Non-steroidal drugs: types and characteristics, features of use. Which NSAIDs are best for long-term use? Which anti-inflammatory medications?

Anti-inflammatory drugs for colds are used if the disease has developed, and traditional means they don't help anymore. Read on to find out what medications there are.

"Nurofen"

"Nurofen" is classified as a non-steroidal anti-inflammatory and antipyretic drug.

The action of the drug is to block the formation of substances that support inflammatory reactions in the body. Capable of influencing immune system, increase the level of body defense. It is one of the best anti-inflammatory drugs.

The medicine has this effect due to ibuprofen, which reduces vascular permeability, improves microcirculation, reduces the release of inflammatory mediators from cells, and suppresses the energy supply of inflammatory processes.

Nurofen is taken orally. Recommended use short period and small doses. The duration of use is determined by the attending physician.

Nurofen should not be given to children who cannot tolerate ibuprofen or other Excipients, which are part of the medicine. It is not recommended to prescribe to patients who have stomach ulcers, gastrointestinal bleeding, as well as to patients with heart, liver and kidney problems.

"Aspirin"

“Aspirin” is a non-steroidal drug that is used as an antipyretic, anti-inflammatory and analgesic for colds when the temperature is elevated. Also to relieve pain in muscles and joints.

The active substance in Aspirin is acetylsalicylic acid. When this substance comes into contact with inflammation, it neutralizes it.

Aspirin is taken in tablets. For an anti-inflammatory effect, larger doses are prescribed. All dosages of the drug are prescribed by the attending physician. The drug should not be used for erosive and ulcerative exacerbations, bronchial asthma.

"Analgin"

"Analgin" is a drug that is widely used for the treatment of various infectious diseases. inflammatory diseases. Quickly absorbed into the blood. Has a moderate anti-inflammatory effect.

The active substance in the product is metamizole sodium.

The drug is administered orally in tablets, intravenously and intramuscularly in the form of a solution, or rectally in the form of capsules. Doses for intravenous or intramuscular use prescribed by the attending physician. For rectal use There are separate candles for adults and for children. The dosage of the medicine depends on the nature of the disease.

Contraindicated if the patient has hypersensitivity, aspirin asthma, impaired renal and liver function, as well as hematopoiesis.

"Paracetamol"

Paracetamol is a drug that has an antiseptic and slight anti-inflammatory effect. Affects pain and thermoregulation centers.

The product is available in tablets, capsules, soluble tablets, syrup and rectal suppositories. Use with plenty of water 1-2 hours after meals. Adults drink 4 times a day. The maximum daily dosage of the drug is 4 g. The duration of treatment is from 5 to 7 days. In patients with impaired liver and kidney function, the dose of the drug should be reduced.

Do not use in patients who are sensitive to paracetamol. It is forbidden to give to patients suffering from liver and kidney failure. It is contraindicated to use a rectal suppository if the patient has inflammation of the intestinal mucosa.

"Amiksin"

"Amiksin" is a drug that has antiviral effect, effectively destroys bacteria and viruses that cause a cold. Stimulates the growth of stem cells. Surpasses other means in terms of harmlessness and the resulting effect.

The product is consumed after meals. The duration of drug treatment depends on the nature and complexity of the disease.

The drug is contraindicated for pregnant and lactating women, children under 7 years of age, and patients who are hypersensitive to the ingredients of the drug.

"Kagocel"

"Kagocel" is antiviral drug, which has an immunostimulating effect. Most often, the drug is used to treat influenza. Stimulates the body's production of its own proteins, which have a strong antiviral effect.

"Kagocel" is taken orally, swallowed with plenty of liquid. It is recommended not to chew or crush the tablets.

Do not use in patients with hypersensitivity to the drug or hereditary galactose intolerance. Patients with impaired absorption of glucose-galactose. Contraindicated for women during pregnancy and breastfeeding. Do not give to children under 6 years of age.

"Cycloferon"

"Cycloferon" is an antiviral, immunostimulating agent. Effectively acts against acute respiratory diseases.

Active substances suppress pathogenic bacteria and viruses.

Cycloferon is taken once a day, half an hour before meals, with water. The tablet is not chewed or crushed. Patients with hepatitis or HIV use different dosages and schedules to take the drug. The number of tablets taken at a time is determined by the attending physician.

Cycloferon should not be taken by patients who have an allergic reaction to this drug. Also contraindicated in patients with liver cirrhosis and women during pregnancy and lactation.

"Amizon"

"Amizon" is classified as a non-steroidal, antipyretic, anti-inflammatory drug. Has an immunomodulatory effect. "Amizon" normalizes metabolism at the site of inflammation and weakens vascular reactions. Strengthens the body's immunity, which allows it to better fight colds. Prescribed to combat influenza and other colds. It is also used in the treatment of infectious diseases and diseases that patients have been suffering from for a long period.

The drug is used after meals without chewing. Treatment lasts on average from 5 to 7 days. The dosage is determined by the attending physician.

Contraindicated in patients with hypersensitivity to iodine, children under 6 years of age, and women in the first trimester of pregnancy.

"Arbidol"

"Arbidol" is an antiviral drug that increases the body's resistance to viruses, strengthening the immune system. Used to treat influenza and colds in light forms. Reduces the risk of complications of viral infections and exacerbation of chronic bacterial diseases. When used, it reduces intoxication and the duration of the disease.

The drug is produced in tablets and capsules.

Should be taken orally before meals. Dosage varies depending on age, weight and disease.

