NSAID medications. All about non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs). Rational use of non-steroidal anti-inflammatory drugs in rheumatology

They are the most common drugs and have long been used in medicine. After all, pain and inflammation accompany most diseases. And for many patients, these drugs bring relief. But their use is associated with the risk of side effects. And not all patients have the opportunity to use them without harm to health. Therefore, scientists create new drugs, trying to keep them highly effective and have no side effects. These properties are possessed by non-steroidal anti-inflammatory drugs of a new generation.

The history of these drugs

In 1829, salicylic acid was obtained, and scientists began to investigate its effect on humans. New substances were synthesized and drugs appeared that eliminated pain and inflammation. And after the creation of aspirin, they started talking about the emergence of a new group of drugs that do not have such negative effects as opiates and are more effective in treating fever and pain. After that, the use of non-steroidal anti-inflammatory drugs became popular. This group of drugs received this name because they do not contain steroids, that is, hormones, and they do not have such strong side effects. But they still have a negative effect on the body. Therefore, for more than a hundred years, scientists have been trying to create a drug that would act effectively and have no side effects. And only in recent years, new generation non-steroidal anti-inflammatory drugs with such properties have been obtained.

How these drugs work

Any inflammation in the human body is accompanied by pain, swelling and hyperemia of tissues.

All these processes are controlled by special substances - prostaglandins. Non-steroidal anti-inflammatory drugs, the list of which is growing, affect the formation of these substances. Due to this, signs of inflammation are reduced, fever and swelling disappear, and pain subsides. Scientists have long found out that the effectiveness of these drugs is due to the fact that they affect the enzyme cyclooxygenase, with the help of which prostaglandins are formed. But recently it has been discovered that it exists in several forms. And only one of them is a specific enzyme of inflammation. Many NSAIDs have an effect on another form of it, and therefore cause side effects. A new generation of non-steroidal anti-inflammatory drugs suppress enzymes that cause inflammation, without affecting those that protect the gastric mucosa.

What diseases are NSAIDs used for?

Treatment with non-steroidal anti-inflammatory drugs is widespread both in medical institutions and in self-treatment of pain symptoms by patients. These drugs relieve pain, reduce fever and swelling, and reduce blood clotting. Their use is effective in such cases:

With diseases of the joints, arthritis, bruises, muscle strain and myositis (as an anti-inflammatory agent). Non-steroidal anti-inflammatory drugs for osteochondrosis are very effective in relieving pain.

Often they are used as an antipyretic for colds and infectious diseases.

These drugs are most in demand as an anesthetic for headaches, renal and hepatic colic, postoperative and premenstrual pain.

Side effects

Most often, with prolonged use of NSAIDs, lesions of the gastrointestinal tract occur: nausea, vomiting, dyspeptic disorders, ulcers and gastric bleeding.

In addition, these drugs also affect the activity of the kidneys, causing a breakdown in their functions, an increase in protein in the urine, urinary retention and other disorders.

Even new generation non-steroidal anti-inflammatory drugs are not spared from the negative impact on the patient's cardiovascular system, they can cause increased pressure, heart palpitations and swelling.

Headache, dizziness, and drowsiness often occur after the use of these drugs.

1. You can not take these drugs for long courses, so as not to increase side effects.

2. You need to start taking a new medicine gradually, in small doses.

3. It is worth drinking these drugs only with water, and to reduce side effects, you need to drink at least a glass of it.

4. You can not take several NSAIDs at the same time. The therapeutic effect of this is not enhanced, but the negative impact will be higher.

5. Do not self-medicate, take drugs only as directed by your doctor.

7. During treatment with these drugs, you can not take alcoholic beverages. In addition, NSAIDs affect the effectiveness of certain drugs, for example, reduce the effect of hypertensive drugs.

Forms of release of NSAIDs

The most popular tablet forms of these drugs. But it is they who have the strongest negative effect on the gastric mucosa.

In order for the drug to immediately enter the bloodstream and begin to act without side effects, it is administered intravenously or intramuscularly, which is possible, though not always.

More accessible is another form of application of these drugs - rectal suppositories. They have less negative effect on the stomach, but they are contraindicated in intestinal diseases.

For local inflammatory processes and diseases of the musculoskeletal system, it is best to use external medicines. NSAIDs come in the form of ointments, solutions, and creams that are effective in relieving pain.

Classification of NSAIDs

Most often, these drugs are divided into two groups according to their chemical composition. Distinguish drugs derived from acids and non-acid. You can also classify NSAIDs according to their effectiveness. Some of them better relieve inflammation, such as Dicofenac, Ketoprofen or Movalis. Others are more effective for pain - Ketonal or Indomethacin. There are also those that are most often used to reduce fever - medicines "Aspirin", "Nurofen" or "Nise". Non-steroidal anti-inflammatory drugs of a new generation are also allocated to a separate group, they are more effective and have no side effects.

NSAIDs derived from acids

The largest list of non-steroidal anti-inflammatory drugs refers to acids. There are several types in this group:

Salicylates, the most common of which is the drug "Aspirin";

Pyrazolidins, for example, the remedy "Analgin";

Those that contain indoleacetic acid - the drug "Indomethacin" or "Etodolac";

Derivatives of propionic acid, for example, the means "Ibuprofen" or "Ketoprofen";

Oxicams are new non-steroidal anti-inflammatory drugs, which include the drug "Piroxicam" or "Meloxicam";

The derivatives of isonicotinic acid include only the medicine "Amizon".

