Nvp instructions for use. What are NSAIDs (non-steroidal anti-inflammatory drugs): a list of NSAIDs for the treatment of joints. Non-steroidal anti-inflammatory ointments

Analgesics and non-steroidal anti-inflammatory drugs used to reduce pain and eliminate inflammation.

The path to the discovery of painkillers was difficult and long. Once upon a time, only folk remedies were used for these purposes, and during surgical operations - alcohol, opium, scopolamine, Indian hemp, and even such inhumane methods as stunning with a blow to the head or partial strangulation.

In folk medicine, willow bark has long been used to relieve pain and fever. Subsequently, it was found that the active ingredient in willow bark is salicin, which, upon hydrolysis, turns into salicylic acid. Acetylsalicylic acid was synthesized as early as 1853, but it was not used in medicine until 1899, when data were accumulated on its effectiveness in arthritis and good tolerability. And only after that the first preparation of acetylsalicylic acid appeared, which is now known throughout the world as Aspirin. Since then, many compounds of various chemical nature have been synthesized that suppress pain sensations without disturbing (loss) of consciousness. These drugs are called analgesics (from the Greek algos- pain). Those that do not cause addiction and do not depress brain activity in therapeutic doses are called non-narcotic analgesics . Since most of them have, in addition, anti-inflammatory properties, they were called “Non-narcotic analgesics and non-steroidal anti-inflammatory drugs”.

These substances are able to suppress the symptoms and signs of inflammation, including pain, since a decrease in the intensity of the inflammatory process leads to a decrease in painful sensations. In addition, they reduce elevated body temperature, that is, they have an antipyretic effect, which is due to the expansion of the superficial vessels of the skin and increased heat radiation.

The group of non-narcotic analgesics and non-steroidal anti-inflammatory drugs includes drugs of various chemical structures and with a different ratio of analgesic and anti-inflammatory effects. The ancestor of this group is already mentioned above. acetylsalicylic acid, which has been successfully used in medicine for more than 100 years. It has anti-inflammatory, analgesic and antipyretic properties approximately equally, although it is most widely used as an analgesic and antipyretic agent. A typical representative of non-narcotic analgesics - metamizole sodium(more commonly known as Analgin). This substance is also more often used as an analgesic and antipyretic agent. Drugs that combine these properties are also called antipyretic analgesics (from the Greek pyretos- fever).

Recently, a number of compounds have been found with particularly pronounced anti-inflammatory activity. Preparations created on their basis, of course, relieve pain and fever, but their anti-inflammatory effect is predominant and is close in strength to glucocorticoids - steroid hormones. The most famous representatives of this series are diclofenac , ibuprofen , indomethacin , ketoprofen , naproxen , piroxicam and others (they are called non-steroidal anti-inflammatory drugs).

Mechanism of anti-inflammatory and analgesic action non-steroidal anti-inflammatory drugs associated with the inhibition of a special enzyme - cyclooxygenase, which promotes the synthesis of prostaglandins - the main mediators of inflammation and pain. Along with this, they affect the synthesis and transformation in the body of other substances (for example, bradykinin) involved in the occurrence and spread of inflammation and pain.

Non-narcotic analgesics and non-steroidal anti-inflammatory drugs are widely used in the treatment of various inflammatory diseases of an infectious and non-infectious nature. First of all, this rheumatic soft tissue lesions and inflammatory and degenerative diseases of the musculoskeletal system. This pathology often leads to long-term disability and even disability.

One of the indications for the appointment of non-steroidal anti-inflammatory drugs is acute arthritis at gout. The writing genius and medical education allowed A.P. Chekhov in "Uncle Vanya" very accurately describe the paroxysmal and short-term pain that occurs mainly at night, which is characteristic of acute gouty arthritis, as well as the protracted course of this disease. The irritability of Professor Serebryakov poisoned the lives of those around him. “- You wrote that he was very ill, rheumatism and something else, but it turns out he is healthy. “Last night he was moping, and today nothing ...”. Irritability is inherent in patients with gout on the eve and during a painful attack. Chekhov knew that gout was not a harmless disease: “They say that Turgenev got angina pectoris from gout.” Turgenev himself described his illness in a letter to L.N. Tolstoy: “My illness is not at all dangerous, although it is rather painful; the main trouble is that, succumbing badly to drugs, it can last a long time and deprives me of the ability to move” (1892).

It should be recalled that gout is incompatible with alcohol and alcoholic beverages can provoke an acute attack of the disease. There are even lines like this:

Another disease that permanently deprives a person of “the ability to move” is described by another classic of literature, O’Henry. In the story Kindred Souls, the author describes an apartment thief who finds it increasingly difficult to work, especially in wet weather. His latest victim and soul mate, a gentleman, has been “deprived of the ability to dress without outside help” for a week now. This is how it manifests osteoarthritis, the next aggravation of which made two people “brothers in misfortune”.

A direct indication for the use of non-steroidal anti-inflammatory drugs is also ankylosing spondylitis. In the autobiographical novel by N. Ostrovsky “How the Steel Was Tempered”, Pavel Korchagin has the most severe form of this disease. “Korchagin knew that if he got off his horse, ... he would not walk a kilometer on his feet.” "The tragedy of immobility awaits this young man, and we are powerless to prevent it."

In the treatment of inflammatory diseases, topical preparations in the form of ointments, creams or gels play an important role. These dosage forms allow you to achieve a rapid analgesic effect and avoid side effects characteristic of injectable forms and drugs administered through the digestive tract ( enterally ).

Non-narcotic analgesics and non-steroidal anti-inflammatory drugs are often prescribed for the treatment of pain of various origins of mild to moderate intensity ( headache , muscle pain, including when colds , flu and other acute respiratory diseases, toothache , pain during menstruation and so on), as antipyretics in feverish conditions accompanying many diseases, often infectious. In terms of consumption, they are among the most popular medicines in the world. This is also due to the fact that many of them are included in the OTC lists, and, therefore, are easily accessible to the public. Every day, about 30 million people take non-steroidal anti-inflammatory drugs and non-narcotic analgesics.

A significant disadvantage of non-steroidal anti-inflammatory drugs is their ability to cause gastrointestinal bleeding, stomach ulcers and increased bleeding of the nasal mucosa and gums. This is because non-steroidal anti-inflammatory drugs block the synthesis of protective prostaglandins in the gastric mucosa and inhibit the adhesion (aggregation) of blood cells responsible for stopping bleeding ( platelets ). As it turned out, the cyclooxygenase enzyme (which we mentioned earlier) has two varieties, one of which is more responsible for the synthesis of prostaglandins - inflammatory mediators, and the other for the synthesis of protective prostaglandins in the gastric mucosa. Increasing the selectivity of the action of new drugs in relation to only the type of enzyme that is responsible for the synthesis of inflammatory mediators, avoids side effects while maintaining the anti-inflammatory effect. Such medicines are already being created and can be exemplified by meloxicam and celecoxib .

Blockade of prostaglandin synthesis can also lead to bronchospasm (the so-called "aspirin" asthma). On the other hand, the property of acetylsalicylic acid to reduce blood clotting and improve its fluidity has been used for prevention. thrombosis, risk reduction stroke with temporary disorders of cerebral circulation, reducing the risk myocardial infarction and death thereafter. For example, long-term acetylsalicylic acid at a dose of 325 mg every other day significantly reduces the incidence of myocardial infarction in men (according to some reports by 40%).

Since inflammatory processes, depending on the localization, may be accompanied by muscle spasms, severe pain, cough, runny nose, swelling and other disorders of body functions, non-narcotic analgesics and non-steroidal anti-inflammatory drugs are combined with other components (antispasmodics, narcotic analgesics, expectorants, vitamins, caffeine, drugs that improve microcirculation, and so on), which can have a complementary effect or enhance (potentiate) the effects of each other.

The group of non-narcotic analgesics is widely represented

Does the abbreviation NSAID mean anything to you? If not, then we suggest broadening your horizons a little and finding out what these mysterious four letters stand for. Read the article - and everything will become absolutely clear. We hope that it will be not only informative, but also interesting!

NSAIDs - transcript

We will not languish our readers in ignorance for a long time. NSAIDs stands for non-steroidal drugs - drugs in our time are very popular and popular, because they are able to simultaneously eliminate pain and relieve inflammation in various organs of our body. If until now you have never had the need to take NSAIDs - this can be considered almost a miracle. You are one of the rare lucky ones, really, your health can be envied!

We are ahead of the next question and immediately talk about the decoding of the word "non-steroidal". This means that these drugs are non-hormonal, i. do not contain any hormones. And this is very good, because everyone knows how unpredictable and dangerous hormonal drugs can be.

