Nonspecific anti-inflammatory drugs. Characteristics of individual drugs. How these drugs work

Does the abbreviation NSAID mean anything to you? If not, then we suggest broadening your horizons a little and finding out what these mysterious four letters stand for. Read the article - and everything will become absolutely clear. We hope that it will be not only informative, but also interesting!

NSAIDs - transcript

We will not languish our readers in ignorance for a long time. NSAIDs stands for non-steroidal drugs - drugs in our time are very popular and popular, because they are able to simultaneously eliminate pain and relieve inflammation in various organs of our body. If until now you have never had the need to take NSAIDs - this can be considered almost a miracle. You are one of the rare lucky ones, really, your health can be envied!

We are ahead of the next question and immediately talk about the decoding of the word "non-steroidal". This means that these drugs are non-hormonal, i. do not contain any hormones. And this is very good, because everyone knows how unpredictable and dangerous hormonal drugs can be.

Most Popular NSAIDs

If you think that NSAIDs are drugs whose names are rarely pronounced in Everyday life then you are wrong. Many people do not even realize how often we have to use non-steroidal anti-inflammatory drugs to cure various ailments that have accompanied the human race since the time of the expulsion of Adam and Eve from paradise. Read the list of such remedies, for sure some of them are in your home first aid kit. So, NSAIDs include drugs such as:

• "Aspirin".
• "Amidopyrine".
• "Analgin".
• "Piroxicam".
• "Bystromgel".
• "Diclofenac".
• "Ketoprofen".
• "Indomethacin".
• "Ketorol".
• "Naproxen".
• "Ketorolac".
• Flurbiprofen.
• "Voltarengel".
• "Nimesil".
• "Diclofenac".
• "Ibuprofen".
• "Indopan".
• "Ipren".
• Upsarin UPSA.
• "Ketanov".
• "Mesulid".
• Movalis.
• "Nise".
• "Nurofen".
• "Ortofen".
• "Trombo ASS".
• "Ultrafen".
• "Fastum".
• "Finalgel".

Yes, they are all NSAIDs. The list turned out to be long, but, of course, far from complete. Nevertheless, it gives an idea of ​​the variety of modern non-steroidal anti-inflammatory drugs. medicines.

Some historical facts

The first primitive NSAIDs were known to people in ancient times. For example, in Ancient Egypt willow bark, a natural source of salicylates and one of the first non-steroidal anti-inflammatory drugs, was widely used to relieve fever and pain. And even in those distant times, healers treated their patients suffering from joint pain and fever with decoctions of myrtle and lemon balm - they also contain salicylic acid.

In the middle of the 19th century, chemistry began to develop rapidly, which gave impetus to the development of pharmacology. At the same time, the first studies of the compositions began medicinal substances obtained from vegetable raw materials. Pure salicin from willow bark was synthesized in 1828 - this was the first step towards the creation of the familiar "Aspirin" to all of us.

But many more years will pass scientific research before this medicine is released. A grand event happened in 1899. Doctors and their patients quickly appreciated the benefits of the new drug. In 1925, when a terrible influenza epidemic hit Europe, Aspirin became a savior for a huge number of people. And in 1950, this non-steroidal anti-inflammatory drug hit the Guinness Book of Records as the anesthetic with the largest sales volume. Well, later pharmacists created other non-steroidal anti-inflammatory drugs (NSAIDs).

What diseases are non-steroidal anti-inflammatory drugs used for?

The spectrum of application of NSAIDs is very wide. They are very effective in the treatment of both acute and chronic diseases accompanied by pain and inflammation. Nowadays, research is in full swing to study the effectiveness of these drugs in the treatment of diseases of the heart and blood vessels. And today almost everyone knows that they can be used for pain in the spine (NSAIDs for osteochondrosis are a real salvation).

Here is a list of painful conditions, in the event of which the use of various non-steroidal anti-inflammatory drugs is indicated:

• Fever.
• Headaches, migraines.
• Renal colic.
• Rheumatoid arthritis.
• Gout.
• Arthrosis.
• Osteoarthritis.
• Dysmenorrhea.
• Inflammatory arthropathies (psoriatic arthritis, ankylosing spondylitis, Reiter's syndrome).
• Pain syndrome postoperative.
• Pain syndrome from mild to moderate severity with injuries and various inflammatory changes.

Classification of NSAIDs according to their chemical structure

Reading this article, you already had the opportunity to make sure that there are a lot of non-steroidal anti-inflammatory drugs. To navigate among them at least a little better, let's classify these funds. First of all, they can be divided as follows: a group - acids and a group of NSAIDs - non-acid derivatives.

The first ones include:

Salicylates (you can immediately recall the "Aspirin").

Derivatives of phenylacetic acid ("Aceclofenac", "Diclofenac", etc.).

Pyrazolidines (metamisole sodium, known to most of us as Analgin, Phenylbutazone, etc.).

Oxicams ("Tenoxicam", "Meloxicam", "Piroxicam", "Tenoxicam").

Derivatives of indoleacetic acid ("Sulindak", "Indomethacin", etc.).

Derivatives of propionic acid ("Ibuprofen", etc.).

The second group is:

Sulfonamide derivatives ("Celecoxib", "Nimesulide", "Rofecoxib").

Alkanones ("Nabumeton").

Classification of non-steroidal anti-inflammatory drugs according to their effectiveness

The use of NSAIDs in osteochondrosis and in the treatment of other joint diseases can literally work wonders. But, unfortunately, not all drugs are the same in their effectiveness. The undisputed leaders among them are:

• "Diclofenac".
• "Ketoprofen".
• "Indomethacin".
• Flurbiprofen.
• "Ibuprofen" and some other drugs.

The listed medicines can be called basic; that is, on their basis, new NSAIDs can be developed and supplied to the pharmacy network, but under a different name and often at a higher price. In order not to waste your money, study the next chapter carefully. The information contained in it will help you make the right choice.

What to look for when choosing a medicine

NSAIDs are, for the most part, excellent modern drugs, but when you come to the pharmacy, it is better to be aware of some of the nuances. What? But read it!

For example, you are faced with a choice of what is better to buy: Diclofenac, Ortofen or Voltaren. And you are trying to ask the pharmacist which of these drugs is better. Most likely, you will be advised the one that is more expensive. But the fact is that the composition of these drugs is almost identical. And the difference in names is explained by the fact that they are produced by different companies, which is why the brands differ from each other. The same can be said, for example, about "Metindol" and "Indomethacin" or "Ibuprofen" and "Brufen", etc.

To understand the confusion, always look carefully at the packaging, because the main active ingredient of the drug must be indicated there. Only it will be written, most likely, in small letters.

But that is not all. Actually, it's not that simple! The use of an NSAID analogue of some drug you are familiar with may unexpectedly cause an allergic reaction or side effects that you have never seen before. What's the matter here? The reason may lie in additional additives, about which, of course, nothing was written on the packaging. So, you need to study the instructions as well.

Other possible reason different results of analogue drugs - the difference in dosage. Ignorant people often do not pay any attention to this, but in vain. After all, small pills can contain a "horse" dose active substance. Conversely, huge pills or capsules happen to be composed of as much as 90 percent fillers.

Sometimes drugs are also produced in a retarded form, that is, as long-acting (prolonged) drugs. An important feature of such drugs is the ability to be absorbed gradually, so that their action can last for a whole day. Such a drug does not need to be drunk 3 or 4 times a day, a single dose will be enough. This feature of the drug should be indicated on the package or directly in the name. For example, "Voltaren" in a prolonged form is called "Voltaren-retard".

List of analogues of known drugs

We publish this little cheat sheet in the hope that it will help you better navigate the many beautiful pharmacy packages. Let's say you immediately need effective NSAIDs for arthrosis to relieve excruciating pain. Take out the cheat sheet and read the following list:

In addition to the already mentioned Voltaren and Ortofen, there are also Diclofen, Dicloran, Diclonac, Rapten, Diclobene, Artrozan, Naklofen.

- "Indomethacin" is sold under such brands as "Indomin", "Indotard", "Metindol", "Revmatin", "Indobene", "Inteban".

Analogues of "Piroxicam": "Erazon", "Piroks", "Roxicam", "Pirocam".

Analogues of "Ketoprofen": "Flexen", "Profenid", "Ketonal", "Artrozilen", "Knavon".

The popular and inexpensive "Ibuprofen" is found in the composition of drugs such as "Nurofen", "Reumafen", "Brufen", "Bolinet".

Rules for taking NSAIDs

Taking NSAIDs can be accompanied by a number of side effects, so it is recommended that you follow the following rules when taking them:

1. Familiarization with the instruction and following the recommendations contained in it are mandatory!

2. When taking capsules or tablets by mouth, take them with a glass of water - this will protect your stomach. This rule must be adhered to, even if you drink the most modern drugs (which are considered safer), because an extra precaution never hurts;

3. Do not lie down after taking the drug for about half an hour. The fact is that gravity will contribute to a better passage of the capsule down the esophagus;

4. It is better to refuse alcoholic beverages, since NSAIDs and alcohol linked together are an explosive mixture that can cause various diseases stomach.

5. You should not take two different non-steroidal drugs on the same day - this will not increase the positive result, but most likely summarizes the side effects.

6. If the medicine does not help, consult your doctor, perhaps you have been prescribed too low a dose.

Side effects and nonsteroidal gastropathy

Now you have to find out what NSAID gastropathy is. Unfortunately, all NSAIDs have significant side effects. They have a particularly negative effect on the gastrointestinal tract. Patients may experience symptoms such as

• Nausea (sometimes very strong).
• Heartburn.
• Vomit.
• Dyspepsia.
• Bleeding gastrointestinal.
• Diarrhea.
• Ulcer duodenum and stomach.