Non-acid NSAIDs

The second group of these drugs are non-acid. These include:

Sulfonamides, for example, the drug "Nimesulide";

Derivatives of coxibs - means "Rofecoxib" and "Celecoxib";

Alkanones, for example, the drug "Nabemeton".

The developing pharmaceutical industry creates more and more new drugs, but often they are the same composition as the already known non-steroidal anti-inflammatory drugs.

List of the most effective NSAIDs

1. Means "Aspirin" - the oldest medical drug, still widely used in inflammatory processes and pain. Now it is produced under other names. This substance can be found in Bufferan, Instprin, Novandol, Upsarin Upsa, Fortalgin S and many others.

2. The drug "Diclofenac" was created in the 60s of the 20th century and is now very popular. Produced under the names "Voltaren", "Ortofen", "Diklak", "Klodifen" and others.

3. The drug "Ibuprofen" has proven itself as an effective analgesic and antipyretic agent, which is also easily tolerated by patients. It is also known under the names "Dolgit", "Solpaflex", "Nurofen", Mig 400" and others.

4. The drug "Indomethacin" has the strongest anti-inflammatory effect. It is produced under the names "Metindol", "Indovazin" and others. These are the most common non-steroidal anti-inflammatory drugs for joints.

5. The drug "Ketoprofen" is also quite popular in the treatment of diseases of the spine and joints. You can buy it under the names "Fastum". "Bystrum", "Ketonal" and others.

New generation NSAIDs

Scientists are constantly developing new drugs that are more effective and have fewer side effects.

These requirements are met by modern NSAIDs. They act selectively, only on those enzymes that control the process of inflammation. Therefore, they have less effect on the gastrointestinal tract and do not destroy the cartilage tissue of patients. It is possible to drink them for a long time without fear of getting side effects. The advantages of these drugs also include a long period of their action, so they can be taken less often - only 1 time per day. The disadvantages of these drugs include a rather high price. Such modern NSAIDs are Nimesulide, Meloxicam, Movalis, Artrozan, Amelotex, Nise and others.

NSAIDs in diseases of the musculoskeletal system

Diseases of the joints and spine often cause unbearable suffering to patients. In addition to severe pain in this case, there are swelling, hyperemia and stiffness of movements. It is best to take NSAIDs at the same time, they are 100% effective in case of inflammatory processes. But since they do not cure, but only relieve symptoms, such drugs are used only at the beginning of the disease, to relieve pain.

The most effective in such cases, external means. The best non-steroidal anti-inflammatory drugs for osteochondrosis are Diclofenac, better known to patients under the name Voltaren, as well as Indomethacin and Ketoprofen, which are used both in the form of ointments and orally. The drugs "Butadion", "Naproxen" and "Nimesulide" relieve pain well. The most effective non-steroidal anti-inflammatory drugs for arthrosis are tablets, it is recommended to use Meloxicam, Celecoxib or Piroxicam medicines. The choice of the drug should be individual, so the doctor should deal with the selection of it.

Analgesics and non-steroidal anti-inflammatory drugs used to reduce pain and eliminate inflammation.

The path to the discovery of painkillers was difficult and long. Once upon a time, only folk remedies were used for these purposes, and during surgical operations - alcohol, opium, scopolamine, Indian hemp, and even such inhumane methods as stunning with a blow to the head or partial strangulation.

In folk medicine, willow bark has long been used to relieve pain and fever. Subsequently, it was found that the active ingredient in willow bark is salicin, which, upon hydrolysis, turns into salicylic acid. Acetylsalicylic acid was synthesized as early as 1853, but it was not used in medicine until 1899, when data were accumulated on its effectiveness in arthritis and good tolerability. And only after that the first preparation of acetylsalicylic acid appeared, which is now known throughout the world as Aspirin. Since then, many compounds of various chemical nature have been synthesized that suppress pain without disturbing (loss) of consciousness. These drugs are called analgesics (from the Greek algos- pain). Those that do not cause addiction and do not depress brain activity in therapeutic doses are called non-narcotic analgesics . Since most of them have, in addition, anti-inflammatory properties, they were called “Non-narcotic analgesics and non-steroidal anti-inflammatory drugs”.

These substances are able to suppress the symptoms and signs of inflammation, including pain, since a decrease in the intensity of the inflammatory process leads to a decrease in painful sensations. In addition, they reduce elevated body temperature, that is, they have an antipyretic effect, which is due to the expansion of the superficial vessels of the skin and increased heat radiation.

The group of non-narcotic analgesics and non-steroidal anti-inflammatory drugs includes drugs of various chemical structures and with a different ratio of analgesic and anti-inflammatory effects. The ancestor of this group is already mentioned above. acetylsalicylic acid, which has been successfully used in medicine for more than 100 years. It has anti-inflammatory, analgesic and antipyretic properties approximately equally, although it is most widely used as an analgesic and antipyretic agent. A typical representative of non-narcotic analgesics - metamizole sodium(more commonly known as Analgin). This substance is also more often used as an analgesic and antipyretic agent. Drugs that combine these properties are also called antipyretic analgesics (from the Greek pyretos- fever).

Recently, a number of compounds have been found with especially pronounced anti-inflammatory activity. Preparations created on their basis, of course, relieve pain and fever, but their anti-inflammatory effect is predominant and is close in strength to glucocorticoids - steroid hormones. The most famous representatives of this series are diclofenac , ibuprofen , indomethacin , ketoprofen , naproxen , piroxicam and others (they are called non-steroidal anti-inflammatory drugs).

