Treatment of osteochondrosis with non-steroidal anti-inflammatory drugs. Best Anti-Inflammatory Drugs Nonsteroidal Anti-Inflammatory Drugs Against

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

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

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

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

How do NSAIDs work?

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

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

When are these drugs prescribed?

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

List the diseases that prescribe these drugs:

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

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

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

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

Operating principle

Soreness, inflammation and fever are common pathological conditions that accompany many diseases. If we consider pathological course at the molecular level, it can be seen 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 soreness.

In addition, these hormone-like substances, reaching the cerebral cortex, affect the center responsible for thermoregulation. Thus, impulses are given about the presence inflammatory process in tissues or organs, so there is a corresponding reaction 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 goes more(may increase blood pressure). selective NSAID COX-1 inhibitors. This group is small, since almost all drugs that affect COX-1 affect in varying degrees and COX-2. 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 portion (plasma) and decrease shaped elements, including lipids that form cholesterol plaques. Due to these properties, NSAIDs are prescribed for many diseases of the heart and blood vessels.

List of NSAIDs

Major non-selective NSAIDs

Acid derivatives:

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

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

Selective COX-2 inhibitors

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

Main indications, contraindications and side effects

Today, the list of NVPS is constantly expanding and 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 organs, is minimized. gastrointestinal tract and urinary system.

Table. Non-steroidal anti-inflammatory drugs - indications

Property medical device	diseases, pathological condition organism
Antipyretic	High temperature (above 38 degrees).
Anti-inflammatory	Diseases of the musculoskeletal system - arthritis, arthrosis, osteochondrosis, muscle inflammation (myositis), spondyloarthritis. This also includes myalgia (often appears after a bruise, sprain, or soft tissue injury).
Painkiller	The drugs are used for menstrual and headaches (migraines), are widely used in gynecology, as well as for biliary and renal colic.
Antiplatelet agent	Cardiological and vascular disorders: ischemic disease heart, atherosclerosis, heart failure, angina pectoris. In addition, it is often recommended for the prevention of stroke and heart attack.

Non-steroidal anti-inflammatory drugs have a number of contraindications that must be taken into account. Drugs are not recommended for treatment if the patient:

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

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

The development of a negative result is explained by inhibition of the production of prostaglandins not only in the inflamed focus, but also in other tissues and blood cells. In healthy organs, hormone-like substances play important role. For example, prostaglandins protect the lining of the stomach from aggressive impact on her digestive juice. Therefore, the intake of NVPS contributes to the development peptic ulcer stomach and duodenum. If a person has these diseases, and he still takes "prohibited" drugs, then the course of the pathology can be aggravated up to perforation (breakthrough) of the defect.

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

violation of hemocoagulation; diseases of the liver, spleen and kidneys; Varicose veins; disease of cardio-vascular system; autoimmune pathologies.

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

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

Consider the most popular and effective medicines.

