Anti-inflammatory drugs for illness. Non-steroidal anti-inflammatory drugs for the treatment of joints: classification, list. By chemical structure

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

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

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

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

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

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

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

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

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

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:

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:

1. 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 a rub.
2. 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. Ksefokam, which contains 30 tablets of 4 mg, costs a rub.
3. 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, rub.
4. 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 a rub.

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.

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

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):

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

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:

1. Violation of the nervous system - mood changes, disorientation, dizziness, apathy, tinnitus, headache, blurred vision;
2. Changes in the work of the heart and blood vessels - palpitations, increased blood pressure, swelling.
3. Gastritis, ulcer, perforation, gastrointestinal bleeding, dyspeptic disorders, changes in liver function with an increase in liver enzymes;
4. Allergic reactions - angioedema, erythema, urticaria, bullous dermatitis, bronchial asthma, anaphylactic shock;
5. 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 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 drug, it is not prescribed so often, however, the drug is quite popular in rheumatology: it is used to treat rheumatoid arthritis, osteoarthritis and other joint diseases.

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

diclofenac

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

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

Ketoprofen

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

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

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.

The best anti-inflammatory for the respiratory system

In most infectious and inflammatory diseases of the respiratory system and ENT organs, non-steroidal anti-inflammatory drugs are widely used as symptomatic therapy. They are prescribed to reduce fever, suppress inflammation and reduce pain.

Varieties of NSAIDs

To date, there are more than 25 different drugs belonging to the group of non-steroidal anti-inflammatory drugs. Classification by chemical structure is considered of little use for comparative evaluation of drug efficacy and safety. Of greatest interest are drugs that have a pronounced antipyretic and anti-inflammatory effect and have a low rate of adverse reactions.

List of anti-inflammatory drugs that can be prescribed for diseases of the respiratory system and ENT organs:

Only the attending physician knows which anti-inflammatory tablets, capsules, powder, mixture or syrup will be effective in each case.

Application features

All non-steroidal anti-inflammatory drugs have similar principles of action, the use of which leads to the elimination of the inflammatory process, fever and pain. In pulmonology and otolaryngology, NSAIDs are preferred, which have more pronounced antipyretic and anti-inflammatory properties. I would like to note that due to the high risk of adverse reactions, the combined use of several NSAIDs at once is highly undesirable. At the same time, their therapeutic effect is not enhanced, but the negative impact on the body, in particular, on the digestive system, sharply increases.

For serious problems with the gastrointestinal tract (for example, peptic ulcer), it is better to use modern, selective NSAIDs of the new generation, which have a much lower likelihood of side effects. Despite the possibility of obtaining these drugs without a prescription, the dosage and duration of the therapeutic course must be agreed with your doctor. During treatment, the use of alcoholic beverages should be excluded.

Paracetamol

Paracetamol effectively copes with the main clinical symptoms of colds. Taking it in the appropriate dosage makes it possible to quickly bring down the high temperature, relieve malaise and fatigue, relieve pain, etc. The main advantages of the drug:

• Recommended for use by the World Health Organization.
• Fast antipyretic effect.
• Fairly well tolerated by most patients.
• Low risk of adverse reactions.
• Compared to other similar anti-inflammatory drugs, the cost is relatively low, making it accessible to all segments of the population.

Paracetamol has its own characteristics of use. It can be used in the form of tablets, powder, rectal suppositories, injections, etc. Ingestion or rectal administration of the drug allows you to achieve more effective results. The interval between applications should be at least 4 hours. The average duration of treatment is 5-7 days. A longer therapeutic course with this antipyretic is not recommended. Usually, the clinical manifestations of colds begin to pass on the 2-3rd day. In case of a significant deterioration in the condition, you should immediately consult a doctor.

If the patient has an allergy to the components of the drug or severe problems with the kidneys and liver, Paracetamol should not be prescribed. The development of the following pathological conditions is referred to as side effects:

• anemia.
• Reducing the number of platelets.
• Renal colic.
• Glomerulonephritis.
• Allergic manifestations (itching, redness of the skin, various rashes, etc.).

In an attempt to achieve a speedy result, some patients ignore the instructions in the official instructions for use, and take a dosage of an anti-inflammatory drug that exceeds the maximum recommended. With an overdose of Paracetamol, the following symptoms are possible:

• The appearance of pallor, nausea, vomiting and pain in the abdomen.
• In case of failure to provide timely assistance and taking too large a dose of the drug, the kidneys and liver are affected. Arrhythmia, pancreatitis, and serious disorders of the central nervous system may develop.

If severe clinical manifestations of an overdose are noted, it is necessary to prescribe Methionine or N-acetylcysteine, which are effective antidotes (antidote). In addition, when using Paracetamol, drug interactions with other drugs should be taken into account. For example, simultaneous use with indirect anticoagulants (coumarin derivatives) increases the effect of the latter. The antipyretic effect is significantly reduced when combined with barbiturates.

A qualified specialist (pharmacist or doctor) will help you choose the best non-steroidal anti-inflammatory drug.

Panadol Extra

Panadol Extra is considered to be a combined NSAID preparation, which contains not only paracetamol, but also caffeine as active substances. Both components reinforce each other's action. Paracetamol relieves pain and relieves fever. Caffeine has a stimulating effect on the central nervous system. In addition, by increasing the level of paracetamol concentration in the brain by increasing the permeability of the blood-brain barrier, caffeine increases the analgesic effect of the drug.

Panadol Extra helps alleviate the condition of colds, acute tonsillitis, laryngopharyngitis and other infectious and inflammatory pathologies of the respiratory system and ENT organs. Most adults and children tolerate this anti-inflammatory drug fairly well. As a rule, there are no special problems with suction and excretion of the drug. Panadol Extra is not prescribed to patients who have hypersensitivity to active substances. In rare cases, side effects occur, which can manifest as:

• Jumps in blood pressure.
• Functional disorders of the liver.
• Allergic reactions (redness, rashes, itching, etc.).

