Anti-inflammatory drugs are a quick help for joint diseases. Painkillers and anti-inflammatory ointments: a list of drugs, indications, instructions

NSAIDs or non-steroidal anti-inflammatory drugs are a special group of drugs with an active analgesic effect. Potent compounds also have anti-inflammatory, antipyretic properties.

In many diseases of the musculoskeletal system, drugs of the NSAID group are included in the list of drugs that are mandatory for use. Useful information about the properties, action, indications and contraindications will help you understand how NSAIDs differ from other anti-inflammatory drugs.

The action of medicines

The effectiveness of NSAID drugs is easy to understand if you know the mechanism of inflammation. The progression of the process is accompanied by pain, fever, swelling, deterioration of health. The production of prostaglandins directly depends on a special enzyme - cyclooxygenase or COX. It is this component that non-steroidal anti-inflammatory compounds act on.

Why do some NSAIDs have more side effects while others have less? The reason is in the action on varieties of the cyclooxygenase enzyme.

Peculiarities:

• compounds with indiscriminate action inhibit the activity of both types of enzymes. But COX - 1 has a positive effect on the viability of platelets, protects the gastric mucosa. The suppression of the activity of this enzyme explains the negative effect of NSAIDs on the gastrointestinal tract;
• new generation drugs suppress the activity of only COX-2, which is produced only in case of deviations from the norm against the background of other inflammatory mediators. It is the selective action of new drugs, without suppressing the production of COX-1, that explains the high efficiency with a minimum number of negative reactions of the body.

Information for patients! It is forbidden to independently choose a drug to relieve inflammation and pain in articular pathologies. Certain non-steroidal compounds have an additional effect on the body systems: they improve blood flow, artificially suppress the immune system. The use of inappropriate formulations with comorbidities can provoke gastric bleeding and cause other dangerous manifestations.

What is the difference between non-steroid drugs and steroid hormones

Many patients believe that both groups of drugs are in many ways similar, the difference is only in the strength of the effect. But when analyzing the chemical composition, it turns out that potent compounds have many differences.

NSAIDs are substances that the body perceives as foreign elements. The reason is the presence of its own anti-inflammatory system. The production of protective steroid hormones occurs in the adrenal glands.

Potent preparations of the group of glucocorticosteroids contain synthetic analogs of hormones that are produced by the adrenal glands. NSAIDs are non-hormonal in nature, exhibit weaker side effects than any hormonal agents, including glucocorticosteroids.

Benefit

Without taking anti-inflammatory drugs, it is impossible to save the patient from the painful symptoms of articular pathologies. Stronger than NSAIDs are only opioid formulations that have many negative effects that cause addiction.

After the use of NSAIDs, signs of inflammation decrease or disappear:

• pain;
• high local and general temperature;
• tissue swelling;
• reddening of the skin over the focus of destruction.

General application rules

Potent drugs for articular pathologies are allowed for oral administration, injection into the rectum, injections, or skin treatment only as directed by a doctor. Patient-initiated use of NSAIDs is often harmful.

Before starting the course, the doctor takes into account the following factors:

• general condition of the patient;
• presence/absence of systemic pathologies, infectious and chronic diseases;
• patient's age;
• types of drugs for maintenance therapy that the patient takes for a long period;
• contraindications (absolute and relative);
• the severity of articular pathology.

Four important rules for minimizing side effects:

• exact observance of a single and daily dosage, the duration of the course - exceeding the normative indicators is fraught with serious complications, up to anaphylactic shock and coma;
• the use of capsules, the application of ointments, the introduction of suppositories only after eating for a milder effect on the mucous membrane of the digestive tract;
• refusal of self-treatment, replacement on one's own initiative of one type of drug with an analogue;
• it is obligatory to take into account the interaction of the prescribed agent and other drugs that the patient takes constantly (antihypertensive compounds, diuretics).

Important! It requires immediate withdrawal of the drug, contacting a doctor or calling an ambulance in case of sharply negative reactions after taking a potent composition in tablets, capsules or other dosage form.

Indications for use

Drugs that relieve pain, swelling, and inflammation are indispensable in the treatment of many joint pathologies. The range of application of NSAIDs is wider: negative processes weaken in various parts of the body, but in diseases of the articular-ligamentous apparatus, injuries, non-steroidal compounds are prescribed most often.

The high efficiency of NSAIDs was noted in the following diseases and negative conditions:

• pain syndrome after arthroscopy, other operations on the joints;
• purulent arthritis;
• inflammatory arthropathy;
• neurological diseases;
• bone metastases.

Non-steroidal formulations for relieving inflammation reduce negative symptoms in sports injuries, severe bruises, fractures, torn / sprained ligaments, meniscus tear, and other types of damage to the articular-ligamentous apparatus.

Contraindications

A high risk of side effects, an active effect on various parts of the body limits the range of patients who can use NSAIDs. The compositions of the new generation have fewer negative manifestations after application, but are also not suitable for everyone.

Reception of NSAIDs is prohibited in the following cases:

• diseases of the digestive system, severe hepatic and renal pathologies;
• ulcers, erosions in the stomach and intestines;
• period of pregnancy and lactation;
• cytopenia;
• increased sensitization of the body, sensitivity to the active substance or auxiliary components of the drug.

Important! Many compositions have age restrictions. Be sure to study the instructions, taking potent drugs only as prescribed by the doctor.

Possible side effects

Negative manifestations depend on the type of drug (traditional or new generation), the chemical composition of the drug, the patient's health status. The instructions for each remedy indicate possible side effects.

The main disturbances in the functioning of organs and systems during therapy with the use of NSAIDs:

• microerosion, peptic ulcers in the stomach, erosion of the small and large intestines;
• headache, sleep disturbance;
• increased angina pectoris, heart failure, increased blood pressure;
• drowsiness, aseptic meningitis;
• violation of the composition of the blood (thrombocytopenia, various types of anemia);
• progression of degenerative-dystrophic changes in weakened cartilage;
• exacerbation of bronchial asthma, allergic rhinitis;
• violation of the level of transaminases in the liver.

To protect the digestive organs, the doctor will prescribe medications that prevent microtrauma of the walls of the stomach and intestines.

Overview of effective drugs

Classification of drugs with analgesic, anti-inflammatory, antipyretic effect is carried out according to the active substance. Preparations have different activity and chemical composition.

The main types of non-steroidal anti-inflammatory compounds.

The most powerful anti-inflammatory effect is provided by drugs:

• Diclofenac.
• Indomethacin.
• Flurbiprofen.
• Piroxicam.

An excellent analgesic effect is given by the following drugs:

• Diclofenac.
• Ketoprofen.
• Ketorolac.
• Indomethacin.

Medicines of the NSAID group enter the pharmacy network in various forms: tablets, capsules, rectal suppositories, solution and lyophilisate for injection. Some formulations are only suitable for external use: gels and ointments.

In what cases is it carried out and what does it show? We have an answer!

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Go to the address and find out effective methods of treatment of spondylosis of the lumbosacral spine.

