Diclofenac ointment or indomethacin, which is better. Nonsteroidal anti-inflammatory drugs: list and prices. Features of the use of Movalis

Piroxicam, Indomethacin, Ibuprofen and Diclofenac are non-steroidal anti-inflammatory drugs (NSAIDs). The widespread use of this group of drugs in all countries is due to the striking positive effect in symptomatic treatment aimed at eliminating pain, inflammation and lowering body temperature.

Compound

Diclofenac and Indomethacin are produced by numerous foreign and domestic pharmaceutical companies and are aimed at treating almost the same symptoms, but differ in composition.

Diclofenac contains diclofenac sodium, dosage form: tablets, ointments, gels, rectal suppositories, injection solution and eye drops.

Indomethacin is produced on the basis of indomethacin in forms identical to Diclofenac.

Indications

Diclofenac and Indomethacin block the enzyme cyclooxygenase (COX), which reduces the production of prostaglandins that support inflammatory processes and increase sensitivity to pain.

Diclofenac and Indomethacin have an anti-inflammatory effect, can eliminate pain, and also act as an antipyretic agent. Almost all NSAIDs are intended for a certain range of diseases, with no exception Diclofenac and Indomethacin, which help cope with:

feverish state
headaches and toothaches
renal colic
joint diseases
osteochondrosis
pain during menstruation and after surgery
painful sensations caused by injuries and various inflammations

Indications for the use of Diclofenac and Indomethacin as an adjunct may include cystitis, prostatitis, adnexitis, colds and some ENT diseases.

Contraindications and unwanted effects

Diclofenac and Indomethacin practically do not differ in their contraindications and side effects.

ulcerative lesions of the gastrointestinal tract
pathological changes in the kidneys and liver (oral use in limited dosages is possible)
the patient's age is less than 15 years
impaired blood clotting
nettle rash
pregnancy
possible allergies to similar drugs, etc.

Numerous undesirable manifestations of Diclofenac and Indomethacin are almost identical and manifest themselves in a possible negative effect on the digestive, nervous, cardiovascular, urinary systems, as well as on the sensory organs. Allergic reactions in the form of rashes on the skin and their redness are possible.

The difference between Indomethacin and Diclofenac in the manifestations of side effects is expressed in their more pronounced manifestation in the first drug compared to the second. In this regard, specialists in rare cases resort to prescribing Indomethacin.

Numerous studies show that Diclofenac is better than Indomethacin in its therapeutic qualities, and is able to get rid of the problem in a shorter period of time.

Diclofenac and Indomethacin are analogues, have a good effect and a reasonable price. However, Declofenac is the reference drug among NSAIDs, which makes it more popular than Indomethacin.

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IMPORTANT. The information on the site is provided for informational purposes only. Do not self-medicate. At the first sign of disease, consult a doctor.

Piroxicam or diclofenac which is better?

V. V. Nikolenko, S. M. Drogovoz, L. V. Derimedved, L. N. Cherepak

Rationale for choosing the most commonly used NSAIDs for inflammatory diseases

Ukrainian Pharmaceutical Academy, Kharkov.

Inflammation is the main pathogenetic component of many diseases of various etiologies and one of the most important problems in general pathology and clinical practice. This complex reaction of the body to damage is involved in the formation of many diseases encountered in the practice of a doctor.

Considering the widespread prevalence of inflammatory diseases, adequate regulation of this pathological process is of great importance. Non-steroidal anti-inflammatory drugs are currently widely used to correct inflammation.

Worldwide practical medicine and pharmacy has a huge arsenal of very effective NSAIDs. According to WHO, drugs in this group occupy 2nd place after antibiotics in terms of their widespread use. According to foreign medical literature, the average consumption of NSAIDs per capita per year is: in Switzerland - 25 g, Australia - 40 g, Denmark - 24 g, USA - 10 g, England - 30 g. It is estimated that NSAIDs are used daily in the world used by about 30 million patients.

Currently, there are about 70 original non-steroidal anti-inflammatory drugs in the world.

Today, about 170 (which is 40% of total production) drugs from various global manufacturers are represented on the Ukrainian market.

Domestic manufacturers produce 47 non-steroidal anti-inflammatory drugs (24 of them are combination drugs) based on 12 substances.

Today, NSAIDs have a large specific gravity in pharmacotherapy of pathologies with systemic and organ-specific inflammatory processes. Complex treatment of rheumatoid arthritis, arthrosis, myalgia, arthralgia, etc. includes long-term use of NSAIDs, which allows for objective and subjective improvement in the course of the disease.

A comparative assessment of the effectiveness of drugs in this group according to their individual pharmacological parameters is important for the optimal selection and use of them in individual pharmacotherapy, as well as for the search and introduction into medical practice of new effective and non-toxic NSAIDs.

Therefore, comparison of the activity of modern NSAIDs and experimental substantiation of an alternative to their choice in the clinic for the treatment of diseases accompanied by inflammation (rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, gout and other connective tissue pathologies) is relevant today.

More than 25 years have passed since the widespread introduction of NSAIDs (indomethacin) into medical practice. During this time, all modern non-steroidal anti-inflammatory drugs have been studied by various authors, on different models, with different approaches to dosing regimens, at different times of the year and day, using different indicators of their effectiveness.

The purpose of our study is a comparative study of informative pharmacological indicators of anti-exudative activity under the same conditions and on the same models of inflammation, taking into account the identified chronological features of modern and new NSAIDs and experimental substantiation of an alternative to choosing them in the clinic for the treatment of inflammatory diseases, their interchangeability in inflammation with severe exudation .

For the study, drugs were selected that have a powerful anti-inflammatory effect, which have already become classic for the treatment of inflammatory-dystrophic diseases of the musculoskeletal system not only in the world, but also in domestic clinics - indomethacin, diclofenac and piroxicam.

Also for a comparative study, a new generation non-steroidal anti-inflammatory drug was taken, recently approved for widespread use in medical practice - meloxicam, which belongs to the group of oxicams, derivatives of enolic acid.

The amino sugar derivatives of glucosamine - glucosamine and oxaglucamine, currently undergoing clinical trials in Ukraine, were compared with the above drugs in terms of pharmacological activity.

The study of the anti-inflammatory activity of the drugs indomethacin, diclofenac, piroxicam, glucosamine oxaglucamine, meloxicam was carried out on various exudation models using the introduction of phlogogenic agents in order to elucidate the mechanisms of action of these drugs at this stage of inflammation.

To compare the antiexudative properties of the studied NSAIDs (indomethacin, diclofenac, piroxicam, glucosamine, oxaglucamine and meloxicam), we used models of acute aseptic inflammation with a pronounced exudation phase caused by carrageenan, histamine, serotonin and prostaglandin.

To conduct this study, we first studied the antiexudative activity of the compared NSAIDs in a model of carrageenan edema in rats, since. Various inflammatory mediators (prostaglandins, biogenic amines, kinin system) are involved in the development of such edema, and this model allows the most informative determination of individual parts of the mechanism of the substances under study. [Methodological recommendations of the Physical Committee of the Ministry of Health of Ukraine for the preclinical study of NSAIDs / Drogovoz S. M. et al.].

In the carrageenan edema model, the average daily value of the antiexudative activity of indomethacin was 44.84%; diclofenac - 40.1%; piroxicam - 60.82%; glucosamine - 14.02%, oxaglucamine - 50.24% and meloxicam - 45.7%.

Thus, we can conclude that in this experiment the drugs piroxicam, oxaglucamine and meloxicam showed the greatest anti-inflammatory activity. Diclofenac and indomethacin had approximately equal anti-edema effects within 24 hours. Glucosamine showed a weak anti-inflammatory effect in this model. The values of its anti-exudative activity during the day were statistically insignificant in relation to the control.

Based on the results obtained over a three-hour experiment on the histamine edema model, the drugs can be arranged in descending order of antiexudative activity values in the following sequence: oxaglucamine (65.9%) > diclofenac (61.4%) > indomethacin (45.5%) > piroxicam (28.6%) > meloxicam (23%) > glucosamine (15.3%).

The average value of anti-exudative activity for the entire duration of the experiment (3 hours) on the model of edema induced by serotonin and indomethacin was 7.8%; diclofenac - 20.1%; piroxicam - 23.3%; meloxicam - 15.8; oxaglucamine - 1.8%; glucosamine did not show antiexudative activity in this model.

The studied drugs can be arranged in descending order of anti-edematous action as follows:

piroxicam > diclofenac > meloxicam > indomethacin > oxaglucamine.

Literature data indicate that almost all NSAIDs currently used in medical practice inhibit the first enzyme of the bienzyme chain of prostaglandin synthesis - cyclooxygenase. Therefore, we studied the effect of the above-mentioned drugs also on the exudation phase of the inflammatory process in rats caused by prostaglandin E2 of the studied drugs.

Oxaglucamine (average anti-exudative activity - 14.7% at p > 0.05) and glucosamine (anti-exudative activity for the entire study period was zero) did not show statistically significant anti-exudative activity in this model.

Indomethacin, diclofenac, piroxicam and meloxicam (average antiexudative activity - 61.4%, 41.2%, 72.6% and 36.6%, respectively) had pronounced antiexudative activity during the entire study period (2 hours) in the edema model, triggered by prostaglandin.

Therefore, in descending order of antiexudative activity, drugs can be arranged as follows: piroxicam > indomethacin > diclofenac > meloxicam.

Thus, as a result of the research, it was found that:

It is advisable to recommend piroxicam and oxaglucamine for clinical use in pathological conditions accompanied by severe exudation with the participation of the kinin system with the release of prostaglandins and biogenic amines;
oxaglucamine and indomethacin, which showed the greatest degree of inhibition of histamine edema in the first hour of the experiment, can be recommended in clinical practice to eliminate edema accompanied by the release of histamine;
among all the NSAIDs studied, piroxicam had the most pronounced anti-exudative activity in the model of serotonin-induced edema;
In the model of prostaglandin-induced edema, the drug piroxicam also showed the greatest activity during the entire study period (3 hours).