All of the above troubles are NSAID-gastropathy. Therefore, doctors so often try to prescribe their patients the lowest possible doses of classic non-steroidal anti-inflammatory drugs. To minimize the harmful effects on the stomach and intestines, it is recommended that you never take such drugs on an empty stomach, but only after a large meal.

But problems with the digestive system are not all the side effects that some of the NSAIDs can give. Certain drugs can have a bad effect on the heart, as well as on the kidneys. Sometimes their reception can be accompanied by a headache and dizziness. Another serious nuisance is that they have a destructive effect on intra-articular cartilage (of course, only with prolonged use). Fortunately, today there are new generation NSAIDs on the market, which are largely freed from these shortcomings.

New generation non-steroidal anti-inflammatory drugs

Over the past two decades, several pharmaceutical companies have simultaneously been intensively developing new modern NSAIDs, which, along with the effective elimination of pain and inflammation, would have as few side effects as possible. The efforts of pharmacists were crowned with success - a whole group of new generation drugs, called selective, was developed.

Imagine - these drugs under the supervision of a doctor can be taken in very long courses. Moreover, the terms can be measured not only in weeks and months, but even in years. Medicines from this group do not have a destructive effect on articular cartilage, side effects are much less common and practically do not cause complications.

New generation NSAIDs are drugs such as:

• Movalis.
• "Nise" (aka - "Nimulid").
• "Arcoxia".
• "Celebrex".

We will talk about some of their advantages using the example of Movalis. It is available both in traditional tablets (7.5 and 15 mg each), and in 15 mg suppositories, and in glass ampoules for intramuscular injection (also 15 mg each). This medicine acts very gently, but at the same time extremely effective: just one tablet is enough for the whole day. When a patient is shown long-term treatment for severe arthrosis of the hip or knee joints, Movalis is simply irreplaceable.

Different forms in which NSAIDs are produced

Most popular nonsteroidal anti-inflammatory drugs can be purchased and used not only in the form of tablets and capsules for oral administration, but also in suppositories and injections. And this, of course, is very good, since such a variety makes it possible in some cases to avoid harm during treatment while obtaining a faster therapeutic effect.

Thus, NSAIDs of the new generation, used in the form of injections for arthrosis, have much less effect on the gastrointestinal tract. But there is a downside to this coin: when administered intramuscularly, almost all nonsteroidal drugs are capable of giving a complication - necrosis of muscle tissue. That is why NSAID injections are never practiced for a long time.

Basically, injections are prescribed for exacerbation of inflammatory and degenerative-dystrophic diseases of the joints and spine, accompanied by severe unbearable pain. After the patient's condition improves, it becomes possible to switch to tablets and external agents in the form of ointments.

Usually, doctors combine different dosage forms, deciding what and when can bring the patient the greatest benefit. The conclusion suggests itself: if you do not want to harm yourself self-treatment such common ailments as osteochondrosis or arthrosis, seek help from a medical institution, that's where they can help you.

Can NSAIDs be used during pregnancy?

Doctors categorically do not advise pregnant women to take NSAIDs (especially this prohibition applies to the third trimester), as well as mothers who are breastfeeding. It is believed that drugs in this group can adversely affect the bearing of the fetus and cause various malformations in it.

According to some reports, such a harmless drug, according to many, like Aspirin, can increase the risk of miscarriage in the early stages. But sometimes doctors, according to indications, prescribe to women this drug(limited course and in minimal doses). In each case, the decision must be made by a medical specialist.

During pregnancy, women often have back pain and there is a need to solve this problem with non-steroidal anti-inflammatory drugs as the most effective and fast-acting. In this case, the use of "Voltaren gel" is acceptable. But - again - its independent use is possible only in the first and second trimester, in late pregnancy, the use of this strong drug is allowed only under the supervision of a doctor.

Conclusion

We told you what we knew ourselves about NSAIDs. Deciphering the abbreviation, the classification of drugs, the rules for taking them, information about side effects - this can be useful in life. But we want our readers to need medicines as rarely as possible. Therefore, at parting, we wish you good heroic health!

A variety of anti-inflammatory drugs are prescribed to relieve inflammation in the lesions. Medicines of this purpose are especially important for diseases that are characterized by a chronic progressive inflammatory process, which can lead to disability.

Types of anti-inflammatory drugs

Anti-inflammatory drugs are one of the main components of treatment:

• rheumatoid arthritis;
• osteoarthritis;
• osteochondrosis;
• gout;
• rheumatism;
• hernia of the spine;
• neuralgia;
• renal and biliary colic;
• myositis;
• injuries and sprains;
• some cardiac, gynecological diseases.

Prohibited or limited anti-inflammatory drugs for:

• peptic ulcer;
• blood clotting disorders;
• pregnancy and lactation;
• allergies to these drugs;
• some kidney diseases;
• cardiovascular diseases;
• varicose disease;
• autoimmune pathology.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs are used to treat complex therapy with inflammation in bone, muscle and joint tissue. The peculiarity of these drugs is their non-specificity - they relieve the inflammatory process of any genesis in any localization. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs in the world because they also act as pain relievers.

The first NSAID in the history of pharmaceuticals was aspirin, which was obtained from willow bark in the 18th century. Based on salicylic acid, other, more modern drugs are also produced with a similar effect and, unfortunately, with similar side effects - a negative effect on the health of the stomach and duodenum, liver and circulatory system. To reduce the likelihood of negative consequences after taking non-steroidal anti-inflammatory drugs of this type, doctors do not recommend exceeding the permitted dosage.

NSAIDs of a new type based on other components have a more pronounced anti-inflammatory effect and prolonged action, but at the same time they cause various complications much less often even with long-term use. Such drugs include Meloxicam, Piroxicam (derivatives of oxicam), Nabumeton, Diclofenac (derivatives of phenylacetic acid), Ibuprofen, Ketotifen (derivatives of propionic acid) and some others.

Steroid anti-inflammatory drugs

Medicines included in the group of hormonal anti-inflammatory drugs are more potent than non-steroidal ones. These funds are produced on the basis of the adrenal hormone - cortisol. The mechanism of action of steroid drugs is the local suppression of the immune system. There are more side effects and contraindications for this group of drugs than for NSAIDs, and they are prescribed for:

• severe allergic reaction on the skin;
• rheumatoid arthritis;
• inflammation of the vessels;
• hepatitis;
• myositis;
• shock states.

Steroidal anti-inflammatory drugs are contraindicated in:

• pregnancy and breastfeeding;
• the presence of a bacterial or viral infection;
• the likelihood of bleeding;
• immunodeficiency;
• significant erosion of the joints;
• taking blood-thinning medications;
• already made three injections of steroid drugs.

Combined anti-inflammatory drugs

Combined anti-inflammatory drugs are drugs that combine several components, thereby significantly enhancing the therapeutic effect of these drugs. The most commonly used anti-inflammatory component of combined preparations is diclofenac, and it is combined with vitamins, paracetamol, lidocaine and other active substances.

Anti-inflammatory drugs - list

Only a doctor is able to correctly select anti-inflammatory drugs in each individual case. Non-steroidal anti-inflammatory drugs block the body's enzymes responsible for the production of prostaglandins - substances that causing pain and inflammation. It is impossible to use different drugs of this group to enhance the action - this will cause an increase in side effects. The use of steroidal anti-inflammatory drugs without a doctor's prescription can provoke hypertension, blood clotting disorders, masculinization of the body in women, and osteoporosis.

Anti-inflammatory pills

Painkillers and anti-inflammatory pills are the most purchased medicines. This form is convenient for use, so the most popular drugs are almost always available in the form of tablets:

• - assigned at severe pain in muscles, joints, spine;
• Celecoxib - effective for arthrosis, osteochondrosis;
• - indicated for arthritis, osteoarthritis, spondyloarthritis;
• Ibuprofen - is prescribed for an average pain syndrome with back pain, inflammation of the periosteum, fever.

Anti-inflammatory injections

Preparations in the form of injections have their analgesic and anti-inflammatory effect much faster than tablets. In addition, the injection can be made in close proximity to the focus of inflammation, which will significantly speed up the flow of the drug into the inflamed tissues. Anti-inflammatory drugs for joints, muscles, bone tissue are most in demand:

• Xefocam, Movalis - effective for arthrosis, are also available in the form of tablets;
• Diclofenac - recommended for osteochondrosis, radiculitis, lumbago, inflammation of bone tissue, are also available in the form of tablets;
• Nurofen, Ketonal - effective for various inflammations, have few contraindications and side effects;
• Hydrocortisone, Kenalog, - steroid drugs used as emergency assistance with severe inflammation and severe pain syndrome (replace opiates), they are injected directly into the inflamed focus.

Anti-inflammatory suppositories

An infection that has penetrated the female reproductive organs and caused thrush, inflammation of the cervix or fibroma requires the use of anti-inflammatory vaginal suppositories, since the health of a woman and her offspring depends on the timeliness and quality of treatment. Rectal anti-inflammatory suppositories are used if necessary to cure the focus of inflammation in the rectum and organs located nearby. In addition, treatment with suppositories reduces the risk of side effects. List of anti-inflammatory suppositories:

• , Diclofenac, Ibuprofen, Paracetamol, Movalis, Voltaren, Flamax - used to relieve inflammation in the rectum or vagina, as well as cystitis, neuralgia, neuritis and when it is impossible to use anti-inflammatory drugs in other forms;
• Longidaza - vaginal suppositories are used in the treatment of inflammation of the pelvic organs;
• Fluomizin, Terzhinan - used for the treatment of endometritis, adnexitis;
• Ultraproct, Proctosedil - a steroid drug used for hemorrhoids, fissures, paraproctitis;
• - immunomodulatory and anti-inflammatory suppositories, used for inflammation of the rectum and after surgery to accelerate healing.