Most Popular NSAIDs

If you think that NSAIDs are drugs whose names are rarely spoken in everyday life, then you are mistaken. Many people do not even realize how often we have to use non-steroidal anti-inflammatory drugs to cure various ailments that have accompanied the human race since the time of the expulsion of Adam and Eve from paradise. Read the list of such remedies, for sure some of them are in your home first aid kit. So, NSAIDs include drugs such as:

"Aspirin".
"Amidopyrine".
"Analgin".
"Piroxicam".
"Bystromgel".
"Diclofenac".
"Ketoprofen".
"Indomethacin".
"Ketorol".
"Naproxen".
"Ketorolac".
Flurbiprofen.
"Voltarengel".
"Nimesil".
"Diclofenac".
"Ibuprofen".
"Indopan".
"Ipren".
Upsarin UPSA.
"Ketanov".
"Mesulid".
Movalis.
"Nise".
"Nurofen".
"Ortofen".
"Trombo ASS".
"Ultrafen".
"Fastum".
"Finalgel".

Yes, they are all NSAIDs. The list turned out to be long, but, of course, far from complete. Nevertheless, it gives an idea of the variety of modern non-steroidal anti-inflammatory drugs.

Some historical facts

The first primitive NSAIDs were known to people in ancient times. For example, in ancient Egypt, willow bark, a natural source of salicylates and one of the first non-steroidal anti-inflammatory drugs, was widely used to relieve fever and pain. And even in those distant times, healers treated their patients suffering from joint pain and fever with decoctions of myrtle and lemon balm - they also contain salicylic acid.

In the middle of the 19th century, chemistry began to develop rapidly, which gave impetus to the development of pharmacology. At the same time, the first studies of the compositions of medicinal substances obtained from plant materials began to be carried out. Pure salicin from willow bark was synthesized in 1828 - this was the first step towards the creation of the familiar "Aspirin" to all of us.

But it will take many more years of scientific research before this medicine is born. A grand event happened in 1899. Doctors and their patients quickly appreciated the benefits of the new drug. In 1925, when a terrible influenza epidemic hit Europe, Aspirin became a savior for a huge number of people. And in 1950, this non-steroidal anti-inflammatory drug was included in the Guinness Book of Records as the pain reliever with the largest sales volume. Well, later pharmacists created other non-steroidal anti-inflammatory drugs (NSAIDs).

What diseases are non-steroidal anti-inflammatory drugs used for?

The spectrum of application of NSAIDs is very wide. They are very effective in the treatment of both acute and chronic diseases accompanied by pain and inflammation. Nowadays, research is in full swing to study the effectiveness of these drugs in the treatment of diseases of the heart and blood vessels. And today almost everyone knows that they can be used for pain in the spine (NSAIDs for osteochondrosis are a real salvation).

Here is a list of painful conditions, in the event of which the use of various non-steroidal anti-inflammatory drugs is indicated:

Fever.
Headaches, migraines.
Renal colic.
Rheumatoid arthritis.
Gout.
Arthrosis.
Osteoarthritis.
Dysmenorrhea.
Inflammatory arthropathies (psoriatic arthritis, ankylosing spondylitis, Reiter's syndrome).
Pain syndrome postoperative.
Pain syndrome from mild to moderate severity with injuries and various inflammatory changes.

Classification of NSAIDs according to their chemical structure

Reading this article, you already had the opportunity to make sure that there are a lot of non-steroidal anti-inflammatory drugs. To navigate among them at least a little better, let's classify these funds. First of all, they can be divided as follows: a group - acids and a group of NSAIDs - non-acid derivatives.

The first ones include:

Salicylates (you can immediately recall the "Aspirin").

Derivatives of phenylacetic acid ("Aceclofenac", "Diclofenac", etc.).

Pyrazolidines (metamisole sodium, known to most of us as Analgin, Phenylbutazone, etc.).

Oxicams ("Tenoxicam", "Meloxicam", "Piroxicam", "Tenoxicam").

Derivatives of indoleacetic acid ("Sulindak", "Indomethacin", etc.).

Derivatives of propionic acid ("Ibuprofen", etc.).

The second group is:

Sulfonamide derivatives ("Celecoxib", "Nimesulide", "Rofecoxib").

Alkanones ("Nabumeton").

Classification of non-steroidal anti-inflammatory drugs according to their effectiveness

The use of NSAIDs in osteochondrosis and in the treatment of other joint diseases can literally work wonders. But, unfortunately, not all drugs are the same in their effectiveness. The undisputed leaders among them are:

"Diclofenac".
"Ketoprofen".
"Indomethacin".
Flurbiprofen.
"Ibuprofen" and some other drugs.

The listed medicines can be called basic; that is, on their basis, new NSAIDs can be developed and supplied to the pharmacy network, but under a different name and often at a higher price. In order not to waste your money, study the next chapter carefully. The information contained in it will help you make the right choice.

What to look for when choosing a medicine

NSAIDs are, for the most part, excellent modern drugs, but when you come to the pharmacy, it is better to be aware of some of the nuances. What? But read it!

For example, you are faced with a choice of what is better to buy: Diclofenac, Ortofen or Voltaren. And you are trying to ask the pharmacist which of these drugs is better. Most likely, you will be advised the one that is more expensive. But the fact is that the composition of these drugs is almost identical. And the difference in names is explained by the fact that they are produced by different companies, which is why the brands differ from each other. The same can be said, for example, about "Metindol" and "Indomethacin" or "Ibuprofen" and "Brufen", etc.

To understand the confusion, always look carefully at the packaging, because the main active ingredient of the drug must be indicated there. Only it will be written, most likely, in small letters.

But that's not all. Actually, it's not that simple! The use of an NSAID analogue of some drug you are familiar with may unexpectedly cause an allergic reaction or side effects that you have never experienced before. What's the matter here? The reason may lie in additional additives, about which, of course, nothing was written on the packaging. So, you need to study the instructions as well.

Another possible reason for the different results of analogue drugs is the difference in dosage. Ignorant people often do not pay any attention to this, but in vain. After all, small tablets can contain a "horse" dose of the active substance. Conversely, huge pills or capsules happen to be composed of as much as 90 percent fillers.

Sometimes drugs are also produced in a retarded form, that is, as long-acting (prolonged) drugs. An important feature of such drugs is the ability to be absorbed gradually, so that their action can last for a whole day. Such a drug does not need to be drunk 3 or 4 times a day, a single dose will be enough. This feature of the drug should be indicated on the package or directly in the name. For example, "Voltaren" in a prolonged form is called "Voltaren-retard".

List of analogues of known drugs

We publish this little cheat sheet in the hope that it will help you better navigate the many beautiful pharmacy packages. Let's say you immediately need effective NSAIDs for arthrosis to relieve excruciating pain. Take out the cheat sheet and read the following list:

In addition to the already mentioned Voltaren and Ortofen, there are also Diclofen, Dicloran, Diclonac, Rapten, Diclobene, Artrozan, Naklofen.

- "Indomethacin" is sold under such brands as "Indomin", "Indotard", "Metindol", "Revmatin", "Indobene", "Inteban".

Analogues of "Piroxicam": "Erazon", "Piroks", "Roxicam", "Pirocam".

Analogues of "Ketoprofen": "Flexen", "Profenid", "Ketonal", "Artrozilen", "Knavon".

The popular and inexpensive "Ibuprofen" is found in the composition of drugs such as "Nurofen", "Reumafen", "Brufen", "Bolinet".

Rules for taking NSAIDs

Taking NSAIDs can be accompanied by a number of side effects, so it is recommended that you follow the following rules when taking them:

1. Familiarization with the instruction and following the recommendations contained in it are mandatory!

2. When taking capsules or tablets by mouth, take them with a glass of water - this will protect your stomach. This rule must be adhered to, even if you drink the most modern drugs (which are considered safer), because an extra precaution never hurts;

3. Do not lie down after taking the drug for about half an hour. The fact is that gravity will contribute to a better passage of the capsule down the esophagus;

4. It is better to refuse alcoholic beverages, since NSAIDs and alcohol combined together are an explosive mixture that can cause various stomach diseases.

5. You should not take two different non-steroidal drugs on the same day - this will not increase the positive result, but most likely summarizes the side effects.

6. If the medicine does not help, consult your doctor, perhaps you have been prescribed too low a dose.

Side effects and nonsteroidal gastropathy

Now you have to find out what NSAID gastropathy is. Unfortunately, all NSAIDs have significant side effects. They have a particularly negative effect on the gastrointestinal tract. Patients may experience symptoms such as

Nausea (sometimes very strong).
Heartburn.
Vomit.
Dyspepsia.
Bleeding gastrointestinal.
Diarrhea.
Ulcer of the duodenum and stomach.

All of the above troubles are NSAID-gastropathy. Therefore, doctors so often try to prescribe their patients the lowest possible doses of classic non-steroidal anti-inflammatory drugs. To minimize the harmful effects on the stomach and intestines, it is recommended that you never take such drugs on an empty stomach, but only after a large meal.

But problems with the digestive system are not all the side effects that some of the NSAIDs can give. Certain drugs can have a bad effect on the heart, as well as on the kidneys. Sometimes their reception can be accompanied by a headache and dizziness. Another serious nuisance is that they have a destructive effect on intra-articular cartilage (of course, only with prolonged use). Fortunately, today there are new generation NSAIDs on the market, which are largely freed from these shortcomings.