Viktorov A.P. Selective inhibition of cyclooxygenase isoforms: a new approach to finding effective and safe non-steroidal anti-inflammatory drugs // Pharmacy Weekly. - 1997. - No. 35 (106). - P. 4.
Inflammation. Guide for doctors. Ed. Serova V.V., Paukova V.S.- M.: Medicine, 1995.- 640 p.
Dzyak G.V. Non-steroidal anti-inflammatory drugs: new ideas about the mechanism of action and new possibilities // Treatment and diagnosis. - 1997. - No. 3. - P. 1–4.
Dobrokhodova T. M. Anti-inflammatory drugs // Paramedic and midwife. - 1990. - No. 9. - P. 37–42.
5. Zupanets I. A. Modern approaches to the clinical selection of NSAIDs and non-narcotic analgesics // Journal of a practical physician. - 1998. - No. 3. - P. 51–52.
Levitsky E. L. NSAIDs - some issues of pharmacodynamics and pharmacokinetics // Pharmacy Weekly. - 1998. - No. 23 (144). - P. 3.
Sigidin Ya. A., Shvarts G. Ya., Arzamastsev A. P., Liberman S. S. Drug therapy of the inflammatory process. - M.: Medicine. - 1988. - 240 p.
Luft S. New directions of pharmacotherapy in rheumatology//News of pharmacy and medicine.- 1994.- No. 3.- pp. 34–39.
Nasonov V. A., Sigidin Ya. A. Pathogenetic therapy of rheumatic diseases. - M., 1985.
Nasonov E. L., Lebedeva O. V. Non-steroidal anti-inflammatory drugs: mechanism of action and clinical use in rheumatology//News of pharmacy and medicine.- 1996.- No. 1.- P. 3.
Nonsteroidal anti-inflammatory drugs // Clinical pharmacology and therapy. - 1994. - No. 3 (1).
Trinus F. P., Klebanov B. M., Ganja I. M., Seifulla R. D. Pharmacological regulation of inflammation. - K.: 3dorovya, 1987. - 144 p.
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Review existing options BPH.

Safe analogues of Diclofenac - tablets, ointments, injection solutions

Despite the high therapeutic effectiveness of Diclofenac, in some patients its use causes unwanted side effects. When choosing a replacement, the doctor must take into account the safety of the drugs, the frequency of dosages used and the duration of the therapeutic course. Analogues of Diclofenac may be structural or similar in their clinical effect. Neurologists, rheumatologists, and traumatologists give preference to drugs from the group of nonsteroidal anti-inflammatory drugs.

Characteristics of non-steroidal anti-inflammatory drugs

Diclofenac - a phenyl derivative acetic acid, used in pharmacological preparations in the form of sodium salt. The mechanism of action of the nonsteroidal anti-inflammatory drug is based on its ability to block the enzyme cyclooxygenase (COX), which stimulates the production of pain and inflammation mediators prostaglandins and bradykinins from arachidonic acid, as well as the bioactive compounds prostacyclin and thromboxane. The use of Diclofenac in tablets, ointments, parenteral solutions has a diverse effect on the human body:

reducing the severity of pain;
relief of inflammation and swelling;
elimination of fever.

In medical practice, analogues of Diclofenac are distinguished based on their composition and therapeutic effect. This classification is necessary to quickly select a replacement NSAID if it is intolerable or exhibits an excessive number of side effects. Structural analogues of Diclofenac include Diclogen, Ortofen, Dikloberl, Voltaren, Diclak, Naklofen. They are of interest, first of all, to patients, since the cost of drugs can vary significantly. For example, the price of Ortofen ointment is rubles, and for a package of Voltaren gel you will have to pay at least 200 rubles.

Structural analogues of Diclofenac

Analogues of Diclofenac by effect

If a doctor prescribes an expensive structural analogue of Diclofenac, then you should not suspect him of any self-interest. The high price is often due to the high quality of the additional and active ingredients included in the ointment or tablets. Such a drug will be better absorbed and cause fewer side effects.

Rheumatologists, traumatologists, and neurologists rarely replace Naklofen with Diclogen or Dicloberl. In case of intolerance to Diclofenac or its low effectiveness in the treatment of any diseases, they include in therapeutic regimens other non-steroidal anti-inflammatory drugs that are similar in pharmacological action:

These analogues of Diclofenac have few differences in instructions for use, price, and consumer reviews. But there is also a difference in action, which is caused by the biochemical properties of the active ingredients. In vitro studies have found that all NSAIDs inhibit prostaglandin production to varying degrees. The relationship between their anti-inflammatory and analgesic properties and the degree of mediator suppression has not yet been proven.

Diclofenac and its analogues are characterized by the presence of similar chemical and pharmacological activity. Most of them are weak organic acids that are quickly absorbed in the digestive tract. All NSAIDs in the systemic circulation bind to albumin and are evenly distributed in tissues. Non-steroidal anti-inflammatory drugs are classified into the following groups:

short-lived (less than 6 hours);
long-lived (more than 6 hours).

To replace Diclofenac, the doctor may prescribe both a short-lived and a long-lived analogue. This is due to the fact that there is no clear relationship between the duration of the drug’s presence in the human body and the severity of the therapeutic effect. Almost all NSAIDs quickly accumulate in the synovial fluid of the joints and are then metabolized in hepatocytes (liver cells) through the process of glucuronidation, forming biologically active and inactive conjugates. They are evacuated by the kidneys by approximately 65-80%.

Comparison of clinical effects of analogues

Diclofenac and its analogues stop the inflammatory process mainly at the exudation stage, when fluid is released from small blood vessels into the tissue or cavity of the body. The most effective are Diclofenac, Indomethacin, and Phenylbutazone, which reduce collagen synthesis.

In terms of the degree of anti-inflammatory action, all NSAIDs are significantly inferior to glucocorticosteroids, which can inhibit the production of prostaglandins.

During clinical trials that were conducted to compare the effectiveness of non-steroidal anti-inflammatory drugs, the features of individual representatives of this group of drugs were identified:

the antipyretic activity turned out to be identical for all NSAIDs, and they only reduced low-grade temperature values, in contrast to the hypothermic drug Chlorpromazine;
the antiaggregant effect was based on inhibition of cyclooxygenase in platelets and suppression of the synthesis of the proaggregant thromboxane. The greatest antiaggregation activity is characteristic of acetylsalicylic acid, and it is significantly lower in Diclofenac and its other analogues;
The immunosuppressive effect is moderate in all NSAIDs with prolonged use and is based on their ability to reduce capillary permeability and impede the contact of cells that trigger an allergic reaction with antigens.

All NSAIDs effectively eliminate pain of moderate intensity, localized in muscle, joint, and tendon tissues. To eliminate severe visceral pain, it is usually practiced to prescribe drugs with morphine - narcotic analgesics. But Diclofenac, Metamizole, Perekoksib, Ketoprofen successfully cope with such intense discomfort.

Even “advanced” joint problems can be cured at home! Just remember to apply this once a day.

These NSAIDs are actively used to relieve renal colic, which often occurs with urolithiasis. The active ingredients of the drugs inhibit the production of prostaglandins in the renal structures, slow down renal blood circulation and urine formation, and this causes a decrease in pressure in the paired organs. Unlike narcotic analgesics, Diclofenac and its analogues do not provoke drug addiction and euphoria, and do not have the ability to suppress the respiratory center.

With a course of taking any non-steroidal anti-inflammatory drugs, especially in elderly and senile patients, chronic heart failure may worsen. The likelihood of events developing according to such a negative scenario is 10 times higher compared to refusal to take NSAIDs.

The most popular analogues from the NSAID group

Often the use of injection solutions and tablets of Diclofenac causes side effects. Doctors try to prevent the negative consequences of treatment by adjusting dosages individually for each patient. NSAIDs are not initially prescribed to people with a history of erosive and hyperacid gastritis, ulcerative lesions of the gastrointestinal tract, since a course of Diclofenac will provoke acute painful relapses.

To prevent ulceration of the mucous membranes of the digestive system, neurologists and traumatologists include proton pump blockers in patients’ therapeutic regimens, which contain the active ingredients lansoprazole, omeprazole, pantoprazole, and esomeprazole. Sometimes even such preventive measures are not enough: pain in the epigastric region, gastrointestinal bleeding, and bouts of vomiting occur. Doctors immediately stop Diclofenac and use other, safer NSAIDs to treat the patient.

A randomized clinical trial was conducted in the USA, which included 1309 patients, mostly women. Average age The volunteers were 64 years old, and the duration of chronic disease was about 9 years. One group of patients took Meloxicam, and the second group was prescribed Diclofenac, Naproxen, Piroxicam, and Ibuprofen. The results of the study showed that treatment with Meloxicam was successful in 66.8% of people, and the use of Diclofenac and analogues brought relief to only 45% of volunteers.

Meloxicam

Meloxicam is a derivative of enoliconic acid. The nonsteroidal anti-inflammatory drug has a positive effect on the intensity of pain, has an antipyretic effect, and is well tolerated by patients. After penetration into the systemic bloodstream, Meloxicam binds to proteins, while 40-50% accumulates in the synovial fluid, which is actively used in the treatment of pathologies of the musculoskeletal system. NSAIDs are characterized by a long elimination period - about 20 hours, so to achieve a therapeutic effect, a single dose or parenteral administration is sufficient. Meloxicam is a safer analogue of Diclofenac, Naproxen, Piroxicam. It does not interact with other drugs:

cytostatics;
antihypertensive drugs;
diuretics;
cardiac glycosides;
β-blockers.

When prescribing, the doctor takes into account the cumulative effect of Meloxicam, the creation of a maximum therapeutic concentration in the bloodstream. To achieve a quick therapeutic effect, intramuscular administration of NSAIDs in an amount of 15 mg is practiced in the first 3 days. After this, the patient is recommended to take oral tablet forms.

Ibuprofen

The results of a recent study of sales of non-steroidal anti-inflammatory drugs revealed that Ibuprofen ointment and tablets are in greatest demand among the population. The advantage of this NSAID is its budget cost. The price for one package is rubles, which makes the drug extremely attractive to pharmacy customers. But the advantages of Ibuprofen do not include safety of use. The following pathological conditions become undesirable consequences of treatment with this analogue of Diclofenac:

bronchospasm;
decreased clarity of vision;
psycho-emotional instability;
hepatitis;
dyspeptic disorders.

But with the right dosage regimen, Ibuprofen has a pronounced analgesic, anti-inflammatory and antipyretic effect. NSAIDs are widely used in pediatrics as an etiotropic and symptomatic agent for viral and bacterial respiratory infections and juvenile arthritis.

When combining oral and local preparations of Ibuprofen for JA, a significant prolongation of the therapeutic effect is achieved, which makes it possible to reduce single and daily dosages, as well as the duration of treatment.

Nimesulide

At the Institute of Rheumatology of the Russian Academy of Medical Sciences in Moscow, a comparative study of the therapeutic effectiveness of tablet forms of Nimesulide (Nise) and Diclofenac was conducted with the participation of 90 volunteers. Its goal was to determine the rate of onset of analgesic and anti-inflammatory effects in patients with acute gouty arthritis. The duration of treatment was 7 days, during which the patients' condition was constantly monitored. According to the results obtained from comparing the clinical effectiveness of relieving an attack of gout, the advantage of Nimesulide was revealed. Indications for its use:

osteoarthritis;
rheumatoid, gouty, juvenile arthritis;
bursitis, tendinitis;
myalgia, algodismenorrhea, toothache, arthralgia, headache;
pain that occurs in the postoperative period.

