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What anti-inflammatory drugs are possible. Latest generation NPS: reviews, list, prices

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

How NSAIDs work
- When are NSAIDs used?
- The main advantage of new generation NSAIDs
- What are new generation NSAIDs?
- Classification of NSAIDs
- Dosage selection
- Side effects
- Use during pregnancy
- Movalis
- Celecoxib
- Indomethacin
- Ibuprofen
- Diclofenac
- Chondroprotectors - alternative drugs

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

How NSAIDs work

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

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

When are NSAIDs used?

Most often, NSAID drugs are used to treat chronic or acute inflammation that is accompanied by pain. Anti-inflammatory non-steroidal drugs have gained great popularity due to their effective treatment of joints.

We list the diseases for which these medications are prescribed:

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

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

Let's consider the most effective and well-known NSAIDs, which are used to treat joints and other diseases when an antipyretic and anti-inflammatory effect is required:

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

The main advantage of new generation NSAIDs

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

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

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

What are new generation NSAIDs?

New generation anti-inflammatory non-steroidal drugs act much more selectively; they inhibit COX-2 to a greater extent, while COX-1 remains almost unaffected. This is what can explain the rather high effectiveness of the drug in combination with a minimum of side effects.

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

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

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

Classification of NSAIDs

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

Acidic preparations:

Non-acidic drugs:

Sulfonamide derivatives;
Alcanons.

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

According to the strength of the anti-inflammatory effect of average doses, the drugs are arranged in the following sequence (the most powerful on top):

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

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

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

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

Dosage selection

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

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

Side effects

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

Treatment with NSAIDs must be carried out for the shortest possible time and in minimal doses.

Use during pregnancy

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

Description of non-steroidal anti-inflammatory drugs

Movalis

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

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

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

Celecoxib

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

Indomethacin

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

Ibuprofen

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

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

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

Diclofenac

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

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

Chondroprotectors - alternative drugs

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

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

Non-steroidal anti-inflammatory ointments (NSAIDs): list of drugs (creams, gels)

As a rule, anti-inflammatory ointments are used externally. But today you can buy products with a creamy texture that are taken orally, vaginally and rectally.

The cream, which has an anti-inflammatory effect, is used to treat joints, allergies and infections. But often such drugs are classified as adjuvant therapy methods.

In addition, almost all anti-inflammatory ointments have an analgesic and regenerating effect. Therefore, they are used to treat:

diseases of the musculoskeletal system;
bruises;
injuries;
local inflammation;
pathologies of muscles and back.

The principle of action for the treatment of joint diseases and other diseases is to inhibit the production of inflammatory substances by cells - mediators (kinin, prostaglandins, lysosomal enzymes histamine).

Also, anti-inflammatory ointments are intended for cutaneous use. However, there are products that need to be inserted directly into the vagina or applied to the mucous membrane.

Nonsteroidal anti-inflammatory ointments are often used in a variety of fields of medicine. Today there are many ointments that are used:

for the treatment of joints;
in orthopedics;
gynecology;
infectology;
dermatology;
venereology.

The advantage of this form of release is that the gel or ointment does not spread along with the blood throughout the body, that is, their effect is local.

Anti-inflammatory drugs for diseases of the musculoskeletal system

Today there are a lot of pathologies in which damage and destruction of bones and joints occurs. The main component of the treatment of rheumatoid diseases are NSAIDs.

The pain syndrome in the case of the development of osteochondrosis, gouty arthritis or arthrosis is so severe that the patient immediately seeks medical help.

The first medications a doctor prescribes are NSAIDs. To achieve a more maximum effect, anti-inflammatory creams and anti-inflammatory ointments for joints are also prescribed, which are applied topically.

There are several groups of drugs, each of them is based on a specific component:

indomethacin;
diclofenac;
nimesulide;
ibuprofen;
piroxicam;
ketoprofen.

Anti-inflammatory drugs, the main active ingredient of which is diclofenac, are very effective after injury, for neurology and degenerative changes in the joints.

