Non-steroidal anti-inflammatory drugs. Nvp (nvs) - what is it? list of drugs. The main advantage of the new generation of NVP

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Non-steroidal anti-inflammatory drugs are a group of medicines widely used in medical practice. Their popularity in the treatment of various diseases is due to the pronounced ability to eliminate pain, temperature and foci of inflammation with high safety for the body. The analgesic and anti-inflammatory activity of NVPS has been proven by numerous medical tests.

They are more effective than "simple" painkillers, and some drugs are close in strength to centrally acting analgesics and opioids.

Mechanisms of action of NSAIDs

The main mechanism of action of NSAIDs, which characterizes their effectiveness and toxic effects, is inhibition of cyclooxygenase activity. It is an enzyme that regulates the conversion of arachidonic acid to prostaglandins, thromboxane and prostacyclin. The anti-inflammatory effect of NSAIDs may also be due to a slowdown in fat peroxidation, stabilization of the lysosome membrane, a decrease in ATP synthesis, a slowdown in neutrophil aggregation, and inhibition of the formation of rheumatoid factor in people suffering from rheumatoid arthritis.

Historical facts

The beginning of the use of non-steroidal anti-inflammatory drugs refers to 46-377 years. BC e., when Hippocrates used willow bark for pain relief and mitigation of inflammation. This fact was confirmed by Celsius in the 30s. n. e. Further mention of the properties of the bark dates back to 1763, and in 1827, when chemists managed to isolate a chemical from a natural material, which turned out to be salicin, a precursor to NSAIDs.

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Irina Martynova. Graduated from the Voronezh State Medical University. N.N. Burdenko. Clinical intern and neurologist of BUZ VO \"Moscow Polyclinic\".

In 1869, salicylic acid was obtained - a more effective substance, which is a derivative of salicin. After the experiments, it became clear that it can damage the gastric mucosa, and scientists began to search for new, safer means. In 1897, the Bayer company and the scientist Felix Hoffman converted the toxic salicylic acid into acetylsalicylic acid. The drug was named Aspirin.

For a long time, aspirin was the only NSAID compound, but since 1950, pharmacologists have received new drugs from the NSAID group, which have become more effective and safer than the previous ones.

Steroid and non-steroidal - differences

To eliminate edema, non-steroidal drugs are also used in medicine. Steroids are produced on the basis of glucocorticoids - hormones of the adrenal glands. Non-steroidal anti-inflammatory drugs have similar effectiveness, but their difference lies in the fact that they do not have characteristic pronounced side effects in the form of hypertension, the development of diabetes mellitus, and do not cause addiction to the body, requiring each time to increase the dosage to achieve a similar effect.

What are the release forms?

NSAIDs are available both in the form of capsules and tablets for oral administration, and in the form of ointments, suppositories, gels and injection solutions. This diversity allows more efficient use of the drug. The use of drugs in the form of injections minimizes the negative effects of drugs on the gastrointestinal tract, but at the same time can cause tissue necrosis.

For this reason, NSAID injections are never used for a long time.

Classification

To date, several dozen drugs are produced in the world, which include selective and non-selective NSAIDs, but in Russia only a part of them have been registered and are used. Their classification can be presented as follows:

By chemical structure:

Salicylates are the oldest group, of which only Aspirin (acetylsalicylic acid) is currently used;
Propionic acid derivatives - Ketoprofen, Ibuprofen, Naproxen;
Acetic acid derivatives - Diclofenac, Indomethacin, Aceclofenac, Ketorolac;
Pyrazolidins - Phelilbutazone, Analgin, Metamizole sodium;
Selective COX-2 inhibitors are considered the safest agents, of which only Rofecoxib and Celecoxib are used in Russia;
Non-acidic - sulfonamides, alkanones;
Other NSAIDs, which include Mefenamic acid, Piroxicam, Nimesulide, Meloxicam.