Suspensions, tablets and rectal suppositories are prescribed to adults and children to reduce body temperature during febrile conditions caused by the penetration of infectious agents into the body.

Review of analogues from the NSAID group

Most often, side effects of drugs appear after their parenteral administration, so doctors quickly select a replacement for Diclofenac with an analogue in ampoules. It is not advisable to include Voltaren or Ortofen injection solutions in patients’ therapeutic regimens. These drugs have a composition identical to Diclofenac. The safest analogues from the NSAID group:

Meloxicam (from 120 rub.);
Movalis (from 650 rub.);
Ksefokam (about 700 rubles);
Ketorol (from 120 rub.);
Ketonal (from 250 rub.).

It is strictly forbidden to replace Diclofenac without prior consultation with your doctor. Despite the similarity of the effect, all analogs differ in the frequency of use and dosage regimen. Each drug has its own characteristics of use and characteristic contraindications.

If allergic rashes occur on the skin after applying Diclofenac ointment, then analogues from the NSAID group do not necessarily become a substitute for the external agent. These can be warming gels, balms with chondroprotectors and even glucocorticosteroids. The greatest anti-inflammatory effectiveness is typical for the following drugs:

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Ibuprofen ointment (from RUR 30);
gel Nise (from 220 RUR);
Amelotex gel (from RUR 240);
Ketonal cream (about 320 rub.);
Indomethacin ointment (from RUR 75).

Analogues of Diclofenac ointment are well absorbed by the skin and quickly penetrate into inflammatory foci, creating a therapeutic concentration in the synovial fluid of joints, muscle and soft tissues.

When choosing analogues of Diclofenac, the doctor must take into account the selectivity of the drug. This factor does not determine effectiveness, but does affect toxicity values. A course of short-lived NSAIDs (Ibuprofen) is better tolerated by patients than the use of Indomethacin, Naproxen, and Piroxicam.

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Non-steroidal anti-inflammatory drugs: list and prices

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) are drugs that have analgesic, antipyretic and anti-inflammatory effects.

The mechanism of their action is based on blocking certain enzymes (COX, cyclooxygenase), they are responsible for the production of prostaglandins - chemicals that promote inflammation, fever, pain.

The word “non-steroidal”, which is contained in the name of the group of drugs, emphasizes the fact that the drugs in this group are not synthetic analogues of steroid hormones - powerful hormonal anti-inflammatory drugs.

The most famous representatives of NSAIDs: aspirin, ibuprofen, diclofenac.

How do NSAIDs work?

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

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

When are these drugs prescribed?

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

We list the diseases for which these drugs are prescribed:

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

List of common NSAIDs for treating joints

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

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

What are the advantages of new generation NSAIDs?

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

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

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

New generation NSAIDs: list and prices

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

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

Movalis. It has antipyretic, pronounced analgesic and anti-inflammatory effects. The main advantage of this remedy is that with regular medical supervision it can be taken for a fairly long period of time. Meloxicam is available in the form of a solution for intramuscular injection, in tablets, suppositories and ointments. Meloxicam (Movalis) tablets are very convenient because they are long-acting and it is enough to take one tablet throughout the day. Movalis, which contains 20 tablets of 15 mg, costs RUB.
Xefocam. A drug based on Lornoxicam. Its distinctive feature is the fact that it has a high ability to relieve pain. In this parameter, it corresponds to morphine, but is not addictive and does not have an opiate-like effect on the central nervous system. Xefocam, which contains 30 tablets of 4 mg, costs rubles.
Celecoxib. This drug significantly alleviates the patient’s condition with osteochondrosis, arthrosis and other diseases, relieves pain well and effectively fights inflammation. Side effects on the digestive system from celecoxib are minimal or absent. Price, rub.
Nimesulide. It is used with great success to treat vertebrogenic back pain, arthritis, etc. Removes inflammation, hyperemia, normalizes temperature. The use of nimesulide quickly reduces pain and improves mobility. It is also used as an ointment to apply to the problem area. Nimesulide, which contains 20 tablets of 100 mg, costs rub.

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

Classification

How are NSAIDs classified and what are they? Based on their chemical origin, these drugs come in acidic and non-acidic derivatives.

Oxicams – piroxicam, meloxicam;
NSAIDs based on indoacetic acid - indomethacin, etodolac, sulindac;
Based on propionic acid – ketoprofen, ibuprofen;
Salicipates (based on salicylic acid) – aspirin, diflunisal;
Phenylacetic acid derivatives – diclofenac, aceclofenac;
Pyrazolidines (pyrazolonic acid) – analgin, metamizole sodium, phenylbutazone.

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

Effectiveness of average doses

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

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

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

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

What dosage should I choose?

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

Therapeutic doses of NSAIDs are in a wide range, and in recent years there has been a tendency to increase single and daily doses of drugs characterized by the best tolerance (naproxen, ibuprofen), while maintaining restrictions on the maximum doses of aspirin, indomethacin, phenylbutazone, piroxicam. In some patients, the therapeutic effect is achieved only when using very high doses of NSAIDs.

Side effects

Long-term use of anti-inflammatory drugs in high doses can cause:

Disruption nervous system– changes in mood, disorientation, dizziness, apathy, tinnitus, headache, blurred vision;
Changes in the functioning of the heart and blood vessels - palpitations, increased blood pressure, swelling.
Gastritis, ulcers, perforation, gastrointestinal bleeding, dyspeptic disorders, changes in liver function with increased activity of liver enzymes;
Allergic reactions – angioedema, erythema, urticaria, bullous dermatitis, bronchial asthma, anaphylactic shock;
Kidney failure, urinary disorders.

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

Use during pregnancy

It is not recommended to use NSAIDs during pregnancy, especially in the third trimester. Although no direct teratogenic effects have been identified, NSAIDs are thought to cause premature closure of the ductus arteriosus and renal complications in the fetus. There is also information about premature births. Despite this, aspirin in combination with heparin has been successfully used in pregnant women with antiphospholipid syndrome.

According to the latest data from Canadian researchers, the use of NSAIDs before 20 weeks of pregnancy was associated with an increased risk of miscarriage. According to the results of the study, the risk of miscarriage increased by 2.4 times, regardless of the dose of the drug taken.

Movalis

The leader among non-steroidal anti-inflammatory drugs can be called Movalis, which has an extended period of action and is approved for long-term use.

It has a pronounced anti-inflammatory effect, which makes it possible to take it for osteoarthritis, ankylosing spondylitis, and rheumatoid arthritis. It has analgesic and antipyretic properties, and protects cartilage tissue. Used for toothache and headache.

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

Celecoxib

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

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

Indomethacin

It is one of the most effective non-hormonal agents. For arthritis, indomethacin relieves pain, reduces joint swelling and has a strong anti-inflammatory effect.

The price of the drug, regardless of the form of release (tablets, ointments, gels, rectal suppositories) is quite low, the maximum cost of tablets is 50 rubles per package. When using the drug you must be careful, as it has a considerable list of side effects.

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

Ibuprofen

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

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

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

Diclofenac

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

It is produced under the names Voltaren, Naklofen, Ortofen, Diclak, Diclonac P, Vurdon, Olfen, Dolex, Dikloberl, Clodifen and others.

Ketoprofen

In addition to the drugs listed above, the group of drugs of the first type, non-selective NSAIDs, i.e. COX-1, includes a drug such as ketoprofen. In terms of the strength of its action, it is close to ibuprofen, and is available in the form of tablets, gel, aerosol, cream, solutions for external use and for injection, rectal suppositories (suppositories).

You can buy this product under the trade names Artrum, Febrofid, Ketonal, OKI, Artrosilen, Fastum, Bystrum, Flamax, Flexen and others.

Aspirin

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

Aspirin is contraindicated for children under 15 years of age, as a possible complication in the form of extremely severe Reye's syndrome, in which 80% of patients die. The remaining 20% of surviving babies may be susceptible to epilepsy and mental retardation.

Alternative drugs: chondroprotectors

Quite often, chondroprotectors are prescribed for the treatment of joints. People often do not understand the difference between NSAIDs and chondroprotectors. NSAIDs quickly relieve pain, but they also have a lot of side effects. And chondroprotectors protect cartilage tissue, but they need to be taken in courses.

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

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2 comments

I read in a medical journal that NSAIDs destroy cartilage and it is necessary to be treated with chondroprotectors. And potent ones, like Elbona. Why then do we all prescribe NSAIDs for arthrosis?! Doctors don't read magazines, do they?

Doctors read magazines; something else is important here: anti-inflammatory and analgesic effects. In addition: NSAIDs are usually used in short courses to reduce fever, relieve inflammation and pain. Then, as a rule, another, more specific treatment begins. Nowhere will you find recommendations to take NSAIDs for years, as is typical for our patients.

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Transcription of analyzes online

Doctors consultation

Fields of Medicine

How do NSAIDs work?

When are these drugs prescribed?

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

We list the diseases for which these drugs are prescribed:

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

List of common NSAIDs for treating joints

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

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

What are the advantages of new generation NSAIDs?

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

New generation NSAIDs: list and prices

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

Movalis. It has antipyretic, pronounced analgesic and anti-inflammatory effects. The main advantage of this remedy is that with regular medical supervision it can be taken for a fairly long period of time. Meloxicam is available in the form of a solution for intramuscular injection, in tablets, suppositories and ointments. Meloxicam (Movalis) tablets are very convenient because they are long-acting and it is enough to take one tablet throughout the day. Movalis, which contains 20 tablets of 15 mg, costs RUB.
Xefocam. A drug based on Lornoxicam. Its distinctive feature is the fact that it has a high ability to relieve pain. In this parameter, it corresponds to morphine, but is not addictive and does not have an opiate-like effect on the central nervous system. Xefocam, which contains 30 tablets of 4 mg, costs rubles.
Celecoxib. This drug significantly alleviates the patient’s condition with osteochondrosis, arthrosis and other diseases, relieves pain well and effectively fights inflammation. Side effects on the digestive system from celecoxib are minimal or absent. Price, rub.
Nimesulide. It is used with great success to treat vertebrogenic back pain, arthritis, etc. Removes inflammation, hyperemia, normalizes temperature. The use of nimesulide quickly reduces pain and improves mobility. It is also used as an ointment to apply to the problem area. Nimesulide, which contains 20 tablets of 100 mg, costs rub.

Classification

How are NSAIDs classified and what are they? Based on their chemical origin, these drugs come in acidic and non-acidic derivatives.

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

Effectiveness of average doses

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

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

What dosage should I choose?