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

Today there are more than 25 various medications, belonging to the group of non-steroidal anti-inflammatory drugs. Classification by chemical structure is considered of little use for comparative assessment of the effectiveness and safety of a drug. 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:

• Paracetamol.
• Citramon.
• Panadol Extra.
• Coldrex.
• TeraFlu.
• Femizol.
• Ferwerks.
• Aspirin-S.
• Ibuprofen.
• Nise.
• Nimesulide.

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

Features of application

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, preference is given to NSAIDs, which have more pronounced antipyretic and anti-inflammatory properties. I would like to note that due to high risk The occurrence of adverse reactions is highly undesirable when taking several NSAIDs at once. At the same time, their therapeutic effect does not increase, but increases sharply negative impact on the body, in particular on the digestive system.

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

Paracetamol

With the main clinical symptoms Colds are effectively treated with Paracetamol. Taking it in the appropriate dosage makes it possible to quickly bring down a high fever, relieve malaise and fatigue, and relieve painful sensations etc. The main advantages of the drug:

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

Paracetamol has its own characteristics of use. Can be used in tablet, powder, rectal suppositories, injections, etc. Taking the drug orally or administering it rectally allows you to achieve more effective results. The interval between use should be at least 4 hours. The average duration of treatment is 5-7 days. A longer therapeutic course with this antipyretic drug is not recommended. Usually clinical manifestations Colds begin to subside on the 2-3rd day. If your condition worsens significantly, you should immediately consult a doctor.

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

• Anemia.
• Decreased platelet count.
• Renal colic.
• Glomerulonephritis.
• Allergic manifestations (itching, redness of the skin, various rashes, etc.).

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

• The appearance of pallor, nausea, vomiting and pain in the abdominal area.
• In case of failure to provide timely assistance and take too large dose medications affect the kidneys and liver. Arrhythmia, pancreatitis, and serious disorders of the central nervous system may develop.

If severe clinical manifestations of overdose are observed, it is necessary to prescribe Methionine or N-acetylcysteine, which are effective antidotes (antidote). In addition, when using Paracetamol, you should consider drug interactions with other drugs. 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 a combined NSAID drug, which contains not only paracetamol, but also caffeine as active substances. Both components enhance 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 concentration of paracetamol 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 quite well. Usually, special problems There is no medicine with suction and excretion. Panadol Extra is not prescribed to patients who have increased sensitivity to active ingredients. In rare cases, side effects occur, which may include:

• Blood pressure surges.
• Functional disorders of the liver.
• Allergic reactions (redness, rashes, itching, etc.).

For details of use and recommended dosage, please read the official instructions. It should only be noted that 8 tablets is the maximum that an adult patient can take per day. Considering pharmacological properties drug, the interval between doses should be at least 4 hours. Anti-inflammatory tablets Panadol Extra cost approximately 45 rubles per pack.

Coldrex

For acute infectious diseases upper respiratory tract you can use Coldrex. This is a complex anti-inflammatory drug consisting of:

• Paracetamol.
• Caffeine.
• Phenylephrine.
• Terpinhydrate.
• Ascorbic acid.

Considering its multi-component composition, Coldrex has a very diverse pharmachologic effect:

1. The presence of paracetamol normalizes the temperature, relieves pain and eliminates the inflammatory process.
2. Ascorbic acid strengthens the local immunity of the respiratory tract.
3. Phenylephrine is responsible for the narrowing of peripheral blood vessels and preventing the increase in edema of the affected tissues.
4. Terpin hydrate 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 clinical signs diseases. There are the following contraindications to its use:

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

The therapeutic course should be no more than 5 days. The dosage and frequency of use are specified in detail in the official instructions. During treatment, drug interactions with other drugs must be taken into account. It is strictly not recommended to combine antidepressants, beta-blockers, etc. with medications from the group. Adverse reactions are rarely recorded. In general, the medicine is well tolerated. When used to treat children, it is better to first consult with your doctor. The cost of a package of 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 effect of the drug is realized:

• The analgesic and antipyretic effect is characteristic of paracetamol.
• Strengthening local immunity and tissue restoration ensures ascorbic acid.
• Pheniramine has an antihistamine effect, which helps reduce mucus production in the nasal cavity, improve breathing through the nose, eliminate sneezing, watery eyes, etc.

Despite the fact that Fervex is considered quite safe medicine, not all patients can use it. For the following pathological conditions and diseases, this product should not be used medicinal product:

• Allergies to the active ingredients (paracetamol, ascorbic acid and pheniramine).
• Serious problems with digestive system(for example, peptic ulcer).
• Severe renal impairment.
• Portal hypertension.
• Alcoholism.
• Glucose-6-phosphate dehydrogenase deficiency.
• Pregnancy and breastfeeding.

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

• Functional liver failure.
• 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 significantly exceeding the recommended dosage increases the risk of developing serious problems with the kidneys and liver. If side effects occur, stop taking the medicine and consult 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 drink completely. The recommended dosage is up to three times a day. The next appointment should be no earlier than 4 hours later. In case of functional disorders of the kidneys and liver, increase the interval between applications to 8 hours. The therapeutic course is up to five days. Can be used for 3 days to reduce fever. The French company UPSA produces powder for oral administration of Fervex. You can purchase 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 reference book.

Aspirin-S

Today one of the most popular medicines For the symptomatic treatment of infectious and inflammatory diseases of the respiratory system, Aspirin-S is considered. Containing acetylsalicylic and ascorbic acids, it is able to effectively eliminate the main clinical manifestations of colds (fever, headaches, malaise, etc.). The effectiveness of the medicine has been proven by numerous scientific studies.