New generation NSAIDs

Features of drugs:

• prolonged action;
• the highest activity in eliminating negative symptoms;
• selective action (active components inhibit the activity of COX - 2, but COX - 1 is not involved in the process);
• a shorter list of side effects;
• there is practically no negative effect on the gastrointestinal tract.

Items:

• Meloxicam.
• Ksefokam.
• Rofecoxib.

NSAIDs of the new generation have a lot of positive feedback on the application. The disadvantage of modern medicines is one - the cost does not suit everyone. The price of drugs with a long half-life: tablets - from 200 rubles for 10 pieces, lyophilisate for injection - from 700 rubles for 5 ampoules.

The cost of medicines

The price range is quite wide. Traditional drugs with a negative effect on the gastrointestinal tract are cheaper than modern analogues. The difference in cost depends on the pharmaceutical company, the name of the pharmacy chain, and the sales region.

Average prices for popular drugs of the NSAID group:

• Indomethacin. From 45 rubles (ointment) to 430 rubles (suppositories).
• Nimesulide. From 130 to 170 rubles (tablets).
• Diclofenac. Tablets cost from 15 to 50 rubles, gel - 60 rubles, solution - 55 rubles, suppositories - 110 rubles.
• Piroxicam. Capsules cost 30-45 rubles, gel - from 130 to 180 rubles.
• Celecoxib. Tablets (10 pieces) cost, on average, 470 rubles, a pack of 30 tablets costs 1200 rubles.
• Ketoprofen. Gel - 60 rubles, tablets - 120 rubles.
• Naproxen. The cost of tablets is from 180 to 230 rubles.
• Meloxicam. Tablets cost from 40 to 70 rubles, injection solution - from 170 to 210 rubles.
• Aspirin. Tablets - 80 rubles, Aspirin Complex (effervescent powder for preparing a solution for oral administration) - 360 rubles.

Non-steroidal anti-inflammatory drugs quickly stop the destructive processes in the joints, alleviate the course of many diseases of the musculoskeletal system. The use of potent compounds requires caution, strict adherence to instructions, and taking into account restrictions. As part of the complex therapy of many articular pathologies, NSAIDs have a positive effect on problem areas, slow down negative changes in bone and cartilage tissue.

Should I take non-steroidal anti-inflammatory drugs on an empty stomach, can I drink alcohol while taking them, and how do these drugs combine with other drugs? Answers in the next video:

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:

1. COX-1 is a protective enzyme of the gastric mucosa, protecting it from acidic contents.
2. 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.

1. 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.
2. 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 (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 most famous representatives of the NSAID group are for most of us aspirin (), 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.

Responsible for triggering the mechanism for the appearance of these prostaglandins is a group of enzymes called cyclooxygenases (COX) . The main action of non-steroidal drugs is aimed at blocking 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.

List of NSAIDs

Major non-selective NSAIDs

Acid derivatives:

• 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 have a number of contraindications that must be taken into account. Drugs are not recommended for treatment if the patient:

• peptic ulcer of the stomach and duodenum;
• kidney disease - limited intake is allowed;
• blood clotting disorder;
• the period of gestation and breastfeeding;
• Previously, pronounced allergic reactions to drugs of this group were observed.

In some cases, the formation of a side effect is possible, as a result of which the composition of the blood changes (a “fluidity” appears) and the walls of the stomach become inflamed.

The development of a negative result is explained by inhibition of the production of prostaglandins not only in the inflamed focus, but also in other tissues and blood cells. In healthy organs, hormone-like substances play an important role. For example, prostaglandins protect the lining of the stomach from the aggressive effects of digestive juice on it. Therefore, taking NVPS contributes to the development of gastric and duodenal ulcers. If a person has these diseases, and he still takes "illicit" drugs, then the course of the pathology can worsen up to perforation (breakthrough) of the defect.

Prostaglandins control blood clotting, so a lack of them can lead to bleeding. Diseases for which examinations should be carried out before prescribing a course of NVPS:

• violation of hemocoagulation;
• diseases of the liver, spleen and kidneys;
• Varicose veins;
• diseases of the cardiovascular system;
• autoimmune pathologies.

Also, side effects include less dangerous conditions, such as nausea, vomiting, loss of appetite, loose stools, and bloating. Sometimes skin manifestations in the form of itching and a small rash are also fixed.

Application on the example of the main drugs of the NSAID group

Consider the most popular and effective medicines.

Attention! The tables show dosages for adults and adolescents whose body weight exceeds 50-50 kg. Many drugs for children under 12 years of age are contraindicated. In other cases, the dosage is selected individually, taking into account body weight and age.

In order for the drug to act as soon as possible and not cause harm to health, one should adhere to the well-known rules:

• Ointments and gels are applied to the painful area, then rubbed into the skin. Before putting on clothes, it is worth waiting for complete absorption. It is also not recommended to take water procedures for several hours after treatment.
• Tablets must be taken strictly as directed, not exceeding the daily allowable rate. If the pain or inflammation is too pronounced, then it is worth informing the attending physician about this in order to select another, stronger drug.
• Capsules should be washed down with plenty of water without removing the protective shell.
• Rectal suppositories act faster than tablets. Absorption of the active substance occurs through the intestines, so there is no negative and irritating effect on the walls of the stomach. If the drug is prescribed for a baby, then the young patient should be laid on his left side, then gently insert the candle into the anus and tightly clamp the buttocks. Within ten minutes, make sure that the rectal medication does not come out.
• Intramuscular and intravenous injections are given only by a medical professional! It is necessary to make injections in the manipulation room of a medical institution.

Despite the fact that non-steroidal anti-inflammatory drugs are available without a prescription, you should definitely consult your doctor before taking them. The fact is that the action of this group of medicines is not aimed at treating the disease, at relieving pain and discomfort. Thus, the pathology begins to progress and it is much more difficult to stop its development upon detection than it would have been done before.

• Anti-inflammatory ointments
• Ointments of complex action
• Chondroprotectors
• homeopathic remedies
• Ointments for massage
• Video about the treatment of joint pain
• Which is better: cream or gel?

After 25-30 years of age, problems with the spine appear in almost all people. They are the result of age-related changes, wear of cartilage, the appearance of bone growths. Degenerative-dystrophic changes are called "osteochondrosis". They affect the intervertebral discs, vertebral bodies, adjacent surfaces of the joints, ligaments. The insidiousness of the disease lies in the possibility of its detection only after the onset of pain, the development of muscle atrophy, etc.

Osteochondrosis is not amenable to definitive treatment, but it is possible to successfully deal with the manifestations of the disease. To do this, use a variety of drugs for internal and local use.

What ointments are the most effective? The agents used for osteochondrosis are divided into several groups according to their effect.

Anti-inflammatory ointments

Such preparations mainly contain non-steroidal anti-inflammatory components. When using these ointments, an analgesic effect is also achieved, due to the elimination of inflammation and the removal of puffiness resulting from osteochondrosis. NSAIDs reduce muscle stiffness, restore joint mobility.