New generation non-steroidal anti-inflammatory drugs

Over the past two decades, several pharmaceutical companies have simultaneously been intensively developing new modern NSAIDs, which, along with the effective elimination of pain and inflammation, would have as few side effects as possible. The efforts of pharmacists were crowned with success - a whole group of new generation drugs, called selective, was developed.

Imagine - these drugs under the supervision of a doctor can be taken in very long courses. Moreover, the terms can be measured not only in weeks and months, but even in years. Medicines from this group do not have a destructive effect on articular cartilage, side effects are much less common and practically do not cause complications.

New generation NSAIDs are drugs such as:

Movalis.
"Nise" (aka - "Nimulid").
"Arcoxia".
"Celebrex".

We will talk about some of their advantages using the example of Movalis. It is available both in traditional tablets (7.5 and 15 mg each), and in 15 mg suppositories, and in glass ampoules for intramuscular injection (also 15 mg each). This medicine acts very gently, but at the same time extremely effective: just one tablet is enough for the whole day. When a patient is shown long-term treatment for severe arthrosis of the hip or knee joints, Movalis is simply irreplaceable.

Different forms in which NSAIDs are produced

Most popular nonsteroidal anti-inflammatory drugs can be purchased and used not only in the form of tablets and capsules for oral administration, but also in suppositories and injectable solutions. And this, of course, is very good, since such a variety makes it possible in some cases to avoid harm during treatment while obtaining a faster therapeutic effect.

Thus, NSAIDs of the new generation, used in the form of injections for arthrosis, have much less effect on the gastrointestinal tract. But there is a downside to this coin: when administered intramuscularly, almost all non-steroidal drugs are capable of producing a complication - necrosis of muscle tissue. That is why NSAID injections are never practiced for a long time.

Basically, injections are prescribed for exacerbation of inflammatory and degenerative-dystrophic diseases of the joints and spine, accompanied by severe unbearable pain. After the patient's condition improves, it becomes possible to switch to tablets and external agents in the form of ointments.

Usually, doctors combine different dosage forms, deciding what and when can bring the greatest benefit to the patient. The conclusion suggests itself: if you do not want to harm yourself by self-treatment of such common ailments as osteochondrosis or arthrosis, seek help from a medical institution, that is where they will be able to help you.

Can NSAIDs be used during pregnancy?

Doctors categorically do not advise pregnant women to take NSAIDs (especially this prohibition applies to the third trimester), as well as mothers who are breastfeeding. It is believed that drugs in this group can adversely affect the bearing of the fetus and cause various malformations in it.

According to some reports, such a harmless drug, according to many, like Aspirin, can increase the risk of miscarriage in the early stages. But sometimes doctors, according to indications, prescribe this drug to women (in a limited course and in minimal doses). In each case, the decision must be made by a medical specialist.

During pregnancy, women often have back pain and there is a need to solve this problem with non-steroidal anti-inflammatory drugs as the most effective and fast-acting. In this case, the use of "Voltaren gel" is acceptable. But - again - its independent use is possible only in the first and second trimester, in late pregnancy, the use of this strong drug is allowed only under the supervision of a doctor.

Conclusion

We told you what we knew ourselves about NSAIDs. Deciphering the abbreviation, the classification of drugs, the rules for taking them, information about side effects - this can be useful in life. But we want our readers to need medicines as rarely as possible. Therefore, at parting, we wish you good heroic health!

NSAIDs - safety concerns

E. G. Shchekina, S. M. Drogovoz, V. V. Strashny
cafe Pharmacology NUPh

Non-steroidal anti-inflammatory drugs (NSAIDs) occupy one of the most important places in clinical practice. The main indications for their appointment are inflammatory processes of various origins, pain, fever, connective tissue diseases, so NSAIDs are widely used not only in rheumatology, but also in other areas of medicine (cardiology, neurology, oncology, etc.).

NSAIDs are among the most effective drugs for the treatment of inflammatory diseases of the musculoskeletal system. Globally, approximately 30 million people use NSAIDs every day, and more than 300 million people annually, with only 1/3 of patients getting prescription anti-inflammatory drugs, and the rest using over-the-counter dosage forms. The main requirements for modern NSAIDs are efficiency and safety.

However, despite the undoubted clinical efficacy, the use of NSAIDs has its limitations. This is due to the fact that even short-term use of these drugs in small doses can lead to the development of side effects, which in general occur in about 25% of cases, and in 5% of patients can pose a serious threat to life. The risk of side effects is especially high in elderly and senile people, who make up more than 60% of NSAID users. It should also be noted that in many diseases there is a need for long-term medication. Therefore, in recent years, special attention has been drawn to the problem of the safe use of NSAIDs.

The main side effect of almost all NSAIDs is a high risk of adverse reactions from the gastrointestinal tract.

In the US, mortality from NSAID-induced gastrointestinal lesions is the same as from AIDS and higher than from melanoma, bronchial asthma, cervical cancer, or lymphogranulomatosis.

In the treatment of anti-inflammatory drugs, 30-40% of patients have dyspeptic disorders, 10-20% - erosion and ulcers of the stomach and duodenum, 2-5% - bleeding and perforation.

Currently, a specific syndrome has been identified - NSAID-gastroduodenopathy. The appearance of this syndrome, on the one hand, is associated with a local damaging effect of NSAIDs (most of them are organic acids) on the mucous membrane of the stomach and intestines, on the other hand, due to inhibition of the COX-1 isoenzyme as a result of the systemic action of drugs.

The mechanism of mucosal damage when using NSAIDs is as follows: inhibition of prostaglandin synthesis in the mucosa reduces the production of protective mucus and bicarbonates mediated by prostaglandins, which leads to the appearance of erosions and ulcers, which can be complicated by bleeding or perforation.

Clinical symptoms in NSAID-gastroduodenopathy are absent in almost 60% of patients, which, apparently, is associated with the analgesic effect of the drugs.

Risk factors for the development of NSAID gastropathy are: age over 60 years, smoking, alcohol abuse, a history of gastrointestinal diseases, concomitant use of glucocorticoids, immunosuppressants, anticoagulants, long-term NSAID therapy, large doses or simultaneous use of two or more NSAIDs.

Among all NSAIDs, indomethacin, acetylsalicylic acid, piroxicam and ketoprofen have the strongest ulcerogenic effect.

In order to improve tolerability and minimize the ulcerogenic side effects of NSAIDs, the following measures are recommended:

The simultaneous administration of drugs that protect the mucous membrane of the gastrointestinal tract (for example, the combination of an anti-inflammatory drug with a synthetic analogue of prostaglandin E2 misoprostol (combined drug - artrotek), a proton pump inhibitor omeprazole, an H2-histamine blocker famotidine, a cytoprotective drug sucralfate gives very good results in reducing gastrotoxicity of NSAIDs).
Changing the tactics of using NSAIDs, suggesting a dose reduction; switching to parenteral, rectal or topical administration; taking enteric-soluble dosage forms; use of prodrugs (eg, sulindac). However, since NSAID-gastroduodenopathy is not so much a local as a systemic reaction, these approaches are an incomplete solution to the problem.
The use of selective NSAIDs that selectively block COX-1, which is responsible for the production of prostaglandins during inflammation, and do not significantly affect (at therapeutic doses) COX-1, which controls the production of prostaglandins that maintain the integrity of the gastrointestinal mucosa, renal blood flow and platelet function . Selective COX-2 inhibitors have less ulcerogenic effect. The predominant COX-2 inhibitors are meloxicam, nabumetone and nimesulide. Currently, highly selective COX-2 inhibitors celecoxib and rofecoxib are widely used in clinical practice.

The second most important group of adverse reactions of NSAIDs is nephrotoxicity. The mechanism of the negative effect of NSAIDs on the kidneys is carried out:

firstly, vasoconstriction and deterioration of renal blood flow as a result of blockade of the synthesis of PG-E2 and prostacyclin in the kidneys, which leads to the development of ischemic changes in the kidneys, a decrease in glomerular filtration and diuresis volume. As a result, disturbances in water and electrolyte metabolism may occur: water retention, edema, hypernatremia, hyperkalemia, an increase in serum creatinine levels, and an increase in blood pressure. The most dangerous in this regard are indomethacin, phenylbutazone, butadione;
secondly, by a direct effect on the kidney parenchyma, causing interstitial nephritis (the so-called "analgesic nephropathy"). The most dangerous are phenylbutazone, metamizole, indomethacin, ibuprofen.

Risk factors for nephrotoxicity are: age over 65 years, liver cirrhosis, previous renal pathology, decreased blood volume, long-term use of NSAIDs, concomitant use of diuretics, heart failure, arterial hypertension.