Read the official instructions for the features of use and recommended dosage. It should only be noted that 8 tablets is the maximum that an adult patient can take per day. Given the pharmacological properties of the drug, the interval between doses should be at least 4 hours. Tablets from the inflammatory process Panadol Extra cost about 45 rubles per pack.

Coldrex

In acute infectious diseases of the upper respiratory tract, Coldrex can be used. It is a complex anti-inflammatory drug, consisting of:

Given the multicomponent composition, Coldrex has a very diverse pharmacological effect:

1. The presence of paracetamol causes the normalization of temperature, the removal of pain and the elimination of the inflammatory process.
2. Ascorbic acid strengthens the local immunity of the respiratory tract.
3. Phenylephrine is responsible for the narrowing of peripheral vessels and preventing the growth of edema of the affected tissues.
4. Terpinhydrate enhances bronchial secretion and facilitates expectoration of sputum.
5. Caffeine potentiates the analgesic effect of paracetamol.

Coldrex has several varieties, each of which is selected individually, taking into account the severity of the clinical signs of the disease. There are such contraindications to its use:

• Allergy to the active ingredients of the drug.
• Severe disorders of the liver and kidneys.
• Diseases of the circulatory system.
• Increased blood pressure.
• Diabetes.
• Cardiovascular pathology (for example, arrhythmias, heart attack, etc.).
• Increased hormonal activity of the thyroid gland.
• Children whose age is less than 6 years.

The therapeutic course should be no more than 5 days. Dosage and frequency of use are detailed in the official instructions. During treatment, drug interactions with other drugs must be taken into account. It is strongly not recommended to combine with drugs from the group of antidepressants, beta-blockers, etc. Adverse reactions are rarely recorded. In general, the drug is well tolerated. When used for the treatment of children, it is better to first consult with your doctor. The cost of packing Coldrex tablets ranges from 160 rubles.

The list of NSAID drugs (tablets, capsules, etc.) is constantly updated and supplemented with new drugs that have more pronounced therapeutic effects and less toxic properties.

Fervex

Another representative of combined non-steroidal anti-inflammatory drugs is Fervex, which today is successfully used for most colds of the upper respiratory tract. How the pharmacological action of the drug is realized:

• The analgesic and antipyretic effect is characteristic of paracetamol.
• Strengthening local immunity and tissue repair provides ascorbic acid.
• The antihistamine effect is given by pheniramine, which helps to reduce the production of mucus in the nasal cavity, improve breathing through the nose, eliminate sneezing, lacrimation, etc.

Despite the fact that Fervex is considered a fairly safe medicine, not all patients can use it. In the following pathological conditions and diseases, this drug should not be used:

Children can use Fervex, starting from the age of 15. Use with extreme caution when:

• Functional insufficiency of the liver.
• Angle-closure glaucoma.
• Congenital disorders of bilirubin metabolism (for example, Gilbert's syndrome).
• Viral hepatitis.
• In old age.

At the recommended dosage, the drug is well tolerated. However, nausea, pain in the abdomen, itching, redness of the skin, rashes and other allergic reactions may occur. Unjustified prolonged use or a significant excess of the recommended dosage increases the risk of developing serious disorders of the kidneys and liver. In case of side effects, stop taking the medicine and contact a specialist for professional medical help.

The anti-inflammatory drug has its own characteristics of use. The contents of the Fervex sachet are dissolved in warm water (200 ml) and drunk completely. The recommended dosage is up to three times a day. The next appointment should be no earlier than 4 hours later. With functional disorders of the kidneys and liver, increase the interval between applications to 8 hours. The therapeutic course is up to five days. To reduce the temperature can be used within 3 days. Fervex is produced by the French company UPSA. You can buy it at a price of 360 rubles per package, which contains 8 sachets.

A complete list of modern anti-inflammatory drugs can be found in the Pharmaceutical Directory.

Aspirin-S

To date, Aspirin-C is considered one of the most popular drugs for the symptomatic treatment of infectious and inflammatory diseases of the respiratory system. Having in its composition acetylsalicylic and ascorbic acids, it is able to effectively eliminate the main clinical manifestations of colds (fever, headaches, malaise, etc.). The effectiveness of the drug has been proven by numerous scientific studies.

Aspirin-C comes in the form of effervescent tablets that can be quickly dissolved in water. This form is very convenient for most patients with colds. Especially with severe sore throats, when the use of conventional tablets or hot drinks provokes a very unpleasant sensation. In addition, it has long been established that ascorbic acid is destroyed at high temperatures. By dissolving it in cool water, we retain all the pharmacological properties of vitamin C. The absorption of the drug occurs quickly enough, which ensures the immediate onset of the therapeutic effect. It is also worth noting that acetylsalicylic acid is completely soluble in water without the formation of sediment, reducing the likelihood of various kinds of side effects.

However, uncontrolled long-term use of the drug can lead to the development of a number of adverse events:

• Vertigo.
• Headaches.
• Nausea.
• Vomiting.
• Breathing problems.
• Drowsiness.
• Lethargy.
• Increased bleeding.
• Allergies (itching, rashes, skin redness, etc.).

In case of an overdose of Aspirin-C, it is necessary to control the acid-base balance in the body. If necessary, special solutions are introduced to normalize the condition (for example, sodium bicarbonate or citrate). The therapeutic measures taken should be aimed at enhancing the excretion of acetylsalicylic acid and its metabolites.

It should be noted that in children with a suspected viral infection, drugs that contain acetylsalicylic acid are not used, since the likelihood of developing a more severe pathology, such as Reye's syndrome, increases. It is manifested by prolonged vomiting, damage to the central nervous system and enlargement of the liver.

Before surgery, it is better to refrain from taking Aspirin-C, which affects the blood clotting system. Also, acetylsalicylic acid slows down the process of excretion of uric acid from the body. Patients suffering from gout may experience a new attack during treatment with this drug. Aspirin-C is a prohibited drug during pregnancy. In the early stages, it often provokes congenital malformations in the fetus, in the later stages it inhibits labor activity.