Aspirin-S is available in the form effervescent tablets, which can be quickly dissolved in water. This form is very convenient for most patients with colds. Especially with severe sore throat, when the use of ordinary tablets or hot drinks provokes a very unpleasant sensation. In addition, it has long been established that ascorbic acid is destroyed when high temperature. By dissolving it in cool water, we retain all the pharmacological properties of vitamin C. The absorption of the medicine occurs quite quickly, which ensures immediate onset 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 side effects.

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

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

In case of an overdose of Aspirin-S, 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). Therapeutic measures taken should be aimed at enhancing the excretion of acetyl salicylic acid and its metabolites.

It should be noted that in children with suspected viral infection do not use medications that contain acetylsalicylic acid, since the likelihood of developing a more severe pathology, such as Reye's syndrome, increases. It manifests itself with prolonged vomiting, damage to the central nervous system and enlarged liver.

Before surgical intervention It is better to refrain from taking Aspirin-C, which affects the blood coagulation system. Also, acetylsalicylic acid slows down the elimination process uric acid from the body. Patients suffering from gout may experience another attack while being treated with this drug. Aspirin-S is a prohibited drug during pregnancy. On early stages often provokes birth defects development in the fetus, in later stages it inhibits labor.

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

Ibuprofen

Complex therapy for infectious and inflammatory diseases of the respiratory system and ENT organs may include Ibuprofen. It is now considered one of the most commonly prescribed non-steroidal anti-inflammatory drugs for the management of fever and pain. Widely used not only in therapeutic but also pediatric practice. Being a very safe and effective antipyretic drug, it is approved 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 inpatient and laboratory conditions. Children are recommended to use Ibuprofen in the form of rectal suppositories, which have a number of advantages compared to other forms of medication:

• Simplicity and painlessness of administration.
• There is no need for additional special tools.
• The integrity of the skin is not compromised.
• There is no danger 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 unwanted effects are still possible, which manifest themselves in the form:

• Decreased appetite.
• Nausea.
• Vomiting.
• Headache.
• Drowsiness.
• Nervousness.
• Hearing and vision impairments.
• Increased blood pressure.
• Increased heart rate.
• Difficulty 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 advisable to use minimally effective dosage non-steroidal anti-inflammatory drug 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. Special attention attention should be paid to the state of the digestive system, which is very sensitive to therapy non-steroidal drugs. Today, Ibuprofen is available under various trade names:

• Ibufen.
• Nurofen.
• Advil.
• Faspik.
• Yprene.

These drugs are produced both foreign and domestic pharmaceutical companies. The cost of the medicine will depend not only on the form of release, but also on the quantity 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 not consult a specialist before using them.

Nise

Some doctors may recommend the drug 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 drug contains the active substance nimesulide. It must be taken when the symptoms of the disease are severe. 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, if there is no sufficient therapeutic effect within 3-4 days, you should visit your doctor and adjust the course of treatment.

During the period of bearing a baby, the drug should absolutely not be used. It has been established that nimesulide has a negative effect on the growth and development of the fetus. In addition, the active substance can penetrate into breast milk, therefore, during treatment it is necessary to switch to artificial feeding. If all recommendations for the use of the medicine specified in the instructions are correctly followed, adverse reactions are practically not observed. In rare cases, the following may occur:

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

Nise should be taken with extreme caution by patients who have problems with the digestive system, in particular peptic ulcers. 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 production of Nise, so the price will often be slightly higher compared to domestic analogues medicines. Pack of tablets (20 pcs.) made in India will cost about 180 rubles.

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

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the main drugs used to treat inflammatory joint diseases.

They are prescribed in periodic courses for chronic processes, and, if necessary, for exacerbations of diseases and acute inflammatory processes. NSAIDs exist in various dosage forms– tablets, ointments, injection solutions. The choice of the necessary remedy, dosage and frequency of its use should be made by a doctor.

NSAIDs - what is this group of drugs?

The group of NSAIDs is quite extensive and includes drugs with different chemical structures. The name “non-steroidal” shows their difference from another large group of anti-inflammatory drugs – corticosteroid hormones.

The common properties of all drugs in this group are their three main effects - anti-inflammatory, analgesic, antipyretic.

This explains another name for this group - non-narcotic analgesics, as well as the enormous breadth of their use. These three effects are expressed differently in each drug, so they cannot be completely interchangeable.

Unfortunately, all NSAID drugs have similar side effects. The most famous of them are the provocation of gastric ulcers, toxicity to the liver and inhibition of hematopoiesis. For this reason, you should not exceed the dosage indicated in the instructions, and also take these drugs if you suspect these diseases.

Abdominal pain cannot be treated with such medications - there is always a risk of worsening your condition. Various dosage forms of NSAIDs have been invented to improve their effectiveness in each specific situation and reduce potential health harm.

History of discovery and formation

The use of herbal remedies with anti-inflammatory, antipyretic and analgesic effects was described in the works of Hippocrates. But the first accurate description of the effect of NSAIDs dates back to the 18th century.

In 1763, the English physician and priest Edward Stone reported in a letter to the chairman of the Royal Society of London that an infusion of willow bark, growing in England, has antipyretic properties, described the recipe for its preparation and the method of use for febrile conditions.

Almost half a century later in France, I. Lear isolated a substance from willow bark that caused it medicinal properties. By analogy with From the Latin name for willow - salix, he called this substance salicin. This was the prototype of modern acetylsalicylic acid, which they learned to produce chemically in 1839.

Industrial production of NSAIDs was established in 1888; the first drug to hit pharmacy shelves was acetylsalicylic acid under trade name Aspirin, produced by Bayer, Germany. She still owns the rights to trademark Aspirin, therefore other manufacturers produce acetylsalicylic acid under the international generic name or create their own (for example, Upsarin).