A drug	Route of administration into the body (form of release) and dosage						Application note
	outdoor		through the gastrointestinal tract		injection
	ointment	gel	pills	candles	Injection in / m	Intravenous administration
Diclofenac (Voltaren)	1-3 times (2-4 grams per affected area) per day		20-25 mg 2-3 times a day	50-100 mg once a day	25-75 mg (2 ml) 2 times a day	-	Tablets should be taken without chewing, 30 minutes before meals, with plenty of water.
Ibuprofen (Nurofen)	Strip 5-10 cm, rub 3 times a day	Strip of gel (4-10 cm) 3 times a day	1 tab. (200 ml) 3-4 times a day	For children from 3 to 24 months. (60 mg) 3-4 times a day	-	2 ml 2-3 times a day	For children, the drug is prescribed if the body weight exceeds 20 kg
Indomethacin	4-5 cm ointment 2-3 times a day	3-4 times a day, (strip - 4-5 cm)	100-125 mg 3 times a day	25-50 mg 2-3 times a day	30 mg - 1 ml of solution 1-2 r. per day	60 mg - 2 ml 1-2 times a day	During pregnancy, indomethacin is used to reduce uterine tone to prevent premature birth.
Ketoprofen	Strip 5 cm 3 times a day	3-5 cm 2-3 times a day	150-200 mg (1 tab.) 2-3 times a day	100-160 mg (1 suppository) 2 times a day	100 mg 1-2 times a day	100-200 mg dissolved in 100-500 ml of saline	Most often, the drug is prescribed for pain of the musculoskeletal system.
Ketorolac	1-2 cm of gel or ointment - 3-4 times a day		10 mg 4 times a day	100 mg (1 suppository) 1-2 times a day	0.3-1 ml every 6 hours	0.3-1 ml bolus 4-6 times a day	Taking the drug may mask signs of an acute infectious disease
Lornoxicam (Xefocam)	-	-	4 mg 2-3 times a day or 8 mg 2 times a day	-	Initial dose - 16 mg, maintenance - 8 mg - 2 times a day		The drug is used for pain syndrome of moderate and high severity
Meloxicam (Amelotex)	-	4 cm (2 grams) 2-3 times a day	7.5-15 mg 1-2 times a day	0.015 g 1-2 times a day	10-15 mg 1-2 times a day	-	In renal failure, the allowable daily dose is 7.5 mg
Piroxicam	2-4 cm 3-4 times a day		10-30 mg 1 time per day	20-40 mg 1-2 times a day	1-2 ml once a day	-	The maximum allowable daily dosage is 40 mg
Celecoxib (Celebrex)	-	-	200 mg 2 times a day	-	-	-	The drug is available only in the form of coated capsules that dissolve in the gastrointestinal tract
Aspirin (acetylsalicylic acid)	-	-	0.5-1 gram, take no more than 4 hours and no more than 3 tablets per day	-	-	-	If there have been allergic reactions to Penicillin in the past, then Aspirin should be prescribed with caution.
Analgin	-	-	250-500 mg (0.5-1 tab.) 2-3 times a day		250 - 500 mg (1-2 ml) 3 times a day		Analgin in some cases may have drug incompatibility, so it is not recommended to mix it in a syringe with other medicines. It is also banned in some countries.

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

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

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

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

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

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

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

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

How do NSAIDs work?

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

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

When are these drugs prescribed?

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

We list the diseases for which these drugs are prescribed:

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

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

List of Common NSAIDs for Joint Treatment

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

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

Alone medications weaker, not as aggressive, others are designed for acute arthrosis when required urgent intervention 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 they can be noted high price which makes it inaccessible to many people.

New generation NSAIDs: list and prices

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

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

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

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

Classification

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

Acid NSAIDs:

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

Non-acid NSAIDs:

Alcanones; Sulfonamide derivatives.

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

Effectiveness of medium doses

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

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

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

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

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

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

What dosage to choose?

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

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

Side effects

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

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

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

Use during pregnancy

It is not recommended to use drugs of the NSAID group during pregnancy, especially in the third trimester. Although no direct teratogenic effects have been identified, it is believed that NSAIDs can cause premature closure of the ductus arteriosus (Botalla) and renal complications at 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 negative impact it has practically no effect on the mucosa of the gastrointestinal tract, since it has a very low degree of affinity for COX-1, therefore, it does not cause a violation of the synthesis of constitutional prostaglandins.

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

Indomethacin

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

The price of the drug, regardless of the form of release (tablets, ointments, gels, rectal suppositories) is quite low, the maximum cost of tablets is 50 rubles per package. 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.

A bunch of pathological changes occurring in the body, accompanied by pain. 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 NSAIDs latest generation. 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. This enzyme (COX) causes 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 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 made it possible to reduce irritant 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 narcotic analgesics. In addition, they provide analgesic, anti-inflammatory effects. The use of NSAIDs reaches a wide scale in clinical setting and in everyday life. Today it is one of the most popular medical drugs.