The Swiss pharmaceutical company Bayer Consumer Care AG is one of the main manufacturers of Aspirin-C effervescent tablets. The cost of a package of medicine (10 pcs.) Is approximately 250 rubles.

ibuprofen

Complex therapy of infectious and inflammatory diseases of the respiratory system and ENT organs may include Ibuprofen. It is currently considered one of the most commonly prescribed non-steroidal anti-inflammatory drugs for fever and pain. It is widely used not only in therapeutic, but also pediatric practice. Being a very safe and effective antipyretic, it is allowed for sale without a doctor's prescription.

If there are appropriate indications, it can be used to treat children from the first days of life, both in stationary and laboratory conditions. Babies are recommended to use Ibuprofen in the form of rectal suppositories, which have a number of advantages over other forms of drug release:

• Simplicity and painlessness of introduction.
• There is no need for additional special tools.
• The integrity of the skin is not violated.
• There is no risk of infection.
• Intestinal fullness does not affect the absorption and effectiveness of the drug.
• Low incidence of allergic reactions.

Most patients do not experience any side effects during treatment with Ibuprofen. However, in rare cases, undesirable effects are still possible, which manifest themselves in the form of:

• Decreased appetite.
• Nausea.
• Vomiting.
• Headache.
• Drowsiness.
• nervousness.
• Hearing and vision disorders.
• Increase in blood pressure.
• Rapid heartbeat.
• Labored breathing.
• Edema syndrome.
• Kidney dysfunction.
• Allergies (rashes, itching, redness of the skin, Quincke's edema, etc.).

It is worth noting that the list of contraindications for the use of Ibuprofen is quite long, so we recommend that you read it in the official instructions for the drug. During therapy, it is desirable to use the minimum effective dosage of non-steroidal anti-inflammatory drugs in order to reduce the risk of adverse reactions. It is also preferable to stick to short courses of treatment. If the drug is ineffective or the condition worsens, you should immediately visit your doctor. Particular attention should be paid to the state of the digestive system, which is very sensitive to nonsteroidal drug therapy. Today, Ibuprofen is available under various trade names:

These drugs are produced by both foreign and domestic pharmaceutical companies. The cost of the medicine will depend not only on the form of release, but also on the amount of the active substance. For example, a package of Ibuprofen tablets from the Russian pharmaceutical company Sintez costs about 40 rubles.

Non-steroidal anti-inflammatory drugs are available without a prescription, but this does not mean that you should neglect the advice of a specialist before using them.

Some doctors may recommend Nise for infectious and inflammatory diseases of the upper and lower respiratory tract, which are accompanied by fever and pain. This modern non-steroidal anti-inflammatory agent contains the active substance nimesulide. It must be taken with severe symptoms of the disease. For example, Nise is able to bring down the temperature in 10-12 hours. He can also relieve headaches, fatigue, weakness, malaise, aching muscles and joints. However, in the absence of a sufficient therapeutic effect for 3-4 days, you should visit your doctor and adjust the course of treatment.

During the period of bearing a baby, the drug can not be used categorically. It has been established that nimesulide adversely affects the growth and development of the fetus. In addition, the active substance can penetrate into breast milk, so during treatment it is necessary to switch to artificial feeding. With proper observance of all recommendations for the use of the drug specified in the instructions, adverse reactions are practically not observed. In rare cases, the appearance of:

• Nausea, vomiting, diarrhea and other dyspeptic disorders.
• Headache, drowsiness, irritability.
• Increased blood pressure, breathing problems.
• Changes in the main blood parameters (for example, anemia, a decrease in the number of platelets, etc.).
• Reversible functional problems with the functioning of the kidneys and liver.
• Rash, itching, erythema, redness of the skin and other allergic reactions.

With extreme caution, Nise should be taken by patients who have problems with the digestive system, in particular, peptic ulcer. It is recommended to use short therapeutic courses, which in most cases successfully cope with the main symptoms of colds. Foreign pharmaceutical companies mainly specialize in the release of Nise, so often the price will be slightly higher compared to domestic analogues of the drug. A pack of Indian-made tablets (20 pcs.) Will cost about 180 rubles.

When choosing an effective non-steroidal anti-inflammatory drug, never neglect the opinion of a specialist.

What are the best non-steroidal anti-inflammatory drugs?

Anti-inflammatory drugs for joints are the main treatment for diseases of cartilage and connective tissue. They slow down the progression of the disease, help fight exacerbations, relieve painful symptoms. The scheme of taking the drug can be different - they are taken in courses, or as needed to alleviate the condition. Non-steroidal anti-inflammatory drugs (NSAIDs) are produced in various dosage forms - ointments and gels for topical use, tablets and capsules, as well as injectable preparations for intraarticular administration.

Anti-inflammatory drugs (NSAIDs) - the principle of action

This group of drugs is very extensive, but they are all united by a common principle of action. The essence of this process is that non-steroidal anti-inflammatory drugs for the treatment of joints interfere with the mechanism of the formation of the inflammatory process. The enzyme cyclooxygenase is responsible for the synthesis of so-called inflammatory mediators. It is she who is inhibited by drugs from the NSAID group, interrupting the chain of development of the inflammatory reaction. They prevent pain, fever and local swelling.

But there is another important feature of the action of non-steroidal anti-inflammatory drugs. There are two types of cyclooxygenase enzyme. One of them (COX-1) is involved in the synthesis of inflammatory mediators, and the second (COX-2) is involved in the synthesis of the protective layer of the stomach wall. NSAIDs act on both types of this enzyme, causing both of them to be inhibited. This explains the side effect common to these drugs, which consists in damage to the mucous membrane of the digestive organs.

According to their effect on COX-2 drugs are divided into selective and non-selective. The development of new NSAIDs aims to increase the selectivity of their effect on COX-1 and eliminate the effect on COX-2. Currently, a new generation of NSAIDs has been developed, which have almost complete selectivity.

The three main therapeutic effects of drugs in this group are anti-inflammatory, antipyretic and analgesic. In diseases of the joints, it is the anti-inflammatory effect that comes to the fore, and the analgesic effect is no less significant. The antipyretic effect is less important and practically does not manifest itself in the new generation of anti-inflammatory non-steroidal drugs that are used to treat joint diseases.