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

Side effects

Long-term use of anti-inflammatory drugs in high doses can cause:

Disruption of the nervous system - mood changes, disorientation, dizziness, apathy, tinnitus, headache, blurred vision;
Changes in the functioning of the heart and blood vessels - palpitations, increased blood pressure, swelling.
Gastritis, ulcers, perforation, gastrointestinal bleeding, dyspeptic disorders, changes in liver function with increased activity of liver enzymes;
Allergic reactions – angioedema, erythema, urticaria, bullous dermatitis, bronchial asthma, anaphylactic shock;
Kidney failure, urinary disorders.

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

Use during pregnancy

Movalis

The leader among non-steroidal anti-inflammatory drugs can be called Movalis, which has an extended period of action and is approved for long-term use.

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

Celecoxib

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

Indomethacin

It is one of the most effective non-hormonal agents. For arthritis, indomethacin relieves pain, reduces joint swelling and has a strong anti-inflammatory effect.

Ibuprofen

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

Diclofenac

It is produced under the names Voltaren, Naklofen, Ortofen, Diclak, Diclonac P, Vurdon, Olfen, Dolex, Dikloberl, Clodifen and others.

Ketoprofen

You can buy this product under the trade names Artrum, Febrofid, Ketonal, OKI, Artrosilen, Fastum, Bystrum, Flamax, Flexen and others.

Aspirin

Alternative drugs: chondroprotectors

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

Which is better Ibuprofen or Indomethacin?

When it comes to choosing an effective pain reliever, patients often doubt whether Ibuprofen or Indomethacin is better. It is worth noting that both drugs belong to the group of non-steroidal anti-inflammatory drugs.

Impact on the body

Ibuprofen and Indomethacin are used for the following disorders:

rheumatoid arthritis;
consequences of colds;
other inflammatory processes of the joints;
traumatic damage to the skin;
toothache;
blood clot formation;
pain during menstruation;
inflammation of the pelvic organs;
cystitis and prostatitis.

Mode of application

Ibuprofen or Indomethacin is taken up to 3-4 times a day. The daily dosage of the drug is prescribed by a specialist after a preliminary examination. Usually, both drugs are allowed to be taken over a long period. If treatment therapy is stopped prematurely, the pain will return.

The maximum daily dose of Indomethacin for an adult is no more than 200 mg. Ibuprofen is taken in a dosage of 200 to 800 mg per day, depending on the severity of symptoms.

Both medications are not prescribed for children under 6 years of age. Therefore, women during lactation are prohibited from using such products.

While taking Ibuprofen and Indomethacin, it is necessary to constantly monitor the internal state of the body. To do this, patients periodically undergo blood and urine tests. This is necessary to monitor the condition of the blood, as well as the urinary system.

Another difference is in cost; Indomethacin is slightly more expensive than Ibuprofen. However, this difference is very insignificant.

The group of non-steroidal drugs also includes: Diclofenac, Ketoprofen, Piroxicam, Naproxen. All these products are analogues and, if necessary, can replace each other.

Indomethacin differs from Ibuprofen in that it is a derivative of indoleacetic acid. In turn, the second drug is a derivative of propionic acid. Due to this, the analgesic effect is achieved when consumed.

Paracetamol is a medicine that also belongs to the group of painkillers. It has antipyretic and anti-inflammatory effects, like Ibuprofen and Indomethacin.

Which remedy is more effective?

It is impossible to definitively answer which is better: Ibuprofen or Indomethacin. These medications cope equally well with pain. Since they belong to the same group, they have a similar mechanism of action.

The doctor prescribes one drug or another depending on the body’s tolerance. Sometimes the patient may experience an allergic reaction to the components of the composition. In this case, these 2 remedies can become a replacement for each other.

Found a mistake? Select it and press Ctrl + Enter

indomethacin or ibuprofen which is better

In the section Diseases, Medicines, to the question tell me which drug is better Indomethacin or Ibuprofen asked by the author Proslav Gvozdev, the best answer is Prescribed.

Calls to the studio:

>then what is the difference between them?? ?

Range of contraindications and side effects; interaction with the circulatory and endocrine systems. In such cases, you need to use the search on vidal.ru - this is an electronic version of the most current, authoritative and professional (doctors use) pharmacological reference book.

>Absolutely the same thing. These two drugs belong to the same group

Vitamins A and B12 also belong to the same group. Penicillin and ampicillin too. And what?

>I smeared it on my knees, it helped.

When I was a child, I smeared green paint on my knees - it helped me too! True, the diagnosis was different, it seems.

Diclofenac, indomethacin, piroxicam, ibuprofen

Changeable weather is poorly tolerated by people with joint diseases. Right now, more often than ever, you can hear the classic complaint of all arthritis patients: “Something in my joints hurts, probably the weather will change.” And lumbar pain due to insidious drafts is found everywhere. At such a time, even those who did without them begin to take painkillers. And this is a good reason to talk about such drugs.

Diclofenac, indomethacin, piroxicam, ibuprofen - the names of these drugs are well known to people over sixty. At this age, it is difficult to find a person who does not have a disease, popularly not quite accurately called “salt deposition in the joints.” Correct name diseases: osteoarthrosis - when the joints are affected and osteochondrosis - when the spine is affected. It is not so much the salts that are to blame for their development, but rather the aging and wear of cartilage in the joints. With age, cartilage tissue recovers less well, and “scars” form at the site of any injury or damage. They deform the intra-articular surfaces, joint mobility decreases, inflammation and pain occur. In such cases, doctors prescribe painkillers and anti-inflammatory drugs.

Fortunately, there is no need to take separate pills for pain and inflammation. These effects are combined in “one bottle” - in the so-called NSAIDs (non-steroidal anti-inflammatory drugs). You have already read the names of the most popular ones. All of them originate from acetylsalicylic acid, or aspirin. This drug, which appeared at the very end of the 19th century, replaced salicylic acid, which helped with joint diseases, but caused stomach ulcers and bleeding. And now aspirin is practically no longer used for these purposes - safer drugs have appeared.

Although the word “safety” here must be understood philosophically: in 1997, scrupulous Americans calculated that these drugs cost them 16.5 thousand deaths per year. Approximately the same number of patients in the United States die each year from AIDS. For comparison, this mortality rate is three times higher than from bronchial asthma, and almost four times higher than from cervical cancer in women. What is the reason? Although these medications are much safer than salicylic acid, they still quite often cause serious complications from the gastrointestinal tract - gastritis, ulcers, stomach bleeding. A breakthrough of the stomach wall and bleeding require emergency surgical treatment and often ends fatally.

Unfortunately, in Russia it is impossible to accurately collect such statistics,” says Natalya Chichasova, professor of the department of rheumatology at the Moscow Medical Academy. THEM. Sechenov. - But the data from our American colleagues seems real to us.

Thus, recently in Russia a study of more than two thousand case histories of patients admitted to clinics with gastric bleeding over the years was completed. 342 of them, i.e. in 16.7%, this complication was chronologically associated with taking anti-inflammatory drugs. And among those whose bleeding was acute, and therefore more severe, requiring emergency treatment (often surgical), the proportion of people taking such medications was even higher - 34.6%. This means that NSAIDs can be suspected in every third case of acute bleeding from the gastrointestinal tract.

The problem is further complicated by the fact that in 58% of patients, the first manifestation of the damaging effect of anti-inflammatory drugs is such life-threatening conditions as bleeding or a breakthrough stomach ulcer, continues Natalya Vladimirovna. - How to explain this “bolt from the blue”? Complications from NSAIDs often occur silently, without pain, nausea, heartburn, without a feeling of discomfort and other symptoms typical of damage to the gastrointestinal tract. This is very dangerous: the patient continues to take the drug, the complication progresses and leads to such acute situations.

“I’ll tell you a little secret,” said John Wayne, a Nobel laureate who received the prize for discovering the mechanism of action of aspirin in 1971. - Medicines that are free of these and many other complications typical of NSAIDs already exist, and they will soon go on sale. What is special about these funds? Aspirin and other NSAIDs block cyclooxygenase (COX). There are two types of this enzyme, and they play a key role in so many processes in our body. Type 2 COX is involved in the development of inflammation and pain in joint diseases. And accordingly, its blockade reduces pain and inflammation. But inhibition of type 1 COX often leads to undesirable consequences - the development of gastric ulcers and bleeding, and kidney damage. New drugs selectively block COX-2, and accordingly they are devoid of these disadvantages.

And indeed, soon the first specific COX-2 blocker, Celebrex, began to be sold in the United States, and then in other countries, including Russia. Viox appeared a little later. Now these American drugs are among the best-selling. After all, there are millions and millions of patients with joint diseases. These drugs are used not only for osteoarthritis, but also for back pain and a number of other diseases.

In Russia, unlike Western countries, the old NSAIDs remain the main means for treating joint diseases, says Natalya Chichasova. - This can be explained for various reasons, including the behavior of doctors. Receiving little money, they tend to transfer their problems to patients. As a result, doctors often do not tell patients that more expensive and safer treatments exist.

Nonsteroidal anti-inflammatory drugs

Before you start taking medications, consult your doctor. Taking medications without a doctor's advice can harm your body. Don't self-medicate

Nonsteroidal anti-inflammatory drugs (NSAIDs) are an optimal group of drugs that reduce the level of inflammation in the joints and reduce the degree of painful symptoms. Since NSAIDs do not contain hormonal components, unlike corticosteroids (hormonal anti-inflammatory drugs), the risk of side effects is much greater below.

Before you start using any medication, carefully read the instructions for it and act according to the recommendations. Simultaneous use of two or three types of NSAIDs is strictly not recommended. The risk of side effects increases, but the effectiveness of the drugs will not increase.
The use of most NSAIDs affects the gastrointestinal tract, liver, kidneys and cardiovascular system. Long-term use of such drugs can negatively affect the functioning of these organs and lead to new diseases. In the presence of gastric and duodenal ulcers, gastritis, colitis, as well as in the case of previously cured these diseases, the use of anti-inflammatory drugs is unacceptable.

As a side effect of taking medications, inflammation of the mucous membrane of organs can occur, even leading to the occurrence of ulcers. If it is necessary to take NSAIDs for stomach diseases, the drugs are used in the form of rectal suppositories.

You should not use suppositories if you have hemorrhoids, fissures or polyps in the rectum.