Quite often, the list of non-steroidal anti-inflammatory drugs is included, which has analgesic and antipyretic effects, but in fact the drug is not included in this group. Its anti-inflammatory activity is very weak, and its analgesic and antipyretic effect is due to the blocking of COX-2 in the central nervous system.

By efficiency. The following painkillers have the most pronounced effect: Diclofenac, Indomethacin, Ketoprofen, Ketorolac. Ibuprofen has the least pronounced analgesic effect. Piroxicam, Indomethacin, Diclofenac, Piroxicam relieve inflammation as quickly as possible. Aspirin, Nise and Nurofen are able to quickly remove the temperature.

New generation drugs. They were created in order to reduce the side effects of drugs of this class on the body. Such drugs are Movalis and Piroxicam, Nise, Arcoxia, which, in addition to selective action, have a prolonged elimination period (long excreted), thereby enhancing the therapeutic effect.

For the treatment of joints

They are used as the basis of drug therapy, especially in the acute stage of the disease, quickly relieving pain, swelling and inflammation. For this use:

in the form of an ointment. The action of the agent is similar to preparations containing, but has a lower efficiency and a pronounced warming effect. Contraindicated in ulcers in the gastrointestinal tract, pregnancy and lactation, bronchial asthma. Price - 43-344 rubles.
- An analogue of Diclofenac with antipyretic, anti-inflammatory and analgesic effects. It is used for inflammatory diseases of the OP. Contraindicated in the "aspirin triad", hypersensitivity, erosive and ulcerative diseases and bleeding in the gastrointestinal tract, liver and kidney diseases, pregnancy, childhood, hyperkalemia and after coronary artery bypass grafting. Price - 134-581 rubles.
- has an auto-aggregate effect, effectively relieves pain and fever. Contraindicated in erosive and ulcerative diseases of the gastrointestinal tract, disorders of porphyrin metabolism, diseases of the liver and kidneys, pregnancy and lactation, under the age of 14 years and hypersensitivity. Price - 35-89 rubles.

At

The following non-steroidal anti-inflammatory drugs are used:

. It has a pronounced anti-inflammatory, analgesic, and moderate antipyretic effect, it is successfully used for spinal hernia. Contraindicated in ulcers and erosions in the gastrointestinal tract, pregnancy and lactation, allergies caused by taking NSAIDs. Price - 14-75 rubles.
. NSAIDs of a new generation, available in the form of tablets, suppositories and injections, are practically devoid of side effects. Price - 502-850 rubles.
. It has a strong anti-inflammatory, moderate analgesic and mild antipyretic effect. Contraindicated in ulcers and bleeding in the gastrointestinal tract, renal and hepatic insufficiency, pregnancy and lactation, under the age of 12 years and hypersensitivity. Price - 126-197 rubles.

With a hernia of the spine

In case of protrusion of the intervertebral disc, the following drugs are used for hernia:

- effectively relieves fever and pain, has a slight anti-inflammatory effect. Contraindicated in leukopenia, severe anemia, hepatic and renal insufficiency and hypersensitivity to the drug. Price - 345-520 rubles.
- has a pronounced analgesic, antipyretic and anti-inflammatory effect, blocks the enzyme involved in inflammatory processes. Contraindicated in peptic ulcers, renal and hepatic insufficiency, "aspirin triad" and hypersensitivity. Price - 502-850 rubles.
- the basic drug used in diseases of the musculoskeletal system, has anti-inflammatory, antipyretic and analgesic effects in spinal hernia. Contraindicated in erosive lesions in the gastrointestinal tract, "aspirin triad", pregnancy, hepatic and renal insufficiency, oppression of hematopoiesis, in childhood and with hypersensitivity reactions. Price 121-247 rubles.