More recent developments have led to the emergence of a number of new drugs. Research continues to this day, creating increasingly safer and effective means. Oddly enough, the first hypothesis about the mechanism of action of NSAIDs was formulated only in the 20s of the 20th century. Previously, drugs were used empirically, their dosages were determined by the patient's well-being, and side effects were not well studied.

Pharmacological properties and mechanism of action

Development mechanism inflammatory reaction in the body is quite complex and includes a chain chemical reactions, launching each other. One of the groups of substances involved in the development of inflammation is prostaglandins (they were first isolated from tissue prostate gland, hence the name). These substances have a dual function - they participate in the formation of protective factors in the gastric mucosa and in the inflammatory process.

Prostaglandin synthesis is carried out by two types of cyclooxygenase enzyme. COX-1 synthesizes “gastric” prostaglandins, and COX-2 synthesizes “inflammatory” ones, and is normally inactive. It is the activity of COX that NSAIDs interfere with. Their main effect - anti-inflammatory - is due to the inhibition of COX-2, and the side effect - disruption of the protective barrier of the stomach - is due to the inhibition of COX-1.

In addition, NSAIDs interfere quite strongly with cellular metabolism, which is responsible for their analgesic effect - they disrupt the conduction of nerve impulses. This is also the cause of lethargy, as a side effect of taking NSAIDs. There is evidence that these drugs stabilize lysosome membranes, slowing down the release of lytic enzymes.

Entering the human body, these drugs are absorbed mostly in the stomach, and in small quantities from the intestines.

Absorption varies; for new drugs, bioavailability can reach 96%. Enteric-coated drugs (Aspirin Cardio) are absorbed much less well. The presence of food does not affect the absorption of drugs, but since they increase acidity, it is advisable to take them after meals.

The metabolism of NSAIDs occurs in the liver, which is associated with their toxicity to this organ and the impossibility of use in various diseases liver. A small part of the incoming dose of the drug is excreted through the kidneys. Modern developments in the field of NSAIDs are aimed at reducing their effect on COX-1 and hepatotoxicity.

Indications for use - scope of application

The diseases and pathological conditions for which NSAIDs are prescribed are varied. Tablets are prescribed as an antipyretic for infectious and non-communicable diseases, and also as a remedy for headaches, dental, joint, menstrual and other types of pain (except for abdominal pain, if its cause is not clear). In children, suppositories containing NSAIDs are used to relieve fever.

Intramuscular injections of NSAIDs are prescribed as an analgesic and antipyretic for in serious condition sick. They are necessarily part of the lytic mixture - a combination of drugs that can quickly bring down a dangerous temperature. Treatment with intra-articular injections severe lesions joints caused by inflammatory diseases.

Ointments are used for local action on inflamed joints, as well as for diseases of the spine, muscle injuries to relieve pain, swelling and inflammation. Ointments can only be applied to healthy skin. For joint diseases, all three dosage forms can be combined.

The most famous drugs of the group

The very first NSAID to go on sale was acetylsalicylic acid under the brand name Aspirin. This name, despite the fact that it is commercial, is strongly associated with the drug. It is prescribed to reduce fever, relieve headaches, small doses - to improve the rheological properties of blood. Rarely used for joint diseases.

Metamizole (Analgin) is no less popular than aspirin. Used to relieve pain of various origins, including joint pain. It is prohibited in many European countries, as it has a strong inhibitory effect on hematopoiesis.

– one of the popular drugs for the treatment of joints. Included in many ointments, available in and. It has a pronounced anti-inflammatory and analgesic effect, with almost no systemic effect.

Side effects

As with any other medication, there are numerous side effects when taking NSAIDs. The most famous among them is ulcerogenic, i.e. provoking ulcers. It is caused by inhibition of COX-1 and is almost completely absent in selective NSAIDs.

Acidic derivatives have an additional ulcerogenic effect by increasing the acidity of gastric juice. Most NSAIDs are contraindicated for gastritis with high acidity, gastric ulcer and duodenum, GERD.

Another common effect is hepatotoxicity. It can manifest itself as pain and heaviness in the abdomen, digestive disorders, and sometimes short-term icteric syndrome, skin itching, other manifestations of liver damage. For hepatitis, cirrhosis and liver failure NSAIDs are contraindicated.

Inhibition of hematopoiesis, which, if the dosage is constantly exceeded, leads to the development of anemia, in some cases - pancytopenia (lack of all blood elements), impaired immunity, and bleeding. NSAIDs are not prescribed for serious illnesses bone marrow and after his transplantation.

Effects associated with poor health – nausea, weakness, slow reaction, decreased attention, feeling tired, allergic reactions up to asthmatic attacks - occur individually.

Classification of NSAIDs

Today, there are many drugs in the NSAID group, and their classification should help the doctor in choosing the most appropriate drug. This classification contains only international nonproprietary names.

Chemical structure

Based on their chemical structure, non-steroidal anti-inflammatory drugs are classified.

Acids (absorbed in the stomach, increase acidity):

• salicylates:
• pyrazolidines:
• indoleacetic acid derivatives:
• phenylacetic acid derivatives:
• oxicams:
• propionic acid derivatives:

Non-acidic derivatives (do not affect the acidity of gastric juice, are absorbed in the intestine):

• alkanones:
• sulfonamide derivatives:

By impact on COX-1 and COX-2

Non-selective - inhibit both types of enzyme, most of the NSAIDs belong to them.

Selective (coxibs) inhibit COX-2, do not affect COX-1:

• Celecoxib;
• Rofecoxib;
• Valdecoxib;
• Parecoxib;
• Lumiracoxib;
• Etoricoxib.