Anti-inflammatory ointments

Ointment is an effective form of preparation for external use, in some cases ointments are used for insertion into the vagina or rectum. Commonly used components of non-steroidal anti-inflammatory ointments are diclofenac, ibuprofen, ketoprofen. Anti-inflammatory ointments:

• Ortofen, Nurofen, Ketonal, Meloxicam - non-steroidal drugs for the treatment of inflammation externally, bypassing the gastrointestinal tract.
• Sinalar, Momat, Akriderm - steroidal anti-inflammatory ointments, are prescribed by doctors in cases where local immunity suppression is necessary - for skin diseases, shock states, hepatitis, allergies, pathologies of muscles, joints, vascular disorders.

Anti-inflammatory cream

The list of non-steroidal anti-inflammatory drugs in the form of a cream includes the names of many drugs that are available in the form of ointments. The cream is a more convenient form for external application, and the active substances are the same for all anti-inflammatory drugs. Names of anti-inflammatory creams:

• Ketoprofen, Artrosilene, Indovazin, Diclovit - non-steroidal creams used to treat skin diseases, joints;
• Momat, Akriderm - steroid drugs used to treat allergies, arthritis.

Anti-inflammatory gels

Gel - another form of preparations for external use, it is easily absorbed and does not leave a greasy film. List of anti-inflammatory drugs in the form of a gel:

• Sinalar, Bematetasone - steroid drugs for the treatment of skin diseases, allergies, accompanied by itching;
• Diclak-gel, Voltaren, Fastum-gel, Finalgel, Indovazin - are used to treat pain and inflammation in muscles and joints.

Eye anti-inflammatory drops

Eye anti-inflammatory drops are used to treat ophthalmic diseases. These anti-inflammatory drugs are produced both with and without steroids. Many eye drops can only be purchased after receiving a prescription from a doctor, since only a qualified specialist can take into account all individual indications and contraindications.

In contact with

classmates

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

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

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

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

How do NSAIDs work?

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

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

When are these drugs prescribed?

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

We list the diseases for which these drugs are prescribed:

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

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

List of Common NSAIDs for Joint Treatment

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

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

What is the advantage of new generation NSAIDs

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

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

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

New generation NSAIDs: list and prices

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

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

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

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

Classification

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

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

1. Alcanones;
2. Sulfonamide derivatives.

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

Effectiveness of medium doses

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

1. Indomethacin;
2. Flurbiprofen;
3. diclofenac sodium;
4. Piroxicam;
5. Ketoprofen;
6. Naproxen;
7. ibuprofen;
8. Amidopyrine;
9. Aspirin.

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

1. Ketorolac;
2. Ketoprofen;
3. diclofenac sodium;
4. Indomethacin;
5. Flurbiprofen;
6. Amidopyrine;
7. Piroxicam;
8. Naproxen;
9. ibuprofen;
10. Aspirin.

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

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

What dosage to choose?

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

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

Side effects

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

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

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

Use during pregnancy

It is not recommended to use drugs of the NSAID group during pregnancy, especially in the third trimester. Although no direct teratogenic effects have been identified, it is believed that NSAIDs can cause premature closure of the ductus arteriosus (Botalla) and renal complications at the fetus. There are also reports of premature births. Despite this, aspirin in combination with heparin has been successfully used in pregnant women with antiphospholipid syndrome.

According to the latest data from Canadian researchers, the use of NSAIDs before 20 weeks of gestation was associated with an increased risk of miscarriage (miscarriage). According to the results of the study, the risk of miscarriage increased by 2.4 times, regardless of the dose of the drug taken.

The leader among non-steroidal anti-inflammatory drugs can be called Movalis, which has an extended period of action and is approved for long-term use.

It has a pronounced anti-inflammatory effect, which allows it to be taken in osteoarthritis, ankylosing spondylitis, rheumatoid arthritis. It is not devoid of analgesic, antipyretic properties, protects cartilage tissue. It is used for toothache, headache.

Determination of dosage, method of administration (tablets, injections, suppositories) depends on the severity, type of disease.

Celecoxib

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

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

Indomethacin

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

The price of the drug, regardless of the form of release (tablets, ointments, gels, rectal suppositories) is quite low, the maximum cost of tablets is 50 rubles per package. When using the drug, you must be careful, as it has a long list of side effects.

In pharmacology, indomethacin is produced under the names Indovazin, Indovis EU, Metindol, Indotard, Indocollir.

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

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

To the most popular trade names ibuprofen include Ibuprom, Nurofen, MIG 200 and MIG 400.

Diclofenac

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

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

Ketoprofen

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

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

Acetylsalicylic acid reduces the ability of blood cells to stick together and form blood clots. When taking Aspirin, the blood thins, and the vessels expand, which leads to relief of a person's condition with headaches and intracranial pressure. The action of the drug reduces the energy supply in the focus of inflammation and leads to the attenuation of this process.4

Aspirin is contraindicated for children under 15 years of age, since a complication is possible in the form of an extremely severe Reye's syndrome, in which 80% of patients die. The remaining 20% ​​of surviving babies may be susceptible to epilepsy and mental retardation.

Alternative drugs: chondroprotectors

Quite often, chondroprotectors are prescribed for the treatment of joints. People often do not understand the difference between NSAIDs and chondroprotectors. NSAIDs quickly relieve pain, but at the same time have a lot of side effects. And chondroprotectors protect cartilage tissue, but they need to be taken in courses.

The composition of the most effective chondroprotectors includes 2 substances - glucosamine and chondroitin.

The widespread use of non-steroidal anti-inflammatory drugs in medicine is due to their pronounced therapeutic effect. They are able to eliminate the symptoms inherent in many diseases: pain, fever, inflammation. In recent years, the list of drugs in this group has been replenished with a list of non-steroidal anti-inflammatory drugs (NSAIDs) of a new generation with increased efficiency against the background of improved tolerability.

What is NSAID

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) belong to a group of drugs aimed at symptomatic therapy of pathologies of acute and chronic course. They do not belong to steroid hormones, they have a pronounced therapeutic effect against inflammation, pain of varying intensity, and fever.

The action of non-steroidal NSAIDs is due to a reduction in the production of enzymes (cyclooxygenase) that trigger reactive processes in the body in response to the effects of pathological factors.

Anti-inflammatory NSAIDs, although similar in chemical structure, may differ in the strength of the effect, the presence and severity of side effects. The choice of the drug is carried out by the doctor, based on the type of pathology, its clinical manifestations. NSAIDs of the new generation are characterized by a high therapeutic result with low toxicity. This is due to their wide application in medicine.

Non-narcotic analgesics, NSAIDs are successfully used all over the world to treat pathologies of the musculoskeletal system, to eliminate pain during various diseases and conditions (premenstrual syndrome, postoperative period, etc.). NSAIDs act on blood clotting, thinning it (by increasing plasma volume), reduce formed elements (cholesterol plaques), which is used in the treatment of a number of diseases of the heart and blood vessels (atherosclerosis, heart failure, and others).

Classification

NSAIDs are classified according to several criteria.

By belonging to the generation of medicines:

• First generation. The drugs of this group have long been present on the pharmacological market: Aspirin, Ibuprofen, Diclofenac, Voltaren, Naproxen and others.
• New generation. This group includes Nise, Nimulid, Movalis, Arcoxia and others.

By chemical composition NSAID drugs may refer to acids or non-acid derivatives.

• Salicylates: Aspirin.
• Pyrazolidines: metamizole sodium NSAIDs (analgin). Despite the difference between analgesics and NSAIDs in terms of chemical structure, they have common pharmacological qualities.

Non-acid agents include Nimesulide, Nabumeton.

According to the mechanism of action:

• Non-selective inhibitors of COX-1 and COX-2 (cyclooxygenase enzymes) - inhibit both types of enzymes. Classical anti-inflammatory drugs belong to this species. The difference between NSAIDs of this group is in the blocking of COX-1, which are constantly present in the body. Their suppression can be accompanied by negative side effects.
• Selective NSAID COX-2 inhibitors. The use of these drugs is preferable, since they act exclusively on enzymes that appear in response to pathological processes in organism. However, their increased effect on the heart and blood vessels is noted (they can cause an increase in blood pressure).
• Selective NSAID COX-1 inhibitors. The group of such drugs is insignificant (aspirin), since by acting on COX-1, the active ingredient usually also affects COX-2.

The strength of the anti-inflammatory effect among NSAIDs, Indomethacin, Flurbiprofen, Diclofenac can be distinguished. Amidopyrine, Aspirin have a weaker effect.

By the strength of the analgesic action The classification of NSAIDs includes drugs with the maximum effect: Ketorolac, Ketoprofen, Diclofenac, and others. Naproxen, Ibuprofen, Aspirin have a minimal analgesic effect.

List of drugs

In pharmacology, a wide range of NSAIDs in various dosage forms is presented. Their action is distinguished by the strength of the therapeutic effect, duration, the presence of side effects, method of application. Modern effective NSAIDs are distinguished by a minimal risk of negative consequences of taking them, a quick and long-lasting result.