Mechanism of anti-inflammatory and analgesic action non-steroidal anti-inflammatory drugs associated with the inhibition of a special enzyme - cyclooxygenase, which promotes the synthesis of prostaglandins - the main mediators of inflammation and pain. Along with this, they affect the synthesis and transformation in the body of other substances (for example, bradykinin) involved in the occurrence and spread of inflammation and pain.

Non-narcotic analgesics and non-steroidal anti-inflammatory drugs are widely used in the treatment of various inflammatory diseases of an infectious and non-infectious nature. First of all, this rheumatic soft tissue lesions And inflammatory and degenerative diseases of the musculoskeletal system. This pathology often leads to long-term disability and even disability.

One of the indications for the appointment of non-steroidal anti-inflammatory drugs is acute arthritis at gout. The writing genius and medical education allowed A.P. Chekhov in "Uncle Vanya" very accurately describe the paroxysmal and short-term pain that occurs mainly at night, which is characteristic of acute gouty arthritis, as well as the protracted course of this disease. The irritability of Professor Serebryakov poisoned the lives of those around him. “- You wrote that he was very ill, rheumatism and something else, but it turns out he is healthy. “Last night he was moping, and today nothing ...”. Irritability is inherent in patients with gout on the eve and during a painful attack. Chekhov knew that gout was not a harmless disease: “They say that Turgenev got angina pectoris from gout.” Turgenev himself described his illness in a letter to L.N. Tolstoy: “My illness is not at all dangerous, although it is rather painful; the main trouble is that, succumbing badly to drugs, it can last a long time and deprives me of the ability to move” (1892).

It should be recalled that gout is incompatible with alcohol and alcoholic beverages can provoke an acute attack of the disease. There are even lines like this:

Another disease that permanently deprives a person of “the ability to move” is described by another classic of literature, O’Henry. In the story Kindred Souls, the author describes an apartment thief who finds it increasingly difficult to work, especially in wet weather. His latest victim and soul mate, a gentleman, has been “deprived of the ability to dress without outside help” for a week now. This is how it manifests osteoarthritis, the next aggravation of which made two people “brothers in misfortune”.

A direct indication for the use of non-steroidal anti-inflammatory drugs is also ankylosing spondylitis. In the autobiographical novel by N. Ostrovsky “How the Steel Was Tempered”, Pavel Korchagin has the most severe form of this disease. “Korchagin knew that if he got off his horse, ... he would not walk a kilometer on his feet.” "The tragedy of immobility awaits this young man, and we are powerless to prevent it."

In the treatment of inflammatory diseases, topical preparations in the form of ointments, creams or gels play an important role. These dosage forms allow you to achieve a rapid analgesic effect and avoid side effects characteristic of injectable forms and drugs administered through the digestive tract ( enterally ).

Non-narcotic analgesics and non-steroidal anti-inflammatory drugs are often prescribed for the treatment of pain of various origins of mild to moderate intensity ( headache , muscle pain, including when colds , flu and other acute respiratory diseases, toothache , pain during menstruation and so on), as antipyretics in feverish conditions accompanying many diseases, often infectious. In terms of consumption, they are among the most popular medicines in the world. This is also due to the fact that many of them are included in the OTC lists, and, therefore, are easily accessible to the public. Every day, about 30 million people take non-steroidal anti-inflammatory drugs and non-narcotic analgesics.

A significant disadvantage of non-steroidal anti-inflammatory drugs is their ability to cause gastrointestinal bleeding, stomach ulcers and increased bleeding of the nasal mucosa and gums. This is because non-steroidal anti-inflammatory drugs block the synthesis of protective prostaglandins in the gastric mucosa and inhibit the adhesion (aggregation) of blood cells responsible for stopping bleeding ( platelets ). As it turned out, the cyclooxygenase enzyme (which we mentioned earlier) has two varieties, one of which is more responsible for the synthesis of prostaglandins - inflammatory mediators, and the other for the synthesis of protective prostaglandins in the gastric mucosa. Increasing the selectivity of the action of new drugs with respect to only the type of enzyme that is responsible for the synthesis of inflammatory mediators allows avoiding side effects while maintaining the anti-inflammatory effect. Such medicines are already being created and can be exemplified by meloxicam And celecoxib .

Blockade of prostaglandin synthesis can also lead to bronchospasm (the so-called "aspirin" asthma). On the other hand, the property of acetylsalicylic acid to reduce blood clotting and improve its fluidity has been used for prevention. thrombosis, risk reduction stroke with temporary disorders of cerebral circulation, reducing the risk myocardial infarction and death thereafter. For example, long-term acetylsalicylic acid at a dose of 325 mg every other day significantly reduces the incidence of myocardial infarction in men (according to some reports by 40%).

Since inflammatory processes, depending on the localization, may be accompanied by muscle spasms, severe pain, cough, runny nose, swelling and other disturbances of body functions, non-narcotic analgesics and non-steroidal anti-inflammatory drugs are combined with other components (antispasmodics, narcotic analgesics, expectorants, vitamins, caffeine, drugs that improve microcirculation, and so on), which can have a complementary effect or enhance (potentiate) the effects of each other.

The group of non-narcotic analgesics is widely represented

Non-steroidal anti-inflammatory drugs, which are briefly called NSAIDs or NSAIDs (means) are widely used throughout the world. In the United States, where statistics cover all branches of life, it was estimated that every year American doctors write more than 70 million prescriptions for NSAIDs. Americans drink, inject, and smear more than 30 billion doses of non-steroidal anti-inflammatory drugs a year. It is unlikely that our compatriots are lagging behind them.

