyclooxygenase (COX) has two active isoforms with their own specific functions:

COX-1, in addition to being responsible for the formation of prostaglandins, protects the gastric mucosa and affects the viability of platelets. Drugs that have non-selective actions and inhibit COX-1 provoke a sufficient number of side effects.
COX-2 is a specific enzyme that is actually absent in the norm, synthesized under the influence of other mediators. The selective potency of new generation drugs is based on the blocking of this particular enzyme, which does not reduce their effectiveness and has a positive effect on their competitiveness.

Important! Modern NVPS, providing the strongest pain relief, do not cause addiction and dependence.

New developments in non-steroidal anti-inflammatory drugs

Unlike glucocorticoids, non-steroidal anti-inflammatory drugs do not contain hormones, do not cause the development of serious anomalies in the form of diabetes mellitus, hypertension. But blocking COX-1 leads not only to a decrease in pain, inflammation, but also adversely affects the condition of the gastric mucosa, often causing ulcers. Preparations in a special shell, which does not allow to be destroyed in the stomach, could not withstand the competitiveness due to the detrimental effect on the intestines.

New generation drugs are selective. Without practically affecting COX-1, they successfully influence the production of COX-2, inhibit the production of prostaglandins. New generation drugs have not lost their effectiveness, the impact on the gastric mucosa, blood clotting, platelet vital activity is minimized.

The anti-inflammatory effect is due to a decrease in the production of inflammatory mediators, a decrease in the permeability of the walls of blood vessels.
Blocking inflammatory factors significantly reduces irritation of nerve receptors, and has a positive effect on reducing pain.
The impact on the thermoregulatory centers allows you to have an antipyretic effect.

When to take NSAIDs

The effectiveness of drugs is observed in the treatment of diseases accompanied by inflammation, pain, fever and swelling. Quite often they are prescribed by doctors, used by patients on their own. We can talk about the competitiveness of non-steroidal anti-inflammatory drugs in the following cases:

With exacerbation of diseases of the musculoskeletal system: various arthritis, arthrosis, osteochondrosis, spinal hernia. With injuries, bruises, sprains.
With severe pain during renal, hepatic colic, headaches and gynecological pains, in the postoperative period.
To lower the temperature of various origins.
Some drugs for the prevention of heart attacks, strokes, in the treatment of neurological diseases.

Carefully! Each drug has a directed action. Self-prescribing medications can have unpredictable consequences.

Who should refrain from taking NSAIDs

Even the latest developments have not completely protected the funds from unwanted actions. To avoid negative consequences, it is better to refrain from taking them in the following cases:

having problems with the heart or blood vessels;
with ailments of the duodenum, stomach;
in case of serious pathologies of the kidneys;
with high blood pressure, problems with blood clotting.

Attention! Pregnant, lactating women are strictly prohibited from taking non-steroidal anti-inflammatory drugs.

Classification of drugs NSAIDs

Pharmacological research in the field of developing new drugs with greater efficiency, high competitiveness due to reduced side effects, continues. There are up to 15 subgroups of drugs in this group on the market.

The classification of NSAIDs divides medicines into two main subgroups:

The first generation, the list consists of Aspirin, Naproxen, Ibuprofen, Voltaren, Nurofen, Diclofenac, Diclak, Movimed, Metindol, Butadion.
A new generation of medicinal medicines, among which are Movalis, Nise, Nimesil, Arcoxia, Celebrex.

There is another classification of NSAIDs. The chemical composition of new generation drugs classifies them as acids and non-acid derivatives:

Salicylates. This group includes Diflunisal, Aspirin.
Means of phenylacetic acid. Names of drugs in this category of NSAIDs: Diclofenac, Indomethacin, Tolmetin, Sulindac, Etodolac, Aceclofenac.
Pyrazolidins. List of drugs: Phenylbutazone, Oxyphenbutazone, Azapropazone.
Anthranilic acid agents. The main representative of this group of drugs is Mefenaminate.
Derivatives of propionic acid. This category contains a wide range of NSAIDs, the list includes Ibuprofen, Ketoprofen, Nabumeton, Pirprofen, Benoxaprofen, Flurbiprofen, Fenbufen, Fenoprofen, Naproxen, Thiaprofenic acid.
Isonicotinic acid preparations. Chief Representative of Amazon.
Pyrazolone derivatives. This category includes the well-known drug Analgin.
Oxycams. The most effective non-steroidal anti-inflammatory drugs. List of medicines: Meloxicam, Piroxicam, Tenoxicam, Lornoxicam. The impact of these drugs has a longer period and differs in strength of action. Despite the significant cost, we can talk about their competitiveness.
Names of non-acid drugs: Rofecoxib, Nimesulide, Celecoxib.

Attention! Which drugs are better to use can only be determined by the attending physician. The effectiveness of treatment depends on many individual factors.

The choice of drugs of various orientations

Comparative characteristics of non-steroidal anti-inflammatory drugs highlight the best in strength actions in various directions:

A pronounced anti-inflammatory effect is observed in Diclofenac, Indomethacin, Flurbiprofen, Piroxicam.
The high competitiveness in the field of pain relief is indicated by the frequent appointments of Ketorolac, Ketoprofen, Indomethacin, Diclofenac.
Efficiency for lowering the temperature can be traced in Aspirin, Nurofen, Nise.

Advice! Trade names of medicines may differ significantly from international names. When purchasing drugs, pay attention to the active ingredients in the composition.

New generation drugs

The latest generation drugs are highly effective in terms of strength of action, the definition of competitiveness is confirmed by the complications minimized.

Carefully! The most harmless drug can be dangerous for your personal health. Do not start taking funds without reading the instructions, contraindications.

The leader among non-steroidal anti-inflammatory drugs can be called Movalis, which has an extended period of action and is approved for long-term use.

It has a pronounced anti-inflammatory effect, which allows it to be taken in osteoarthritis, ankylosing spondylitis, rheumatoid arthritis. It is not devoid of analgesic, antipyretic properties, protects cartilage tissue. It is used for toothache, headache.

Determination of dosage, method of administration (tablets, injections, suppositories) depends on the severity, type of disease.

In terms of analgesic power of action, it surpasses many analogues, the effect is achieved after 20 minutes. These properties are used to relieve paroxysmal pain. It relieves inflammation, has an antioxidant effect, positively affecting collagen fibers and cartilage tissues.

It is prescribed for traumatic, arthritic, toothaches, nerve infringement. The drug is well tolerated by patients, rarely causes dizziness, drowsiness, headache, nausea, heartburn, urticaria.

Belongs to the group of oxycams, has an extended period of excretion from the body. The action of the drug lasts up to 12 hours, and in its power to relieve pain has a comparison with morphine. It is not addictive, does not affect the nervous system. The determination of the frequency of reception is based on the prolonged action of the agent.