Fastum gel for osteochondrosis

Fastum gel is considered to be a very effective medicine of this series. Its active ingredient is ketoprofen. It is its content that determines the anti-inflammatory, analgesic, anti-edematous and anti-exudative action. The therapeutic effect is based on the inhibition of the production of prostaglandins: they are the "culprits" of the inflammatory reaction and pain. Thanks to auxiliary substances, the ointment penetrates deep into the lesion. The lavender and neroli oils included in the gel enhance the effectiveness of ketoprofen.

This is a foreign-made drug, but today there are also domestic analogues (Bystrum gel). The ointment is used for cervical, thoracic and lumbar osteochondrosis.

Other means of this group:

• ibuprofen;
• Nurofen;
• Voltaren;
• Ketonal;
• Nise gel
• Indomethacin.

Ointments of complex action

The use of complex therapeutic ointments is very effective for osteochondrosis. The drugs in this group have the following effect:

• anti-inflammatory;
• anesthetic;
• antimicrobial;
• antithrombotic;
• regenerating.

With osteochondrosis of the cervical, lumbar, the result is manifested in a short time due to the rapid penetration of active substances into the tissues. Treatment with these drugs contributes to the dissolution of blood clots in the capillaries and a significant improvement in microcirculation. As a result, the process of regeneration begins in the affected cartilage tissue. At the same time, pain is relieved and inflammation is reduced. The result is the restoration of mobility of the affected parts of the spine. One of the most commonly prescribed complex preparations for osteochondrosis is Dolobene ointment. It includes:

• Dimethyl sulfoxide - helps to eliminate inflammation, swelling, when rubbed into the neck, back, it has a local analgesic effect due to a decrease in the conduction of pain impulses in neurons. The substance activates local metabolic reactions and stimulates the deep penetration of other medications when used simultaneously with Dolobene.
• Heparin also has anti-inflammatory properties, accelerates the regeneration of connective tissues, and has an antithrombotic effect.
• Dexpanthenol - after penetration into the skin, it is transformed into pantothenic acid, which takes part in catabolic and anabolic processes.

Painkillers and warming ointments

The use of anesthetic ointments for osteochondrosis improves local blood circulation. They are essential in the cervical form of the disease, since circulatory disorders in this case lead to a deterioration in the nutrition of the brain and can provoke serious consequences. These local remedies for osteochondrosis also have a warming effect and eliminate tension and muscle spasms. When using warming ointments, blood flow to the skin is activated, as a result of which its redness and a local increase in temperature are observed. Metabolic processes in the affected areas are also restored.

These ointments are very effective when used for osteochondrosis in the lumbar region. They relieve stiffness, increase mobility, eliminate pain.

Since warming ointments have a pronounced tonic effect on the nervous system, their use is advisable in the daytime. In case of exacerbation, the funds are rubbed with a thin layer into the affected area. During the remission stage, they are used for prevention. The most commonly prescribed drugs are:

• Kapsikam;
• Turpentine ointment;
• Nicoflux.

Chondroprotectors

In the treatment of osteochondrosis, it is very important to use agents that help restore damaged cartilage tissues of the cervical and other parts. We are talking about chondroprotectors, produced in the form of tablets or ointments. In addition to tissue regeneration, they have an analgesic effect and significantly reduce inflammation. The substances included in the composition of chondroprotectors restore the structure of the connective tissue and activate the production of joint fluid, which makes it possible to achieve a reduction in pain in the joints.

Ointments of this group bind calcium and accelerate the restoration of bone tissue, a smooth surface of the joints, articular bags. The use of ointments and gels of chondroprotective action in osteochondrosis slows down the degenerative processes occurring in the spine. Fixed assets of this group:

• Chondroxide;
• Chondroart;
• Chondroitin.

The question of which of these ointments is better to choose is decided by the attending physician. In principle, they have the same (chondroprotective and chondrostimulating) effect, correct the metabolism of cartilage tissue and are very effective in any form of osteochondrosis.

homeopathic remedies

These drugs are prepared using components of plant and mineral origin, due to which they have minimal side effects. Their disadvantage can be considered the likelihood of allergies, so if you are prone to it, homeopathic ointments should be used with caution.

Which of them are the most effective? Osteochondrosis can be treated with the following means:

• Traumeel S;
• Target T;
• Sabelnik;
• Zhivokost;
• Preparations containing snake or bee venom.

Ointments for massage

They are used for therapeutic massage. Such ointments have an analgesic, anti-inflammatory, regenerating effect. With osteochondrosis, they should be rubbed with massaging movements. The most famous means of this series are Dikul's ointments. In addition to pain relief and inflammation relief, they:

• stimulate metabolism;
• improve microcirculation;
• restore local blood circulation;
• increase the regeneration of cartilage tissue;
• increase the production of synovial fluid.

Dikul's ointments are very effective for osteochondrosis in the cervical and lumbar regions. The products are made on the basis of the purest water, enriched with silver ions. Massage products include:

• sea ​​buckthorn oil;
• tea tree oil;
• oil extracts of aloe, chamomile, nettle, wild rose, celandine;
• from bee products: propolis, bee venom, wax;
• collagen hydrolyzate;
• bear bile;
• vitamins A, E.

Other popular massage ointments for osteochondrosis are:

• Artrocin gel (comprises: dimethicone, extracts of hop cones, laurel, barberry roots, bergenia);
• Sophia (contains bee venom);
• Comfrey (based on the medicinal plant of the same name).

Video - drugs and ointments for osteochondrosis

Which is better: cream or gel?

The difference between these remedies lies in the base substance that serves as the basis for the main active ingredient. In the gel, this function is performed by water - therefore, gel preparations for osteochondrosis are absorbed faster, and their action begins after a short time period.

As for creams, they are based on fats or oils, which reach the lesion much more slowly, but have a longer therapeutic effect.

pozvonki.com

What are NSAIDs and NSAIDs

These drugs relieve inflammation and reduce pain, devoid of the negative effects of steroid drugs and are effective in acute and chronic forms of joint diseases.

But even such relatively safe medicines, non-steroidal anti-inflammatory drugs, NSAIDs are not without drawbacks. The most common problems are associated with the consequences of the use of NSAIDs on the digestive tract and kidneys.

With prolonged use of non-steroidal anti-inflammatory drugs, damage to the mucous membrane of the duodenum and stomach is possible with the formation of ulcers, bleeding. Frequent nausea, diarrhea. The risk increases with increasing dosage and duration of NSAID use.

Therefore, it is necessary to consult a doctor before starting the use of NSAIDs. The specialist selects an effective minimum dosage for the minimum time period.

Application restrictions

The kidneys also suffer from excessive enthusiasm for local treatment of the joints. The consequences appear as:

• delays in the withdrawal of fluid and salts;
• pressure increase.

Extremely rare, but not excluded are such phenomena as acute renal failure and nephritis.

During the gestation period, NSAIDs should not be used, especially in the last months. Headaches, dizziness, rash, heart failure, bronchospasm are not excluded.

With a reasonable dosage and the condition of using anti-inflammatory drugs for a limited time, they will not cause irreparable harm to health. On the contrary, ointments will relieve excruciating pain in the joints and improve the condition.

