New generation non-steroidal anti-inflammatory drugs. Application and reviews

Non-steroidal inflammatory drugs can cope with pain, inflammation and swelling, the main symptoms of many diseases. What are their advantages and disadvantages of PSVS, what groups are they divided into?

How do NSAIDs work?

Relieve pain, eliminate fever, block the inflammatory response - all these functions can be performed by non-steroidal anti-inflammatory drugs.

They are called non-steroidal because they do not contain synthetically analogous steroid hormones of the human body (corticosteroids and sex hormones responsible for regulating vital processes).

What are the benefits of non-steroidal anti-inflammatory drugs (NSAIDs):

• Unlike conventional painkillers, NSAID drugs act in three directions simultaneously: they relieve pain, inflammation, and swelling;
• do not have a negative effect on the body;
• wide range of applications for different age groups;
• not enough big list contraindications.

According to the characteristics of the composition and effect on the body, drugs from the group of non-steroidal anti-inflammatory drugs share:

1. With a pronounced anti-inflammatory function: Diclofenac, Indomethacin, Phenylbutazone.
2. With a pronounced antipyretic function: Aspirin, Mefenamic acid,.
3. With a pronounced analgesic function: Metamizole, Ketoprofen, Ketorolac.
4. With pronounced antiaggregation functions (suppression of thrombus formation, normalization of blood microcirculation): Aspecard, Cardiomagnyl.

When are these drugs prescribed?

NSAIDs are indicated in the treatment of acute and chronic stages diseases that are accompanied by pain and inflammation.

These are feverish conditions, myalgia, menstrual, postoperative pain, renal colic.

NSAID drugs are effective in the treatment of bones and joints: arthritis, arthrosis, post-traumatic injuries.

Osteochondrosis of the spine of any part is inevitably accompanied by pain and inflammation. The main goal of treatment is to relieve pain and relieve the inflammatory reaction. NSAIDs are primarily used. NSAIDs are selected individually, taking into account medical history and prevailing symptoms.

Indications for use

NSAIDs are effective for treating most pathologies accompanied by pain, inflammation, fever, and swelling.

In therapeutic, neurological practice: renal and hepatic colic, inflammatory diseases internal organs, myalgia, inflammatory neurological diseases.

NSAIDs with antiaggregation effects are prescribed for the prevention of heart attacks and strokes.

In traumatological practice: arthritis, arthrosis, degenerative changes in the spine, hernial protrusions, traumatic injuries (fractures, bruises, sprains).

Contraindications

According to the instructions, pregnant women should abstain from taking NSAIDs

Anti-inflammatory non-steroidal drugs are not indicated in therapy if the patient suffers from severe diseases of the heart, blood vessels, erosive or ulcerative lesions of the gastrointestinal tract, severe impairment of the liver and kidneys.

They are contraindicated in people with intolerance to the constituent components of NSAIDs.

According to the instructions, pregnant women should refrain from taking NSAIDs, especially during the third trimester.

There is evidence that NSAIDs can cause disturbances in placental blood flow, miscarriages, premature birth, and renal failure in the fetus.

Side effects

The most dangerous side effects of NSAIDs include:

1. Impact on cellular composition blood. With the ability to reduce coagulation, medicines may cause hemorrhages.
2. Negative effect on the mucous membrane. Medicines can cause erosions and ulcerations in the stomach and duodenum.
3. Medicines can provoke allergic manifestations: itching, urticaria, Quincke's edema.

Although NSAIDs are available over the counter, uncontrolled reception may have a negative impact on the patient's health.

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Classification of NSAID drugs

NSAID group according to chemical composition it is divided into two subgroups:

1. Oxycams (acid based). With indoacetic - Indomethacin. With propionic acid - Ketoprofen. With acetylsalicylic acid Aspirin. With phenylacetic acid - Diclofenac. With pyrazolonic acid Metamizole, Phenylbutazol. With atranilic acid Mefenaminate.

1. Non-acid NSAIDs include alkanes and derivatives with a sulfanilide base - Refecoxib, Nimesulide.

In turn, in terms of effectiveness, novelty of developments, and competitiveness of NSAIDs are divided into the following categories:

• First generation drugs. These are Aspirin, Ibuprofen, Voltaren, Nurofen, Butadione.
• Medicines of the second (new) generation. This is Nise, et al.

New generation NSAIDs

Treatment of many diseases involves long-term use of NSAIDs.

To minimize adverse reactions and complications, new generations of medicines have been developed and continue to be developed.

NSAIDs give minimal side effects and do not affect hematological parameters.

New generation NSAIDs act selectively. Their anti-pain indicators are close to opiate-like effects.

The anti-inflammatory and anti-edematous indicators of the new generation NSAIDs are also significantly higher, therapeutic effect longer.

New generation drugs do not inhibit or stimulate the processes of the central nervous system and do not cause addiction.

The list of the most widely used NSAIDs includes the following drugs::

1. Movalis (Meloxicam). Produced in all dosage forms: tablets, injection solutions, rectal suppositories, gels. Approved for long-term treatment.

1. Xefocam (Lornoxicam). Has a high degree of pain suppression. In terms of analgesic effect, the drug is equivalent to opiates. The drug is not addictive and does not affect processes in the central nervous system.
2. Celecoxib. Long-term treatment with a drug without influence or side effects on the gastrointestinal mucosa. Effectively relieves pain during severe forms diseases of osteochondrosis, arthrosis.
3. Nimesulide. Gives a good antipyretic effect. Used in the treatment of pathologies of the musculoskeletal system. The drug effectively eliminates bone and joint pain and improves joint mobility.