Rofecoxib

Relieve pain, inflammation, swelling. Assign for chronic polyarthritis, bursitis, rheumatoid arthritis, various injuries. Eliminates pain in neuralgia, osteochondrosis, radicular syndromes, toothache. It is not recommended for use by people who have had a heart attack, children under 12 years of age, pregnant women who have problems with the heart and kidneys.

Non-steroidal anti-inflammatory drugs remain indispensable assistants in the treatment of many ailments. But it is worth remembering that they only remove symptoms that negatively affect well-being, the treatment of the disease is carried out with other drugs and methods.

Anti-inflammatory drugs are drugs that reduce inflammation. There are anti-inflammatory agents of etiotropic and pathogenetic action. The first - antibiotics (see), (see) and other chemotherapeutic agents - cause an anti-inflammatory effect during inflammation of an infectious nature, affecting microorganisms. The latter suppress the inflammatory response by influencing its physiological mechanisms. The pathogenetically active anti-inflammatory drugs include glucocorticoids - cortisone (see), (see) (see), dexamethasone (see), sinalar, etc. In ophthalmic and skin practice, they use local, and with rheumatoid arthritis and other collagenoses - resorptive anti-inflammatory action of these drugs. Due to the fact that adrenocorticotropic hormone (see) of the anterior pituitary gland causes the release of glucocorticoids from the adrenal cortex, it is also referred to as anti-inflammatory drugs. In the treatment of rheumatism, neuritis, myositis, salicylic acid derivatives are widely used as anti-inflammatory drugs - acetylsalicylic acid (see), etc.; pyrazolone - (see), butadiene (see), etc. In recent years, it has been used as anti-inflammatory drugs for rheumatoid arthritis, systemic lupus erythematosus and other collagenoses (see). Anti-inflammatory drugs also include ionized calcium preparations (see), since calcium nones seal the capillary walls. When applied topically, the anti-inflammatory effect is caused by adrenaline (see), (see), etc. They are used in the treatment of inflammatory diseases of the nose and its paranasal sinuses, as well as conjunctivitis. The anti-inflammatory effect is achieved by exposure to inflamed tissues with astringents (see) and enveloping agents (see). These substances protect sensitive nerve endings from irritation and thereby eliminate the reflexes that support the inflammatory process.

Anti-inflammatory drugs (Antiphlogistica) - medicinal substances that limit the intensity of the inflammatory reaction. There are anti-inflammatory agents of etiotropic and pathogenetic action. Etiotropically acting anti-inflammatory drugs include antimicrobial substances (antibiotics, sulfanilamide drugs and other chemotherapeutic agents), which cause an anti-inflammatory effect in inflammatory processes of an infectious nature; anti-inflammatory agents with pathogenetic action are called substances that suppress the inflammatory response due to the impact on the physiological mechanisms of its formation.

Pathogenetically active anti-inflammatory drugs include hormonal preparations of the adrenal cortex with a predominant effect on the processes of carbohydrate and protein metabolism, i.e., the so-called glycocorticoids (see Cortisone, Prednisolone). Glycocorticoids suppress the exudative and proliferative components of the inflammatory response and enhance its necrotic component. The anti-inflammatory effect of glycocorticoids is explained by the fact that they reduce the permeability of blood vessels in the focus of inflammation and weaken the response of connective tissue to the effects of inflammation-causing agents. These effects of glycocorticoids appear to be the result of the changes they cause in tissue metabolism. Glycocorticoids cause an anti-inflammatory effect both with resorptive and local action. Their resorptive anti-inflammatory action is most widely used in the treatment of rheumatism, rheumatoid arthritis and other collagen diseases. The local anti-inflammatory effect of glycocorticoids is used in ophthalmic and dermatological practice, and sometimes in the treatment of rheumatoid arthritis (hydrocortisone injections into the joint cavity). Since glycocorticoids weaken the immune response, which can contribute to the spread of infection, then when they are used in conditions of inflammation of an infectious nature, antibiotics (see) with a wide spectrum of action should be simultaneously introduced into the body. Glucocorticoid preparations for external use, produced by the industry in the form of ointments, as a rule, contain tetracycline antibiotics. The adrenocorticotropic hormone (see) of the anterior pituitary gland also has an anti-inflammatory effect, since it causes the release of glycocorticoids from the adrenal cortex.

Widely used anti-inflammatory agents of pathogenetic action are derivatives of salicylic acid (see) and pyrazolone (see Antipyrine, Amidopyrine, Analgin, Butadion), which are also used as painkillers and antipyretics. The anti-inflammatory effect of sodium salicylate, acetylsalicylic acid (see), butadione and amidopyrine is most often used in the treatment of rheumatism, neuritis, myositis, phlebitis. The mechanism of the anti-inflammatory action of these substances has not been elucidated. It has been suggested that as a result of their action on the central nervous system, the release of ACTH from the anterior pituitary gland increases, which in turn leads to an increase in the secretion of glycocorticoids by the adrenal cortex. It was also noted that these substances inhibit the inactivation of glycocorticoids in the liver, in connection with which the concentration of the latter in the blood increases. However, according to the nature of the effect on metabolism, salicylates and pyrazolone derivatives differ significantly from glycocorticoids, and therefore the mediation of the action of salicylates and pyrazolone derivatives through the pituitary-adrenal cortex system is called into question. The anti-inflammatory effect of salicylates and pyrazolone derivatives is also explained by their inhibitory effect on the activity of hyaluronidase (see), as a result of which the permeability of tissue membranes decreases. However, the anti-inflammatory effect of these substances is manifested at such concentrations in the blood that do not significantly affect the activity of hyaluronidase.

Recently, great importance in the formation of the inflammatory response is given to bradykinin, a polypeptide that is formed from blood serum globulins as a result of some enzymatic reactions activated by inflammation-causing agents. Experiments have shown that bradykinin dilates blood vessels, increases capillary permeability, leads to the migration of leukocytes and, irritating sensitive nerve endings, causes a feeling of pain. Thus, the formation of an inflammatory reaction is possibly carried out through the mediation of bradykinin. There is evidence that salicylates and pyrazolone derivatives interfere with the action of bradykinin, and also inhibit its formation.

Zinhofen also has anti-inflammatory, analgesic and antipyretic properties (see), which is used in the treatment of gout, since it also increases the excretion of uric acid in the urine.

As anti-inflammatory drugs in recent years, the antimalarial drug hingamin (see), or chloroquine has been used. It is used in the treatment of rheumatoid arthritis, systemic lupus erythematosus and other collagenoses. The mechanism of anti-inflammatory action of chingamine is unknown.

