General anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs: list of medications, why they are prescribed, for what diseases Non-steroidal anti-inflammatory drugs NSAIDs

Colds are almost always accompanied by severe weakness and fatigue. Pain throughout the body gives no rest. Only an analgesic and anti-inflammatory drug will help cope with such symptoms. We choose anti-inflammatory drugs for colds.

Most drugs that eliminate inflammatory processes in the body are made on the basis of:

• ketoprofen;
• aspirin;
• ibuprofen;
• naproxena.

These drugs not only reduce inflammation, but also relieve high fever and all pain.

Drugs that have a strong anti-inflammatory effect

Behind Lately The number of medications for the treatment of colds has increased significantly. Most do not cause serious contraindications or negative effects. You can buy them at any pharmacy without a prescription.

A medicine with a narrow scope of application. High efficiency and the absence of serious side effects ensured high popularity of Arbidol. Used for colds and seasonal exacerbations of chronic respiratory diseases.

The main active ingredient of Panadol is Paracetamol. It is produced in various forms, the application depends on the age of the patient and his general condition. The product is quite easily tolerated, effectively reduces fever and eliminates headaches and muscle pain. It has a pronounced antipyretic and analgesic effect.

The product is intended for oral use; the tablet must be dissolved in water before use.

Used in complex therapy to reduce temperature, eliminate pain and inflammatory processes in the body. It does not have any serious side effects.

A combined medicine in aerosol form is intended for the treatment of the upper respiratory tract. The active substances are fixed in the mucous membrane, providing a rapid therapeutic effect. Neutralizes pathogenic microorganisms, stops the inflammatory process, cleanses the mucous membrane of purulent plaque.

Inhalipt does not affect metabolic processes, is well tolerated, and does not cause allergic reactions.

Produced on the basis of biologically active and plant substances. This composition provides a wide spectrum of action in the treatment of colds and respiratory viral infections.

The components of Tonsilgon relieve swelling of tissues and mucous membranes, fight infections, and stimulate the restoration of immunity. There are no similar analogues.

The drug for the common cold is available in several forms. Relieves bacterial and inflammatory processes in the nasal cavity. Used in the treatment of rhinitis, sinusitis, sinusitis.

Natural components are well tolerated by most patients; in rare cases, individual intolerance to plant components and allergic reactions to them are possible. Most often used in complex treatment, together with vasoconstrictor medications.

Medicine plant origin. Promotes rapid removal of phlegm and relieves inflammation.

Produced in the form:

• tablets;
• drops;
• syrup.

A universal drug for normalizing the patient’s general condition and eliminating all signs of the disease.

The anti-inflammatory effect is achieved due to the targeted effect of the drug on the processes occurring in the source of inflammation. Affects thermoregulation centers, reducing elevated body temperature.

During colds has a strong analgesic effect, relieves mild inflammation and lowers temperature.

All drugs containing paracetamol effectively relieve inflammation, acting directly on its source. Relieves all unpleasant symptoms of acute respiratory and viral diseases. They do not have any side effects on the body and have no contraindications. Individual intolerance to paracetamol and allergic reactions to it are possible. Available without a prescription.

How safe is it to take anti-inflammatory drugs?

For most people, drugs with this spectrum of action are safe, can speed up recovery and relieve all unpleasant symptoms.

But, like all medications, anti-inflammatory drugs for colds have a number of contraindications:

• For ulcers duodenum and other stomach diseases, it is not recommended to take drugs with anti-inflammatory effects. Taking these medications may cause unwanted complications, stomach disorders.
• With asthma, severe shortness of breath may develop.
• During liver failure, the use of such drugs provokes swelling.
• An allergic reaction to the components of the drugs may develop.

Take medications only as directed, without violating the dosage and pay attention to contraindications. At the first sign of intolerance, discontinue use of these products.

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Effect of medications

The effectiveness of NSAID drugs is easy to understand if you know the mechanism of inflammation. The progression of the process is accompanied by pain, fever, swelling, and deterioration of well-being. The production of prostaglandins directly depends on a special enzyme - cyclooxygenase or COX. It is this component that is affected by non-steroidal anti-inflammatory compounds.

Why do some NSAIDs have more side effects, while other compounds have fewer? The reason is the effect on a variety of the enzyme cyclooxygenase.

Peculiarities:

• compositions with non-selective action inhibit the activity of both types of enzymes. But COX-1 has a positive effect on platelet viability and protects the gastric mucosa. Suppression of the activity of this enzyme explains the negative effect of NSAIDs on the gastrointestinal tract;
• New generation drugs suppress the activity of only COX-2, which is produced only when there are deviations from the norm against the background of other inflammatory mediators. It is the selective effect of new drugs, without suppressing the production of COX-1, that explains the high efficiency with a minimum amount negative reactions body.

What is the difference between non-steroidal drugs and steroid hormones

Many patients believe that both groups of drugs are similar in many ways, the only difference being the strength of their effect. But when analyzing the chemical composition, it turns out that potent compounds have many differences.

NSAIDs are substances that the body perceives as foreign elements. The reason is the presence of its own anti-inflammatory system. The production of protective steroid hormones occurs in the adrenal glands.

Potent drugs from the glucocorticosteroid group contain synthetic analogues of hormones produced by the adrenal glands. NSAIDs are non-hormonal in nature and exhibit weaker side effects than any hormonal agents, including glucocorticosteroids.

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Benefit

Without taking anti-inflammatory drugs, it is impossible to relieve the patient from painful symptoms due to joint pathologies. Only opioid compounds, which have many negative and addictive effects, are stronger than NSAIDs.

After using NSAIDs, signs of inflammation decrease or disappear:

• pain;
• high local and general temperature;
• swelling of tissues;
• redness skin above the site of destruction.

General rules of application

Potent medications for joint pathologies are allowed for oral administration, administration into the rectum, injections or treatment of the skin only as prescribed by a doctor. Patient-initiated use of NSAIDs is often harmful.

Before starting the course, the doctor takes into account the following factors:

• general state patient;
• presence/absence of systemic pathologies, infectious and chronic diseases;
• patient's age;
• types of medications for maintenance therapy that the patient takes over a long period;
• contraindications (absolute and relative);
• severity of joint pathology.

Four important rules to minimize side effects:

• exact adherence to single and daily dosage, course duration - exceeding standard indicators is fraught with serious complications, including anaphylactic shock and coma;
• taking capsules, applying ointments, introducing suppositories only after eating for a milder effect on the mucous membrane of the gastrointestinal tract;
• refusal of self-medication, replacement on one’s own initiative of one type of drug with an analogue;
• It is necessary to take into account the interaction of the prescribed drug and other drugs that the patient takes constantly (antihypertensive compounds, diuretics).

Indications for use

Drugs that relieve pain, swelling, and reduce inflammation are indispensable in the treatment of many joint pathologies. The range of use of NSAIDs is wider: negative processes weaken in various parts of the body, but for diseases of the joint-ligamentous apparatus and injuries, non-steroidal compounds are most often prescribed.

The high effectiveness of NSAIDs has been noted in the following diseases and negative conditions:

• rheumatoid arthritis;
• gout;
• osteoarthritis;
• psoriatic arthritis;
• pain syndrome after arthroscopy, endoprosthetics, and other joint operations;
• purulent arthritis;
• inflammatory arthropathy;
• neurological diseases;
• bone metastases.

Non-steroidal compounds for relieving inflammation reduce negative symptoms in sports injuries, severe bruises, fractures, rupture/sprain of ligaments, meniscal tears, and other types of damage to the articular-ligamentous apparatus.

Contraindications

High risk of side effects, active effect on various departments the body limits the range of patients who can use NSAIDs. New generation formulations have fewer negative side effects after use, but are also not suitable for everyone.

Taking NSAIDs is prohibited in the following cases:

• diseases of the digestive system, severe liver and kidney pathologies;
• ulcers, erosions in the stomach and intestines;
• period of pregnancy and lactation;
• cytopenia;
• increased sensitization of the body, sensitivity to the active substance or auxiliary components of the drug.

Possible side effects

Negative manifestations depend on the type of drug (traditional or new generation), the chemical composition of the drug, and the patient’s health condition. The instructions for each product indicate possible side effects.