Diclofenac

Diclofenac ointment is recognized as the most effective non-steroidal agent. Drugs work in the same way "Diklonak-P", "Ortofen" and "Voltaren Emulgel". The agent is applied in a thin layer to the affected area, gently massaging into the problem area so as not to cause additional pain.

The product is quickly absorbed without greasy traces, penetrates well deep into the tissues and is approved for use by children. In the form of an ointment or gel, the drug is easy to apply to the skin. The tool is forbidden to freeze: the healing properties of NSAIDs are lost.

Use an anti-inflammatory agent only externally to relieve swelling and reduce pain in the joint. Apply this medication only on uninjured areas.

• Do not apply to open wounds.
• You don't need to put on a bandage.
• Do not allow contact with mucous membranes and eyes.

Both dosage and duration of use of NSAIDs depend on the effectiveness of treatment. If there is no improvement even after a couple of weeks, a visit to the doctor is mandatory.

The drug is contraindicated in bronchial asthma, during pregnancy and breastfeeding, rhinitis and individual intolerance to the components of the drug. For problems with the gastrointestinal tract, an ulcer, the use of Diclofenac is not recommended. This anti-inflammatory drug is prohibited for the treatment of joint pain in children under 6 years of age. With poor blood clotting and chronic cardio insufficiency, you can start the course only with the permission of the doctor.

"Bystrumgel" or "Indovazin"?

"Bystrumgel" will relieve inflammation and action will last quite a long time. But an anti-inflammatory nonsteroidal drug is prohibited in case of hypersensitivity to the components of the drug, for children under 6 years old, in the last stages of pregnancy. During the use of NSAIDs, redness, swelling, rashes, blisters and even burns are not excluded.

The gel without pressure is massaged into the skin several times a day in problem areas.

With intolerance to aspirin, the use of Indomethacin ointment is excluded. If there are no contraindications, such a remedy will quickly and effectively relieve pain, relieve inflammation of the joint. The drug can be applied under a bandage.

Unpleasant side effects in the form of urticaria, reddening of the skin, rash, swelling, burning of the skin, suffocation and dry cough are not excluded. To solve the problem, it is recommended to either change the drug, or consult a doctor.

"Indovazin" will relieve pain in the joints. Apply it to sore spots several times a day massage the problem area. An anti-inflammatory agent can be applied at night in the form of a compress. The gel has no side effects.

Against edema, inflammation of the joints, pain, the Dolgit cream is effective. This remedy is especially effective for gout, arthritis, sciatica. The drug relieves morning stiffness and increases joint activity. It is forbidden to use NSAIDs for children under 14 years of age, during pregnancy, breastfeeding. You can not use the cream for skin diseases and hypersensitivity to the components of the drug.

It is permissible to apply the ointment within a month. But in the absence of noticeable improvements, a visit to the doctor is mandatory.

Gels "Nise" and "Ketonal"

There are few side effects of Nise Gel. Non-steroidal drug of a new generation is effective relieves joint pain and inflammation. But with diseases of the stomach, exacerbations of skin diseases, with peptic ulcers, the drug is contraindicated.

Rub this anti-inflammatory agent delicately, slowly, without pressure. Before application, problem areas are washed and wiped dry. The course of application of the gel is 10 days.

If other drugs do not work well enough, Ketonal gel is used. This tool is powerful and works effectively against joint pain.

• In case of hypersensitivity to NSAID components, the gel cannot be used.
• The use of NSAIDs is also prohibited for adolescents under 15 years of age.
• You should not use Ketonal Gel for longer than 2 weeks without consulting a specialist.

There are two active substances in the composition of the non-steroidal ointment "Deep Relief". They mutually reinforce each other's action, relieving inflammation, swelling, pain. When applied, massage the gel to dryness, applying over the diseased joint.

Funds for children

Almost all anti-inflammatory creams and ointments for joints contraindicated for children and adolescents. But there are products with a milder effect, without side effects on the children's body. But before you start using these funds for a child, you should consult with a specialist. In this way, the negative consequences of treatment can be avoided.

Ointment "Traumeel S" is a homeopathic remedy based on plant extracts. It gently acts, improving the condition of the joints. Use for babies under 3 years is contraindicated.

On a plant basis and the drug "Alorom". But it is also designed for children over 3 years old. This drug will help against inflammation of the joints, relieve pain and remove swelling. The list goes on, but joint problems are unusual for children. Therefore, if you suspect a pathology, you should consult a doctor, and not self-medicate with the use of NSAIDs.

"Diklovit" and "Nurofen"

Cream "Diklovit" effectively relieves inflammation and reduces joint pain. Water-alcohol base provides additional anesthesia.

The anti-inflammatory drug is applied externally with a thin layer over the affected area, gently massaging until completely absorbed. Only the doctor determines the exact dosage, duration of treatment. The course of joint treatment leaves a maximum of 2 weeks and is extended according to a medical prescription.

In case of intolerance to any substance from the NSAID group, the use of a non-steroidal gel or cream is prohibited. With caution, Diklovit ointment is used for cardio insufficiency and disorders of the liver and kidneys.

The side effect is manifested in the form of skin itching, allergies, swelling and redness. Excessive passion for the use of this drug provokes a rash, spasms of the bronchi, increased skin sensitivity to light.

Ointment "Nurofen" indicated for joint problems in adults and children over 12 years of age. Apply this anti-inflammatory drug no more than 4 times a day with breaks of 4 hours. Rub the product until completely absorbed. If no improvement has occurred in 2 weeks, this cream is replaced with another drug.

Side effects with use are rare, but possible. They appear in the deterioration of appetite and the appearance of ulcers on the walls of the stomach with prolonged use of the cream.

Headaches, sleep disturbances, hyperexcitability are the consequences of exceeding the dosage of NSAIDs. With excessive enthusiasm for the anti-inflammatory drug, shortness of breath, the development of hypertension and heart rhythm disturbances are possible.

Skin rash, swelling, spasms are not excluded. Renal failure, cystitis, nephritis may occur. Anemia is also considered a side effect of joint treatment.

"Finalgel" and "Ketoprofen"

A contraindication to use and the cause of side effects remains the specific aroma of many effective non-steroidal drugs. This disadvantage is deprived of the anti-inflammatory drug "Finalgel". He relieves pain quickly. But such a tool is not universal. If NSAIDs are intolerant, you will have to look for another option for getting rid of joint disease. Under the supervision of a doctor, they use an ointment for pathologies of the lungs and nasal polyps.

Restrictions are possible with asthma and a tendency to allergies. A negative reaction of the immune system to the components of this cream is not excluded. Possible manifestations of a skin reaction in the form of a rash, peeling, dryness, redness. The list of negative consequences can go on and on. But with the manifestation of any symptom, it is necessary to change the drug and consult a specialist for help.

The main difference between "Ketoprofen" and other ointments is in the instantaneous effect of anesthesia. Healing and restoration of the joint begins only on the 3rd day of application.

Adverse negative reactions are practically excluded: this anti-inflammatory drug is completely eliminated from the body. After applying the gel, it is recommended to wash your hands. It is important to cover the treated areas from the sun's rays.