Anti-inflammatory drugs have long been also ionized calcium preparations (see). The anti-inflammatory effect of calcium ions is explained by their sealing effect on tissue membranes, in particular on the walls of capillaries.

With local action, the anti-inflammatory effect is exerted by substances that constrict blood vessels. Of these substances, adrenaline (see), ephedrine (see) and other sympathomimetic drugs (see) are of the greatest importance. They are used in the treatment of inflammatory diseases of the nose and paranasal sinuses, as well as in the treatment of conjunctivitis. The anti-inflammatory effect is also achieved by exposure to inflamed tissues with substances that protect sensitive nerve endings from irritating effects. This eliminates the reflexes that support the inflammatory process. Anti-inflammatory agents of this type of action include astringents (see), as well as enveloping agents (see) and adsorbing agents.

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Inflammatory reactions- these are universal protective and adaptive reactions to the impact of various exogenous and endogenous damaging factors (microorganisms, chemical agents, physical effects, etc.), which play an important role in the pathogenesis of most diseases of the maxillofacial region (periodontitis, alveolitis, periostitis, osteomyelitis, acute herpetic gingivostomatitis, etc.). This process is initiated and maintained by endogenous biologically active substances (prostaglandins, thromboxane, prostacyclin, leukotrienes, histamine, interleukins (IL), NO, kinins), which are produced in the focus of inflammation.

Despite the fact that inflammation is a protective reaction, the excessive severity of this process can disrupt the functions of organs and tissues, which requires appropriate treatment. The specificity of the pharmacological regulation of this process depends on the characteristics of the etiology, pathogenesis and severity of individual phases of inflammation in a given patient, the presence of concomitant pathology.

In dental practice, anti-inflammatory drugs of local and resorptive action are used (astringents, enzymes, vitamins, steroids and NSAIDs, dimexide, calcium salts, heparin ointment, etc.), which differ significantly in the mechanism of action, chemical structure, physicochemical properties, pharmacokinetics. , pharmacodynamics, as well as the effect on certain phases of inflammatory reactions. Despite the presence in the arsenal of a dentist of a large number of drugs of various directions of action, the main drugs used to obtain anti-inflammatory and analgesic effects are NSAIDs, the effect of which is manifested not only with a resorptive action, but also with topical application.

The use of enzymes in medicine (enzyme therapy) is based on their selective effect on certain tissues. Enzyme preparations cause hydrolysis of proteins, polynucleotides and mucopolysaccharides, resulting in liquefaction of pus, mucus and other products of inflammatory origin. In dental practice, proteases, nucleases and lyases are most commonly used.

Non-steroidal anti-inflammatory drugs and non-narcotic analgesics

Index of drug descriptions

Acetylsalicylic acid
Benzydamine
Diclofenac
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac
Lornoxicam
Meloxicam
Metamizole sodium
Nimesulide
Paracetamol
Piroxicam
Phenylbutazone
Celecoxib
INN is missing

Holisal

The widespread use of NSAIDs in dentistry is due to the spectrum of their pharmacological activity, which includes anti-inflammatory, analgesic, antipyretic, and antiplatelet effects. This allows the use of NSAIDs in the complex therapy of inflammatory processes in the maxillofacial area, for drug preparation of patients before performing traumatic interventions, as well as to reduce pain, swelling and inflammation after they are performed. The analgesic and anti-inflammatory activity of NSAIDs has been proven in numerous controlled trials that meet the standards of "evidence-based medicine".

The range of NSAIDs currently used in medical practice is extremely wide: from traditional groups of salicylic acid derivatives (acetylsalicylic acid (aspirin) and pyrazolone (phenylbutazone (butadione)) to modern drugs derived from a number of organic acids: anthranilic acid - mefenamic acid and flufenamic acid; indolacetic - indomethacin (methindol), phenylacetic - diclofenac (ortofen, voltaren, etc.), phenylpropionic - ibuprofen (brufen), propionic - ketoprofen (artrosilene, OKI, ketonal), naproxen (naprosin), heteroaryl acetic - ketorolac (ketalgin, ketanov, ketorol) and oxicam derivatives (piroxicam (pyroxifer, hotemin), lornoxicam (xefocam), meloxicam (movalis).

NSAIDs have the same type of effects, but their severity in drugs of different groups varies significantly. So, paracetamol has a central analgesic and antipyretic effect, and its anti-inflammatory effect is not pronounced. In recent years, drugs with powerful analgesic potential have appeared, comparable in activity to tramadol (tramal), such as ketorolac, ketoprofen and lornoxicam. Their high efficiency in severe pain syndrome of various localization allows wider use of NSAIDs in the preoperative preparation of patients.

NSAIDs have also been created for topical use (based on ketoprofen, choline salicylate and phenylbutazone). Since the anti-inflammatory effect is associated with the blockade of cyclooxygenase (COX) COX-2, and many side effects are associated with the blockade of COX-1, NSAIDs have been created that predominantly block COX-2 (meloxicam, nimesulide, celecoxib, etc.), which are better tolerated, especially risk group patients with a history of peptic ulcer of the stomach and duodenum, bronchial asthma, kidney damage, blood clotting disorders.

Mechanism of action and pharmacological effects

NSAIDs inhibit COX, a key enzyme in the metabolism of arachidonic acid, which regulates its conversion to prostaglandins (PG), prostacyclin (PGI2) and thromboxane TxA2. PGs are involved in the processes of pain, inflammation and fever. By inhibiting their synthesis, NSAIDs reduce the sensitivity of pain receptors to bradykinin, reduce tissue swelling in the focus of inflammation, thereby weakening the mechanical pressure on nociceptors.

In recent years, it has been shown that the prevention of activation of immunocompetent cells in the early stages of inflammation is important in the anti-inflammatory effect of these drugs. NSAIDs increase the content of intracellular Ca2+ in T-lymphocytes, which contributes to their proliferation, the synthesis of interleukin-2 (IL-2) and the suppression of neutrophil activation. A relationship was established between the severity of the inflammatory process in the tissues of the maxillofacial region and changes in the content of arachidonic acid, PG, especially PGE2 and PGF2a, lipid peroxidation products, IL-1β and cyclic nucleotides. The use of NSAIDs under these conditions reduces the severity of hyperergic inflammation, swelling, pain, and the degree of tissue destruction. NSAIDs act primarily on two phases of inflammation: the exudation phase and the proliferation phase.

The analgesic effect of NSAIDs is especially pronounced in inflammatory pain, which is due to a decrease in exudation, prevention of the development of hyperalgesia, and a decrease in the sensitivity of pain receptors to pain mediators. Analgesic activity is higher in NSAIDs, solutions of which have a neutral pH. They accumulate less in the focus of inflammation, penetrate the BBB faster, affect the thalamic centers of pain sensitivity, suppressing COX in the central nervous system. NSAIDs reduce the level of PG in the brain structures involved in the conduction of pain impulses, but do not affect the mental component of pain and its assessment.

