A short guide to anti-inflammatory drugs used in gynecology. Anti-inflammatory drugs New non-steroidal anti-inflammatory drugs list

They are the most common medicines and have been used in medicine for a long time. After all, pain and inflammation accompany most diseases. And for many patients, these medications 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 ensure that they remain highly effective and have no side effects. New generation non-steroidal anti-inflammatory drugs have these properties.

The history of these drugs

In 1829, salicylic acid was obtained, and scientists began to study 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 appearance new group medications that do not have the same negative effects as opiates and are more effective in treating fever and pain. After this, 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 medicine that would act effectively and have no side effects. And only in last years New generation non-steroidal anti-inflammatory drugs with such properties have been obtained.

The principle of action of such drugs

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

All these processes are controlled by special substances - prostaglandins. Nonsteroidal anti-inflammatory drugs, the list of which is growing, affect the formation of these substances. Thanks to this, signs of inflammation are reduced, heat 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, through which prostaglandins are formed. But recently it was discovered that it exists in several forms. And only one of them is a specific inflammatory enzyme. Many NSAIDs act on another form of it, and therefore cause side effects. And new generation non-steroidal anti-inflammatory drugs suppress enzymes that cause inflammation without affecting those that protect the gastric mucosa.

For what diseases are NSAIDs used?

Treatment with nonsteroidal anti-inflammatory drugs is widespread, both in medical institutions, and during self-relief by patients pain symptoms. These medications relieve pain, reduce fever and swelling, and reduce blood clotting. Their use is effective in the following cases:

For joint diseases, arthritis, bruises, muscle strains and myositis (as an anti-inflammatory agent). Non-steroidal anti-inflammatory drugs for osteochondrosis are very effective in relieving pain.

They are often used as an antipyretic for colds and infectious diseases.

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

Side effects

Most often, with long-term use of NSAIDs, gastrointestinal lesions occur: nausea, vomiting, dyspeptic disorders, ulcers and gastric bleeding.

In addition, these drugs also affect the activity of the kidneys, causing disruption of their functions, increased protein in the urine, delayed urine outflow and other disorders.

Even new generation non-steroidal anti-inflammatory drugs are not free from negative effects on the patient’s cardiovascular system; they can cause increased blood pressure, rapid heartbeat and swelling.

Headache, dizziness, and drowsiness often occur after using these medications.

1. These drugs cannot be taken in long courses, so as not to increase the side effects.

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

3. Take these medications with water only, and to reduce side effects you need to drink at least a glass of it.

4. You cannot take several NSAIDs at the same time. This does not enhance the therapeutic effect, but the negative impact will be greater.

5. Do not self-medicate; take medications only as prescribed by your doctor.

7. During treatment with these drugs, you should not drink alcoholic beverages. In addition, NSAIDs affect the effectiveness of some medications, for example, they reduce the effect of hypertensive drugs.

Release forms of NSAIDs

The most popular tablet forms of these drugs. But they are the ones that have the strongest negative effect on the basal lining of the stomach.

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

Another more accessible form of using these drugs is rectal suppositories. They have less negative effects on the stomach, but they are contraindicated for intestinal diseases.

For local inflammatory processes and diseases of the musculoskeletal system, it is best to use external medications. NSAIDs are available in the form of ointments, solutions and creams that effectively relieve combat sensations.

Classification of NSAIDs

Most often, these drugs are divided into two groups according to their chemical composition. There are drugs derived from acids and non-acid. NSAIDs can also be classified according to their effectiveness. Some of them relieve inflammation better, for example, the drugs Dicofenac, Ketoprofen or Movalis. Others are more effective for pain - Ketonal or Indomethacin. There are also those that are most often used to reduce elevated temperature- medications "Aspirin", "Nurofen" or "Nise". New generation non-steroidal anti-inflammatory drugs are also included in a separate group; they are more effective and have no side effects.

NSAIDs, acid derivatives

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

Salicylates, the most common of which is Aspirin;

Pyrazolidines, for example, the drug "Analgin";

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

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

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

Only the drug "Amizon" belongs to isonicotinic acid derivatives.

Non-acid NSAIDs

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

Sulfonamides, for example, the drug "Nimesulide";

Coxib derivatives - Rofecoxib and Celecoxib;

Alkanones, for example, the drug "Nabemeton".

The developing pharmaceutical industry is constantly creating new drugs, but often they are the same in composition as already known non-steroidal anti-inflammatory drugs.

List of the most effective NSAIDs

1. The drug "Aspirin" is the oldest medical drug, still widely used for inflammatory processes and pain. Now it is produced under other names. This substance can be found in the medications “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. It is produced under the names "Voltaren", "Ortofen", "Diklak", "Clodifen" and others.

3. The drug "Ibuprofen" has proven itself to be 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 name "Fastum". "Bystrum", "Ketonal" and others.

New generation NSAIDs

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

Modern NSAIDs meet these requirements. They act selectively, only on those enzymes that control the inflammation process. Therefore, they have less effect on the gastrointestinal tract and do not destroy the cartilage tissue of patients. You can take them for a long time without fear of side effects. The benefits of these medications also include a long period their actions, thanks to which they can be taken less frequently - only once a day. The disadvantages of these drugs include quite high price. Such modern NSAIDs are the drug "Nimesulide", "Meloxicam", "Movalis", "Artrosan", "Amelotex", "Nise" and others.

NSAIDs for 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 is swelling, hyperemia and stiffness of movement. It is best to take NSAIDs; they are 100% effective in cases of inflammatory processes. But since they do not cure, but only relieve symptoms, such medications are used only at the beginning of the disease, to relieve pain.

External agents are most effective in such cases. The best non-steroidal anti-inflammatory drugs for osteochondrosis are the drug "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. Medicines Butadione, Naproxen and Nimesulide are good for pain relief. The most effective non-steroidal anti-inflammatory drugs for arthrosis are tablets; it is recommended to use the medications Meloxicam, Celecoxib or Piroxicam. The choice of drug should be individual, so the doctor should select it.

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

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

Range of products

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

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

Classification

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

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

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

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

New generation

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

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

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

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

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

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

Nimesulide

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

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

Xefocam

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

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

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

Rofecoxib

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

Celecoxib

This drug is very effective in severe pain, while it has absolutely no negative effect on the gastric mucosa, which is a big advantage of the drug. It is produced in the form of capsules of 100 and 200 mg. The cost of 10 capsules is 250 rubles.

Indications

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

• Arthritis, osteoarthritis, gout;
• Bekhterev's disease;
• Pain in various diseases of bones and joints;
• Osteochondrosis;
• Inflammation of soft tissues, synovitis, bursitis;
• Toothache;
• Pain after surgery;
• Fever.

