Anti-inflammatory drugs in capsules. New generation non-steroidal anti-inflammatory drugs: list and description. By COX inhibition

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

The word “non-steroidal”, which is contained in the name of a 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?

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

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

When are these drugs prescribed?

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

We list the diseases for which these drugs are prescribed:

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

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

List of common NSAIDs for treating joints

We list the most well-known and effective NSAIDs that are used to treat joints and other diseases when anti-inflammatory and antipyretic effects are necessary:

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

What are the advantages of new generation NSAIDs?

Adverse reactions are observed with long-term use of NSAIDs (for example, in the treatment of osteochondrosis) and consist of damage to the gastric mucosa and duodenum with the formation of ulcers and bleeding. This disadvantage of non-selective NSAIDs has led to the development of a new generation of drugs that block only COX-2 (an inflammatory enzyme) and do not affect the functioning of COX-1 (a defense enzyme).

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

Among the disadvantages of the new generation of drugs, one can note only their high price, which makes it inaccessible to many people.

New generation NSAIDs: list and prices

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

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

1. Movalis. It has antipyretic, pronounced analgesic and anti-inflammatory effects. 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 because they are long-acting and it is enough to take one tablet throughout the day. Movalis, which contains 20 tablets of 15 mg, costs RUB.
2. Xefocam. A drug based on Lornoxicam. Its distinctive feature is the fact that it has a high ability to relieve pain. In this parameter, it corresponds to morphine, but 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 rubles.
3. Celecoxib. This drug significantly 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. Price, rub.
4. Nimesulide. It is used with great success to treat vertebrogenic back pain, arthritis, etc. Removes inflammation, hyperemia, normalizes temperature. The use of nimesulide quickly reduces pain and improves mobility. It is also used as an ointment to apply to the problem area. Nimesulide, which contains 20 tablets of 100 mg, costs rub.

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

Classification

How are NSAIDs classified and what are they? Based on their chemical origin, these drugs come in 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. Phenylacetic acid derivatives – diclofenac, aceclofenac;
6. Pyrazolidines (pyrazolonic acid) – analgin, metamizole sodium, phenylbutazone.

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

Effectiveness of average doses

Based on the strength of the anti-inflammatory effect of average doses of NSAIDs, they can be arranged in the following sequence (the strongest at the top):

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

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

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

What dosage should I choose?

Any drug new to a given patient must be prescribed first in the lowest dose. If well tolerated, the daily dose is increased after 2-3 days.

Therapeutic doses of NSAIDs are in a wide range, with last years There has been a tendency towards an increase in 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. Disruption nervous system– mood changes, disorientation, dizziness, apathy, tinnitus, headache, visual impairment;
2. Changes in the functioning 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. Kidney failure, urinary disorders.

Treatment with NSAIDs should be carried out for the minimum permissible time and in the minimum effective doses.

Use during pregnancy

It is not recommended to use NSAIDs during pregnancy, especially in the third trimester. Although no direct teratogenic effects have been identified, NSAIDs are thought to cause premature closure of the ductus arteriosus and renal complications in the fetus. There is also information about premature birth. 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 pregnancy was associated with an increased risk of miscarriage. According to the results of the study, the risk of miscarriage increased by 2.4 times, regardless of the dose of the drug taken.

Movalis

Leader among non-steroidal anti-inflammatory drugs medicines 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 makes it possible to take it for osteoarthritis, ankylosing spondylitis, and rheumatoid arthritis. It has analgesic and antipyretic properties, and protects cartilage tissue. Used for toothache and headache.

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

Celecoxib

A specific inhibitor of COX-2, which has a pronounced anti-inflammatory and analgesic effect. When used in therapeutic doses, it has virtually no negative effect on the mucous membrane of the gastrointestinal tract, since it has a very low degree of affinity for COX-1, therefore, it does not cause disruption in the synthesis of constitutional prostaglandins.

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

Indomethacin

It is one of the most effective non-hormonal agents. For arthritis, indomethacin relieves pain, reduces joint swelling 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 considerable list of side effects.

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

Ibuprofen

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

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

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

Diclofenac

Perhaps one of the most popular NSAIDs, created back in the 60s. Release form: tablets, capsules, injection solution, suppositories, gel. This joint treatment product combines both high anti-pain activity and high anti-inflammatory properties.

It is produced under the names Voltaren, Naklofen, Ortofen, Diclak, Diclonac P, Vurdon, Olfen, Dolex, Dikloberl, Clodifen 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. In terms of 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 product under the trade names Artrum, Febrofid, Ketonal, OKI, Artrosilen, Fastum, Bystrum, Flamax, Flexen and others.

Aspirin

Acetyl salicylic acid reduces the ability of blood cells to stick together and form blood clots. When taking Aspirin, the blood thins and the blood vessels dilate, which leads to relief from headaches and intracranial pressure. The action of the drug reduces the energy supply at the site of inflammation and leads to the attenuation of this process.4

Aspirin is contraindicated for children under 15 years of age, as a possible complication in the form of 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 they also have a lot of side effects. And chondroprotectors protect cartilage tissue, but they need to be taken in courses.

The most effective chondroprotectors include 2 substances - glucosamine and chondroitin.

The best anti-inflammatory agent for the respiratory system

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

Types of NSAIDs

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

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

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

Features of application

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

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

Paracetamol

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

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

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

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

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

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

• The appearance of pallor, nausea, vomiting and pain in the abdominal area.
• If timely assistance is not provided and too large a dose of medication is taken, the kidneys and liver are affected. Arrhythmia, pancreatitis, and serious disorders of the central nervous system may develop.

