home Audience 6 Npvs species. Characteristics of individual drugs. Forms of release of a group of drugs

Npvs species. Characteristics of individual drugs. Forms of release of a group of drugs

Osteoarthritis, rheumatoid arthritis and other diseases of the joints and spine that occur with pain and inflammation.

Peculiarities: all the drugs in this group act on a similar principle and cause three main effects: analgesic, anti-inflammatory and antipyretic.

These effects are expressed to varying degrees in different drugs, so some drugs are better suited for long-term treatment of joint diseases, while others are mainly used as painkillers and antipyretics.

Most common side effects: allergic reactions, nausea, abdominal pain, erosions and ulcers of the gastrointestinal mucosa.

Main contraindications: individual intolerance, exacerbation of gastric and duodenal ulcers.

Important information for the patient:

Drugs that have a pronounced analgesic effect and a significant number of side effects (diclofenac, ketorolac, nimesulide and others) can only be used as prescribed by a doctor.

Among nonsteroidal anti-inflammatory drugs, there is a group of so-called “selective” drugs that are less likely to have side effects from the gastrointestinal tract.

Even over-the-counter pain relief medications cannot be used long-term. If they are required frequently, several times a week, it is necessary to be examined by a doctor and treated according to the recommendations of a rheumatologist or neurologist.

In some cases, long-term use of drugs from this group requires additional use of proton pump inhibitors that protect the stomach.