The antipyretic effect of NSAIDs is mainly associated with an increase in heat transfer and manifests itself only at elevated temperatures. This is due to inhibition of PGE1 synthesis in the CNS and inhibition of their activating effect on the thermoregulatory center located in the hypothalamus.

The inhibition of platelet aggregation is due to the blockade of COX and inhibition of the synthesis of thromboxane A2. With prolonged use of NSAIDs, a desensitizing effect develops, which is due to a decrease in the formation of PGE2 in the focus of inflammation and leukocytes, inhibition of blast transformation of lymphocytes, a decrease in the chemotactic activity of monocytes, T-lymphocytes, eosinophils, and polymorphonuclear neutrophils. PGs are involved not only in the implementation of inflammatory reactions. They are necessary for the normal course of physiological processes, perform a gastroprotective function, regulate renal blood flow, glomerular filtration, and platelet aggregation.

There are two isoforms of COX. COX-1 is an enzyme that is constantly present in most cells and is necessary for the formation of PG involved in the regulation of homeostasis and affecting trophism and functional activity of cells, and COX-2 is an enzyme that is normally found only in some organs (brain, kidneys, bones, female reproductive system). The process of inflammation induces the production of COX-2. The blockade of COX-2 determines the presence of anti-inflammatory activity in drugs, and most of the side effects of NSAIDs are associated with the suppression of COX-1 activity.

Pharmacokinetics

Most NSAIDs are weak organic acids with a low pH. When taken orally, they have a high degree of absorption and bioavailability. NSAIDs bind well to plasma proteins (80-99%). With hypoalbuminemia, the concentration of free fractions of NSAIDs in the blood plasma increases, as a result of which the activity and toxicity of drugs increase.

NSAIDs have approximately the same volume of distribution. They are metabolized in the liver with the formation of inactive metabolites (with the exception of phenylbutazone), and are eliminated by the kidneys. NSAIDs are more rapidly excreted in alkaline urine. Some NSAIDs (indomethacin, ibuprofen, naproxen) are excreted by 10-20% unchanged, and therefore, with kidney disease, their concentration in the blood may change. T1 / 2 in different drugs in this group varies significantly. To drugs with a short T1 / 2 (1-6 hours) include acetylsalicylic acid, diclofenac, ibuprofen, indomethacin, ketoprofen, etc., to drugs with a long T1 / 2 (more than 6 hours) - naproxen, piroxicam, phenylbutazone, etc. The pharmacokinetics of NSAIDs may be affected by liver and kidney function, as well as the age of the patient.

Place in therapy

In dental practice, NSAIDs are widely used for inflammatory diseases of the maxillofacial region and oral mucosa, inflammatory edema after trauma, surgery, pain syndrome, arthrosis and arthritis of the temporomandibular joint, myofascial pain syndrome of the maxillofacial region, neuritis, neuralgia, postoperative pain, fever.

Tolerability and side effects

NSAIDs are widely and uncontrolledly used as anti-inflammatory, analgesic and antipyretic drugs, while their potential toxicity is not always taken into account, especially in patients at risk with a history of diseases of the gastrointestinal tract, liver, kidneys, cardiovascular system, bronchial asthma and predisposed to allergic reactions.

When using NSAIDs, especially coursework, complications from many systems and organs are possible.

From the gastrointestinal tract: stomatitis, nausea, vomiting, flatulence, epigastric pain, constipation, diarrhea, ulcerogenic effect, gastrointestinal bleeding, gastroesophageal reflux, cholestasis, hepatitis, jaundice.
From the side of the central nervous system and sensory organs: headache, dizziness, irritability, fatigue, insomnia, tinnitus, hearing loss, impaired sensitivity, hallucinations, convulsions, retinopathy, keratopathy, optic neuritis.
Hematological reactions: leukopenia, anemia, thrombocytopenia, agranulocytosis.
From the urinary system: interstitial nephropathy,
swelling.
Allergic reactions: bronchospasm, urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), allergic purpura, angioedema, anaphylactic shock.
From the skin and subcutaneous fat: rash, bullous eruptions, erythema multiforme, erythroderma (exfoliative dermatitis), alopecia, photosensitivity, toxicoderma.

The most common complications associated with COX-1 inhibition (gastrointestinal lesions, impaired renal function and platelet aggregation, effects on the circulatory system).

Contraindications

Hypersensitivity to drugs of this group.
Course therapy of NSAIDs is contraindicated:

- with peptic ulcer of the stomach and duodenum;
- with leukopenia;
- with severe damage to the kidneys and liver;
- in the first trimester of pregnancy;
- during lactation;
- children under 6 years old (meloxicam - up to 15 years old, ketorolac - up to 16 years old).

Cautions

NSAIDs should be used with caution in patients with bronchial asthma, arterial hypertension and heart failure. Elderly patients are advised to prescribe low doses and short courses of NSAIDs.

Interaction

When taken together with anticoagulants, antiplatelet agents and fibrinolytics, the risk of gastrointestinal bleeding increases. When combined with β-blockers or angiotensin-converting enzyme (ACE) inhibitors, the antihypertensive effect may decrease. NSAIDs increase the side effects of corticosteroids and estrogens. Deterioration of kidney function can be observed when NSAIDs are combined with potassium-sparing diuretics (triamterene), ACE inhibitors, cyclosporine. The combination of paracetamol with barbiturates, anticonvulsants and ethyl alcohol increases the risk of a hepatotoxic state. The use of paracetamol in conjunction with ethanol contributes to the development of acute pancreatitis.

Examples of TN NSAIDs and non-narcotic analgesics registered in the Russian Federation

	Synonyms
Acetylsalicylic acid
Benzydamine	tantum verde
Diclofenac	Voltaren, Diclobene, Naklofen, Ortofen
Ibuprofen	Brufen, Nurofen
Indomethacin	Metindol
Ketoprofen	Artrosilene, Ketonal, OKI
Ketorolac	Ketalgin, Ketanov, Ketorol
Lornoxicam	Xefocam
Meloxicam
Metamizole sodium	Analgin
Nimesulide	Aulin, Nise, Nimesil, Novolid, Flolid
Paracetamol	Tylenol
Piroxicam	Piroxicam
Phenylbutazone	Butadion
Celecoxib	Celebrex

G.M. Barer, E.V. Zoryan

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) are drugs that have analgesic (analgesic), antipyretic and anti-inflammatory effects.