Classification of anti-inflammatory drugs

Taking into account the peculiarities of the structure of the active substance, all NSAIDs can be divided into several groups:

Non-selective NSAIDs (affect mainly COX-1)

These include the following tools:

Non-selective NSAIDs (equally affecting COX-1 and COX-2).

• Lornoxicam;
• Xefocam;
• Lorakam.

Selective NSAIDs (inhibit COX-2)

• Celecoxib;
• Meloxicam;
• Nimesulide;
• Rofecoxib.

Some of these drugs have a strong anti-inflammatory effect, others are more antipyretic (Aspirin, Ibuprofen) or analgesic (Ketorolac) effect.

Indications for the use of NSAIDs

knee arthritis is one of the causes

In diseases of the joints, nonsteroidal drugs are prescribed according to several schemes, depending on the dosage form and stage of the disease. The list of diseases for which NSAIDs are prescribed is quite long - these are arthritis of various etiologies, including autoimmune, most arthrosis, the recovery period after injuries of the joints and muscular apparatus.

With exacerbation of chronic diseases of the joints, non-steroidal anti-inflammatory drugs are used in a complex manner. They are prescribed in the form of a course of tablets and ointments, in a serious condition, the treatment is supplemented by intra-articular injections. Outside of exacerbation and in acute conditions, they are used as needed if symptoms of inflammation of the joints occur.

Side effects

Non-steroidal anti-inflammatory drugs have many side effects, so be sure to read the instructions before taking them. The most common side effects are:

• provocation of a stomach or duodenal ulcer,
• dyspepsia,
• dysfunction of the nervous system,
• allergic reactions

They are especially pronounced in medicines in tablets, suppositories and solutions for intramuscular injections. Local remedies (ointments and intra-articular injections) do not have such an effect.

Another common group of side effects is the effect on the hematopoietic system. NSAIDs have a blood-thinning effect, and this effect must be taken into account when taking these drugs so as not to harm your health. A more dangerous effect on the blood system is expressed in the inhibition of hematopoietic processes. It is manifested by a gradual decrease in the number of formed elements in the blood - first anemia develops, then - thrombocytopenia, subsequently - pancytopenia.

In addition, there are other side effects caused by the chemical characteristics of the drugs, they are indicated in the instructions for use. Due to the large number of side effects, you should consult your doctor before taking NSAIDs for the treatment of joints.

Contraindications

Contraindications to the use of NSAIDs in diseases of the joints stem from their side effects and relate primarily to tablet forms. They are not prescribed to patients during an exacerbation of diseases of the gastrointestinal tract, as well as to patients with diseases of the blood system - anemia of various origins, clotting disorders, leukemia and leukemia.

NSAIDs should not be administered simultaneously with drugs that reduce blood clotting (heparin), and it is also not recommended to take the same drug in different dosage forms - this leads to increased side effects. First of all, this applies to drugs containing ibuprofen and diclofenac.

In addition, it is possible to develop an allergic reaction to drugs of the NSAID group. Its intensity is not related to the dosage form, and appears with the same frequency when taking tablets, using ointments and injecting into the joints. Sometimes allergies can take very severe forms, for example, aspirin asthma - an asthmatic attack when using the drug. An allergic reaction to NSAIDs can be cross-reactive, so care should be taken when taking drugs.

Ointments with NSAIDs for joint diseases

Ointments are the most common dosage form that is used for joint pain. Their popularity is due to the fact that the effect of the ointment comes quickly enough, and the side effects are minimal. The ointment can be used to relieve acute pain and in the recovery period after injuries. But if a course of injections is prescribed, then the ointments are usually canceled.

The most popular drugs in the form of ointments are Diclofenac and preparations based on it (Voltaren), Dolobene, and others. Most of them can be bought at the pharmacy without a doctor's prescription. You can use such products for a long time without harm to health.

Non-steroidal anti-inflammatory drugs in tablets for diseases of the joints

NSAIDs in tablets are prescribed for joint lesions, osteochondrosis, systemic connective tissue diseases with articular syndrome. They are used in courses, several times a year, prescribed in the acute period. But the main task of NSAID tablets is to prevent the exacerbation of diseases.

This dosage form is most effective for the treatment of diseases of the joints and spine, but has the greatest number of contraindications. In addition to the conditions listed above, tablets containing NSAIDs should not be used for liver diseases - fibrosis, cirrhosis, hepatitis, liver failure. In diseases of the kidneys, accompanied by a decrease in the filtration rate, a reduction in dosage or frequency of administration is required.

A complete list of anti-inflammatory drugs can be found on Wikipedia. Among the most famous of them is Diclofenac in tablets. Of the more modern drugs of the new generation - Xefocam, Celecoxib and Movalis. New drugs are safer, but have another negative point - high cost. Tablets should be taken after meals or with meals.

NSAIDs in solutions for intra-articular injections

This dosage form is prescribed for severe disease and for the relief of severe exacerbation. It is used by courses that are held only in a medical institution. Intra-articular injections allow the most effective delivery of the active substance to the site of inflammation. But they require high qualifications from the doctor who conducts them, since they are associated with a risk of damage to the ligament of the joint.

Diclofenac, Movalis, Ksefokam and other drugs are available in injectable form. They are used to treat lesions of large joints, most often the knee, less often the elbow. Intra-articular injections are not prescribed for lesions of the joints of the hands and feet, as well as for diseases of the spine. This is due to the fact that the technical difficulties of administering the drug make this method of treatment almost impossible.

Intra-articular injections are considered a rather complex medical manipulation, and must be carried out in a treatment room, as they require sterility to avoid infection and highly qualified medical staff.

List of the best anti-inflammatory drugs

Let us consider in more detail the features of the use of the most popular drugs from the NSAID group.

Diclofenac (Voltaren, Naklofen, Olfen, Diklak, etc.)