Forms of release of a group of drugs

The routes of administration of NVPS may be different. NSAIDs are manufactured in liquid injectable and solid forms. Many medicines are also represented by rectal suppositories, creams, ointments, and gels for external use.

For osteochondrosis, systemic administration of NSAIDs is indicated: dosage forms are combined with each other

Tablets and capsules

NSAIDs are available in solid dosage form: Advil, Actasulide, Bixicam, Viox, Voltaren, Glucosamine, Diclomelan, Meloxicam, Mesulide, Methindol, Naklofen, Nalgesin, Nimesulide, Remoxicam.

Ampoules and solutions

Injectable forms of NSAIDs are prescribed for pathologies in the acute stage, and for severe forms of the disease.

NSAIDs are administered intramuscularly or intravenously.

NSAID injections can quickly relieve pain, relieve swelling in a short period, and provide a powerful anti-inflammatory effect.

From liquid dosage forms (injectable NSAIDs) doctors most often prefer:

• Tenoxicam;
• Lornoxicam;
• Ibuprofen;

Ointments and creams

External forms of NSAIDs are less effective. But local application reduces the likelihood of developing unwanted side reactions.

NSAID ointments, gels and creams are effective when, in the initial stage of the disease, the pain syndrome is not yet severe enough.

External agents are also used in complex treatment along with NSAID tablets and injections. Butadione, Indomethacin ointment, Voltaren and Nise gel are applied to the affected area.

In order for the depth of penetration to be greater, the external forms should be rubbed in with massage movements.

List of medications

Mainly for treatment acute form osteochondrosis, new generation NSAIDs are used. The choice of medication depends on which symptoms are more or less pronounced.

If the pain syndrome is severe, Nimesulide is prescribed.

In the line of NSAIDs, it has the most effective analgesic effect, superior to many similar drugs.

The medicine is indicated for paroxysmal pain, pinched nerve endings, joint and bone pain. Nimesil is well tolerated and produces extremely rare side effects.

The drug is produced in suspension granules, ready suspension, tablets, gel.

A drug from the NSAID group with prolonged action (drug action time – 12 hours).

In terms of its anti-pain effect, the drug is equivalent to opiates, but does not cause drug dependence.

The NSAID Xefocam does not inhibit the functioning of the central nervous system.

The drug is available in the form of tablets 4.8 mg and lyophilized powder 8 mg with a special solvent.

Rofecoxib

The drug belongs to the group of anti-inflammatory and antirheumatic drugs.

Rofecoxib is indicated in the treatment of polyarthritis, bursitis, and rheumatoid arthritis.

The NSAID Rofecoxib is prescribed to relieve pain caused by neurological pathology and osteochondrosis.

The drug is available in the form of tablets and suspensions for oral use.

The drug has a pronounced anti-inflammatory property and gives a good analgesic effect.

The solid form is represented by gelatin capsules. Drug analogues: Celebrex, Dilaxa, Arcoxia, Dynastat.

In the pharmaceutical market, this drug is considered the most common and popular.

The NSAID Diclofenac is available in the form of tablets, capsules, injection solutions, rectal suppositories, and gel.

The drug combines a high degree of analgesic activity with an anti-inflammatory effect.

Analogs of the drug are known as Voltaren, Diklak.

It has a good anti-inflammatory effect, combines anti-pain and antipyretic functions. Acetylsalicylic acid is used as a single drug and as a component of a fairly large number of combination drugs.

Acetylsalicylic acid is a first-generation NSAID. The drug has several serious disadvantages. It is gastrotoxic, inhibits prothrombin synthesis, and increases the tendency to hemorrhage.

Also, side effects of Acetylsalicylic acid include a high likelihood of bronchospasm and allergic manifestations.

Butadion

The anti-inflammatory effect is superior to Acetylsalicylic acid. Treatment with Butadion can provoke the development of side reactions and complications, so it is indicated only if other NSAIDs are ineffective. Type of medicine: ointments, dragees.

Naproxen and indomethacin

The NSAID Naproxen is prescribed for the symptomatic treatment of inflammatory and degenerative diseases musculoskeletal system: rheumatoid, juvenile, gouty arthrosis, spondylitis, osteoarthrosis.

The drug effectively relieves moderate pain in myalgia, neuralgia, radiculitis, toothache, and tendinitis. It is prescribed to patients suffering from pain when oncological diseases, with post-traumatic and postoperative pain syndrome.

As an analgesic and anti-inflammatory drug, Naprosken is prescribed in gynecological practice, diseases of the ENT organs, and infectious pathologies.

The anti-inflammatory effect from the use of NSAIDs appears only towards the end of treatment, after about a month. The drug is available in the form of tablets, dragees and oral suspension.

Osteochondrosis, rheumatoid arthritis, tendonitis, systemic lupus erythematosus, juvenile chronic arthritis, vasculitis, gout, bursitis, spondyloarthrosis, osteoarthritis - these are many different connective tissue diseases. All of the above names of states have only one thing in common: successful application NSAIDs, in other words non-steroidal anti-inflammatory drugs. These drugs are the most common drugs in clinical practice, and in the hospital these drugs are prescribed to only twenty percent of patients with diseases of the internal organs. Nonsteroidal anti-inflammatory drugs account for approximately five percent of all prescriptions written.

Non-steroidal anti-inflammatory drugs: types and characteristics

Nonsteroidal anti-inflammatory drugs, or NSAIDs for short, are enough large group drugs that have three main effects: antipyretic, anti-inflammatory and analgesic.

The term “non-steroidal” distinguishes this group of steroid drugs, or, to be more precise, hormonal drugs, which also have one of three effects, namely anti-inflammatory. Lack of addiction with long-term use is the property that is considered beneficial to NSAIDs among other analgesics.