Serious side effects of NSAIDs also include:

hematotoxicity, manifested by aplastic anemia, thrombocytopenia, agranulocytosis (most often occurs against the background of the use of pyrazolone derivatives, indomethacin, acetylsalicylic acid);
coagulopathy, manifested in the form of gastrointestinal bleeding (almost all NSAIDs inhibit platelet aggregation and have a moderate anticoagulant effect by inhibiting the formation of prothrombin in the liver);
hepatotoxicity (changes in transaminases are possible, in severe cases - jaundice, hepatitis, most often with the use of phenylbutazone, diclofenac, sulindac);
allergic reactions - urticaria, Quincke's edema, anaphylactic shock, Lyell and Stevens-Johnson syndromes, allergic interstitial nephritis, are more often observed when using pyrazolones and pyrazolidines;
bronchospasm, "aspirin" asthma (or Vidal's syndrome) develops most often when taking acetylsalicylic acid. Its causes may be the predominant formation of leukotrienes and thromboxane A2 from arachidonic acid, as well as inhibition of the synthesis of PG-E2, which is an endogenous bronchodilator. NSAIDs should be used with caution in patients with bronchial asthma;
prolongation of pregnancy and slowing down of labor associated with the effect of prostaglandins on the myometrium;
teratogenicity (in some NSAIDs, for example, acetylsalicylic acid, indomethacin), in particular, premature closure of the battal duct in the fetus;
mutagenicity and carcinogenicity (amidopyrine);
retinopathy and keratopathy, as a result of the deposition of indomethacin in the retina and cornea.

Due to serious side effects in a number of countries, the clinical use of flufenamic acid, indoprofen, oxyphenbutazone, isoxicam and a number of other NSAIDs is prohibited.

Pharmacovigilance with long-term use of NSAIDs

NSAIDs should be used with caution in individuals who have previously had adverse reactions with any other NSAIDs.

Preparations of this group should be used with caution in patients with bronchial asthma, erosive and ulcerative lesions of the gastrointestinal tract, a tendency to bleeding, with liver diseases, and impaired renal function. Patients should be warned about the symptoms of lesions of the gastrointestinal tract.

All non-steroidal anti-inflammatory drugs, especially acetylsalicylic acid, should not be combined with alcohol, due to a sharp increase in the risk of ulcerogenic action, as well as side effects from the central nervous system.

All NSAIDs, especially acetylsalicylic acid preparations, should be taken after meals.

Rectal suppositories with NSAIDs should be used in patients who have undergone surgery on the upper gastrointestinal tract, and in patients receiving several drugs at the same time. They should not be used for inflammation of the rectum and after recent anorectal bleeding.

Acetylsalicylic acid, diclofenac, indomethacin, surgam, naproxen, tenoxicam, ketoprofen reduce platelet aggregation and blood clotting, contribute to the development of hemorrhagic syndrome.

The excretion of non-steroidal anti-inflammatory drugs from the body increases significantly with an alkaline urine reaction, which leads to a decrease in the effectiveness of drugs and a shorter time of their action.

With long-term administration of NSAIDs, it is necessary to promptly identify clinical signs of liver damage. Every 1-3 months, liver function should be monitored, transaminase activity should be determined.

Along with clinical observation, a clinical blood test should be performed once every 2-3 weeks. Special control is necessary when prescribing pyrazolone and pyrazolidine derivatives.

For patients with hypertension or heart failure, NSAIDs should be selected that have the least effect on renal blood flow. It is necessary to monitor the appearance of edema, measure blood pressure. Once every 3 weeks, a clinical urine test is performed.

When using ketoprofen, naproxen, surgam and indomethacin, dizziness, insomnia and even hallucinations are possible (due to the accumulation of serotonin-like metabolites), so these drugs are not recommended for drivers and other professions that require increased attention.

Ketorolac is not intended for long-term use.

When using phenylbutazone, salt intake should be limited.

For the elderly, it is necessary to prescribe the minimum effective doses and short courses of NSAIDs.

Ointments and gels containing NSAIDs should be applied only to undamaged skin, avoid contact with the mucous membranes of the eyes and other mucous membranes.

When using anti-inflammatory ointments and gels, itching, hyperemia, swelling of the skin, the appearance of papules, scales, vesicles may occur. With these phenomena, the use of the ointment should be stopped immediately.

If ointments and gels containing NSAIDs are applied to large areas of the skin and for a long time, then side effects characteristic of the resorptive use of these drugs may occur.

When using ointments and gels containing diclofenac, photosensitivity is possible.

Drug interactions with NSAIDs

Quite often, patients who receive NSAIDs are prescribed other drugs. In this case, it is necessary to take into account the possibility of their interaction with each other. Thus, NSAIDs can enhance the effect of indirect anticoagulants and oral hypoglycemic agents. At the same time, they weaken the effect of antihypertensive drugs, increase the toxicity of antibiotics of the aminoglycoside group, digoxin.

Butadion, sodium metamizole, surgam, ketoprofen should be combined with extreme caution with anticoagulants, sulfanilamide drugs, oral hypoglycemic agents, since it is possible to increase the effectiveness of these drugs and the occurrence of appropriate side effects.

If possible, the simultaneous administration of NSAIDs and diuretics should be avoided, due, on the one hand, to a weakening of the diuretic effect (especially indomethacin, diclofenac, surgam, ketoprofen and acetylsalicylic acid reduce the diuretic effect of loop diuretics) and, on the other hand, the risk of developing renal failure. The most dangerous in this regard is the combination of indomethacin with triamterene.

When Ketorolac is combined with preparations of garlic, onion, ginkgo biloba, the risk of hemorrhagic complications increases.

Many drugs prescribed simultaneously with NSAIDs, in turn, can affect their pharmacokinetics and pharmacodynamics:

aluminum-containing antacids (almagel, maalox, etc.) and cholestyramine weaken the absorption of NSAIDs in the gastrointestinal tract, so the concomitant administration of such antacids may require an increase in the dose of NSAIDs, and an interval of at least 4 hours is necessary between taking cholestyramine and NSAIDs;
sodium bicarbonate enhances the absorption of NSAIDs in the gastrointestinal tract;
the anti-inflammatory effect of NSAIDs is enhanced by glucocorticoids and "slow-acting" (basic) anti-inflammatory drugs (gold preparations, aminoquinolines);
the analgesic effect of NSAIDs is enhanced by narcotic analgesics and sedatives.

Features of the appointment and dosing of NSAIDs in order to reduce side effects

For each patient, the most effective drug with the best tolerance should be selected individually.

When using NSAIDs in rheumatology (especially when replacing one drug with another), it must be taken into account that the development of the anti-inflammatory effect lags behind the analgesic effect in time. The latter is noted in the first hours, while anti-inflammatory - after 10-14 days of regular intake, and when naproxen or oxicams are prescribed even later - at 2-4 weeks.

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

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).

In some patients, the therapeutic effect is achieved only when using very high doses of NSAIDs.

With a long course appointment (for example, in rheumatology), NSAIDs are taken after meals. However, to obtain a rapid analgesic or antipyretic effect, it is possible to prescribe them 30 minutes before or 2 hours after a meal, drinking 1/2-1 glass of water. After taking NSAIDs, it is advisable not to lie down for 15 minutes in order to prevent the development of esophagitis.

The moment of taking NSAIDs can also be determined by the time of maximum severity of the symptoms of the disease (pain, stiffness in the joints), i.e., taking into account the chronopharmacology of drugs. In this case, you can deviate from the generally accepted schemes (2-3 times a day) and prescribe NSAIDs at any time of the day, which often allows you to achieve a greater therapeutic effect with a lower daily dose.

With severe morning stiffness, it is advisable to take rapidly absorbed NSAIDs as early as possible (immediately after waking up) or to prescribe long-acting drugs at night. Naproxen, potassium diclofenac, water-soluble ("effervescent") aspirin, ketoprofen have the highest absorption rate in the gastrointestinal tract.

the effectiveness of such combinations has not been objectively proven;
in some such cases, there is a decrease in the concentration of drugs in the blood (for example, acetylsalicylic acid reduces the concentration of indomethacin, diclofenac, ibuprofen, naproxen, piroxicam), which leads to a weakening of the effect;
increases the risk of adverse reactions. An exception is the use of paracetamol in combination with any other NSAID to enhance the analgesic effect.

In some cases, two NSAIDs may be administered at different times of the day, for example, a fast-absorbing NSAID in the morning and afternoon, and a long-acting NSAID in the evening.

Based on the foregoing, we can conclude that, despite the fact that the characteristic features of modern NSAIDs are obvious - this is a combination of maximum efficiency with a minimum risk of side effects, the issue of effective and safe pharmacotherapy of inflammatory diseases has not been fully resolved. The solution to the problem of the safety of the use of modern NSAIDs, in our opinion, is possible in several directions.

First, at the beginning of treatment (especially in patients with risk factors for side effects), less toxic NSAIDs with a short half-life should be prescribed, which include propionic acid derivatives (ibuprofen), diclofenac. The dose of NSAIDs should be increased gradually, the effect should be evaluated within 5-10 days, and only if it is absent, a more toxic drug should be used. In the presence of risk factors and the development of dyspeptic symptoms, it is necessary to resolve the issue of a possible refusal to take NSAIDs, or the average daily dose of these drugs should be reduced as much as possible. In some cases, this is achieved with the use of simple analgesics (paracetamol), and in rheumatoid arthritis - with the appointment of low doses of glucocorticoids. Also, a decrease in the dose of NSAIDs is possible when combined with systemic enzyme therapy drugs, using new chondroprotectors with anti-inflammatory properties, combining drug treatment with physiotherapy, local therapy. It is also possible to use antiulcer therapy in parallel both in relation to the treatment and prevention of NSAID gastropathy. The most effective drugs are misoprostol, omeprazole; with scarring of duodenal ulcers and stomach ulcers (especially in the presence of H. pylori infection), H2 receptor antagonists can be used.