Diclofenac and preparations based on it are produced in the form of tablets, capsules, ointments, gels, suppositories, injection solutions. These drugs exhibit a powerful anti-inflammatory effect, quickly relieve pain, lower the temperature and alleviate the patient's condition. A high concentration of the active ingredient in the blood is noted within 20 minutes after taking the drug.

Like most drugs from the NSAID group, they have a negative effect on the gastrointestinal tract, I have a rather extensive list of contraindications and side effects, so they should be used only as directed by a doctor, in short courses. The standard daily dose of Diclofenac in tablets for adult patients is 150 mg, it is divided into 2-3 doses. Local forms (ointments, gels) are applied to the affected area with a thin layer up to 3 times a day.

Indomethacin (Metindol)

It has the same therapeutic effect as Diclofenac. Available in the form of tablets, capsules, ointment, gel, rectal suppositories. But this drug has many more pronounced side effects, so it is now rarely used, giving preference to more modern drugs.

Piroxicam

A drug from the group of oxycams, with a pronounced analgesic, anti-inflammatory and antipyretic effect. Available in the form of capsules, tablets, ointments, creams, suppositories. It is used to treat gout, arthritis, joint and muscle pain, as well as in preparation for the IVF procedure.

Like other NSAIDs, it has an extensive list of side effects associated with damage to the digestive tract, impaired hematopoiesis, and reactions from the nervous system. Therefore, the drug should be used only as directed by a doctor. The analgesic effect of taking Piroxicam tablets persists throughout the day. The standard dose of the drug for an adult is up to 40 mg per day.

Lornoxicam (Xefocam, Lorakam, Larfix)

The drug has a pronounced anti-inflammatory effect, quickly copes with excruciating pain syndrome. Does not show antipyretic action. The drug is used to treat postoperative pain, algomenorrhea, in the treatment of osteoarthritis and rheumatoid arthritis.

Available in the form of tablets and powder, intended for the preparation of a solution for injection. The recommended dose for oral administration is up to 4 tablets per day in 2 divided doses. For injection into a muscle or vein, a single dose of the drug is 8 mg, the solution is prepared immediately before administration.

When using the drug, the likelihood of complications in people with gastroenterological pathologies increases, therefore, the drug is not used for diseases of the gastrointestinal tract, as well as during pregnancy, lactation, pathologies of the heart, liver and in childhood.

Meloxicam (Movalix, Revmoxicam, Melox)

Drugs based on enolic acid belong to the class of selective COX-2 inhibitors. In this regard, they cause fewer side effects from the digestive organs and do not provoke toxic damage to the kidneys and liver. Meloxicam tablets, rectal suppositories and injections in ampoules are produced.

Indications for the use of the drug are diseases of the joints of an inflammatory and degenerative nature with a pronounced pain syndrome - spondyloarthritis, osteoarthrosis and arthritis. As a rule, in the first days of treatment, the drug is used in the form of intramuscular injections, after the acute inflammatory process subsides, they switch to taking Meloxicam in tablet form (1 tablet twice a day).

Nimesulide (Nimesil, Nimesin, Remesulide)

The drug belongs to the group of highly selective COX-2 inhibitors, has a powerful anti-inflammatory effect, which is complemented by antipyretic and analgesic properties. Nimesulide is produced in the form of tablets, granules for suspension and in the form of a gel for topical use. A single dose of the drug in tablets is 100 mg, taken twice a day.

The gel is applied to the affected area several times a day (3-4), lightly rubbing. Suspension with a pleasant orange flavor can be prescribed to children from 12 years of age. The drug is intended for the treatment of post-traumatic and postoperative pain, degenerative joint lesions (accompanied by inflammation), bursitis, tendonitis.

In addition, Nimesulide is prescribed for atralgia, myalgia, painful periods, as well as for the relief of headache and toothache. The drug can have a toxic effect on the liver and kidneys, therefore, in diseases of these organs, the dose of the drug must be reduced.

Celecoxib (Revmroxib, Celebrex)

A drug from the group of coxibs, used in the treatment of inflammatory diseases of the joints, acute pain syndrome, menstrual pain. Available in the form of capsules, which may contain 100 or 200 mg of the active substance. It shows a pronounced analgesic and anti-inflammatory effect, while, if not exceeding the therapeutic dose, it has practically no negative effect on the gastrointestinal mucosa.

The maximum allowable daily dose of the drug is 400 mg divided into 2 doses. With prolonged use of Celecoxib in high doses, side effects develop - ulceration of the mucosa, disorders of the hematopoietic system and other undesirable reactions from the nervous, cardiovascular and genitourinary systems.

Aceclofenac (Zerodol)

The action of the drug is similar to Diclofenac, it is available in the form of tablets containing 100 mg of the active substance. Adults are advised to take 1 tablet twice a day. The drug is intended for the treatment of gout, arthritis of various etiologies, osteoarthritis and spondylitis.

This medication is much less likely than other NSAIDs to provoke erosive lesions of the gastrointestinal tract, but its administration may be accompanied by a number of side effects from the digestive, nervous, hematopoietic, and respiratory systems. With extreme caution, the drug is prescribed for pathologies of the liver, kidneys, diabetes mellitus, ischemia, arterial hypertension and other conditions, a list of which is given in the instructions for the drug.

Rofecoxib

This is a modern remedy from the category of highly selective COX-2 inhibitors, which have practically no negative effect on the gastrointestinal mucosa and kidneys. It is used as a strong analgesic and anti-inflammatory agent for most inflammatory and degenerative lesions of the musculoskeletal system. In addition, the medication is prescribed for migraine, neuralgia, lumbago, osteochondrosis, pain syndrome with muscle and ligament injuries.

This universal remedy is often included in the scheme of complex treatment of thrombophlebitis, diseases of the genitourinary system, is used in ophthalmology, for diseases of the ENT organs or for dental problems (stomatitis, pulpitis). With severe pain syndrome, you can take up to 4 tablets at a time. With caution, the drug is prescribed for bronchial asthma, in early pregnancy, during lactation. This medication has much fewer contraindications and side effects than other anti-inflammatory drugs.