The main dysfunctions of organs and systems during therapy with NSAIDs:

• microerosions, peptic ulcers in the stomach, erosions of the small and large intestines;


• headache, sleep disturbance;
• increased angina pectoris, heart failure, increased blood pressure;
• drowsiness, aseptic meningitis;
• blood composition disorders (thrombocytopenia, various types of anemia);
• progression of degenerative-dystrophic changes in weakened cartilage;
• exacerbation of bronchial asthma, allergic rhinitis;
• violation of the level of transaminases in the liver.

To protect the digestive organs, the doctor will prescribe medications that prevent microtrauma to the walls of the stomach and intestines.

Review of effective drugs

The classification of drugs with analgesic, anti-inflammatory, antipyretic effects is carried out according to the active substance. The drugs have different potencies and chemical compositions.

The main types of non-steroidal anti-inflammatory compounds.

The drugs that have the most powerful anti-inflammatory effect are:

• Diclofenac.
• Indomethacin.
• Flurbiprofen.
• Piroxicam.

The following medications provide excellent pain relief:

• Diclofenac.
• Ketoprofen.
• Ketorolac.
• Indomethacin.

Medicines of the NSAID group are supplied to the pharmacy chain in various forms: tablets, capsules, rectal suppositories, solution and lyophilisate for injection. Some formulations are suitable only for external use: gels and ointments.

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New generation NSAIDs

Features of the drugs:

• prolonged action;
• highest activity in eliminating negative symptoms;
• selective action ( active ingredients inhibit the activity of COX-2, but COX-1 is not involved in the process);
• shorter list of side effects;
• There is practically no negative effect on the gastrointestinal tract.

Names:

• Meloxicam.
• Rofecoxib.

New generation NSAIDs have many positive reviews about their use. Modern medicines have one drawback - the cost does not suit everyone. Price of drugs with a long half-life: tablets - from 200 rubles for 10 pieces, lyophilisate for injection - from 700 rubles for 5 ampoules.

Cost of medicines

The price range is quite wide. Traditional medicines with negative effects on the gastrointestinal tract are cheaper than modern analogues. The difference in cost depends on pharmaceutical company, name of the pharmacy chain, sales region.

Average prices for popular NSAID drugs:

• Indomethacin. From 45 rubles (ointment) to 430 rubles (suppositories).
• Nimesulide. From 130 to 170 rubles (tablets).
• Diclofenac. Tablets cost from 15 to 50 rubles, gel – 60 rubles, solution – 55 rubles, suppositories – 110 rubles.
• Piroxicam. Capsules cost 30–45 rubles, gel – from 130 to 180 rubles.
• Celecoxib. Tablets (10 pieces) cost, on average, 470 rubles, a pack of 30 tablets costs 1,200 rubles.
• Ketoprofen. Gel – 60 rubles, tablets – 120 rubles.
• Naproxen. The cost of tablets is from 180 to 230 rubles.
• Meloxicam. Tablets cost from 40 to 70 rubles, solution for injections - from 170 to 210 rubles.
• Aspirin. Tablets – 80 rubles, Aspirin Complex (effervescent powder for preparing a solution for oral use) – 360 rubles.

Should you take nonsteroidal anti-inflammatory drugs on an empty stomach, can you drink alcohol while taking them, and how do these drugs combine with other medications? Answers in the following video:

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NSAIDs - what is this group of drugs?

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

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

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

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

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

History of discovery and formation

The use of herbal remedies with anti-inflammatory, antipyretic and analgesic effects was described in the works of Hippocrates. But the first accurate description of the effect of NSAIDs dates back to the 18th century.

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

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

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

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

Pharmacological properties and mechanism of action

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

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

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

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

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

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

Indications for use - scope of application

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

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

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

The most famous drugs of the group

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

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

Diclofenac is one of the popular drugs for treating joints. It is included in many ointments and is available in tablets and injections. It has a pronounced anti-inflammatory and analgesic effect; when applied topically, it causes almost no systemic effect.

Side effects

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

Acidic derivatives have an additional ulcerogenic effect by increasing the acidity of gastric juice. Most NSAIDs are contraindicated for gastritis with high acidity, gastric and duodenal ulcers, and GERD.

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

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

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

Classification of NSAIDs

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

Chemical structure

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

Acids (absorbed in the stomach, increase acidity):

• salicylates:
• pyrazolidines:
• indole derivatives acetic acid:
• phenylacetic acid derivatives:
• oxicams:
• derivatives propionic acid:

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

• alkanones:
• sulfonamide derivatives:

By impact on COX-1 and COX-2

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

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

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

Selective and non-selective NSAIDs

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

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

New generation drugs

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

New generation non-steroidal anti-inflammatory drugs:

• Movalis– has an extended period of validity;
• Nimesulide– has the strongest analgesic effect;
• – extended period of action and pronounced analgesic effect (comparable to morphine);
• Rofecoxib– the most selective drug, approved for patients with gastritis and peptic ulcer without exacerbation.

Non-steroidal anti-inflammatory ointments

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

• Indomethacin;
• Diclofenac;
• Piroxicam;
• Ketoprofen;
• Nimesulide.

NSAIDs in tablets

The most common dosage form of NSAIDs is tablets. Used to treat various pains, including joint pain.

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

Injection forms

The advantages of this form of NSAID are its very high effectiveness. Intramuscular injections are used for treatment acute conditions associated with high fever or severe pain (Ketorol, Analgin).

Intra-articular injections are prescribed to treat severe exacerbations of joint disease; they allow the exacerbation to quickly stop, but the injections themselves are very painful. Drugs used:

• Rofecoxib (Denebol);
• Movalis in solutions for injections;
• Indomethacin in solutions for injections;
• Celecoxib (Celebrex).

TOP 3 joint diseases for which NSAIDs are prescribed

The use of NSAIDs is most often justified for the following joint diseases:

1. For osteochondrosis is a disease of the intervertebral discs, most often affecting the cervical and lumbar spine. To treat the disease, ointments with NSAIDs are prescribed in the initial stages during exacerbation and for preventive purposes, especially in cold weather. Tablets are prescribed for severe cases.
2. For mild forms arthritis NSAID ointments are prescribed as needed and tablets in courses to prevent exacerbations. During an exacerbation, ointments and tablets are prescribed; in case of severe arthritis, ointments and intra-articular injections are prescribed. day hospital, tablets as needed.
3. The most common drugs for arthrosis are Xefocam in the form of tablets and injections, Movalis in the form of injections and tablets (these are all new generation NSAIDs), and also ointments based on Diclofenac do not lose their effectiveness. Since arthrosis, unlike arthritis, rarely worsens, the main emphasis in treatment is on maintaining the functional state of the joints.

General application features

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

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

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

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

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Excursion into history

The “roots” of non-steroidal anti-inflammatory drugs go back to the distant past. Hippocrates, who lived 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 is excellent at alleviating signs of inflammation.

The next mention of analgesic bark occurs only in 1763. And only in 1827 chemists were able to isolate from 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 obtained 30 g of purified salicin.

In 1869, a more effective salicin derivative, salicylic acid, was first obtained. It soon became clear that it damages the gastric mucosa, and scientists began an active search for new substances. In 1897, German chemist Felix Hoffmann and the Bayer company opened a new era in pharmacology by converting 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 new drugs, each of which was more effective and safer than the previous one.

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How do NSAIDs work?

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

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

• reducing vascular permeability and improving microcirculation in them;
• decreased release from cells of special substances that stimulate inflammation - inflammatory mediators.

In addition, NSAIDs block energy processes at the site of inflammation, thereby depriving it of “fuel”. The analgesic (pain-relieving) effect develops as a result of a decrease in the inflammatory process.

Serious drawback

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 influence of its own hydrochloric acid. When non-selective COX-1 and COX-2 inhibitors begin to work, they completely block prostaglandins - both the “harmful” ones that cause inflammation and the “good” ones that protect the stomach. Thus, non-steroidal anti-inflammatory drugs provoke the development of gastric and duodenal ulcers, as well as internal bleeding.

But among the NSAID family there are also special drugs. 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 provoke gastrointestinal problems and are more secure 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 body temperature rises.

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

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

By the way, it has been established that ibuprofen has the most pronounced antipyretic properties. It has surpassed its closest competitor, paracetamol, in this regard.

Classification of non-steroidal anti-inflammatory drugs

Now let's try to figure out what drugs belong to non-steroidal anti-inflammatory drugs.