At

. It exhibits analgesic, anti-inflammatory, antipyretic properties that can relieve a neuralgic attack, inhibits platelet adhesion. Contraindicated in ulcers in the gastrointestinal tract, severe disorders of the liver and kidneys, pregnancy, breastfeeding and in childhood, hypersensitivity. Price - 44-125 rubles.
Nise. Nimesulide, which is part of the composition, has antipyretic, anti-inflammatory, analgesic and antiplatelet effects. Contraindicated in acute ulcerative manifestations and bleeding in the gastrointestinal tract, severe disorders of the liver and kidneys, pregnancy and lactation, under the age of 2 years and intolerance to the drug. Price - 173-424 rubles.
. It has a pronounced analgesic, antipyretic, as well as a weak antispasmodic and anti-inflammatory effect. Contraindicated in hypersensitivity, oppression of hematopoiesis, liver or kidney failure, "aspirin" asthma, leukopenia, pregnancy and lactation, anemia. Price - 27-60 rubles.

With osteoarthritis

The following drugs are used:

, more often used in the form of an ointment, gel or cream, has an analgesic and anti-inflammatory effect, relieves swelling associated with inflammation. Contraindicated in hypersensitivity, allergic rhinitis, attacks of bronchial obstruction, pregnancy and lactation, violations of the integrity of the skin at the site of application, under the age of 14 years and in conjunction with drugs, including phenylbutazone. Price - 119-206 rubles.
, is used as a new generation drug for arthrosis. It has analgesic, anti-inflammatory and antipyretic effects. Contraindicated in hypersensitivity, heart failure and arrhythmia, liver disease and stomach ulcers, leukopenia and pregnancy. Price 220-475 rubles.
. It has analgesic, anti-inflammatory and antipyretic effects. Contraindicated in erosive and ulcerative lesions in the gastrointestinal tract, "aspirin" asthma, rhinitis, urticaria caused by taking NSAIDs, severe impairment of kidney function, pregnancy and lactation, hypersensitivity. Price - 120-345 rubles.

For gout

The following NSAIDs are used:

, is produced in the form of tablets and ointments. The maximum effectiveness of the drug is ensured after the simultaneous use of both forms of the drug. It is forbidden for hypersensitivity, ulcerative bleeding, inflammatory diseases in the gastrointestinal tract, hyperkalemia, liver and kidney failure, pregnancy and lactation. Price - 173-380 rubles.
Other NSAIDs - Ibuprofen.

Cheap drugs

Ibuprofen (analogue). Price (tablets) - 14-26 rubles.
sodium (similar to Voltaren tablets). Price: tablets - 14-35 rubles, gel or ointment - 32-75 rubles.
Meloxicam (similar to Movalis tablets). Price - 31-84 rubles.
Acetylsalicylic acid (Aspirin). Price - 7-17 rubles.
Analgin. Price - 27-60 rubles.

Criterias of choice

All NSAIDs are modern and effective medicines, but when choosing a particular drug, you need to know some features. So, if you need to buy one of the three drugs -, or, the seller in the pharmacy will most likely offer a more expensive option, despite their identity with respect to the active substance. The situation is similar when choosing Indomethacin, or Metindol.

In addition to the identical active substance, when choosing an analogue of the agent, it is necessary to pay attention to the accompanying components, since the analogue of the usual drug may contain components that can cause an allergic reaction. Also, in the analogue of the drug there may be a different dosage of the active substance or a retarded form (long-acting).

All the features of the drug are indicated in the instructions or on the packaging, and before use it is subject to careful study.

Application

Since non-steroidal anti-inflammatory drugs can cause various side effects, the following rules must be followed before using them:

Mandatory familiarization and strict adherence to the recommendations set out in the instructions.
Capsules or tablets taken orally, be sure to drink a glass of water, which will protect the stomach. The rule applies, among other things, to the most modern means, which are the safest.
After taking the product inside, it is recommended not to take a supine position for at least 3 minutes, so that under the influence of gravity the capsule would better pass down the esophagus.
Simultaneous intake of drugs and alcohol-containing substances can provoke stomach diseases. At the time of the course of taking NSAIDs, alcohol is completely abandoned.
It is not recommended to take two non-steroidal drugs on the same day, as this sums up side effects, and will not bring an increase in action.
If the drug is ineffective, the doctor must be informed to find out the cause, adjust the dose and more carefully select the remedy.