Selective and non-selective NSAIDs

Most NSAIDs are non-selective because they inhibit both types of COX. Selective NSAIDs are more modern drugs that act mainly on COX-2 and minimally affect COX-1. This reduces the risk of side effects.

However, complete selectivity of drug action has not yet been achieved, and there will always be a risk of side effects.

New generation drugs

The new generation includes not only selective, but also some non-selective NSAIDs, which have pronounced effectiveness, but are less toxic to the liver and hematopoietic system.

New generation non-steroidal anti-inflammatory drugs:

• – has an extended period of validity;
• – has the strongest analgesic effect;
• – extended period of action and pronounced analgesic effect (comparable to morphine);
• Rofecoxib– the most selective drug, approved for patients with gastritis and peptic ulcer without exacerbation.

Non-steroidal anti-inflammatory ointments

The use of NSAID drugs in the form for local use (ointments and gels) has a number of advantages, primarily the absence of a systemic effect and a targeted effect on the site of inflammation. For diseases of the joints they are almost always prescribed. The most popular ointments:

• Indomethacin;

NSAIDs in tablets

The most common dosage form of NSAIDs is tablets. Used to treat various diseases, including articular ones.

Among the advantages, they can be prescribed to treat manifestations of a systemic process involving several joints. The disadvantages include pronounced side effects. The list of NSAID drugs in tablets is quite long, they include:

The most common drugs are in the form of tablets and injections, in the form of injections and tablets (these are all new generation NSAIDs), and ointments based on Diclofenac do not lose their effectiveness. Since arthrosis, unlike arthritis, rarely worsens, the main emphasis in treatment is on maintaining functional state joints.

General application features

Nonsteroidal anti-inflammatory drugs for the treatment of joints are prescribed in courses or as needed, depending on the course of the disease.

The main feature of their use is that there is no need to take several drugs of this group in the same dosage form at the same time (especially tablets), since this increases the side effects, and therapeutic effect remains the same.

It is permissible to use different dosage forms at the same time if necessary. It is important to remember that contraindications to taking NSAIDs are common to most drugs in the group.

NSAIDs remain the most important means for the treatment of joints. They are difficult and sometimes almost impossible to replace by any other means. Modern pharmacology is developing new drugs from this group in order to reduce the risk of their side effects and increase the selectivity of action.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs whose name indicates their composition, purpose and function.

Non-steroidal- do not contain the core, which is part of hormones and biologically active substances.

Anti-inflammatory- have a pronounced impact on inflammatory processes in a living organism, interrupting the chemical process of inflammation.

History of drugs from the NSAID group

The anti-inflammatory properties of willow have been known since the fifth century BC. In 1827, 30 grams of salicin were isolated from the bark of this plant. In 1869, based on salicin, the active substance, salicylic acid, was obtained.

The anti-inflammatory properties of salicylic acid have been known for a long time, but its pronounced ulcerogenic effect limited its use in medicine. The addition of an acetyl group to the molecule greatly reduced the risk of gastrointestinal ulcers.

First medical drug from the NSAID group was synthesized in 1897 by Bayer. It was obtained by acetylation of salicylic acid. It received a patented name - “Aspirin”. Only the drug of this pharmacological company has the right to be called Aspirin.

Until 1950, aspirin remained the only nonsteroidal anti-inflammatory drug. Then, active work began to create more effective means.

However, the importance of acetylsalicylic acid in medicine is still great.

Mechanism of action of NSAIDs

The main point of application of NSAIDs are biologically active substances – prostaglandins. The first of them were found in the secretion of the prostate gland, hence their name. Two main types are more studied:

• Cyclooxygenase type 1 (COX-1), responsible for the synthesis of protective factors gastrointestinal tract and thrombosis processes.
• Cyclooxygenase type 2 (COX-2), involved in the basic mechanisms of the inflammatory process.

By blocking enzymes, the effects of reducing pain, reducing inflammation and lowering body temperature are achieved.

There are drugs with selective and non-selective action. Selective agents block the COX-2 enzyme to a greater extent. Reduce inflammation without affecting processes in the digestive tract.

The action of cyclooxygenase of the second type is directed:

• to increase vascular permeability;
• release of inflammatory mediators in the damaged area;
• increased swelling in the area of ​​inflammation;
• migration of phagocytes, mast cells, fibroblasts;
• an increase in the general temperature of the body, through thermoregulation centers in the central nervous system.

Inflammation

The process of inflammation is the body’s universal response to any damaging effect and has several stages:

• alteration stage develops in the first minutes of exposure to a damaging factor. The agents causing damage may be physical, chemical or biological. Biologically active substances are released from destroyed cells, triggering subsequent stages;
• exudation (impregnation), is characterized by the effect on mast cells of substances from dead cells. Activated basophils release histamine and serotonin into the site of damage, causing an increase in vascular permeability to the liquid part of the blood and macrophages. Swelling occurs and local temperature rises. Enzymes are released into the blood, attracting even more immunocompetent cells, triggering a cascade of biochemical and protective processes. The reaction becomes excessive. Pain occurs. It is at this stage that non-steroidal anti-inflammatory drugs are effective;
• proliferation stage, occurs at the moment of resolution of the second stage. The main cells are fibroblasts, which form a connective tissue matrix to restore the destroyed structure.

The stages do not have a clear time frame and are often included in combination. With a pronounced stage of exudation, occurring with a hyperergic component, the stage of proliferation is delayed. Prescribing NSAID drugs promotes speedy recovery and facilitates general state sick.