Today, several dozen drugs from this group are known, but not all of them are registered and used in Russia. We will consider only those medications that can be bought in domestic pharmacies. NSAIDs are classified according to their chemical structure and mechanism of action. So as not to scare the reader 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 medications.

Acetic acid derivatives

No less famous are acetic acid derivatives: indomethacin, ketorolac, diclofenac, aceclofenac and others.

Selective COX-2 inhibitors

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

Other non-steroidal anti-inflammatory drugs

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

Paracetamol is an antipyretic and analgesic drug, which is often classified as a non-steroidal anti-inflammatory drug, but in fact it is not one of them.

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 for which non-steroidal anti-inflammatory drugs are used:

• arthrosis;
• rheumatoid arthritis;
• moderate pain due to inflammation or soft tissue injury;
• osteochondrosis;
• lower back pain;
• headache;
• migraine;
• 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, nonsteroidal anti-inflammatory drugs are used to treat babies whose ductus arteriosus does not close within 24 hours of birth.

This amazing aspirin!

Aspirin can safely be considered one of the drugs that surprised the whole world. The most common non-steroidal anti-inflammatory pills, which were used to reduce fever and treat migraines, showed an unusual side effect. It turned out that by blocking COX-1, aspirin also inhibits the synthesis of thromboxane A2, a substance that increases blood clotting. Some scientists suggest that there are other mechanisms by which aspirin affects 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.

Several years ago, scientists discovered that aspirin reduces the overall risk of developing cancer and mortality from it. This effect is especially true for colorectal cancer. American doctors recommend that their patients take aspirin specifically to prevent the development of colorectal cancer. In their opinion, the risk of developing side effects due to long-term treatment with aspirin is still lower than oncological ones. 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 its group brethren. 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 had a heart attack should avoid NSAID treatment. According to statistics, the use of these drugs increases the likelihood of developing unstable angina by almost 10 times. According to research data, naproxen is considered the least dangerous from this point of view.

On July 9, 2015, the most authoritative American drug quality control organization, the FDA, published 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 he is closely connected with pharmacological action all non-selective inhibitors of COX-1 and COX-2. However, NSAIDs not only reduce the level of prostaglandins and thereby deprive the gastric mucosa of protection. Drug molecules themselves behave aggressively towards the mucous membranes of the gastrointestinal tract.

During treatment with nonsteroidal anti-inflammatory drugs, nausea, vomiting, dyspepsia, diarrhea, and gastric ulcers, including those accompanied by bleeding, may appear. Gastrointestinal side effects of NSAIDs develop regardless of how the drug enters the body: oral in the form of tablets, injectable in the form of injections, or rectal in the form of suppositories.

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

Recent studies show that more than 50% of people taking non-steroidal anti-inflammatory drugs have mucosal small intestine still gets damaged.

Scientists note that drugs from the NSAID group affect the gastric mucosa in different ways. Thus, 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 the enteric coatings that cover non-steroidal anti-inflammatory tablets. Manufacturers claim that this coating helps reduce or completely eliminate the risk of gastrointestinal complications of NSAIDs. However, research and clinical practice show that such protection does not actually work. The likelihood of damage to the gastric mucosa is much more effectively reduced by the simultaneous use of medications that block the production of hydrochloric acid. Proton pump inhibitors - omeprazole, lansoprazole, esomeprazole and others - can somewhat mitigate the damaging effects of drugs from the group of non-steroidal anti-inflammatory drugs.

Say a word about citramone...

Citramon is the product of the brainstorming of Soviet pharmacologists. In ancient times, when the range of our pharmacies did not amount to thousands of drugs, pharmacists came up with an excellent analgesic-antipyretic formula. 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 substance 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 were removed from the old version of citramon, which, in fact, gave citramon its name. The 21st century drug contains aspirin 0.24 g, paracetamol 0.18 g and caffeine 0.03 g. And despite the 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 proven that it seriously damages the gastrointestinal mucosa. So serious that the term “citramone ulcer” even appeared in the literature.

The reason for such obvious 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 the protection of prostaglandins, is exposed to 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 Citramon is absorbed into the blood.

Let us add that “citramone”, or as they are sometimes called, “aspirin ulcers” are different large sizes. Sometimes they don’t “grow” into giant ones, but they take in numbers, settling in whole groups in different departments stomach.

The moral of this digression is simple: do not overdo Citramon, despite all its benefits. The consequences could be too severe.

NSAIDs and... sex

In 2005, the 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. Let us remember that by 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 assessed only on the basis of the man’s personal feelings and was not tested by specialists.

However, in 2011, the authoritative Journal of Urology published data from another study. It also showed a link between treatment with non-steroidal anti-inflammatory drugs and erectile dysfunction. However, doctors say 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

We have dealt with the serious problems that can arise from treatment with non-steroidal anti-inflammatory drugs. Let's move on to less common adverse events.

Renal dysfunction

NSAIDs are also associated with a relatively high level of renal side effects. Prostaglandins are involved in expansion blood vessels in the renal glomeruli, which allows maintaining 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 - kidney function may be impaired.

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

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 most involved in this side effect.

People taking anti-inflammatory drugs may react to sun exposure 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, angioedema, and even anaphylactic shock. Is it true, last effect is extremely rare and therefore should not frighten potential patients.

In addition, taking NSAIDs may be accompanied by headache, dizziness, drowsiness, and bronchospasm. Rarely, ibuprofen has been associated with irritable bowel syndrome.

Nonsteroidal anti-inflammatory drugs during pregnancy

Quite often, pregnant women are faced with the acute issue of pain relief. Can expectant mothers use NSAIDs? Unfortunately no.

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

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

Nevertheless, selected drugs are still used during pregnancy. For example, Aspirin is often prescribed along with heparin to women who have developed antiphospholipid antibodies during pregnancy. Recently, the old and rather rarely used Indomethacin has gained particular popularity 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 has issued an official order prohibiting the use of non-steroidal anti-inflammatory drugs, including aspirin, after the sixth month of pregnancy.

NSAIDs: take it or leave it?

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

NSAIDs are needed	NSAIDs should be taken with caution	It's best to avoid NSAIDs
If you have osteoarthritis, which is accompanied by pain, inflammation of the joints and impaired joint mobility, which 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 other than osteoarthritis, such as in your back.	If you often suffer from indigestion If you are over 50 years old or have previously suffered from gastrointestinal diseases and/or have a family history of early heart disease If you smoke, have high level cholesterol or high blood pressure or have kidney disease If you are taking steroids or blood thinners (clopidogrel, warfarin) If you have been taking NSAIDs to relieve the symptoms of osteoarthritis for many years, especially if you have a history of gastrointestinal problems	If you have ever had a stomach ulcer or stomach bleeding If you have coronary artery disease or any other heart condition 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. Now let's figure out which anti-inflammatory drugs are best to use for pain, which for inflammation, and which for fever and colds.

Acetylsalicylic acid

The first NSAID to see the light of day, acetylsalicylic acid is still widely used today. As a rule, it is used:

• to reduce body temperature.

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

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

Cardioaspirin has many names and forms of release, 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 drugs based on it are sold without a prescription. Ibuprofen is also used as an antipyretic for newborns. It has been proven to reduce fever better than other non-steroidal anti-inflammatory drugs.

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

To the most popular trade names 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 with severe heart failure. Most often, the non-steroidal anti-inflammatory drug naproxen is used as an anesthetic for headaches, dental, periodic, joint and other types of pain.

In Russian pharmacies, naproxen is sold under the names Nalgesin, 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 produced by the Slovak company Lek. The 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 unsafety: it can cause stomach bleeding, provoke gastric ulcers, as well as liver failure. Therefore, ketorolac can be used 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 long-lasting action.

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

• Voltaren is an original drug from the Swiss company Novartis. It is distinguished by high quality and an equally high price;
• Diklak is a line of German drugs from the Hexal company, 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. Used when 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 fairly mild effect on the digestive tract, so it is often preferred for the treatment of patients with a history of stomach or intestinal diseases.

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

Nimesulide

Most often, nimesulide is used as a moderate 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, let’s 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 medications are rightfully among the most important and necessary, which cannot be replaced or bypassed. It remains only to praise the tireless pharmacists who continue to create new formulas and treat themselves with ever safer NSAIDs.