Indications for use

NSAIDs are among the most commonly used drugs in medicine. So, they are assigned to 1/5 of the patients to eliminate pain and inflammation in diseases related to the following areas:

Rheumatology.
Gynecology.
Traumatology.
Surgery.
Dentistry.
Neurology.
With eye diseases.

The analgesic effect of NSAIDs is especially effective for:

Dysmenorrhea.
Pain syndrome of various origins - dental, head, muscular.
Migraine.
Renal colic.

The ability to reduce high temperature causes the use of drugs for "cold" diseases and in emergency situations when hyperthermia threatens a person's life. Then the drugs are administered parenterally as a means of emergency therapy. NSAIDs are widely used to treat sports injuries and treat complications from chemotherapy sessions.

Aspirin's ability to thin the blood has been used to prevent thrombosis.

NSAIDs are used in the treatment of various stages of inflammation, accompanied by pain. These pathologies include the following diseases:

and pain.
Acute and migraine.
Pain accompanying menstruation.
Rheumatoid arthritis and.
Pain in the bones with metastases.
Pain associated with Parkinson's disease.
Fever (feeling feverish).
Moderate pain after soft tissue injury or inflammation.
Intestinal obstruction.
Renal colic.
postoperative pain.

NSAIDs can be used to treat newborns who do not close the ductus arteriosus within 2 days after birth.

Contraindications

Ulcerative manifestations and the presence of bleeding in the stomach.
Uncontrolled arterial hypertension.
Kidney diseases.
Inflammation of the intestines.
Stroke, myocardial infarction and transient ischemic attack in the past, as well as cardiac ischemia (except Aspirin).
Bypass grafting of the coronary artery and stomach.
thrombocytopenia.

special instructions

With long-term use of NSAIDs, the state of the blood and the functioning of the liver and kidneys should be monitored, which is especially important for patients over 65 years of age. With extreme caution, funds are used in patients suffering from high blood pressure, problems with the cardiovascular system, leading to fluid retention in the body.

It should be fate that this type of drugs is able to mask the symptoms of infectious diseases and affect the ability to concentrate.

What drugs are best for children?

NSAIDs can be used in childhood for the treatment of inflammatory processes, accompanied by swelling, high fever, inflammation of the lymph nodes and pain. Means should be used with extreme caution, as they can cause irritation of the gastric mucosa, allergies, problems with breathing, vision and hearing, internal bleeding.

In the treatment of inflammatory diseases in children, mefenamic acid is also used due to the absence of serious side effects, but at the same time they can provoke indigestion or constipation. To eliminate foci of inflammation and temperature, use Aspirin.

Prescribing medications is done only by a doctor who carefully adjusts the dosage to prevent possible side effects.

Flaws

The main disadvantage of non-steroidal anti-inflammatory drugs is is gastrointestinal toxicity. Prostaglandins belonging to group E play a major role in gastroduodenal protection. With a decrease in the concentration of prostaglandins in the gastric mucosa under the influence of drugs, this protection is violated, causing ulcers, erosions and other lesions. Under the influence of NSAIDs, a stomach ulcer develops in 30% of cases. They also have a destructive effect on the duodenal mucosa, increasing the risk of ulcers, perforations and bleeding in it.

In contact with

Classmates

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

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

How NSAIDs work

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

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

When are NSAIDs used?

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

We list the diseases for which these medicines are prescribed:

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

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

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

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

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

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

The main advantage of NSAIDs of a new generation

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

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

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

What are new generation NSAIDs?

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

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

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

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

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

Acid preparations:

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

Non-acid drugs:

Sulfonamide derivatives;
Alcanones.