Combined NSAIDs

New generation anti-inflammatory drugs combine a combination of an active ingredient with vitamins or other active ingredients that enhance their therapeutic effect. We present to your attention a list of the most popular drugs of combined action:

• Flamidez (diclofenac + paracetamol);
• Neurodiclovit (diclofenac + vitamins B1, B6, B12);
• Olfen-75 (diclofenac + lidocaine);
• Diclocaine (lidocaine + diclofenac in low dosage);
• Dolaren gel (diclofenac + flax oil + menthol + methyl salicylate);
• Nimid Forte (nimesulide + tizanidine);
• Alit (soluble tablets containing nimesulide and muscle relaxant dicycloverine);

This is not a complete list of combined anti-inflammatory drugs that are used to treat joints and degenerative lesions of the musculoskeletal system. For each patient, the doctor selects a treatment regimen individually, taking into account many factors. Drugs from the NSAID group have many contraindications and can cause a number of undesirable side reactions from various organs and systems.

Therefore, you can not self-medicate! Only a specialist can recommend the optimal remedy, taking into account the clinical picture of the disease, the severity of symptoms, comorbidities, and determine the required dosage of the drug and the duration of the course of treatment. This will help to avoid unwanted complications, will alleviate the patient's condition and speed up recovery.

Who to contact?

Depending on the nature of the pathology, the following specialists can deal with the treatment of a patient with joint diseases: a neurologist, a general practitioner, an orthopedist or a rheumatologist. It is these doctors who have the right to prescribe drugs from the NSAID group for the treatment of specialized diseases.

If the intake of anti-inflammatory drugs has led to the occurrence of adverse reactions, such narrow specialists as a gastroenterologist, cardiologist, allergist, nephrologist can join the treatment of the patient. If the patient is forced to take NSAIDs for a long time, be sure to consult a nutritionist and choose the best diet that will protect the gastric mucosa from damage.

Osteoarthritis, rheumatoid arthritis and other diseases of the joints and spine, occurring with pain and inflammation.

Peculiarities: all drugs in this group act on a similar principle and cause three main effects: analgesic, anti-inflammatory and antipyretic.

In different drugs, these effects are expressed to varying degrees, so some drugs are better suited for the long-term treatment of joint diseases, others are mainly used as painkillers and antipyretics.

The most common side effects: allergic reactions, nausea, abdominal pain, erosion and ulcers of the mucous membrane of the gastrointestinal tract.

Main contraindications: individual intolerance, exacerbation of peptic ulcer of the stomach and duodenum.

Important information for the patient:

Drugs that have a pronounced analgesic effect and a significant number of side effects (diclofenac, ketorolac, nimesulide and others) can only be used as directed by a doctor.

Among non-steroidal anti-inflammatory drugs, a group of so-called "selective" drugs is distinguished, which are less likely to have side effects from the gastrointestinal tract.

Even over-the-counter pain relievers cannot be used long-term. If they are required frequently, several times a week, it is necessary to be examined by a doctor and treated according to the recommendations of a rheumatologist or neurologist.

In some cases, long-term use of this group of drugs requires additional intake of proton pump inhibitors that protect the stomach.

Remember, self-medication is life-threatening, consult a doctor for advice on the use of any medications.

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Classmates

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

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

How NSAIDs work

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

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

When are NSAIDs used?

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

We list the diseases for which these medicines are prescribed:

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

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

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

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

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

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

The main advantage of NSAIDs of a new generation

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

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

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

What are new generation NSAIDs?

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

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

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

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

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

Acid preparations:

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

Non-acid drugs:

• Sulfonamide derivatives;
• Alcanones.

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

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

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

By analgesic effect drugs are listed in the following order:

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

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

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

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

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

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

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

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

Use in pregnancy

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

Description of non-steroidal anti-inflammatory drugs Movalis

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

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

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

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

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

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

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

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

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

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

Chondroprotectors - alternative drugs

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

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

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

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

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

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

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

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

Types behind the mechanism of action

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

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

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

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

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

Major non-selective NSAIDs

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

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

Selective COX-2 inhibitors

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

Main indications, contraindications and side effects

Today, the list of NVPS is constantly expanding and pharmacy shelves regularly receive new generation drugs that can simultaneously lower the temperature, relieve inflammation and pain in a short period of time. Due to the mild and gentle effect, the development of negative consequences in the form of allergic reactions, as well as damage to the organs of the gastrointestinal tract and urinary system, is minimized.

Table. Non-steroidal anti-inflammatory drugs - indications

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

This can be explained by their actions:

• Anti-inflammatory;
• Antipyretic;
• Analgesic.

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

What it is?

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

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

Now we will look at them in more detail.

The effect of these drugs

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

PGs have the following focus:

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

Indication for use

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

Most often, drugs in this group are prescribed for:

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

Release forms

NSAIDs are produced in the following forms:

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

Classification of non-steroidal anti-inflammatory drugs

There are several classifications of the described group.

By chemical structure:

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

All drugs in this group are divided into 2 types:

• Type 1 cyclooxygenase inhibitors;
• Type 2 cyclooxygenase inhibitors.

List of first generation drugs

List of second generation drugs

1. Movalis.
2. Nise.
3. Nimesil.
4. Arcoxia.
5. Celebrex.

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

List of the most effective NSAIDs

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

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

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

Impact principle

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

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

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

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

New developments

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

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

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

Indications for use

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

A positive impact is noted with the following factors:

1. Diseases of the musculoskeletal system. With various sprains, bruises, arthrosis, these drugs are simply irreplaceable. NSAIDs are used for osteochondrosis, inflammatory arthropathy, arthritis. The drug has an anti-inflammatory effect in myositis, herniated discs.
2. Strong pains. The drugs are quite successfully used for biliary colic, gynecological ailments. They eliminate headaches, even migraines, kidney discomfort. NSAIDs are successfully used for patients in the postoperative period.
3. Heat. The antipyretic effect allows the use of drugs for ailments of a diverse nature, both for adults and children. Such medicines are effective even in fever.
4. 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:

1. Old drugs (first generation). This category includes well-known drugs: Citramon, Aspirin, Ibuprofen, Naproxen, Nurofen, Voltaren, Diklak, Diclofenac, Metindol, Movimed, Butadion .
2. 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:

1. Salicylates. This group of NSAIDs contains drugs: Aspirin, Diflunisal, Lysine monoacetylsalicylate.
2. Pyrazolidins. Representatives of this category are drugs: Phenylbutazone, Azapropazone, Oxyphenbutazone.
3. 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.
4. Derivatives of phenylacetic acid. This group of NSAIDs contains funds: Diclofenac, Tolmetin, Indomethacin, Etodolac, Sulindac, Aceclofenac.
5. Anthranilic acid preparations. The main representative is the medicine "Mefenaminat".
6. Propionic acid agents. This category contains many excellent NSAIDs. List of drugs: Ibuprofen, Ketoprofen, Benoxaprofen, Fenbufen, Fenoprofen, Thiaprofenic acid, Naproxen, Flurbiprofen, Pirprofen, Nabumeton.
7. Derivatives of isonicotinic acid. The main medicine "Amizon".
8. Pyrazolone preparations. The well-known remedy "Analgin" belongs to this category.

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

Side effects

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

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

The main side effects can be:

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

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

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

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

Effective analgesics are Ketorolac, Ketoprofen, Indomethacin, Diclofenac.

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

The drug "Movalis"

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

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

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

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

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

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

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

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

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

The opinion of consumers about the drug

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

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

The drug "Celecoxib"

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

The indications for use given in the instructions are:

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

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

Consumer opinion

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

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

The drug "Nimesulide"

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

The remedy is used for:

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

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

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

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

The average price of a medicine is 76.9 rubles.

Non-steroidal anti-inflammatory drugs are a large group of pharmacological agents characterized by pronounced anti-inflammatory, analgesic and antipyretic effects.

Note:nonsteroidal anti-inflammatory drugs (NSAIDs) are abbreviated as NSAIDs or NSAIDs.

Important:such a common pain reliever and howParacetamol , does not belong to the group of NSAIDs, because it does not affect the inflammatory process, and is used only to relieve symptoms.

How do non-steroidal anti-inflammatory drugs work?

The action of NSAIDs is aimed at inhibiting the production of the cyclooxygenase (COX) enzyme, which in turn is responsible for the synthesis of biologically active substances - thromboxane, prostaglandins (PG) and prostacyclins, which act as inflammatory mediators. A decrease in the level of PG production contributes to the reduction or complete relief of the inflammatory process.

Different varieties of cyclooxygenase are present in a variety of organs and tissues. The COX-1 enzyme, in particular, is responsible for the normal blood supply to the mucous membrane of the digestive organs and maintaining a stable pH of the stomach by reducing the synthesis of hydrochloric acid.

COX-2 is normally present in tissues in small amounts, or not detected at all. An increase in its level is directly related to the development of inflammation. Drugs that selectively inhibit the activity of this enzyme act directly on the pathological focus. Due to this, there is no indirect negative effect on the organs of the digestive tract.

Note:COX-3 does not affect the dynamics of the inflammatory process, but is responsible for the development of pain and febrile reaction due to hyperthermia (rise in overall body temperature).

Classification of non-steroidal anti-inflammatory drugs for joints

According to the selectivity of the impact, all NSAIDs are divided into:

1. Non-selective, inhibiting all types of COX, but mainly - COX-1.
2. Non-selective, affecting both COX-1 and COX-2.
3. Selective COX-2 inhibitors.

The first group includes:

• Acetylsalicylic acid;
• Piroxicam;
• Indomethacin;
• Naproxen;
• Diclofenac;
• Ketoprofen.

The representative of the second category is Lornoxicam.

The third group includes:

• Nimesulide;
• Rofecoxib;
• Meloxicam;
• Celecoxib;
• Etodolac.

Important:Acetylsalicylic acid and Ibuprofen mainly reduce body temperature, and Ketorolac (Ketorol) reduces the intensity of pain. To reduce inflammation of the joints, they are ineffective, and can only be used for symptomatic therapy.

Pharmacokinetics

Systemic NSAIDs when taken per os are very rapidly absorbed. They are characterized by very high bioavailability (it varies from 70 to 100%). The process of absorption slows down somewhat with an increase in the pH of the stomach. The highest content in the blood serum is reached 1-2 hours after ingestion.

If the drug is administered intramuscularly, it is conjugated (connected) with plasma proteins (the level of binding is up to 99%). The resulting active complexes freely penetrate into the joint tissues and synovial fluid, mainly concentrating in the focus of inflammation.

The active substances of NSAIDs and their metabolites are excreted by the kidneys.

Contraindications

It is highly undesirable for women to use systemic NSAIDs (enteral or parenteral forms) for the treatment of joints during pregnancy. Some drugs in this category may be prescribed by the attending physician if the intended benefit to the mother is higher than the possible risk to the fetus.

Contraindications also include:

• individual hypersensitivity to the drug;
• and erosion of the digestive tract;
• leukopenia;
• thrombopenia;
• and/or liver failure.

Side effects of non-steroidal anti-inflammatory drugs

Drugs that inhibit COX-1 can provoke the development or exacerbation of gastrointestinal diseases, including hyperacid and ulcerative-erosive lesions of the walls of the digestive tract.

Often noted side effects are dyspeptic disorders (, severity "in the pit of the stomach",).

Regular use of NSAIDs or exceeding the recommended dosages often causes a violation of blood clotting, manifested by bleeding. With prolonged use, a decrease in the number of blood cells is possible, up to the development of such a serious disease as aplastic anemia.

Many NSAIDs have a nephrotoxic effect, leading to a decrease in the functional activity of the kidneys, and provoking. With prolonged use, they contribute to the development of nephropathy. Drugs can have a negative effect on liver function.

There is also a possibility of developing bronchospasm while taking non-steroidal anti-inflammatory drugs for the treatment of joints.