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Classmates

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) are new generation medications that have anti-inflammatory, antipyretic and analgesic effects. Their mechanism of action is based on blocking certain enzymes (cyclooxygenase, COX), which are responsible for the formation of prostaglandins - chemicals that promote pain, fever, and inflammation.

The word “non-steroidal” in the name of these drugs indicates the fact that medications in this group are not artificial analogues of steroid hormones - powerful anti-inflammatory hormonal drugs. The most popular representatives of NSAIDs are diclofenac, ibuprofen.

How NSAIDs work

If analgesics are intended to combat pain, then NSAIDs reduce two unpleasant symptoms diseases: inflammation and pain. Many drugs in this group are considered non-selective inhibitors of the cyclooxygenase enzyme, which suppress the effects of both of its isoforms (types) - COX-1 and COX-2.

Cyclooxygenase is responsible for the formation of thromboxane and prostaglandins from arachidonic acid, which, in turn, is obtained from cell membrane phospholipids using the enzyme phospholipase A2. Among other functions, prostaglandins are regulators and mediators in the formation of inflammation.

When are NSAIDs used?

The most commonly used drugs are NSAIDs for the treatment of chronic or acute inflammation which are accompanied by pain. Anti-inflammatory non-steroidal drugs have gained great popularity due to effective treatment joints.

We list the diseases for which these medications are prescribed:

• dysmenorrhea (pain during menstruation);
• acute gout;
• postoperative pain;
• bone pain due to metastasis;
• intestinal obstruction;
• fever (high body temperature);
• minor pain due to injury or inflammation of soft tissues;
• renal colic;
• lower back pain;
• Parkinson's disease;
• osteochondrosis;
• migraine;
• headaches;
• rheumatoid arthritis;
• arthrosis

NSAIDs should not be used during erosive and ulcerative lesions of the gastrointestinal tract, especially at the stage of exacerbation, cytopenias, severe disorders of the kidneys and liver, pregnancy, individual intolerance. Should be prescribed with caution to patients with asthma, as well as to people who have previously had negative reactions while taking any other NSAIDs.

Non-steroidal anti-inflammatory drugs: list of NSAIDs for the treatment of joints

Let's look at the most effective and well-known NSAIDs that are used to treat joints and other diseases when required antipyretic and anti-inflammatory effect:

• Ibuprofen;
• Indomethacin;
• Meloxicam;
• Naproxen;
• Celecoxib;
• Diclofenac;
• Etodolac;
• Ketoprofen.

Some medications are weaker, not so aggressive, some are designed for acute arthrosis, if emergency intervention is necessary in order to stop dangerous processes in the body.

The main advantage of new generation NSAIDs

Side effects are observed during prolonged use of NSAIDs (for example, during the treatment of osteochondrosis) and consist of damage to the intestinal and gastric mucosa with the formation of bleeding and ulcers. This disadvantage of non-selective NSAIDs was the reason for the creation of a new generation of drugs that block only COX-2 (an inflammatory enzyme) and do not affect the function of COX-1 (a defense enzyme).

That is, the new generation drugs have almost no ulcerogenic side effects (damage to the mucous membranes of organs digestive system) associated with prolonged use of non-selective NSAIDs, but increase the chance of thrombotic complications.

The only disadvantage of the new generation of drugs is their high cost, which makes them inaccessible to most people.

What are new generation NSAIDs?

The new generation of anti-inflammatory non-steroidal drugs act much more selectively, they are more inhibit COX-2, and COX-1 remains almost unaffected. This is what can explain the rather high effectiveness of the drug in combination with a minimum of side effects.

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

• Xefocam. A medicine that is based on Lornoxicam. His characteristic feature is the fact that the drug has an increased ability to relieve pain. In terms of this indicator, it is similar to morphine, but at the same time it does not create addiction and does not have an opiate-like effect on the central nervous system.
• Movalis. It has an antipyretic, well-defined anti-inflammatory and analgesic effect. The main advantage of this drug is that with constant medical supervision it can be used for quite a long time. Meloxicam is produced in the form of a solution for intramuscular injections, in ointments, suppositories and tablets. The tablets of the drug are quite convenient in that they have a long-lasting effect, and it is enough to use one tablet throughout the day.
• Nimesulide. Used successfully to treat arthritis, vertebrogenic back pain, etc. Normalizes temperature, relieves hyperemia and inflammation. Taking the drug quickly leads to improved mobility and reduced pain. It is also used in the form of an ointment for application to the problem area.
• Celecoxib. This drug significantly alleviates the patient’s condition with arthrosis, osteochondrosis and other diseases, effectively fights inflammation and perfectly relieves pain. Side effects on the digestive system from the drug are minimal or completely absent.

In cases where long-term use of anti-inflammatory non-steroidal drugs is not necessary, then older generation drugs are used. However, sometimes this is simply a necessary measure, since not all people can afford a course of treatment with these drugs.

Based on their chemical origin, these drugs come in non-acidic and acidic derivatives.

Acidic preparations:

• Preparations based on indoacetic acid - sulindac, etodolac, indomethacin;
• Oxicams – meloxicam, piroxicam;
• Salicipates – diflunisal, aspirin;
• Based on propionic acid – ibuprofen, ketoprofen;
• Pyrazolidines – phenylbutazone, metamizole sodium, analgin;
• Phenylacetic acid preparations – aceclofenac, diclofenac.

Non-acidic drugs:

• Sulfonamide derivatives;
• Alcanons.

At the same time, non-steroidal drugs differ in intensity and type of action - anti-inflammatory, analgesic, combined.

According to the strength of the anti-inflammatory effect Medium doses of drugs are arranged in the following order (strongest on top):

• Flurbiprofen;
• Indomethacin;
• Piroxicam;
• Diclofenac sodium;
• Naproxen;
• Ketoprofen;
• Aspirin;
• Amidopyrine;
• Ibuprofen.

According to analgesic effect The drugs are arranged in the following order:

• Ketoprofen;
• Ketorolac;
• Indomethacin;
• Diclofenac sodium;
• Amidopyrine;
• Flurbiprofen;
• Naproxen;
• Piroxicam;
• Aspirin;
• Ibuprofen.

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

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

Any medicine new to the patient should be prescribed initially in a minimal dose. If tolerated normally, after a few days daily dose is increased.

Therapeutic dosages of NSAIDs are in a wide range, while recently there has been a tendency to increase single and daily doses drugs that are well tolerated (ibuprofen, naproxen), while maintaining restrictions on maximum dosage indomethacin, aspirin, piroxicam, phenylbutazone. In some patients, the therapeutic effect is achieved only with the use of increased doses of NSAIDs.

Long-term use of anti-inflammatory drugs in higher dosages can cause:

• Changes in the functioning of blood vessels and the heart - swelling, increased blood pressure, palpitations;
• Impaired urination, renal failure;
• Disturbance of the central nervous system - disorientation, mood changes, apathy, dizziness, blurred vision, headache, tinnitus;
• Allergic reactions - urticaria, angioedema, erythema, anaphylactic shock, bronchial asthma, bullous dermatitis;
• Ulcer, gastritis, gastrointestinal bleeding, perforation, changes in liver function, dyspeptic disorders.

Treatment with NSAIDs must be continued for the minimum possible time and minimum doses.

Use during pregnancy

It is undesirable to use NSAIDs during pregnancy, especially in the third trimester. Although no direct teratogenic effects are found, it is believed that NSAIDs can cause renal complications in the fetus and premature closure of the ductus arteriosus. There is also information about premature birth. Despite this, aspirin in combination with heparin has been used successfully in women with antiphospholipid syndrome.

Description of non-steroidal anti-inflammatory drugs Movalis

Is a leader among non-steroidal anti-inflammatory drugs, which has a long duration of action and is approved for long-term use.

It has a pronounced anti-inflammatory effect, which makes it possible to use it for rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. Protects cartilage tissue and is not without antipyretic and analgesic properties. Used for headaches and toothaches.

The determination of doses and administration options (suppositories, injections, tablets) depends on the type and severity of the disease.

A COX-2 inhibitor, which has a pronounced analgesic and anti-inflammatory effect. When used in therapeutic doses, it has almost no negative effect on the gastrointestinal mucosa, since it has a fairly low degree of affinity for COX-1 and, accordingly, does not cause disruption in the synthesis of constitutional prostaglandins.