Diclofenac promotes rapid restoration of joint mobility, it reduces swelling, local temperature in the affected area and has an analgesic effect. The trade name of diclofenac-based NSAIDs is Ortofen ointment, Diclofenac gel, Diclak-gel, Diclovit and Voltaren.

Pay attention! Diclofenac-based gel or ointment should not be used to treat children under 6 years of age or pregnant women.

It is also forbidden to apply it to damaged areas of the skin, and people suffering from stomach and duodenal ulcers can use such drugs only after the approval of a doctor.

Ibuprofen

Drugs that relieve inflammation, which contain ibuprofen (Nurofen, Dolgit), are indicated for the same symptoms as when using diclofenac-based products. That is, their main effect is pain relief and elimination of inflammation.

However, such funds cannot be used if you have:

"aspirin" asthma;
kidney and liver diseases;
children under 2 years of age;
gastrointestinal diseases;
pregnancy;
during lactation.

A cream that eliminates inflammatory processes with ketoprofen is used for various injuries and degenerative changes in the joints. Ketoprofen also prevents the formation of blood clots.

Products based on it should not be applied to damaged skin. Also, NSAIDs with ketoprofen are contraindicated in children under 12 years of age and pregnant women.

The most common products, the main component of which is ketoprofen:

Febrofeed;
Fastum-gel;
Artrosilene;
Ketonal;
Febrofeed.

Indomecin

The drugs based on indomethacin include: Indovazin, Sopharma, Indomethacin-Acri and Sofar. Their effect is similar to ketoprofan, but it is not so pronounced, and the indications and contraindications are similar to similar NSAIDs

Anti-inflammatory anesthetic cream Finalgel belongs to the group of piroxicam-containing medications. The gel restores joint health, relieves swelling and eliminates pain without drying out the skin.

This remedy is used for osteoarthrosis, periarthrosis and tendonitis. Pregnant women and children are prohibited from using the gel.

Indovazin cream, the main active ingredient of which is nimesulide. This is the only medicine in the entire group of NSAIDs intended for the safe treatment of joints.

Indovazin gel is not as toxic as other products, so it does not have a detrimental effect on the gastrointestinal tract. But despite this, like other drugs, Indovazin can be used only after a doctor’s prescription, because it also has side effects, although less significant.

Contraindications to the use of the product are as follows:

age up to 3 years;
joint and bone injuries;
osteochondrosis;
bursitis;
arthritis.

It should be noted that the process by which anti-inflammatory drugs are rubbed into the skin helps to accelerate and improve the effect of the product. Local external preparations for the treatment of joint diseases, such as epicondylitis or arthritis, are more effective if combined with phonophoresis.

This treatment method improves the absorption of the active component. At the same time, the amount of product applied is reduced, which significantly saves its consumption, and most importantly, it is safer for the body.

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Nonsteroidal anti-inflammatory drugs are a group of drugs widely used in medical practice. Their popularity in the treatment of various diseases is due to their pronounced ability to eliminate pain, temperature and inflammation while being highly safe for the body. The analgesic and anti-inflammatory activity of NSAIDs has been proven in numerous medical trials.

In terms of effectiveness, they are better than “simple” painkillers, and some drugs are close in strength to centrally acting analgesics and opioids.

Mechanisms of action of NSAIDs

The main mechanism of action of NSAIDs, characterizing their effectiveness and toxic effects, is inhibition of cyclooxygenase activity. It is an enzyme that regulates the conversion of arachidonic acid into prostaglandins, thromboxane and prostacyclin. The anti-inflammatory effect of NSAIDs can also be caused by slowing down fat peroxidation, stabilizing the lysosomal membrane, reducing ATP synthesis, slowing down neutrophil aggregation and inhibiting the formation of rheumatoid factor in people suffering from rheumatoid arthritis.

Historical facts

The beginning of the use of non-steroidal anti-inflammatory drugs dates back to 46-377. BC e., when Hippocrates used willow bark to relieve pain and alleviate inflammation. This fact was confirmed by Celsius in his own experience in the 30s. n. e. Further mention of the properties of the bark dates back to 1763, and in 1827, when chemists managed to isolate a chemical substance from natural material, which turned out to be salicin, a precursor to NSAIDs.