The very first non-steroidal anti-inflammatory drugs are the following - indomentacin and phenylbutazone - they were introduced into clinical practice since the middle of the last century. Immediately after them, an “avalanche-like” discovery of completely new, more effective NSAIDs began to appear:

• Arylpropionic acid derivatives - in 1969;
• Arylacetic acid - in 1971;
• Enolic acid - 1980.

All of these drugs are not only highly effective, but also have improved tolerability, unlike the first two drugs. Modifications in the above classes of acids resulted in nothing less than the synthesis of non-steroidal anti-inflammatory drugs, but quite long time The only and most importantly the first representatives of NSAIDs remained the well-known aspirin. Pharmacologists began to synthesize absolutely all new drugs that appeared in the world and each of them was safer and more effective than the previous one, and all this began in 1950.

The principle of action of non-steroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs block the production of substances such as prostaglandins. These substances are involved in the development of inflammation, muscle cramps, fever and pain. A large number of NSAIDs ingeniously block two different fragments that are needed to produce the aforementioned prostaglandin substance. These fragments are called cyclooxygenases, or COX-1 and COX-2 for short.

In addition to all this, the company of French manufacturers Bristol Myers produces special effervescent tablets Usparin Upsa. Cardioaspirin has a fairly large number of release forms and, accordingly, names, including Aspinat, CardiASK, Thrombo ACC, Aspirin Cardio and other drugs.

Non-steroidal anti-inflammatory drugs. “Gold standard” in rheumatology: Traditions and innovations

Traditions

For various kinds of diseases of the musculoskeletal system (muscle pain, osteochondrosis, soft tissue injuries, pain syndromes from the spine, tendon-muscle sprains, sciatica, joint pain), in moments of which it is necessary to relieve inflammation and the pain itself - this is the primary task, in In such cases, not only non-steroidal anti-inflammatory drugs are used, but also analgesics.

IN Lately A fairly large number of different kinds of drugs have appeared - new representatives of this group of drugs, but the “gold standard” is considered Diclofenac sodium, which opened in 1971. In terms of tolerability and effectiveness, all newer non-steroidal anti-inflammatory drugs that are being introduced into clinical practice are currently being compared.

The reason for all this is quite simple - among the truly effective non-steroidal anti-inflammatory drugs, it is the best clinical effectiveness actions: impact on the quality of life of patients, anti-inflammatory and analgesic effects, cost and reactions, as well as tolerability.

At the moment, there are other drugs in the world, this includes drugs with a reduced amount side effects, but the following often happens: the patient begins to use new drug, however, it ultimately returns to Diclofinac sodium (Voltaren), and this happens not only in our country.

In our case, it is important to consider the mechanism of pain development in diseases of the musculoskeletal system. Pain when rheumatic diseases has a fairly multifactorial nature, including both peripheral and central components. With the same disease, if pain occurs, then it is possible to use different kinds of mechanisms. The peripheral mechanism of pain is quite strongly associated with the activation of nerve endings (in other words, nociceptors) in different tissues by local inflammation and biochemical factors.

For example, with a disease such as osteoarthritis, there is the possibility of a sudden increase in pain of a non-inflammatory and inflammatory nature (increased age-related bone fragility, spasm, venous stasis in the tissues of the extremities, muscle strain, microfractures), the area of ​​influence of which is considered to be various types of joint tissue, such as ligaments, synovial membrane, joint capsule, periarticular muscles, bones.

A drug such as Diclofenac has a special combination of anti-inflammatory and analgesic effects, therefore, in the absence of contraindications, it can be used with great success in the treatment of appropriate drugs. Suppression of prostaglandin synthesis through inhibition of cyclooxygenase enzymes (two fragments COX-1 and COX-2) is the main mechanism of action of this drug. Diclofenac is considered a non-selective non-steroidal anti-inflammatory drug - it suppresses all two activities (fragments) of cyclooxygenesis COX-1 and COX-2. Although a number of non-steroidal anti-inflammatory drugs have been developed that selectively suppress one of the two fragments of COX-2 cyclooxygenase, non-selective drugs remain of great importance in patients with severe acute and chronic pain as drugs that can provide a sufficiently powerful anti-inflammatory and analgesic effect.

Of course, a drug like Diclofenac (there is another name, Voltaren), like any of a number of non-steroidal anti-inflammatory drugs, has contraindications and side effects (SE). But it should be noted that side effects often develop in people with risk factors. One of the most common side effects among all is non-steroidal anti-inflammatory gastropathy.

Factors that increase the risk of developing PE when using the drug diclofenac (Voltaren):

• History of peptic ulcer;
• Huge doses or simultaneous administration several non-steroidal anti-inflammatory drugs;
• Female gender because discovered increased sensitivity women to this group of drugs;
• Alcohol abuse;
• Presence of H. pylory;
• Smoking;
• Concomitant therapy with glucocorticoids;
• Eating food that increases gastric secretion (fatty, salty, spicy foods);
• Age over sixty-five.

In persons who belong to such risk groups daily dose Voltaren (Diclofenac), for example, should not exceed the mark of one hundred milligrams, and preference, as a rule, should be given to short-acting dosage forms of Voltaren (Diclofenac), and prescribe it either in a dose of fifty milligrams twice every twenty-four hours , or in doses of twenty-five milligrams four times every twenty-four hours.

Diclofenac must be used exclusively after meals.

If you take this drug for quite a long time, you must approach this strictly and refrain from drinking alcohol, because the drug Diclofenac is the same as alcohol, it is processed and broken down in the liver. In patients with hypertension, blood levels should be monitored blood pressure, and in patients with bronchial asthma while taking Diclofenac, some exacerbation may be observed.