The medicine should be taken with plenty of water, at least 250 ml, while reducing the degree of irritation of the gastric mucosa. It is not recommended to drink other types of liquids; this affects the level of absorption of the drug.
Since NSAIDs affect the retention of water and sodium in the kidneys, affecting the outflow of blood, taking anti-inflammatory drugs can not only cause hypertension, but also impair the functioning of the kidneys and liver. Therefore, if these organs are diseased, anti-inflammatory drugs are not recommended.
Individual intolerance and hypersensitivity to drugs can cause negative consequences for the body. Regardless of the presence or absence of system diseases internal organs listed above, taking NSAIDs should be started gradually and with small doses and always under the supervision of the attending physician.
The simultaneous use of anti-inflammatory drugs and alcohol is harmful to health, since the effect of the drug on the gastric mucosa increases several times. In addition, side effects may appear in the area of disruption of the cardiovascular system.
Pregnant women are not recommended to take NSAIDs. In case of urgent need for treatment with such drugs, be sure to consult your doctor.
Taking NSAIDs, like any anti-inflammatory drugs, is carried out only after consultation with a doctor and under his supervision. Self-medication can cause complications and side effects, which can lead to negative consequences.

List of funds:

There are 2 types of NSAIDs: COX-1 and COX-2 inhibitors (cyclooxygenase types 1 and 2). The first type inhibitors include: aspirin, diclofenac, ibuprofen, indomethacin, ketoprofen.

Aspirin or acetylsalicylic acid

Acetylsalicylic acid (aspirin) is the most popular drug. Due to properties such as antipyretic, anti-inflammatory and analgesic effects, the medicine is prescribed for the treatment of rheumatoid arthritis.

The beginning of treatment for osteoporosis usually begins with aspirin, but with the advent of new and more effective drugs, this drug is losing in terms of effectiveness on the human body. Patients with a blood disorder should take aspirin with caution, as the drug slows down the blood clotting process.

Diclofenac

Diclofenac - the drug was synthesized in 1966 in the Geigy laboratory and, due to its properties, showed excellent results in the treatment of rheumatoid joint diseases. The drug has an analgesic, anti-inflammatory effect, reduces swelling and swelling, and is well tolerated by the body.

Diclofenac is available in the form of tablets, ointments and injections. The most commonly used drugs are known as: Voltaren, Diclak, Diclonac P, Naklofen, Ortofen, Dolex, Vurdon, Olfen, Dikloberl, Clodifen and others.

Ibuprofen

Ibuprofen is most effective for inflammation of the joints, and its antipyretic effects are identical to aspirin. When used externally, in the form of applying ointment to the affected area, ibuprofen reduces hyperemia, relieves pain, and reduces the degree of swelling and morning stiffness. Good tolerance by the body was noted.

The drug is available in the form of suspensions, ointments and tablets, known under the names Ibuprom, Nurofen, Solpaflex, Faspik, Advil, Reumafen, MIG-400, Burana, Dolgit, Bonifen, Brufen, Ibalgin, Bolinet and others.

Indomethacin

Indomethacin is one of the most effective non-hormonal agents. For arthritis, indomethacin relieves pain, reduces joint swelling and has a strong anti-inflammatory effect.

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

Ketoprofen

Ketoprofen, or ketanol, is a widely used medicine in many areas of medicine in general and in the treatment of arthrosis in particular. Due to the high degree of analgesic and anti-inflammatory effects, the drug is often prescribed in the form of tablets, suspensions, ointments, suppositories, ointments, gels and aerosols, as well as injection solutions.

At the pharmacy you can buy ketoprofen under the names Artrosilen, Fastum, OKI, Flamax, Bystrum, Artrum, Febrofid, Ketonal, Flexen.

COX-2 inhibitors

Type 2 cyclooxygenase inhibitors (COX-2) include the following new generation NSAIDs: meloxicam, nimesulide, celecoxib, etoricoxib (Arcoxia) and others. Studies have shown that this group of NSAIDs has fewer side effects. At the same time, COX-2-selective agents have a selective effect on the body, without irritating the gastric mucosa with the correct dosage of oral medications.

Patients with diseases of the cardiovascular system are advised to take drugs from this group with caution, as complications in this area of the body are possible. Measure your blood pressure regularly, and if it increases, contact your doctor.

Meloxicam

Meloxicam is a drug whose main advantage is the possibility of long-term therapeutic use for months and even years without the occurrence of new side effects. Treatment must be carried out under medical supervision.

Movalis

Movalis is the most famous medicine based on meloxicam. In the treatment of arthritis and arthrosis, it is used as an anti-inflammatory agent and has analgesic properties. It is enough to take one tablet of Movalis at any time of the day, without reference to a regimen, treatment can be carried out throughout the year. Pharmacists produce meloxicam in the form of tablets, injections, ointments and rectal suppositories.

The following drugs are known, in which the main ingredient is meloxicam: Artrosan, Movasin, Mesipol, Melox, Mirlox, Bi-xicam, Melbek and Melbek-forte, Mataren, Mixol-od, Lem, Amelotex, Meloflam, and, most common in domestic pharmacies, Movalis.

Celecoxib

Celecoxib is available in the form of capsules of 100 and 200 ml. The main effect is an anti-inflammatory and analgesic that practically does not irritate the gastric mucosa. Known as Celebrex.

Nimesulide

Nimesulide, like all drugs of the COX-2 group, is well tolerated by the body and has an analgesic and anti-inflammatory effect. Distinctive feature Nimesulide inhibits the action of substances that destroy cartilage tissue and collagen fibers.

An indispensable drug in the treatment of arthrosis. The product is known under the following names: Aulin, Nimegesic, Aktasulide, Nimica, Flolid, Aponin, Koxtral, Nimid, Prolide, Rimesid, Nise, Mesulide - tablets, granules, gels.

Etoricoxib

Etoricoxib is marketed in pharmacology under the name Arcoxia. With small doses of this drug (up to 150 mg per day), it does not irritate the gastrointestinal mucosa. Effective in the treatment of joint diseases as an excellent analgesic with a high degree of anti-inflammatory effect.

You should start taking the medication with small doses and under the supervision of a doctor, since a side effect of taking etoricoxib is an increase in blood pressure. Daily monitoring of blood pressure is recommended. Technologies in medicine do not stand still and new generations and types of non-steroidal anti-inflammatory drugs aimed at treating arthritis and arthrosis are constantly appearing.

Despite the differences in the essence of these diseases (with arthritis, the joint becomes inflamed, swollen and painful; with arthrosis, the cartilage tissue does not have time to recover, and therefore painful symptoms appear when moving the joints), drugs for their treatment are selected from NSAIDs. In each specific case, an experienced doctor will prescribe a comprehensive treatment - tablets, injections and always externally - ointments and gels.

You should always be aware of the side effects of any medical product, carefully read the instructions and follow the rules and regimen for taking medications.

Many pathological changes occurring in the body accompany pain. NSAIDs, or drugs, have been developed to combat such symptoms. 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 still 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 a chemical reaction, as a result of which it turns 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. A new release form was developed. 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 influence of 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:

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.
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.
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.
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:

Old drugs (first generation). This category includes well-known drugs: Citramon, Aspirin, Ibuprofen, Naproxen, Nurofen, Voltaren, Diklak, Diclofenac, Metindol, Movimed, Butadione .
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:

Salicylates. This group of NSAIDs contains the following drugs: Aspirin, Diflunisal, Lysine monoacetylsalicylate.
Pyrazolidines. Representatives of this category are the following drugs: “Phenylbutazone”, “Azapropazone”, “Oxyphenbutazone”.
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.
Derivatives of phenylacetic acid. This group of NSAIDs contains the following drugs: Diclofenac, Tolmetin, Indomethacin, Etodolac, Sulindac, Aceclofenac.
Anthranilic acid preparations. The main representative is the drug Mefenaminat.
Propionic acid agents. This category contains many excellent NSAIDs. List of drugs: “Ibuprofen”, “Ketoprofen”, “Benoxaprofen”, “Fenbufen”, “Fenoprofen”, “Tiaprofenic acid”, “Naproxen”, “Flurbiprofen”, “Pirprofen”, “Nabumeton”.
Derivatives of isonicotinic acid. The main medicine is Amizon.
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 exposed to severe pain, indicate that the drug "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. Very important factor, according to most consumers, is the protection of cartilage tissue, since the drug does not have a negative effect on them. This is very important for patients who use arthrosis.

In addition, the medicine perfectly relieves various pains - toothache, headache. Patients pay special attention to the 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:

osteoarthritis;
rheumatoid arthritis;
ankylosing spondylitis.

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, as 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, impaired functioning of the kidneys, eyesight or heart should take the drug "Nimesulide" with extreme caution.

The average price of the medicine is 76.9 rubles.

Doctors whose professional responsibilities involve the need to treat a large number of patients experiencing chronic pain of a non-cancer nature (primarily rheumatologists and neurologists) need effective, convenient and inexpensive analgesic drugs in their therapeutic arsenal. This position in the modern pharmacological market is occupied by non-selective non-steroidal anti-inflammatory drugs (n-NSAIDs). This is a large family of so-called. “traditional” drugs, the main pharmacological action of which is associated with the blockade of cyclooxygenase-2 (COX-2) and a decrease in the synthesis of pro-inflammatory prostaglandins, the therapeutic use of which dates back more than 130 years - from the moment when the first data on the effectiveness of salicylic acid in acute rheumatism were published . To date, 11 representatives of the n-NSAID group have been registered and widely used in Russia: acetylsalicylic acid, ibuprofen, indomethacin, piroxicam, lornoxicam, ketoprofen, dexketoprofen, naproxen, ketorolac, diclofenac and aceclofenac.

Diclofenac has long been considered the “gold standard” among NSAIDs. Possessing moderate selectivity for COX-2 (the ratio of inhibitory activity towards this enzyme and its physiological isoform COX-1 is approximately 1:1), this drug combines high analgesic and anti-inflammatory activity and is quite satisfactory compared to most other drugs. NSAIDs, tolerability. So, in 1994, Henry D. et al. conducted an analysis of all available data on the incidence of gastrointestinal bleeding and perforation of ulcers when using various NSAIDs, which allowed the authors to present a gradation of the main representatives of this drug group depending on the risk of developing dangerous gastrointestinal complications. Diclofenac occupied an honorable second place in this list, only 2 times higher in toxicity than the safest drug at that time from the n-NSAID group - ibuprofen, and far behind such popular drugs as indomethacin, piroxicam and ketoprofen. Subsequent studies confirmed this relationship. Thus, in a population study Lanas A. et al. (2006) among n-NSAIDs, the risk of developing gastrointestinal complications while taking diclofenac and ibuprofen also turned out to be several times less than when using the three drugs mentioned above.

It should be noted that ibuprofen is a relatively safe drug only when used in low, analgesic doses (up to 1600 mg/day). Increasing the dose of this drug is naturally accompanied by an increase in the risk of developing drug complications, and in standard anti-inflammatory doses (up to 2400 mg/day) it is no less dangerous than indomethacin.