Contraindications

New generation products have the following contraindications:

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

During the treatment period, it is not recommended to drink alcohol or smoke, and it is also necessary to carry out treatment with caution if the patient is taking anticoagulants, glucocorticosteroids, sirotonin reuptake inhibitors, or antiplatelet agents.

Side effects

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

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

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

What to replace

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

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

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

And comfrey.

About the products (video)

The inflammatory process in almost all cases accompanies rheumatic pathology, significantly reducing the patient’s quality of life. That is why one of the leading areas of treatment for joint diseases is anti-inflammatory treatment. Several groups of drugs have this effect: non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids for systemic and local application, partly, only as part of complex treatment - chondroprotectors.

In this article we will look at the group of drugs listed first - NSAIDs.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

This is a group of drugs whose effects are anti-inflammatory, antipyretic and analgesic. The severity of each of them varies from drug to drug. These drugs are called nonsteroidal because they differ in structure from hormonal drugs, glucocorticoids. The latter also have a powerful anti-inflammatory effect, but at the same time they have the negative properties of steroid hormones.

Mechanism of action of NSAIDs

The mechanism of action of NSAIDs is their non-selective or selective inhibition (inhibition) of varieties of the COX enzyme - cyclooxygenase. COX is found in many tissues of our body and is responsible for the production of various biologically active substances: prostaglandins, prostacyclins, thromboxane and others. Prostaglandins, in turn, are mediators of inflammation, and the more of them, the more pronounced the inflammatory process. NSAIDs, by inhibiting COX, reduce the level of prostaglandins in tissues, and the inflammatory process regresses.

NSAID prescription regimen

Some NSAIDs have a number of quite serious side effects, while other drugs in this group are not characterized as such. This is due to the peculiarities of the mechanism of action: influence medicinal substances for different types of cyclooxygenase - COX-1, COX-2 and COX-3.

COX-1 healthy person found in almost all organs and tissues, in particular in the digestive tract and kidneys, where it performs its essential functions. For example, prostaglandins synthesized by COX are actively involved in maintaining the integrity of the gastric and intestinal mucosa, maintaining adequate blood flow in it, reducing secretion of hydrochloric acid, increasing pH, secretion of phospholipids and mucus, stimulating cell proliferation (reproduction). Drugs that inhibit COX-1 cause a decrease in the level of prostaglandins not only in the site of inflammation, but throughout the body, which can lead to Negative consequences, which will be discussed below.

COX-2, as a rule, is absent in healthy tissues or is found, but in insignificant quantities. Its level increases directly during inflammation and at its very source. Drugs that selectively inhibit COX-2, although often taken systemically, act specifically on the lesion, reducing the inflammatory process in it.

COX-3 is also involved in the development of pain and fever, but it has nothing to do with inflammation. Some NSAIDs act specifically on this type of enzyme and have little effect on COX-1 and 2. Some authors, however, believe that COX-3, as an independent isoform of the enzyme, does not exist, and is a variant of COX-1: these questions require conducting additional research.

Classification of NSAIDs

Exists chemical classification non-steroidal anti-inflammatory drugs, based on the structural features of the active substance molecule. However, biochemical and pharmacological terms are probably of little interest to a wide range of readers, so we offer you another classification, which is based on the selectivity of COX inhibition. According to it, all NSAIDs are divided into:
1. Non-selective (affect all types of COX, but mainly COX-1):

• Indomethacin;
• Ketoprofen;
• Piroxicam;
• Aspirin;
• Diclofenac;
• Acyclofenac;
• Naproxen;
• Ibuprofen.

2. Non-selective, affecting equally COX-1 and COX-2:

• Lornoxicam.

3. Selective (inhibit COX-2):

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

Some of the drugs listed above have virtually no anti-inflammatory effect, but rather have an analgesic (Ketorolac) or antipyretic effect (Aspirin, Ibuprofen), so we will not talk about these drugs in this article. Let's talk about those NSAIDs whose anti-inflammatory effect is most pronounced.

Briefly about pharmacokinetics

Nonsteroidal anti-inflammatory drugs are used orally or intramuscularly.
When taken orally, they are well absorbed in the digestive tract, their bioavailability is about 70-100%. They are better absorbed in an acidic environment, and a shift in gastric pH to the alkaline side slows down absorption. The maximum concentration of the active substance in the blood is determined 1-2 hours after taking the drug.

When administered intramuscularly, the drug binds to blood proteins by 90-99%, forming functionally active complexes.

They penetrate well into organs and tissues, especially into the source of inflammation and synovial fluid (located in the joint cavity). NSAIDs are excreted from the body in the urine. The half-life varies widely depending on the drug.

Contraindications to the use of NSAIDs

It is undesirable to use drugs in this group in the following conditions:

• individual hypersensitivity to components;
• , as well as other ulcerative lesions of the digestive tract;
• leuko- and thrombopenia;
• heavy and;
• pregnancy.

Main side effects of NSAIDs

These are:

• ulcerogenic effect (the ability of drugs in this group to provoke the development of the gastrointestinal tract);
• dyspeptic disorders (stomach discomfort, etc.);
• bronchospasm;
• toxic effects on the kidneys (impaired kidney function, increased blood pressure, nephropathy);
• toxic effects on the liver (increased activity of liver transaminases in the blood);
• toxic effects on the blood (reduction in the number of formed elements up to aplastic anemia, manifested);
• prolongation of pregnancy;
• (skin rashes, anaphylaxis).

Number of reports of adverse reactions of NSAID drugs received in 2011-2013

Features of NSAID therapy

Since drugs in this group, to a greater or lesser extent, have a damaging effect on the gastric mucosa, most of them must be taken after meals, with a sufficient amount of water, and, preferably, with the parallel use of drugs to maintain the gastrointestinal tract. As a rule, proton pump inhibitors play this role: Omeprazole, Rabeprazole and others.

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

Persons with impaired renal function, as well as elderly patients, are usually prescribed a dose lower than the average therapeutic dose, since the processes in these categories of patients are slowed down: the active substance both has an effect and is eliminated over a longer period.
Let us consider individual drugs of the NSAID group in more detail.

Indomethacin (Indomethacin, Methindol)

Release form: tablets, capsules.

It has a pronounced anti-inflammatory, analgesic and antipyretic effect. Inhibits the aggregation (sticking together) of platelets. The maximum concentration in the blood is determined 2 hours after administration, the half-life is 4-11 hours.

Prescribed, as a rule, 25-50 mg orally 2-3 times a day.

The side effects listed above are quite pronounced for this drug, so at present it is used relatively rarely, giving way to other drugs that are safer in this regard.

Diclofenac (Almiral, Voltaren, Diklak, Dikloberl, Naklofen, Olfen and others)

Release form: tablets, capsules, injection solution, suppositories, gel.