In patients with chronic kidney or liver diseases, it is necessary to use small dosages of the drug, while monitoring the level of renal enzymes. In addition, it is necessary to remember that the so-called “individual reactions” to non-steroidal anti-inflammatory drugs may vary between patients. This also applies to other medications, especially in older people, in whom polymorbidity is noted - the accumulation of a whole bunch of chronic diseases is absolutely varying degrees expressiveness.

Innovation

Today, there is a different view on the problem of the “gold standard” of non-steroidal anti-inflammatory drugs in rheumatology. There is an expert opinion that the reputation of the drug Diclofenac in the country (RF) was tarnished (spoiled) after the appearance of a large number of generics of this drug on the shelves of municipal pharmacies and pharmacological markets.

The safety and effectiveness of the vast majority of all these parodies of the drug Diclofenac, or as they are also called “Diclofenac”, have not been tested in well-long and well-designed randomized controlled trials (RCTs for short).

In truth, these “Diclofenacs” are quite accessible and cheap for socially vulnerable groups Russian Federation, which naturally made the drug Diclofenac the only and most popular among non-steroidal anti-inflammatory drugs in our country. According to a special survey of about three thousand patients in six regions of Russia and the capital itself (Moscow), those who regularly receive non-steroidal anti-inflammatory drugs, about seventy-two percent of respondents used this drug.

But it is precisely these generic Diclofenacs that in recent moments are associated with the largest absolute number of the most dangerous drug complications that are observed in the Russian Federation. According to some reports, among three thousand eighty-eight rheumatological patients who regularly took Diclofenac, gastrointestinal erosions and ulcers were identified in five hundred and forty patients - this, by the way, is seventeen and a half percent.

With all this, gastrointestinal complications while taking the drug Diclofenac did not differ from the frequency of similar complications that arise when using generally accepted more toxic drugs - piroxicam (about nineteen point one percent) and indomethacin (about seventeen point one point seven percent).

It is quite important that the development of dyspepsia, in contrast to non-steroidal anti-inflammatory gastropathy, in to a greater extent is determined by the contact effect of the same non-steroidal anti-inflammatory drug, it follows that all this depends on pharmacological properties specific drug. Quite often, drugs from different commercial companies that contain the same active ingredient have very different tolerability, and this, first of all, applies to the same “diclofenac” or, more simply, to cheap generics of Diclofenac.

Due to the fairly widespread and deep use of generics, which have significantly displaced the rather expensive, but justified by their quality, original drug on pharmaceutical market, the majority of Russian doctors and patients have formed the opinion of Diclofenac as a drug with moderate effectiveness, but with a high risk of unwanted effects. Although leading Russian experts and scientists have repeatedly spoken out and stated evidence of the existence in the world of others of various kinds in the safety and effectiveness of action between the original drug Diclofenac and its cheap analogues(or simply copies), to date no serious and strict clinical trials in the Russian Federation in order to confirm this provision.

There is another aspect of this problem with the safety of the drug Diclofenac - this is an increased risk of cardiovascular accidents. If we agree with the data obtained from meta-analysis, large observational and cohort studies of non-steroidal anti-inflammatory drugs, the use of Diclofenac is associated with a greater risk of developing factors such as myocardial infarction, compared to other equally popular non-steroidal anti-inflammatory drugs. For this drug the RR of this severe complication was approximately one point four, while for Naproxen it was zero point nine, for ibuprofen one point seven, for Indomethacin one point three, and for Piroxicam one point six.

In addition to all this, the use of Diclofenac can cause the development of such a rare, but potential life-threatening complications such as acute drug-induced hepatitis or acute liver failure. Back in 1995, the medical regulatory authority of the United States of America (FDA) provided data from a general analysis of one hundred and eighty cases of serious acute complications from the liver when using this drug, which at that time led to death. With all this, in the United States of America, a drug such as Diclofenac was not considered such a deep and widely used non-steroidal anti-inflammatory drug (inferior, of course, to Acetylsalicylic acid, Naproxen and Ibuprofen). At the approaching time of the analysis, Diclofenac had been used in the United States for only seven years, because it was approved by the FDA on the pharmacological market of the same country back in 1988.

If we add up all of the above, we can already conclude that at the moment the drug Diclofenac cannot be considered a true member of the “Gold Standard” among non-steroidal anti-inflammatory drugs, and primarily because it is present high risk undesirable effects that occur while taking the drug. It no longer corresponds to modern ideas about normal safe analgesic therapy.

An alternative to the drug Diclofenac on Russian pharmacological markets can be its closest relative in essence and composition - this is Aceclofenac. This drug has more significant advantages, mainly this highest degree safety, high efficiency and accessibility - all these qualities allow Aceclofenac to claim one of the positions of non-steroidal anti-inflammatory drugs with the best combinations of pharmacological properties at the moment.

Aceclofenac is a derivative of phenylacetic acid, considered a representative of one of the intermediate groups of predominantly selective COX-2 fragment inhibitors. The ratio of the inhibitory concentrations of the two fragments COX-1 and COX-2 in this drug is about point twenty-six hundredths, and this is much less than that of the reference selective inhibitor of the COX-2 fragment celecoxib - only zero point seven, but this is more than that of rofecoxib, which is only zero point twelve. Recent studies show that after taking the drug at a dosage of one hundred milligrams (Aceclofenac), the activity of the physiological fragment of COX-1 is only forty-six percent. For taking seventy-five milligrams of Diclofenac, this ratio was ninety-seven and eighty-two percent, respectively.