Trade name of the drug	Price range (Russia, rub.)	Features of the drug that are important for the patient to know about
Active substance: Diclofenac
Voltaren(Novartis)		A powerful pain reliever, mainly used for back and joint pain. It is not advisable to use it for a long time, as the drug has numerous side effects. May negatively affect liver function, causing headaches, dizziness and tinnitus. Contraindicated in aspirin-induced asthma, hematopoiesis and blood clotting disorders. Do not use during pregnancy, breastfeeding and children under 6 years of age.
Diclofenac(different manufacturers)
Naklofen(KRKA)
Ortofen(different manufacturers)
Rapten rapid(Stada)
Active substance: Indomethacin
Indomethacin(different manufacturers)	11,4-29,5	Has a powerful anti-inflammatory and analgesic effect. However, it is considered quite outdated, as it leads in the likelihood of developing various side effects. It has many contraindications, including the third trimester of pregnancy, age up to 14 years.
Methindol retard(Polfa)	68-131,5
Active substance: Diclofenac + paracetamol
Panoxen(Oxford Laboratories)	59-69	A powerful two-component pain reliever. Used to reduce severe pain and inflammation in arthritis, osteoarthritis, osteochondrosis, lumbago, dental and other diseases. Side effects are the same as diclofenac. Contraindications are inflammatory bowel diseases, severe liver, kidney and heart failure, the period after coronary artery bypass surgery, progressive kidney disease, active liver disease, pregnancy, breastfeeding, childhood.
Active substance: Tenoxicam
Texamen(Mustafa Nevzat Ilach Sanai)	186-355	It has a powerful analgesic and anti-inflammatory effect, the antipyretic effect is less pronounced. A distinctive feature of the drug is its long duration of action: more than a day. Indications are radicular syndrome with osteochondrosis, osteoarthritis with inflammation in the joints, neuralgia, muscle pain. Has a number of side effects. Contraindicated in case of bleeding from the gastrointestinal tract, pregnancy and during breastfeeding.
Active substance: Ketoprofen
Artrosilene(Dompe farmacheutichi)	154-331	A drug with a pronounced analgesic and anti-inflammatory effect. Does not have a negative effect on the condition of articular cartilage. Indications for use are symptomatic therapy of various arthritis, osteoarthritis, gout, headache, neuralgia, radiculitis, muscle pain, post-traumatic and postoperative pain, pain in cancer, painful periods. It causes many side effects and has many contraindications, including the third trimester of pregnancy and breastfeeding. In children, age restrictions depend on the trade name of the drug.
Quickcaps(Medana Pharma)	161-274
Ketonal (Lec. d.d.)	93-137
Ketonal duo(Lec. d. d.)	211,9-295
Okie (Dompe farmacheutichi)	170-319
Flamax(Sotex)	86,7-165,8
Flamax forte(Sotex)	105-156,28
Flexen(Italpharmaco)	97-397
Active substance: Dexketoprofen
Dexalgin(Berlin-Chemie/Menarini)	185-343	A new powerful short-acting drug. The analgesic effect occurs 30 minutes after taking the drug and lasts from 4 to 6 hours. Indications for use are acute and chronic inflammatory diseases of the musculoskeletal system (rheumatoid arthritis, spondyloarthritis, arthrosis, osteochondrosis), pain during menstruation, toothache. Side effects and contraindications are similar to those of other drugs. In general, with short-term use according to indications and in recommended doses, it is well tolerated.
Active substance: Ibuprofen
Ibuprofen(different manufacturers)	5,5-15,9	It is often used as an antipyretic drug and a means to relieve headaches. However, in large dosages it can also be used for diseases of the spine, joints and to relieve pain after bruises and other injuries. Possible side effects from the gastrointestinal tract, hematopoietic organs, as well as headache, dizziness, insomnia, increased blood pressure and a number of other undesirable reactions. Has many contraindications. Cannot be used in the third trimester of pregnancy and while breastfeeding; in the first and second trimester it should be used with caution, only on the recommendation of a doctor. cha.
Burana (Orion Corporation)	46,3-98
Ibufen (Polfa, Medana Pharma)	69-95,5
Moment (Berlin-Chemie/Menarini)	71,6-99,83
Nurofen(Reckitt Benckiser)	35,65-50
Nurofen Ultracap(Reckitt Benckiser)	116-122,56
Nurofen Express(Reckitt Benckiser)	102-124,4
Nurofen Express Neo(Reckitt Benckiser)	65-84
Faspik(Zambon)	80-115
Active substance: Ibuprofen + paracetamol
Ibuklin(Dr. Reddy's)	78-234,5	A combined drug containing two analgesic and antipyretic substances. It is more powerful than the same drugs taken separately. Can be used for pain in the joints and spine, injuries. However, it does not have a very pronounced anti-inflammatory effect, so it is not recommended for long-term treatment for rheumatic diseases. It has many side effects and contraindications. Do not use in children under 12 years of age, as well as in the third trimester of pregnancy and while breastfeeding.
Brustan(Runbaxy)	60-121
Next(Pharmstandard)	83-137
Active substance: Nimesulide
Nise(Dr. Reddy's)	111-225	A selective pain reliever mainly used for back and joint pain. May also relieve menstrual pain, headaches and toothaches. It has a selective effect, therefore it has less negative effects on the gastrointestinal tract. However, it has a number of contraindications and side effects. Contraindicated during pregnancy and breastfeeding; in children, age restrictions depend on the trade name of the drug.
Nimesulide(different manufacturers)	65-79
Aponil(Medohemi)	71-155,5
Nemulex(Sotex)	125-512,17
Nimesil(Berlin-Chemie/Menarini)	426,4-990
Nimika (IPKA)	52,88-179,2
Nimulid(Panacea Biotek)	195-332,5
Active substance: Naproxen
Nalgesin(KRKA)	104-255	A potent drug. It is used to treat arthritis, osteoarthritis, adnexitis, exacerbation of gout, neuralgia, radiculitis, pain in bones, tendons and muscles, headaches and toothaches, pain during cancer and after operations. It has quite a few contraindications and can cause a variety of side effects, so long-term treatment is only possible under the supervision of a doctor.
Naproxen(Pharmstandard)	56,5-107
Naproxen-acri (Akrikhin)	97,5-115,5
Active substance: Naproxen + esomeprazole
Vimovo(AstraZeneca)	265-460	A combination drug containing naproxen with analgesic and anti-inflammatory effects and the proton pump inhibitor esomeprazole. Formulated as sequential delivery tablets with immediate-release esomeprazole magnesium in the coating and enteric-coated sustained-release naproxen in the core. As a result, esomeprazole is released in the stomach before naproxen dissolves, thereby protecting the gastric mucosa from the possible negative effects of naproxen. Indicated for symptomatic relief in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis in patients at risk of developing gastric and duodenal ulcers. Despite its good protective properties against the stomach, it can cause a number of other side effects. Contraindicated in severe liver, heart and kidney failure, gastrointestinal and other bleeding, cerebral hemorrhage and a number of other diseases and conditions. Not recommended in the third trimester of pregnancy, while breastfeeding and children under 18 years of age.
Active substance: Amtolmetin guacil
Nizilat(Dr. Reddy's)	310-533	A new non-steroidal anti-inflammatory drug with minimal negative effects on the gastric mucosa. Despite a number of possible side effects, it was generally well tolerated by patients (including long-term use for 6 months). It can be used both for rheumatic diseases (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout, etc.) and for the treatment of pain syndromes of other origins. It has quite a lot of contraindications. Not for use during pregnancy, breastfeeding and under 18 years of age.
Active substance: Ketorolac
Ketanov(Runbaxy)	214-286,19	One of the most potent analgesics. Due to the large number of contraindications and side effects, it should be used sporadically and only in cases of very severe pain.
Ketorol(Dr. Reddy's)	12,78-64
Ketorolac(different manufacturers)	12,1-17
Active substance: Lornoxicam
Xefocam(Nycomed)	110-139	It has a pronounced analgesic and anti-inflammatory effect. Indicated for short-term treatment of pain, including rheumatic diseases (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout, etc.). It has many side effects and contraindications.
Xefocam Rapid(Nycomed)	192-376
Active substance: Aceclofenac
Aertal(Gedeon Richter)	577-935	Has good anti-inflammatory and analgesic effects. Helps significantly reduce the severity of pain, morning stiffness, swelling of joints, and does not have a negative effect on cartilage tissue. It is used to reduce inflammation and pain in lumbago, toothache, rheumatoid arthritis, osteoarthritis and a number of other rheumatological diseases. Causes many side effects. Contraindications are similar to those of Panoxen. Do not use during pregnancy, breastfeeding and children under 18 years of age.
Active substance: Celecoxib
Celebrex(Pfizer, Searle)	365,4-529	One of the most selective (selectively acting) drugs in this group, which has minimal negative effects on the gastrointestinal tract. Indications for use are the symptomatic treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis, back pain, bone and muscle pain, postoperative, menstrual and other types of pain. May cause swelling, dizziness, coughing, and a number of other side effects. It has many contraindications for use, including class II-IV heart failure, clinically significant coronary heart disease, peripheral arterial disease and severe cerebrovascular disease. Not for use during pregnancy, breastfeeding and under 18 years of age.
Active substance: Etoricoxib
Arcoxia(Merck Sharp & Dome)	317-576	A potent selective drug. Its mechanism of action, side effects and contraindications are similar to celecoxib. Indications for use include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and acute gouty arthritis.
Active substance: Meloxicam
Amelotex(Sotex)	52-117	A modern selective drug with a pronounced anti-inflammatory effect. Indications for use are pain and inflammatory syndrome in osteoarthritis, osteochondrosis, rheumatoid arthritis and ankylosing spondylitis. It is not usually used for antipyretic purposes or for the treatment of other types of pain. It can cause a variety of side effects, but the negative effect on the gastrointestinal tract is less than that of non-selective drugs of this group. It has many contraindications, including pregnancy, breastfeeding and children under 12 years of age.
Arthrozan(Pharmstandard)	87,7-98,7
Bi-xicam(Veropharm)	35-112
Meloxicam(different manufacturers)	9,5-12,3
Mirlox(Polfa)	47-104
Movalis(Boehringer Ingelheim)	418-709
Movasin(Synthesis)	73,1-165