The specifics of anti-inflammatory therapy

All means of this group should be used only as directed by a doctor, followed by control of the dynamics of the inflammatory process. The patient should immediately notify the attending physician about all negative changes in the condition. Therapy is carried out at the lowest effective doses for the shortest possible time!

Preparations in the form of capsules or tablets should preferably be taken after meals with plenty of liquid (preferably pure water). So you can reduce the damaging effect of drugs on the mucous membrane of the digestive tract.

With the local use of anti-inflammatory gels and ointments, the likelihood of side effects is almost zero, since the active ingredients almost do not enter the systemic circulation.

Selected NSAIDs for the treatment of joint inflammation

When choosing a drug, the doctor takes into account the nature of the disease, the severity of the pathological process, as well as the individual characteristics of the patient's body (including the presence of chronic diseases and age).

Most often used:

Indomethacin

This medicine is available in the form of capsules and tablets. Standard single dosages are from 25 to 50 mg, and the frequency of administration is 2-3 times a day. Against the background of taking Indomethacin, the side effects characteristic of NSAIDs are especially common, so other, safer means are increasingly being preferred.

diclofenac

Analogues of this drug are Voltaren, Naklofen and Diklak. Diclofenac is produced by pharmacological companies in the form of tablets and capsules, an injection solution, gels for application to the affected joint area, and in the form of suppositories. Inside, it is prescribed at a dose of 50-75 mg 2-3 times a day, and the daily dose should not exceed 300 mg. The solution is injected intramuscularly (in the buttock), 3 ml each, observing the time interval between at least 12 hours. Injections are carried out in courses of no more than 5-7 days. The gel should be applied in the projection of the affected joint 2-3 times a day.

Etodolac

The analogue of the drug is Etol Fort. Etodolac is available in 400 mg capsules. It is selective, preferentially inhibiting the activity of COX-2. The drug is prescribed for both emergency care and course therapy, ankylosing spondylitis and osteoarthritis. Single dose - 1 capsule (1-3 times a day after meals). If there is a need for a course, the attending physician adjusts the dosage every 2-3 weeks after assessing the dynamics of the process. Side effects are relatively rare.

Important:Etodolac may reduce the effectiveness of some blood pressure medicines.

Aceclofenac

Analogues of the drug - Zerodol, Diclotol and Aertal. Aceclofenac is a good alternative to Diclofenac in terms of effectiveness. It is produced in tablets of 100 mg, and is used both for urgent relief of symptoms and for course treatment. It is advisable to take tablets 1 pc. 2 times a day with meals. Against the background of admission, pain in the abdominal region is also possible (symptoms are observed in almost 10% of patients), so it is advisable to treat the joints with minimally effective doses and short courses.

Piroxicam

The drug is available in tablets of 10 mg and in the form of a solution for injection; analogue of Piroxicam - Fedin-20. The active substance penetrates into the synovial fluid of the joints, acting directly in the focus of inflammation. Depending on the nosological form and the activity of the process (severity of symptoms), dosages vary from 10 to 40 mg per day (taken simultaneously or divided into several doses). The analgesic effect develops already 30 minutes after taking the tablets and lasts an average of a day.

Tenoxicam

Tenoxicam (Texamen-L) is sold as a powder for the preparation of an injection solution for intramuscular administration. The standard dosage is 2 ml, which corresponds to 20 mg of the active substance (administered 1 time per day). When during the period of exacerbation, a course of treatment is recommended for 5 days (up to 40 mg is administered to the patient daily).

Lornoxicam

The medicine is available in tablets (4 and 8 mg each), as well as in the form of a powder (8 mg) for dilution. Analogues - Lorakam, Ksefokam and Larfiks. The usual dosage of Lornoxicam is 8 to 16 mg 2-3 times a day before meals. Tablets should be taken with a large amount of liquid. The solution is intended for intravenous or intramuscular administration of 8 mg 1-2 times a day. The maximum allowable daily dose for the injection form is 16 mg.

Important:special care in the treatment of Loraxicam should be observed in patients suffering from diseases of the stomach.

Nimesulide

The most common analogues of this drug include Nimesil, Remesulide and Nimegezik. This NSAID is available in the form of granules for suspension, 100 mg tablets and gel for topical external use. The recommended dose is 100 mg 2 times a day after meals. The gel is recommended to be applied to the skin in the projection of the affected joint with light rubbing movements 2-4 times a day.

Important:patients with renal or hepatic insufficiency are assigned smaller doses. The drug has a hepatotoxic effect.

Meloxicam

Other trade names for Meloxicam are Melox, Recoxa, Movalis and Revmoxicam. This remedy for the treatment of inflammation of the joints is produced in the form of tablets of 7.5 or 15 mg, as well as in the form of a solution in ampoules of 2 ml (corresponding to 15 mg of the active ingredient) and suppositories for rectal administration.

The drug selectively inhibits COX-2; it rarely has a negative effect on the stomach and does not lead to nephropathy. At the very beginning of the course of treatment, Meloxicam is prescribed for intramuscular injection (1-2 ml each), and as the activity of the inflammatory process decreases, the patient is prescribed tablets. A single dosage of this NSAID is 7.5 mg, and the frequency of administration is 1-2 times a day.

Rofecoxib

Rofecoxib (another trade name is Denebol) is sold in pharmacies as an injection solution (2 ml ampoules contain 25 mg of the active substance) and in tablets. The degree of negative impact of this NSAID on the kidneys and gastrointestinal tract of this drug is extremely low. The standard therapeutic dose is 12.5-25 mg. The frequency of admission (or intramuscular injection) - 1 time per day. With intense joint pain at the beginning of the course, the patient is prescribed 50 mg of Rofecoxib.

Celecoxib

This selective COX-2 inhibitor is produced in the form of capsules containing 100 or 200 mg of the active substance. Analogues of Celecoxib are Flogoxib, Revmoksib, Celebrex and Zycel. NSAIDs rarely provoke the development or exacerbation of gastrointestinal pathologies if the prescribed treatment regimen is strictly followed. The recommended daily dose is 100-200 mg (at the same time or in 2 doses), and the maximum is 400 mg.