Secondly, the use of selective and highly selective COX-2 inhibitors (meloxicam, nimesulide, nabumetone, celecoxib, rofecoxib) is certainly preferable, which can significantly reduce toxicity and improve the tolerability of pharmacotherapy for inflammatory diseases.

Thirdly, the use of new drugs with an unconventional mechanism of action and minimal side effects is especially relevant. It has been proven that, in addition to prostaglandins, leukotrienes and platelet activating factor, as well as metalloproteinases, play an important role in the development of inflammation. It is possible to use 5-lipoxygenase inhibitors as NSAIDs, which reduce the formation of leukotrienes (a new domestic drug, analben, developed and studied by scientists at the National Pharmacopoeia).

Fourth, currently promising and pathogenetically justified is the use of drugs with antioxidant properties in the complex pharmacotherapy of inflammation. This is due to modern ideas about the significant role of free radical oxidation processes in the pathogenesis of inflammatory reactions and destruction of connective tissue. The spectrum of biological action of antioxidants is very diverse and is mainly due to their protective functions, expressed in the ability to neutralize the negative effects of free radicals. Among the most well-known antioxidants are tocopherols, quercetin, superoxide dismutase preparations, which, although somewhat inferior in anti-inflammatory activity to traditional NSAIDs, however, have significantly fewer side effects and have a wide range of pharmacological actions. The combination of NSAIDs and antioxidants with anti-inflammatory properties will not only reduce the dose of NSAIDs, which significantly reduces the risk of side effects, but also bring the pharmacotherapy of inflammatory diseases to a new qualitative level.

Thus, the correct assessment of risk factors for side effects, the competent prescription of NSAIDs, the widespread use of selective COX-2 inhibitors, anti-inflammatory drugs with non-traditional mechanisms of action can significantly improve the safety of treatment of many widespread inflammatory diseases.

Literature

Drogovoz S. M. Pharmacology.- Kh., 1994.
Drogovoz S. M. Pharmacology on the bottom. - H., 2001.
Drogovoz S. M., Strashny V. V. Pharmacology to help the doctor, pharmacist and student.- H., 2002.
Zmushko E. I., Belozerov E. S. Drug complications.- S.-Pb., 2001.
Mashkovsky M. D. Medicines. T. 1.- Kh., 1997.
Mikhailov I. B. Handbook of a doctor in clinical pharmacology.- M., 2001.
Nasonov E. L. Prospects for the use of a new non-steroidal anti-inflammatory drug nimesulide // Klin. pharmacol. Therapy.- 1999.- No. 8.- S. 65-69.
Nasonov E. L. Specific inhibitors of cyclooxygenase-2 and inflammation: prospects for the use of the drug Celebrex // Russian Rheumatology.- 1999.- No. 4.- P. 2-13.
Nasonov E. L., Tsvetkova E. S., Balabanova R. M. et al. New aspects of anti-inflammatory therapy of rheumatic diseases: theoretical background and clinical application of meloxicam // Klin. medicine. - 1996. - No. 4. - S. 4-8.
Nasonov E. L., Tsvetkova E. S., Tov N. L. Selective inhibitors of cyclooxygenase-2: new prospects for the treatment of human diseases // Therapist. archive.- 1998.- No. 5.- S. 8-14.
Side effects of drugs / Ed. M. N. Dyuksa - M., 1983.
Reference book Vidal. - M., 2002.
Tarakhovsky M. L. Treatment of acute poisoning. - K., 1982.
Kharkevich D. A. Pharmacology.- M., 1999.
Chekman I. S. Complications of pharmacotherapy.- K., 1980.
Checkman I. S. Pharmacology. - K., 2001.
Dequeker J., Hawkey C., Kahan A. et al. Improvement in gastrointestinal tolerability of the selective cyclooxygenase (COX-2) inhibitors, meloxicam, compared with piroxicam: resilts of the safety and efficacy large-scale evaluation of COX-inhibiting therapies (Select) trial in osteoarthritis. Br. J. Rheumatol. 1998; 37:946-51.
Hawkey C., Kahan A., Steinbruck K. et al. Gastrointestinal tolerability of meloxicam compared to diclofenac in osteoarthritis. Br. J. Rheumatol. 1998; 37:037-945.

The widespread use of non-steroidal anti-inflammatory drugs in medicine is due to their pronounced therapeutic effect. They are able to eliminate the symptoms inherent in many diseases: pain, fever, inflammation. In recent years, the list of drugs in this group has been replenished with a list of non-steroidal anti-inflammatory drugs (NSAIDs) of a new generation with increased efficiency against the background of improved tolerability.

What is NSAID

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) belong to a group of drugs aimed at symptomatic therapy of acute and chronic pathologies. They do not belong to steroid hormones, they have a pronounced therapeutic effect against inflammation, pain of varying intensity, and fever.

The action of non-steroidal NSAIDs is due to a reduction in the production of enzymes (cyclooxygenase) that trigger reactive processes in the body in response to the effects of pathological factors.

Anti-inflammatory NSAIDs, although similar in chemical structure, may differ in the strength of the effect, the presence and severity of side effects. The choice of the drug is carried out by the doctor, based on the type of pathology, its clinical manifestations. NSAIDs of the new generation are characterized by a high therapeutic result with low toxicity. This is due to their widespread use in medicine.

Non-narcotic analgesics, NSAIDs are successfully used all over the world to treat pathologies of the musculoskeletal system, to eliminate pain in various diseases and conditions (premenstrual syndrome, postoperative period, etc.). NSAIDs act on blood clotting, thinning it (by increasing plasma volume), reduce formed elements (cholesterol plaques), which is used in the treatment of a number of diseases of the heart and blood vessels (atherosclerosis, heart failure, and others).

Classification

NSAIDs are classified according to several criteria.

By belonging to the generation of medicines:

First generation. The drugs of this group have long been present on the pharmacological market: Aspirin, Ibuprofen, Diclofenac, Voltaren, Naproxen and others.
New generation. This group includes Nise, Nimulid, Movalis, Arcoxia and others.

By chemical composition NSAID drugs may refer to acids or non-acid derivatives.

Salicylates: Aspirin.
Pyrazolidines: metamizole sodium NSAIDs (analgin). Despite the difference between analgesics and NSAIDs in chemical structure, they have common pharmacological qualities.
Propionic acid agents: NSAIDs Ibuprofen, Ketoprofen.
Means of indolacetic acid: Indomethacin.
Anthranilic acid agents: Mefenaminate.
Means of phenylacetic acid: NSAIDs Diclofenac.
Means of isonicotinic acid: Amizon.
Oxicams: Piroxicam, Meloxicam. Differ in long effect and more expressed force of action.

Non-acid agents include Nimesulide, Nabumeton.

According to the mechanism of action:

Non-selective inhibitors of COX-1 and COX-2 (cyclooxygenase enzymes) - inhibit both types of enzymes. Classical anti-inflammatory drugs belong to this species. The difference between NSAIDs of this group is in the blocking of COX-1, which are constantly present in the body. Their suppression can be accompanied by negative side effects.
Selective NSAID COX-2 inhibitors. The use of these drugs is preferable, since they act exclusively on enzymes that appear in response to pathological processes in the body. However, their increased effect on the heart and blood vessels is noted (they can cause an increase in blood pressure).
Selective NSAID COX-1 inhibitors. The group of such drugs is insignificant (aspirin), since by acting on COX-1, the active ingredient usually also affects COX-2.

The strength of the anti-inflammatory effect among NSAIDs, Indomethacin, Flurbiprofen, Diclofenac can be distinguished. Amidopyrine, Aspirin have a weaker effect.

By the strength of the analgesic action The classification of NSAIDs includes drugs with the maximum effect: Ketorolac, Ketoprofen, Diclofenac, and others. Naproxen, Ibuprofen, Aspirin have a minimal analgesic effect.

List of drugs

In pharmacology, a wide range of NSAIDs in various dosage forms is presented. Their action is distinguished by the strength of the therapeutic effect, duration, the presence of side effects, method of application. Modern effective NSAIDs are distinguished by a minimal risk of negative consequences of taking them, a quick and long-lasting result.

Tablets

The tablet dosage form of NSAID preparations is considered the most common. It has a high absorption of the active components of the drug into the systemic circulation, which ensures the therapeutic efficacy of drugs. However, NSAIDs in tablets more than other forms affect the patient's digestive tract, in some cases causing negative side effects.

Arcoxia

The active ingredient of the drug is etoricoxib. It has analgesic, anti-inflammatory, antipyretic properties. Selective suppression of COX-2 causes a reduction in the clinical manifestations of diseases without negative effects on the digestive tract and platelet function.