Main groups of non-steroidal anti-inflammatory drugs

There are many classifications. The most popular are based on chemical structure And biological effects substances.

Salicylates

The most studied substance is acetylsalicylic acid. The analgesic effect is very moderate. It is used as a drug to reduce temperature during febrile conditions and as a means of improving microcirculation in cardiology (in small doses it reduces blood viscosity by blocking type 1 cyclooxygenase).

Propionates

Salts of propionic acid have moderate analgesic and pronounced antipyretic effects. The best known is ibuprofen. Due to its low toxicity and high bioavailability, it is widely used in pediatric practice.

Acetates

Derivatives of acetic acid are well known and widely used in medicine. They have a pronounced anti-inflammatory effect and a strong analgesic effect. Due to the large effect on type 1 cyclooxygenase, they are used with caution in case of peptic ulcer and risk of bleeding. The most famous representatives: Diclofenac, Ketorolac, Indomethacin.

Selective COX-2 inhibitors

The most modern selective drugs today are considered Celecoxib and Rofecoxib. They are registered on the Russian market.

Other drugs

Paracetamol, nimesulide, meloxicam. They mainly act on COX-2. They have a pronounced analgesic and antipyretic effect of central action.

The most popular NSAID drugs and their costs

• Acetylsalicylic acid.

Efficient and inexpensive drug. Available in dosages of 500 milligrams and 100 mg. average price on the market 8-10 rubles for 10 tablets. Included in the list of vital essentials.

• Ibuprofen.

Safe and inexpensive drug. The price depends on the form of release and the manufacturer. Has a pronounced antipyretic effect. Widely used in pediatrics.

400 milligram film-coated tablets, made in Russia, cost from 50-100 rubles for 30 tablets.

• Paracetamol.

A popular drug all over the world. Available in European countries without a doctor's prescription. The most popular forms are 500 milligram tablets and syrup.

Included in combination drugs, as an analgesic and antipyretic component. It has central mechanism actions without affecting hematopoiesis and the gastrointestinal tract.

The price depends on the brand. Russian-made tablets cost about 10 rubles.

• Citramon P.

A combined drug containing anti-inflammatory and psychostimulating components. Caffeine increases the sensitivity of brain receptors tropic to paracetamol, enhancing the effect of the anti-inflammatory component.

Available in 500 milligram tablets. The average price is 10-20 rubles.

• Diclofenac.

It is available in various dosage forms, but is most in demand in the form of injections and local forms (ointments and patches).

The cost for a package of three ampoules is from 50 to 100 rubles.

• Nimesulide.

A selective drug that has a blocking effect on type 2 cyclooxygenase. Has a good analgesic and antipyretic effect. Widely used in dentistry and the postoperative period.

Available in the form of tablets, gels and suspensions. The average cost on the market is from 100-200 rubles for 20 tablets.

• Ketorolac.

A drug characterized by a pronounced analgesic effect, comparable to the effect of non-narcotic analgesics. It has a strong ulcerogenic effect on the mucous membrane of the gastrointestinal tract. Use with caution.

Must be released strictly according to a doctor's prescription. Release forms are varied. Tablets of 10 milligrams cost from one hundred rubles per pack.

Main indications for the use of NSAIDs

The most common reasons for taking this class of substances are diseases accompanied by inflammation, pain and fever. It should be remembered that drugs are rarely used for monotherapy. Treatment must be comprehensive.

Important. Use the information in this paragraph only if emergency situation prevents you from contacting a qualified specialist in the near future. Please discuss all treatment issues with your doctor.

Arthrosis

A disease that causes changes in the anatomical structure of the articular surface. Active movements are extremely painful due to joint swelling and increased synovial fluid effusion.

In severe cases, treatment is reduced to joint replacement.

NSAIDs are indicated for moderate or moderate severity of the process. At pain syndrome 100-200 milligrams of nimesulide are prescribed. No more than 500 mg per day. Taken in 2-3 doses. Drink with a small amount of water.

Rheumatoid arthritis

– inflammatory process of autoimmune etiology. Multiple inflammatory processes occur in various tissues. The joints and endocardial tissues are predominantly affected. NSAIDs are the drugs of choice in combination with steroid therapy. Damage to the endocardium always leads to the deposition of blood clots on the surface of the valves and chambers of the heart. Taking acetylsalicylic acid 500 milligrams per day reduces the risk of thrombosis by 5 times.

Pain from soft tissue injuries

Associated with swelling at the point of application of the traumatic factor and surrounding tissues. As a result of exudation, small venous vessels and nerve endings are compressed.

Stagnation occurs venous blood in the damaged organ, which further enhances metabolic disorders. A vicious circle arises, worsening the conditions for regeneration.

For moderate pain syndrome, it is possible to use local forms of Diclofenac.

Apply to the area of ​​bruise or sprain three times a day. The damaged organ needs rest and immobilization for several days.

Osteochondrosis

With this pathological process, compression of the spinal nerve roots occurs between the upper and lower vertebrae, forming the exit channels of the spinal nerves.

When the canal lumen decreases nerve roots, innervating organs and muscles, experience compression. This leads to the development of inflammatory processes and swelling of the nerves themselves, which further disrupts trophic processes.

To break the vicious circle, local ointments and gels containing Diclofenac are used in combination with injectable forms drug. Three milliliters of Diclofenac solution are injected intramuscularly once a day.

The course of treatment is at least 5 days. Given the high ulcerogenicity of the drug, you should take proton pump blockers and antacids (Omeprazole 2 capsules twice a day and Almagel one or two scoops three times a day).