Their mechanism of action is based on the blocking of certain enzymes (COX, cyclooxygenase), they are responsible for the production of prostaglandins - chemicals that contribute to inflammation, fever, pain.

The word "non-steroidal", which is contained in the name of the group of drugs, emphasizes the fact that the drugs in this group are not synthetic analogues of steroid hormones - powerful hormonal anti-inflammatory drugs.

The most famous representatives of NSAIDs: aspirin, ibuprofen, diclofenac.

How do NSAIDs work?

When are these drugs prescribed?

Typically, NSAIDs are used to treat acute or chronic inflammation accompanied by pain. Non-steroidal anti-inflammatory drugs have gained particular popularity for the treatment of joints.

List the diseases that prescribe these drugs:

(menstrual pain);
bone pain caused by metastases;
postoperative pain;
fever (increased body temperature);
intestinal obstruction;
renal colic;
moderate pain due to inflammation or soft tissue injury;
lower back pain;
pain at .

In contact with

Classmates

How NSAIDs work

When are NSAIDs used?

We list the diseases for which these medicines are prescribed:

dysmenorrhea (pain during menstruation);
acute gout;
postoperative pain;
bone pain due to metastasis;
intestinal obstruction;
fever (high body temperature);
minor pain due to trauma or inflammation of the soft tissues;
renal colic;
lower back pain;
Parkinson's disease;
osteochondrosis;
migraine;
pain in the head;
rheumatoid arthritis;
arthrosis.

Non-steroidal anti-inflammatory drugs: a list of NSAIDs for the treatment of joints

Consider the most effective and well-known NSAIDs that are used to treat joints and other diseases when required. antipyretic and anti-inflammatory effect:

ibuprofen;
Indomethacin;
Meloxicam;
Naproxen;
Celecoxib;
Diclofenac;
Etodolac;
Ketoprofen.

Some medical drugs are weaker, not so aggressive, some are designed for acute arthrosis, if emergency intervention is needed in order to stop dangerous processes in the body.

The main advantage of NSAIDs of a new generation

Of the minuses of new generation drugs, only their high cost can be distinguished, which makes them inaccessible to most people.

What are new generation NSAIDs?

List of effective and popular anti-inflammatory nonsteroidal drugs new generation:

Ksefokam. A drug that is based on Lornoxicam. Its characteristic feature is the fact that the drug has an increased ability to relieve pain. According to this indicator, it is similar to morphine, but at the same time it does not create addiction and does not have an opiate-like effect on the central nervous system.
Movalis. It has antipyretic, well-pronounced anti-inflammatory and analgesic effect. The main advantage of this drug is that with the constant supervision of a doctor, it can be used for quite a long time. Meloxicam is made in the form of a solution for intramuscular injections, in ointments, suppositories and tablets. The tablets of the drug are quite convenient in that they have a lasting effect, and it is enough to use one tablet throughout the day.
Nimesulide. It has been successfully used to treat arthritis, vertebrogenic back pain, etc. Normalizes temperature, relieves hyperemia and inflammation. Taking the drug quickly leads to improved mobility and reduced pain. It is also used in the form of an ointment for application to the problem area.
Celecoxib. This drug significantly alleviates the patient's condition with arthrosis, osteochondrosis and other diseases, effectively fights inflammation and perfectly relieves pain. Side effects on the digestive system from the drug is minimal or completely absent.

By chemical origin, these drugs come with non-acid and acid derivatives.

Acid preparations:

Preparations based on indoacetic acid - sulindac, etodolac, indomethacin;
Oxicams - meloxicam, piroxicam;
Salicipates - diflunisal, aspirin;
Based on propionic acid - ibuprofen, ketoprofen;
Pyrazolidines - phenylbutazone, metamizole sodium, analgin;
Preparations from phenylacetic acid - aceclofenac, diclofenac.

Non-acid drugs:

Sulfonamide derivatives;
Alcanones.

At the same time, nonsteroidal drugs differ in intensity and type of action - anti-inflammatory, analgesic, combined.

The strength of the anti-inflammatory effect medium doses, the drugs are arranged in the following sequence (top of the most powerful):

Flurbiprofen;
Indomethacin;
Piroxicam;
diclofenac sodium;
Naproxen;
Ketoprofen;
Aspirin;
Amidopyrine;
Ibuprofen.

By analgesic effect drugs are listed in the following order:

Ketoprofen;
Ketorolac;
Indomethacin;
diclofenac sodium;
Amidopyrine;
Flurbiprofen;
Naproxen;
Piroxicam;
Aspirin;
Ibuprofen.

Any new drug for the patient should be prescribed at the beginning in the minimum dose. With normal tolerance after a few days increase the daily dose.

Prolonged use of anti-inflammatory drugs in high doses can cause:

Changes in the functioning of blood vessels and the heart - swelling, increased pressure, palpitations;
urinary incontinence, renal failure;
Violation of the central nervous system - disorientation, mood changes, apathy, dizziness, blurred vision, headache, tinnitus;
Allergic reactions - urticaria, angioedema, erythema, anaphylactic shock, bronchial asthma, bullous dermatitis;
Ulcer, gastritis, gastrointestinal bleeding, perforation, changes in liver function, dyspeptic disorders.

NSAIDs should be treated for minimum possible time and minimum doses.

Use in pregnancy

Description of non-steroidal anti-inflammatory drugs Movalis

Is the leader among non-steroidal anti-inflammatory drugs, which has a long time of action and is approved for long-term use.

Determination of doses, administration options (suppositories, injections, tablets) depends on the type and severity of the disease.

As an anti-inflammatory drug, it is not used so often, but the medicine is also very popular in rheumatology: it is used to treat osteoarthritis, rheumatoid arthritis and other joint diseases.

The most popular names include Nurofen, Ibuprom, MIG 400 and 200.

It is manufactured under the names Naklofen, Voltaren, Diklak, Ortofen, Vurdon, Diklonak P, Dolex, Olfen, Klodifen, Dicloberl, etc.

Chondroprotectors - alternative drugs

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) are a group of drugs whose action is aimed at symptomatic treatment (pain relief, inflammation and temperature reduction) in acute and chronic diseases. Their action is based on a decrease in the production of special enzymes called cyclooxygenases, which trigger the reaction mechanism to pathological processes in the body, such as pain, fever, inflammation.

Medicines of this group are widely used all over the world. Their popularity is ensured by good efficiency against the background of sufficient safety and low toxicity.

The best-known representatives of the NSAID group are for most of us aspirin (acetylsalicylic acid), ibuprofen, analgin and naproxen, available in pharmacies in most countries of the world. Paracetamol (acetaminophen) is not an NSAID because it has a relatively weak anti-inflammatory activity. It acts against pain and temperature on the same principle (by blocking COX-2), but mainly only in the central nervous system, almost without affecting the rest of the body.