It is one of the most effective non-hormonal drugs. For arthritis, it reduces joint swelling, relieves pain and has a strong anti-inflammatory effect. When using a medication, you need to be careful, as it has a long list of side effects. In pharmacology, the drug is manufactured under the names Indovis EC, Indovazin, Indocollir, Indotard, Metindol.

It combines the ability to effectively reduce pain and temperature, and is relatively safe, which is why medications based on it can be purchased without a prescription. Ibuprofen is used as an antipyretic drug, including and for newborns.

It is not used as often as an anti-inflammatory drug, but the medicine is very popular in rheumatology: it is used to treat osteoarthritis, rheumatoid arthritis and other joint diseases.

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

Form of manufacture - capsules, tablets, gel, suppositories, injection solution. This drug for the treatment of joints perfectly combines both a high anti-inflammatory effect and high analgesic activity.

It is manufactured under the names Naklofen, Voltaren, Diklak, Ortofen, Vurdon, Diclonac P, Dolex, Olfen, Clodifen, Dikloberl, etc.

Chondroprotectors - alternative drugs

Very common for treating joints use chondroprotectors. People often do not understand the differences between chondroprotectors and NSAIDs. The latter quickly remove pain, but at the same time have many side effects. And chondroprotectors protect cartilage tissue, but they must be used in courses. The most effective chondroprotectors contain two substances - chondroitin and glucosamine.

Anti-inflammatory non-steroidal drugs are excellent assistants during the treatment of many diseases. But we must not forget that they only remove the negatively impacting symptoms on well-being; diseases are treated directly by other methods and drugs.

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) are a group of drugs whose action is aimed at symptomatic treatment (pain relief, inflammation relief and temperature reduction) in acute and chronic diseases. Their action is based on reducing the production of special enzymes called cyclooxygenase, which trigger a reaction mechanism to pathological processes in the body, such as pain, fever, inflammation.

Medicines in this group are widely used throughout the world. Their popularity is ensured by good efficiency against the background of sufficient safety and low toxicity.

The most well-known representatives of the NSAID group for most of us are aspirin (acetylsalicylic acid), ibuprofen, analgin and naproxen, available in pharmacies in most countries of the world. Paracetamol (acetaminophen) is not a NSAID, since it has relatively weak anti-inflammatory activity. It acts against pain and fever according to the same principle (blocking COX-2), but mainly only in the central nervous system, almost without affecting the rest of the body.

Soreness, inflammation and fever are common pathological conditions that accompany many diseases. If we consider the pathological course at the molecular level, we can see that the body “forces” the affected tissues to produce biologically active substances - prostaglandins, which, acting on blood vessels and nerve fibers, cause local swelling, redness and soreness.

In addition, these hormone-like substances, reaching the cerebral cortex, affect the center responsible for thermoregulation. Thus, impulses are sent about the presence of an inflammatory process in tissues or organs, so a corresponding reaction occurs in the form of fever.

A group of enzymes called cyclooxygenases (COX) are responsible for triggering the mechanism for the appearance of these prostaglandins. The main effect of non-steroidal drugs is to block these enzymes, which in turn leads to inhibition of the production of prostaglandins, which increase the sensitivity of nociceptive receptors responsible for pain. Consequently, painful sensations that bring a person suffering and unpleasant sensations are relieved.

Types by mechanism of action

NSAIDs are classified according to their chemical structure or mechanism of action. Long-known drugs of this group were divided into types according to their chemical structure or origin, since at that time their mechanism of action was still unknown. Modern NSAIDs, on the contrary, are usually classified according to their principle of action - depending on what type of enzymes they act on.

There are three types of cyclooxygenase enzymes – COX-1, COX-2 and the controversial COX-3. At the same time, non-steroidal anti-inflammatory drugs, depending on the type, affect the main two of them. Based on this, NSAIDs are divided into groups:

• non-selective inhibitors (blockers) of COX-1 and COX-2– act on both types of enzymes at once. These drugs block COX-1 enzymes, which, unlike COX-2, are constantly present in our body, performing various important functions. Therefore, exposure to them may be accompanied by various side effects, and a particular negative effect is on the gastrointestinal tract. This includes most classic NSAIDs.
• selective COX-2 inhibitors. This group affects only enzymes that appear in the presence of certain pathological processes, such as inflammation. Taking such drugs is considered safer and preferable. They do not have such a negative impact on the gastrointestinal tract, but at the same time they put a strain on the cardiovascular system goes more(may increase blood pressure).
• selective NSAIDs COX-1 inhibitors. This group is small, since almost all drugs that affect COX-1 also affect COX-2 to varying degrees. An example is acetylsalicylic acid in a small dosage.

In addition, there are controversial COX-3 enzymes, the presence of which has only been confirmed in animals, and they are also sometimes classified as COX-1. It is believed that their production is slightly slowed down by paracetamol.

In addition to reducing fever and eliminating pain, NSAIDs are recommended for blood viscosity. The drugs increase the liquid part (plasma) and reduce the formed elements, including lipids that form cholesterol plaques. Due to these properties, NSAIDs are prescribed for many diseases of the heart and blood vessels.

Basic non-selective NSAIDs

• acetylsalicylic acid (aspirin, diflunisal, salasate);
• arylpropionic acid (ibuprofen, flurbiprofen, naproxen, ketoprofen, tiaprofenic acid);
• arylacetic acid (diclofenac, fenclofenac, fentiazac);
• heteroarylacetic (ketorolac, amtolmetin);
• indole/indene acetic acid (indomethacin, sulindac);
• anthranilic acid (flufenamic acid, mefenamic acid);
• enolic acid, in particular oxicam (piroxicam, tenoxicam, meloxicam, lornoxicam);
• methanesulfonic acid (analgin).

Acetylsalicylic acid (aspirin) is the first known NSAID, discovered back in 1897 (all others appeared after the 1950s). In addition, this is the only drug that can irreversibly inhibit COX-1 and is also indicated to stop platelet aggregation. Such properties make it useful in the treatment of arterial thrombosis and for the prevention of cardiovascular complications.

Selective COX-2 inhibitors

• rofecoxib (Denebol, Vioxx discontinued in 2007)
• lumiracoxib (Prexige)
• parecoxib (Dynastat)
• etoricoxib (Arcosia)
• celecoxib (Celebrex).

Main indications, contraindications and side effects

Today, the list of NSAIDs is constantly expanding and new generation drugs are regularly arriving on pharmacy shelves that can simultaneously lower the temperature, relieve inflammation and pain in a short period of time. Thanks to its mild and gentle effect, the development of negative consequences in the form of allergic reactions, as well as damage to the gastrointestinal tract and urinary system is minimized.

Table. Non-steroidal anti-inflammatory drugs - indications

Nonsteroidal anti-inflammatory drugs are considered the most used at this time.

This can be explained by their actions:

• Anti-inflammatory;
• Antipyretic;
• Analgesic.

Suitable for symptomatic treatment, since most diseases are accompanied by the listed manifestations. Over the past few years, new drugs in this area have appeared, and most of them are effective, have a prolonged effect, and are well tolerated.

What it is?

NSAIDs are medications for symptomatic treatment. Many of the drugs sold in pharmacies without a prescription.

About 30 million people on Earth use it daily the medicines we describe, 45% users are over 62 years of age, 15% Patients in the hospital receive such drugs as a means of treatment. These drugs are popular due to their actions described above.

Now we will look at them in more detail.

The effect of such drugs

The main one is the inhibition of the synthesis of prostaglandins (PG) from arachidonic acid by inhibiting the enzyme cyclooxygenase (PG synthetase).

PGs have the following focus:

1. Local dilation of blood vessels, due to which there is a decrease in swelling, exudation, and rapid healing of the damage.
2. Reduce pain.
3. They help reduce fever due to their effect on the hypothalamic regulation centers.
4. Anti-inflammatory effect.

Indications for use

Medicines of this group, as a rule, prescribed for acute and chronic pathologies, in the clinic where pain and inflammation are observed.

Most often, drugs in this group are prescribed for:

1. Rheumatoid arthritis is chronic inflammation of the joints.
2. Osteoarthritis – not inflammatory chronic illness joint of unknown etiology.
3. Inflammatory arthropathy: ankylosing spondylitis; psoriatic arthritis; Reiter's syndrome.
4. Gout is the deposition of urate in body tissues.
5. Dysmenorrhea - menstrual pain.
6. Bone cancer accompanied by pain.
7. Migraine pain. B
8. Pain observed after operations.
9. Minor pain due to injuries and inflammation.
10. Heat.
11. Pain syndrome in diseases of the urinary system.