Despite their popularity, most NSAIDs are distinguished by high safety and extremely low toxicity. Even when used in high doses, complications are extremely unlikely. What are these miraculous remedies?

Non-steroidal anti-inflammatory drugs are a large group of drugs that have three effects at once:

• painkillers;
• antipyretic;
• anti-inflammatory.

The term "non-steroidal" distinguishes these drugs from steroids, i.e. hormonal drugs, which also have anti-inflammatory effects.

The property that favorably distinguishes NSAIDs from other analgesics is the absence of addiction with prolonged use.

Excursion into history

The "roots" of non-steroidal anti-inflammatory drugs go back to the distant past. Hippocrates, who lived in 460-377. BC, reported the use of willow bark for pain relief. A little later, in the 30s BC. Celsius confirmed his words and stated that willow bark perfectly softens the signs of inflammation.

The next mention of the analgesic cortex is found only in 1763. And only in 1827, chemists were able to isolate from the willow extract the very substance that became famous in the time of Hippocrates. The active ingredient in willow bark turned out to be the glycoside salicin, a precursor to non-steroidal anti-inflammatory drugs. From 1.5 kg of bark, scientists received 30 g of purified salicin.

In 1869, for the first time, a more effective derivative of salicin, salicylic acid, was obtained. It soon became clear that it damages the gastric mucosa, and scientists began an active search for new substances. In 1897, the German chemist Felix Hoffmann and the Bayer company ushered in a new era in pharmacology by converting the toxic salicylic acid into acetylsalicylic acid, which was named Aspirin.

For a long time, aspirin remained the first and only representative of the NSAID group. Since 1950, pharmacologists began to synthesize more and more new drugs, each of which was more effective and safer than the previous one.

How do NSAIDs work?

Non-steroidal anti-inflammatory drugs block the production of substances called prostaglandins. They are directly involved in the development of pain, inflammation, fever, muscle cramps. Most NSAIDs non-selectively (non-selectively) block two different enzymes that are required for prostaglandin production. They are called cyclooxygenase - COX-1 and COX-2.

The anti-inflammatory effect of non-steroidal anti-inflammatory drugs is largely due to:

• a decrease in vascular permeability and an improvement in microcirculation in them;
• a decrease in the release from cells of special substances that stimulate inflammation - inflammatory mediators.

In addition, NSAIDs block energy processes in the focus of inflammation, thereby depriving it of "fuel". Analgesic (pain-relieving) action develops as a result of a decrease in the inflammatory process.

Serious disadvantage

It's time to talk about one of the most serious disadvantages of non-steroidal anti-inflammatory drugs. The fact is that COX-1, in addition to participating in the production of harmful prostaglandins, also plays a positive role. It is involved in the synthesis of prostaglandin, which prevents the destruction of the gastric mucosa under the action of its own hydrochloric acid. When non-selective COX-1 and COX-2 inhibitors begin to work, they completely block prostaglandins - both "harmful" ones that cause inflammation and "beneficial" ones that protect the stomach. So non-steroidal anti-inflammatory drugs provoke the development of gastric and duodenal ulcers, as well as internal bleeding.

But there are special drugs among the NSAID family. These are the most modern tablets that can selectively block COX-2. Cyclooxygenase type 2 is an enzyme that is involved only in inflammation and does not carry any additional load. Therefore, blocking it is not fraught with unpleasant consequences. Selective COX-2 blockers do not cause gastrointestinal problems and are safer than their predecessors.

Nonsteroidal anti-inflammatory drugs and fever

NSAIDs have a completely unique property that sets them apart from other drugs. They have an antipyretic effect and can be used to treat fever. To understand how they work in this capacity, you should remember why the body temperature rises.

Fever develops due to an increase in the level of prostaglandin E2, which changes the so-called firing rate of neurons (activity) within the hypothalamus. Namely, the hypothalamus - a small area in the diencephalon - controls thermoregulation.

Antipyretic non-steroidal anti-inflammatory drugs, also called antipyretics, inhibit the COX enzyme. This leads to inhibition of prostaglandin production, which as a result contributes to the inhibition of neuronal activity in the hypothalamus.

By the way, it was found that ibuprofen has the most pronounced antipyretic properties. It outperformed its closest competitor, paracetamol, in this respect.

Classification of non-steroidal anti-inflammatory drugs

And now let's try to figure out what kind of drugs belong to non-steroidal anti-inflammatory drugs.

Today, several dozen drugs of this group are known, but far from all of them are registered and used in Russia. We will consider only those medicines that can be bought in domestic pharmacies. NSAIDs are classified according to their chemical structure and mechanism of action. In order not to frighten the reader with complex terms, we present a simplified version of the classification, in which we present only the most famous names.

So, the entire list of non-steroidal anti-inflammatory drugs is divided into several subgroups.

Salicylates

The most experienced group, with which the history of NSAIDs began. The only salicylate that is still used today is acetylsalicylic acid, or Aspirin.

Propionic acid derivatives

These include some of the most popular non-steroidal anti-inflammatory drugs, in particular drugs:

• ibuprofen;
• naproxen;
• ketoprofen and some other medicines.

Acetic acid derivatives

Acetic acid derivatives are no less famous: indomethacin, ketorolac, diclofenac, aceclofenac and others.