Contraindications: hypersensitivity, ulcerative lesions of the digestive tract, internal bleeding, hemostasis disorders, severe cardiac pathologies, severe renal and hepatic dysfunctions, coronary heart disease, peripheral arterial pathologies, pregnancy, lactation, age up to 16 years.

Side effects: epigastric pain, dyspepsia, stool disorders, gastric ulcer, headache, increased blood pressure, cough, edema, renal and hepatic dysfunction, bronchospasm, hyperreaction of the body to the drug.

denebol

The active ingredient of the drug is rofecoxib. By blocking COX-2, the drug has pronounced analgesic, decongestant, anti-inflammatory, anti-febrile effects. The absence of an effect on COX-2 ensures good tolerance of the drug, the minimum number of negative consequences of taking it.

Contraindications: hypersensitivity, oncology, asthma, pregnancy, lactation, age up to 12 years.

Side effects: intestinal disorders, dyspepsia, abdominal pain, hallucinations, confusion, renal and hepatic dysfunction, hypertension, circulatory disorders (coronary and cerebral), swelling of the legs, hypersensitivity reactions.

Xefocam

The active substance is lornoxicam. It has analgesic, anti-inflammatory, antipyretic properties. The drug inhibits the activity of cyclooxygenase enzymes, inhibits the production of prostaglandins, the release of free radicals. Does not affect the opioid receptors of the central nervous system, respiratory function. There is no addiction and dependence on the medication.

Contraindications: hypersensitivity, ulcers, bleeding in the gastrointestinal tract, severe renal and hepatic dysfunction, pregnancy, lactation, severe heart disease, dehydration, age under 18 years.

Side effects: visual impairment, hearing impairment, hepatic, renal dysfunction, headache, increased blood pressure, chills, peptic ulcers, bleeding from the gastrointestinal tract, dyspepsia, hypersensitivity reactions.

Movalis

The active ingredient is meloxicam. The drug has pronounced anti-inflammatory, antipyretic, analgesic qualities. It has a long-lasting effect and the possibility of long-term use. There are fewer side effects than when taking other NSAIDs. Does not affect the state of the platelet hemostasis system.

Contraindications: hypersensitivity, ulcers (acute period), bleeding in the gastrointestinal tract, severe renal and hepatic dysfunction, hemostasis disorders, pregnancy, lactation, age up to 12 years.

Side effects: manifestations of hypersensitivity, headache, perforation and bleeding from the gastrointestinal tract, colitis, gastropathy, abdominal pain, changes in liver function, increased blood pressure, acute renal dysfunction, urinary retention.

Nimesulide

The active ingredient of the drug is nimesulide. Selectively inhibits COX-2, reducing the production of prostaglandins. At the same time, it also affects their precursors (short-lived prostaglandins H2). This is due to the pronounced analgesic, anti-febrile, anti-inflammatory qualities of NSAIDs. The drug activates glucocorticoid centers, reducing inflammation in the tissues. It is effective in acute pain syndrome due to the rapid analgesic effect.

Contraindications: pregnancy, age up to 12 years, ulcers and bleeding in the digestive tract, hypersensitivity, severe renal and hepatic insufficiency.

Side effects: headache, gastralgia, dyspepsia, ulceration of mucous tissues, oliguria, hematuria, hypersensitivity reactions, changes in blood counts.

Celecoxib

NSAIDs of the coxibs class, has analgesic, anti-inflammatory, antipyretic properties. It is mainly used in rheumatology for the treatment of arthrosis, arthritis, ankylosing spondylitis. Effectively and quickly eliminates pain in the muscles, back, in the postoperative period. It is used to treat primary dysmenorrhea.

Contraindications: hypersensitivity, ulcers, bleeding in the gastrointestinal tract, coronary heart disease, severe renal and hepatic dysfunction, pregnancy, lactation, age up to 18 years.

Side effects: ulcers, bleeding from the gastrointestinal tract, renal, hepatic dysfunction, bronchospasm, cough, hypersensitivity reactions, epigastric pain, dyspepsia, headache.

Ointments

This dosage form is used externally. It has a local therapeutic effect without being absorbed in the body and without causing systemic side effects when used correctly.

Apizartron

Active components of the drug: methyl salicylate, bee venom, allyl isothiocyanate, Roymakur aquasols, rapeseed oil, ethanol denatured with camphor. The ointment has an analgesic, anti-inflammatory effect. Local irritant and vasodilating effects of the drug improve blood circulation in the damaged area. It is used for arthralgia, myalgia, neuritis, sprains and other problems. After spreading the ointment on the skin, it is recommended to keep the treated area warm.

Contraindications: acute arthritis, skin diseases, severe renal and hepatic dysfunction, pregnancy, hypersensitivity.

Side effects: local hypersensitivity reactions.

Ben Gay

The active ingredients of the drug are methyl salicylate, menthol. The ointment has an irritating effect on the skin receptors, a vasodilating effect on the capillaries. The use of the cream relieves muscle spasms, reduces pain, tension, improves blood circulation in tissues. As a result of therapy, the range of motion increases, inflammation in the affected area is reduced.

Contraindications: sensitivity to the components of the drug, damage to the skin, dermatological diseases, age up to 12 years, pregnancy, lactation.

Side effects: local hypersensitivity reactions (itching, urticaria, erythema, peeling, irritation).

Kapsikam

The active components of the drug are nonivamide, dimethyl sulfoxide, camphor, turpentine, benzyl nicotinate. The ointment has analgesic, irritating, warming qualities. As a result of application in the affected area, blood circulation improves. A decrease in pain syndrome is noted half an hour after application and lasts about 6 hours. A small amount of the drug is absorbed into the systemic circulation.

Contraindications: hypersensitivity, skin lesions, dermatological diseases, pregnancy, lactation, childhood.

Side effects: local hypersensitivity reactions (itching, tissue swelling, rash).

Mataren Plus

The active component of the cream is meloxicam, supplemented with pepper tincture. It has analgesic, anti-edematous, anti-inflammatory properties. The warming effect of the ointment improves blood circulation in the tissues. It is used for pathologies of the joints and spine, injuries, sprains.

Contraindications: skin damage or disease, hypersensitivity to components, age up to 12 years.

Side effects: local hypersensitivity reactions, manifested by irritation, rash, itching, burning, peeling.

Finalgon

The active ingredients of the ointment are nonivamide, nicoboxyl. The drug has analgesic, vasodilating, hyperemic effects. The combined effect of the drug improves blood supply to tissues, accelerates enzymatic reactions, metabolic processes. A decrease in clinical manifestations is observed already a few minutes after the distribution of the ointment on the skin and becomes maximum after half an hour.

Contraindications: hypersensitivity, age up to 12 years, damaged skin or its sensitive areas (lower abdomen, neck, etc.), dermatological diseases.

Side effects: manifestations of hypersensitivity, paresthesia, burning in the area of application, cough, shortness of breath.

Candles

Suppositories are often used in gynecological, urological practice. They have less negative impact on the gastric mucosa. Designed for rectal administration.

denebol

The active ingredient of the drug is rofecoxib. Suppositories are applied rectally, are prescribed for acute pain syndrome of inflammatory origin, for the treatment of primary dysmenorrhea. Candles are placed twice a day, the course should not exceed 6 weeks.

Contraindications: oncological pathologies, bronchial asthma, age up to 12 years, pregnancy, lactation, hypersensitivity.

Side effects: soreness in the abdomen, bowel disorder, hallucinations, confusion, renal and hepatic dysfunction, circulatory disorders (coronary and cerebral), hypertension, swelling of the legs, hypersensitivity reactions.

Melbeck

The active active component of the selective NSAID is meloxicam. The drug has analgesic, antipyretic, anti-inflammatory properties. It is used for symptomatic treatment of various diseases of the musculoskeletal system, including for the relief of significant pain syndrome (with osteoarthritis and rheumatoid arthritis). Effective for relieving muscle, toothache.

Contraindications: hypersensitivity, severe renal and hepatic dysfunction, acute ulcers, bleeding in the gastrointestinal tract, asthma, pregnancy, lactation, age up to 18 years.

Side effects: dyspeptic manifestations, intestinal disorders, abdominal pain, stomach ulcers, increased blood pressure, blurred vision, headache, hypersensitivity reactions.

Movalis

The active ingredient in suppositories is meloxicam. NSAIDs are derivatives of enolic acid. The drug has pronounced anti-inflammatory, analgesic, anti-febrile qualities. Often prescribed for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis.

Contraindications: hypersensitivity, ulcers, bleeding in the digestive tract (exacerbation), severe renal and hepatic failure, severe cardiac dysfunction, pregnancy, lactation, age up to 12 years.

Side effects: perforation in the gastrointestinal tract, dyspepsia, gastritis, colitis, abdominal pain, renal and hepatic dysfunction, diarrhea, cytopenias, bronchospasm, headache, palpitations, increased blood pressure, hypersensitivity reactions.

Revmoxicam

The active ingredient of the drug is meloxicam. Suppositories have pronounced anti-inflammatory, antipyretic, analgesic properties. The drug effectively reduces pain, inflammation in diseases of the musculoskeletal system. There is no effect on the activity of chondrocytes and the production of proteoglycan, which is important in diseases of the joints.