The drug Aceclofinac has a fairly high bioavailability, which is completely and quickly absorbed after oral administration, with peak plasma concentrations achieved after sixty to one hundred and eighty minutes. IN human body in general, all this is almost completely metabolized in the liver, its main metabolite is considered to be the biologically active four-hydroxyaceclofenac, and one of the additional metabolites is Diclofenac itself. In the average body, after four hours, half of the drug leaves the body, with about seventy to eighty percent exiting in the urine, and the remaining twenty to thirty percent passing into the feces. The concentration of this drug in synovial fluid is approximately fifty percent of the plasma concentration.

Instead of main (main) pharmacological effect, the so-called (blockade of COX-2), for aceclofenac it has been proven to suppress the synthesis of the most important anti-inflammatory cytokines, exactly the same as interleukin-1 (abbreviated IL-1) and the tumor anesthesia factor itself (TNF-alpha). A decrease in interleukin-1-associated activation of metalloproteinases is considered one of the most important mechanisms that determines the positive effect of aceclofenac on the synthesis of articular cartilage proteoglycans. This property is one of the main advantages of the feasibility of its use in osteoarthritis, the most common rheumatological disease.

A drug such as aceclofenac has been used in clinical practice since the end of 1980. At the moment, eighteen different types of drugs based on the composition of aceclofenac are presented on the pharmacological market:

1. Aceflan (BR);
2. Airtal (ES, PT, CL);
3. Barcan (FI, SE, NO, DK);
4. Berlofen (AR);
5. Bristaflam (CL, MX, AR);
6. Gerbin (ES);
7. Preservex (GB);
8. Sanein (ES);
9. Aital (NL);
10. Sovipan (GR);
11. Proflam (BR);
12. Locomin (CH);
13. Falcol (ES);
14. Biofenac (GR, PT, NL, BE);
15. Beofenac (DE, AT);
16. Aitral Difucrem (ES);
17. Air-Tal (BE);
18. Aceclofar (AE).

In the Russian Federation, Aceclofenac has been registered since 1996 and is still used under the brand name Airtal.

Aceclofinac has proven itself quite well in the treatment of rheumatoid arthritis. Also, the effectiveness of this drug has been proven in such a common pathological condition as dysmenorrhea. Recent studies have shown that single or repeated use of aceclofenac is as successful in relieving the same pain as, for example, Naproxen (five hundred milligrams), significantly exceeding the effect of placebo.

In addition, on the classical model of dental procedures (tooth extraction), the very possibility of using the drug aceclofenac in the complex therapy of postoperative pain was studied quite well, especially the situation if the initial appointment was carried out in the “preoperative analgesia” mode, that is, sixty minutes before removal the tooth itself.

To date, a comparative study of the safety of aceclofenac in real clinical practice has also been carried out (the most important control was Diclofenac). The data obtained showed us that aceclofenac is superior to the drug that was used for comparison in terms of its safety: the total complications amounted to only twenty-two point one and one tenth and twenty-seven point one and one tenth percent (p less than zero point one and one thousandth), of which from Gastrointestinal tract ten point six and fifteen point two percent (p less than zero point one thousand). While taking aceclofenac, discontinuations of therapy due to undesirable effects were also observed - fourteen point one and one tenth and eighteen point one and seven tenth percent, respectively (p less than zero point one and one thousandth).

Population studies (case-control type) have provided evidence of a relatively low risk of dangerous gastrointestinal complications when using the drug aceclofenac. Aceclofenac demonstrated the lowest risk of gastrointestinal bleeding compared to other non-steroidal anti-inflammatory drugs.

Currently, there is very little data that allows us to assess the risk of developing cardiovascular complications while taking the drug aceclofenac. But in one study, this drug was associated with the lowest risk of myocardial infarction:

• Aceclofenac– OR one point and twenty three hundredths (from zero point ninety seven hundredths to one point sixty two hundredths);

Than the following drugs:

• Indomethacin– one point and fifty-six hundredths (from one point and twenty-one hundredths to two point and three tenths);
• Ibuprofen– one point and forty-one hundredths (from one point and twenty-eight hundredths to one point and fifty-five hundredths);
• Diclofenac– one point and thirty-five hundredths (from one point and eighteen hundredths to one point and fifty-four hundredths).

If we summarize everything, we can state that the drug Aceclofenac is considered one of the representatives of non-steroidal anti-inflammatory drugs with quite convincingly proven anti-inflammatory and analgesic activity through a list of well-organized RCTs, as well as fairly long-term cohort and observational studies. You can say it in your own way therapeutic effects this drug is not inferior and one might say even superior to the following fairly popular traditional non-steroidal anti-inflammatory drugs such as Ibuprofen, Ketoprofen, Diclofenac, and is also much more effective than regular Paracetamol. The drug Aceclofenac causes dyspepsia less frequently (twenty to thirty percent) compared to other non-steroidal anti-inflammatory drugs.

The ulcerogenic potential of this drug is also quite low (it is approximately two, four and seven times less than that of Naproxen, Indomethacin and Diclofenac). There is data that shows a significant reduction in the risk of gastrointestinal bleeding when using Aceclofenac. Similar results, which reflect actual clinical practice, have been obtained to date regarding the reduced risk of cardiovascular complications.

A sufficient advantage of the drug Aceclofenac, in contrast to Diclofenac and other equally popular representatives of non-steroidal anti-inflammatory drugs, is considered to be the absence of a negative effect on the metabolism of articular cartilage, which makes this drug quite appropriate for its use and symptomatic treatment of osteoarthritis.

So, today aceclofenac is the most affordable drug for consumers and a fairly high-quality original product, with a balanced combination of anti-inflammatory and analgesic effectiveness and sufficient tolerability. The drug may well claim to be the leader among standard non-steroidal anti-inflammatory drugs used for both long-term and short-term treatment of chronic diseases, this includes rheumatology, which are accompanied by pain.