Selective COX-2 inhibitors

The safest non-steroidal anti-inflammatory drugs include seven new drugs of the latest generation, but only two of them are registered in Russia. Remember their international names are celecoxib and rofecoxib.

Other non-steroidal anti-inflammatory

Separate subgroups include piroxicam, meloxicam, mefenamic acid, nimesulide.

Paracetamol has very weak anti-inflammatory activity. It mainly blocks COX-2 in the central nervous system and has an analgesic, as well as a moderate antipyretic effect.

When are NSAIDs used?

Typically, NSAIDs are used to treat acute or chronic inflammation accompanied by pain.

We list the diseases in which non-steroidal anti-inflammatory drugs are used:

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

In addition, non-steroidal anti-inflammatory drugs are used to treat children whose ductus arteriosus does not close within 24 hours of birth.

This amazing aspirin!

Aspirin can be safely attributed to the drugs that surprised the whole world. The most common non-steroidal anti-inflammatory pills that have been used to reduce fever and treat migraine have shown an unusual side effect. It turned out that by blocking COX-1, aspirin at the same time inhibits the synthesis of thromboxane A2, a substance that increases blood clotting. Some scientists suggest that there are other mechanisms for the effect of aspirin on blood viscosity. However, for millions of patients with hypertension, angina pectoris, coronary heart disease and other cardiovascular diseases, this is not so significant. For them, it is much more important that aspirin in low doses helps prevent cardiovascular disasters - heart attack and stroke.

Most experts recommend taking low-dose cardiac aspirin to prevent myocardial infarction and stroke in men aged 45–79 and women aged 55–79. The dose of aspirin is usually prescribed by a doctor: as a rule, it ranges from 100 to 300 mg per day.

A few years ago, scientists discovered that aspirin reduces the overall risk of developing cancer and mortality from them. This effect is especially true for rectal cancer. American doctors recommend that their patients take aspirin specifically to prevent the development of colorectal cancer. In their opinion, the risk of side effects due to long-term treatment with aspirin is still lower than oncological. By the way, let's take a closer look at the side effects of non-steroidal anti-inflammatory drugs.

Cardiac risks of non-steroidal anti-inflammatory drugs

Aspirin, with its antiplatelet effect, stands out from the orderly row of fellows in the group. The vast majority of non-steroidal anti-inflammatory drugs, including modern COX-2 inhibitors, increase the risk of myocardial infarction and stroke. Cardiologists warn that patients who have recently experienced a heart attack should stop taking NSAIDs. According to statistics, the use of these drugs almost 10 times increases the likelihood of developing unstable angina. According to research data, naproxen is considered the least dangerous from this point of view.

On July 9, 2015, the FDA, the most authoritative American drug quality control organization, issued an official warning. It talks about an increased risk of stroke and heart attack in patients using non-steroidal anti-inflammatory drugs. Of course, aspirin is a happy exception to this axiom.

The effect of non-steroidal anti-inflammatory drugs on the stomach

Another known side effect of NSAIDs is gastrointestinal. We have already said that it is closely related to the pharmacological action of all non-selective inhibitors of COX-1 and COX-2. However, NSAIDs not only reduce prostaglandin levels and thereby deprive the gastric mucosa of protection. Drug molecules themselves behave aggressively towards the mucous membranes of the gastrointestinal tract.

Against the background of treatment with non-steroidal anti-inflammatory drugs, nausea, vomiting, dyspepsia, diarrhea, stomach ulcers, including those accompanied by bleeding, may occur. Gastrointestinal side effects of NSAIDs develop regardless of how the drug enters the body: oral in the form of tablets, injections in the form of injections or rectal suppositories.

The longer the treatment lasts and the higher the dosage of NSAIDs, the higher the risk of developing peptic ulcer. To minimize the likelihood of it occurring, it makes sense to take the lowest effective dose for the shortest period.

Recent studies show that more than 50% of people taking non-steroidal anti-inflammatory drugs, the lining of the small intestine is still damaged.

Scientists note that drugs of the NSAID group affect the gastric mucosa in different ways. So, the most dangerous drugs for the stomach and intestines are indomethacin, ketoprofen and piroxicam. And among the most harmless in this regard are ibuprofen and diclofenac.

Separately, I would like to say about enteric coatings that cover non-steroidal anti-inflammatory tablets. Manufacturers claim that this coating helps to reduce or completely eliminate the risk of gastrointestinal complications of NSAIDs. However, research and clinical practice show that such protection does not actually work. Much more effectively, the likelihood of damage to the gastric mucosa reduces the simultaneous use of drugs that block the production of hydrochloric acid. Proton pump inhibitors - omeprazole, lansoprazole, esomeprazole and others - can somewhat mitigate the damaging effect of drugs from the group of non-steroidal anti-inflammatory drugs.

Say a word about citramone ...

Citramon is the product of a brainstorming session of Soviet pharmacologists. In ancient times, when the assortment of our pharmacies did not number in the thousands of drugs, pharmacists came up with an excellent formula for analgesic-antipyretic. They combined "in one bottle" a complex of a non-steroidal anti-inflammatory drug, an antipyretic and seasoned the combination with caffeine.

The invention turned out to be very successful. Each active ingredient enhanced the effect of each other. Modern pharmacists have somewhat modified the traditional prescription, replacing the antipyretic phenacetin with safer paracetamol. In addition, cocoa and citric acid, which, in fact, gave the name to citramone, were removed from the old version of citramone. The preparation of the XXI century contains aspirin 0.24 g, paracetamol 0.18 g and caffeine 0.03 g. And despite a slightly modified composition, it still helps with pain.