It has a pronounced anti-inflammatory, analgesic and antipyretic effect. Quickly and completely absorbed from the gastrointestinal tract. The maximum concentration of the active substance in the blood is achieved after 20-60 minutes. Almost 100% absorbed from blood proteins and transported throughout the body. The maximum concentration of the drug in synovial fluid is determined after 3-4 hours, its half-life from it is 3-6 hours, from blood plasma - 1-2 hours. Excreted in urine, bile and feces.

As a rule, the recommended dose of diclofenac for adults is 50-75 mg 2-3 times a day orally. Maximum daily dose equal to 300 mg. The retard form, equal to 100 g of the drug in one tablet (capsule), is taken once a day. When administered intramuscularly, the single dose is 75 mg, the frequency of administration is 1-2 times a day. The drug in the form of a gel is applied in a thin layer to the skin in the area of ​​inflammation, the frequency of application is 2-3 times a day.

Etodolac (Etol Fort)

Release form: 400 mg capsules.

The anti-inflammatory, antipyretic and analgesic properties of this drug are also quite pronounced. It has moderate selectivity - it acts predominantly on COX-2 at the site of inflammation.

Rapidly absorbed from the gastrointestinal tract when taken orally. Bioavailability is independent of food intake and antacid medications. The maximum concentration of the active substance in the blood is determined after 60 minutes. 95% binds to blood proteins. The half-life from blood plasma is 7 hours. It is excreted from the body mainly in urine.

It is used for emergency or long-term treatment of rheumatological pathology: as well as in the case of pain syndrome of any etiology.
It is recommended to take the drug 400 mg 1-3 times a day after meals. If long-term therapy is necessary, the dose of the drug should be adjusted once every 2-3 weeks.

Contraindications are standard. Side effects are similar to those of other NSAIDs, however, due to the relative selectivity of the drug, they appear less frequently and are less pronounced.
Reduces the effect of some antihypertensive drugs, in particular ACE inhibitors.

Aceclofenac (Aertal, Diclotol, Zerodol)

Available in the form of 100 mg tablets.

A worthy analogue of diclofenac with a similar anti-inflammatory and analgesic effect.
After oral administration, it is quickly and almost 100% absorbed by the gastric mucosa. When eating at the same time, the rate of absorption slows down, but its degree remains the same. It binds to plasma proteins almost completely, spreading throughout the body in this form. The concentration of the drug in the synovial fluid is quite high: it reaches 60% of its concentration in the blood. The average half-life is 4-4.5 hours. It is excreted primarily by the kidneys.

Among the side effects, dyspepsia, increased activity of liver transaminases, dizziness should be noted: these symptoms occur quite often, in 1-10 cases out of 100. Other adverse reactions are observed much less frequently, in particular, in less than one patient per 10,000.

The likelihood of side effects can be reduced by prescribing the patient a minimum effective dose in the shortest possible time.

It is not recommended to take aceclofenac during pregnancy and breastfeeding.
Reduces the antihypertensive effect of antihypertensive drugs.

Piroxicam (Piroxicam, Fedin-20)

Release form: 10 mg tablets.

In addition to anti-inflammatory, analgesic and antipyretic effects, it also has an antiplatelet effect.

Well absorbed from the gastrointestinal tract. Simultaneous food intake slows down the rate of absorption, but does not affect the degree of its effect. The maximum concentration in the blood is observed after 3-5 hours. The concentration in the blood is much higher when the drug is administered intramuscularly than after taking it orally. Penetrates 40-50% into synovial fluid and is found in breast milk. Undergoes a number of changes in the liver. Excreted in urine and feces. The half-life is 24-50 hours.

The analgesic effect appears within half an hour after taking the tablet and persists throughout the day.

Dosages of the drug vary depending on the disease and range from 10 to 40 mg per day in one or more doses.

Contraindications and side effects are standard.

Tenoxicam (Texamen-L)

Release form: powder for the preparation of solution for injection.

Apply intramuscularly at 2 ml (20 mg of the drug) per day. In acute cases - 40 mg 1 time per day for 5 days in a row at the same time.

Enhances the effects of indirect anticoagulants.

Lornoxicam (Xefocam, Larfix, Lorakam)

Release form: tablets of 4 and 8 mg, powder for the preparation of solution for injection containing 8 mg of the drug.

The recommended dose for oral administration is 8-16 mg per day 2-3 times. The tablet should be taken before meals with plenty of water.

8 mg is administered intramuscularly or intravenously at a time. Frequency of administrations per day: 1-2 times. The injection solution must be prepared immediately before use. The maximum daily dose is 16 mg.
Elderly patients do not need to reduce the dosage of lornoxicam; however, due to the likelihood of adverse reactions from the gastrointestinal tract, persons with any gastroenterological pathology should take it with caution.

Meloxicam (Movalis, Melbek, Revmoxicam, Recoxa, Melox and others)

Release form: tablets of 7.5 and 15 mg, injection solution of 2 ml in an ampoule containing 15 mg of active substance, rectal suppositories also containing 7.5 and 15 mg of Meloxicam.

Selective COX-2 inhibitor. Less common than other drugs in the NSAID group, it causes side effects such as kidney damage and gastropathy.

As a rule, the drug is administered parenterally in the first few days of treatment. 1-2 ml of solution is injected deep into the muscle. When the acute inflammatory process subsides a little, the patient is transferred to the tablet form of meloxicam. It is taken orally, regardless of food intake, 7.5 mg 1-2 times a day.

Celecoxib (Celebrex, Revmoxib, Zycel, Flogoxib)

Release form: capsules of 100 and 200 mg of the drug.

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

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

Side effects are rare. In case of long-term use of the drug in high dosage, ulceration of the mucous membrane of the digestive tract is possible, gastrointestinal bleeding, agranulocytosis and.

Rofecoxib (Denebol)

Release form: solution for injection in 1 ml ampoules containing 25 mg of active substance, tablets.

A highly selective COX-2 inhibitor with pronounced anti-inflammatory, analgesic and antipyretic properties. It has virtually no effect on the mucous membrane of the gastrointestinal tract and kidney tissue.

Prescribed with caution to women in the 1st and 2nd trimesters of pregnancy, during breastfeeding, to persons suffering or severe.

The risk of developing side effects from the gastrointestinal tract increases when taking high dosages of the drug for a long time, as well as in elderly patients.

Etoricoxib (Arcoxia, Exinef)

Release form: tablets of 60 mg, 90 mg and 120 mg.

Selective COX-2 inhibitor. It does not affect the synthesis of gastric prostaglandins and has no effect on platelet function.

The drug is taken orally regardless of food intake. The recommended dose directly depends on the severity of the disease and varies between 30-120 mg per day in 1 dose. Elderly patients do not need to adjust the dosage.

Side effects are extremely rare. As a rule, they are noted by patients taking etoricoxib for 1 year or more (for serious rheumatic diseases). Range adverse reactions, arising in this case, is extremely wide.