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

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

Panadol Extra

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

Panadol Extra helps alleviate the condition of colds, acute tonsillitis, laryngopharyngitis and other infectious and inflammatory pathologies of the respiratory system and ENT organs. Most adults and children tolerate this anti-inflammatory drug quite well. As a rule, there are no special problems with the absorption and excretion of the medicine. Panadol Extra is not prescribed to patients who have increased sensitivity to active ingredients. In rare cases, side effects occur, which may include:

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

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

Coldrex

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

Considering its multicomponent composition, Coldrex has a very diverse pharmachologic effect:

1. The presence of paracetamol normalizes the temperature, relieves pain and eliminates the inflammatory process.
2. Ascorbic acid strengthens the local immunity of the respiratory tract.
3. Phenylephrine is responsible for the narrowing of peripheral blood vessels and preventing the increase in edema of the affected tissues.
4. Terpin hydrate enhances bronchial secretion and facilitates expectoration of sputum.
5. Caffeine potentiates the analgesic effect of paracetamol.

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

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

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

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

Fervex

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

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

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

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

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

At the recommended dosage, the drug is well tolerated. However, nausea, pain in the abdomen, itching, redness of the skin, rashes and other allergic reactions may occur. Unjustified prolonged use or significantly exceeding the recommended dosage increases the risk of developing serious problems with the kidneys and liver. If side effects occur, stop taking the medicine and consult a specialist for professional medical help.

The anti-inflammatory drug has its own characteristics of use. The contents of the Fervex sachet are dissolved in warm water(200 ml) and drink completely. Recommended dosage - up to three times in a day. The next appointment should be no earlier than 4 hours later. At functional disorders kidneys and liver, increase the interval between applications to 8 hours. The therapeutic course is up to five days. Can be used for 3 days to reduce fever. The French company UPSA produces powder for oral administration of Fervex. You can purchase it at a price of 360 rubles per package, which contains 8 sachets.

A complete list of modern anti-inflammatory drugs can be found in the pharmaceutical reference book.

Aspirin-S

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

Aspirin-S is available in the form effervescent tablets, which can be quickly dissolved in water. This form is very convenient for most patients with colds. Especially with severe sore throat, when the use of conventional tablets or hot drinks provokes very unpleasant feeling. In addition, it has long been established that ascorbic acid is destroyed when high temperature. By dissolving it in cool water, we preserve all the pharmacological properties of vitamin C. The absorption of the medicine occurs quite quickly, which ensures the immediate onset of the therapeutic effect. It is also worth noting that acetylsalicylic acid completely dissolves in water without the formation of sediment, reducing the likelihood of various side effects.

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

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

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

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

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

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

Ibuprofen

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

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

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

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

• Decreased appetite.
• Nausea.
• Vomiting.
• Headache.
• Drowsiness.
• Nervousness.
• Hearing and vision impairments.
• Increased blood pressure.
• Increased heart rate.
• Difficulty breathing.
• Edema syndrome.
• Kidney dysfunction.
• Allergies (rashes, itching, redness of the skin, Quincke's edema, etc.).

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

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

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

Some doctors may recommend the drug Nise for infectious and inflammatory diseases of the upper and lower respiratory tract, which are accompanied by fever and pain. This modern non-steroidal anti-inflammatory drug contains the active substance nimesulide. It must be taken when the symptoms of the disease are severe. For example, Nise is able to bring down the temperature in 10-12 hours. He can also relieve headaches, fatigue, weakness, malaise, aching muscles and joints. However, if there is no sufficient therapeutic effect within 3-4 days, you should visit your doctor and adjust the course of treatment.

During the period of bearing a baby, the drug should absolutely not be used. It has been established that nimesulide has a negative effect on the growth and development of the fetus. In addition, the active substance can pass into breast milk, so during treatment you need to switch to artificial feeding. If all recommendations for the use of the medicine specified in the instructions are correctly followed, practically no adverse reactions are observed. In rare cases, the following may occur:

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

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

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

Which non-steroidal anti-inflammatory drugs are best?

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

Anti-inflammatory drugs (NSAIDs) - principle of action

This group of drugs is very broad, but they all have one thing 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 formation of the inflammatory process. The enzyme cyclooxygenase is responsible for the synthesis of so-called inflammatory mediators. It is this that is inhibited by drugs from the NSAID group, interrupting the chain of development of the inflammatory reaction. They prevent pain, high fever and local swelling.

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

Based on 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, new generation NSAID drugs have been developed that have almost complete selectivity.

The three main therapeutic effects of drugs in this group are anti-inflammatory, antipyretic and analgesic. In case of joint diseases, 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 new generation anti-inflammatory non-steroidal drugs that are used to treat joint diseases.

Classification of anti-inflammatory drugs

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

Non-selective NSAIDs (affect mainly COX-1)

These include the following:

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

• Lornoxicam;
• Xefocam;
• Lorakam.

Selective NSAIDs (inhibit COX-2)

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

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

Indications for use of NSAIDs

arthritis knee joint- one of the reasons

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

During exacerbation chronic diseases joints, non-steroidal anti-inflammatory drugs are used in combination. They are prescribed in the form of a course of tablets and ointments; in severe cases, treatment is supplemented intra-articular injections. Outside of exacerbation and in acute conditions, they are used as needed if symptoms of joint inflammation occur.

Side effects

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

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

They are especially pronounced in medications in tablets, suppositories and solutions for intramuscular injections. Local remedies(ointments and intra-articular injections) do not have this 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 manifests itself as a gradual decrease in the amount of formed elements in the blood - first anemia develops, then thrombocytopenia, and 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 to treat joints.

Contraindications

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

NSAIDs should not be prescribed 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. This primarily applies to drugs containing ibuprofen and diclofenac.

In addition, it is possible to develop an allergic reaction to NSAIDs. Its intensity is not related to the dosage form, and appears with the same frequency when taking tablets, using ointments and giving injections into the joints. Sometimes allergies can be very severe forms, for example, aspirin asthma - an asthmatic attack when using the drug. An allergic reaction to NSAIDs can occur, so caution should be exercised when taking the drugs.