Tableted dosage form NSAID drugs are considered the most common. It has a high absorption of the active components of the drug into the systemic circulation, which ensures the therapeutic efficacy of drugs. However, NSAIDs in tablets more than other forms affect the patient's digestive tract, in some cases causing negative side effects.

The active ingredient of the drug is etoricoxib. It has analgesic, anti-inflammatory, antipyretic properties. Selective suppression of COX-2 causes a reduction in the clinical manifestations of diseases without negative effects on the digestive tract and platelet function.

Contraindications: hypersensitivity, ulcerative lesions of the digestive tract, internal bleeding, hemostasis disorders, severe cardiac pathologies, severe renal and hepatic dysfunctions, coronary heart disease, peripheral arterial pathologies, pregnancy, lactation, age up to 16 years.

Side effects: epigastric pain, dyspepsia, stool disorders, gastric ulcer, headache, growth blood pressure, cough, edema, renal and hepatic dysfunction, bronchospasm, hyperreaction of the body to the drug.

The active ingredient of the drug is rofecoxib. By blocking COX-2, the drug has pronounced analgesic, decongestant, anti-inflammatory, anti-febrile effects. The absence of an effect on COX-2 ensures good tolerance of the drug, the minimum number of negative consequences of taking it.

Contraindications: hypersensitivity, oncology, asthma, pregnancy, lactation, age up to 12 years.

Side effects: intestinal disorders, dyspepsia, abdominal pain, hallucinations, confusion, renal and hepatic dysfunction, hypertension, circulatory disorders (coronary and cerebral), swelling of the legs, hypersensitivity reactions.

The active substance is lornoxicam. It has analgesic, anti-inflammatory, antipyretic properties. The drug inhibits the activity of cyclooxygenase enzymes, inhibits the production of prostaglandins, the release of free radicals. Does not affect the opioid receptors of the central nervous system, respiratory function. There is no addiction and dependence on the medication.

Contraindications: hypersensitivity, ulcers, bleeding in the gastrointestinal tract, severe renal and hepatic dysfunction, pregnancy, lactation, severe heart disease, dehydration, age under 18 years.

Side effects: visual impairment, hearing impairment, hepatic, renal dysfunction, headache, increased blood pressure, chills, peptic ulcers, bleeding from the gastrointestinal tract, dyspepsia, hypersensitivity reactions.

The active ingredient is meloxicam. The drug has pronounced anti-inflammatory, antipyretic, analgesic qualities. It has a long-lasting effect and the possibility of long-term use. There are fewer side effects than when taking other NSAIDs. Does not affect the state of the platelet hemostasis system.

Contraindications: hypersensitivity, ulcers (acute period), bleeding in the gastrointestinal tract, severe renal and hepatic dysfunction, hemostasis disorders, pregnancy, lactation, age up to 12 years.

Side effects: manifestations of hypersensitivity, headache, perforation and bleeding from the gastrointestinal tract, colitis, gastropathy, abdominal pain, changes in liver function, increased blood pressure, acute renal dysfunction, urinary retention.

The active ingredient of the drug is nimesulide. Selectively inhibits COX-2, reducing the production of prostaglandins. At the same time, it also affects their precursors (short-lived prostaglandins H2). This is due to the pronounced analgesic, anti-febrile, anti-inflammatory qualities of NSAIDs. The drug activates glucocorticoid centers, reducing inflammation in the tissues. It is effective in acute pain syndrome due to the rapid analgesic effect.

Contraindications: pregnancy, age up to 12 years, ulcers and bleeding in the digestive tract, hypersensitivity, severe renal and hepatic insufficiency.

Side effects: headache, gastralgia, dyspepsia, ulceration of mucous tissues, oliguria, hematuria, hypersensitivity reactions, changes in blood counts.

Celecoxib

NSAIDs of the coxibs class, has analgesic, anti-inflammatory, antipyretic properties. It is mainly used in rheumatology for the treatment of arthrosis, arthritis, ankylosing spondylitis. Effectively and quickly eliminates pain in the muscles, back, in the postoperative period. It is used to treat primary dysmenorrhea.

Contraindications: hypersensitivity, ulcers, bleeding in the gastrointestinal tract, coronary heart disease, severe renal and hepatic dysfunction, pregnancy, lactation, age up to 18 years.

Side effects: ulcers, bleeding from the gastrointestinal tract, renal, hepatic dysfunction, bronchospasm, cough, hypersensitivity reactions, epigastric pain, dyspepsia, headache.

This dosage form is used externally. It has a local therapeutic effect without being absorbed in the body and without causing systemic side effects when used correctly.

Apizartron

Active components of the drug: methyl salicylate, bee venom, allyl isothiocyanate, Roymakur aquasols, rapeseed oil, ethanol denatured with camphor. The ointment has an analgesic, anti-inflammatory effect. Local irritant and vasodilating effects of the drug improve blood circulation in the damaged area. It is used for arthralgia, myalgia, neuritis, sprains and other problems. After spreading the ointment on the skin, it is recommended to keep the treated area warm.

Contraindications: arthritis acute course, skin diseases, severe renal and hepatic dysfunctions, pregnancy, hypersensitivity.

Side effects: local reactions hypersensitivity.

The active ingredients of the drug are methyl salicylate, menthol. The ointment has an irritating effect on the skin receptors, a vasodilating effect on the capillaries. The use of the cream relieves muscle spasms, reduces pain, tension, improves blood circulation in tissues. As a result of therapy, the range of motion increases, inflammation in the affected area is reduced.

Contraindications: sensitivity to the components of the drug, damage to the skin, dermatological diseases, age up to 12 years, pregnancy, lactation.

Side effects: local hypersensitivity reactions (itching, urticaria, erythema, peeling, irritation).

The active components of the drug are nonivamide, dimethyl sulfoxide, camphor, turpentine, benzyl nicotinate. The ointment has analgesic, irritating, warming qualities. As a result of application in the affected area, blood circulation improves. A decrease in pain syndrome is noted half an hour after application and lasts about 6 hours. A small amount of the drug is absorbed into the systemic circulation.

Contraindications: hypersensitivity, skin lesions, dermatological diseases, pregnancy, lactation, childhood.

Side effects: local hypersensitivity reactions (itching, tissue swelling, rash).

Mataren Plus

The active component of the cream is meloxicam, supplemented with pepper tincture. It has analgesic, anti-edematous, anti-inflammatory properties. The warming effect of the ointment improves blood circulation in the tissues. It is used for pathologies of the joints and spine, injuries, sprains.

Contraindications: skin damage or disease, hypersensitivity to components, age up to 12 years.

Side effects: local hypersensitivity reactions, manifested by irritation, rash, itching, burning, peeling.

The active ingredients of the ointment are nonivamide, nicoboxyl. The drug has analgesic, vasodilating, hyperemic effects. The combined effect of the drug improves blood supply to tissues, accelerates enzymatic reactions, metabolic processes. A decrease in clinical manifestations is observed already a few minutes after the distribution of the ointment on the skin and becomes maximum after half an hour.

Contraindications: hypersensitivity, age up to 12 years, damaged skin or its sensitive areas (lower abdomen, neck, etc.), dermatological diseases.

Side effects: manifestations of hypersensitivity, paresthesia, burning in the area of ​​application, cough, shortness of breath.

Suppositories are often used in gynecological, urological practice. They have less negative impact on the gastric mucosa. Designed for rectal administration.

The active ingredient of the drug is rofecoxib. Suppositories are applied rectally, are prescribed for acute pain syndrome of inflammatory origin, for the treatment of primary dysmenorrhea. Candles are placed twice a day, the course should not exceed 6 weeks.

Contraindications: oncological pathologies, bronchial asthma, age up to 12 years, pregnancy, lactation, hypersensitivity.

Side effects: soreness in the abdomen, bowel disorder, hallucinations, confusion, renal and hepatic dysfunction, circulatory disorders (coronary and cerebral), hypertension, swelling of the legs, hypersensitivity reactions.

The active active component of the selective NSAID is meloxicam. The drug has analgesic, antipyretic, anti-inflammatory properties. Is used for symptomatic therapy various diseases of the musculoskeletal system, including for the relief of significant pain (with osteoarthritis and rheumatoid arthritis). Effective for relieving muscle, toothache.

Contraindications: hypersensitivity, severe renal and hepatic dysfunction, acute ulcers, bleeding in the gastrointestinal tract, asthma, pregnancy, lactation, age up to 18 years.

Side effects: dyspeptic manifestations, intestinal disorders, abdominal pain, stomach ulcers, increased blood pressure, blurred vision, headache, hypersensitivity reactions.

The active ingredient in suppositories is meloxicam. NSAIDs are derivatives of enolic acid. The drug has pronounced anti-inflammatory, analgesic, anti-febrile qualities. Often prescribed for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis.

Contraindications: hypersensitivity, ulcers, bleeding in the digestive tract (exacerbation), severe renal and hepatic failure, severe cardiac dysfunction, pregnancy, lactation, age up to 12 years.

Side effects: perforation in the gastrointestinal tract, dyspepsia, gastritis, colitis, abdominal pain, renal and hepatic dysfunction, diarrhea, cytopenias, bronchospasm, headache, palpitations, increased blood pressure, hypersensitivity reactions.

Revmoxicam

The active ingredient of the drug is meloxicam. Suppositories have pronounced anti-inflammatory, antipyretic, analgesic properties. The drug effectively reduces pain, inflammation in diseases of the musculoskeletal system. There is no effect on the activity of chondrocytes and the production of proteoglycan, which is important in diseases of the joints.