Remember, self-medication is life-threatening; consult a doctor for advice on the use of any medications.

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

How do NSAIDs work?

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

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

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

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

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

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

When are these drugs prescribed?

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

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

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

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

Indications for use

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

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

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

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

Contraindications

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

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

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

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

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

Side effects

The most dangerous side effects of NSAIDs include:

Impact on the cellular composition of blood. Having the ability to reduce clotting, medications can cause hemorrhages.
Negative effect on the mucous membrane. Medicines can cause erosions and ulcerations in the stomach and duodenum.
Medicines can provoke allergic manifestations: itching, urticaria, Quincke's edema.

Despite the fact that NSAIDs are available over the counter, uncontrolled use can negatively affect the patient's health.

Video on the topic:

Classification of NSAID drugs

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

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

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

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

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

New generation NSAIDs

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

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

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

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

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

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

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

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

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

Forms of release of a group of drugs

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

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

Tablets and capsules

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

Ampoules and solutions

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

NSAIDs are administered intramuscularly or intravenously.

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

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

Tenoxicam;
Lornoxicam;
Ibuprofen;

Ointments and creams

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

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

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

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

List of medications

Basically, new generation NSAIDs are used to treat acute forms of osteochondrosis. The choice of medication depends on which symptoms are more or less pronounced.

If the pain syndrome is severe, Nimesulide is prescribed.

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

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

The drug is produced as suspension granules, ready-made suspension, tablets, and gel.