Nimesulide (Nimegesic, Nimesil, Nimid, Aponil, Nimesin, Remesulide and others)

Release form – tablets of 100 mg, granules for the preparation of a suspension for oral administration in sachets containing 1 dose of the drug – 100 mg each, gel in a tube.

A highly selective COX-2 inhibitor with pronounced anti-inflammatory, analgesic and antipyretic effects.

Take the drug orally, 100 mg twice a day, after meals. The duration of treatment is determined individually. The gel is applied to the affected area, lightly rubbing into the skin. Frequency of application – 3-4 times a day.

When prescribing Nimesulide to elderly patients, no dose adjustment is required. The dose should be reduced if severe violation the patient's liver and kidney function. May have a hepatotoxic effect, inhibiting liver function.

During pregnancy, especially in the 3rd trimester, taking nimesulide is strictly not recommended. The drug is also contraindicated during breastfeeding.

Nabumethon (Sinmeton)

Release form: tablets of 500 and 750 mg.

Non-selective COX inhibitor.

A single dose for an adult patient is 500-750-1000 mg during or after meals. In especially severe cases, the dose can be increased to 2 grams per day.

Side effects and contraindications are similar to those of other non-selective NSAIDs.
It is not recommended to take during pregnancy and breastfeeding.

Combined non-steroidal anti-inflammatory drugs

There are drugs that contain two or more active substances from the NSAID group, or NSAIDs in combination with vitamins or other drugs. The main ones are listed below.

• Dolaren. Contains 50 mg diclofenac sodium and 500 mg paracetamol. In this drug, the pronounced anti-inflammatory effect of diclofenac is combined with the strong analgesic effect of paracetamol. Take the drug orally, 1 tablet 2-3 times a day after meals. The maximum daily dose is 3 tablets.
• Neurodiclovit. Capsules containing 50 mg of diclofenac, vitamin B1 and B6, as well as 0.25 mg of vitamin B12. Here, the analgesic and anti-inflammatory effect of diclofenac is enhanced by B vitamins, which improve metabolism in nervous tissue. The recommended dose of the drug is 1-3 capsules per day in 1-3 doses. Take the drug after meals with a sufficient amount of liquid.
• Olfen-75, produced in the form of an injection solution, in addition to diclofenac in an amount of 75 mg, also contains 20 mg of lidocaine: due to the presence of the latter in the solution, injections of the drug become less painful for the patient.
• Fanigan. Its composition is similar to that of Dolaren: 50 mg of diclofenac sodium and 500 mg of paracetamol. It is recommended to take 1 tablet 2-3 times a day.
• Flamidez. Very interesting, different from others medicinal product. In addition to 50 mg of diclofenac and 500 mg of paracetamol, it also contains 15 mg of serratiopeptidase, which is a proteolytic enzyme and has fibrinolytic, anti-inflammatory and decongestant effects. Available in the form of tablets and gel for topical use. The tablet is taken orally, after meals, with a glass of water. As a rule, 1 tablet is prescribed 1-2 times a day. The maximum daily dose is 3 tablets. The gel is used externally, applying it to the affected area of ​​the skin 3-4 times a day.
• Maxigesik. A drug similar in composition and action to Flamidez, described above. The difference lies in the manufacturing company.
• Diplo-P-Pharmex. The composition of these tablets is similar to that of Dolaren. The dosages are the same.
• Dollar The same.
• Dolex. The same.
• Oksalgin-DP. The same.
• Cynepar. The same.
• Dilocaine. Like Olfen-75, it contains diclofenac sodium and lidocaine, but both active ingredients are in half the dosage. Accordingly, it is weaker in action.
• Dolaren gel. Contains sodium diclofenac, menthol, linseed oil and methyl salicylate. All these components, to one degree or another, have an anti-inflammatory effect and potentiate each other’s effects. The gel is applied to the affected areas of the skin 3-4 times during the day.
• Nimid forte. Tablets containing 100 mg nimesulide and 2 mg tizanidine. This drug successfully combines the anti-inflammatory and analgesic effects of nimesulide with the muscle relaxant (muscle relaxing) effect of tizanidine. Used when acute pain caused by spasm skeletal muscles(popularly - when the roots are pinched). Take the drug orally after meals with plenty of liquid. The recommended dose is 2 tablets per day in 2 divided doses. The maximum duration of treatment is 2 weeks.
• Nizalid. Like nimide forte, it contains nimesulide and tizanidine in similar dosages. The recommended doses are the same.
• Alit. Soluble tablets containing 100 mg of nimesulide and 20 mg of dicycloverine, which is a muscle relaxant. Take orally after meals with a glass of liquid. It is recommended to take 1 tablet 2 times a day for no longer than 5 days.
• Nanogan. The composition of this drug and recommended dosages are similar to those of the drug Alit described above.
• Oxygen. The same.

Anti-inflammatory drugs I

drugs that suppress the inflammatory process by preventing the mobilization or transformation of arachidonic acid. To P. s. do not include drugs that can influence the inflammatory process through other mechanisms, in particular, “basic” antirheumatic drugs (gold salts, D-penicillamine, sulfasalazine), (colchicine), quinoline derivatives (chloroquine).

There are two main groups of P. s.: glucocorticosteroids and nonsteroidal anti-inflammatory drugs.

Indications for the use of glucocorticosteroids as P. s. are predominantly pathoimmune. They are widely used in the acute phase of systemic diseases connective tissue(Connective tissue), arthritis, sarcoidosis, alveolitis, non-infectious inflammatory diseases skin.

Taking into account the influence of glucocorticosteroids on many functions of the body (see Corticosteroid hormones) and the possible formation of a dependence of the course of a number of illnesses (etc.) on the regularity of use of these drugs (dangerous manifestations of withdrawal) to their prescription as P. s. treat with some caution and strive to reduce the duration of their continuous use. On the other hand, among all P. s. glucocorticosteroids have the most pronounced anti-inflammatory effect, so a direct indication for their use is an inflammatory process that is dangerous to the life or ability of the patient (in the central nervous system, in the conduction system of the heart, in the eyes, etc.).

Side effects of glucocorticosteroids depend on their daily dose, duration of use, route of administration (local, systemic), as well as on the properties of the drug itself (severity of mineralocorticoid activity, effect on, etc.). When used locally, a local decrease in resistance to infectious agents is possible with the development of local infectious complications. With the systemic use of glucocorticosteroids, Cushing's, steroid, gastric steroid, steroid, development of osteoporosis, sodium and water retention, potassium loss, arterial, myocardial dystrophy, infectious complications (primarily tuberculosis), development of psychosis, withdrawal syndrome in a number of diseases (severe symptoms after cessation of treatment), adrenal insufficiency (after long-term use of glucocorticosteroids).