Contraindications: hypersensitivity, ulcers, bleeding in the digestive tract, severe renal, hepatic dysfunction, heart failure inflammation in the rectum, pregnancy, lactation, age up to 15 years.

Side effects: dyspeptic manifestations, epigastric pain, ulcers, bleeding in the gastrointestinal tract, hypertension, edema, arrhythmias, liver dysfunction.

Tenoxicam

The active ingredient in rectal suppositories is tenoxicam. The drug has anti-inflammatory, antipyretic, analgesic properties. Eliminates pain in muscles, spine, joints. Helps increase range of motion, get rid of morning stiffness and swelling in the joints. Normalization of the patient's condition is noted within a week of therapy.

Contraindications: ulcers, bleeding in the digestive tract, hypersensitivity to the components of the drug, severe renal dysfunction, pregnancy, lactation.

Side effects: dyspeptic manifestations, abdominal pain, headache, hypersensitivity reactions, hepatic dysfunction, gastric ulcer, local irritation, pain during defecation.

It is used for local effects on the affected area. The active components are minimally absorbed into the systemic circulation, which ensures good tolerability of the drug, the absence of negative consequences. May cause manifestations of hypersensitivity in the area of ​​application.

The active substance is meloxicam. It has pronounced local analgesic and anti-inflammatory properties. It is distinguished by the absence of a negative effect on cartilage tissue, which ensures the widespread use of the gel in degenerative-dystrophic changes. skeletal system.

Contraindications: skin lesions in the area of ​​application, skin diseases, age up to 18 years, pregnancy, lactation, hypersensitivity.

Side effects: itching, burning, peeling, hyperemia, rash, photosensitivity.

The active ingredients of the drug are rofecoxib, methyl salicylate, menthol, linseed oil. The drug has a local analgesic, anti-inflammatory effect. Methyl salicylate increases blood flow in the affected area, eliminating swelling and bruising. It is used for musculoskeletal pathologies (arthritis, arthrosis, neuralgia, osteochondrosis, etc.), injuries. The gel is applied externally 3-4 times a day with light rubbing movements.

Contraindications: hypersensitivity.

Side effects: itching, burning, peeling, irritation of the skin in the area of ​​application.

The active component of the gel is nimesulide, when applied externally it has analgesic and anti-inflammatory effects. Used for local therapy pathologies of the spine, joints, muscle pain, injuries, sprains. As a result of treatment, pain at rest and movement, stiffness (in the morning), and swelling of the joints are reduced. Absorption of the drug into the systemic circulation is minimal.

Contraindications: hypersensitivity, ulcers, bleeding in the digestive tract, skin lesions and dermatological diseases, severe renal and hepatic dysfunction, pregnancy, lactation, age up to 7 years.

Side effects: overreaction of the body. With prolonged therapy and applying the gel to a large area of ​​the body, systemic negative phenomena may be observed.

The active ingredient of the drug is nimesulide. When used externally, the absorption of the active component into the systemic circulation is minimal, which ensures good tolerability of the agent, its low toxicity. It is used to relieve pain, inflammatory symptoms in pathologies of the spine and joints, injuries, inflammation of soft tissues, etc.

Contraindications: hypersensitivity, damage to the skin, dermatological diseases in the area of ​​application of the product, age up to 12 years, 3rd trimester of pregnancy.

Side effects: local and general hypersensitivity reactions.

The active ingredient of the drug is nimesulide. The drug is applied topically, has analgesic, anti-inflammatory qualities. The gel is distributed in a thin layer over the painful area. Do not use more than 4 times a day, avoid contact with eyes. Therapy is usually long. With external use, the absorption of the active component into the systemic circulation is minimal, which ensures the absence of pronounced side effects.

Contraindications: hypersensitivity, damaged skin in the area of ​​​​application of the product.

Side effects: itching, burning, peeling, irritation of the skin at the site of application of the drug.

The parenteral form of administration is often used to eliminate acute pain. It is usually used in the first days of therapy, after which a transition to other dosage forms is carried out.

The drug is presented in ampoules with a solution for intramuscular injection. The active ingredient is rofecoxib. It is forbidden to administer the drug intravenously. It is used for a quick analgesic effect in various diseases and conditions (arthritis, trauma, migraine, neuralgia, algomenorrhea). It has anti-edema, anti-inflammatory, antipyretic properties.

Contraindications: oncology, pregnancy, lactation, age up to 12 years, hypersensitivity, condition after a heart attack and stroke, progressive atherosclerosis, malignant hypertension.

Side effects: dyspeptic manifestations, abdominal pain, confusion, hallucinations, renal, hepatic dysfunction, hypertension, circulatory disorders (cerebral and coronary), congestive heart failure, hypersensitivity reactions.

The medicine is presented in the form of a powder for making a solution. The introduction is made intramuscularly or intravenously. Parenteral use is recommended for acute pain syndrome (after surgery, with sciatica). The drug has a rapid analgesic effect (after a quarter of an hour).

Contraindications: hypersensitivity, hemostasis disorders, ulcers, bleeding in the gastrointestinal tract, severe hepatic and renal dysfunction, asthma, heart failure, hemorrhagic stroke, pregnancy, lactation, age up to 18 years.

Side effects: headache, aseptic meningitis, hearing and vision disorders, renal and hepatic dysfunctions, dyspeptic manifestations, ulcers, bleeding in the gastrointestinal tract, hypersensitivity phenomena.

Meloxicam

The drug is intended for intramuscular injection. Differs in speed of therapeutic effect, possesses anti-inflammatory, febrifugal, analgesic action. Injections are made exclusively into the muscle, intravenous use is prohibited. Parenteral administration is indicated in the first days of therapy, then the transition to tablet forms is carried out.

Contraindications: hypersensitivity, severe cardiac dysfunction, ulcers in the gastrointestinal tract, internal bleeding, severe renal and hepatic dysfunction, pregnancy, lactation, age up to 12 years.

Side effects: dyspepsia, epigastric pain, intestinal disorders, ulcer, bleeding from the gastrointestinal tract, hepatic and renal dysfunction, headache, edema, bronchospasm, hypersensitivity reactions.

The drug is intended for intramuscular route of administration. The active ingredient is meloxicam. It is considered a popular, frequently prescribed and effective drug in the treatment of pathologies of the musculoskeletal system due to pronounced medicinal properties and low toxicity. Actively inhibits COX-2 enzymes (and slightly COX-1), reducing the biosynthesis of prostaglandins. It has chondroneutrality, is often used for articular pathologies.

Contraindications: hypersensitivity, pronounced renal, hepatic dysfunction, ulcers, bleeding in the gastrointestinal tract, pregnancy, lactation, age up to 15 years.

Side effects: dyspeptic manifestations, abdominal pain, intestinal disorders, ulcers, bleeding in the gastrointestinal tract, renal, hepatic dysfunction, anemia, headache, edema, increased blood pressure, allergic reactions.

Revmoxicam

The drug is presented in an injectable form, the active ingredient is meloxicam. Indicated for use in degenerative pathologies of the skeletal system (including arthrosis, rheumatoid arthritis, spondyloarthritis). The drug is administered exclusively by intramuscular route. The dose and duration of therapy is determined by the doctor, based on the type of pathology and the patient's condition.

Contraindications: hypersensitivity, ulcers, bleeding in the gastrointestinal tract, severe renal, hepatic dysfunction, heart failure, inflammation in the rectum, pregnancy, lactation, age up to 15 years.

Side effects: dyspeptic manifestations, abdominal pain, ulcers, bleeding in the gastrointestinal tract, hypertension, edema, arrhythmias, liver dysfunction.

In ophthalmic practice, the use of NSAIDs for local application. In the vast majority of cases, the active ingredients of the drugs are diclofenac or indomethacin, as an alternative to glucocorticosteroids.

The active ingredient is bromfenac. Eye drops are used in the treatment of inflammation and pain after surgery for cataract extraction. The therapeutic effect (analgesic and anti-inflammatory) persists throughout the day.

Contraindications: hypersensitivity, age up to 18 years, pregnancy, lactation, bleeding tendency.

Side effects: discomfort, pain, itching in the eye area, their hyperemia, inflammation of the iris, erosion, corneal perforation, its thinning, headache, retinal hemorrhage, decreased vision, edema, hypersensitivity reactions.

Diclofenac

The active component of the drops is diclofenac sodium. The drug has a pronounced local analgesic and anti-inflammatory effects. It is used for inhibition of miosis, prevention and treatment of cystic macular edema during cataract surgery, in the treatment of inflammation of non-infectious etiology.

Contraindications: hypersensitivity, pregnancy, child and elderly age, tendency to bleeding, violations of hemostasis.

Side effects: burning, itching, hyperemia of the eye area, blurred vision after application, nausea, vomiting, hypersensitivity reactions.

The active ingredient is diclofenac. The use of the drug reduces inflammation in the eye (after infection, trauma, surgery), reduces miosis during operations, the production of prostaglandins in the fluid of the anterior chamber of the eyes. The absorption of the drug into the systemic circulation is negligible and has no clinical significance.

Contraindications: violations of hemostasis, exacerbation of ulcerative lesions in the digestive tract, hypersensitivity.

Side effects: burning, blurred vision after application, clouding of the cornea, itching, redness of the eyes, hypersensitivity reactions.