The tolerability of diclofenac has been compared successfully with selective NSAIDs in a number of randomized controlled trials (RCTs), notably the large 18-month MIDAL trial (diclofenac vs eterocoxib, n = 34,701). This allowed one of the world's leading experts on the effectiveness and safety of this class of drugs, Singh G., to classify this drug as a “low-toxic” NSAID. Singh G.'s opinion is confirmed by data from the population-based study “Comparing Apples with Oranges...”, which assessed the risk of developing dangerous gastrointestinal complications in 688,424 residents of California, USA, in 1999-2005. regularly taking various NSAIDs. It turned out that diclofenac caused serious adverse effects 30% more often than the famous “coxibs” - celecoxib (relative risk, RR 0.72) and valdecoxib (RR 0.73), and was not significantly different from rofecoxib, but at the same time significantly superior in safety to such a popular NSAID in the USA as naproxen.

However, one should be frank - the glory of the “gold standard” among NSAIDs was won not by the abstract diclofenac, but by the original drug created by the Swiss company Ciba-Gaigi. This drug, currently manufactured by Novartis, is still widely used throughout the world and has been used in most known NSAID clinical trials using diclofenac as a comparator.

Unfortunately, the reputation of diclofenac in our country was spoiled after the appearance of a huge number of generic versions of this drug on the pharmacological market. The effectiveness and safety of the vast majority of these “diclofenacs” have not been tested in well-designed and long-term RCTs. True, generics are cheap and quite accessible to socially vulnerable segments of the population of our country, which made diclofenac the most popular NSAID in Russia. According to a survey of 3,000 patients in 6 regions of Russia and Moscow who regularly receive NSAIDs, 72% of respondents used this drug. However, low cost is perhaps the only advantage of cheap generics.

It is with generic diclofenac that the largest absolute number of dangerous drug complications observed in our country has recently been associated. According to our data, among 3088 rheumatological patients who regularly took diclofenac, ulcers and erosions of the gastrointestinal tract were detected in 540 (17.5%). Interestingly, the frequency of gastrointestinal complications while taking diclofenac did not differ from the frequency of similar complications that arose when using generally more toxic drugs - indomethacin (17.7%) and piroxicam (19.1%).

The opinion of the patients themselves about the safety of the drug is very important, and this opinion is based, first of all, on its subjective tolerability. Indeed, in real clinical practice, the risk of developing NSAID gastropathy - asymptomatic ulcers and relatively rare, life-threatening complications - bleeding and perforation (this pathology occurs, fortunately, in less than 1 in 100 patients during a year of regular use of NSAIDs) worries patients less, than the appearance of severe dyspepsia. Pain in the epigastric region, heaviness and nausea occur in at least every fifth patient receiving NSAIDs (according to our data, more than 30%), and the patients themselves determine a clear relationship between the development of these symptoms and taking medications.

It is important to note that the development of dyspepsia, in contrast to NSAID gastropathy, is largely determined by the contact action of NSAIDs, and therefore depends on the pharmacological properties of a particular drug. Often, drugs from different commercial companies containing the same active ingredient have different tolerability, and this primarily applies to cheap generic diclofenac.

Due to the widespread use of generics, which have significantly displaced the higher quality, but significantly more expensive original drug on the pharmacological market, many Russian doctors and patients have formed the opinion of diclofenac as a drug with moderate effectiveness, but with a high risk of undesirable effects. Unfortunately, although leading Russian experts have repeatedly stated significant differences in effectiveness and safety between the original diclofenac and its cheap copies, to date no serious clinical studies have been conducted in our country to confirm this position.

Another aspect of the safety problem of diclofenac is the increased risk of cardiovascular accidents. This issue has been actively discussed in recent years in light of the infamous “Coxib crisis” and increased attention to the possibility of class-specific negative effects of NSAIDs on the cardiovascular system. Thus, according to data obtained by McGettigan P. and Henry D. (2006) in a meta-analysis of the largest observational and cohort studies of NSAIDs, the use of diclofenac is associated with the greatest risk of myocardial infarction compared to other popular n-NSAIDs. For diclofenac, the RR for this severe complication was 1.4, while for naproxen it was 0.97, for piroxicam 1.06, for ibuprofen 1.07 and for indomethacin 1.3.

Some concern when using diclofenac is the possibility of developing such rare but potentially life-threatening complications as acute drug-induced hepatitis and acute liver failure. Back in 1995, the US medical regulatory authority (FDA) presented data from an analysis of 180 cases of serious liver complications when using this drug, including those that led to death. However, in the United States, diclofenac was not such a widely used NSAID (inferior to acetylsalicylic acid, ibuprofen and naproxen). At the time of the analysis, diclofenac had been used in the United States for only 7 years, since it was approved by the FDA on the pharmacological market of this country only in 1988.

Summarizing the above, we can conclude that today diclofenac cannot be considered a true “gold standard” among n-NSAIDs, primarily because the fairly high frequency of undesirable effects that occur while taking this drug no longer corresponds to modern ideas about the safety analgesic therapy.

An alternative to diclofenac on the Russian pharmacological market may be its “closest relative” aceclofenac. This interesting drug has significant advantages - first of all, high efficiency, safety and availability, allowing it to claim the place of n-NSAIDs with the best combination of pharmacological properties to date. Leading foreign and Russian experts and, above all, Academician V. A. Nasonova expressed their positive opinion on this issue.

Aceclofenac is a derivative of phenylacetylic acid, which is a member of the intermediate group (identified by some authors) of “predominantly selective COX-2 inhibitors.” Thus, according to Saraf S., the ratio of inhibitory concentrations of COX-2/COX-1 in this drug is 0.26, and this is less than that of the reference selective COX-2 inhibitor celecoxib - 0.7, although more than rofecoxib - 0.12. A study by Hinz B. et al. (2003) showed that after taking 100 mg of aceclofenac, the activity of COX-2 in human neutrophils is blocked by more than 97%, while the activity of “physiological” COX-1 is blocked by only 46%. For 75 mg diclofenac, this ratio was significantly worse and amounted to 97% and 82%, respectively.

Aceclofenac has high bioavailability, being rapidly and completely absorbed after oral administration, with peak plasma concentrations achieved within 1-3 hours. In the human body, it is almost completely metabolized in the liver, its main metabolite is the biologically active 4-hydroxyaceclofenac, and one of the additional, interestingly, diclofenac. On average, after 4 hours, half of the drug leaves the body, with 70-80% excreted in the urine, and approximately 20% in the feces. The concentration of the drug in the synovial fluid is 50% of the plasma concentration.

In addition to the main pharmacological effect (blockade of COX-2), aceclofenac has been proven to suppress the synthesis of the most important pro-inflammatory cytokines - such as interleukin-1 (IL-1) and tumor necrosis factor (TNF-alpha). A decrease in IL-1 - associated activation of metalloproteinases is one of the most important mechanisms that determines the positive effect of aceclofenac on the synthesis of articular cartilage proteoglycans. This property is one of the main advantages of this drug, since it serves as an additional argument in terms of the advisability of its use in the most common rheumatological disease - osteoarthritis (OA). A large-scale confirmation of this fact was the study of Dingle J. (1999), during which the effect of 13 different NSAIDs on the condition of cartilage was analyzed (650 samples taken from patients with OA and, as a control, material from 180 individuals without joint pathology). According to the results obtained, aceclofenac was classified as a drug that actively suppresses the catabolism of cartilage tissue. This is especially important given the fact that many other n-NSAIDs - indomethacin, ibuprofen and diclofenac - have been shown in vitro to have no effect or even a negative effect on the condition of articular cartilage.

Such data were obtained, in particular, in the study of Blot L. et al. (2000), the material for which was biopsy samples of the medial femoral epicondyle from 40 patients with moderate or severe gonarthrosis. Cartilage tissue was incubated with the addition of labeled glucosamine in the presence or absence (control) of aceclofenac, meloxicam and diclofenac. Subsequently, the concentration of chondroitin and hyaluronic acid as markers of cartilage metabolism activity was assessed using anion exchange chromatography. According to the results obtained, diclofenac did not have a significant effect on cartilage metabolism, while aceclofenac and meloxicam had a significant stimulating effect.

Aceclofenac has been used in clinical practice since the late 80s, and as of 2004, more than 75 million people in the world were treated with it. Currently, there are 18 different aceclofenac preparations on the pharmacological market: Aceclofar (AE); Aceflan (BR); Air-Tal (BE); Airtal (CL, ES, PT); Airtal Difucrem (ES); Aital (NL); Barcan (DK, FI, NO, SE); Beofenac (AT, DE); Berlofen (AR); Biofenac (BE, GR, NL, PT); Bristaflam (AR, CL, MX); Falcol (ES); Gerbin (ES); Locomin (CH); Preservex (GB); Proflam (BR); Sanein (ES); Sovipan (GR). In Russia, aceclofenac has been registered since 1996 and is used under the brand name “Aertal”.

The evidence base for the effectiveness and safety of aceclofenac is well presented in the work of Dolley M. (2001). This work is probably the largest meta-analysis, evaluating the results of 13 active-controlled RCTs (n = 3574), as well as observational, cohort and non-randomized studies (total of 142,746 patients). Aceclofenac has been proven effective in reducing the severity of pain in rheumatic and non-rheumatic diseases, improving function and increasing activity in osteoarthritis and dorsopathies, as well as influencing the number of inflamed joints and morning stiffness in rheumatoid arthritis and ankylosing spondylitis. At the same time, the therapeutic effect of this drug is no less, and in some situations slightly higher, compared to diclofenac, ketoprofen, ibuprofen and naproxen.

The largest number of well-organized studies of the effectiveness and safety of aceclofenac are related to the treatment of OA. In this disease, aceclofenac successfully compared with paracetamol, piroxicam, naproxen and diclofenac (Table).

Thus, in a recent study by Batlle-Gualde E. et al. (2007), 168 patients with OA took aceclofenac 200 mg/day or paracetamol 3 g/day for 6 weeks. The study revealed the undoubted advantage of aceclofenac - the reduction in pain according to VAS was 7.6 mm greater, the Lequesne index by 1.6, the absence of an effect was noted in only 1 patient (when taking paracetamol - in 8), p = 0.001. The total number of any adverse effects did not differ and amounted to 29% and 32%, respectively.

In a 12-week RCT, Ward D. et al. (1995) showed a higher therapeutic effect of aceclofenac at a dose of 200 mg/day compared to diclofenac 150 mg/day in 397 patients with OA. Thus, a significant (more than 50%) reduction in pain severity was observed in 71% and 59% of patients (p = 0.005), respectively. At the same time, unpleasant symptoms from the gastrointestinal tract occurred significantly less frequently when taking aceclofenac, in particular, diarrhea occurred in only 1%, while during therapy with diclofenac in 6.6% of patients.