However, despite the extremely affordable price and very high efficiency, Citramon has its own huge skeleton in the closet. Doctors have long found out and fully proved that it seriously damages the mucosa of the gastrointestinal tract. So seriously that the term "citramone ulcer" even appeared in the literature.

The reason for this apparent aggression is simple: the damaging effect of Aspirin is enhanced by the activity of caffeine, which stimulates the production of hydrochloric acid. As a result, the gastric mucosa, already left without protection of prostaglandins, is exposed to the action of an additional amount of hydrochloric acid. Moreover, it is produced not only in response to food intake, as it should be, but also immediately after the absorption of Citramon into the blood.

We add that "citramone", or as they are sometimes called, "aspirin ulcers" are large. Sometimes they do not "grow" to gigantic, but they take in quantity, settling in whole groups in different parts of the stomach.

The moral of this digression is simple: don't go overboard with Citramon despite all its benefits. The consequences can be too severe.

NSAIDs and… sex

In 2005, in the piggy bank of unpleasant side effects of non-steroidal anti-inflammatory drugs arrived. Finnish scientists conducted a study that showed that long-term use of NSAIDs (over 3 months) increases the risk of erectile dysfunction. Recall that under this term, doctors mean erectile dysfunction, popularly called impotence. Then urologists and andrologists were consoled by the not very high quality of this experiment: the effect of drugs on sexual function was evaluated only on the basis of the man's personal feelings and was not verified by specialists.

However, in 2011, another study was published in the authoritative Journal of Urology. It also showed an association between treatment with non-steroidal anti-inflammatory drugs and erectile dysfunction. However, doctors argue that it is too early to draw final conclusions regarding the effect of NSAIDs on sexual function. In the meantime, scientists are looking for evidence, it is still better for men to refrain from long-term treatment with non-steroidal anti-inflammatory drugs.

Other side effects of NSAIDs

With the serious troubles that threaten treatment with non-steroidal anti-inflammatory drugs, we figured it out. Let's move on to less common adverse events.

Impaired kidney function

The use of NSAIDs is also associated with a relatively high level of renal side effects. Prostaglandins are involved in the expansion of blood vessels in the renal glomeruli, which allows you to maintain normal filtration in the kidneys. When the level of prostaglandins falls - and it is on this effect that the action of non-steroidal anti-inflammatory drugs is based - the work of the kidneys may be disturbed.

People with kidney disease are, of course, most at risk for kidney side effects.

photosensitivity

Quite often, long-term treatment with non-steroidal anti-inflammatory drugs is accompanied by increased photosensitivity. It is noted that piroxicam and diclofenac are more involved in this side effect.

People taking anti-inflammatory drugs may react to the sun's rays with skin redness, rashes, or other skin reactions.

Hypersensitivity reactions

Non-steroidal anti-inflammatory drugs are also "famous" for allergic reactions. They can manifest as a rash, photosensitivity, itching, Quincke's edema, and even anaphylactic shock. True, the latter effect is among the extremely rare and therefore should not frighten potential patients.

In addition, taking NSAIDs may be accompanied by headache, dizziness, drowsiness, bronchospasm. Rarely, ibuprofen causes irritable bowel syndrome.

Non-steroidal anti-inflammatory during pregnancy

Quite often, pregnant women face the issue of anesthesia. Can expectant mothers use NSAIDs? Unfortunately no.

Despite the fact that non-steroidal anti-inflammatory drugs do not have a teratogenic effect, that is, they do not cause gross malformations in a child, they can still do harm.

So, there is evidence that suggests a possible premature closure of the ductus arteriosus in the fetus if his mother took NSAIDs during pregnancy. In addition, some studies show an association between NSAID use and preterm birth.

Nevertheless, selected drugs are still used during pregnancy. For example, Aspirin is often given with heparin to women who have antiphospholipid antibodies during pregnancy. Recently, the old and rather rarely used Indomethacin has gained particular fame as a medicine for the treatment of pregnancy pathologies. It began to be used in obstetrics for polyhydramnios and the threat of premature birth. However, in France, the Ministry of Health issued an official order banning the use of non-steroidal anti-inflammatory drugs, including aspirin, after the sixth month of pregnancy.

NSAIDs: accept or refuse?

When do NSAIDs become a necessity, and when should they be abandoned outright? Let's look at all possible situations.

NSAIDs needed	Take NSAIDs with caution	Better to avoid NSAIDs
If you have osteoarthritis that is accompanied by pain, inflammation of the joints and impaired mobility that is not relieved by other drugs or paracetamol If you have rheumatoid arthritis with severe pain and inflammation If you have a moderate headache, joint or muscle injury (NSAIDs are prescribed only for a short time. It is possible to start pain relief with paracetamol) If you have mild chronic pain that is not related to osteoarthritis, such as in your back.	If you often suffer from indigestion If you are over 50 years of age or have a history of gastrointestinal disease and/or a family history of early heart disease If you smoke, have high cholesterol or high blood pressure, or have kidney disease if you are taking steroids or blood thinners (clopidogrel, warfarin) If you are forced to take NSAIDs to relieve symptoms of osteoarthritis for many years, especially if you have had gastrointestinal diseases	if you have ever had a stomach ulcer or stomach bleeding If you suffer from coronary artery disease or any other heart disease If you suffer from severe hypertension If you have chronic kidney disease If you have ever had a myocardial infarction If you are taking aspirin to prevent a heart attack or stroke If you are pregnant (especially in the third trimester)

NSAIDs in faces

We already know the strengths and weaknesses of NSAIDs. And now let's figure out which anti-inflammatory drugs are best used for pain, which ones for inflammation, and which ones for fever and colds.