Indocollier

The active ingredient is indomethacin. The drug has pronounced local anti-inflammatory and analgesic properties. Systemic absorption of the drug is minimal, which ensures its good tolerability. It is used for the treatment of inflammation after eye surgery, conjunctivitis of non-infectious origin, suppression of miosis during surgery due to cataracts.

Contraindications: hypersensitivity, violations of hemostasis.

Side effects: burning, blurred vision when using drops, hypersensitivity reactions.

The active component of the drops is nepafenac. When used locally, the active ingredient enters the cornea, where it is converted to amfenac, which inhibits the activity of cyclooxygenase. It is used for the treatment and prevention of pain, inflammation, the formation of macular edema (in people with diabetes) after surgery due to cataracts.

Contraindications: hypersensitivity, age up to 18 years, pregnancy, lactation.

Side effects: punctate keratitis, feeling of a foreign object in the eye, the formation of crusts on the edges of the eyelids, sinusitis, lacrimation, hyperemia, hypersensitivity reactions.

Indications for the use of NSAIDs are:

• Joint diseases. However, in most cases they have only a symptomatic effect, without affecting the course of the pathology. NSAIDs are used for arthritis (rheumatoid, gouty, psoriatic), rheumatism, ankylosing spondylitis, Reiter's syndrome. The use of NSAIDs for arthrosis greatly facilitates clinical manifestations diseases.
• Osteochondrosis, sciatica, sciatica, trauma, osteoarthritis, myositis. The course use of NSAIDs for hernia helps to eliminate pain.
• inflammatory processes in soft tissues, bursitis, synovitis.
• Renal and hepatic colic. Drugs are used for the purpose of pain relief.
• Fever. The antipyretic effect of drugs is used at temperatures above 38 degrees. For this purpose, NSAIDs are often used for children, mainly in the form of suppositories or syrup.
• Pain of various etiologies(head, dental, postoperative).
• In the complex therapy of coronary heart disease, atherosclerosis, heart failure, in order to prevent arterial thrombosis.
• Dysmenorrhea and other gynecological pathologies. They are used to relieve pain and reduce blood loss.

Mechanism of action

Symptoms of most acute and chronic diseases include inflammation, pain, fever. Direct participation in the formation of these phenomena in the body is taken by bioactive substances - prostaglandins. Their production depends on cyclooxygenase enzymes, presented in two isoforms COX-1 and COX-2, which are targeted by the inhibitory effect of non-steroidal anti-inflammatory drugs.

• Anti-inflammatory effect achieved by reducing the production of inflammatory mediators, reducing the permeability of the vascular walls;
• blocking inflammation reduces irritation of nerve receptors, which helps to eliminate pain;
• Impact on body thermoregulation causes a decrease in temperature during fever.

The difference between new generation drugs and classic NSAIDs lies in the selectivity of action. Classical drugs usually suppress not only the direct inflammatory mediator COX-2, but also COX-1, which is constantly present in the body, providing a protective effect on the gastric mucosa, platelet viability. As a result, there are many negative side effects, especially on the digestive tract. Modern safe NSAIDs, inhibiting only COX-2, significantly reduce the risk of side effects.

The choice of the drug is carried out by the doctor, based on the type of disease and the desired therapeutic effect. This takes into account the patient's history, the presence of contraindications for admission, tolerability of the drug. The dosage is also set by the doctor, it is recommended to start with the lowest effective dose. With good tolerance, the norm is increased after 2-3 days.

Therapeutic dosages of drugs differ, while there is a tendency to increase the daily and single dose of drugs (Ibuprofen, Naproxen), which have a minimum number of side effects. Restrictions on the maximum intake per day of Aspirin, Indomethacin, Phenylbutazone, Piroxicam remain. The frequency of taking drugs in this group also varies and ranges from 1 to 3-4 times a day.

In some pathologies, the effectiveness of the use of these drugs is observed only at high dosages of drugs, while the combination of several NSAIDs is impractical (except for Paracetamol, which is combined with other drugs to enhance the effect).

Ways to receive

When using NSAIDs, one should take into account their features and adhere to certain rules for use:

• Topical agents (gels, ointments), which are considered the safest NSAIDs, are distributed over the painful area. It is necessary to wait for absorption and only then put on clothes. Water procedures may be taken after a few hours.
• When taking NSAIDs, it is necessary to strictly observe the dose prescribed by the doctor, not exceeding the daily dose. If symptoms persist, it is recommended to consult a doctor to change the drug to a more potent one.
• Dosage forms for oral administration are preferably taken after eating, minimizing the damaging effect on the mucosa of the digestive tract. For a faster effect, it is possible to use half an hour before meals or 2 hours after. The protective shell from the capsules is not removed, you need to drink the product with a sufficient amount of water.
• When using suppositories, a faster therapeutic effect is noted than with a tablet form. This method of administration is used in young children. To do this, the child is placed on the left side, and the suppository is inserted rectally, the buttocks are compressed. Within 10 minutes, make sure that the drug does not come out.
• Injection requires sterility and certain medical skills.
• When using medications, it is necessary to consult a doctor, since the action of NSAIDs is directed more to the elimination of symptoms than to treatment. In some cases, the analgesic effect may mask the symptoms. dangerous diseases(gynecological, digestive tract, etc.).
• It is necessary to take into account the possible interaction of drugs with other medications taken. Joint reception NSAIDs with antibiotics (aminoglycosides), digoxin increases the toxicity of the latter. During therapy, there may be a weakening of the therapeutic effect of antihypertensive drugs. NSAIDs can increase the effect of indirect anticoagulants and hypoglycemic drugs.

Contraindications

When prescribing and taking NSAIDs, it is necessary to take into account possible contraindications to their use:

• a pronounced degree of allergy to NSAIDs in history (bronchospasm, rash);
• ulcers, bleeding in the digestive tract;
• period of pregnancy and lactation;
• severe heart disease;
• pathology of the liver and kidneys of severe course;
• violations of hemostasis;
• old age (with prolonged therapy);
• alcoholism;
• children's age (for some dosage forms and preparations);

Side effects

NSAIDs of the new generation minimize the risk of negative effects, without irritating the mucous tissues of the digestive tract and hyaline cartilage. However, some side effects from taking NSAIDs, especially with prolonged therapy, are still present:

• hypersensitivity reactions;
• digestive dysfunctions: stool disorder, dyspepsia, gastropathy;
• fluid retention in tissues, edema;
• the presence of protein in the urine;
• bleeding, mainly in the gastrointestinal tract;
• increased activity of liver indicators;
• aplastic anemia, agranulocytosis;
• headaches, weakness, dizziness, increased blood pressure;
• dry cough, bronchospasm.

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

Impact principle

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

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

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

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

New developments

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

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

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

Indications for use

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

A positive impact is noted with the following factors:

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

Classification

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

The classification of NSAIDs implies a division into two groups:

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

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

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

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

Side effects

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

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

The main side effects can be:

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

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

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

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

Effective analgesics are Ketorolac, Ketoprofen, Indomethacin, Diclofenac.

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

The drug "Movalis"

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

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

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

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

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

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

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

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

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

Inflammation is a process that accompanies to some extent almost all pathologies of organs and systems. A group of non-steroidal anti-inflammatory drugs successfully fights inflammation, relieves pain and brings relief to suffering.

The popularity of NSAIDs is explainable:

• drugs quickly stop pain, have antipyretic and anti-inflammatory effects;
• modern drugs are available in various dosage forms: they are conveniently used in the form of ointments, gels, sprays, injections, capsules or suppositories;
• many of the drugs in this group can be purchased without a prescription.

Despite the availability and general fame, NSAIDs are not at all a safe group of drugs. Uncontrolled intake and self-administration by patients can cause more harm to the body than good. The doctor must prescribe the medicine!

Classification of NSAIDs

The group of non-steroidal anti-inflammatory drugs is very extensive and includes many drugs that are diverse in chemical structure and mechanisms of action.

The study of this group began in the first half of the last century. Its very first representative is acetylsalicylic acid, the active substance of which is salicillin, was isolated in 1827 from willow bark. After 30 years, scientists have learned how to synthesize this drug and its sodium salt - the same aspirin that occupies its niche on the pharmacy shelves.

Currently in clinical medicine more than 1000 items are used medicines based on NSAIDs.

The following directions in the classification of these drugs can be distinguished:

By chemical structure

NSAIDs can be derivatives:

• carboxylic acids (salicylic - Aspirin; acetic - Indomethacin, Diclofenac, Ketorolac; propionic - Ibuprofen, Naproxen; nicotinic - niflumic acid);
• pyrozalones (Phenylbutazone);
• oxicam (Piroxicam, Meloxicam);
• coxibs (Celocoxib, Rofecoxib);
• sulfonanilide (Nimesulide);
• alkanones (Nabumetone).

By the severity of the fight against inflammation

The most important clinical effect for this group of drugs is anti-inflammatory, so an important classification of NSAIDs is one that takes into account the strength of this effect. All drugs belonging to this group are divided into those with:

• a pronounced anti-inflammatory effect (Aspirin, Indomethacin, Diclofenac, Aceclofenac, Nimesulide, Meloxicam);
• weak anti-inflammatory effect or non-narcotic analgesics (Metamizol (Analgin), Paracetamol, Ketorolac).