According to the results of a study similar in design, duration and size of the study group (n = 374) by Kornasoff D. et al. (1997), aceclofenac 200 mg was as effective as naproxen 1000 mg/day in terms of pain severity and dysfunction in patients with gonarthrosis. At the same time, undesirable effects occurred in 12.6% and 16.3% of patients, respectively.

Similar data were obtained by Perez Busquier M. et al. (1997). In this 2-month RCT (n = 240 patients with gonarthrosis), the therapeutic effect of aceclofenac 200 mg/day was similar to that of piroxicam 20 mg/day. However, dyspepsia occurred in 24 and 33 patients, while in 7 patients receiving piroxicam, undesirable effects caused discontinuation of therapy, and one developed dangerous gastrointestinal bleeding, while there were no serious complications with aceclofenac.

Aceclofenac has proven itself in the treatment of rheumatoid arthritis (RA). In the work of Martin-Mele E. et al. (1998) compared the effectiveness of this drug at a dose of 200 mg/day with ketoprofen 200 mg/day in 169 patients with RA. During three months of observation, both drugs provided a significant reduction in the severity of pain, an improvement in overall well-being, while a significant decrease in the severity of arthritis (decrease in the Ritchie index) and the duration of morning stiffness was also noted. Aceclofenac was slightly more effective - treatment was interrupted due to ineffectiveness in only 4 patients, while among those taking ketoprofen - in 7. It is very important that aceclofenac demonstrated better tolerability, since side effects caused its discontinuation in 2 patients, compared with 11 patients receiving a comparison drug.

In the work of Schaltenkircher M. et al. (2003) studied the comparative effectiveness of aceclofenac 200 mg/day and diclofenac 150 mg/day in 227 patients with low back pain. After 10 days of treatment, the average reduction in pain severity was the same: -61.6 and -57.3 mm according to VAS, respectively. However, complete relief from pain was observed in 6 patients taking aceclofenac, and only in one receiving diclofenac. At the same time, at least one undesirable effect occurred in the aceclofenac group somewhat less frequently than in the control group - 14.9% and 15.9%, respectively.

The effectiveness of aceclofenac has been shown not only for rheumatic diseases, but also for such a common pathological condition as dysmenorrhea. Thus, Letzel H. et al. (2006) showed that single or repeated use of aceclofenac is as successful in relieving pain as naproxen 500 mg, significantly superior to placebo.

The possibility of using aceclofenac in the complex therapy of postoperative pain was studied using the classical model of dental procedures (tooth extraction). In the work of Presser Lima P. et al. (2006) it was shown that this drug had an effective analgesic effect, especially in the situation if the first dose was carried out in the “preoperative analgesia” mode, i.e. 1 hour before tooth extraction.

The largest study examining the effectiveness of aceclofenac in real clinical practice was the European program for assessing the satisfaction of doctors and patients with the results of analgesic therapy (Lammel E. et al., 2002). The study group consisted of 23,407 patients in Austria, Belgium, Holland and Greece experiencing pain associated with rheumatic pathology (RA, OA, AS and dorsopathies), injuries and operations. Interestingly, more than half of them were dissatisfied with previous NSAID therapy, which was the reason for switching to aceclofenac. The duration of therapy and the number of visits were not limited and were determined by the attending physicians based on the clinical situation.

The results of the study were assessed by its organizers as excellent. At the end of the observation period, 85% of patients rated the effectiveness of aceclofenac as “very good”, 32% had complete relief of pain, and the number of patients rating pain as “severe” at the time of enrollment decreased from 41% to 2%.

In fact, in parallel with the work of Lammel E. et al. In the UK, the famous SAMM study was conducted, the purpose of which was to comparatively study the safety of aceclofenac in real clinical practice (diclofenac was the control) (Fig. 1). Aceclofenac was prescribed to 7890, and diclofenac to 2252 patients with RA, OA and AS for a period of 12 months. The study was completed by 27.9% and 27.0% of patients, the average duration of taking NSAIDs was about six months. The data obtained fully justified the hopes of the researchers - aceclofenac was significantly superior to the comparison drug in terms of safety: the total number of complications was 22.4% and 27.1% (p< 0,001), из них со стороны ЖКТ 10,6% и 15,2% (р < 0,001). Отмены терапии из-за нежелательных эффектов также достоверно реже наблюдались на фоне приема ацеклофенака — 14,1% и 18,7% соответственно (р < 0,001). Угрожающие жизни осложнения со стороны ЖКТ (кровотечения, перфорации) возникли лишь у небольшого числа пациентов — 7 при использовании ацеклофенака и 4 на фоне приема диклофенака (разница недостоверна) .

The most important evidence of the relatively low risk of dangerous gastrointestinal complications when using aceclofenac was population-based studies (case-control type) by Laporte J. et al. (2004) and Lanas A. et al. (2006), conducted in Italy and Spain. In both studies, aceclofenac demonstrated the lowest risk of gastrointestinal bleeding compared to all n-NSAIDs, as well as meloxicam and nimesulide. Thus, in the work of Lanas A., the material for which was data on bleeding in 2777 patients (5532 were controls) admitted to clinics in Spain in 2002-2004, the relative risk of this complication when using aceclofenac was 2.6 (1.5 -4.6). A similar risk when using diclofenac was 3.1 (2.3-4.2), ibuprofen 4.1 (3.1-5.3), naproxen 7.3 (4.7-11.4), ketoprofen 8. 6 (2.5-29.2), indomethacin 9.0 (3.9-20.7), piroxicam 12.6 (7.8-20.3) (Fig. 2).

Currently, we have little data to assess the risk of developing cardiovascular complications that occur while taking aceclofenac. Perhaps the only major analysis devoted to this issue is a large-scale case-control study conducted by Finnish scientists Helin-Salmivaara A. et al. (2006). The authors assessed the relative risk of myocardial infarction when using various n-NSAIDs, using data on 33,309 episodes of this dangerous complication (138,949 controls). Aceclofenac was associated with a lower risk of myocardial infarction - RR 1.23 (0.97-1.62) than indomethacin - 1.56 (1.21-2.03), ibuprofen - 1.41 (1.28- 1.55) and diclofenac - 1.35 (1.18-1.54).

Evaluating the above, we can conclude that aceclofenac is a representative of the group of NSAIDs with convincingly proven analgesic and anti-inflammatory activity in a series of well-organized RCTs, as well as long-term observational and cohort studies. In terms of its therapeutic effect, this drug is not inferior to and even slightly superior to such popular traditional NSAIDs as diclofenac, ibuprofen and ketoprofen, and is much more effective than paracetamol. Aceclofenac causes dyspepsia significantly less frequently (20-30%) compared to other n-NSAIDs.

Short-term and small-scale work shows a significantly lower ulcerogenic potential of aceclofenac (according to Grau M., it is 2, 4 and 7 times less than that of naproxen, diclofenac and indomethacin). The mechanism of better gastrointestinal tolerance of aceclofenac is not entirely clear; some authors associate it with the lack of influence on the synthesis of a number of natural components of the protective layer of the gastric mucosa (in particular, hexosamine), as well as increased submucosal blood flow.

On the other hand, at the moment the author does not have clear data on reducing the risk of dangerous gastrointestinal complications (such as bleeding, perforation and ulcers) while taking aceclofenac; Nor does the large observational study SAMM demonstrate this. Unfortunately, there is no information on large comparative endoscopic studies of aceclofenac to determine the risk of developing the most important “surrogate marker” of gastrointestinal complications—endoscopic ulcers.

However, we have important data showing a significant reduction in the risk of gastrointestinal bleeding with the use of aceclofenac, obtained from two large retrospective population-based studies. Similar results, reflecting real clinical practice, were obtained with regard to reducing the risk of cardiovascular complications.

Interestingly, according to a pharmacoeconomic study conducted in Spain, a significant reduction in the risk of various undesirable effects at a relatively low nominal cost makes the use of aceclofenac in real clinical practice more profitable than other popular n-NSAIDs.

The great advantage of aceclofenac, in contrast to diclofenac and many other representatives of n-NSAIDs, is the absence of a negative effect on the metabolism of articular cartilage, which makes it advisable to use this drug for the symptomatic treatment of OA.

Unfortunately, in Russia there are only a few studies (for example, the work of T. P. Grishaeva and R. M. Balabanova) devoted to Russia’s own experience of using aceclofenac. In our opinion, this drug undoubtedly deserves closer attention from Russian research, as well as carrying out major in-house work that would make it possible to more accurately determine the merits of using aceclofenac in Russian patients.

However, today aceclofenac is an affordable and high-quality original drug available to consumers, with a balanced combination of analgesic and anti-inflammatory effectiveness and good tolerability. In our country, taking into account the peculiarities of the pharmacological market, aceclofenac may well claim to be the leader among traditional NSAIDs used for both short-term and long-term treatment chronic diseases accompanied by pain.

For questions regarding literature, please contact the editor.

A. E. Karateev, Doctor of Medical Sciences
GU IR RAMS, Moscow

The anti-inflammatory drug Indomethacin is often used to treat various pathological processes of the joints. The pharmaceutical agent directly affects the inflammatory focus, eliminating painful symptoms and improving the patient’s well-being. However, it should be taken into account that the medicine is used as an adjuvant in combination with drugs, the main purpose of which will be the treatment of damaged joints.

Indomethacin is available in several pharmacological forms (tablets, suppositories, ointments). First of all, it is forbidden to use the drug without the consent of a specialist. The medicine is classified as a non-steroidal anti-inflammatory drug. Its effect is aimed at eliminating inflammation and reducing pain in the affected area. Taking Indomethacin tablets helps block the action of pathogens and makes it possible to remove platelet aggregation. The drug in tablet form contains the active ingredient – indomethacin. Other forms may use other additional elements.

Pills

The number and duration of use of tablets varies depending on the severity of the disease. Mostly, they are produced in 30 and 60 pcs. packaged. Covered with an enteric coating. Quickly absorbed by the body. Before taking, you must carefully read the instructions for the drug.

Ointment

For joint diseases, Indomethacin ointment is used for application or rubbing into the affected area. Contains a 10% concentration of the active substance. It also contains auxiliary elements: cholesterol, stearyl alcohol, dimethyl sulfoxide, bronopol, lanolin, white petrolatum. In tubes of 30 or 40 g, in a cardboard pack 1 tube.

Drops

Indomethacin eye drops are an effective medication widely used in ophthalmology to achieve analgesic and anti-inflammatory effects. The medicine is effective for infections and eye injuries. Pack contains 5 ml. The content of the main active component indomethacin is 0.1%. In addition, there are auxiliary elements: thiomersal, arginine, lodextrin. In some cases, experts recommend drops for preventive purposes.