Release forms

NSAIDs are available in the following forms:

So you can choose according to your taste; some forms are suitable for treating children.

Classification of non-steroidal anti-inflammatory drugs

There are several classifications of the described group.

According to chemical structure:

1. Salicylic acid derivatives- Aspirin.
2. Pyrazolone derivatives- Analgin.
3. Anthranilic acid derivatives– Sodium mefenaminate.
4. Propionic acid derivatives– representative of the group – Ibuprofen. Read more here: ibuprofen instructions for use.
5. Acetic acid derivatives– in this group is Diclofenac sodium. Here, read the article Diclofenac instructions for use in more detail.
6. Oxicam derivatives– representatives of Piroxicam and Meloxicam.
7. Derivatives of isonicotinic acid– this includes Amizon.
8. Coxib derivatives– in this group are Celecoxib, Rofecoxib.
9. Derivatives of other chemical groups– Mesulide, Etodolac.
10. Combination drugs– Reopirin, Dilocaine.

All drugs in this group are divided into 2 types:

• Cyclooxygenase type 1 inhibitors;
• Cyclooxygenase type 2 inhibitors.

List of first generation drugs

List of second generation drugs

1. Movalis.
2. Nise.
3. Nimesil.
4. Arcoxia.
5. Celebrex.

Answer to the question: nise or nimesil - which is better? - read here.

List of the most effective NSAIDs

Now we will present you a list of the most effective NSAIDs:

1. Nimesulide. Very effective against pain in the spine, back muscles, arthritis, etc. Relieves inflammation, hyperemia, reduces temperature. The use of this drug reduces pain and normalizes mobility in the joints. Available in the form of ointments and tablets. Skin reactions are not considered a contraindication. It is not advisable to use during pregnancy, especially in the last trimester. Nimesulide tablets 100 mg 20 pieces cost from 87 to 152 rubles.
2. Celecoxib. It is used for osteochondrosis, arthrosis, etc. diseases. Perfectly relieves pain and inflammation. Side effects on digestion are minimal or non-existent. The price of Celecoxib tablets varies between 500-800 rubles and depends on the number of capsules in the package. Read about doctors who treat arthrosis here.
3. Meloxicam. Another name is Movalis. It relieves fever very well, relieves pain, relieves inflammation. It is very important that under the supervision of a doctor you can take it for a long time. Forms of the drug: ampoules for intramuscular injection, dragees, suppositories, ointment. The tablets are effective for 24 hours, so one per day is enough. Meloxicam ampoules 15 mg, 1.5 ml, 3 pcs. Price 237 rub. Meloxicam-Tevatablets 15 mg 20 pcs. Price 292 rub. Meloxicam rectal suppositories 15 mg, 6 pcs. Price 209 rub. Meloxicam Avexima tablets 15 mg 20 pcs. Price 118 rub.
4. Xefocam. It is a powerful analgesic and acts like morphine. Effective for 12 hours. And fortunately, the drug is not addictive. Xefocam tablets are coated. captivity. about. 8 mg 10 pcs. Price 194 rub. Xefocam tablets are coated. captivity. about. 8 mg 30 pcs. Price 564 rub.

Many pathological changes occurring in the body accompany pain. To combat such symptoms, NSAIDs, or nonsteroidal anti-inflammatory drugs, have been developed. They provide excellent pain relief, relieve inflammation, and reduce swelling. However, the drugs have a large number of side effects. This limits their use in some patients. Modern pharmacology has developed the latest generation of NSAIDs. Such medications are much less likely to cause unpleasant reactions, but remain effective drugs against pain.

Impact principle

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

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

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

The action of NSAIDs, such as inhibition of COX-1, carries many side effects.

New developments

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

This forced chemists to synthesize completely new substances. They differed fundamentally from previous drugs in their mechanism of action. New generation NSAIDs are characterized by a selective effect on COX-2, as well as inhibition of prostaglandin production. This allows you to achieve all the necessary effects - analgesic, antipyretic, anti-inflammatory. At the same time, NSAIDs of the latest generation make it possible to minimize the effect on blood clotting, platelet function, and gastric mucosa.

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

Indications for use

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

A positive effect is noted under the following factors:

1. Diseases of the musculoskeletal system. For various sprains, bruises, and arthrosis, these medications are simply irreplaceable. NSAIDs are used for osteochondrosis, inflammatory arthropathy, and arthritis. The medicine has an anti-inflammatory effect in myositis, herniated intervertebral discs.
2. Severe pain. The drugs are quite successfully used for biliary colic and gynecological ailments. They eliminate headaches, even migraines, and kidney discomfort. NSAIDs are successfully used for patients in the postoperative period.
3. Heat. The antipyretic effect allows the drugs to be used for a variety of ailments by both adults and children. Such medicines are effective even for fever.
4. Thrombosis. NSAID drugs are antiplatelet agents. This allows them to be used for ischemia. They are a preventative against heart attack and stroke.

Classification

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

The classification of NSAIDs involves division into two groups:

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

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

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

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

Side effects

New generation NSAIDs, the list of which is given above, have an effective effect on the body. However, they have virtually no effect on the functioning of the gastrointestinal tract. These drugs have one more positive aspect: new generation NSAIDs do not have a destructive effect on cartilage tissue.

However, even such effective means can provoke a number of undesirable effects. You should know them, especially if the drug is used for a long time.

The main side effects may be:

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

However, damage to the gastric mucosa is not observed when taking new NSAIDs. The drugs do not cause exacerbation of the ulcer with bleeding.

The best anti-inflammatory properties are phenylacetic acid drugs, salicylates, pyrazolidones, oxicams, alkanones, propionic acid and sulfonamide drugs.

The medications that most effectively relieve joint pain are Indomethacin, Diclofenac, Ketoprofen, and Flurbiprofen. These are the best NSAIDs for osteochondrosis. The above medications, with the exception of Ketoprofen, have a pronounced anti-inflammatory effect. Piroxicam belongs to this category.

Effective analgesics are the drugs Ketorolac, Ketoprofen, Indomethacin, Diclofenac.

The leader among the latest generation of NSAIDs is the drug Movalis. This product can be used for a long period. Anti-inflammatory analogues of an effective drug are the drugs “Movasin”, “Mirlox”, “Lem”, “Artrosan”, “Melox”, “Melbek”, “Mesipol” and “Amelotex”.

The drug "Movalis"

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

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

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

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

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

For adult patients diagnosed with osteoarthritis, it is recommended to take 7.5 mg per day. If necessary, this dose can be increased by 2 times.

For rheumatoid arthritis and ankylosing spondylitis, the daily dose is 15 mg.

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

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

Consumer opinion about the medicine

Reviews from many people who are subject to severe pain indicate that Movalis is the most suitable remedy for long-term use. It is well tolerated by patients. In addition, its long-term presence in the body makes it possible to take the medicine once. A very important factor, according to most consumers, is the protection of cartilage tissue, since the drug does not affect them negative impact. This is very important for patients who use the drug for osteochondrosis and arthrosis.

In addition, the medicine perfectly relieves various pains - toothache, headache. Special attention Patients point out an impressive list of side effects. While taking NSAIDs, treatment, despite the manufacturer's warning, was not complicated by unpleasant consequences.

The drug "Celecoxib"

The action of this remedy is aimed at alleviating the patient’s condition with osteochondrosis and arthrosis. The drug perfectly eliminates pain and effectively relieves the inflammatory process. No adverse effects on the digestive system were identified.

Indications for use given in the instructions are:

This drug has a number of contraindications. In addition, the medicine is not intended for children under 18 years of age. Particular caution should be exercised by people diagnosed with heart failure, since the drug increases the susceptibility to fluid retention.

The cost of the drug varies, depending on the packaging, in the region of 500-800 rubles.

Consumer Opinion

Reviews about this medicine are quite contradictory. Some patients, thanks to this remedy, were able to overcome joint pain. Other patients claim that the drug did not help. Thus, this remedy is not always effective.

In addition, you should not take the drug yourself. In some European countries, this medicine is banned because it has cardiotoxic effects, which is quite harmful to the heart.