Ointments with NSAIDs for joint diseases

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

The most popular drugs in the form of ointments are Diclofenac and drugs based on it (Voltaren), Dolobene, and others. Most of them can be bought at a 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 joint diseases

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 tableted NSAIDs is to prevent 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 cannot be used for liver diseases - fibrosis, cirrhosis, hepatitis, liver failure. For kidney diseases accompanied by a decrease in 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 tablets. Among the more modern drugs of the new generation are Xefocam, Celecoxib and Movalis. New drugs are safer, but have another negative point - high cost. It is necessary to take tablets after meals or with meals.

NSAIDs in solutions for intra-articular injections

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

Diclofenac, Movalis, Xefocam and other drugs are available in injection form. They are used to treat lesions large joints, most often - the knee, less often - the elbow. Intra-articular injections are not prescribed for damage to 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 procedure, and must be carried out in a treatment room, since they require sterility to avoid infection and highly qualified medical staff.

List of the best anti-inflammatory drugs

Let's take a closer look at the features of using the most popular drugs from the NSAID group.

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

Diclofenac and drugs based on it are produced in the form of tablets, capsules, ointments, gels, suppositories, and injection solutions. These drugs exhibit a powerful anti-inflammatory effect, quickly relieve pain, reduce fever and alleviate the patient’s condition. A high concentration of the active ingredient in the blood is observed 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 prescribed by a doctor, in short courses. The standard daily dose of Diclofenac tablets for adult patients is 150 mg, divided into 2-3 doses. Local forms (ointments, gels) are applied to the affected area in a thin layer up to 3 times a day.

Indomethacin (Metindol)

Has the same therapeutic effect as Diclofenac. Available in the form of tablets, capsules, ointments, gels, and rectal suppositories. But this drug has numerous side effects that are more pronounced, so at present it is rarely used, giving preference to more modern drugs.

Piroxicam

A drug from the oxicam group with pronounced analgesic, anti-inflammatory and antipyretic effects. 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, disruption of hematopoietic processes, and reactions from the nervous system. Therefore, the drug should be used only as prescribed by a doctor. The analgesic effect of taking Piroxicam tablets lasts 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 and quickly copes with painful pain. Does not exhibit antipyretic effects. The drug is used for the treatment of postoperative pain, algodismenorrhea, and in the treatment of osteoarthritis and rheumatoid arthritis.

Available in the form of tablets and powder intended for the preparation of 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)

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

Indications for the use of the drug are diseases of the joints of an inflammatory and degenerative nature with severe pain - spondyloarthritis, osteoarthritis 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 and has a powerful anti-inflammatory effect, which is complemented by antipyretic and analgesic properties. Nimesulide is produced in the form of tablets, granules for preparing a 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. The 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, tendinitis.

In addition, Nimesulide is prescribed for atralgia, myalgia, painful periods, as well as to relieve headaches and toothaches. The drug can have a toxic effect on the liver and kidneys, so in case of diseases of these organs, the dose of the drug must be reduced.

Celecoxib (Revmroxib, Celebrex)

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

The maximum permissible daily dose of the drug is 400 mg, divided into 2 doses. With long-term 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 genitourinary system.

Aceclofenac (Zerodol)

The effect of the drug is similar to Diclofenac and is available in the form of tablets containing 100 mg of the active substance. Adults are recommended 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 use may be accompanied by a number of side effects from the digestive, nervous, hematopoietic, and respiratory systems. The drug is prescribed with extreme caution 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 remedy from the category of highly selective COX-2 inhibitors, which have virtually 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 due to injury to muscles and ligaments.

This universal remedy often included in the diagram complex treatment thrombophlebitis, diseases of the genitourinary system, used in ophthalmology, for diseases of the ENT organs or for dental problems (stomatitis, pulpitis). In case of severe pain, you can take up to 4 tablets at a time. The drug is prescribed with caution when 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 drugs with anti-inflammatory effects combine a combination of the active substance with vitamins or other active ingredients that enhance their therapeutic effect. We present to your attention a list of the most popular combination drugs:

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

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

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

Who should I contact?

Depending on the nature of the pathology, the following specialists can treat 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 taking anti-inflammatory drugs leads to adverse reactions, specialists such as a gastroenterologist, cardiologist, allergist, nephrologist can join the patient’s treatment. If the patient is forced to take NSAIDs for a long time, be sure to consult with a nutritionist and choose the optimal diet that will protect the gastric mucosa from damage.

Inflammation is a process that accompanies, to one degree or another, almost all pathologies of organs and systems. A group of non-steroidal anti-inflammatory drugs successfully fights inflammation, relieves pain and relieves suffering.

The popularity of NSAIDs is understandable:

• the drugs quickly relieve pain and have antipyretic and anti-inflammatory effects;
• modern products are available in various dosage forms: they are convenient to use 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 their availability and universal popularity, NSAIDs are not a safe group of drugs. Uncontrolled use and self-prescription by patients can cause more harm to the body than good. A doctor must prescribe the medicine!

Classification of NSAIDs

The group of non-steroidal anti-inflammatory drugs is very extensive and includes many drugs, varied 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, salicylin, was isolated in 1827 from willow bark. 30 years later, scientists have learned to synthesize this drug and its sodium salt - the same aspirin that occupies its niche on pharmacy shelves.

Currently in clinical medicine more than 1000 items are used medicines created on the basis of NSAIDs.