Rational use of non-steroidal anti-inflammatory drugs in rheumatology

In conclusion, it should be noted that a modern doctor has a fairly impressive arsenal of medications that can significantly reduce pain and improve the condition of patients and their functional activity of the joints, and thus the patient’s overall quality of life. This concerns the effectiveness of non-steroidal anti-inflammatory drugs, among which long-term observations highly evaluate the drugs arylacetic (Diclofenac) and arylpropionic (Ibuprofen and others) acids, as specific (Celecoxib) and selective (Nimesulide and Meloxicam) non-steroidal anti-inflammatory drugs that appeared in the last years of the last century.

But by the beginning of the twenty-first century, evidence had accumulated on the need for the most serious attention to the second side of treatment - safety, that is, to safety / effectiveness - “two sides of the coin” that determine the disadvantages and advantages of a particular drug. With all this, the price of this drug and the aggravating cost of treating a side effect, if of course this happens, are of no small importance.

Therefore, so-called rational therapy implies the use of a clinically acceptable and reasonable drug, good knowledge mechanisms of action, including social application and adverse effects, ways of prevention and the mechanism of action itself. Only a doctor can provide safe and effective treatment.

Basic principles of modern safe and effective treatment in rheumatology

• Patients who are at risk of developing gastropathy can be prescribed specific and selective inhibitors of the COX-2 fragment or, if they are highly effective in specific patients, non-selective non-steroidal anti-inflammatory drugs, but always together with misoprostol (a synthetic prostaglandin that provides protection to the mucous membrane). gastrointestinal tract) or proton pump inhibitors (omeprazole).
• Patients are required to continue taking reduced doses acetylsalicylic acid(or indirect anticoagulants) in the presence of a risk of thrombosis, if, of course, treatment is carried out in combination with inhibitors of the COX-2 fragment. However, in such cases, careful monitoring of the state of the gastrointestinal tract is necessary (gastroscopy at least twice a year) for timely diagnosis of the erosive and ulcerative process of the mucous membrane.
• It must be emphasized that in the context of the proliferation of very effective, but not always safe, medicines, it is especially necessary for the doctor to cooperate with patients, increase the patient’s responsibility during the treatment process and eliminate those risk factors that contribute to the most frequent development of side effects. From this point of view, the feeling of mutual responsibility between the doctor and the patient when taking highly effective but unsafe medications, such as non-steroidal anti-inflammatory drugs, is especially significant. At the same time, it is important to be aware of the fact that even in seriously ill patients, the use of modern non-steroidal anti-inflammatory drugs can lead to a decrease or even complete disappearance of objective and subjective symptoms.
• For patients who have suffered a myocardial infarction/stroke and who require long-term treatment with non-steroidal anti-inflammatory drugs, we recommend following a diet, that is, using special measures that have proven to be prophylactic against recurrent strokes and myocardial infarction.
• In patients with signs of renal failure (increased serum creatinine), it is advisable not to prescribe non-steroidal anti-inflammatory drugs, or, on the contrary, to prescribe specific and selective inhibitors, but only under the close supervision of doctors.
• A thorough examination of the patient to exclude risk factors for the development of pathology from the gastrointestinal tract, kidneys and cardiovascular system.

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

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

How NSAIDs work

If analgesics are intended to combat 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 suppress the effects of both of its isoforms (types) - COX-1 and COX-2.

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

When are NSAIDs used?

More often NSAID drugs use for the treatment of chronic or acute inflammation which are accompanied by pain. Anti-inflammatory non-steroidal drugs have gained great popularity due to effective treatment joints.

We list the diseases for which these medications are prescribed:

• dysmenorrhea (pain during menstruation);
• acute gout;
• postoperative pain;
• bone pain due to metastasis;
• intestinal obstruction;
• fever ( heat body);
• minor pain due to injury or inflammation of soft tissues;
• renal colic;
• lower back pain;
• Parkinson's disease;
• osteochondrosis;
• migraine;
• headaches;
• rheumatoid arthritis;
• arthrosis

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

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

Let's look at the most effective and well-known NSAIDs, which are used to treat joints and other diseases when required. antipyretic and anti-inflammatory effect:

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

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

The main advantage of new generation NSAIDs

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

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

The only disadvantage of the new generation of drugs is their high cost, which makes them inaccessible to most people.

What are new generation NSAIDs?

The new generation of anti-inflammatory non-steroidal drugs act much more selectively, they are more inhibit COX-2, and COX-1 remains almost unaffected. This can be explained quite high efficiency drug in combination with a minimum side effects.

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

• Xefocam. A medicine that is based on Lornoxicam. His characteristic feature is the fact that the drug has an increased ability to relieve pain. In terms of 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 an antipyretic, well-defined anti-inflammatory and analgesic effect. The main advantage of this drug is that with constant medical supervision it can be used for quite a long time. Meloxicam is produced 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 long-lasting effect, and it is enough to use one tablet throughout the day.
• Nimesulide. Used successfully 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 are minimal or completely absent.

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

Based on their chemical origin, these drugs come in non-acidic and acidic derivatives.

Acidic preparations:

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

Non-acidic drugs:

• Sulfonamide derivatives;
• Alcanons.

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

According to the strength of the anti-inflammatory effect Medium doses of drugs are arranged in the following order (strongest on top):

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

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

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

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

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

Any medicine new to the patient should be prescribed initially in a minimal dose. If tolerated normally, after a few days 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 tolerability (ibuprofen, naproxen), while maintaining restrictions on the maximum dosage of indomethacin, aspirin, piroxicam, phenylbutazone. In some patients therapeutic effect achieved only with the use of increased doses of NSAIDs.