For COX inhibition

COX or cyclooxygenase is an enzyme responsible for the cascade of transformations that promote the production of inflammatory mediators (prostaglandins, histamine, leukotrienes). These substances support and enhance the inflammatory process, increase tissue permeability. There are two types of the enzyme: COX-1 and COX-2. COX-1 is a “good” enzyme that promotes the production of prostaglandins that protect the gastrointestinal mucosa. COX-2 is an enzyme that promotes the synthesis of inflammatory mediators. Depending on which type of COX blocks the drug, there are:

• non-selective COX inhibitors (Butadion, Analgin, Indomethacin, Diclofenac, Ibuprofen, Naproxen, Ketorolac).

They block both COX-2, due to which they relieve inflammation, and COX-1 - the result of prolonged use is undesirable side effects from the digestive tract;

• selective COX-2 inhibitors (Meloxicam, Nimesulide, Celecoxib, Etodolac).

Selectively block only the COX-2 enzyme, while reducing the synthesis of prostaglandins, but do not have a gastrotoxic effect.

According to recent studies, another third type of enzyme is isolated - COX-3, which is found in the cerebral cortex and cerebrospinal fluid. The drug acetaminophen (aceclofenac) selectively affects this isomer of the enzyme.

Mechanism of action and effects

The main mechanism of action of this group of drugs is the inhibition of the enzyme cyclooxygenase.

Anti-inflammatory action

Inflammation is maintained and develops with the formation of specific substances: prostaglandins, bradykinin, leukotrienes. In the inflammatory process, prostaglandins are formed from arachidonic acid with the participation of COX-2.

NSAIDs block the production of this enzyme, respectively, mediators - prostaglandins are not formed, an anti-inflammatory effect develops from taking the drug.

In addition to COX-2, NSAIDs can also block COX-1, which is also involved in the synthesis of prostaglandins, but necessary to restore the integrity of the gastrointestinal mucosa. If the drug blocks both types of the enzyme, it can have a negative effect on the gastrointestinal tract.

By reducing the synthesis of prostaglandins, edema and infiltration in the focus of inflammation are reduced.

NSAIDs, entering the body, contribute to the fact that another inflammatory mediator - bradykinin becomes unable to interact with cells, and this contributes to the normalization of microcirculation, narrowing of capillaries, which has positive effect for the relief of inflammation.

Under the influence of this group of drugs, the production of histamine and serotonin decreases - biologically active substances that exacerbate inflammatory changes in the body and contribute to their progression.

NSAIDs inhibit peroxidation in cell membranes, and as you know, free radicals are a powerful factor that supports inflammation. Inhibition of peroxidation is one of the directions in the anti-inflammatory effect of NSAIDs.

Analgesic action

The analgesic effect when taking NSAIDs is achieved due to the ability of drugs of this group to penetrate the central nervous system, suppress the activity of pain sensitivity centers there.

In the inflammatory process, a large accumulation of prostaglandins causes hyperalgesia - an increase in sensitivity to pain. Since NSAIDs help to reduce the production of these mediators, the patient's pain threshold automatically increases: when the synthesis of prostaglandins stops, the patient feels pain less acutely.

Among all NSAIDs, there is a separate group of drugs that has an unexpressed anti-inflammatory effect, but a strong pain reliever - these are non-narcotic analgesics: Ketorolac, Metamizol (Analgin), Paracetamol. They are able to fix:

• headache, dental, joint, muscle, menstrual pain, pain in neuritis;
• pain is predominantly inflammatory.

Unlike narcotic painkillers, NSAIDs do not act on opioid receptors, which means:

• do not cause drug dependence;
• do not inhibit the respiratory and cough centers;
• do not lead to constipation with frequent use.

Antipyretic action

NSAIDs have an inhibitory, inhibitory effect on the production of substances in the central nervous system that excite the thermoregulatory center in the hypothalamus - prostaglandins E1, interleukins-11. The drugs inhibit the transmission of excitation in the nuclei of the hypothalamus, there is a decrease in heat generation - elevated body temperature is normalized.

The effect of drugs occurs only at high body temperature, NSAIDs do not have this effect when normal level temperature.

Antithrombotic action

This effect is most pronounced in acetylsalicylic acid (aspirin). The drug is able to inhibit the aggregation (clumping) of platelets. It is widely used in cardiology as an antiplatelet agent - an agent that prevents the formation of blood clots, is prescribed for their prevention in heart diseases.

Indications for use

It is unlikely that any other group of any drugs can boast of such a wide list of indications for use that NSAIDs have. It is the variety of clinical cases and diseases in which drugs have the desired effect that makes NSAIDs one of the most commonly recommended drugs by doctors.

Indications for the appointment of NSAIDs are:

• rheumatological diseases, gouty and psoriatic arthritis;
• neuralgia, sciatica with radicular syndrome (back pain radiating to the leg);
• other diseases of the musculoskeletal system: osteoarthritis, tendovaginitis, myositis, traumatic injuries;
• renal and hepatic colic (as a rule, a combination with antispasmodics is shown);
• fever above 38.5⁰С;
• inflammatory pain syndrome;
• antiplatelet therapy (aspirin);
• pain in the postoperative period.

Since inflammatory pains accompany up to 70% of all diseases, it becomes obvious how wide the spectrum of prescription for this group of drugs is.

NSAIDs are the drugs of choice for the relief and relief of acute pain in articular pathology of various origins, neurological radicular syndromes - lumbodynia, sciatica. It should be understood that NSAIDs do not affect the cause of the disease, but only relieves acute pain. In osteoarthritis, drugs have only a symptomatic effect, without preventing the development of joint deformity.

In oncological diseases, doctors may recommend NSAIDs in combination with opioid analgesics to reduce the dosage of the latter, as well as to provide a more pronounced and prolonged analgesic effect.

NSAIDs are prescribed for painful periods due to increased uterine tone due to hyperproduction of prostaglandin-F2a. The drugs are prescribed at the first appearance of pain at the beginning or on the eve of the monthly course of up to 3 days.

This group of medicines is not harmless at all and has side effects and adverse reactions, so a doctor should prescribe NSAIDs. Uncontrolled intake and self-treatment can threaten the development of complications and unwanted side effects.

Many patients ask themselves: what is the most effective NSAID that relieves pain better? An unequivocal answer to this question cannot be given, since NSAIDs should be selected for the treatment of inflammatory diseases in each patient individually. The choice of drug should be made by a doctor, and is determined by its effectiveness, tolerability of side effects. There is no best NSAID for all patients, but there is a best NSAID for each individual patient!

Side effects and contraindications

On the part of many organs and systems, NSAIDs can cause undesirable effects and reactions, especially with frequent and uncontrolled intake.

Gastrointestinal disorders

The most characteristic side effect for non-selective NSAIDs. In 40% of all patients receiving NSAIDs, there are digestive disorders, in 10-15% - erosion and ulcerative changes in the gastrointestinal mucosa, in 2-5% - bleeding and perforation.

The most gastrotoxic are Aspirin, Indomethacin, Naproxen.

Nephrotoxicity

The second most common group of adverse reactions that occur against the background of taking medications. Initially, functional changes in the functioning of the kidneys may develop. Then, with prolonged use (from 4 months to six months), organic pathology develops with the formation of renal failure.

Decreased blood clotting

This effect is more likely to occur in patients already taking indirect anticoagulants(Heparin, Warfarin), or those with liver problems. Poor clotting can lead to spontaneous bleeding.

Liver disorders

Liver damage can occur from any NSAIDs, especially against the background of alcohol intake, even in small doses. With prolonged (more than a month) intake of Diclofenac, Phenylbutazone, Sulindac, toxic hepatitis with jaundice may develop.

Disorders of the cardiovascular and hematopoietic system

Changes in the blood count with the occurrence of anemia, thrombocytopenia develop most often when taking Analgin, Indomethacin, Acetylsalicylic acid. If the hematopoietic sprouts of the bone marrow are not damaged, 2 weeks after discontinuation of the drugs, the picture in the peripheral blood normalizes and the pathological changes disappear.

In patients with a history of arterial hypertension or the risk of coronary artery disease, with long-term use of NSAIDs, blood pressure numbers may "grow" - destabilization of hypertension develops, and when taking both non-selective and selective anti-inflammatory drugs, there is a possibility of an increased risk of developing myocardial infarction.

allergic reactions

With individual intolerance to the drug, as well as in persons with a predisposition to hyperergic reactions (suffering from bronchial asthma allergic origin, pollinosis) various manifestations of an allergy to NSAIDs can be observed - from urticaria to anaphylaxis.

Allergic manifestations account for 12 to 14% of all adverse reactions on this group of drugs and are more common when taking Phenylbutazone, Analgin, Amidopyrine. But they can be observed on absolutely any representative of the group.

Allergy can be manifested by itchy rashes, swelling of the skin and mucous membranes, allergic rhinitis, conjunctiva, urticaria. Quincke's edema and anaphylactic shock account for up to 0.05% of all complications. When taking ibuprofen, hair loss can sometimes occur up to baldness.

Undesirable effects during pregnancy

Some NSAIDs have a teratogenic effect on the fetus: taking aspirin in the first trimester can lead to a splitting of the upper palate in the fetus. In the last weeks of pregnancy, NSAIDs inhibit the onset of labor. Decreases due to inhibition of prostaglandin synthesis physical activity uterus.

There is no optimal NSAID without side effects. Less pronounced gastrotoxic reactions in selective NSAIDs (Meloxicam, Nimesulide, Aceclofenac). But for each patient, the drug should be individually selected, taking into account its concomitant diseases and tolerability.

Reminder when taking NSAIDs. What the patient should know

Patients should remember that a “magic” pill that perfectly eliminates toothache, headache or other pain may not be harmless to their body at all, especially if it is taken uncontrollably and not as directed by a doctor.