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

By chemical structure

NSAIDs can be derivatives:

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

According to the severity of the fight against inflammation

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

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

By COX inhibition

COX or cyclooxygenase is an enzyme responsible for a cascade of transformations that promotes the production of inflammatory mediators (prostaglandins, histamine, leukotrienes). These substances support and enhance 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 what type of COX the drug blocks, there are:

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

They block both COX-2, which reduces inflammation, and COX-1 - long-term use results in unwanted side effects from the gastrointestinal tract;

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

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

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

Mechanism of action and effects

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

Anti-inflammatory effect

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

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

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

By reducing the synthesis of prostaglandins, swelling and infiltration at the site 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 a positive effect to relieve inflammation.

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

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

Analgesic effect

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

During the inflammatory process, a large accumulation of prostaglandins causes hyperalgesia - increased sensitivity to pain. Since NSAIDs help 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 have an unexpressed anti-inflammatory effect, but a strong pain reliever - these are non-narcotic analgesics: Ketorolac, Metamizole (Analgin), Paracetamol. They can eliminate:

• headaches, dental, joint, muscle, menstrual pain, painful sensations with neuritis;
• pain is predominantly inflammatory in nature.

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

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

Antipyretic effect

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

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

Antithrombotic effect

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

Indications for use

It is unlikely that any other group of 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 frequently recommended drugs by doctors.

Indications for the use of NSAIDs are:

• rheumatological diseases, gouty and psoriatic arthritis;
• neuralgia, radiculitis with radicular syndrome (lower 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 indicated);
• fever above 38.5⁰С;
• inflammatory pain syndrome;
• antiplatelet therapy (aspirin);
• pain in the postoperative period.

Since inflammatory pain accompanies up to 70% of all diseases, it becomes obvious how wide the range of prescriptions for this group of drugs is.

NSAIDs are the drugs of choice for the relief and relief of acute pain in joint pathologies of various origins, neurological radicular syndromes - lumbodynia, sciatica. It should be understood that NSAIDs do not affect the cause of the disease, but only relieve acute pain. For osteoarthritis, drugs have only a symptomatic effect and do not prevent the development of joint deformation.

At 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 lasting analgesic effect.

NSAIDs are prescribed for painful menstruation, caused by increased uterine tone due to overproduction of prostaglandin-F2a. The drugs are prescribed at the first appearance of pain at the beginning or on the eve of menstruation for a course of up to 3 days.

This group of drugs is not at all harmless and has side effects and undesirable reactions, therefore a doctor should prescribe NSAIDs. Uncontrolled use and self-medication can lead to the development of complications and unwanted side effects.

Many patients wonder: which NSAID is the most effective and best relieves pain? A definite answer to this question cannot be given, since NSAIDs should be selected for the treatment of an inflammatory disease for each patient individually. The choice of drug should be made by a doctor, and is determined by its effectiveness and 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 use.

Gastrointestinal disorders

The most common side effect for non-selective NSAIDs. 40% of all patients receiving NSAIDs experience digestive disorders, 10-15% have erosions and ulcerative changes in the gastrointestinal mucosa, and 2-5% have bleeding and perforation.

The most gastrotoxic are Aspirin, Indomethacin, Naproxen.

Nephrotoxicity

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

Decreased blood clotting

This effect is more likely to occur in patients already taking indirect anticoagulants(Heparin, Warfarin), or having liver problems. Low coagulability can lead to spontaneous bleeding.

Liver disorders

Liver damage can occur from any NSAID, especially when drinking alcohol, even in small doses. With long-term (more than a month) use 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 and thrombocytopenia develop most often when taking Analgin, Indomethacin, and 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 is normalized and pathological changes disappear.

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

Allergic reactions

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

Allergic manifestations account for 12 to 14% of all adverse reactions to 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.

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

Undesirable effects during pregnancy

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

There is no optimal NSAID without side effects. Gastrotoxic reactions are less pronounced in selective NSAIDs (Meloxicam, Nimesulide, Aceclofenac). But for each patient the drug should be selected individually, 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, especially if it is taken uncontrolled and not as prescribed by a doctor.

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

1. If the patient has the opportunity to choose an NSAID, one should choose selective drugs that have fewer side effects: aceclofenac, movalis, nise, celecoxib, rofecoxib. The most aggressive for the stomach are aspirin, ketorolac, and indomethacin.
2. If the patient has a history of peptic ulcers 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 the inflammation subsides) and only under the protection of proton pump inhibitors (PPIs): omeprazole, rameprazole , pantoprozole. Thus, the toxic effect of NSAIDs on the stomach is neutralized 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, before long-term use the patient needs to undergo an FGDS and examine the condition of the gastrointestinal tract. If the examination reveals even minor changes in the mucous membrane, or the patient has subjective complaints about the digestive organs, NSAIDs should be taken together with proton pump inhibitors (omeprazole, pantoprazole) constantly.
4. When prescribing aspirin for the prevention of blood clots, persons 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 worsened, allergic reactions, stomach pain, weakness, pale skin, difficulty breathing or other manifestations of individual intolerance appeared, you should immediately consult your doctor.

Individual characteristics of drugs

Let's 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 ACC)

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 for diseases of the heart and blood vessels.

The drug is prescribed in the form of tablets orally after meals.

Anti-inflammatory and antipyretic effects The drug is used for feverish conditions, headaches, migraines, rheumatological diseases, and neuralgia.

Drugs such as Citramon, Askofen, Cardiomagnyl contain acetylsalicylic acid.

Acetylsalicylic acid has many side effects, especially negatively affecting the gastric mucosa. To reduce the ulcerogenic effects, aspirin should be taken after meals, and the tablets should be washed down with water.

A history of gastric and duodenal ulcers are contraindications for the use of this drug.

Currently, modern drugs are produced with alkalizing additives, or in the form of effervescent tablets containing acetylsalicylic acid, which is better tolerated and provides less irritation to the gastric mucosa.