Contraindications: hypersensitivity, ulcers, bleeding in the digestive tract, severe renal, hepatic dysfunction, heart failure inflammation in the rectum, pregnancy, lactation, age up to 15 years.

Side effects: dyspeptic manifestations, epigastric pain, ulcers, bleeding in the gastrointestinal tract, hypertension, edema, arrhythmias, liver dysfunction.

Tenoxicam

The active ingredient in rectal suppositories is tenoxicam. The drug has anti-inflammatory, antipyretic, analgesic properties. Eliminates pain in muscles, spine, joints. Helps increase range of motion, get rid of morning stiffness and swelling in the joints. Normalization of the patient's condition is noted within a week of therapy.

Contraindications: ulcers, bleeding in the digestive tract, hypersensitivity to the components of the drug, severe renal dysfunction, pregnancy, lactation.

Side effects: dyspeptic manifestations, abdominal pain, headache, hypersensitivity reactions, hepatic dysfunction, gastric ulcer, local irritation, pain during defecation.

Gel

It is used for local effects on the affected area. The active components are minimally absorbed into the systemic circulation, which ensures good tolerability of the drug, the absence of negative consequences. May cause manifestations of hypersensitivity in the area of application.

Amelotex

The active substance is meloxicam. It has pronounced local analgesic and anti-inflammatory properties. It is distinguished by the absence of a negative effect on cartilaginous tissue, which ensures the widespread use of the gel in degenerative-dystrophic changes in the skeletal system.

Contraindications: skin lesions in the area of application, skin diseases, age up to 18 years, pregnancy, lactation, hypersensitivity.

Side effects: itching, burning, peeling, hyperemia, rash, photosensitivity.

denebol

The active components of the drug are rofecoxib, methyl salicylate, menthol, linseed oil. The drug has a local analgesic, anti-inflammatory effect. Methyl salicylate increases blood flow in the affected area, eliminating swelling and bruising. It is used for musculoskeletal pathologies (arthritis, arthrosis, neuralgia, osteochondrosis, etc.), injuries. The gel is applied externally 3-4 times a day with light rubbing movements.

Contraindications: hypersensitivity.

Side effects: itching, burning, peeling, irritation of the skin in the area of application.

nise

The active component of the gel is nimesulide, when applied externally it has analgesic and anti-inflammatory effects. It is used for local therapy of pathologies of the spine, joints, muscle pain, injuries, sprains. As a result of treatment, pain at rest and movement, stiffness (in the morning), and swelling of the joints are reduced. Absorption of the drug into the systemic circulation is minimal.

Contraindications: hypersensitivity, ulcers, bleeding in the digestive tract, skin lesions and dermatological diseases, severe renal and hepatic dysfunction, pregnancy, lactation, age up to 7 years.

Side effects: overreaction of the body. With prolonged therapy and applying the gel to a large area of the body, systemic negative phenomena may be observed.

Nimid

The active ingredient of the drug is nimesulide. When used externally, the absorption of the active component into the systemic circulation is minimal, which ensures good tolerability of the agent, its low toxicity. It is used to relieve pain, inflammatory symptoms in pathologies of the spine and joints, injuries, inflammation of soft tissues, etc.

Contraindications: hypersensitivity, damage to the skin, dermatological diseases in the area of application of the product, age up to 12 years, 3rd trimester of pregnancy.

Side effects: local and general hypersensitivity reactions.

Nimulid

The active ingredient of the drug is nimesulide. The drug is applied topically, has analgesic, anti-inflammatory qualities. The gel is distributed in a thin layer over the painful area. Do not use more than 4 times a day, avoid contact with eyes. Therapy is usually long. With external use, the absorption of the active component into the systemic circulation is minimal, which ensures the absence of pronounced side effects.

Contraindications: hypersensitivity, damaged skin in the area of application of the product.

Side effects: itching, burning, peeling, irritation of the skin at the site of application of the drug.

injections

The parenteral form of administration is often used to eliminate acute pain. It is usually used in the first days of therapy, after which a transition to other dosage forms is carried out.

denebol

The drug is presented in ampoules with a solution for intramuscular injection. The active ingredient is rofecoxib. It is forbidden to administer the drug intravenously. It is used for a quick analgesic effect in various diseases and conditions (arthritis, trauma, migraine, neuralgia, algomenorrhea). It has anti-edema, anti-inflammatory, antipyretic properties.

Contraindications: oncology, pregnancy, lactation, age up to 12 years, hypersensitivity, condition after a heart attack and stroke, progressive atherosclerosis, malignant hypertension.

Side effects: dyspeptic manifestations, abdominal pain, confusion, hallucinations, renal, hepatic dysfunction, hypertension, circulatory disorders (cerebral and coronary), congestive heart failure, hypersensitivity reactions.

Xefocam

The medicine is presented in the form of a powder for making a solution. The introduction is made intramuscularly or intravenously. Parenteral use is recommended for acute pain syndrome (after surgery, with sciatica). The drug has a rapid analgesic effect (after a quarter of an hour).

Contraindications: hypersensitivity, hemostasis disorders, ulcers, bleeding in the gastrointestinal tract, severe hepatic and renal dysfunction, asthma, heart failure, hemorrhagic stroke, pregnancy, lactation, age up to 18 years.

Side effects: headache, aseptic meningitis, hearing and vision disorders, renal and hepatic dysfunctions, dyspeptic manifestations, ulcers, bleeding in the gastrointestinal tract, hypersensitivity phenomena.

Meloxicam

The drug is intended for intramuscular injection. Differs in speed of therapeutic effect, possesses anti-inflammatory, febrifugal, analgesic action. Injections are made exclusively into the muscle, intravenous use is prohibited. Parenteral administration is indicated in the first days of therapy, then the transition to tablet forms is carried out.

Contraindications: hypersensitivity, severe cardiac dysfunction, ulcers in the gastrointestinal tract, internal bleeding, severe renal and hepatic dysfunction, pregnancy, lactation, age up to 12 years.

Side effects: dyspepsia, epigastric pain, intestinal disorders, ulcer, bleeding from the gastrointestinal tract, hepatic and renal dysfunction, headache, edema, bronchospasm, hypersensitivity reactions.

Movalis

The drug is intended for intramuscular route of administration. The active ingredient is meloxicam. It is considered a popular, frequently prescribed and effective drug in the treatment of pathologies of the musculoskeletal system due to its pronounced medicinal properties and low toxicity. Actively inhibits COX-2 enzymes (and slightly COX-1), reducing the biosynthesis of prostaglandins. It has chondroneutrality, is often used for articular pathologies.

Contraindications: hypersensitivity, pronounced renal, hepatic dysfunction, ulcers, bleeding in the gastrointestinal tract, pregnancy, lactation, age up to 15 years.

Side effects: dyspeptic manifestations, abdominal pain, intestinal disorders, ulcers, bleeding in the gastrointestinal tract, renal, hepatic dysfunction, anemia, headache, edema, increased blood pressure, allergic reactions.

Revmoxicam

The drug is presented in an injectable form, the active ingredient is meloxicam. Indicated for use in degenerative pathologies of the skeletal system (including arthrosis, rheumatoid arthritis, spondyloarthritis). The drug is administered exclusively by intramuscular route. The dose and duration of therapy is determined by the doctor, based on the type of pathology and the patient's condition.

Contraindications: hypersensitivity, ulcers, bleeding in the gastrointestinal tract, severe renal, hepatic dysfunction, heart failure, inflammation in the rectum, pregnancy, lactation, age up to 15 years.

Side effects: dyspeptic manifestations, abdominal pain, ulcers, bleeding in the gastrointestinal tract, hypertension, edema, arrhythmias, liver dysfunction.

Drops

In ophthalmic practice, the use of NSAID drugs for topical use is common. In the vast majority of cases, the active ingredients of the drugs are diclofenac or indomethacin, as an alternative to glucocorticosteroids.

Broxinac

The active ingredient is bromfenac. Eye drops are used in the treatment of inflammation and pain after surgery for cataract extraction. The therapeutic effect (analgesic and anti-inflammatory) persists throughout the day.

Contraindications: hypersensitivity, age up to 18 years, pregnancy, lactation, bleeding tendency.

Side effects: discomfort, pain, itching in the eye area, their hyperemia, inflammation of the iris, erosion, corneal perforation, its thinning, headache, retinal hemorrhage, decreased vision, edema, hypersensitivity reactions.

Diclofenac

The active component of the drops is diclofenac sodium. The drug has a pronounced local analgesic and anti-inflammatory effects. It is used for inhibition of miosis, prevention and treatment of cystic macular edema during cataract surgery, in the treatment of inflammation of non-infectious etiology.

Contraindications: hypersensitivity, pregnancy, childhood and old age, tendency to bleeding, violations of hemostasis.

Side effects: burning, itching, hyperemia of the eye area, blurred vision after application, nausea, vomiting, hypersensitivity reactions.