There are a number of simple rules that patients must follow when taking NSAIDs:

1. If the patient has the choice of NSAIDs, one should stop at selective drugs with fewer side effects: aceclofenac, movalis, nise, celecoxib, rofecoxib. The most aggressive for the stomach are aspirin, ketorolac, indomethacin.
2. If the patient had a history of peptic ulcer or erosive changes, gastropathy, and the doctor prescribed anti-inflammatory drugs to relieve acute pain, they should be taken for no more than five days (until inflammation is relieved) and only under the protection of proton pump inhibitors (PPIs): omeprazole, rameprazole , pantoprazole. Thus, the toxic effect of NSAIDs on the stomach is leveled and the risk of recurrence of erosive or ulcerative processes is reduced.
3. Some diseases require constant use of anti-inflammatory drugs. If the doctor recommends taking NSAIDs regularly, the patient should undergo EGD and examine the condition of the gastrointestinal tract before long-term use. If, as a result of the examination, even minor changes in the mucosa are revealed, or the patient has subjective complaints about the digestive organs, NSAIDs should be taken in conjunction with proton pump inhibitors (omeprazole, pantoprazole) constantly.
4. When prescribing aspirin to prevent thrombosis, people over 60 years of age should also undergo gastroscopy once a year, and if there are risks from the gastrointestinal tract, they should constantly take a drug from the PPI group.
5. If, as a result of taking NSAIDs, the patient's condition worsens, allergic reactions, stomach pains, weakness, pallor of the skin, worsening of breathing or other manifestations of individual intolerance appear, you should immediately contact your doctor.

Individual characteristics of drugs

Consider the currently popular representatives of NSAIDs, their analogues, dosage and frequency of administration, indications for use.

Acetylsalicylic acid (Aspirin, Aspirin UPSA, Aspirin Cardio, Thrombo ASS)

Despite the emergence of new NSAIDs, aspirin continues to be actively used in medical practice not only as an antipyretic and anti-inflammatory agent, but also as an antiplatelet agent in diseases of the heart and blood vessels.

Assign the drug in the form of tablets inside after meals.

The drug has anti-inflammatory and antipyretic effects in febrile conditions, headache, migraine, rheumatological diseases, neuralgia.

Drugs such as Citramon, Askofen, Cardiomagnyl contain acetylsalicylic acid in their composition.

Acetylsalicylic acid has many side effects, especially negatively it affects the gastric mucosa. To reduce the ulcerogenic effect, aspirin should be taken after meals, the tablets should be taken with water.

A history of gastric ulcer and duodenal ulcer is a contraindication for prescribing this drug.

Currently, modern preparations are produced with alkalizing additives, either in the form effervescent tablets containing acetylsalicylic acid, which is better tolerated and provides less irritant effect on the gastric mucosa.

Nimesulide (Nise, Nimesil, Nimulide, Kokstral)

The drug has anti-inflammatory, analgesic and antipyretic effects. It has an effect on osteoarthritis, tendovaginitis, pain in trauma, postoperative period.

It is produced under various trade names in the form of tablets of 0.1 and 0.2 g, granules for oral administration in sachets of 2 g (. active ingredient), 1% suspension for oral administration, 1% gel for external use. A variety of forms of release makes the drug very popular for taking.

Nimesulide is prescribed orally for adults at 0.1-0.2 g 2 times a day, for children - at the rate of 1.5 mg / kg 2-3 times a day. The gel is applied to the painful area of ​​the skin 2-3 times a day for no more than 10 days in a row.

Peptic ulcer of the stomach, pronounced violations of the liver and kidneys, pregnancy and lactation are contraindications for taking the medicine.

Meloxicam (Movalis, Artrozan, Melox, Meloflex)

The drug belongs to selective NSAIDs. Its undoubted advantages, unlike non-selective drugs, are less ulcerogenic effect on the gastrointestinal tract and better tolerability.

It has a pronounced anti-inflammatory and analgesic activity. It is used for rheumatoid arthritis, arthrosis, ankylosing spondylitis, to relieve episodes of pain of inflammatory origin.

Available in the form of tablets of 7.5 and 15 mg, rectal suppositories of 15 mg. The usual daily dose for adults is 7.5-15 mg.

It should be borne in mind that the lower incidence of side effects when taking meloxicam does not guarantee their absence, as with other NSAIDs, individual intolerance may develop to the drug, an increase in blood pressure, dizziness, dyspepsia, and hearing loss while taking meloxicam are rarely observed.

You should not get carried away with taking the drug for peptic ulcer, erosive processes of the stomach in history, its use during pregnancy and lactation is contraindicated.

Diclofenac (Ortofen, Voltaren, Dicloberl, Diclobene, Naklofen)

Diclofenac injections for many patients suffering from "lumbago" in the lower back become "saving injections" that help relieve pain and relieve inflammation.

The drug is available in different dosage forms: in the form of a 2.5% solution in ampoules for intramuscular injection, tablets of 15 and 25 mg, rectal suppositories 0.05 g, 2% ointment for external use.

In an adequate dose, diclofenac rarely causes side effects, but they are possible: disorders of the digestive system (pain in the epigastrium, nausea, diarrhea), headaches, dizziness, allergic reactions. In case of side effects, you should stop the medicine and consult your doctor.

To date, diclofenc sodium preparations are produced with a prolonged action: dieloberl retard, voltaren retard 100. The action of one tablet lasts for a day.

Aceclofenac (Aertal)

Some researchers call Aertal the leader among NSAIDs, because according to clinical studies, this drug caused much fewer side effects than other selective NSAIDs.

It cannot be reliably stated that aceclofenac is “the best of the best”, but the fact that side effects when taking it are less than when taking other NSAIDs is a clinically proven fact.

The drug is available in the form of tablets of 0.1 g. It is used for chronic and acute inflammatory pains.

Side effects in rare cases occur and manifest themselves in the form of dyspepsia, dizziness, sleep disorders, skin allergic reactions.

With caution, aceclofenac should be taken by people who have problems with the digestive tract. The drug is contraindicated during pregnancy, lactation.

Celecoxib (Celebrex)

A relatively new, modern selective NSAID with a reduced negative effect on the gastric mucosa.

The drug is available in capsules of 0.1 and 0.2 g. It is used for articular pathologies: rheumatoid arthritis, arthrosis, synovitis, as well as other inflammatory processes in the body, accompanied by pain.

Assigned to 0.1 g 2 times a day or 0.2 g once. Frequency rate and terms of reception have to be stipulated by the attending physician.

Like all NSAIDs, celecoxib is not without undesirable effects and side effects, albeit to a lesser extent. Patients taking the medicine may be disturbed by dyspepsia, stomach pain, sleep disturbance, changes in the blood formula with the development of anemia. If side effects occur, you should stop using the medicine and consult a doctor.

Ibuprofen (Nurofen, MIG 200, Bonifen, Dolgit, Ibupron)

One of the few NSAIDs that have not only anti-inflammatory, analgesic and antipyretic effects, but also immunomodulatory.

There is evidence of the ability of ibuprofen to influence the production of interferon in the body, which provides a better immune response and improves the body's non-specific defense response.

The drug is taken for pain syndrome of inflammatory origin, both in acute conditions and in chronic pathology.

The drug can be produced in the form of tablets 0.2; 0.4; 0.6 g, chewable tablets, dragees, extended-release tablets, capsules, syrup, suspension, cream and gel for external use.

Apply ibuprofen inside and out, rubbing the affected areas and places on the body.

Ibuprofen is usually well tolerated, has a relatively weak ulcerogenic activity, which gives it a great advantage over acetylsalicylic acid. Sometimes, while taking ibuprofen, belching, heartburn, nausea, flatulence, increased blood pressure, and allergic skin reactions may occur.

With exacerbation of peptic ulcer, pregnancy and lactation, this drug should not be taken.

Pharmacy showcases are full of various representatives of NSAIDs, advertising on TV screens promises that the patient will forget about pain forever by taking exactly the “same” anti-inflammatory drug ... Doctors strongly recommend: if pain occurs, you should not self-medicate! The choice of NSAIDs should be carried out only under the supervision of a specialist!

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

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

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

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

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

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

Classification of anti-inflammatory drugs

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

Non-selective NSAIDs (affect mainly COX-1)

These include the following tools:

• Aspirin;
• Ketoprofen;

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

• Lornoxicam;
• Lorakam.

Selective NSAIDs (inhibit COX-2)

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

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

Indications for the use of NSAIDs

knee arthritis is one of the causes

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

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

Side effects

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

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

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

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

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

Contraindications

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

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

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

Ointments with NSAIDs for joint diseases

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

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

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

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

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

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

NSAIDs in solutions for intra-articular injections

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

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

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

List of the best anti-inflammatory drugs

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

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

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

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

Indomethacin (Metindol)

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

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

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

Lornoxicam (Xefocam, Lorakam, Larfix)

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

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

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

Meloxicam (Movalix, Revmoxicam, Melox)

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

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

Nimesulide (Nimesil, Nimesin, Remesulide)

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

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

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

Celecoxib (Revmroxib, Celebrex)

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

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

(Zerodol)

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

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

Rofecoxib

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

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

Combined NSAIDs

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

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

This is far from full list combined anti-inflammatory drugs that are used to treat joints and degenerative lesions of the musculoskeletal system. For each patient, the doctor selects a treatment regimen individually, taking into account many factors. Drugs from the NSAID group have many contraindications and can cause a number of undesirable side reactions from various organs and systems.

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

Who to contact?

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

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