Nimesulide (Nise, Nimesil, Nimulid, Kokstral)

The drug has anti-inflammatory, analgesic and antipyretic effects. It has an effect in osteoarthritis, tendovaginitis, pain syndrome due to injuries, and the postoperative period.

Available under different 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. The variety of release forms makes the drug very popular for use.

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

Gastric ulcers, severe liver and kidney dysfunction, pregnancy and breastfeeding are contraindications for taking the medicine.

Meloxicam (Movalis, Artrosan, Melox, Meloflex)

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

It has pronounced anti-inflammatory and analgesic activity. It is used for rheumatoid arthritis, arthrosis, ankylosing spondylitis, and 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 to the drug may develop; increased blood pressure, dizziness, dyspepsia, and hearing loss are rarely observed while taking meloxicam.

You should not get carried away with taking the drug if you have a peptic ulcer or a history of erosive processes in the stomach; its use is contraindicated during pregnancy and lactation.

Diclofenac (Ortofen, Voltaren, Dikloberl, 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 (epigastric pain, nausea, diarrhea), headaches, dizziness, allergic reactions. If side effects occur, you should stop taking the medicine and consult your doctor.

Today, diclofencan sodium preparations are produced that have a prolonged effect: dieloberl retard, voltaren retard 100. The effect of one tablet lasts throughout the day.

Aceclofenac (Aertal)

Some researchers call Airtal 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 pronounced 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 pain inflammatory in nature.

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

People with problems with the gastrointestinal tract should take aceclofenac with caution. The drug is contraindicated during pregnancy and breastfeeding.

Celecoxib (Celebrex)

A relatively new, modern selective NSAID that has 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 joint pathologies: rheumatoid arthritis, arthrosis, synovitis, as well as other inflammatory processes in the body accompanied by pain.

Prescribed 0.1 g 2 times a day or 0.2 g once. The frequency and timing of administration must be specified 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 experience dyspepsia, stomach pain, sleep disturbances, changes in the blood count 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 ones.

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 nonspecific 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 internally and externally, rubbing the affected areas and places on the body.

Ibuprofen is usually well tolerated and has 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.

During exacerbation of peptic ulcer disease, pregnancy and breastfeeding, this drug should not be taken.

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

Nonsteroidal anti-inflammatory drugs are used for various pathologies, they relieve pain, heat and inflammation in tissues. Most orthopedic problems cannot be solved without this group of medications, since patients are bothered by quite severe pain that interferes with the quality of life.

NSAIDs should be prescribed by a doctor, taking into account the indications and contraindications of a particular drug, especially if there is a need to take the drug long time. Despite their effectiveness, such drugs have severe side effects, the risk of which increases with long-term use of the drug.

Range of products

Non-steroidal anti-inflammatory drugs perfectly relieve pain syndromes, reduce high fever and inhibit the inflammatory process in body tissues. This effect is achieved by inhibiting enzymes that provoke the production of prostaglandins.

Prostaglandins are substances that are responsible for inflammatory processes in the body, in addition, they make a person more sensitive to pain. Thus, non-steroidal anti-inflammatory drugs dull pain and stop the development of the inflammatory process, this is a big advantage of the drug compared to analgesics that only relieve pain.

Classification

A couple of decades ago, only 7 groups of non-steroidal anti-inflammatory drugs were known, but nowadays there are already more than 15. NSAIDs are quite popular due to their complex action and good effect, so they have replaced opioid analgesics, which suppressed respiratory function, from the market.

There are two classifications of such drugs. They are divided into new and old, as well as acidic and non-acidic. Older drugs include, etc. New generation NSAID drugs include, etc.

Depending on whether NSAIDs are acids, they are divided into the following types:

• Preparations based on finylacetic acid. This acid is used in perfumery because it smells like honey. This substance is also part of amphetamine and is under control in the Russian Federation.
• Products made using anthranilic acid. This acid is used to make dyes and flavors.
• Pyrazolone preparations.
• Preparations made using isonicotinic acid.
• Propionic acid derivatives.
• Salicylates.
• Oxycams.
• Pyrazolidines.

New generation

It is no secret that old NSAIDs have a large number of side effects, while they do not have a strong enough anti-inflammatory effect. Conventionally, this can be explained in such a way that the drugs inhibit 2 types of enzymes COX-1 and COX-2, the first is responsible for protecting the body, and the second for the inflammatory process.

Thus, with long-term use of old-generation NSAIDs, patients experienced disturbances in the stomach, as its protective layer was destroyed. As a result, ulcers and other gastrointestinal problems appeared.

As it turned out, it is quite possible to reduce side effects, and at the same time increase the effectiveness of the drug, if you develop a drug that will suppress COX-2, practically without affecting the COX-1 enzymes. In recent years, new generation NSAID drugs have been developed that do just that. Below we look at the most popular new products.

This is one of the most popular non-steroidal anti-inflammatory drugs of the new generation. It is produced in Germany and Spain, and is available in the form of tablets, ointments, injections and suppositories. Movalis is a very good pain reliever, relieves high fever and inflammation, and has few contraindications.

Taken for inflammatory and degenerative diseases of the joints, in particular for various arthritis and arthrosis, for gout attacks, for severe pain. The big advantage of this drug is the ability to take it for a long time under the supervision of a doctor, which is exactly necessary for severe joint pathologies.

Movalis is very easy to use; you only need to take one tablet a day, as the drug lasts quite a long time. The cost of a package with 20 tablets of the product is approximately 600 rubles.

Nimesulide

Another popular new generation product is Nimesulide. It is actively used for various diseases, in particular for pathologies of the musculoskeletal system. The big advantage of this remedy is that it not only relieves inflammation, heat and pain, but also neutralizes enzymes that destroy cartilage tissue.