Pain in the lumbar region

With this localization, it is most often affected. The pain is quite intense. is formed from spinal roots emerging in the intervertebral foramina of the sacrum, emerging in a limited area into the shallow tissues of the gluteal region. This predisposes it to inflammation during hypothermia.

Ointments with NSAIDs containing Diclofenac or Nimesulide are used. In case of severe pain, the nerve exit site is blocked with an anesthetic drug. Local dry heat is used. It is important to avoid hypothermia.

Headache

Caused by various pathological processes. Most common reason– brain. The brain itself does not have pain receptors. Pain sensations are transmitted from its membranes and receptors in the vessels.

Nonsteroidal anti-inflammatory drugs have a direct effect on prostaglandins, which regulate painful sensations in the center of the thalamus. Pain causes vasospasm, metabolic processes decrease, and pain intensifies. NSAIDs, relieving pain, stop the spasm, interrupting the pathological process. The most effective drugs are Ibuprofen in a dose of 400 milligrams.

Migraine

It is caused by local spasm of blood vessels in the brain. More often the head hurts on one side. There are extensive neurological focal symptoms. Experience shows that non-steroidal analgesics in combination with antispasmodics are most effective.

Fifty percent Metamizole sodium solution (analgin) in the amount of two milliliters and two milliliters Drotaverine in one syringe intramuscularly or intravenously. After the injection, vomiting occurs. After some time, the pain is completely relieved.

Acute attack of gout

The disease is caused by a violation of uric acid metabolism. Its salts are deposited in various organs and tissues of the body, causing widespread pain. NSAIDs help stop. Ibuprofen preparations are used in a dosage of 400-800 milligrams.

Complex. Includes a diet low in purine and pyrimidine bases. In the acute period, animal products, broths, alcohol, coffee and chocolate are completely excluded.

Products shown plant origin, except mushrooms, and large volumes of water (up to three to four liters per day). If your condition improves, you can add low-fat cottage cheese to your food.

Dysmenorrhea

Painful periods or pain in the lower abdomen before them are common in women of fertile age. Caused by spasms in the smooth muscles of the uterus during rejection of the mucous membrane. The duration of pain and its intensity varies from person to person.

For relief, Ibuprofen preparations in a dose of 400-800 milligrams or selective NSAIDs (Nimesulide, Meloxicam) are suitable.

Treatment of painful menstruation may include the use of biphasic estrogen drugs that normalize hormonal background body.

Fever

An increase in body temperature is a nonspecific pathological process that accompanies many painful conditions. Normal body temperature is between 35 and 37 degrees Celsius. With hyperthermia above 41 degrees, protein denaturation occurs and death can occur.

At normal temperature body, most biochemical processes take place in the body. The mechanisms of thermoregulation in higher organisms are of a neurohumoral nature. A small section of the hypothalamus, called the infundibulum, plays a major role in maintaining temperature homeostasis.

Anatomically, it connects the hypothalamus and thalamus at the junction of the optic nerves.

Substances called pyrogens are responsible for activating the hyperthermic reaction. One of the pyrogens is prostaglandin, produced by immune cells.

Its synthesis is regulated by cyclooxygenase. Nonsteroidal anti-inflammatory drugs can influence prostaglandin synthesis, indirectly reducing body temperature. Paracetamol acts on COX-1 in the center of thermoregulation, providing a rapid but short-lived antipyretic effect.

During fever, Ibuprofen exhibits the greatest antipyretic activity, acting indirectly. To reduce fever at home, a regimen with both drugs is justified.

500 milligrams Paracetamol and 800 milligrams Ibuprofen. The first quickly reduces the temperature to acceptable values, the second slowly and maintains the effect for a long time.

Teething fever in children

It is a consequence of the destruction of bone tissue during rapid tooth growth. Biologically active substances are released from the destroyed cells, which have a direct effect on the centers of the hypothalamus. Macrophages contribute to the inflammation process.

Most effective drug, eliminating inflammation and reducing temperature, is Nimesulide at a dose of 25-30 milligrams, taken once or twice, completely stops the phenomena in 90-95 percent of cases.

Risks of using NSAIDs

Studies have shown that long-term use of non-selective drugs has a detrimental effect on the mucous membrane of the stomach and intestines. The ulcerogenic effect of acetylsalicylic acid has been confirmed. Long-term use of non-selective agents is recommended in conjunction with proton pump blockers (omeprazole).

Selective NSAIDs increase the risk of developing coronary heart disease tenfold even with long-term use. Aspirin is the only exception to this list. The antiplatelet properties of acetylsalicylic acid are used to prevent thrombosis, preventing blockage of great vessels.

Cardiologists warn that patients who have recently had a heart attack should avoid NSAID treatment. According to research data, Naproxen is considered the least dangerous from this point of view.

Research has been published that long-term use NSAIDs can cause erectile dysfunction. However, these studies were largely based on the feelings of the patients themselves. No objective data were provided on testosterone levels, seminal fluid examinations or physical examination methods.

Conclusion

A hundred years ago, the world's population was just over a billion people. Over the past twentieth century, humanity has made a huge breakthrough in all sectors of its activity. Medicine has become an evidence-based, effective and progressive science.

Today there are more than seven billion of us. The three main discoveries that influenced the survival of the human race are:

• vaccines;
• antibiotics;
• non-steroidal anti-inflammatory drugs.

There is something to think about and something to strive for.