Contraindications to the systemic use of glucocorticosteroids: tuberculosis and other infectious diseases, diabetes, (including in the postmenopausal period), stomach and duodenum, arterial hypertension, tendency to thrombosis, mental disorders, . When used locally (respiratory tract), the main contraindication is the presence of an infectious process in the same area of ​​the body.

The main forms of release of glucocorticosteroids used as P. s. are given below.

Beclamethasone- dosed (beclomet-easyhaler) and dosed for inhalation with bronchial asthma(aldecine, beclazon, beclomet, beklocort, beclofort, becotide) or for intranasal use for allergic rhinitis (beconase, nasobek) at 0.05, 0.1 and 0.25 mg in one dose. For bronchial asthma, the daily value ranges from 0.2-0.8 mg. To prevent the development of candidiasis oral cavity and upper respiratory tract It is recommended to use oral water after each inhalation of the drug. At the beginning of treatment, hoarseness and sore throat sometimes appear, which usually disappear within the first week.

Betamethasone(celeston) - tablets 0.5 mg and solution in ampoules of 1 ml (4 mg) for intravenous, intra-articular, subconjunctival administration; depot form (“diprospan”) - solution in ampoules of 1 ml (2 mg betamethasone disodium phosphate and 5 mg slowly absorbed betamethasone dipropionate) for intramuscular and intraarticular administration.

For cutaneous use - creams and tubes under the names “Betnovate” (0.1%), “Diprolene” (0.05%), “Kuterid” (0.05%), “Celestoderm” (0.1%).

Budesonide(budesonide mite, budesonide forte, pulmicort) - dosed at 0.05 and 0.2 mg in one dose, as well as dosed powder of 0.2 mg(pulmicort turbuhaler) for inhalation for bronchial asthma (therapeutic dose 0.2-0.8 mg/day); 0.025% ointment (“apulein”) for external use for atopic dermatitis, eczema, psoriasis (apply a thin layer to the affected areas of the skin 1-2 times a day).

Hydrocortisone(solu-cortef, sopolcort N) - injection suspension 5 ml in bottles (25 mg in 1 ml), as well as solution for injection in ampoules of 1 ml (25 mg) and lyophilized powder for injection, 100 mg with the supplied solvent. Used for intravenous, intramuscular and intra-articular administration (25 mg drug, in small ones - 5 mg). For external use it is available in the form of 0.1% creams, ointments, lotions, emulsions (under the names “laticort”, “lokoid”) and 1% ointments (“Cortade”).

When administered intra-articularly, the drug can cause the development of osteoporosis and the progression of degenerative changes in the joints. Therefore, it should not be used for secondary synovitis in patients with deforming arthrosis.

Desonide(prenacid) - 0.25% solution in bottles of 10 ml(eye) and 0.25% eye ointment (10 G in a tube). A water-soluble, halogen-free glycocorticoid with a pronounced anti-inflammatory effect. Indicated for iritis, iridocyclitis, episcleritis, conjunctivitis, scaly blepharitis, chemical damage to the cornea. Drops are used during the day (1-2 drops 3-4 times a day), and eye ointment is used at night.

Dexamethasone(decdan, dexabene, dexaven, dexazone, dexamed, dexona, detazone, fortecortin, fortecortin) - tablets of 0.5, 1.5 and 4 mg; solution in ampoules of 1 ml (4 mg), 2 ml(4 or 8 mg) and 5 ml (8 mg/ml) for intramuscular or intravenous (in isotonic sodium chloride solution or 5% glucose solution) administration; 0.1% solution in bottles of 10 and 15 ml(eye drops) and 0.1% eye suspension in bottles of 10 ml. Fluorinated synthetic glucocorticoid with a pronounced anti-inflammatory and antiallergic effect. Parenteral use of the drug during systemic therapy should not be long (no more than a week). 4-8 are prescribed orally mg 3-4 times a day.

Clobetasol(dermovate) - 0.05% cream and ointment in tubes. Used for psoriasis, eczema, discoid lupus erythematosus. Apply a thin layer to the affected areas of the skin 1-2 times a day until improvement occurs. Side effects: local skin.

Mazipredone- water-soluble synthetic derivative of prednisolone: ​​solution for injection in ampoules of 1 ml(30 pcs.) for intravenous (slow) or intramuscular administration, as well as 0.25% emulsion ointment (deperzolon) for external use for dermatitis, eczema, diaper rash, red lichen planus, discoid lupus, psoriasis, otitis externa. Apply a thin layer to the skin (on the soles and palms - under compression bandages) 2-3 times a day. Avoid getting the ointment in your eyes! With long-term use, systemic side effects are possible.

Methylprednisolone(medrol, metypred, solu-medrol, urbazon) - tablets of 4, 16, 32 and 100 mg; dry matter 250 mg and 1 G in ampoules with the accompanying solvent for intravenous administration; depot forms (“depo-medrol”) - for injection in bottles of 1, 2 and 5 ml (40 mg/ml), characterized by long-term (up to 6-8 days) suppression of the activity of the hypothalamic-pituitary-adrenal system. Mainly used for systemic therapy (, systemic diseases connective tissue, leukemia, different kinds shock, adrenal insufficiency, etc.). Depo-Medrol can be administered intra-articularly (20-40 mg in large joints, 4-10 mg- into small ones). Side effects are systemic.

Methylprednisolone aceponate(“advantan”) - ointment 15 G in tubes. Used for various forms eczema. Apply to affected areas of the skin once a day. With prolonged use, erythema, skin atrophy, and acne-like elements are possible.

Mometasone- dosed aerosol (1 dose - 50 mcg) for intranasal use for allergic rhinitis (drug “Nasonex”); 0.1% cream, ointment (in tubes), lotion, used for psoriasis, atopic and other dermatitis (drug “elokom”).

Intranasal inhalation of 2 doses each 1 time per day. The ointment and cream are applied in a thin layer to the affected areas of the skin once a day; For hairy parts use lotion on the skin (a few drops rubbed in once a day). With long-term use, systemic side effects are possible.

Prednisone(apo-prednisone) - tablets of 5 and 50 mg. Clinical Application limited.

Prednisolone(decortin N, medopred, prednisol) - tablets of 5, 20, 30 and 50 mg; solution for injection in ampoules of 1 ml containing 25 or 30 mg prednisolone or 30 mg mazipredone (see above); suspension for injection in ampoules of 1 ml (25 mg); lyophilized powder in ampoules of 5 ml (25 mg); eye suspension in bottles of 10 ml (5 mg/ml); 0.5% ointment in tubes. For systemic therapy, it is used in the same cases as methylprednisolone, but in comparison it exhibits a greater mineralocorticoid effect with a more rapid development of systemic side effects.