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

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

Treatment with NSAIDs must be continued for the minimum possible time and minimum doses.

Use during pregnancy

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

Description of non-steroidal anti-inflammatory drugs Movalis

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

It has a pronounced anti-inflammatory effect, which makes it possible to use it for rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. Protects cartilage tissue and is not without antipyretic and analgesic properties. Used for headaches and toothaches.

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

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

It is one of the most effective non-hormonal drugs. For arthritis, it reduces joint swelling, relieves pain and has a strong anti-inflammatory effect. When using a medication, you need to be careful, as it has a long list of side effects. In pharmacology, the drug is manufactured under the names Indovis EC, Indovazin, Indocollir, Indotard, Metindol.

It combines the ability to effectively reduce pain and temperature, and is relatively safe, which is why medications based on it can be purchased without a prescription. Ibuprofen is used as an antipyretic drug, including and for newborns.

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

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

Form of manufacture - capsules, tablets, gel, suppositories, injection solution. This drug for the treatment of joints perfectly combines both a high anti-inflammatory effect and high analgesic activity.

It is manufactured under the names Naklofen, Voltaren, Diklak, Ortofen, Vurdon, Diclonac P, Dolex, Olfen, Clodifen, Dikloberl, etc.

Chondroprotectors - alternative drugs

Very common for treating joints use chondroprotectors. People often do not understand the differences between chondroprotectors and NSAIDs. The latter are quickly deleted painful sensations, but at the same time have many side effects. And chondroprotectors protect cartilage tissue, but they must be used in courses. The most effective chondroprotectors contain 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 impacting symptoms on well-being; diseases are treated directly by other methods and drugs.

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) in 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 (acetylsalicylic acid), 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.

Soreness, inflammation and fever are common pathological conditions accompanying 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. 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 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 chemical structure or origin, since at that time 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 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, the impact on them may be accompanied by various side effects, and has a particular negative effect 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 affecting COX-1 affect 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 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, NSAIDs are 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.

Basic non-selective NSAIDs

• 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 its mild 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 is minimized.

Table. Non-steroidal anti-inflammatory drugs - indications

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

This can be explained by their actions:

• Anti-inflammatory;
• Antipyretic;
• Analgesic.

Suitable for symptomatic treatment, since most diseases are accompanied by precisely the listed manifestations. Over the past few years, new drugs in this area have appeared, and most of them are effective, have a prolonged effect, and are well tolerated.

What it is?

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

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

Now we will look at them in more detail.

The effect of such drugs

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

PGs have the following focus:

1. Local dilation of blood vessels, due to which there is a decrease in edema, exudation, speedy healing damage.
2. Reduce pain.
3. They help reduce fever due to their effect on the hypothalamic regulation centers.
4. Anti-inflammatory effect.

Indications for use

Medicines of this group, as a rule, prescribed for acute and chronic pathologies, in the clinic where pain and inflammation are observed.

Most often, drugs in this group are prescribed for:

1. Rheumatoid arthritis is chronic inflammation of the joints.
2. Osteoarthritis – not inflammatory chronic illness joint of unknown etiology.
3. Inflammatory arthropathy: ankylosing spondylitis; psoriatic arthritis; Reiter's syndrome.
4. Gout is the deposition of urate in body tissues.
5. Dysmenorrhea - menstrual pain.
6. Bone cancer accompanied by pain.
7. Migraine pain. B
8. Pain observed after operations.
9. Minor pain due to injuries and inflammation.
10. Heat.
11. Pain syndrome in diseases of the urinary system.

Release forms

NSAIDs are available in the following forms:

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

Classification of non-steroidal anti-inflammatory drugs

There are several classifications of the described group.

According to chemical structure:

1. Salicylic acid derivatives- Aspirin.
2. Pyrazolone derivatives- Analgin.
3. Anthranilic acid derivatives– Sodium mefenaminate.
4. Propionic acid derivatives– representative of the group – Ibuprofen. Read more here: ibuprofen instructions for use.
5. Acetic acid derivatives– in this group is Diclofenac sodium. Here, read the article Diclofenac instructions for use in more detail.
6. Oxicam derivatives– representatives of Piroxicam and Meloxicam.
7. Derivatives of isonicotinic acid– this includes Amizon.
8. Coxib derivatives– in this group are Celecoxib, Rofecoxib.
9. Derivatives of others chemical groups – Mesulide, Etodolac.
10. Combination drugs– Reopirin, Dilocaine.

All drugs in this group are divided into 2 types:

• Cyclooxygenase type 1 inhibitors;
• Cyclooxygenase type 2 inhibitors.

List of first generation drugs

List of second generation drugs

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

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

List of the most effective NSAIDs

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

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

A bunch of pathological changes occurring in the body is accompanied by pain. To combat such symptoms, NSAIDs, or nonsteroidal anti-inflammatory drugs, have been developed. They provide excellent pain relief, relieve inflammation, and 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 medications are much less likely to cause unpleasant reactions, but remain effective drugs against pain.

Impact principle

What causes 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 a chemical reaction, as a result of which arachidonic acid is converted into prostaglandins, thromboxanes and leukotrienes.

COX-1 is responsible for the production of prostaglandins. They protect the gastric mucosa from unpleasant effects, influence 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.

The action of NSAIDs, such as inhibition of COX-1, carries many side effects.

New developments

It is no secret that first-generation NSAID drugs had an adverse effect on the gastric mucosa. Therefore, scientists have set themselves the goal of reducing undesirable impacts. A new release form was 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 wall damage digestive tract still preserved.