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

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

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

By analgesic effect drugs are listed in the following order:

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

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

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

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

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

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

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

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

Use in pregnancy

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

Description of non-steroidal anti-inflammatory drugs Movalis

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

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

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

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

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

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

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

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

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

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

Chondroprotectors - alternative drugs

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

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

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

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

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

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

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

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

Types behind the mechanism of action

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

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

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

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

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

Major non-selective NSAIDs

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

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

Selective COX-2 inhibitors

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

Main indications, contraindications and side effects

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

Table. Non-steroidal anti-inflammatory drugs - indications

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

This can be explained by their actions:

Anti-inflammatory;
Antipyretic;
Analgesic.

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

What it is?

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

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

Now we will look at them in more detail.

The effect of these drugs

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

PGs have the following focus:

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

Indication for use

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

Most often, drugs in this group are prescribed for:

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

Release form

NSAIDs are produced in the following forms:

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

Classification of non-steroidal anti-inflammatory drugs

There are several classifications of the described group.

By chemical structure:

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

All drugs in this group are divided into 2 types:

Type 1 cyclooxygenase inhibitors;
Type 2 cyclooxygenase inhibitors.

List of first generation drugs

List of second generation drugs

Movalis.
Nise.
Nimesil.
Arcoxia.
Celebrex.

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

List of the most effective NSAIDs

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

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

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

Impact principle

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

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

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

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

New developments

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

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

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

Indications for use

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

A positive impact is noted with the following factors:

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

Classification

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

The classification of NSAIDs implies a division into two groups:

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

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

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

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

Side effects

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

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

The main side effects can be:

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

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

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

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

Effective analgesics are Ketorolac, Ketoprofen, Indomethacin, Diclofenac.

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

The drug "Movalis"

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

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

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

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

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

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

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

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

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

The opinion of consumers about the drug

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

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

The drug "Celecoxib"

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

The indications for use given in the instructions are:

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

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

Consumer opinion

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

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

The drug "Nimesulide"

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

The remedy is used for:

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

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

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

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

The average price of a medicine is 76.9 rubles.

There is practically no such disease in which non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) would not be used. This is a huge class of injection tablets and ointments, the ancestor of which is the usual Aspirin. The most common indications for their use are joint diseases, accompanied by pain and inflammation. In our pharmacies, both long-tested, well-known drugs, and anti-inflammatory non-steroidal drugs of the new generation are popular.

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

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

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

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

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

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

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

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

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

These include:

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

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

These are such selective non-steroids as:

Nimesil;
Nise;
Nimesulide;
Celebrex;
Indomethaxin.

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

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

This includes:

Lornoxicam;
Piroxicam;
Meloxicam;
Tenoxicam.

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

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

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

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

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

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

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

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

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

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

In Europe, where all NSAIDs are prescription drugs, over-the-counter Paracetamol (taken as a pain reliever up to 6 tablets per day) is in wide use. There appeared such a medical concept as “paracetamol liver damage”, that is, cirrhosis while taking this medication.

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

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

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

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

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

The best drugs

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

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

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

Ketoprofen;
Voltaren or Diclofenac;
Indomethacin;
Xefocam or Lornoxicam.

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

Xefocam

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

Available in the form:

tablets;
injections.

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

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

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

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

Nimesulide

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

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

Available as:

powders;
suspensions;
gels;
tablets.

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

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

Release form:

candles;
tablets;
injections.

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

Celecoxib

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

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

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

Rofecoxib

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

Available as:

injection solutions;
tablets;
candles;
gel.

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

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

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

Non-steroidal anti-inflammatory drugs- an extensive group of drugs in medicine, prescribed for the relief of pain, lowering the temperature in various diseases. Medicines have not only a pronounced therapeutic effect, but also certain contraindications, side effects.

Non-steroidal anti-inflammatory drugs have a number of contraindications

Classification of NSAIDs

In pharmacology, different signs are used to distribute non-steroidal anti-inflammatory drugs.

By chemical structure

According to the chemical structure and activity, drugs are divided into acidic and non-acidic drugs.