DIKLO-F

The active ingredient is diclofenac. The use of the drug reduces inflammation in the eye (after infection, trauma, surgery), reduces miosis during operations, the production of prostaglandins in the fluid of the anterior chamber of the eyes. The absorption of the drug into the systemic circulation is negligible and has no clinical significance.

Contraindications: violations of hemostasis, exacerbation of ulcerative lesions in the digestive tract, hypersensitivity.

Side effects: burning, blurred vision after application, clouding of the cornea, itching, redness of the eyes, hypersensitivity reactions.

Indocollier

The active ingredient is indomethacin. The drug has pronounced local anti-inflammatory and analgesic properties. Systemic absorption of the drug is minimal, which ensures its good tolerability. It is used for the treatment of inflammation after eye surgery, conjunctivitis of non-infectious origin, suppression of miosis during surgery due to cataracts.

Contraindications: hypersensitivity, violations of hemostasis.

Side effects: burning, blurred vision when using drops, hypersensitivity reactions.

Nevanak

The active component of the drops is nepafenac. When used locally, the active ingredient enters the cornea, where it is converted to amfenac, which inhibits the activity of cyclooxygenase. It is used for the treatment and prevention of pain, inflammation, the formation of macular edema (in people with diabetes) after surgery due to cataracts.

Contraindications: hypersensitivity, age up to 18 years, pregnancy, lactation.

Side effects: punctate keratitis, feeling of a foreign object in the eye, the formation of crusts on the edges of the eyelids, sinusitis, lacrimation, hyperemia, hypersensitivity reactions.

Indications

Indications for the use of NSAIDs are:

Joint diseases. However, in most cases they have only a symptomatic effect, without affecting the course of the pathology. NSAIDs are used for arthritis (rheumatoid, gouty, psoriatic), rheumatism, ankylosing spondylitis, Reiter's syndrome. The use of NSAIDs for arthrosis greatly facilitates the clinical manifestations of the disease.
Osteochondrosis, sciatica, sciatica, trauma, osteoarthritis, myositis. The course use of NSAIDs for hernia helps to eliminate pain.
Inflammatory processes in soft tissues, bursitis, synovitis.
Renal and hepatic colic. Drugs are used for the purpose of pain relief.
Fever. The antipyretic effect of drugs is used at temperatures above 38 degrees. For this purpose, NSAIDs are often used for children, mainly in the form of suppositories or syrup.
Pain of various etiologies(head, dental, postoperative).
In the complex therapy of coronary heart disease, atherosclerosis, heart failure, in order to prevent arterial thrombosis.
Dysmenorrhea and other gynecological pathologies. They are used to relieve pain and reduce blood loss.

Mechanism of action

Symptoms of most acute and chronic diseases include inflammation, pain, fever. Direct participation in the formation of these phenomena in the body is taken by bioactive substances - prostaglandins. Their production depends on cyclooxygenase enzymes, presented in two isoforms COX-1 and COX-2, which are targeted by the inhibitory effect of non-steroidal anti-inflammatory drugs.

Anti-inflammatory effect achieved by reducing the production of inflammatory mediators, reducing the permeability of the vascular walls;
blocking inflammation reduces irritation of nerve receptors, which helps to eliminate pain;
Impact on body thermoregulation causes a decrease in temperature during fever.

The difference between new generation drugs and classic NSAIDs lies in the selectivity of action. Classical drugs usually suppress not only the direct inflammatory mediator COX-2, but also COX-1, which is constantly present in the body, providing a protective effect on the gastric mucosa, platelet viability. As a result, there are many negative side effects, especially on the digestive tract. Modern safe NSAIDs, inhibiting only COX-2, significantly reduce the risk of side effects.

NSAIDs, even with prolonged use, do not cause addiction and dependence.

Dosage

The choice of the drug is carried out by the doctor, based on the type of disease and the desired therapeutic effect. This takes into account the patient's history, the presence of contraindications for admission, tolerability of the drug. The dosage is also set by the doctor, it is recommended to start with the lowest effective dose. With good tolerance, the norm is increased after 2-3 days.

Therapeutic dosages of drugs differ, while there is a tendency to increase the daily and single dose of drugs (Ibuprofen, Naproxen), which have a minimum number of side effects. Restrictions on the maximum intake per day of Aspirin, Indomethacin, Phenylbutazone, Piroxicam remain. The frequency of taking drugs in this group also varies and ranges from 1 to 3-4 times a day.

In some pathologies, the effectiveness of the use of these drugs is observed only at high dosages of drugs, while the combination of several NSAIDs is impractical (except for Paracetamol, which is combined with other drugs to enhance the effect).

Ways to receive

When using NSAIDs, one should take into account their features and adhere to certain rules for use:

Topical agents (gels, ointments), which are considered the safest NSAIDs, are distributed over the painful area. It is necessary to wait for absorption and only then put on clothes. Water procedures can be taken after a few hours.
When taking NSAIDs, it is necessary to strictly observe the dose prescribed by the doctor, not exceeding the daily dose. If symptoms persist, it is recommended to consult a doctor to change the drug to a more potent one.
Dosage forms for oral administration are preferably taken after eating, minimizing the damaging effect on the mucosa of the digestive tract. For a faster effect, it is possible to use half an hour before meals or 2 hours after. The protective shell from the capsules is not removed, you need to drink the product with a sufficient amount of water.
When using suppositories, a faster therapeutic effect is noted than with a tablet form. This method of administration is used in young children. To do this, the child is placed on the left side, and the suppository is inserted rectally, the buttocks are compressed. Within 10 minutes, make sure that the drug does not come out.
Injection requires sterility and certain medical skills.
When using medications, it is necessary to consult a doctor, since the action of NSAIDs is directed more to the elimination of symptoms than to treatment. In some cases, the analgesic effect can mask the symptoms of dangerous diseases (gynecological, digestive tract, etc.).
It is necessary to take into account the possible interaction of drugs with other medications taken. The joint use of NSAIDs with antibiotics (aminoglycosides), digoxin increases the toxicity of the latter. During therapy, there may be a weakening of the therapeutic effect of antihypertensive drugs. NSAIDs can increase the effect of indirect anticoagulants and hypoglycemic drugs.
The combined use of NSAIDs and alcohol significantly increases the likelihood of developing negative phenomena in the body.

Contraindications

When prescribing and taking NSAIDs, it is necessary to take into account possible contraindications to their use:

a pronounced degree of allergy to NSAIDs in history (bronchospasm, rash);
ulcers, bleeding in the digestive tract;
period of pregnancy and lactation;
severe heart disease;
pathology of the liver and kidneys of severe course;
violations of hemostasis;
old age (with prolonged therapy);
alcoholism;
children's age (for some dosage forms and preparations);

With caution, NSAIDs are prescribed to patients with bronchial asthma.

Side effects

NSAIDs of the new generation minimize the risk of negative effects, without irritating the mucous tissues of the digestive tract and hyaline cartilage. However, some side effects from taking NSAIDs, especially with prolonged therapy, are still present:

hypersensitivity reactions;
digestive dysfunctions: stool disorder, dyspepsia, gastropathy;
fluid retention in tissues, edema;
the presence of protein in the urine;
bleeding, mainly in the gastrointestinal tract;
increased activity of liver indicators;
aplastic anemia, agranulocytosis;
headaches, weakness, dizziness, increased blood pressure;
dry cough, bronchospasm.

In contact with

Classmates

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?

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 by 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:

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.

Classification

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

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.

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):

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

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

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

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.

Side effects

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.

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.

Celecoxib

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.

Indomethacin

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 drug, 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.

Diclofenac

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.

Ketoprofen

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.

What is NSAID

The action of non-steroidal NSAIDs is due to a reduction in the production of enzymes (cyclooxygenase) that trigger reactive processes in the body in response to the effects of pathological factors.

Classification

NSAIDs are classified according to several criteria.

By belonging to the generation of medicines:

First generation. The drugs of this group have long been present on the pharmacological market: Aspirin, Ibuprofen, Diclofenac, Voltaren, Naproxen and others.
New generation. This group includes Nise, Nimulid, Movalis, Arcoxia and others.

By chemical composition NSAID drugs may refer to acids or non-acid derivatives.

Salicylates: Aspirin.
Pyrazolidines: metamizole sodium NSAIDs (analgin). Despite the difference between analgesics and NSAIDs in chemical structure, they have common pharmacological qualities.

Non-acid agents include Nimesulide, Nabumeton.

According to the mechanism of action:

Non-selective inhibitors of COX-1 and COX-2 (cyclooxygenase enzymes) - inhibit both types of enzymes. Classical anti-inflammatory drugs belong to this species. The difference between NSAIDs of this group is in the blocking of COX-1, which are constantly present in the body. Their suppression can be accompanied by negative side effects.
Selective NSAID COX-2 inhibitors. The use of these drugs is preferable, since they act exclusively on enzymes that appear in response to pathological processes in the body. However, their increased effect on the heart and blood vessels is noted (they can cause an increase in blood pressure).
Selective NSAID COX-1 inhibitors. The group of such drugs is insignificant (aspirin), since by acting on COX-1, the active ingredient usually also affects COX-2.