Nimesulide tablets are not expensive; for 20 pieces you will have to pay no more than 40 rubles. There are also analogues, for example Nise. This product can be purchased in the form of tablets, gel for external use, or powder for suspension. For 20 Nise tablets and 20 grams of gel you will have to pay about 200 rubles.

Xefocam

This drug is especially effective for severe pain; it is often prescribed for unspecified pain, as well as for joint pain, for example, gout, rheumatoid arthritis, severe stages of arthrosis and arthritis, and ankylosing spondylitis.

Interestingly, its action is comparable to Morphine, but it does not affect the central nervous system and is not addictive. The drug has side effects, so before use you need to consult a specialist who can calculate the minimum dosage, depending on the severity of the disease.

Ksefokam is produced in the form of tablets and solution for intravenous and intramuscular administration. The cost of tablets ranges from 300 to 500 rubles, depending on the required dosage, and 5 ampoules for injection will cost around 700 rubles.

Rofecoxib

This drug relieves pain, swelling, and inflammation. It is used mainly for orthopedic pathologies, in particular for arthritis, arthrosis, and also for toothaches. This product is sold under the name Denebol in the form of ointments and tablets.

Celecoxib

This drug is very effective in severe pain, and does not have any negative effect on the gastric mucosa, which is a big advantage of the drug. It is produced in the form of capsules of 100 and 200 mg. The cost of 10 capsules is 250 rubles.

Indications

NSAIDs are used for various inflammatory diseases, fever, pain of various etiologies. These drugs have an excellent antipyretic effect, and the effect lasts quite a long time, which makes the use of NSAIDs convenient in children. New generation drugs are indicated in the following cases:

• Bekhterev's disease;
• Pain when various diseases bones and joints;
• Osteochondrosis;
• Inflammation of soft tissues;
• Toothache;
• Pain after surgery;
• Fever.

Contraindications

New generation products have the following contraindications:

• Intolerance to the components of the drug;
• Stomach ulcers in the acute stage;
• Bleeding in the gastrointestinal tract;
• Reaction to acetylsalicylic acid (in particular rash, bronchospasm);
• Severe heart pathology;
• Severe kidney pathologies;
• Severe liver pathologies;
• Blood clotting disorder;
• Old age with long-term use;
• Alcoholism;
• Pregnancy and breastfeeding;
• Children's age up to 12 years.

Side effects

New generation non-steroidal anti-inflammatory drugs were developed specifically to reduce the impact on the mucous membranes of the gastrointestinal tract when taken. Therefore, these drugs do not have a destructive effect on the gastrointestinal tract, and on hyaline cartilage too. But still, with long-term use, some side effects may occur:

• Allergic reactions to the components of the drug;
• Fluid retention in the body;
• The appearance of protein in the urine;
• Increased activity of liver enzymes;
• Digestive problems;
• Headache;
• General weakness and drowsiness;
• Dizziness;
• Increased blood pressure;
• Fast fatiguability;
• The appearance of a dry cough;
• Dyspnea.

To avoid side effects, it is necessary to consult a doctor before taking the product and study the instructions for the drug. It is very important to use the product correctly and not exceed the dosage, then the risk of side effects will be minimal.

What to replace

There are situations when pain takes you by surprise, and you don’t have the medicine prescribed by your doctor at hand. In this case, you can temporarily replace its intake using various folk remedies: rubbing, ointments, compresses. But you should not abuse such methods and neglect basic treatment, as you can provoke a worsening of the condition.

To relieve body temperature above 38.5 degrees, rubbing is done. To do this, the patient must be undressed, and drafts in the room must be excluded. The body needs to be wiped warm water and leave it to dry on the skin on its own, so the body will cool down faster. Adults can be wiped at high temperatures with vodka diluted with water or add a little vinegar to the water. Children are wiped exclusively with water.

You can relieve pain due to joint pathologies using a rubbing mixture of iodine, analgin and vodka. To do this, grind 8 analgin tablets into powder, add 50 ml of alcohol and 50 ml of iodine, mix everything well. Rub the resulting pulp into the sore joint twice a day.

And comfrey.

About the products (video)

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

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

NSAIDs - what is this group of drugs?

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

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

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

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

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

History of discovery and formation

Application herbal remedies, which have anti-inflammatory, antipyretic and analgesic effects, were described in the works of Hippocrates. But the first accurate description of the effect of NSAIDs dates back to the 18th century.

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

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

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

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

Pharmacological properties and mechanism of action

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

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

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

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

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

The metabolism of NSAIDs occurs in the liver, which is why they are toxic to this organ and cannot be used for various liver diseases. A small part of the incoming dose of the drug is excreted through the kidneys. Modern developments in the field of NSAIDs are aimed at reducing their effect on COX-1 and hepatotoxicity.

Indications for use - scope of application

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

Intramuscular injections of NSAIDs are prescribed as an analgesic and antipyretic for severe patient conditions. They are necessarily part of the lytic mixture - a combination of drugs that can quickly bring down a dangerous temperature. Intra-articular injections treat severe joint damage caused by inflammatory diseases.

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

The most famous drugs of the group

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

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

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

Side effects

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

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

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

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

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

Classification of NSAIDs

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

Chemical structure

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

Acids (absorbed in the stomach, increase acidity):

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

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

• alkanones:
• sulfonamide derivatives:

By impact on COX-1 and COX-2

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

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

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

Selective and non-selective NSAIDs

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

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

New generation drugs

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

New generation non-steroidal anti-inflammatory drugs:

• – has an extended period of validity;
• – has the strongest analgesic effect;
• – extended period of action and pronounced analgesic effect (comparable to morphine);
• Rofecoxib– the most selective drug, approved for patients with gastritis peptic ulcer beyond exacerbation.