Groups of acid preparations:

oxicam - Meloxicam, Piroxicam;
preparations based on indoleacetic acid - Indomethacin, Sulindac;
drugs that contain propionic acid - Ketoprofen, Ibuprofen;
salicylates - Aspirin;
preparations based on phenylacetic acid - Diclofenac, Aceclofenac;
pyrazolone derivatives - Analgin, Phenylbutazone.

Aspirin belongs to the group of salicylates.

Non-acid agents include alkanones (Nabumeton), sulfonamides (Nimesulide), coxibs (Celecoxib, Rofecoxib).

All non-steroidal drugs have a similar mechanism of action, have a non-specific effect on inflammatory enzymes, therefore, they well eliminate pain of various origins, cope well with fever during colds and flu. But for each drug, this or that action is somewhat more pronounced than for other drugs of the same group.

According to the principle of general action

According to the mechanism of action, NSAIDs are classified into selective and non-selective drugs.

non-selective NSAIDs

The body produces 2 types of cyclooxygenase enzymes. COX-1 appear only as a response to the inflammatory process, COX-2 protects the walls of the stomach from the influence of negative factors.

Non-selective NSAIDs inhibit the synthesis of COX-1 and COX-2, therefore, they have an extensive list of adverse reactions, this group includes most nonsteroidal drugs.

Indications - high fever, migraine, gynecological and dental diseases, biliary colic, chronic prostatitis. But most often, NSAIDs are prescribed to eliminate the manifestation of problems with joints, muscles - arthritis, arthrosis, myositis, bruises, sprains, fractures. The main contraindications are peptic ulcer, poor blood clotting, kidney and liver pathologies, asthma.

List of popular non-selective NSAIDs

Pharmaceutical companies are constantly trying to reduce the negative impact of NSAIDs on the gastrointestinal tract, so modern non-selective drugs are safe, have a long period of action, which allows you to take drugs once a day.

List of non-selective NSAIDs of the new generation:

Movalis is an effective remedy, there are solutions for injections, pills, ointments on sale, the medicine has a powerful antipyretic effect, quickly eliminates pain and signs of inflammation.
Xefocam is one of the best remedies for relieving an acute attack of pain, the action of the drug is similar to morphine, but it belongs to non-narcotic drugs. Available in tablets and powder.
Nimesulide - tablets and gel with a pronounced anti-inflammatory effect, help well with back and joint pain, the medicine eliminates hyperemia, swelling, signs of the inflammatory process, improves mobility.
Aertal - in terms of therapeutic effect, the drug is similar to Diclofenac, but has greater selectivity, is produced in tablets, powder for suspensions, in the form of a cream.

During long-term treatment with NSAIDs, it is necessary to regularly monitor the functioning of the liver, kidneys, and blood counts, this is especially true for elderly patients.

Movalis is an effective non-steroidal agent

selective NSAIDs

Most modern NSAIDs are selective inhibitors, they block only the inflammatory enzyme, as practice shows, they have a more gentle effect on the gastrointestinal tract, so the risk of ulcers and bleeding is reduced, but the likelihood of blood clots increases. The disadvantage is the high cost.

Selective drugs are more effective than non-selective drugs, the therapeutic effect is observed within 20-30 minutes after taking the medicine, they are successfully practiced in severe joint diseases - infectious non-specific polyarthritis, rheumatoid spondylitis and arthritis, gout, osteoarthritis, osteochondrosis.

List of the best NSAIDs:

Celebrex - capsules to eliminate fever, pain and inflammation, significantly reduce the risk of colon cancer. The medicine helps well with arthritis, osteochondrosis.
Firocoxib is a highly selective drug in the form of tablets.
Rofecoxib - the drug quickly copes with pain, swelling with bursitis, tendonitis, sprains, eliminates fever, headache and toothache of varying degrees of intensity. Produced in the form of tablets, suppositories, solution for injections, gel.