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Irina Martynova. Graduated from Voronezh State Medical University named after. N.N. Burdenko. Clinical resident and neurologist of the BUZ VO \"Moscow Polyclinic\".

In 1869, salicylic acid was obtained, a more effective substance that is a derivative of salicin. After experiments, it became clear that it can damage the gastric mucosa, and scientists began searching for new, safer means. In 1897, the Bayer company and scientist Felix Hoffman converted the toxic salicylic acid into acetylsalicylic acid. The drug was called Aspirin.

Aspirin was the only NSAID compound for a long time, but since 1950, pharmacologists have developed new drugs from the NSAID group, which have become more effective and safe than the previous ones.

Steroidal and non-steroidal - differences

To eliminate edema, non-steroidal drugs are also used in medicine. Steroids are produced on the basis of glucocorticoids - adrenal hormones. Non-steroidal anti-inflammatory drugs have similar effectiveness, but their difference is that they do not have characteristic pronounced side effects such as hypertension, the development of diabetes mellitus, and do not cause addiction to the body, requiring each time an increase in dosage to achieve a similar effect.

What are the release forms?

NSAIDs are available both in the form of capsules and tablets for oral use, and in the form of ointments, suppositories, gels and solutions for injections. This variety allows for more effective use of the medicinal drug. The use of injections minimizes the negative effects of drugs on the gastrointestinal tract, but at the same time can cause tissue necrosis.

For this reason, NSAID injections are never used for a long time.

Classification

Today, several dozen drugs are produced in the world, which include selective and non-selective NSAIDs, but in Russia only a part have been registered and are used. Their classification can be presented as follows:

According to chemical structure:

Salicylates are the oldest group, of which only Aspirin (acetylsalicylic acid) is currently used;
Propionic acid derivatives – Ketoprofen, Ibuprofen, Naproxen;
Acetic acid derivatives - Diclofenac, Indomethacin, Aceclofenac, Ketorolac;
Pyrazolidines – Felilbutazone, Analgin, Metamizole sodium;
Selective COX-2 inhibitors are considered the safest agents, of which only Rofecoxib and Celecoxib are used in Russia;
Non-acidic – sulfonamides, alkanones;
Other NSAIDs, which include Mefenamic acid, Piroxicam, Nimesulide, Meloxicam.

Quite often, the list of non-steroidal anti-inflammatory drugs includes drugs that have analgesic and antipyretic effects, but in fact the drug is not included in this group. Its anti-inflammatory activity is very weak, and its analgesic and antipyretic effect is due to blocking COX-2 in the central nervous system.

By efficiency. The following painkillers have the most pronounced effect: Diclofenac, Indomethacin, Ketoprofen, Ketorolac. Ibuprofen has the least pronounced analgesic effect. Piroxicam, Indomethacin, Diclofenac, Piroxicam relieve inflammation as quickly as possible. Aspirin, Nise and Nurofen can quickly relieve fever.

New generation drugs. They were created to reduce the side effects of drugs of this class on the body. Such drugs are Movalis and Piroxicam, Nise, Arcoxia, which, in addition to their selective action, have a prolonged elimination period (they are eliminated for a long time), thereby enhancing the therapeutic effect.

For the treatment of joints

They are used as the basis of drug therapy, especially in the acute stage of the disease, quickly relieving pain, swelling and inflammation. For this use:

in the form of an ointment. The action of the product is similar to drugs containing, but has lower efficiency and a pronounced warming effect. Contraindicated for ulcers in the gastrointestinal tract, pregnancy and lactation, bronchial asthma. Price – 43-344 rub.
– an analogue of Diclofenac with antipyretic, anti-inflammatory and analgesic effects. Used for inflammatory diseases of opacitis. Contraindicated in the “aspirin triad”, hypersensitivity, erosive and ulcerative diseases and bleeding in the gastrointestinal tract, liver and kidney diseases, pregnancy, childhood, hyperkalemia and after coronary artery bypass surgery. Price – 134-581 rub.
– has an autoaggregative effect, effectively relieves pain and fever. Contraindicated in erosive and ulcerative diseases of the gastrointestinal tract, disorders of porphyrin metabolism, liver and kidney diseases, pregnancy and lactation, under the age of 14 years and hypersensitivity. Price – 35-89 rub.