Balm "Horsepower"

Made from natural ingredients balm "Horsepower". The composition of the product contains vitamin E, and mint oil, and lavender ether. Balm quickly relieves pain and is suitable for therapeutic massage.

Do not apply this drug to skin lesions, mucous membranes, sites of malignant tumors. Due to the irritating effect of the ointment, a negative reaction of sensitive skin is possible. Perhaps the appearance of a network of vessels, the formation of hematomas.

To eliminate unpleasant consequences, try the gel on a small area and leave for 12 hours. The universal tool starts working a quarter of an hour after application. It relaxes muscles, relieving pain and reducing joint inflammation. There are no restrictions on the duration of application: NPVS removes this condition.

NSAIDs with bee venom

A transparent gel with a lavender scent is Artosilen. The active substance is quickly absorbed. This drug acts as an analgesic and anti-inflammatory agent.

The action of the anti-inflammatory cream lasts for a day, but it is recommended to apply the drug twice a day to enhance the effect. The course of treatment is 10 days. To extend the use without negative consequences, a visit to the doctor is mandatory.

"Flexengel" has a similar effect. They can safely replace the drug NSAIDs: the composition is almost identical.

On the basis of bee venom, a non-steroidal drug "Apizartron" was developed. This remedy and anesthetizes, and relieves inflammation of the joint, and removes toxins from the focus of pathology.

The ointment is applied to the affected areas and massaged after redness or a feeling of warmth, slowly and intensively. After treatment, be sure to insulate problem areas. Treatment of PNVS will take from a week to a decade for acute pain. If the problem is chronic, the treatment time is increased.

It is forbidden to use this drug for oncology, mental illness and individual intolerance to the components of the ointment. Ointments work the same way. based on the venom of bees "Ungavipen", "Apiveren" and "Virapen".

There are many effective remedies for treating joints, relieving pain and reducing inflammation. But the choice of ointment on the "maybe" will not bring the desired results. To select an effective NSAID drug, you should seek the advice of a specialist.

artrit.guru

Pain in the back, neck, joints is the leading symptom in diseases of the musculoskeletal system and is one of the most common reasons for visiting a doctor. Non-steroidal anti-inflammatory drugs (NSAIDs) are most commonly used in the treatment of musculoskeletal pain. In the practice of a doctor involved in the treatment of pain syndromes, the determining criterion for choosing a drug is its analgesic efficacy, individual intolerance, the likelihood of complications or side effects.

The use of NSAIDs orally or parenterally is often accompanied by the development of side effects and complications in patients, primarily from the gastrointestinal tract, kidneys, and central nervous system. The ability to apply drugs locally (externally) allows you to deliver the active substance as close as possible to the source of pain, without causing systemic effects, which significantly reduces the risk of side effects and complications.

Currently, the arsenal of drugs for local use containing NSAIDs for diseases of the musculoskeletal system is quite wide, including in connection with the release of the same drugs by different manufacturers under different (proprietary) names.

All NSAIDs for topical use can be divided into the following groups according to the main active drug substance that is part of multicomponent or combined preparations.

1. The active substance is diclofenac.

• 
  — Voltaren Emulgel.
  — Diklovit.
  — Diklak.
  — Diklobene.
  — Diklonat P gel.
  — Dicloran.
  — Diclofenac.
  - Diclofenac-Acre.
  - Ortofen ointment.
• Combined preparations containing diclofenac:
  — Diclofenacol.
  - Dicloran plus.

2. The active substance is ibuprofen.

- Nurofen gel.
- Dolgit.
- The cream lasts.

3. The active substance is indomethacin.

• Monocomponent preparations:
  - Indomethacin.
  - Indomethacin Sopharma ointment.
  - Indomethacin-Acre.
• Combined preparations containing indomethacin:
  — Indovazin.

4. The active substance is ketoprofen.

- Artrosilene.
- Quickgel.
— Ketonal.
— Ketoprofen Vramed.
— Fastum.
- Febrofid.
— Flexen.

5. The active substance is nimesulide.

— Nise.

6. The active substance is piroxicam.

- Finalgel.

The main mechanism of action of monocomponent preparations with the active substance diclofenac is non-selective inhibition of the activity of cyclooxygenase (COX): COX-1 and COX-2, which leads to a violation of the metabolism of arachidonic acid and suppression of prostaglandin synthesis in the inflammation focus. With the external use of these drugs, there is a decrease in pain at the site of their application, a decrease in swelling and an increase in the range of motion in the affected joints.

Indications for use are pain syndrome in inflammatory and degenerative diseases of the joints and spine, rheumatic lesions of soft tissues, post-traumatic pain syndrome, neuralgia.

Side effects can be observed in the form of local skin manifestations, with prolonged use of drugs, a resorptive effect and the development of systemic reactions (urticaria, bronchospasm, angioedema) are possible.

Contraindications for use are peptic ulcer of the stomach and duodenum in the acute stage, impaired hematopoiesis, impaired integrity of the skin, pregnancy, lactation, age up to 6 years, hypersensitivity to diclofenac.

When diclofenac is combined with menthol in the Diclofenacol preparation, there is also an additional local irritant and mild analgesic effect.

When diclofenac is combined with methyl salicylate, menthol, linseed oil in the Dicloran preparation, plus the anti-inflammatory and analgesic effect of diclofenac is enhanced by the second drug from the NSAID group - methyl salicylate, as well as a-linolenic acid, which is part of linseed oil; menthol has a local irritant and mild analgesic effect.

The main pharmacological effect of drugs with the active ingredient ibuprofen is a local analgesic and anti-inflammatory effect, the mechanism of which is associated with inhibition of prostaglandin synthesis due to non-selective blocking of the COX enzyme.

Indications for use are myalgia, back pain, arthritis, injuries and sprains, sports injuries, neuralgia.

Side effects are most often noted in the form of a slight reddening of the skin, burning or tingling. Systemic reactions in the form of allergic reactions and bronchospasm are extremely rare.

Contraindications for use are "aspirin" asthma, age up to 12 years, hypersensitivity to the components of the drug. With caution, the drug is used for concomitant diseases of the liver and kidneys, gastrointestinal tract, urticaria, rhinitis, pregnancy and lactation.

The main pharmacological effect of monocomponent preparations with the active ingredient indomethacin is a local pronounced anti-inflammatory and analgesic effect due to non-selective blocking of the COX enzyme and suppression of prostaglandin synthesis. Indications for use are pain syndrome and local inflammatory reactions in rheumatoid diseases, acute musculoskeletal pain, gout, neuralgia.

Side effects are observed in the form of local skin reactions (hyperemia, peeling, urticaria, etc.). Systemic reactions in the form of dyspepsia, nausea, dizziness, ataxia are possible with prolonged use, more than 10 days, or when the drug is applied to a large area of ​​the skin.

The drug is contraindicated in gastrointestinal diseases, kidney diseases, central nervous system, infectious diseases, during pregnancy and lactation, is not prescribed for children.