Soreness, inflammation and fever are common pathological conditions that accompany many diseases. If we consider the pathological course at the molecular level, we can see that the body "forces" the affected tissues to produce biologically active substances - prostaglandins, which, acting on the vessels and nerve fibers, cause local swelling, redness and pain.

In addition, these hormone-like substances, reaching the cerebral cortex, affect the center responsible for thermoregulation. Thus, impulses are given about the presence of an inflammatory process in tissues or organs, so a corresponding reaction occurs in the form of fever.

A group of enzymes called cyclooxygenases (COX) are responsible for starting the mechanism for the appearance of these prostaglandins. The main effect of non-steroidal drugs is to block these enzymes, which in turn leads to inhibition of the production of prostaglandins, which increase the sensitivity of nociceptive receptors responsible for pain. Consequently, painful sensations that bring suffering to a person, unpleasant sensations, are stopped.

Types behind the mechanism of action

NSAIDs are classified according to their chemical structure or mechanism of action. The long-known drugs of this group were divided into types according to their chemical structure or origin, since then the mechanism of their action was still unknown. Modern NSAIDs, on the contrary, are usually classified according to the principle of action - depending on what type of enzymes they act on.

There are three types of cyclooxygenase enzymes - COX-1, COX-2 and the controversial COX-3. At the same time, non-steroidal anti-inflammatory drugs, depending on the type, affect the main two of them. Based on this, NSAIDs are divided into groups:

non-selective inhibitors (blockers) of COX-1 and COX-2- act immediately on both types of enzymes. These drugs block COX-1 enzymes, which, unlike COX-2, are constantly present in our body, performing various important functions. Therefore, exposure to them can be accompanied by various side effects, and a particular negative effect is on the gastrointestinal tract. This includes most classic NSAIDs.
selective COX-2 inhibitors. This group affects only enzymes that appear in the presence of certain pathological processes, such as inflammation. Taking such drugs is considered safer and preferable. They do not affect the gastrointestinal tract so negatively, but at the same time, the load on the cardiovascular system is greater (they can increase pressure).
selective NSAID COX-1 inhibitors. This group is small, since almost all drugs that affect COX-1 affect COX-2 to varying degrees. An example is acetylsalicylic acid in a small dosage.

In addition, there are controversial COX-3 enzymes, the presence of which has been confirmed only in animals, and they are also sometimes referred to as COX-1. It is believed that their production is slightly slowed down by paracetamol.

In addition to reducing fever and eliminating pain, NSAIDs are recommended for blood viscosity. The drugs increase the liquid part (plasma) and reduce formed elements, including lipids that form cholesterol plaques. Due to these properties, NSAIDs are prescribed for many diseases of the heart and blood vessels.

Major non-selective NSAIDs

acetylsalicylic (aspirin, diflunisal, salasat);
arylpropionic acid (ibuprofen, flurbiprofen, naproxen, ketoprofen, thiaprofenic acid);
arylacetic acid (diclofenac, fenclofenac, fentiazac);
heteroarylacetic (ketorolac, amtolmetin);
indole/indene of acetic acid (indomethacin, sulindac);
anthranilic (flufenamic acid, mefenamic acid);
enolic, in particular oxicam (piroxicam, tenoxicam, meloxicam, lornoxicam);
methanesulfonic (analgin).

Acetylsalicylic acid (aspirin) is the first known NSAID, discovered back in 1897 (all others appeared after the 1950s). In addition, it is the only agent capable of irreversibly inhibiting COX-1 and has also been shown to stop platelets from sticking together. Such properties make it useful in the treatment of arterial thrombosis and for the prevention of cardiovascular complications.

Selective COX-2 inhibitors

rofecoxib (Denebol, Vioxx discontinued in 2007)
Lumiracoxib (Prexige)
parecoxib (Dynastat)
etoricoxib (Arcosia)
celecoxib (Celebrex).

Main indications, contraindications and side effects

Today, the list of NVPS is constantly expanding and new generation drugs are regularly supplied to the pharmacy shelves, capable of simultaneously lowering the temperature, relieving inflammation and pain in a short period of time. Due to the mild and sparing effect, the development of negative consequences in the form of allergic reactions, as well as damage to the organs of the gastrointestinal tract and urinary system, is minimized.

Table. Non-steroidal anti-inflammatory drugs - indications

Non-steroidal anti-inflammatory drugs are considered the most used at this time.

This can be explained by their actions:

Anti-inflammatory;
Antipyretic;
Analgesic.

Suitable for symptomatic treatment, since most diseases are accompanied by precisely the listed manifestations. Over the past few years, new drugs in this direction have appeared, and most of them have efficacy, prolonged action, and good tolerability.

What it is?

NSAIDs are drugs for symptomatic therapy. Many of the drugs sold in pharmacies without a prescription.

Order 30 million people on Earth use daily the medicines we describe 45% applying is over 62 years of age, 15% patients in the hospital receive such drugs as a means of treatment. These drugs are popular due to their actions described above.

Now we will look at them in more detail.

The effect of these drugs

The main one is the inhibition of the synthesis of prostaglandins (PG) from arachidonic acid by inhibiting the enzyme cyclooxygenase (PG synthetase).

PGs have the following focus:

Local expansion of blood vessels, due to which there is a decrease in edema, exudation, and the speedy healing of damage.
Reduce pain.
Contribute to lowering heat, due to the action on the hypothalamic centers of regulation.
Anti-inflammatory action.

Indication for use

Medicines of this group, as a rule, prescribed for acute and chronic pathologies, in the clinic of which there is pain and inflammation.

Most often, drugs in this group are prescribed for:

Rheumatoid arthritis is a chronic inflammation of the joints.
Osteoarthritis is a non-inflammatory chronic joint disease of unknown etiology.
Inflammatory arthropathy: ankylosing spondylitis; psoriatic arthritis; Reiter's syndrome.
Gout is the deposition of urate in body tissues.
Dysmenorrhea - menstrual pain.
Bone cancer with pain.
Migraine pains. B
Pain observed after surgery.
Slight pain with injuries and inflammation.
Heat.
Pain syndrome in diseases of the urinary system.

Release forms

NSAIDs are produced in the following forms:

So you can choose to your taste, some forms are suitable for treating children.

Classification of non-steroidal anti-inflammatory drugs

There are several classifications of the described group.