A positive impact is noted with the following factors:

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

Classification

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

The classification of NSAIDs implies a division into two groups:

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

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

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

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

Side effects

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

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

The main side effects can be:

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

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

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

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

Effective analgesics are Ketorolac, Ketoprofen, Indomethacin, Diclofenac.

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

The drug "Movalis"

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

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

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

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

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

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

For rheumatoid arthritis and ankylosing spondylitis daily rate 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 inflammatory process is, in general, the body's natural response to an attempt to introduce foreign microorganisms into it. Thus, the lesion is limited and destroyed infectious agent. But the body is not always able to cope with the disease. In order not to lead to significant damage to organs and tissues, when their functions may even be impaired, anti-inflammatory drugs are often used. Without them, you can do with the effectiveness of etiotropic treatment. If we are talking about the chronic course of the systemic inflammatory disease connective tissue, and there is a danger of disability of the patient, then the use of anti-inflammatory drugs as early as possible is simply necessary.

All anti-inflammatory pills are divided into three main categories: steroid, non-steroid and slow-acting.

Steroids

These include Initially, these were: cortisone and hydrocortisone, obtained from the adrenal glands. Now a number of these drugs have been replenished with synthetic drugs: prednisolone, methylprednisolone, fluorinated derivatives - dexamethasone, triamcinolone, flumethasone, betamethasone. Steroids actively inhibit phospholipase A2, which is why they have an anti-inflammatory effect. Indications for the use of steroids are all forms of active rheumatism. Treatment is long, up to 2 months, often combined with non-steroidal drugs.

Means of slow action

These anti-inflammatory pills are used to treat systemic lesions rheumatoid arthritis. These are basic treatment drugs with a slow effect that manifests itself within a few months. These include hingamin (delagil, chloroquine), penicillinamine, cytostatics, etc.

Non-steroidal anti-inflammatory drugs (NSAIDs)

This group is the most common. tablets also have antipyretic and analgesic effects. They gained great popularity wide range action and high efficiency. More than 30 million people around the world take drugs of this group every day, almost half of them are over the age of 60 years. Many people buy drugs from pharmacies without a prescription.

NSAIDs are divided into groups depending on the chemical structure and nature of action. The first includes anti-inflammatory pills of high efficiency. These are salicylates (among them the well-known aspirin), pyrazolidines (phenylbutazone), derivatives of indolacetic (indomethacin, sulindac) and phenylacetic (diclofenac) acids, oxicam (piroxicam, etc.), derivatives (ibuprofen, ketaprofen, naproxen, etc.) . This group also includes some non-acid derivatives, for example, alkanones (namubetone), sulfonamide derivatives (nimesulide, rofecoxib).

The drugs of the second group have a weak anti-inflammatory activity. By the way, the popular paracetamol belongs to them.

The action of NSAIDs is based on the inhibition of cyclooxygenase (COX) - an enzyme involved in the synthesis of prostaglandins. The latter are modulators of the inflammatory process, produce the appearance of pain and jumps temperature (fever).

NSAIDs have many side effects, but recent times A new generation of drugs began to appear (meloxicam, tenoxicam, nabumeton, solpaflex), which selectively inhibit prostaglandins, thereby significantly reducing the likelihood of unpleasant complications. Knowing the many severe side effects that many antibiotics have, anti-inflammatory drugs are often preferred when given the choice.

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) are medical preparations new generation, which have anti-inflammatory, antipyretic and analgesic (analgesic) effect. 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.

• How NSAIDs work
  • When are NSAIDs used?
• • The main advantage of NSAIDs of a new generation
  • What are new generation NSAIDs?
  • Classification of NSAIDs
  • Choice of dosage
  • Side effects
  • Use in pregnancy
• • Movalis
  • Celecoxib
  • Indomethacin
  • ibuprofen
  • Diclofenac
  • Chondroprotectors - alternative drugs

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?