Suppositories

Rectal suppositories have been used in medical practice for quite a long time; they have a number of positive qualities needed in the treatment of pathological processes in the spine and joints. Suppositories are available in 50 mg and 100 mg. There are up to 10 suppositories in a package. In addition to the main component Indomethacin, the medicine contains excipients: silicon dioxide, castor oil, solid fat, urea, polysorbate.

Indications

A drug with a strong anti-inflammatory effect is prescribed to patients in order to accelerate the recovery of the musculoskeletal system after an injury.

It is optimal to use Indomethacin to eliminate inflammatory changes in joints, get rid of swelling after surgery and relieve pain in soft tissues and joints.

With the help of this medication, patients can eliminate arthritis, osteochondrosis, rheumatism and neuritis. Indomethacin is also used during the treatment of thrombophlebitis.

Systemic use: articular syndrome (osteoarthritis, gout, spondylitis), pain in the spine, myalgia, neuralgia, inflammation in soft tissues and joints due to trauma, diffuse connective tissue pathologies. In addition, the product is used comprehensively in the presence of prostatitis, adnexitis, cystitis, and ENT diseases.
External use: articular syndrome during exacerbation of gout and rheumatism, arthritis, spondyloarthritis, pain in the spine, osteochondrosis, radiculitis, neuralgia. Indomethacin is also used for post-traumatic inflammatory processes in soft tissues and joints, pain in the muscles.

Doses, duration of treatment

Indomethacin in tablet form is recommended to be taken after meals. The exact dosage is selected individually, taking into account the course of the pathological process and the severity of symptoms. The initial dose of the drug generally starts with 25 mg three times a day (in adults), then, taking into account susceptibility, the daily dosage is increased to 100 mg per day (3 doses).

Acute attacks - 0.05 g of medication 3 times a day.
Prevention of exacerbations - 0.025 g 2 times a day.

The highest daily dose is 200 mg.

When the desired therapeutic effect is achieved, Indomethacin therapy continues for a month at the same or reduced dose. With prolonged use, the daily dosage cannot be higher than 75 mg.

Injections. To eliminate acute manifestations or relieve chronic processes, the drug is administered intramuscularly at a dose of 60 mg up to 2 times a day. The duration of such therapy is 1-2 weeks. Subsequent treatment is carried out using tablets or suppositories.

Suppositories. Used for exacerbation of chronic processes or acute conditions. In such a situation, the usual dose is 1 suppository twice a day. It is necessary to monitor that the maximum daily dosage does not exceed 0.2 g. As maintenance therapy, suppositories of 0.05-0.1 g are used 1 time before bedtime. The suppository is administered after natural bowel movement deep into the anus.

Ointment. In accordance with the instructions, the product is applied to the damaged part in a small layer. During the day, it is forbidden to increase the maximum dose - up to 15 cm of the drug, which is squeezed out of the tube. For children, the largest amount of Indomethacin does not exceed 7 cm. The medicine is mainly used for a long time. Early cessation of use can return negative symptoms. The duration of therapy depends on the course of the pathological process.

Contraindications

The use of Indomethacin for the treatment of diseases of the joints and musculoskeletal system is prohibited in the presence of the following contraindications:

lactation period and pregnancy;
age up to 6 years;
blood clotting disorders;
exacerbation of erosions and ulcers in the digestive tract;
hypersensitivity to the components of the drug;
open wounds on the skin and other injuries to the dermis near inflamed joints.

Side effects

When treating joint diseases with Indomethacin, the following adverse effects occur:

nausea;
burning inside the esophagus;
loss of appetite;
pain in the abdominal cavity;
failure of the liver;
dizziness;
increased fatigue;
painful sensations in the head;
depression;
sleep disorders;
irritability;
high blood pressure;
tinnitus;
presence of blood impurities in urine;
bleeding;
allergies;
anemia;
swelling.

With prolonged use of the drug, the formation of local negative manifestations such as burning, redness, itching and rash, redness of the skin, and the appearance of allergies is likely. When side effects appear, you should immediately contact a specialist.

Price

Indomethacin is available for purchase at pharmacies without a prescription. The cost of the medication, which is produced in the form of suppositories, is 350 rubles. Tablets cost from 70 to 100 rubles. The price of the ointment varies between 90-120 rubles. The medicine should be stored in a dry place, out of reach of sunlight, with appropriate humidity and a temperature of no more than 25 degrees. If all instructions for storing Indomethacin are followed, its service life will be 3 years.

Analogues

Since Indomethacin is classified as an NSAID, virtually every drug from this subgroup is considered its analogue. However, in reality everything is somewhat more complicated. NSAIDs are divided into groups based on their chemical structure, duration and direction of effect. All drugs in this series have 3 effects:

anti-inflammatory;
antipyretic;
anesthetic.

This feature is due to their structure. In addition, NSAIDs tend to influence any inflammation, regardless of the factor that provoked it. But not every drug is equally effective in treating such manifestations of pathologies as fever, inflammation and pain.

Some of them effectively eliminate fever, but almost do not relieve pain. Others, on the contrary, have a pronounced analgesic effect, but do not affect fever. Such means are not interchangeable.

Particular emphasis should be placed on drugs that have a pronounced anti-inflammatory effect. They are often used for pathological changes in the musculoskeletal system:

arthrosis;
osteochondrosis;
muscle strain;
dislocations and fractures.

Medications from this series are analogues of Indomethacin in action.

When the prescribed drug is not available in pharmacies or the patient has contraindications for it, it may be replaced with an analogue. However, you should not do this yourself to avoid worsening the situation. Before starting therapy, it is imperative to find out the recommendations of a specialist.

Indobene or Indomethacin - what is the difference?

Indobene is the best synthetic analogue of Indomethacin. It is an NSAID that has anti-inflammatory, analgesic and antipyretic effects. During internal and parenteral administration, it helps to relieve pain, in particular in the joints at rest and during movement, reduce stiffness in the morning and increase motor activity.

The anti-inflammatory effect is formed by 6-7 days of therapy. When used topically, discomfort goes away and swelling decreases. The side effects of the drug in question are the same as Indomethacin. The absorption of the drugs is also identical. Indobene is released as suppositories. The price of candles starts from 400 rubles.

Diclofenac or Indomethacin - which is better?

Diclofenac is one of the most prescribed drugs by rheumatologists. It is used in virtually any pathological process in connective tissue and joints. It has an intense anti-inflammatory and anesthetic effect. Used as an analogue of Indomethacin if necessary.

For external use it is known as Diklak-gel. In addition, it is produced as an ointment. Suppositories are widely popular due to the reduced risk of side effects of NSAIDs. Rectal suppositories with diclofenac are sold in pharmacies under the names Dicloberl and Diclovit. They have the same structure, differing only in cost and manufacturer. They also act as an analogue of Indomethacin.

Diclofenac and Indomethacin have virtually no differences in their contraindications. Various studies prove that Diclofenac is superior to Indomethacin in its medicinal properties. It relieves unpleasant symptoms in a shorter time.

The drugs under consideration are similar in their action, have a good effect and are affordable. But, Diclofenac is considered a reference drug among NSAIDs, and therefore is prescribed much more often by doctors in the presence of diseases of the musculoskeletal system.

Ortofen or Indomethacin - what to choose for joint diseases?

Ortofen is a drug from the NSAID group, a derivative of acetic acid. The active component of the drug is diclofenac. Prescribed for all pathologies of the spine that are accompanied by inflammatory changes or pain:

Spinal tumors;
Postoperative period as a result of surgery on the spinal column;
Spinal injuries;
Intervertebral disc herniation.

Just like Indomethacin, it is available in the form of tablets, ointment, gel and solution for injection. However, the drugs differ in composition. The main active ingredient of Ortofen is sodium diclofenac. The occurrence of side effects with Indomethacin is higher than with Ortofen. Because of this, doctors are less likely to prescribe Indomethacin to patients.

Ketanov or Indomethacin - which is stronger?

Ketanov is available in tablet form and as an injection solution. Recommended for short-term use to eliminate moderate and intense pain of various origins and locations:

post-operative pain;
acute injury to muscles, bones and soft tissues.

The advantages of Ketanov include minimal effects on blood circulation and respiration, intestinal motility, and the absence of drug-induced potential. The product is distinguished by high safety - the number of side effects during its use is much less than when using opiates. The drug in question is superior in analgesic effects to most NSAIDs. The anti-inflammatory effectiveness of oral forms (tablets) is not the highest and is inferior in these qualities to Indomethacin, but the analgesic effect will far exceed it. In addition, regular use of narcotic analgesics is associated with the risk of drug addiction. In terms of price, Ketanov will cost approximately twice as much as Indomethacin.

Diclofenac ointment or indomethacin, which is better. Nonsteroidal anti-inflammatory drugs: list and prices. Features of the use of Movalis

Compound

Indications

Contraindications and unwanted effects

Piroxicam or diclofenac which is better?

Rationale for choosing the most commonly used NSAIDs for inflammatory diseases

Safe analogues of Diclofenac - tablets, ointments, injection solutions

Characteristics of non-steroidal anti-inflammatory drugs

Comparison of clinical effects of analogues

The most popular analogues from the NSAID group

Meloxicam

Ibuprofen

Nimesulide

Review of analogues from the NSAID group

How to forget about joint pain?

Non-steroidal anti-inflammatory drugs: list and prices

How do NSAIDs work?

When are these drugs prescribed?

List of common NSAIDs for treating joints

What are the advantages of new generation NSAIDs?

New generation NSAIDs: list and prices

Classification

Effectiveness of average doses

What dosage should I choose?

Side effects

Use during pregnancy

Movalis

Celecoxib

Indomethacin

Ibuprofen

Diclofenac

Ketoprofen

Aspirin

Alternative drugs: chondroprotectors

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Antiviral drugs are inexpensive and effective

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Transcription of analyzes online

Doctors consultation

Fields of Medicine

Popular

How do NSAIDs work?

When are these drugs prescribed?

List of common NSAIDs for treating joints

What are the advantages of new generation NSAIDs?

New generation NSAIDs: list and prices

Classification

Effectiveness of average doses

What dosage should I choose?

Side effects

Use during pregnancy

Movalis

Celecoxib

Indomethacin

Ibuprofen

Diclofenac

Ketoprofen

Aspirin

Alternative drugs: chondroprotectors

Which is better Ibuprofen or Indomethacin?

Impact on the body

Mode of application

Which remedy is more effective?

indomethacin or ibuprofen which is better

Diclofenac, indomethacin, piroxicam, ibuprofen

Nonsteroidal anti-inflammatory drugs

List of funds:

Aspirin or acetylsalicylic acid

Diclofenac

Ibuprofen

Indomethacin

Ketoprofen

COX-2 inhibitors

Meloxicam

Movalis

Celecoxib

Nimesulide

Etoricoxib

Impact principle