By chemical structure:

Salicylic acid derivatives- Aspirin.
Pyrazolone derivatives- Analgin.
Anthranilic acid derivatives- Sodium mefenaminate.
Propionic acid derivatives- representative of the group - Ibuprofen. Read more here: ibuprofen instructions for use.
Acetic acid derivatives- in this group Diclofenac-sodium. Read more about the article Diclofenac instructions for use.
Oxycam derivatives– representatives of Piroxicam and Meloxicam.
Derivatives of isonicotinic acid- this includes Amizon.
Derivatives of coxibs- in this group Celecoxib, Rofecoxib.
Derivatives of other chemical groups- Mesulides, Etodolac.
Combined drugs- Reopirin, Diclocaine.

All drugs in this group are divided into 2 types:

Type 1 cyclooxygenase inhibitors;
Type 2 cyclooxygenase inhibitors.

List of first generation drugs

List of second generation drugs

Movalis.
Nise.
Nimesil.
Arcoxia.
Celebrex.

The answer to the question: nise or nimesil - which is better? - read here.

List of the most effective NSAIDs

Now we will present you a list of the most effective NSAIDs:

Nimesulide. Very effective in relation to pain in the spine, back muscles, arthritis, etc. Removes inflammation, hyperemia, reduces temperature. The use of this drug reduces pain and normalizes mobility in the joints. Available in the form of ointment and tablets. Skin reactions are not considered a contraindication. It is undesirable to use during pregnancy, especially in the last trimester. Nimesulide tablets 100 mg 20 pieces cost from 87 to 152 rubles.
Celecoxib. It is used for osteochondrosis, arthrosis, etc. diseases. Great for relieving pain and inflammation. Side effects on digestion are minimal or non-existent. The price of Celecoxib tablets varies between 500-800 rubles and depends on the number of capsules in the package. Read more about doctors who treat osteoarthritis here.
Meloxicam. Another name is Movalis. It relieves fever very well, anesthetizes, relieves inflammation. It is very important that, under the supervision of a doctor, you can take it for a long time. Forms of the drug: ampoules for intramuscular injections, dragees, suppositories, ointment. The tablets work for 24 hours, so one per day is enough. Meloxicam ampoules 15 mg, 1.5 ml, 3 pcs. Price 237 rubles. Meloxicam-Tevatablets 15 mg 20 pcs. Price 292 rubles. Meloxicam rectal suppositories 15 mg, 6 pcs. Price 209 rubles. Meloxicam Avexima tablets 15 mg 20 pcs. Price 118 rubles.
Ksefokam. It is a powerful analgesic, acts like morphine. Effective for 12 hours. And fortunately, the drug is not addictive. Xefocam tablets are coated. captivity. about. 8 mg 10 pcs. Price 194 rubles. Xefocam tablets are coated. captivity. about. 8 mg 30 pcs. Price 564 rubles

A lot of pathological changes occurring in the body accompany the pain syndrome. To combat such symptoms, NSAIDs, or non-steroidal anti-inflammatory drugs, have been developed. They perfectly anesthetize, relieve inflammation, reduce swelling. However, the drugs have a large number of side effects. This limits their use in some patients. Modern pharmacology has developed the latest generation of NSAIDs. Such drugs are much less likely to cause unpleasant reactions, but they remain effective drugs for pain.

Impact principle

What is the effect of NSAIDs on the body? They act on cyclooxygenase. COX has two isoforms. Each of them has its own functions. Such an enzyme (COX) causes a chemical reaction, as a result of which arachidonic acid passes into prostaglandins, thromboxanes and leukotrienes.

COX-1 is responsible for the production of prostaglandins. They protect the gastric mucosa from unpleasant effects, affect the functioning of platelets, and also affect changes in renal blood flow.

COX-2 is normally absent and is a specific inflammatory enzyme synthesized due to cytotoxins, as well as other mediators.

Such an action of NSAIDs as inhibition of COX-1 carries many side effects.

New developments

It is no secret that the drugs of the first generation of NSAIDs had an adverse effect on the gastric mucosa. Therefore, scientists have set themselves the goal of reducing undesirable effects. A new release form has been developed. In such preparations, the active substance was in a special shell. The capsule was made from substances that did not dissolve in the acidic environment of the stomach. They began to break down only when they entered the intestines. This allowed to reduce the irritating effect on the gastric mucosa. However, the unpleasant mechanism of damage to the walls of the digestive tract still remained.

This forced chemists to synthesize completely new substances. From previous drugs, they are fundamentally different mechanism of action. NSAIDs of the new generation are characterized by a selective effect on COX-2, as well as inhibition of prostaglandin production. This allows you to achieve all the necessary effects - analgesic, antipyretic, anti-inflammatory. At the same time, NSAIDs of the latest generation make it possible to minimize the effect on blood clotting, platelet function, and the gastric mucosa.

The anti-inflammatory effect is due to a decrease in the permeability of the walls of blood vessels, as well as a decrease in the production of various inflammatory mediators. Due to this effect, irritation of the nerve pain receptors is minimized. The influence on certain centers of thermoregulation located in the brain allows the latest generation of NSAIDs to perfectly lower the overall temperature.

Indications for use

The effects of NSAIDs are widely known. The effect of such drugs is aimed at preventing or reducing the inflammatory process. These drugs give an excellent antipyretic effect. Their effect on the body can be compared with the effect of narcotic analgesics. In addition, they provide analgesic, anti-inflammatory effects. The use of NSAIDs reaches a wide scale in the clinical setting and in everyday life. Today it is one of the most popular medical drugs.

A positive impact is noted with the following factors:

Diseases of the musculoskeletal system. With various sprains, bruises, arthrosis, these drugs are simply irreplaceable. NSAIDs are used for osteochondrosis, inflammatory arthropathy, arthritis. The drug has an anti-inflammatory effect in myositis, herniated discs.
Strong pains. The drugs are quite successfully used for biliary colic, gynecological ailments. They eliminate headaches, even migraines, kidney discomfort. NSAIDs are successfully used for patients in the postoperative period.
Heat. The antipyretic effect allows the use of drugs for ailments of a diverse nature, both for adults and children. Such medicines are effective even in fever.
thrombus formation. NSAIDs are antiplatelet agents. This allows them to be used in ischemia. They are a preventive measure against heart attack and stroke.

Classification

About 25 years ago, only 8 groups of NSAIDs were developed. Today, this number has increased to 15. However, even doctors cannot name the exact number. Having appeared on the market, NSAIDs quickly gained wide popularity. Drugs have replaced opioid analgesics. Because they, unlike the latter, did not provoke respiratory depression.

The classification of NSAIDs implies a division into two groups:

Old drugs (first generation). This category includes well-known drugs: Citramon, Aspirin, Ibuprofen, Naproxen, Nurofen, Voltaren, Diklak, Diclofenac, Metindol, Movimed, Butadion .
New NSAIDs (second generation). Over the past 15-20 years, pharmacology has developed excellent drugs, such as Movalis, Nimesil, Nise, Celebrex, Arcoxia.