Celebrex is a selective drug

But even drugs that do not affect the stomach should not be taken in the presence of internal bleeding, perforation of the gastrointestinal mucosa, which occurred while taking NSAIDs. Potent medicines are also contraindicated in severe forms of dysfunction of the kidneys, liver, heart, hemocoagulation disorders, aspirin asthma.

NSAIDs are antiplatelet agents, they are prescribed for diseases of the heart and blood vessels - ischemia, angina pectoris, prevention of stroke, heart attack, hypertension.

Non-steroidal anti-inflammatory drugs during pregnancy

NSAIDs have teratogenic properties, can provoke a miscarriage, cause the development of severe pathologies in a newborn, so it is dangerous to take these drugs during pregnancy.

NSAIDs pass into breast milk in small amounts, but there is no reliable data on how safe such doses are for children, so doctors recommend refraining from taking these drugs during lactation, or taking drugs with a short half-life after feeding.

What analgesics can be taken by lactating and pregnant women? Paracetamol, drugs based on ibuprofen can be drunk in the I, II trimester.

NSAIDs can prevent or delay the onset of ovulation, negatively affect human reproductive functions, but how great this risk is has not yet been clinically identified.

NSAIDs for children

Due to the large number of negative reactions, the destructive effect on the gastric mucosa, the ability to thin the blood, most NSAIDs are prohibited for the treatment of children.

Medicines based on nimesulide, ibuprofen and paracetamol, in the form of suppositories and suspensions, are considered safe for children. The main indications are fever, colds, headache, teething.

List of safe NSAIDs for children:

Ibuprofen, Nurofen, Ibuklin, Ibufen - drugs help reduce fever, are effective painkillers, adverse reactions are rare, and are used in pediatrics for children older than 3 months.
Paracetamol, Panadol, Efferalgan - can be given to children older than 2 months, but these medicines are not recommended to be given to a child in the presence of liver pathologies.
Nimesulide, Nise, Nimesil - representatives of the latest generation of NSAIDs, have a long analgesic effect, are used to treat children over 12 years old.

Nimesulide can be given to children over 12 years of age

The most dangerous for children are derivatives of acetylsalicylic acid - Aspirin, Citramon, they should not be taken by patients under 16 years of age. These drugs can provoke the development of Reye's syndrome, the disease is accompanied by encephalopathy and depression of liver function.

How to protect the stomach when taking nonsteroidal drugs?

NSAIDs negatively affect the integrity of the gastric mucosa, which often causes the development of ulcers, erosions, gastritis, and internal bleeding. To avoid the occurrence of such dangerous complications, it is necessary to adhere to certain rules.

How to reduce the negative impact of NSAIDs:

It is strictly forbidden to drink alcohol while taking nonsteroidal drugs, otherwise the risk of erosions and ulcers increases significantly.
Tablets should not be taken on an empty stomach, you need to drink the medicine during meals, drink plenty of purified water or milk.
Be sure to study the interaction of other medicines with NSAIDs in the instructions.
During treatment, you must not only strictly observe the dosage, but also follow the regimen, try to take the medicine at the same time.
To protect the stomach from the negative effects of NSAIDs, it is necessary to take proton pump inhibitors in parallel with them - Omeprazole, Pantoprazole.

Omeprazole helps to cope with the negative effects of NSAIDs

If you have to take non-steroidal anti-inflammatory drugs for a long time, you need to do a gastroscopy, get tested for the presence of Helicobacter pylori bacteria - this will help to avoid the development of severe stomach problems.

NSAIDs are the most popular group of medicines in the world, but they must be taken wisely, clearly follow the instructions. If the dosages are not observed, internal bleeding, ulcers may occur, with extreme caution, drugs are prescribed to pregnant lactating women, children, and the elderly.

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 through the enzyme phospholipase A2. Prostaglandins, among other functions, are mediators and regulators in the development of inflammation. This mechanism was discovered by John Wayne, who later received the Nobel Prize for his discovery.

When are these drugs prescribed?

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

List the diseases that prescribe these drugs:

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