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

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

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

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

Rofecoxib

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

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

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

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

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

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

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

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

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

Analogs of the drug are known as Voltaren, Diklak.

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

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

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

Butadion

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

Naproxen and indomethacin

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

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

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

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

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:

COX-1 is a protective enzyme in the gastric mucosa, protecting it from acidic contents.
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:

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 the latest generation of NSAIDs, 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.
Severe 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:

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 the 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.

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. And 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.
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 powerful drugs against pain and inflammation 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. An effective medicine with a pronounced anti-inflammatory effect. Does not affect heart rate, blood pressure and respiratory 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. For asthma, use with caution, as an allergic reaction in the form of bronchospasm is possible. 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. The active substance of the drug 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.

NSAIDs today are a dynamically developing class of drugs. This is due to the wide range of applications of this pharmaceutical group, which has antipyretic and analgesic activity.

NSAIDs are a whole group of drugs

NSAIDs block the action of the enzyme cyclooxygenase (COX), inhibiting the synthesis of prostaglandins from arachidonic acid. Prostaglandins in the body are mediators of inflammation, lower the threshold of sensitivity to pain, inhibit lipid peroxidation and inhibit neutrophil aggregation.
The main effects of NSAIDs include:

Anti-inflammatory. Suppress the exudative phase of inflammation, and, to a lesser extent, the proliferative phase. Diclofenac and Indomethacin are the most powerful drugs for this effect. But the anti-inflammatory effect is less pronounced than that of glucocorticosteroids.
Practitioners use a classification according to which all NSAIDs are divided into: drugs with high anti-inflammatory activity and drugs with weak anti-inflammatory activity. Aspirin, Indomethacin, Diclofenac, Piroxicam, Ibuprofen and many others have high activity. This group includes a large number of different drugs. Paracetamol, Metamizole, Ketorolac and some others have low anti-inflammatory activity. The group is small.
Painkiller. Most pronounced in Diclofenac, Ketoralac, Metamizol, Ketaprofen. Used for pain of low and medium intensity: dental, muscle, headache. Effective for renal colic, because Not . Compared to narcotic analgesics (morphine group), they do not have a depressing effect on the respiratory center and are not addictive.
Antipyretic. All drugs have this property to varying degrees. But it only appears in the presence of fever.
Anti-aggregation. Manifests itself due to suppression of thromboxane synthesis. This effect is most pronounced with Aspirin.
Immunosuppressive. It manifests itself secondarily due to deterioration of the permeability of capillary walls.

Indications for use of NSAIDs

The main indications include:

Rheumatic diseases. Includes rheumatism, rheumatoid arthritis, ankylosing spondylitis, gouty and psoriatic arthritis, and Reiter's disease. For these diseases, the use of NSAIDs is symptomatic, without affecting the pathogenesis. That is, taking NSAIDs cannot slow down the development of the destructive process in rheumatoid arthritis or prevent joint deformation. But patient complaints of pain and stiffness in the joints in the initial stages of the disease become less frequent.
Diseases of the musculoskeletal system of a non-rheumatic nature. This includes injuries (bruises, sprains), myositis, tendovaginitis. For the above diseases, NSAIDs are used orally, in the form of injections. And external agents (ointments, creams, gels) that contain active ingredients of this group are very effective.
Neurological diseases. Lumbago, radiculitis, myalgia. Combinations of various forms of drug release are often prescribed simultaneously (ointment and tablets, injections and gel, etc.)
Renal, . Drugs from the NSAID group are effective for all types of colic, because... do not cause additional spasm of smooth cell muscle structures.
Painful symptoms of various etiologies. Pain relief in the postoperative period, toothache and headache.
Dysmenorrhea. NSAIDs are used to relieve pain in primary dysmenorrhea and to reduce the amount of blood loss. Naproxen and Ibuprofen have a good effect, which are recommended to be taken on the eve of menstruation and for three days thereafter. Such short-term courses prevent the occurrence of unwanted effects.
Fever. Antipyretic drugs are recommended to be taken at body temperatures above 38.5 °C.
Prevention of thrombosis. To prevent the formation of blood clots, low dosage of Acetylsalicylic acid is used. Prescribed to prevent heart attacks and strokes in various forms of coronary heart disease.

Undesirable effects and contraindications

NSAIDs have a negative effect on:

and intestines
Liver
Kidneys
Blood
Nervous system

The most common area that suffers from taking NSAIDs is the stomach. This manifests itself as nausea, diarrhea, pain in the epigastric region and other dyspeptic complaints. There is even such a syndrome - NSAID gastropathy, the occurrence of which is directly related to the use of NSAIDs. Elderly patients, with a history of gastric ulcers, and concurrently taking glucocorticosteroid drugs are especially at risk of pathology.