However, this is not the only classification of NSAIDs. New generation drugs are divided into non-acid derivatives and acids. Let's look at the last category first:

Salicylates. This group of NSAIDs contains drugs: Aspirin, Diflunisal, Lysine monoacetylsalicylate.
Pyrazolidins. Representatives of this category are drugs: Phenylbutazone, Azapropazone, Oxyphenbutazone.
Oxycams. These are the most innovative NSAIDs of the new generation. List of drugs: Piroxicam, Meloxicam, Lornoxicam, Tenoxicam. Medicines are not cheap, but their effect on the body lasts much longer than other NSAIDs.
Derivatives of phenylacetic acid. This group of NSAIDs contains funds: Diclofenac, Tolmetin, Indomethacin, Etodolac, Sulindac, Aceclofenac.
Anthranilic acid preparations. The main representative is the medicine "Mefenaminat".
Propionic acid agents. This category contains many excellent NSAIDs. List of drugs: Ibuprofen, Ketoprofen, Benoxaprofen, Fenbufen, Fenoprofen, Thiaprofenic acid, Naproxen, Flurbiprofen, Pirprofen, Nabumeton.
Derivatives of isonicotinic acid. The main medicine "Amizon".
Pyrazolone preparations. The well-known remedy "Analgin" belongs to this category.

Non-acid derivatives include sulfonamides. This group includes drugs: Rofecoxib, Celecoxib, Nimesulide.

Side effects

NSAIDs of the new generation, the list of which is given above, have an effective effect on the body. However, they practically do not affect the functioning of the gastrointestinal tract. These drugs are distinguished by another positive point: NSAIDs of the new generation do not have a devastating effect on cartilage tissue.

However, even such effective means can provoke a number of undesirable effects. They should be known, especially if the drug is used for a long time.

The main side effects can be:

dizziness;
drowsiness;
headache;
fatigue;
increased heart rate;
increase in pressure;
slight shortness of breath;
dry cough;
indigestion;
the appearance of protein in the urine;
increased activity of liver enzymes;
skin rash (spot);
fluid retention;
allergy.

At the same time, damage to the gastric mucosa is not observed when taking new NSAIDs. The drugs do not cause an exacerbation of the ulcer with the occurrence of bleeding.

Phenylacetic acid preparations, salicylates, pyrazolidones, oxicams, alkanones, propionic acid and sulfonamide drugs have the best anti-inflammatory properties.

From joint pain most effectively relieve medications "Indomethacin", "Diclofenac", "Ketoprofen", "Flurbiprofen". These are the best NSAIDs for osteochondrosis. The above drugs, with the exception of the drug "Ketoprofen", have a pronounced anti-inflammatory effect. This category includes the tool "Piroxicam".

Effective analgesics are Ketorolac, Ketoprofen, Indomethacin, Diclofenac.

Movalis has become the leader among the latest generation of NSAIDs. This tool is allowed to be used for a long period. Anti-inflammatory analogues of an effective drug are the drugs Movasin, Mirloks, Lem, Artrozan, Melox, Melbek, Mesipol and Amelotex.

The drug "Movalis"

This drug is available in the form of tablets, rectal suppositories and a solution for intramuscular injection. The agent belongs to the derivatives of enolic acid. The drug has excellent analgesic and antipyretic properties. It has been established that in almost any inflammatory process, this medicine brings a beneficial effect.

Indications for the use of the drug are osteoarthritis, ankylosing spondylitis, rheumatoid arthritis.

However, you should know that there are contraindications to taking the drug:

hypersensitivity to any of the components of the drug;
peptic ulcer in the acute stage;
severe renal failure;
ulcer bleeding;
severe liver failure;
pregnancy, child feeding;
severe heart failure.

The drug is not taken by children under 12 years of age.

Adult patients diagnosed with osteoarthritis are recommended to use 7.5 mg per day. If necessary, this dose can be increased by 2 times.

With rheumatoid arthritis and ankylosing spondylitis, the daily norm is 15 mg.

Patients who are prone to side effects should take the drug with extreme caution. People who have severe renal failure and who are on hemodialysis should take no more than 7.5 mg throughout the day.

The cost of the drug "Movalis" in tablets of 7.5 mg, No. 20, is 502 rubles.

The opinion of consumers about the drug

Reviews of many people who are prone to severe pain indicate that Movalis is the most suitable remedy for long-term use. It is well tolerated by patients. In addition, its long stay in the body makes it possible to take the medicine once. A very important factor, according to most consumers, is the protection of cartilage tissues, since the drug does not adversely affect them. This is very important for patients who use the remedy for osteochondrosis, arthrosis.

In addition, the medicine perfectly relieves various pains - toothache, headache. Patients pay particular attention to the impressive list of side effects. While taking NSAIDs, the treatment, despite the warning of the manufacturer, was not complicated by unpleasant consequences.

The drug "Celecoxib"

The action of this remedy is aimed at alleviating the patient's condition with osteochondrosis and arthrosis. The drug perfectly eliminates pain, effectively relieves the inflammatory process. No adverse effects on the digestive system have been identified.

The indications for use given in the instructions are:

This drug has a number of contraindications. In addition, the medicine is not intended for children under 18 years of age. Particular caution must be observed in people who are diagnosed with heart failure, as the drug increases the susceptibility to fluid retention.

The cost of the drug varies, depending on the packaging, in the region of 500-800 rubles.

Consumer opinion

Quite conflicting reviews about this medicine. Some patients, thanks to this remedy, were able to overcome joint pain. Other patients claim that the drug did not help. Thus, this remedy is not always effective.

In addition, you should not take the drug yourself. In some European countries, this medicine is banned because it has a cardiotoxic effect, which is quite unfavorable for the heart.

The drug "Nimesulide"

This medicine has not only anti-inflammatory and anti-pain effects. The tool also has antioxidant properties, due to which the drug inhibits substances that destroy cartilage and collagen fibers.

The remedy is used for:

arthritis;
arthrosis;
osteoarthritis;
myalgia;
arthralgia;
bursitis;
fever
various pain syndromes.

In this case, the drug has an analgesic effect very quickly. As a rule, the patient feels relief within 20 minutes after taking the drug. That is why this remedy is very effective in acute paroxysmal pain.

Almost always, the medicine is well tolerated by patients. But sometimes side effects may occur, such as dizziness, drowsiness, headache, nausea, heartburn, hematuria, oliguria, urticaria.

The product is not approved for use by pregnant women and children under 12 years of age. With extreme caution should take the drug "Nimesulide" people who have arterial hypertension, impaired functioning of the kidneys, vision or heart.

The average price of a medicine is 76.9 rubles.