Triamcinolone(azmacort, berlicort, kenacort, kenalog, nazacort, polcortolone, triacort, tricort, fluorocort) - 4 tablets mg; dosed aerosols for inhalation for bronchial asthma (1 dose - 0.1 mg) and for intranasal use for allergic rhinitis (1 dose - 55 mcg); solution and suspension for injection in bottles and ampoules of 1 ml(10 or 40 mg); 0.1% cream, 0.025% and 0.1% ointments for cutaneous use (in tubes); 0.1% for topical use in dentistry (Kenalog Orabase drug). Used for systemic and local therapy; Local use in ophthalmology is prohibited. When administered intra-articularly (in large joints 20-40 mg, in small joints - 4-10 mg) duration therapeutic effect can reach 4 weeks. and more. The drug is used orally and cutaneously 2-4 times a day.

Flumethasone(Lorindene) - 0.02% lotion. Glucocorticoid for external use. Included in combination ointments. Used for psoriasis, eczema, allergic dermatitis. Apply a thin layer to the affected areas of the skin 1-3 times a day. Avoid getting the drug in your eyes! For extensive skin lesions, it is used only for a short time.

Flunisolide(Ingacort, Sintaris) - dosed aerosols for inhalation for bronchial asthma (1 dose - 250 mcg) and for intranasal use for allergic rhinitis (1 dose - 25 mcg). Prescribed 2 times a day.

Fluocinolone(sinalar, sinaflan, flucort, flucinar) - 0.025% cream, ointment in tubes. Used in the same way as flumethasone.

Fluticasone(cutivate, flixonase, flixotide) - metered aerosol (1 dose - 125 or 250 mcg) and powder in rotadiscs (doses: 50, 100, 250 and 500 mcg) for inhalation for bronchial asthma; dosed aqueous spray for intranasal use for allergic rhinitis. Apply 2 times a day.

Nonsteroidal anti-inflammatory drugs(NSAIDs) are substances of various chemical structures that, in addition to anti-inflammatory, also, as a rule, have analgesic and antipyretic activity. The NSAID group consists of derivatives of salicylic acid (acetylsalicylic acid, mesalazine), indole (indomethacin, sulindac), pyrazolone (phenylbutazone, clofezone), phenylacetic acid (diclofenac), propionic acid (ibuprofen, naproxen, flurbiprofen, ketoprofen), oxicam (meloxicam, piroxicam , tenoxicam) and other chemical groups (benzydamine, nabumetone, niflumic acid, etc.).

The mechanism of the anti-inflammatory action of NSAIDs is associated with their inhibition of the enzyme cyclooxygenase (COX), which is responsible for the transformation of arachidonic acid into prostacyclin and thromboxane. There are two isoforms of cyclooxygenase. COX-1 is constitutional, “useful”, participating in the formation of thromboxane A 2, prostaglandin E 2, prostacyclin. COX-2 is an “inducible” enzyme that catalyzes the synthesis of prostaglandins involved in the inflammatory process. Most NSAIDs equally inhibit COX-1 and COX-2, which leads, on the one hand, to suppression of the inflammatory process, and on the other, to a decrease in the production of protective prostaglandins, which disrupts reparative processes in the stomach and underlies the development of gastropathy. That is, the mechanism of the main action of NSAIDs also contains a mechanism for the development of their main “side” actions, which are more correctly called undesirable for their intended use as P. s.

NSAIDs are used mainly in rheumatology. Indications for their use include other systemic connective tissue diseases: acute and chronic inflammatory diseases of the joints; secondary in degenerative joint diseases; microcrystalline (chondrocalcinosis, hydroxyapatite); extra-articular rheumatism. As part of complex therapy, NSAIDs are also used for other inflammatory processes (adnexitis, prostatitis, cystitis, phlebitis, etc.), as well as for neuralgia, myalgia, and injuries of the musculoskeletal system. The antiplatelet properties of acetylsalicylic acid (it irreversibly inhibits cyclooxygenase; in other drugs this effect is reversible within the half-life of the drug) led to its use in cardio- and angiology for the prevention of thrombosis.

A single dose of any NSAID provides only an analgesic effect. The anti-inflammatory effect of the drug appears after 7-10 days of regular use. The anti-inflammatory effect is monitored according to clinical (reduction of swelling, pain severity) and laboratory data. If there is no effect within 10 days, the drug should be replaced with another from the NSAID group. In case of local inflammatory process (bursitis, enthesitis, moderately severe), treatment should begin with local dosage forms (ointments, gels) and only if there is no effect, systemic therapy should be resorted to (orally, in suppositories, parenterally). For patients with acute arthritis (for example, gout), parenteral administration of drugs is indicated. For clinically significant chronic arthritis Systemic NSAID therapy should be immediately prescribed, with empirical selection of an effective and well-tolerated drug.

All NSAIDs have comparable anti-inflammatory effects, approximately equal to those of aspirin. Group differences relate mainly to side effects not related to the action of NSAIDs.

Side effects common to all NSAIDs include, first of all, the so-called NSAID gastropathy, affecting predominantly the antrum of the stomach (erythema of the mucous membrane, hemorrhage, erosion, ulcers); possibly gastric. Other gastrointestinal side effects include constipation. Inhibition of renal cyclooxygenase can clinically manifest itself as fluid retention (sometimes with arterial hypertension and heart failure), the development of acute or progression of existing renal failure, hyperkalemia. By reducing platelet aggregation, NSAIDs can promote bleeding, including from gastrointestinal ulcers, and aggravate the course of NSAID gastropathy. Other manifestations of the side effects of NSAIDs include skin (itching, cervical dysfunction). - (more often when using indomethacin), tinnitus, visual disturbances, sometimes (, confusion,), as well as side effects associated with individual hypersensitivity to the drug (urticaria, Quincke's edema).

Contraindications to the use of NSAIDs: up to 1 year (for certain drugs - up to 12 years); "aspirin"; stomach ulcer and duodenum; renal or liver failure, edema; increased, upcoming, individual intolerance to NSAIDs in history (asthma attacks, urticaria), last trimester of pregnancy, breastfeeding.

Selected NSAID medications are listed below.

Lysine acetylsalicylate(aspizol) - powder for injection 0.9 G in bottles with the supplied solvent. Administered intramuscularly or intravenously, mainly for fever, at a dose of 0.5-1 G; daily dose - up to 2 G.

Acetylsalicylic acid(aspilite, aspirin, aspirin UPSA, acesal, acylpyrin, bufferin, Magnyl, Novandol, Plidol, Salorin, Sprit-Lime, etc.) - tablets of 100, 300, 325 and 500 mg, "effervescent tablets" 325 and 500 mg. As a P. s. prescribed 0.5-1 G 3-4 times a day (up to 3 G/day); for the prevention of thrombosis, incl. repeated myocardial infarction is used in a daily dose of 125-325 mg(preferably in 3 doses). In case of an overdose, dizziness occurs in the ears. In children, aspirin use can lead to the development of Reye's syndrome.