Non-steroidal anti-inflammatory ointments

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

• Indomethacin;

NSAIDs in tablets

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

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

General application features

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

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

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

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

There is practically no disease for which non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) would not be used. This is a huge class of tablets, injections and ointments, the ancestor of which is regular Aspirin. The most common indications for their use are joint diseases accompanied by pain and inflammation. In our pharmacies, both long-tested, well-known drugs and new generation anti-inflammatory non-steroidal drugs are popular.

The era of such drugs began quite a long time ago - in 1829, when salicylic acid was first discovered. Since then, new substances and dosage forms have begun to appear that can eliminate inflammation and pain.

With the creation of Aspirin, NSAID drugs were classified as a separate group of non-steroidal anti-inflammatory drugs. Their name determines that they do not contain hormones (steroids) and have fewer side effects than steroid ones.

Despite the fact that in our country most NSAIDs can be bought in pharmacies without a prescription, there are some points that you need to know about. Especially for those people who are wondering what is better to choose – drugs that have been offered for years, or modern NSAIDs.

The principle of action of NSAIDs is the effect on the enzyme cyclooxygenase (COX), namely its two varieties:

1. COX-1 is a protective enzyme in the gastric mucosa, protecting it from acidic contents.
2. COX-2 is an inducible, that is, a synthesized enzyme that is produced in response to inflammation or damage. Thanks to it, the inflammatory process plays out in the body.

Since first-generation non-steroids are non-selective, that is, they act on both COX-1 and COX-2, along with the anti-inflammatory effect, they also have strong side effects. It is important to take these tablets after meals, as they are irritating to the stomach and can lead to erosions and ulcers. If you already have stomach ulcers, you need to take them with proton pump inhibitors (Omeprazole, Nexium, Controloc, etc.), which protect the stomach.

Time does not stand still, non-steroids are developing and becoming more selective for COX-2. Now at the moment there are drugs that selectively act on the COX-2 enzyme, on which inflammation depends, without affecting COX-1, that is, without damaging the gastric mucosa.

About a quarter of a century ago there were only eight groups of NSAIDs, but today there are more than fifteen. Having gained widespread popularity, non-steroidal tablets quickly replaced the opioid painkillers of the analgesics group.

Today, there are two generations of non-steroidal anti-inflammatory drugs. The first generation is NSAID drugs, most of them non-selective.

These include:

• Aspirin;
• Citramon;
• Naproxen;
• Voltaren;
• Nurofen;
• Butadion and many others.

New generation non-steroidal anti-inflammatory drugs are safer in terms of side effects, and they have a greater ability to relieve pain.

These are selective non-steroids such as:

• Nimesil;
• Nise;
• Nimesulide;
• Celebrex;
• Indomethaxin.

This is not a complete list and not the only classification of new generation NSAIDs. There is a division into non-acidic and acidic derivatives.

Among NSAIDs latest generation the most innovative drugs are oxicams. These are non-steroidal anti-inflammatory drugs of a new generation of the acid group, which affect the body much longer and more clearly than others.

This includes:

• Lornoxicam;
• Piroxicam;
• Meloxicam;
• Tenoxicam.

The acid group of drugs also includes the following series of non-steroids:

Non-acid drugs, that is, those that do not affect the gastric mucosa, include new generation NSAIDs of the sulfonamide group. Representatives of this group are Nimesulide, Rofecoxib, Celecoxib.

New generation NSAIDs have gained widespread use and popularity due to their ability not only to relieve pain, but also to have an excellent antipyretic effect. The drugs stop the inflammatory process and prevent the disease from developing, so they are prescribed for:

• Diseases of musculoskeletal tissue. Nonsteroids are used to treat injuries, wounds, and bruises. They are indispensable for arthrosis, arthritis and other diseases of a rheumatic nature. Also, for herniated intervertebral discs and myositis, the drugs have an anti-inflammatory effect.
• Strong pain syndromes. They are successfully used in the postoperative period, for biliary and renal colic. The tablets have a positive effect on headaches, gynecological pain, and successfully relieve pain from migraines.
• Risk of blood clots. Since nonsteroids are antiplatelet, that is, they thin the blood, they are prescribed for ischemia and for the prevention of strokes and heart attacks.
• High temperature. These tablets and injections are the primary antipyretic for adults and children. They are recommended for use even in feverish conditions.

The drugs are also used for gout and intestinal obstruction. In case of bronchial asthma, it is not recommended to use NVPP on its own; prior consultation with a doctor is necessary.

Unlike non-selective anti-inflammatory drugs, new generation NSAIDs do not irritate the body’s gastrointestinal system. Their use in the presence of gastric and duodenal ulcers does not lead to exacerbation and bleeding.

However, their long-term use can cause a number of undesirable effects, such as:

• increased fatigue;
• dizziness;
• dyspnea;
• drowsiness;
• destabilization of blood pressure.
• the appearance of protein in the urine;
• indigestion;

Also, with long-term use, allergies may occur, even if previously there was no susceptibility to any substances.

Non-selective non-steroids such as Ibuprofen, Paracetamol or Diclofenac have greater hepatotoxicity. They have a very strong effect on the liver, especially Paracetamol.

In Europe, where all NSAIDs are prescription drugs, over-the-counter Paracetamol is widely used (taken as a pain reliever up to 6 tablets per day). There appeared such a medical concept as “paracetamol liver damage,” that is, cirrhosis while taking this medicine.

Several years ago, a scandal broke out abroad regarding the influence of modern non-steroids - coxibs on cardiovascular system. But our scientists did not share the concerns of their foreign colleagues. The Russian Association of Rheumatologists acted as an opponent to Western cardiologists and proved that the risk of cardiac complications while taking new generation NSAIDs is minimal.