At

The following non-steroidal anti-inflammatory drugs are used:

. It has a pronounced anti-inflammatory, analgesic, and moderate antipyretic effect, and is successfully used for spinal hernia. Contraindicated for ulcers and erosions in the gastrointestinal tract, pregnancy and lactation, allergies caused by taking NSAIDs. Price – 14-75 rub.
. A new generation of NSAIDs, available in the form of tablets, suppositories and injection solution, is practically free of side effects. Price – 502-850 rub.
. It has a strong anti-inflammatory, moderate analgesic and mild antipyretic effect. Contraindicated for ulcers and bleeding in the gastrointestinal tract, renal and liver failure, pregnancy and lactation, under the age of 12 years and hypersensitivity. Price – 126-197 rub.

For herniated spine

In case of protrusion of the intervertebral disc, the following drugs are used for the hernia:

– effectively relieves fever and pain, has a slight anti-inflammatory effect. Contraindicated in case of leukopenia, severe anemia, liver and kidney failure and hypersensitivity to the drug. Price – 345-520 rub.
– has a pronounced analgesic, antipyretic and anti-inflammatory effect, blocks an enzyme involved in inflammatory processes. Contraindicated in case of peptic ulcer, renal and liver failure, “aspirin triad” and hypersensitivity. Price – 502-850 rub.
– a basic drug used for diseases of the musculoskeletal system, has an anti-inflammatory, antipyretic and analgesic effect in cases of spinal hernia. Contraindicated in case of erosive lesions in the gastrointestinal tract, the “aspirin triad”, pregnancy, liver and kidney failure, suppression of hematopoiesis, in childhood and hypersensitivity reactions. Price 121-247 rub.

At

. It exhibits analgesic, anti-inflammatory, antipyretic properties that can relieve a neuralgic attack, and inhibits platelet aggregation. Contraindicated for ulcers in the gastrointestinal tract, severe disorders of the liver and kidneys, pregnancy, breastfeeding and in childhood, hypersensitivity. Price – 44-125 rub.
Nise. Nimesulide, which is included in the composition, has antipyretic, anti-inflammatory, analgesic and antiplatelet effects. Contraindicated in acute ulcerative manifestations and bleeding in the gastrointestinal tract, severe liver and kidney dysfunction, pregnancy and breastfeeding, under the age of 2 years and intolerance to the drug. Price – 173-424 rubles.
. It has a pronounced analgesic, antipyretic, as well as weak antispasmodic and anti-inflammatory effect. Contraindicated in case of hypersensitivity, suppression of hematopoiesis, liver or kidney failure, aspirin-induced asthma, leukopenia, pregnancy and lactation, anemia. Price – 27-60 rub.

For osteoarthritis

The following drugs are used:

, most often used in the form of an ointment, gel or cream, has an analgesic and anti-inflammatory effect, relieves swelling associated with inflammation. Contraindicated in case of hypersensitivity, allergic rhinitis, attacks of bronchial obstruction, pregnancy and breastfeeding, violations of the integrity of the skin at the sites of application, under the age of 14 years and in combination with drugs including phenylbutazone. Price – 119-206 rub.
, is used as a new generation drug for arthrosis. It has analgesic, anti-inflammatory and antipyretic effects. Contraindicated in case of hypersensitivity, heart failure and arrhythmia, liver diseases and stomach ulcers, leukopenia and pregnancy. Price 220-475 rub.
. It has an analgesic, anti-inflammatory and antipyretic effect. Contraindicated in case of erosive and ulcerative lesions in the gastrointestinal tract, “aspirin” asthma, rhinitis, urticaria caused by taking NSAIDs, severe renal impairment, pregnancy and lactation, hypersensitivity. Price – 120-345 rubles.