When indomethacin is combined with troxerutin, Indovazin additionally has a local anti-edematous and angioprotective effect.

The main mechanism of action of drugs with the active substance ketoprofen (a derivative of propionic acid) is the suppression of the activity of COX-1 and COX-2, which regulates the synthesis of prostaglandins. The anti-inflammatory and analgesic activity of ketoprofen is similar to that of indomethacin and is 20 times higher than that of ibuprofen. Ketoprofen has anti-bradykinin activity, stabilizes lysosomal membranes, causes significant inhibition of neutrophil activity in patients with rheumatoid arthritis, and inhibits platelet aggregation.

Indications for use are acute and chronic inflammatory and degenerative-dystrophic diseases of the musculoskeletal system, injuries.

Side effects are observed in the form of skin hyperemia at the site of application of the drug, photosensitization of purpura. With prolonged use, systemic reactions are rarely possible: abdominal pain, vomiting, asthenia, transient dysuria.

Contraindicated for use in patients with eczema, infected wounds, in children under 12 years of age, with individual intolerance to the drug. With caution, it is possible to use during pregnancy and lactation.

The main mechanism of action of drugs with the active substance nimesulide is the selective suppression of the activity of COX-2, which regulates the synthesis of prostaglandins. Nimesulide reversibly inhibits the synthesis of prostaglandin E2 both in the area of ​​inflammation and in the ascending pathways of the nociceptive system. Suppresses platelet aggregation, release of histamine and tumor necrosis factor a, has antioxidant activity. The drug is well tolerated during long-term therapy. When applied topically, it causes a decrease or disappearance of pain at the site of application of the gel, reduces swelling, morning stiffness of the joints, and increases the range of motion.

Indications for use are inflammatory diseases with pain syndrome of moderate intensity: diseases of the musculoskeletal system, including arthritis, osteochondrosis, osteoarthritis, arthralgia, myalgia, bursitis, traumatic injuries.

Side effects are associated with local reactions when applying the gel - itching, urticaria, peeling, transient discoloration of the skin - and do not require discontinuation of the drug.

Contraindications: dermatoses, skin infections in the area of ​​application of the gel, age up to 2 years, hypersensitivity to the drug, pregnancy and lactation.

The main mechanism of action of drugs with the active substance piroxicam is the suppression of prostaglandin synthesis due to non-selective inhibition of COX-1 and COX-2 enzymes. The use of the drug reduces swelling, inflammation, muscle and joint pain, does not cause dry skin.

Indications for use are pain syndrome in sports injuries, ankylosing spondylitis, osteoarthritis, humeroscapular periarthrosis, tendinitis.

Side effects are associated with local reactions and manifest as redness and peeling, local itching, urticaria.

Contraindications for use are renal failure, age up to 14 years, pregnancy, individual intolerance to the drug.

Literature

1. Gusev E. I., Drobysheva N. A., Nikiforov A. S. Medicines in neurology. M., 1998.
2. Handbook Vidal. Pharmaceuticals in Russia: A Handbook. M.: AstraPharmService, 2007.
3. Lawrence D.R., Benitt P.N. Clinical pharmacology: in 2 volumes / per. from English. M.: Medicine, 1991.

L. E. Kornilova, Candidate of Medical Sciences
E. L. Sokov, doctor of medical sciences, professor
RUDN University, Pain Treatment Clinic, City Clinical Hospital No. 64, Moscow

www.lvrach.ru

Ointments and gels for joints based on medicines (pharmacy)

Ointment Diclofenac (aka Voltaren Emulgel)

Diclofenac is one of the most effective first-generation anti-inflammatory drugs. The most famous drugs containing this active substance are Voltaren, Ortofen, Diclonac-P and others.

This medicine is produced not only in the form of tablets, suppositories and solutions for intravenous use, but also in the form of an ointment. One gram of 1% diclofenac ointment contains 10 mg of the active ingredient - diclofenac sodium.

Apply this ointment as follows. For pain in the joints, deforming osteoarthritis, arthritis, gout, an ointment in the amount of 2-4 grams is applied with a thin layer to the area of ​​\u200b\u200bthe diseased joint and gently rubbed into the diseased area with soft, gentle movements, trying not to cause additional pain.

You can repeat the use of the ointment during the day up to 2-3 times, but you need to ensure that the daily dose of the ointment used does not exceed 8 grams. Do not forget that non-steroidal anti-inflammatory drugs have their own contraindications, even when used externally.

You can buy Voltaren Emulgel with delivery in Moscow and Russia, for example, at the Pilluli.ru pharmacy or (slightly cheaper) at the E-pharmacy.

Please note: the course of treatment with this remedy should not exceed two weeks. If during this period it was not possible to improve the condition of the joints, it is necessary to consult a doctor so that he either adjusts the dose of the medicine, or prescribes another.

Bystrumgel

The active substance of Bystrum-gel is ketoprofen: 1 g of the gel contains 25 mg of this medicinal substance. This medicine is produced by the Russian company Akrikhin.

The use of this drug is indicated for inflammatory diseases of the joints, ligaments and muscles: arthritis, deforming osteoarthrosis, bursitis, traumatic dislocations and other diseases.

To use, squeeze three to five centimeters of gel out of the tube and gently, with gentle movements, distribute it over the entire surface of the skin over the sore joint. Lightly massage this area so that the gel is successfully absorbed. You can use this medicine two to three times a day.

Quickgel is not suitable for massage, so for these purposes it is better to use other gels and balms - for example, Valentin Dikul's balm for joints.

This gel is an analogue of Bystrumgel, although in fact Fastumgel appeared on the market much earlier, and it is produced by the Italian company A.Menarini Pharmaceutical Industry's Group. The active substance is the same ketoprofen. Indications, contraindications and other features of this drug are almost identical to Bystrumgel.

Indomethacin ointment

As the name implies, the active ingredient in this ointment is the non-steroidal anti-inflammatory drug indomethacin. Ointment 10%, i.e. 1 gram contains 100 mg of active ingredient.

The use of this ointment is indicated for inflammatory lesions of the joints, which are accompanied by pain, swelling of the joints - osteoarthritis, rheumatoid and psoriatic arthritis, gout, ankylosing spondylitis (Bekhterev's disease) - in other words, for all diseases in which the so-called articular syndrome is observed, as well as for muscle pain and diseases such as neuralgia, neuritis, lumbago, osteochondrosis, etc.

This is how you should use the tool. Squeeze out a few centimeters of ointment from the tube and with soft, gentle movements begin to rub the ointment into the skin over the sore joint until you rub it dry. You can use the ointment 2-3 times a day, but make sure that the daily volume of the medicine does not exceed 15 cm of squeezed ointment in adults and seven and a half for children.

In addition, the drug should not be applied to an open wound surface and should be used with great caution in gastric ulcers. You should also avoid getting indomethacin ointment in the eyes and mucous membranes.

Cream Dolgit

Cream Dolgit is a medicine containing 5% of the active ingredient ibuprofen with excipients.