Most anti-inflammatory non-steroids should absolutely not be used during pregnancy, especially in the third trimester. Some of them can be prescribed by a doctor in the first half of pregnancy for special indications

By analogy with antibiotics, new generation NSAIDs should not be taken in too short courses (drink for 2-3 days and stop). This will be harmful, because in the case of antibiotics, the temperature will go away, but the pathological flora will acquire resistance (resistance). The same is with non-steroids - you need to take them for at least 5-7 days, since the pain may go away, but this does not mean that the person has recovered. The anti-inflammatory effect occurs a little later than the anesthetic and proceeds more slowly.

1. Do not combine non-steroids from different groups under any circumstances. If you take one tablet for pain in the morning and then another, their beneficial effects do not add up and are not enhanced. A side effects increase exponentially. Especially you should not combine cardiac Aspirin (Aspirin-Cardio, Cardiomagnyl) and other NSAIDs. In this situation, there is a danger of a heart attack, since the effect of aspirin, which thins the blood, is blocked.
2. If any joint hurts, it is better to start with ointments, for example, based on ibuprofen. They should be used 3-4 times a day, especially at night, and rubbed intensively into the sore spot. You can use the ointment to self-massage the sore spot.

The main condition is peace. If you continue to actively work or play sports during treatment, the effect of using the medications will be very small.

The best drugs

Coming to the pharmacy, every person thinks about which non-steroidal anti-inflammatory drugs to choose, especially if he came without a doctor’s prescription. The choice is huge - non-steroids are available in ampoules, tablets, capsules, ointments and gels.

Tablets that are derivatives of acids have the greatest anti-inflammatory effect.

The following have a good analgesic effect in diseases of the musculoskeletal tissue:

• Ketoprofen;
• Voltaren or Diclofenac;
• Indomethacin;
• Xefocam or Lornoxicam.

But the most strong remedies against pain and inflammation - these are the newest selective NSAIDs - coxibs, which have the least side effects. The best non-steroidal anti-inflammatory drugs in this series are Arcoxia, Nise, Movalis, Celecoxib, Xefocam, Etoricoxib.

Xefocam

Analogues of the drug are Lornoxicam, Rapid. The active ingredient is xefocam. Effective medicine, which has a pronounced anti-inflammatory effect. Does not affect heart rate, arterial pressure and breathing rate.

Available in the form:

• tablets;
• injections.

For elderly patients, no special dosage is required in the absence of renal failure. In case of kidney disease, the dose must be reduced, since the substance is excreted by these organs.

With excessive duration of treatment, manifestations in the form of conjunctivitis, rhinitis and shortness of breath are possible. Use with caution in asthma, as it may allergic reaction in the form of bronchospasm. When the injection is administered intramuscularly, pain and hyperemia at the injection site are possible.

The drug Arcoxia or its only analogue Exinev are drugs used for acute gouty arthritis, osteoarthritis of the rheumatoid type, and in the treatment of postoperative conditions associated with pain. Available in the form of tablets for oral use.

The active ingredient of this drug is etoricoxib, which is the most modern and safe substance among the selective COX-2 inhibitors. The product perfectly relieves pain and begins to act on the source of pain within 20-25 minutes. Active substance The medicine is absorbed into the bloodstream and has high bioavailability (100%). It is excreted unchanged in the urine.

Nimesulide

Most sports traumatology specialists identify a non-steroid such as Nise or its analogues Nimesil or Nimulid. There are many names, but they have one active ingredient - nimesulide. This medicine is quite cheap and occupies one of the first places in sales.

This is a good pain reliever, but Nimesulide-based products should not be used by children under 12 years of age, as there is a high risk of allergic reactions.

Available in:

• powders;
• suspensions;
• gels;
• tablets.

It is used in the treatment of arthritis, arthrosis, ankylosing spondylitis, sinusitis, lumbago, and pain of various localizations.

Movalis is much more selective for COX-2 than Nise, and accordingly has even fewer side effects in relation to the stomach.

Release form:

• candles;
• pills;
• injections.

With long-term use, the risk of developing cardiac thrombosis, heart attacks, and angina is increased. Therefore, people with a predisposition to these diseases need to be careful in use. It is also not recommended for women planning pregnancy as it affects fertility. It is excreted in the form of metabolites, mainly in urine and feces.

Celecoxib

In the group with the most proven safety base is the new generation NSAID Celecoxib. This was the first drug from the group of selective coxibs, combining the three strengths of this class - the ability to reduce pain, inflammation, and fairly high safety. Release form: capsules of 100 and 200 mg.

The active component celecoxib selectively acts on COX-2 without affecting the gastric mucosa. Quickly absorbed into the blood, the substance reaches its highest concentration after 3 hours, but simultaneous use with fatty foods can slow down the absorption of the drug.

Celecoxib is prescribed for soriatic and rheumatoid arthritis, osteoarthritis and ankylosing spondylitis. This drug is not prescribed for liver and kidney failure.

Rofecoxib

The main substance rofecoxib effectively helps restore motor function of joints, quickly relieving inflammation.

Available in:

• injection solutions;
• tablets;
• candles;
• gel.

The substance is a highly selective inhibitor of cyclooxygenase 2, which is quickly absorbed by the gastrointestinal tract after administration. The substance reaches its maximum concentration in the blood after 2 hours. It is excreted primarily in the form of inactive metabolites by the kidneys and intestines.

The result of long-term use may be disorders of the nervous system - sleep disorders, dizziness, confusion. It is recommended to start treatment with injections, then switch to tablets and external agents.

When choosing any NSAIDs, you should be guided not only by price and their modernity, but also take into account the fact that all such drugs have their contraindications. Therefore, you should not self-medicate; it is best if they are prescribed by a doctor, taking into account your age and history of diseases. It should be remembered that thoughtless use of medications may not only not bring relief, but will also force a person to treat many complications.