NSAIDs are different drugs, but their effect is the same!

The likelihood of developing NSAID gastropathy increases with long-term use of drugs in high doses, as well as when taking two or more NSAIDs. Lansoprazole, Esomeprazole and other proton pump inhibitors are used to protect the gastric mucosa. may be in the form of severe toxic hepatitis, or may manifest itself as transient dysfunction with an increase in the level of transaminases in the blood.

The liver is most often affected when taking Indomethacin, Phenylbutazone, and Aspirin. On the part of the kidneys, decreased diuresis, acute renal failure, and nephrotic syndrome may develop as a result of damage to the kidney tubules. The greatest danger is represented by Ibuprofen and Naproxen.

In the blood, clotting processes are disrupted and anemia occurs. Diclofenac, Piroxicam, Butadione are dangerous in terms of side effects from the blood system. Often, undesirable effects on the nervous system occur when taking Aspirin and Indomethacin. And they manifest themselves as headaches, tinnitus, nausea, and sometimes vomiting, and mental disorders. Taking NSAIDs is contraindicated in the following cases:

or intestines
Pregnancy and breastfeeding
Presence of bronchial asthma
Epilepsy, parkinsonism, mental disorders
Hemorrhagic diathesis, thrombocytopenia
Arterial hypertension and heart failure (not all groups of drugs)
Individual drug intolerance

NSAIDs are used in almost all areas of medicine. This is due to their numerous effects: anti-inflammatory, antipyretic and analgesic. NSAIDs alleviate the suffering of patients with corresponding symptoms, improving their quality of life and providing a state of comfort.

Aspirin is a representative of the NSAID group. About its benefits and harms for the human body in the video:

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How and with what to treat the pancreas, an integrated approach with…

Nonsteroidal anti-inflammatory drugs (NSAIDs) or NSAIDs)- a group of drugs that have analgesic, antipyretic and anti-inflammatory effects. Their action is based on blocking the production of prostaglandins, which are released at the site of any tissue damage. Currently, non-steroidal anti-inflammatory drugs are rightfully among the most popular drugs used in clinical practice.

The most well-known NSAID is aspirin (acetylsalicylic acid). Non-steroidal anti-inflammatory drugs also include: diflunisal, lysine monoacetylsalicylate, phenylbutazone, indomethacin, sulindac, etodolac, diclofenac, piroxicam, tenoxicam, lornoxicam, meloxicam, ibuprofen, naproxen, flurbiprofen, ketoprofen, tiaprofenic acid, nabumetone, nimesulide, cele coxib, rofecoxib, mesalazine and a lot others.

The main problem with the use of non-steroidal anti-inflammatory drugs is that, being the most effective drugs in the treatment of many diseases, they also have a damaging effect on the mucous membrane of the stomach and duodenum, and both therapeutic and and the damaging effects of NSAIDs are consequences of NSAID inhibition of prostaglandin production.

The main physiological functions of prostaglandins in the digestive tract are stimulation of the secretion of protective bicarbonates and mucus, activation of cell proliferation in the processes of normal regeneration and increased local blood flow in the mucous membrane. The anti-inflammatory and analgesic effects of non-steroidal anti-inflammatory drugs are due to inhibition of the enzyme cyclooxygenase (COX). There are two isoforms of COX: COX-1 and COX-2. The first of these is present in most tissues, including the gastrointestinal mucosa, and controls the production of prostaglandins, which regulate the integrity of the gastrointestinal mucosa, platelet function and renal blood flow. COX-2 plays the role of a “structural” enzyme only in some organs (brain, kidneys, bones, etc.) and is not normally found in other tissues. Its expression increases significantly under the influence of “pro-inflammatory” stimuli and, on the contrary, decreases under the influence of endogenous substances with anti-inflammatory activity. It is believed that the anti-inflammatory effect of NSAIDs depends on the blocking of COX-2, and their side effects are associated with the suppression of COX-1 (Vasiliev Yu.V.).

Non-steroidal anti-inflammatory drugs - the cause of gastrointestinal diseases

One of the most important problems of gastroenterology is the treatment and prevention of NSAID gastropathy - diseases of the gastrointestinal tract associated with the use of non-steroidal anti-inflammatory drugs and acetylsalicylic acid. In the late 1970s, it was found that patients with rheumatic diseases taking NSAIDs die from gastrointestinal bleeding and perforated ulcers more often than those not taking NSAIDs.