It has a decongestant effect, reduces inflammation in the joints and reduces pain in them, and also increases the range of motion in the joint, reduces morning stiffness. Dolgit cream is especially indicated for rheumatoid arthritis, deforming osteoarthritis, gout, sciatica.

This cream should not be used by women during pregnancy and lactation, children under 14 years of age, in the presence of skin diseases (weeping eczema, etc.), as well as in case of hypersensitivity to the main active substance (ibuprofen).

Cream Dolgit is used only externally (like other ointments and gels), 3-4 times a day. Depending on the volume of the treated skin surface, a strip of cream 4 to 10 cm long can be used. The course of treatment with Dolgit can be up to 3-4 weeks; if no significant improvement has occurred during this period, this is a strong reason to see a doctor and start receiving other treatments.

Nise gel

This medicine is a 1% gel containing the active substance nimesulide.

The peculiarity of this drug is that it belongs to the second generation non-steroidal anti-inflammatory drugs, or COX-2. Due to this, when using this agent, there are much fewer side effects that are characteristic of first-generation NSAIDs (COX-1). Indications for the use of the gel are joint diseases such as deforming osteoarthritis, rheumatoid arthritis, bursitis, tendovaginitis.

The drug is contraindicated in gastric ulcer in the acute stage, infectious and inflammatory skin diseases, during pregnancy and lactation.

Nise gel can be applied 2-3 times a day, using a column of gel up to 3 cm long at a time and rubbing it into the skin with gentle movements. Please note that before using the drug, you must thoroughly wash and then dry the skin in the area of ​​\u200b\u200bdiseased joints, and only then rub the gel. You can use this medicine for no longer than 10 days.

You can buy Nise-gel in the same E-pharmacy.

Ketonal gel

Ketonal Gel is a 2.5% ketoprofen gel that has a powerful analgesic effect and can be used for joint pain when other medicines do not work well.

Ketonal gel is indicated for diseases such as Bechterew's disease, periarthritis, deforming arthrosis, psoriatic and reactive arthritis (including Reiter's syndrome), radiculitis, injuries and bruises of the joints, muscles and ligaments.

This medicine should be used with caution in bronchial asthma, severe diseases of the heart, liver and kidneys, as well as ulcerative lesions of the gastrointestinal tract. This gel should not be used by people with hypersensitivity to ketoprofen and other components of the gel (including fragrances), with weeping dermatitis, with some other diseases, as well as in the 3rd trimester of pregnancy and children under 15 years of age.

It is necessary to use this drug 1-2 times a day, squeezing 3-5 cm of the gel from the tube and gently rubbing the gel into the skin over the area of ​​the diseased joint to dryness. It is not recommended to use this gel for more than 2 weeks without consulting a doctor.

Gel Deep Relief

This gel, unlike the other ointments and creams listed above, contains two active ingredients at once: the non-steroidal anti-inflammatory drug ibuprofen and the locally irritating drug levomenthol (or simply menthol).

Together, these drugs enhance each other's action, providing analgesic, decongestant, anti-inflammatory effects, reducing the formation of excess fluid in the joint and lowering the temperature in the inflamed joint.

You can use Deep Relief no more than four times a day, covering the skin area over the diseased joint with a thin layer of gel and rubbing it dry. This medicine should not be used for longer than ten days without the advice of a doctor.

You can buy this remedy, for example, in the pharmacy Pilyuli.ru >>>

Ointments based on traditional medicine recipes

Despite the abundance of pharmacy ointments, one should not forget that nature itself has prepared natural ingredients for the treatment of many diseases, including joint diseases.

We offer selected traditional medicine recipes for the treatment of joint pain, which can be used in parallel with the medical treatment of these diseases.

Magic egg-vinegar ointment

To prepare the ointment, take 1 chicken egg, preferably not from a poultry farm, but a real one from a village, and break it into a small jar. Do not throw away the shell, but throw it there. Then pour vinegar essence into the jar so that it covers the egg poured there with a layer of about 1 centimeter.

After that, close the jar and put it in a dark place for four to five days. By the end of this period, the shell should already dissolve. Add 200 ml of sunflower or vegetable oil to the jar, mix thoroughly and place the jar now in the sun for the same four days. After that, the ointment is ready. Store it in the refrigerator and mix well before use.

Apply this ointment as follows. Take a small amount of ointment, and at night, before going to bed, rub it on sore joints. After that, insulate the joint area with a warm woolen scarf or scarf and leave it overnight.

This ointment not only helps reduce joint pain, but also helps prevent osteoporosis of the bones.

Medical clay ointment

Buy regular medical clay, which is sold in a pharmacy, and mix it with 50 ml of sunflower oil (clay is usually sold in packs of 100 grams). After thoroughly mixing the resulting ointment, cover the diseased joint with a thin layer of it, and leave it for an hour and a half.

After that, carefully wash off the remaining ointment from the skin, and then warm the area tightly with a clean, warm woolen scarf, and leave the diseased joint in a state of rest for another hour: for this, it is best to just lie down.

Such rubbing with this ointment should be done every day for three weeks. The ointment can be stored in the refrigerator.

Egg ammonia ointment

To prepare the ointment, take 5% ammonia (2 tablespoons), gum turpentine, preferably with GOST printed on the label (the same amount), as well as 2 ordinary raw eggs. Thoroughly beat the resulting mixture until a homogeneous emulsion is formed, similar in consistency to sour cream.

Rub the resulting ointment into diseased joints - both large (knee, shoulder, hip) and small joints of the hands and feet.

Usually, the effect occurs already at the first application of this healing ointment. It can also be used in courses every day for 5 days in a row, then take a break and repeat the same course in another month.

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Anti-inflammatory drugs for diseases of the musculoskeletal system

Today, there are a lot of pathologies in which damage and destruction of bones and joints occurs. The main component of the treatment of rheumatoid diseases are NSAIDs.

The pain syndrome in the case of the development of osteochondrosis, gouty arthritis or arthrosis is so strong that the patient immediately seeks medical help.

The first drugs that a doctor prescribes are NSAIDs. To achieve a more maximum effect, anti-inflammatory creams and anti-inflammatory ointments for joints are also prescribed, which are applied topically.

There are several groups of drugs, each of them is based on a specific component:

• indomethacin;
• diclofenac;
• nimesulide;
• ibuprofen;
• piroxicam;
• ketoprofen.

Anti-inflammatory drugs, the main active ingredient of which is diclofenac, are very effective after suffering injuries, with neurological and degenerative changes in the joints.

Diclofenac contributes to the rapid restoration of joint mobility, it reduces swelling, local temperature in the affected area and has an analgesic effect. The trade name for NSAIDs based on diclofenac is Ortofen ointment, Diclofenac gel, Diclofenac gel, Diclovit and Voltaren.

Note! Gel or ointment based on diclofenac should not be used to treat children under 6 years of age and pregnant women.

It is also forbidden to apply it to damaged areas of the skin, and for people suffering from stomach and duodenal ulcers, such drugs can be used only after the approval of a doctor.

ibuprofen

Drugs that remove inflammation, which include ibuprofen (Nurofen, Dolgit), are indicated for the same symptoms as when using diclofenac-based products. That is, their main effect is pain relief and elimination of inflammation.