This forced chemists to synthesize completely new substances. They differed fundamentally from previous drugs in their mechanism of action. New generation NSAIDs 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 gastric mucosa.

The anti-inflammatory effect is due to a decrease in the permeability of vascular walls, as well as a decrease in the production of various inflammatory mediators. Due to this effect, irritation of nerve pain receptors is minimized. The influence on certain thermoregulation centers located in the brain allows the latest generation of NSAIDs to effectively lower 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 medications provide an excellent antipyretic effect. Their effect on the body can be compared with the effect narcotic analgesics. In addition, they provide analgesic and anti-inflammatory effects. Use of NSAIDs reaches a wide scale in clinical settings and in everyday life. Today these are one of the popular medical drugs.

A positive effect is noted under the following factors:

1. Diseases of the musculoskeletal system. For various sprains, bruises, and arthrosis, these medications are simply irreplaceable. NSAIDs are used for osteochondrosis, inflammatory arthropathy, and arthritis. The medicine has an anti-inflammatory effect for myositis, herniated intervertebral discs.
2. Severe pain. The drugs are quite successfully used for biliary colic and gynecological ailments. They eliminate headaches, even migraines, and kidney discomfort. NSAIDs are successfully used for patients in the postoperative period.
3. Heat. The antipyretic effect allows the drugs to be used for a variety of ailments by both adults and children. Such medicines are effective even for fever.
4. Thrombosis. NSAIDs are antiplatelet drugs. This allows them to be used for ischemia. They are a preventative 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 give an exact figure. Having appeared on the market, NSAIDs quickly gained wide popularity. The drugs have replaced opioid analgesics. Since they, unlike the latter, did not provoke respiratory depression.

The classification of NSAIDs involves division into two groups:

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

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

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

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

Side effects

New generation NSAIDs, the list of which is given above, have an effective effect on the body. However, they have virtually no effect on the functioning of the gastrointestinal tract. These drugs have one more positive aspect: new generation NSAIDs do not have a destructive effect on cartilage tissue.

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

The main side effects may be:

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

However, damage to the gastric mucosa is not observed when taking new NSAIDs. The drugs do not cause exacerbation of the ulcer with bleeding.

The best anti-inflammatory properties are phenylacetic acid drugs, salicylates, pyrazolidones, oxicams, alkanones, propionic acid and sulfonamide drugs.

The medications that most effectively relieve joint pain are Indomethacin, Diclofenac, Ketoprofen, and Flurbiprofen. These are the best NSAIDs for osteochondrosis. The above medications, with the exception of Ketoprofen, have a pronounced anti-inflammatory effect. Piroxicam belongs to this category.

Effective analgesics are the drugs Ketorolac, Ketoprofen, Indomethacin, Diclofenac.

The leader among the latest generation of NSAIDs is the drug Movalis. This product can be used for a long period. Anti-inflammatory analogues effective medicine are the drugs “Movasin”, “Mirlox”, “Lem”, “Artrosan”, “Melox”, “Melbek”, “Mesipol” and “Amelotex”.

The drug "Movalis"

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

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

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

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

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

For adult patients diagnosed with osteoarthritis, it is recommended to take 7.5 mg per day. If necessary, this dose can be increased by 2 times.

For rheumatoid arthritis and ankylosing spondylitis daily norm is 15 mg.

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

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

Consumer opinion about the medicine

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

In addition, the medicine perfectly relieves various pains - toothache, headache. Special attention Patients point out an impressive list of side effects. While taking NSAIDs, treatment, despite the manufacturer's warning, was not complicated by unpleasant consequences.

The drug "Celecoxib"

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

Indications for use given in the instructions are:

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

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

Consumer Opinion

Reviews about this medicine are quite contradictory. Some patients, thanks to this remedy, were able to overcome joint pain. Other patients claim that the drug did not help. Thus, this remedy is not always effective.

In addition, you should not take the drug yourself. In some European countries, this medicine is banned because it has cardiotoxic effects, which is quite harmful to the heart.

The drug "Nimesulide"

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

The product is used for:

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

At the same time, the medicine has an analgesic effect very quickly. As a rule, the patient feels relief within 20 minutes after taking the drug. That is why this remedy is very effective for acute paroxysmal pain.

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

The product is not approved for use by pregnant women and children under 12 years of age. People who have arterial hypertension, the functioning of the kidneys, vision or heart is impaired.

The average price of the medicine is 76.9 rubles.

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. Able to influence the immune system and increase the body's defense level. 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. It is recommended to use a 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, as well as other excipients that 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 or bronchial asthma.

"Analgin"

"Analgin" is a drug that is widely used for the treatment of various infectious and 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 are 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 hepatic and renal 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 an antiviral effect and 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 allergic reaction for 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 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. The dosage varies depending on age, weight and disease.

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 effect 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 of the gastrointestinal tract and thrombus formation 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 ones are based on the 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, use with caution when peptic ulcer and the risk of bleeding. The most famous representatives: Diclofenac, Ketorolac, Indomethacin.

Selective COX-2 inhibitors

The most modern selective drugs today they 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.

An effective and inexpensive drug. Available in dosages of 500 milligrams and 100 mg. The average price on the market is 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 the emergency situation prevents you from contacting a qualified professional immediately. 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. For pain, 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 due to 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.

Venous blood stagnates in the damaged organ, which further intensifies 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 pain 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 painful menstruation may include the use of biphasic estrogen drugs that normalize hormonal background body.

Fever

The increase in body temperature is nonspecific pathological process accompanying 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 body temperature, most biochemical processes in the body occur. 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 growth tooth 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 proven 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 disease hearts and 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.

Studies have been published that long-term use of 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, semen studies, 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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