Acetylsalicylic acid

The first NSAID to be released, acetylsalicylic acid, is still widely used today. As a rule, it is used:

• to lower body temperature.

  Please note that acetylsalicylic acid is not prescribed to children under the age of 15 years. This is due to the fact that with childhood fever against the background of viral diseases, the drug significantly increases the risk of developing Reye's syndrome, a rare liver disease that poses a threat to life.

  The adult dosage of acetylsalicylic acid as an antipyretic is 500 mg. Tablets are taken only when the temperature rises.

• as an antiplatelet agent for the prevention of cardiovascular accidents. The dose of cardioaspirin can range from 75 mg to 300 mg per day.

In an antipyretic dosage, acetylsalicylic acid can be bought under the names Aspirin (manufacturer and trademark owner of the German corporation Bayer). Domestic enterprises produce very inexpensive tablets, which are called Acetylsalicylic acid. In addition, the French company Bristol Myers produces Upsarin Upsa effervescent tablets.

Cardioaspirin has many names and formulations, including Aspirin Cardio, Aspinat, Aspicor, CardiASK, Thrombo ACC, and others.

Ibuprofen

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

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

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

Naproxen

Naproxen is prohibited for use in children and adolescents under 16 years of age, as well as in adults suffering from severe heart failure. Most often, non-steroidal anti-inflammatory drugs naproxen are used as painkillers for headache, dental, periodic, joint and other types of pain.

In Russian pharmacies, naproxen is sold under the names Nalgezin, Naprobene, Pronaxen, Sanaprox and others.

Ketoprofen

Ketoprofen preparations are distinguished by anti-inflammatory activity. It is widely used to relieve pain and reduce inflammation in rheumatic diseases. Ketoprofen is available in the form of tablets, ointments, suppositories and injections. Popular drugs include the Ketonal line manufactured by the Slovak company Lek. German joint gel Fastum is also famous.

Indomethacin

One of the outdated non-steroidal anti-inflammatory drugs, Indomethacin is losing ground every day. It has modest analgesic properties and moderate anti-inflammatory activity. In recent years, the name "indomethacin" has been heard more and more often in obstetrics - its ability to relax the muscles of the uterus has been proven.

Ketorolac

A unique non-steroidal anti-inflammatory drug with a pronounced analgesic effect. The analgesic abilities of ketorolac are comparable to those of some weak narcotic analgesics. The negative side of the drug is its insecurity: it can cause stomach bleeding, provoke stomach ulcers, and liver failure. Therefore, you can use ketorolac for a limited period of time.

In pharmacies, Ketorolac is sold under the names Ketanov, Ketalgin, Ketorol, Toradol and others.

Diclofenac

Diclofenac is the most popular non-steroidal anti-inflammatory drug, the "gold standard" in the treatment of osteoarthritis, rheumatism and other joint pathologies. It has excellent anti-inflammatory and analgesic properties and is therefore widely used in rheumatology.

Diclofenac has many forms of release: tablets, capsules, ointments, gels, suppositories, ampoules. In addition, diclofenac patches have been developed to provide a long-lasting effect.

There are a lot of analogues of diclofenac, and we will list only the most famous of them:

• Voltaren is the original drug of the Swiss company Novartis. Differs in high quality and the same high price;
• Diklak - a line of German drugs from Heksal, combining both reasonable cost and decent quality;
• Dicloberl made in Germany, Berlin Chemie company;
• Naklofen - Slovak drugs from KRKA.

In addition, the domestic industry produces many inexpensive non-steroidal anti-inflammatory drugs with diclofenac in the form of tablets, ointments and injections.

Celecoxib

A modern non-steroidal inflammatory drug that selectively blocks COX-2. It has a high safety profile and pronounced anti-inflammatory activity. It is used for rheumatoid arthritis and other joint diseases.

The original celecoxib is sold under the name Celebrex (Pfizer). In addition, pharmacies have more affordable Dilaxa, Coxib and Celecoxib.

Meloxicam

A popular NSAID used in rheumatology. It has a rather mild effect on the digestive tract, so it is often preferred for the treatment of patients with a history of diseases of the stomach or intestines.

Assign meloxicam in tablets or injections. Meloxicam preparations Melbek, Melox, Meloflam, Movalis, Exen-Sanovel and others.

Nimesulide

Most often, nimesulide is used as a mild analgesic, and sometimes as an antipyretic. Until recently, pharmacies sold a children's form of nimesulide, which was used to reduce fever, but today it is strictly prohibited for children under 12 years of age.

Trade names of nimesulide: Aponil, Nise, Nimesil (German original drug in the form of a powder for preparing a solution for internal use) and others.

Finally, we will devote a couple of lines to Mefenamic acid. It is sometimes used as an antipyretic, but it is significantly inferior in effectiveness to other non-steroidal anti-inflammatory drugs.

The world of NSAIDs is truly amazing in its diversity. And despite the side effects, these drugs are rightfully among the most important and necessary, which can neither be replaced nor bypassed. It remains only to give praise to the tireless pharmacists who continue to create new formulas, and to be treated with ever safer NSAIDs.