Benzydamine(tantum) - tablets 50 each mg; 5% gel in a tube. It has good absorption when applied to the skin; used mainly for phlebitis, thrombophlebitis, after operations on the veins of the extremities. 50 are prescribed orally mg 4 times a day; The gel is applied to the skin of the affected area and gently rubbed until absorbed (2-3 times a day).

For use in dentistry (gingivitis, glossitis, stomatitis,) and for diseases of the ENT organs (laryngitis, tonsillitis), the drug “tantum verde” is produced - lozenges of 3 mg; 0.15% solution in bottles of 120 ml and metered dose aerosol (1 dose - 255 mcg) for topical use.

In gynecology, the drug “tantum rose” is used - 0.1% solution for topical use, 140 ml in disposable syringes and dry substance for preparing a similar solution in bags containing 0.5 G benzydamine hydrochloride and other ingredients (up to 9.4 G).

When taken orally and the resorptive effect of a locally applied drug, side effects are possible: dry mouth, nausea, swelling, sleep disturbances, hallucinations. Contraindications: age under 12 years, pregnancy and breastfeeding, increased use of the drug.

Diclofenac(Veral, Voltaren, Votrex, Diclogen, Diclomax, Naklof, Naklofen, Ortofen, Rumafen, etc.) - tablets of 25 and 50 mg; retard tablets 75 and 100 mg; 50 each mg; capsules and retard capsules (75 and 100 each mg); 2.5% solution for injection in ampoules of 3 and 5 ml(75 and 125 mg); rectal 25, 50 and 100 mg; 0.1% solution in bottles of 5 ml- eye drops (drug “naklof”); 1% gel and 2% ointment in tubes. Orally, adults are prescribed 75-150 mg/day in 3 doses (retard forms in 1-2 doses); intramuscularly - 75 mg/day (as an exception for 75 mg 2 times a day). For juvenile rheumatoid arthritis, the exact dose should not exceed 3 mg/kg. Gel and ointment (cutaneously over the affected area) are used 3-4 times a day. The drug is well tolerated; side effects are rare.

Ibuprofen(brufen, burana, ibusan, ipren, markofen, perofen, solpaflex, etc.) - tablets of 200, 400 and 600 mg; 200 tablets mg; extended-release capsules 300 each mg; 2% and 2% suspension in bottles of 100 ml and suspension in bottles of 60 and 120 ml (100 mg at 5 ml) for oral administration. The therapeutic dose in adults orally is 1200-1800 mg/day (maximum - 2400 mg/day) in 3-4 doses. The drug "Solpaflex" (long-acting) is prescribed at 300-600 mg 2 times a day. (maximum daily dose 1200 mg). Overdose may cause liver dysfunction.

Indomethacin(indobene, indomin, methindol) - tablets and dragees 25 each mg; retard tablets 75 each mg; capsules 25 and 50 mg; rectal suppositories 50 and 100 mg; solution for injection in ampoules of 1 and 2 ml(30 each mg in 1 ml); 1% gel and 5% ointment for cutaneous use in tubes. The therapeutic dose for adults orally is 75-150 mg/day (in 3 doses), maximum - 200 mg/day use 1 time per day. (at night). At acute attack gout patients are recommended to take the drug 50 mg every 3 h. In case of an overdose, severe headache and dizziness (sometimes combined with an increase), as well as nausea, disorientation, are possible. With long-term use, retino- and due to deposition of the drug in the retina and cornea are observed.

Ketoprofen(actron, ketonal, knavon, oruvel, prontoket spray) - 50 capsules mg, tablets 100 mg and retard tablets 150 and 200 mg; 5% solution (50 mg/ml) for oral administration (drops); injection solution (50 mg/ml) in ampoules of 2 ml; lyophilized dry substance for intramuscular injection and the same for intravenous administration, 100 each mg in bottles with the supplied solvent; candles 100 each mg; 5% cream and 2.5% gel in tubes; 5% solution (50 mg/ml) for external use 50 each ml in a spray bottle. Prescribed orally at 50-100 mg 3 times a day; retard tablets - 200 mg 1 time per day. during meals or 150 mg 2 times a day; suppositories, as well as cream and gel are used 2 times a day. (at night and in the morning). 100 are administered intramuscularly mg 1-2 times a day; intravenous administration produced only in a hospital (in cases where intramuscular injection is not possible), in a daily dose of 100-300 mg no more than 2 days. contract.

Clofezone(perclusone) is an equimolecular compound of clofexamide and phenylbutozone in capsules, suppositories and ointment form. Lasts longer than phenylbutazone; prescribed at 200-400 mg 2-3 times a day. The drug cannot be combined with other pyrazolone derivatives.

Mezalazine(5-AGA, salosinal, salofalk), 5-aminosalicylic acid - dragees and enteric-coated tablets of 0.25 and 0.5 G; rectal suppositories 0.25 and 0.5 G; suspension for use in enemas (4 G by 60 ml) in disposable containers. Used for Crohn's disease, nonspecific ulcerative colitis, irritable bowel syndrome, postoperative anastomositis, complicated hemorrhoids. In the acute phase of these diseases, 0.5-1 G 3-4 times a day, for maintenance therapy and prevention of exacerbations - 0.25 G 3-4 times a day.

Meloxicam(movalis) - tablets 7.5 mg; rectal suppositories 15 each mg. It primarily inhibits COX-2, and therefore has a less pronounced ulcerogenic effect than other NSAIDs. Therapeutic dose for secondary inflammation in patients with arthrosis - 7.5 mg/day; for rheumatoid arthritis, use the maximum daily dose - 15 mg(in 2 doses).

Nabumethon(relafen) - tablets of 0.5 and 0.75 G. metabolized in the liver to form an active metabolite with a T1/2 of about 24 h. Highly effective for rheumatid arthritis. Prescribed once a day. in dose 1 G, if necessary - up to 2 G/day (in 2 doses). Side effects, in addition to those common to NSAIDs: the possibility of developing eosinophilic pneumonia, alveolitis, interstitial nephritis, nepheotic syndrome, hyperuricemia.

Naproxen(apo-naproxen, apranax, daprox, nalgesin, naprobene, naprosyn, noritis, pronaxen) - tablets of 125, 250, 275, 375, 500 and 550 mg; oral suspension (25 mg/ml) in bottles of 100 ml; rectal suppositories 250 and 500 mg. has a pronounced analgesic effect. Prescribed 250-550 mg 2 times a day; for an acute attack of gout, the first dose is 750 mg, then every 8 h 250-500 each mg for 2-3 days (until the attack stops), after which the dose is reduced.