The drug "Nimesulide"

This medicine has not only anti-inflammatory and anti-pain effects. The product also has antioxidant properties, thanks to which the drug inhibits substances that destroy cartilage tissue and collagen fibers.

The product is used for:

• arthritis;
• arthrosis;
• osteoarthritis;
• myalgia;
• arthralgia;
• bursitis;
• fever;
• various pain syndromes.

At the same time, the medicine has an analgesic effect very quickly. As a rule, the patient feels relief within 20 minutes after taking the drug. That is why this remedy is very effective for acute paroxysmal pain.

Almost always, the medicine is well tolerated by patients. But sometimes side effects may occur, such as dizziness, drowsiness, headache, nausea, heartburn, hematuria, oliguria, urticaria.

The product is not approved for use by pregnant women and children under 12 years of age. People who have arterial hypertension, the functioning of the kidneys, vision or heart is impaired.

The average price of the medicine is 76.9 rubles.

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

How do NSAIDs work?

Relieve soreness, eliminate fever, block inflammatory reaction- all these functions can be performed by non-steroidal anti-inflammatory drugs.

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

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

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

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

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

When are these drugs prescribed?

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

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

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

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

Indications for use

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

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

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

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

Contraindications

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

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

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

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

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

Side effects

The most dangerous side effects of NSAIDs include:

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

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

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Classification of NSAID drugs

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

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

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

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

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

New generation NSAIDs

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

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

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

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

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

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

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

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

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

Forms of release of a group of drugs

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

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

Tablets and capsules

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

Ampoules and solutions

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

NSAIDs are administered intramuscularly or intravenously.

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

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

• Tenoxicam;
• Lornoxicam;
• Ibuprofen;

Ointments and creams

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

NSAID ointments, gels and creams are effective when initial stage disease, the pain syndrome is not yet expressed sufficiently acutely.

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

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

List of medications

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

If the pain syndrome is severe, Nimesulide is prescribed.

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

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

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

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

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

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

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

Rofecoxib

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

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

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

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

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

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

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

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

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

Analogs of the drug are known as Voltaren, Diklak.

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

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

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

Butadion

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

Naproxen and indomethacin

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

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

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

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

Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs whose name indicates their composition, purpose and function.

Non-steroidal- do not contain the core, which is part of hormones and biologically active substances.

Anti-inflammatory- have a pronounced effect on inflammatory processes in a living organism, cutting off chemical process inflammation.

History of drugs from the NSAID group

The anti-inflammatory properties of willow have been known since the fifth century BC. In 1827, 30 grams of salicin were isolated from the bark of this plant. In 1869, based on salicin, the active substance, salicylic acid, was obtained.

The anti-inflammatory properties of salicylic acid have been known for a long time, but its pronounced ulcerogenic effect limited its use in medicine. The addition of an acetyl group to the molecule greatly reduced the risk of gastrointestinal ulcers.

First medical drug from the NSAID group was synthesized in 1897 by Bayer. It was obtained by acetylation of salicylic acid. It received a patented name - “Aspirin”. Only the drug of this pharmacological company has the right to be called aspirin.

Until 1950, aspirin remained the only nonsteroidal anti-inflammatory drug. Then, active work began to create more effective means.

However, the importance of acetylsalicylic acid in medicine is still great.

Mechanism of action of NSAIDs

The main point of application of NSAIDs are biologically active substances – prostaglandins. The first of them were found in the secretion of the prostate gland, hence their name. Two main types are more studied:

• Cyclooxygenase type 1 (COX-1), responsible for the synthesis of protective factors of the gastrointestinal tract and thrombus formation processes.
• Cyclooxygenase type 2 (COX-2), involved in the basic mechanisms of the inflammatory process.

By blocking enzymes, the effects of reducing pain, reducing inflammation and lowering body temperature are achieved.

There are drugs with selective and non-selective action. Selective agents block the COX-2 enzyme to a greater extent. Reduce inflammatory phenomena without affecting processes in the digestive tract.

The action of cyclooxygenase of the second type is directed:

• to increase vascular permeability;
• release of inflammatory mediators in the damaged area;
• increased swelling in the area of ​​inflammation;
• migration of phagocytes, mast cells, fibroblasts;
• an increase in the general temperature of the body, through thermoregulation centers in the central nervous system.

Inflammation

The process of inflammation is the body’s universal response to any damaging effect and has several stages:

• alteration stage develops in the first minutes of exposure to a damaging factor. The agents causing damage may be physical, chemical or biological. Biologically active substances are released from destroyed cells, triggering subsequent stages;
• exudation (impregnation), is characterized by the effect on mast cells of substances from dead cells. Activated basophils release histamine and serotonin into the site of damage, causing an increase in vascular permeability to the liquid part of the blood and macrophages. Swelling occurs and local temperature rises. Enzymes are released into the blood, attracting even more immunocompetent cells, triggering a cascade of biochemical and protective processes. The reaction becomes excessive. Pain occurs. It is at this stage that non-steroidal anti-inflammatory drugs are effective;
• proliferation stage, occurs at the moment of resolution of the second stage. The main cells are fibroblasts, which form a connective tissue matrix to restore the destroyed structure.

The stages do not have a clear time frame and are often included in combination. With a pronounced stage of exudation, occurring with a hyperergic component, the stage of proliferation is delayed. Prescribing NSAID drugs promotes speedy recovery and alleviates the general condition of the patient.

Main groups of non-steroidal anti-inflammatory drugs

There are many classifications. The most popular ones are based on the chemical structure and biological effects of substances.

Salicylates

The most studied substance is acetylsalicylic acid. The analgesic effect is very moderate. It is used as a drug to reduce temperature during febrile conditions and as a means of improving microcirculation in cardiology (in small doses it reduces blood viscosity by blocking type 1 cyclooxygenase).

Propionates

Salts of propionic acid have moderate analgesic and pronounced antipyretic effects. The best known is ibuprofen. Due to its low toxicity and high bioavailability, it is widely used in pediatric practice.

Acetates

Derivatives of acetic acid are well known and widely used in medicine. They have a pronounced anti-inflammatory effect and a strong analgesic effect. Due to the large effect on type 1 cyclooxygenase, they are used with caution in case of peptic ulcer and risk of bleeding. The most famous representatives: Diclofenac, Ketorolac, Indomethacin.

Selective COX-2 inhibitors

The most modern selective drugs today are considered Celecoxib and Rofecoxib. They are registered on the Russian market.

Other drugs

Paracetamol, nimesulide, meloxicam. They mainly act on COX-2. They have a pronounced analgesic and antipyretic effect of central action.

The most popular NSAID drugs and their costs

• Acetylsalicylic acid.

An effective and inexpensive drug. Available in dosages of 500 milligrams and 100 mg. The average price on the market is 8-10 rubles for 10 tablets. Included in the list of vital essentials.

• Ibuprofen.

Safe and inexpensive drug. The price depends on the form of release and the manufacturer. Has a pronounced antipyretic effect. Widely used in pediatrics.

400 milligram tablets, film-coated, Russian production, have a cost of 50-100 rubles for 30 tablets.

• Paracetamol.

A popular drug all over the world. Available in European countries without a doctor's prescription. The most popular forms are 500 milligram tablets and syrup.

Included in combination drugs, as an analgesic and antipyretic component. It has a central mechanism of action, without affecting hematopoiesis and the gastrointestinal tract.

The price depends on the brand. Russian-made tablets cost about 10 rubles.

• Citramon P.

A combined drug containing anti-inflammatory and psychostimulating components. Caffeine increases the sensitivity of brain receptors tropic to paracetamol, enhancing the effect of the anti-inflammatory component.

Available in 500 milligram tablets. The average price is 10-20 rubles.

• Diclofenac.

It is available in various dosage forms, but is most in demand in the form of injections and local forms (ointments and patches).

The cost for a package of three ampoules is from 50 to 100 rubles.

• Nimesulide.

A selective drug that has a blocking effect on type 2 cyclooxygenase. Has a good analgesic and antipyretic effect. Widely used in dentistry and the postoperative period.

Available in the form of tablets, gels and suspensions. The average cost on the market is from 100-200 rubles for 20 tablets.

• Ketorolac.

A drug characterized by a pronounced analgesic effect, comparable to the effect of non-narcotic analgesics. It has a strong ulcerogenic effect on the mucous membrane of the gastrointestinal tract. Use with caution.