However, such funds cannot be used if:

• "aspirin" asthma;
• diseases of the kidneys and liver;
• children under 2 years of age;
• diseases of the gastrointestinal tract;
• pregnancy;
• during lactation.

A cream that eliminates inflammation with ketoprofen is used for various injuries and degenerative changes in the joints. Ketoprofen also prevents the formation of blood clots.

Means based on it should not be applied to damaged skin. Also, NSAIDs with ketoprofen are contraindicated in children under 12 years of age and pregnant women.

The most common drugs, the main component of which is ketoprofen:

1. Febrofid;
2. Fastum-gel;
3. artrosilene;
4. Ketonal;
5. Febrofid.

Indomycin

The means, which are based on indomethacin, include: Indovazin, Sopharma, Indomethacin-Akri and - Sofar. Their action is similar to ketoprofan, but it is not so pronounced, and the indications and contraindications are similar to similar NSAIDs.

Anti-inflammatory anesthetic cream Finalgel belongs to the group of piroxicam-containing medicines. The gel restores the health of the joints, relieves swelling and eliminates pain without overdrying the skin.

This tool is used for osteoarthritis, periarthrosis and tendonitis. Pregnant women and children are not allowed to use the gel.

Cream Indovazin, the main active ingredient of which is nimesulide. This is the only medication from the entire group of NSAIDs designed for the safe treatment of joints.

Gel Indovazin in comparison with other means is not so toxic, so it does not have a detrimental effect on the gastrointestinal tract. But despite this, like other drugs, Indovazin can only be used after a doctor's prescription, because it also has side effects, albeit less significant.

Contraindications to the use of the drug are as follows:

• age up to 3 years;
• joint and bone injuries;
• osteochondrosis;
• bursitis;
• arthritis.

It should be noted that the process in which anti-inflammatory drugs are rubbed into the skin helps to accelerate and improve the effect of the drug. Topical topical preparations for the treatment of joint diseases, such as epicondylitis or arthritis, are more effective when combined with phonophoresis.

This method of treatment improves the absorption of the active ingredient. At the same time, the amount of the applied agent is reduced, which significantly saves its consumption, and most importantly, it is safer for the body.

When choosing an NSAID, you should always consult a doctor who will select a gel, cream or ointment for joints that relieves pain, swelling and regenerates affected tissues.

However, when choosing drugs for the treatment of bones, joints, one should not ignore the presence of diseases of the stomach and duodenum. Therefore, in the treatment of anti-inflammatory drugs, you should take drugs that will protect the gastrointestinal mucosa (pantoprozol, nolpaza, etc.).

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.

Operating principle

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.

List of NSAIDs

Major non-selective NSAIDs

Acid derivatives:

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, Viox 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 have a number of contraindications that must be taken into account. Drugs are not recommended for treatment if the patient:

peptic ulcer of the stomach and duodenum; kidney disease - limited intake is allowed; blood clotting disorder; the period of gestation and breastfeeding; Previously, pronounced allergic reactions to drugs of this group were observed.

In some cases, the formation of a side effect is possible, as a result of which the composition of the blood changes (a “fluidity” appears) and the walls of the stomach become inflamed.

The development of a negative result is explained by inhibition of the production of prostaglandins not only in the inflamed focus, but also in other tissues and blood cells. In healthy organs, hormone-like substances play an important role. For example, prostaglandins protect the lining of the stomach from the aggressive effects of digestive juice on it. Therefore, taking NVPS contributes to the development of gastric and duodenal ulcers. If a person has these diseases, and he still takes "illicit" drugs, then the course of the pathology can worsen up to perforation (breakthrough) of the defect.

Prostaglandins control blood clotting, so a lack of them can lead to bleeding. Diseases for which examinations should be carried out before prescribing a course of NVPS:

violation of hemocoagulation; diseases of the liver, spleen and kidneys; Varicose veins; diseases of the cardiovascular system; autoimmune pathologies.

Also, side effects include less dangerous conditions, such as nausea, vomiting, loss of appetite, loose stools, and bloating. Sometimes skin manifestations in the form of itching and a small rash are also fixed.

Application on the example of the main drugs of the NSAID group

Consider the most popular and effective medicines.

Attention! The tables show dosages for adults and adolescents whose body weight exceeds 50-50 kg. Many drugs for children under 12 years of age are contraindicated. In other cases, the dosage is selected individually, taking into account body weight and age.

In order for the drug to act as soon as possible and not cause harm to health, one should adhere to the well-known rules:

Ointments and gels are applied to the painful area, then rubbed into the skin. Before putting on clothes, it is worth waiting for complete absorption. It is also not recommended to take water procedures for several hours after treatment. Tablets must be taken strictly as directed, not exceeding the daily allowable rate. If the pain or inflammation is too pronounced, then it is worth informing the attending physician about this in order to select another, stronger drug. Capsules should be washed down with plenty of water without removing the protective shell. Rectal suppositories act faster than tablets. Absorption of the active substance occurs through the intestines, so there is no negative and irritating effect on the walls of the stomach. If the drug is prescribed for a baby, then the young patient should be laid on his left side, then gently insert the candle into the anus and tightly clamp the buttocks. Within ten minutes, make sure that the rectal medication does not come out. Intramuscular and intravenous injections are given only by a medical professional! It is necessary to make injections in the manipulation room of a medical institution.

Despite the fact that non-steroidal anti-inflammatory drugs are available without a prescription, you should definitely consult your doctor before taking them. The fact is that the action of this group of medicines is not aimed at treating the disease, at relieving pain and discomfort. Thus, the pathology begins to progress and it is much more difficult to stop its development upon detection than it would have been done before.

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.

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:

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

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

What is the advantage of new generation NSAIDs

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

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

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

New generation NSAIDs: list and prices

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

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

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

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

Classification

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

Acid NSAIDs:

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

Non-acid NSAIDs:

Alcanones; Sulfonamide derivatives.

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

Effectiveness of medium doses

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

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.

Movalis

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

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

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

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

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.

Aspirin

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.

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 medicine has an anti-inflammatory effect in myositis, herniated discs. Severe pain. 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. High temperature. The antipyretic effect allows the use of drugs for ailments of a diverse nature, both for adults and children. Such drugs are effective even with 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. Pyrazolidines. 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. Phenylacetic acid derivatives. This group of NSAIDs contains funds: Diclofenac, Tolmetin, Indomethacin, Etodolac, Sulindac, Aceclofenac. Anthranilic acid preparations. The main representative is the drug Mefenaminate. Propionic acid products. This category contains many excellent NSAIDs. List of drugs: Ibuprofen, Ketoprofen, Benoxaprofen, Fenbufen, Fenoprofen, Thiaprofenic acid, Naproxen, Flurbiprofen, Pirprofen, Nabumeton. Isonicotinic acid derivatives. 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; increased pressure; slight shortness of breath; dry cough; indigestion; the appearance of protein in the urine; increased activity of liver enzymes; skin rash (pinpoint); 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, feeding a child; 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.