Despite significant progress in the study of NSAIDs and the creation of safer drugs, modern statistics show: the risk of gastrointestinal bleeding when taking NSAIDs increases by 3-5 times, perforation - by 6, the risk of death from complications associated with damage to the gastrointestinal tract – 8 times. In 40–50% of patients hospitalized with a diagnosis of acute gastrointestinal bleeding, it is caused by taking this class of drugs. In the UK, up to 2,000 patients die annually from such complications; in the US, NSAID use is responsible for 100,000 hospitalizations and 16,000 deaths per year.

In Moscow, 34.6% of hospitalizations with a diagnosis of “acute gastrointestinal bleeding” are directly related to the use of NSAIDs. Bleeding and perforation of the ulcer are the cause of death in patients suffering from rheumatic diseases and taking NSAIDs, and account for 13.8% of the direct causes of death in patients with rheumatoid arthritis, ankylosing spondylitis and systemic lupus erythematosus (Burkov S.G.).

All patients requiring chronic use of NSAIDs should be stratified according to the risk of bleeding complications
if there is a high risk of bleeding, it is recommended to transfer patients to selective COX-2 inhibitors in combination with the constant use of proton pump inhibitors or misoprostol
if bleeding develops, NSAIDs should be discontinued (replaced with drugs from other groups); A combination of endoscopic and drug (proton pump inhibitors) hemostasis is recommended.

Professional medical articles concerning the damaging effects of non-steroidal anti-inflammatory drugs on the gastrointestinal mucosa

Abdulganieva D.I., Belyanskaya N.E., Nasonov E.L. Relationship between clinical manifestations of NSAID gastropathy in patients with rheumatoid arthritis and motor disorders of the upper gastrointestinal tract // Scientific and practical rheumatology. 2011. No. 3. pp. 25–28.

Vasiliev Yu.V. Proton pump inhibitors in the treatment of gastric and duodenal ulcers associated with non-steroidal anti-inflammatory drugs // Farmateka. – 2005. – No. 7. – p. 1–4.

Nasonov E.L. The use of non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors at the beginning of the 21st century // Russian Medical Journal. – 2003. – Volume 11. – No. 7. – p. 375–378.

Agapova N.G. About drug-induced gastroduodenal ulcers // Journal "Mystery of Likuvannya". Ukraine. – 2007. – 2(38).

Burkov S.G. Modern approaches to the treatment of acid-dependent diseases // Breast Cancer. – 2007. – Volume 15. – No. 6.

Guidelines for the use of non-steroidal anti-inflammatory drugs and the official instructions of Actavis Ellzabeth LCC “Diclofenac sodium extended-release tablets” for US healthcare professionals (English, pdf): “Diclofenac sodium extended-realeas tablets”.

Official instructions from the manufacturer of naproxen drugs Year Genentech, Inc. for US patients (medical guide) “What are non-steroidal anti-inflammatory drugs? EC-Naprosyn (naproxen delayed-release tablets), Naprosyn (naproxen tablets), Anaprox / Anaprox DS (naproxen sodium tablets), Naprosyn (naproxen suspension)" (in English, pdf): "Medication Guide EC-Naprosyn ® (naproxen delayed -release tablets), Naprosyn ® (naproxen tablets), Anaprox ® / Anaprox ® DS (naproxen sodium tablets), Naprosyn ® (naproxen suspension)."

On the website in the literature catalog there is a section “NSAIDs and other drug-induced gastropathy”, containing articles devoted to diseases of the gastrointestinal tract caused by taking medications and their treatment.

Application. Nonsteroidal anti-inflammatory drugs in the Anatomical Therapeutic Chemical Classification (ATC)

Nonsteroidal anti-inflammatory drugs are widely used in medicine for the treatment of various diseases and conditions and, therefore, they are presented in various sections of the Anatomical Therapeutic Chemical Classification (ATC), in particular, in the section “ Code M. Drugs for the treatment of diseases of the musculoskeletal system » there are two subsections of different levels containing the following positions:

M01A Non-steroidal anti-inflammatory drugs:

M01AA Butylpyrazolidones

M01AA01 Phenylbutazone
M01AA02 Mofebutazone
M01AA03 Oxyphenbutazone
M01AA05 Clofezone
M01AA06 Kebuzon