Niflumic acid(donalgin) - capsules 0.25 G. For exacerbation of rheumatic diseases, 0.25 is prescribed G 3 times a day. (maximum 1 G/day), upon achieving improvement, the dose is reduced to 0.25-0.5 G/day For an acute attack of gout, the first dose is 0.5 G, in 2 h - 0,25 G and after 2 more h - 0,25 G.

Piroxicam(apo-piroxicam, Breksik-DT, movon, pirocam, remoxicam, roxicam, sanikam, felden, hotemin, erazon) - tablets and capsules of 10 and 20 mg; dissolvable tablets 20 each mg; 2% solution (20 mg/ml) for injection in ampoules of 1 and 2 ml; rectal suppositories 10 and 20 mg; 1% cream, 1% and 2% gel in tubes (for cutaneous use). After absorption, it penetrates well into the synovial fluid; T 1/2 from 30 to 86 h. Prescribed orally, intramuscularly and in suppositories 1 time per day. at a dose of 20-30 mg(maximum dose - 40 mg/day); during an acute attack of gout on the first day 40 mg once, in the next 4-6 days - 20 mg 2 times a day. (For long-term treatment gout drug is not recommended).

Sulindak(clinoril) - tablets 200 mg. Prescribed 2-3 times a day. The therapeutic dose is 400-600 mg/day

Tenoxicam(tenikam, tenoctil, tilcotil, tobitil) - tablets and capsules 20 each mg; rectal suppositories 10 each mg. Penetrates well into synovial fluid; T 1/2 60-75 h. Prescribed once a day. on average 20 mg. In case of an acute attack of gout, in the first two days the maximum daily dose is given - 40 mg. Special side effects: swelling around, visual disturbances; interstitial, glomerulonephritis, probable.

Phenylbutazone(butadione) - tablets of 50 and 150 mg, tablets 200 each mg; 20% solution for injection (200 mg/ml) in ampoules of 3 ml; 5% ointment in tubes. Prescribed orally at 150 mg 3-4 times a day. The ointment is applied in a thin layer (without rubbing) onto the skin over the affected joint or other affected area (for dermatitis, skin burns, insect bites, superficial thrombophlebitis etc.) 2-3 times a day. In case of deep thrombophlebitis, the drug is not used. other NSAIDs are more likely to develop aplastic and agranulocytosis.

Flurbiprofen(flugalin) - tablets of 50 and 100 mg, retard capsules 200 each mg; rectal suppositories 100 each mg. The therapeutic dose is 150-200 mg/day (in 3-4 doses), maximum daily dose 300 mg. Retard capsules are used once a day.

II Anti-inflammatory drugs

The ability to reduce inflammatory processes varies chemical structure. The most active hormones in this regard are the hormones of the adrenal cortex and their synthetic substitutes - the so-called glucocorticoids (prednisolone, dexamethasone, etc.), which, in addition, have a strong anti-allergic effect. During treatment with glucocorticoids, their side effects often occur: metabolic disorders, retention of sodium and water in the body and an increase in blood plasma volume, increased blood pressure, ulceration of the gastric mucosa and duodenum, immunosuppression, etc. With long-term use of glucocorticoids, the synthesis of natural hormones in the adrenal glands decreases, as a result of which, when taking these drugs, signs of insufficient function of the adrenal cortex may develop. In this regard, treatment with glucocorticoids should be carried out under constant medical supervision, using them without a doctor’s prescription is dangerous. also included in a number of ointments and suspensions (for example, prednisolone ointment, ointments “Ftorokort”, “Sinalar”, “Locacorten”, “Lorinden S”, “Celestoderm V”, etc.) used externally for inflammatory diseases of the skin and mucous membranes . Use these dosage forms You shouldn’t do it without a doctor’s prescription, either. In this case, exacerbations of certain skin diseases and other serious complications may occur.

As a P. s. Some painkillers are used from among the so-called non-narcotic analgesics, for example acetylsalicylic acid, analgin, amidopyrine, butadione and drugs similar in properties (indomethacin, ibuprofen, ortofen, etc.). They are inferior to glucocorticoids in anti-inflammatory activity, but also have less pronounced side effects, which allows them to be widely used for the treatment of inflammatory diseases of the joints, muscles and internal organs.

A moderate anti-inflammatory effect is also exerted by (tannin, tanalbin, oak bark, romazulon, basic bismuth nitrate, dermatol, etc.), which are used mainly topically for inflammatory lesions of the skin and mucous membranes. Forming a protective film with protein substances of tissues, they protect the mucous membranes and the affected surface from irritation and prevent the further development of the inflammatory process.

For inflammatory processes of the gastrointestinal tract, especially in children, they are prescribed, for example, mucus from starch, flax seeds, rice water, etc.; they do not have an anti-inflammatory effect, but only protect the surface of the mucous membrane from irritation. Enveloping agents are also used when prescribing medications that, in addition to the main ones, also have an irritating effect.

The listed groups of drugs do not directly affect the cause of inflammation. In contrast, chemotherapeutic drugs - sulfonamide drugs, etc. - have specific anti-inflammatory properties, which are determined primarily by their ability to suppress the vital activity of certain microorganisms and prevent the development of inflammatory processes in infectious diseases. They are used for inflammatory processes infectious origin only as prescribed by a doctor.

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

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

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

• Paracetamol.
• Citramon.
• Panadol Extra.
• Coldrex.
• TeraFlu.
• Femizol.
• Ferwerks.
• Aspirin-S.
• Ibuprofen.
• Nise.
• Nimesulide.

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

Features of application

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

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

Paracetamol

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

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

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

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

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

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

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

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

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

Panadol Extra

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

Panadol Extra helps relieve colds, acute tonsillitis, laryngopharyngitis and other infectious and inflammatory pathologies of the respiratory system and ENT organs. Most adults and children tolerate this anti-inflammatory drug quite well. Usually, special problems There is no medicine with suction and excretion. Panadol Extra is not prescribed to patients who have hypersensitivity to the active substances. In rare cases, side effects occur, which may include:

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

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

Coldrex

For acute infectious diseases of the upper respiratory tract, Coldrex can be used. This is a complex anti-inflammatory drug consisting of:

• Paracetamol.
• Caffeine.
• Phenylephrine.
• Terpinhydrate.
• Ascorbic acid.

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

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

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

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

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

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

Fervex

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

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

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

• Allergies to the active ingredients (paracetamol, ascorbic acid and pheniramine).
• Serious problems with digestive system(for example, peptic ulcer).
• Severe renal impairment.
• Portal hypertension.
• Alcoholism.
• Glucose-6-phosphate dehydrogenase deficiency.
• Pregnancy and breastfeeding.

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

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

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

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

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

Aspirin-S

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

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

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

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

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

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

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

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

Ibuprofen

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

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

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

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

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

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

• Ibufen.
• Nurofen.
• Advil.
• Faspik.
• Yprene.

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

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

Nise

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

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

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

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

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