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

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

The most well-known representatives of the NSAID group for most of us are aspirin (), ibuprofen, analgin and naproxen, available in pharmacies in most countries of the world. Paracetamol (acetaminophen) is not a NSAID, since it has relatively weak anti-inflammatory activity. It acts against pain and fever according to the same principle (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, you can see that the body “forces” the affected tissues to produce biologically active substances - prostaglandins, which, acting on blood 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 sent 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 triggering the mechanism for the appearance of these prostaglandins. . Main action non-steroidal drugs the blocking of these enzymes is aimed, 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 a person suffering and unpleasant sensations are relieved.

Types by mechanism of action

NSAIDs are classified according to their chemical structure or mechanism of action. Long-known drugs of this group were divided into types according to their chemical structure or origin, since at that time their mechanism of 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 on both types of enzymes at once. These drugs block COX-1 enzymes, which, unlike COX-2, are constantly present in our body, performing various important functions. Therefore, exposure to them may 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 have such a negative impact on the gastrointestinal tract, but at the same time the load on cardiovascular system goes more(may increase blood pressure).
• selective NSAIDs COX-1 inhibitors. This group is small, since almost all drugs that affect COX-1 also 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 only been confirmed in animals, and they are also sometimes classified as COX-1. It is believed that their production is slightly slowed down by paracetamol.

In addition to reducing fever and eliminating pain, certain NSAIDs are also recommended for blood viscosity. The drugs increase the liquid part (plasma) and reduce 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

Basic non-selective NSAIDs

Acid derivatives:

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

Acetylsalicylic acid (aspirin) is the first known NSAID, discovered back in 1897 (all others appeared after the 1950s). In addition, this is the only drug that can irreversibly inhibit COX-1 and is also indicated to stop platelet aggregation. 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 NSAIDs is constantly expanding and new generation drugs are regularly arriving on pharmacy shelves that can simultaneously lower the temperature, relieve inflammation and pain in a short period of time. Thanks to the soft and gentle effect, the development of negative consequences in the form of allergic reactions, as well as damage to the gastrointestinal tract and urinary system.

Table. Non-steroidal anti-inflammatory drugs - indications

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

Nonsteroidal anti-inflammatory drugs have a number of contraindications that should be taken into account. The drugs are not recommended for treatment if the patient:

• peptic ulcer of the stomach and duodenum;
• kidney disease - limited intake is allowed;
• blood clotting disorder;
• the period of gestation and breastfeeding;
• Severe allergic reactions to medications in this group have previously been observed.

In some cases it is possible to form side effect, as a result of which the composition of the blood changes (“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 lesion, 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 the aggressive effects of digestive juice on it. Consequently, taking NSAIDs contributes to the development of gastric and duodenal ulcers. If a person has these diseases and still takes “prohibited” drugs, then the course of the pathology may worsen, even to the point of 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:

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

Side effects can also include less dangerous conditions such as nausea, vomiting, loss of appetite, loose stool, bloating. Sometimes they are fixed and skin manifestations in the form of itching and small rash.

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

Let's look at the most popular and effective medications.

A drug	Route of administration (form of release) and dosage						Application note
	external		through the gastrointestinal tract		injection
	ointment	gel	pills	candles	IM injection	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 1 time per day	25-75 mg (2 ml) 2 times a day	—	The 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	Gel strip (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	The drug is prescribed to children if their body weight exceeds 20 kg
Indomethacin	4-5 cm of 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 solution 1-2 r. per day	60 mg – 2 ml 1-2 times a day	During pregnancy, Indomethacin is used to reduce the tone of the uterus to prevent premature birth.
Ketoprofen	Strip 5 cm 3 times a day	3-5 cm 2-3 times a day	150-200 mg (1 tablet) 2-3 times a day	100-160 mg (1 suppository) 2 times a day	100 mg 1-2 times a day	Dissolve 100-200 mg in 100-500 ml saline solution	Most often, the drug is prescribed for pain in 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 in a stream 4-6 times a day	Taking the drug may mask the 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 dose – 8 mg – 2 times a day		The medication is used for pain syndrome of moderate and high degree 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	—	At renal failure acceptable daily dose– 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 1 time per day	—	The maximum permissible daily dosage is 40 mg
Celecoxib (Celebrex)	—	—	200 mg 2 times a day	—	—	—	The drug is available only in the form of capsules coated with a coating that dissolves 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 you have previously had allergic reactions to Penicillin, then Aspirin should be prescribed with caution.
Analgin	—	—	250-500 mg (0.5-1 tablet) 2-3 times a day		250 - 500 mg (1-2 ml) 3 times a day		In some cases, Analgin may have drug incompatibility, so mixing it in a syringe with other medications is not recommended. It is also banned in some countries

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

In order for the drug to work as quickly as possible and not cause harm to health, you 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, you should wait until it is completely absorbed. It is also not recommended to take water procedures for several hours after treatment.
• Tablets must be taken strictly as directed, without exceeding the daily allowance. If pain or inflammation is too severe, then you should inform your doctor about this so that another, stronger drug can be selected.
• Capsules should be washed down with plenty of water without removing the protective shell.
• Rectal suppositories work faster than tablets. Absorption of the active substance occurs through the intestines, so there is no negative or irritating effect on the walls of the stomach. If the drug is prescribed to a child, then the young patient should be placed on his left side, then carefully insert the suppository into the anus and squeeze the buttocks tightly. Make sure that the rectal medication does not come out for ten minutes.
• Intramuscular and intravenous injections are given only medical worker! Injections must be given in the manipulation room of a medical institution.

Although many non-steroidal anti-inflammatory drugs are available without a prescription or some pharmacies may not require one, you should always consult with your doctor before taking them. The fact is that the action of this group of medications is not aimed at treating the disease, at relieving pain and discomfort. Thus, the pathology begins to progress and stopping its development once identified is much more difficult than it would have been done before.