Must be released strictly according to a doctor's prescription. Release forms are varied. Tablets of 10 milligrams cost from one hundred rubles per pack.

Main indications for the use of NSAIDs

The most common reasons for taking this class of substances are diseases accompanied by inflammation, pain and fever. It should be remembered that drugs are rarely used for monotherapy. Treatment must be comprehensive.

Important. Use the information in this paragraph only if the emergency situation prevents you from contacting a qualified professional immediately. Please discuss all treatment issues with your doctor.

Arthrosis

Disease causing change anatomical structure articular surface. Active movements are extremely painful due to joint swelling and increased synovial fluid effusion.

In severe cases, treatment is reduced to joint replacement.

NSAIDs are indicated for moderate or moderate severity of the process. For pain, 100-200 milligrams of nimesulide are prescribed. No more than 500 mg per day. Taken in 2-3 doses. Drink with a small amount of water.

Rheumatoid arthritis

– inflammatory process of autoimmune etiology. Multiple inflammatory processes occur in various tissues. The joints and endocardial tissues are predominantly affected. NSAIDs are the drugs of choice in combination with steroid therapy. Damage to the endocardium always leads to the deposition of blood clots on the surface of the valves and chambers of the heart. Taking acetylsalicylic acid 500 milligrams per day reduces the risk of thrombosis by 5 times.

Pain due to soft tissue injuries

Associated with swelling at the point of application of the traumatic factor and surrounding tissues. As a result of exudation, small venous vessels and nerve endings are compressed.

Venous blood stagnates in the damaged organ, which further intensifies metabolic disorders. A vicious circle arises, worsening the conditions for regeneration.

For moderate pain syndrome, it is possible to use local forms of Diclofenac.

Apply to the area of ​​bruise or sprain three times a day. The damaged organ needs rest and immobilization for several days.

Osteochondrosis

With this pathological process, compression of the spinal nerve roots occurs between the upper and lower vertebrae, forming the exit channels of the spinal nerves.

When the lumen of the canal decreases, the nerve roots innervating organs and muscles experience compression. This leads to the development of inflammatory processes and swelling of the nerves themselves, which further disrupts trophic processes.

To break the vicious circle, local ointments and gels containing Diclofenac are used in combination with injectable forms of the drug. Three milliliters of Diclofenac solution are injected intramuscularly once a day.

The course of treatment is at least 5 days. Given the high ulcerogenicity of the drug, you should take proton pump blockers and antacids (Omeprazole 2 capsules twice a day and Almagel one or two scoops three times a day).

Pain in the lumbar region

With this localization, it is most often affected. The pain is quite intense. is formed from spinal roots emerging in the intervertebral foramina of the sacrum, emerging in a limited area into the shallow tissues of the gluteal region. This predisposes it to inflammation during hypothermia.

Ointments with NSAIDs containing Diclofenac or Nimesulide are used. In case of severe pain, the nerve exit site is blocked with an anesthetic drug. Local dry heat is used. It is important to avoid hypothermia.

Headache

Caused by various pathological processes. The most common cause is the brain. The brain itself does not have pain receptors. Pain sensations are transmitted from its membranes and receptors in the vessels.

Nonsteroidal anti-inflammatory drugs have a direct effect on prostaglandins, which regulate pain in the center of the thalamus. Pain causes vasospasm, metabolic processes decrease, and pain intensifies. NSAIDs, relieving pain, stop the spasm, interrupting the pathological process. The most effective drugs are Ibuprofen in a dose of 400 milligrams.

Migraine

It is caused by local spasm of blood vessels in the brain. More often the head hurts on one side. There are extensive neurological focal symptoms. Experience shows that non-steroidal analgesics in combination with antispasmodics are most effective.

Fifty percent Metamizole sodium solution (analgin) in the amount of two milliliters and two milliliters Drotaverine in one syringe intramuscularly or intravenously. After the injection, vomiting occurs. After some time, the pain is completely relieved.

Acute attack of gout

The disease is caused by metabolic disorders uric acid. Its salts are deposited in different organs and body tissues, causing widespread pain. NSAIDs help stop. Ibuprofen preparations are used in a dosage of 400-800 milligrams.

Complex. Includes a diet with reduced content purine and pyrimidine bases. IN acute period completely exclude animal products, broths, alcohol, coffee and chocolate.

Products of plant origin, except mushrooms, and large volumes of water (up to three to four liters per day) are indicated. If your condition improves, you can add low-fat cottage cheese to your food.

Dysmenorrhea

Painful periods or pain in the lower abdomen before them are common in women of fertile age. Caused by spasms in the smooth muscles of the uterus during rejection of the mucous membrane. The duration of pain and its intensity varies from person to person.

For relief, Ibuprofen preparations in a dose of 400-800 milligrams or selective NSAIDs (Nimesulide, Meloxicam) are suitable.

Treatment painful menstruation may include the use of biphasic estrogen drugs that normalize the body's hormonal levels.

Fever

An increase in body temperature is a nonspecific pathological process that accompanies many painful conditions. Normal body temperature is between 35 and 37 degrees Celsius. With hyperthermia above 41 degrees, protein denaturation occurs and death can occur.

At normal body temperature, most biochemical processes in the body occur. The mechanisms of thermoregulation in higher organisms are of a neurohumoral nature. A small section of the hypothalamus, called the infundibulum, plays a major role in maintaining temperature homeostasis.

Anatomically, it connects the hypothalamus and thalamus at the junction of the optic nerves.

Substances called pyrogens are responsible for activating the hyperthermic reaction. One of the pyrogens is prostaglandin, produced by immune cells.

Its synthesis is regulated by cyclooxygenase. Nonsteroidal anti-inflammatory drugs can influence prostaglandin synthesis, indirectly reducing body temperature. Paracetamol acts on COX-1 in the center of thermoregulation, providing a rapid but short-lived antipyretic effect.

During fever, Ibuprofen exhibits the greatest antipyretic activity, acting indirectly. To reduce fever at home, a regimen with both drugs is justified.

500 milligrams Paracetamol and 800 milligrams Ibuprofen. The first quickly reduces the temperature to acceptable values, the second slowly and maintains the effect for a long time.

Teething fever in children

Is a consequence of destruction bone tissue at rapid growth tooth Biologically active substances are released from the destroyed cells, which have a direct effect on the centers of the hypothalamus. Macrophages contribute to the inflammation process.

The most effective drug that eliminates inflammation and reduces temperature is Nimesulide at a dose of 25-30 milligrams, taken once or twice, completely stops the phenomena in 90-95 percent of cases.

Risks of using NSAIDs

Studies have shown that long-term use of non-selective drugs has a detrimental effect on the mucous membrane of the stomach and intestines. The ulcerogenic effect of acetylsalicylic acid has been confirmed. Long-term use of non-selective agents is recommended in conjunction with proton pump blockers (omeprazole).

Selective NSAIDs increase the risk of developing coronary heart disease tenfold even with long-term use. Aspirin is the only exception to this list. The antiplatelet properties of acetylsalicylic acid are used to prevent thrombosis, preventing blockage of great vessels.

Cardiologists warn that patients who have recently had a heart attack should avoid NSAID treatment. According to research data, Naproxen is considered the least dangerous from this point of view.

Studies have been published that long-term use of NSAIDs can cause erectile dysfunction. However, these studies were largely based on the feelings of the patients themselves. No objective data were provided on testosterone levels, seminal fluid examinations or physical examination methods.

Conclusion

A hundred years ago, the world's population was just over a billion people. Over the past twentieth century, humanity has made a huge breakthrough in all sectors of its activity. Medicine has become an evidence-based, effective and progressive science.

Today there are more than seven billion of us. Three major discoveries that impacted survival human race, are called:

• vaccines;
• antibiotics;
• non-steroidal anti-inflammatory drugs.

There is something to think about and something to strive for.

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Interesting

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 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 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 recent years have new generation non-steroidal anti-inflammatory drugs with such properties been obtained.

The principle of action of such drugs

Any inflammation in human body 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 non-steroidal anti-inflammatory drugs is widespread both in medical institutions and when patients self-relieve 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";

Propionic acid derivatives, for example, 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".

Developing pharmaceutical industry creates more and more 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 advantages of these medications also include their long period of action, due to which they can be taken less frequently - only once a day. The disadvantages of these drugs include their rather 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.