Often NSAID drugs used to treat chronic or acute inflammation that are accompanied by pain. Non-steroidal anti-inflammatory drugs have gained great popularity due to effective treatment joints.

We list the diseases for which these medicines are prescribed:

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

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

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

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 and stomach mucosa with the formation of bleeding and ulcers. 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 membranes of organs 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 nonsteroidal drugs of the new generation act much more selectively, they inhibit COX-2 to a greater extent, while COX-1 remains almost unaffected. This can explain quite high efficiency drug in combination with a minimum of side effects.

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

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

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

Classification of NSAIDs

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

Acid preparations:

Non-acid drugs:

• Sulfonamide derivatives;
• Alcanones.

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

According to the strength of the anti-inflammatory effect of medium doses, the drugs are arranged in the following sequence (the strongest from above):

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

According to the analgesic effect, the drugs are arranged in the following order:

Most often, the NSAIDs listed above are used for chronic and acute illnesses accompanied by inflammation and pain. As a rule, anti-inflammatory nonsteroidal drugs are used to treat joints and relieve pain: injuries, arthrosis, arthritis, etc.

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

Choice of dosage

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

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

Side effects

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

Treatment of NSAIDs must be carried out for the 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

It 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.

Celecoxib

COX-2 inhibitor, which has a pronounced analgesic and anti-inflammatory effect. 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.

Indomethacin

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.

ibuprofen

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

Diclofenac

Form of production - capsules, tablets, gel, suppositories, injection solution. AT 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 often, chondroprotectors are used to treat joints. People often do not understand the difference between chondroprotectors and NSAIDs. The latter are quickly removed. 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 ointments (NSAIDs): a list of drugs (creams, gels)

As a rule, anti-inflammatory ointments are used externally. But today you can buy products that have a creamy texture, which are taken orally, intervaginally and rectally.

The cream, which has an anti-inflammatory effect, is used to treat joints, allergies and infections. But often such drugs are referred to as adjunctive therapy methods.

In addition, almost all anti-inflammatory ointments have an analgesic and regenerating effect. Therefore, they are used to treat:

• diseases of the musculoskeletal system;
• bruises;
• injuries;
• local inflammation;
• pathologies of the muscles and back.

The principle of action of the treatment of diseases of the joints and other diseases is to inhibit the production of inflammatory substances by cells - mediators (kinin, prostaglandins, lysosomal enzymes histamine).

Also, anti-inflammatory ointments are intended for cutaneous use. However, there are drugs that need to be injected directly into the vagina or applied to the mucous membrane.

Non-steroidal anti-inflammatory ointments are often used in the most various fields medicine. Today there are many ointments that are used:

1. for the treatment of joints;
2. in orthopedics;
3. gynecology;
4. infectology;
5. dermatology;
6. venereology.

The advantage of this form of release is that the gel or ointment does not spread along with the blood throughout the body, that is, their effect is local.

Anti-inflammatory drugs for diseases of the musculoskeletal system

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

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

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

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

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

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

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

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

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

ibuprofen

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

However, such funds cannot be used if:

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

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

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

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

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

Indomycin

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

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

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

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

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

Contraindications to the use of the drug are as follows:

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

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

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

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

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 are preferably 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 pathological process, as well as the individual characteristics of the patient's body (including the presence 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 preference is increasingly given to other, safer means.

Diclofenac

Analogues of this drug are Voltaren, Naklofen and Diklak. Diclofenac is produced by pharmacological companies in the form of tablets and capsules, injection solution, gels for application in the area of ​​the diseased joint, 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 tool is prescribed for emergency care, and for 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 good alternative 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 liver failure smaller doses are given. 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 (other tradename- 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 observed. The recommended daily dose is 100-200 mg (at the same time or in 2 doses), and the maximum is 400 mg.