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

NSAIDs - transcript

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

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

Most Popular NSAIDs

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

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

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

Some historical facts

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

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

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

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

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

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

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

Classification of NSAIDs according to their chemical structure

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

The first ones include:

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

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

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

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

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

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

The second group is:

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

Alkanones ("Nabumeton").

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

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

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

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

What to look for when choosing a medicine

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

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

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

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

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

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

List of analogues of known drugs

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

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

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

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

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

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

Rules for taking NSAIDs

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

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

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

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

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

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

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

Side effects and nonsteroidal gastropathy

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

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

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

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

New generation non-steroidal anti-inflammatory drugs

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

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

New generation NSAIDs are drugs such as:

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

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

Different forms in which NSAIDs are produced

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

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

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

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

Can NSAIDs be used during pregnancy?

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

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

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

Conclusion

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

Content

Pain in the joints is excruciating and unbearable, it prevents a person from living normally. Many people have firsthand experience of how difficult it is to tolerate this phenomenon. If this problem has also affected you, then non-steroidal anti-inflammatory drugs for the treatment of joints will come to the rescue. You will soon find out which of them are really capable of relieving pain.

What are non-steroidal anti-inflammatory drugs

These drugs are abbreviated as NSAIDs. They begin the medical treatment of arthrosis. Anti-inflammatory drugs are called nonsteroidal because they do not contain hormones. They are safer for the body and give a minimum of side effects. There are selective agents that act directly on the focus of inflammation, and non-selective agents that also affect the organs of the gastrointestinal tract. The first one is preferable.

Treatment of joints NSAIDs

Means must be prescribed by a doctor, based on the intensity of pain and the manifestation of other symptoms. Diagnoses in which NSAIDs help:

• infectious, aseptic, autoimmune, gouty or rheumatoid arthritis;
• arthrosis, osteoarthritis, deforming osteoarthritis;
• osteochondrosis;
• rheumatic arthropathy: psoriasis, ankylosing spondylitis, Reiter's syndrome;
• bone tumors, metastases;
• pain after surgery, trauma.

Anti-inflammatory drugs for joints

The range includes pharmacological agents in the form of:

• tablets;
• intramuscular injections;
• injections into the joint itself;
• plasters;
• candles;
• creams, ointments.

In severe forms of joint diseases and a deterioration in the patient's well-being, the doctor, as a rule, prescribes stronger medicines. They help quickly. We are talking about injections in the joint. Such drugs do not spoil the gastrointestinal tract. In milder forms of the disease, the specialist prescribes pills, intramuscular injections. The use of creams and ointments is always recommended as an addition to the main therapy complex.

Pills

There are such effective NVPS (means):

1. "Indomethacin" (another name is "Metindol"). Pills for joint pain relieve inflammation, have an antipyretic effect. The drug is drunk twice or thrice a day for 0.25-0.5 g.
2. "Etodolak" ("Etol fort"). Produced in capsules. Anesthetizes quickly. Acts on inflammation. It should be taken one tablet 1-3 times after meals.
3. "Aceclofenac" ("Aertal", "Diclotol", "Zerodol"). diclofenac analogue. The drug is taken on a tablet twice a day. The drug often causes side effects: nausea, dizziness.
4. "Piroxicam" ("Fedin-20"). They have an antiplatelet effect, relieve pain, fever. The dosage and rules of admission are always determined by the doctor, based on the severity of the disease.
5. Meloxicam. Tablets are prescribed one or two per day after the disease passes from the acute stage to the next.

Ointments for the treatment of joints

Classification:

1. With ibuprofen ("Dolgit", "Nurofen"). An anti-inflammatory and analgesic ointment for joints with such a main component will help those with arthritis, trauma. Acts very quickly.
2. With diclofenac ("Voltaren", "Diklak", "Diclofenac", "Diklovit"). Such medicinal ointments warm up, relieve pain and block inflammatory processes. Quickly help those who have difficulty moving.
3. With ketoprofen ("Ketonal", "Fastum", "Ketoprofen Vramed"). Prevent the formation of blood clots. With too long use of ointments, a rash may appear on the body.
4. With indomethacin ("Indomethacin Sopharma", "Indovazin"). They act similarly to drugs based on ketoprofen, but less intensively. They warm well, help with rheumatoid arthritis, gout.
5. With piroxicam ("Finalgel"). They relieve painful symptoms, do not dry the skin.

injections

There are such NSAIDs for injection:

1. "Diclofenac". Relieves inflammation, pain, is prescribed for severe diseases. Intramuscularly injected 0.75 g of the drug once or twice a day.
2. "Tenoxicam" ("Teksamen L"). Soluble powder for injection. 2 ml per day is prescribed for mild pain syndrome. The dose is doubled and a five-day course is prescribed for gouty arthritis.
3. "Lornoxicam" ("Larfix", "Lorakam"). 8 mg of the drug is injected into a muscle or vein once or twice a day.

Anti-inflammatory non-steroidal drugs of a new generation

More modern, and therefore more effective means:

1. "Movalis" ("Mirloks", "Artrozan"). A very effective drug, produced in tablets, injection solution, suppositories. Virtually no side effects. For injections use 1-2 ml of solution per day. Tablets are taken at 7.5 mg once or twice a day.
2. "Celecoxib". Does not have a detrimental effect on the stomach. Take one or two tablets per day, but not more than 0.4 g of the drug per day.
3. Arcoxia. The drug is in tablets. The dosage is prescribed depending on the severity of the disease.
4. "Nimesulide". Available in tablets, sachets for dilution, in the form of a gel. The dose is determined by the doctor, as well as the rules of admission.