For gout

The following NSAIDs are used:

, is produced in the form of tablets and ointments. Maximum effectiveness of the drug is ensured after simultaneous use of both forms of the drug. Prohibited for hypersensitivity, ulcerative bleeding, inflammatory diseases in the gastrointestinal tract, hyperkalemia, liver and kidney failure, pregnancy and lactation. Price – 173-380 rub.
Other NSAIDs – , Ibuprofen.

Cheap drugs

Ibuprofen (analog). Price (tablets) – 14-26 rubles.
sodium (analogue of Voltaren tablets). Price: tablets – 14-35 rubles, gel or ointment – 32-75 rubles.
Meloxicam (analogue of Movalis tablets). Price – 31-84 rub.
Acetylsalicylic acid (Aspirin). Price – 7-17 rub.
Analgin. Price – 27-60 rub.

Selection criteria

All NSAIDs - modern and effective medicines, but when choosing a specific drug you need to know some features. So, if you need to buy one of three drugs -, or, the seller at the pharmacy will most likely offer a more expensive option, despite their identity regarding the active substance. The situation is similar when choosing Indomethacin or Methindol.

In addition to an identical active ingredient, when choosing an analogue of a drug, it is necessary to pay attention to the accompanying components, since an analogue of a familiar drug may contain components that can cause an allergic reaction. Also, an analogue of the drug may contain a different dosage of the active substance or a retarded form (long-acting).

All features of the medicine are indicated in the instructions or on the packaging, and before use it is subject to careful study.

Application

Since non-steroidal anti-inflammatory drugs can cause various side effects, before using them you must adhere to the following rules:

It is mandatory to read and strictly follow the recommendations set out in the instructions.
Capsules or tablets taken orally must be washed down with a glass of water, which will protect the stomach. The rule also applies to the most modern means, which are the safest.
After taking the product orally, it is recommended not to take a lying position for at least 3 minutes, so that under the influence of gravity the capsule passes down the esophagus better.
The simultaneous use of drugs and alcohol-containing substances can provoke stomach diseases. During the course of taking NSAIDs, alcohol is completely abandoned.
It is not recommended to take two non-steroidal drugs on the same day, as this adds up the side effects and does not enhance the effect.
If the drug is ineffective, be sure to notify the doctor to find out the reason, adjust the dose and more carefully select the drug.

Indications for use

NSAIDs are among the most commonly used drugs in medicine. Thus, they are prescribed to 1/5 of patients to eliminate pain and inflammation in diseases related to the following areas:

Rheumatology.
Gynecology.
Traumatology.
Surgery.
Dentistry.
Neurology.
For eye diseases.

The analgesic effect of NSAIDs is especially effective when:

Dysmenorrhea.
Pain syndrome of various origins: dental, head, muscle.
Migraines.
Renal colic.

The ability to reduce high temperature determines the use of drugs for “colds” and in emergency situations when hyperthermia threatens human life. The drugs are then administered parenterally as emergency treatment. NSAIDs are widely used to treat sports injuries and treat complications after chemotherapy sessions.

Aspirin's ability to thin the blood has been used to prevent thrombosis.

NSAIDs are used in the treatment of various stages of inflammation, accompanied by pain. Such pathologies include the following diseases:

and pain.
Acute and migraine.
Pain accompanying menstruation.
Rheumatoid arthritis and.
Bone pain with metastases.
Pain accompanying Parkinson's disease.
Increased temperature (feeling of fever).
Moderate pain after soft tissue injury or inflammation.
Intestinal obstruction.
Renal colic.
Postoperative pain.

NSAIDs can be used to treat newborns who do not close the ductus arteriosus within 2 days after birth.

Contraindications

Ulcerative manifestations and the presence of bleeding in the stomach.
Uncontrolled arterial hypertension.
Kidney diseases.
Intestinal inflammation.
Stroke, myocardial infarction and transient ischemic attack in the past, as well as cardiac ischemia (except Aspirin).
Bypass surgery of the coronary artery and stomach.
Thrombocytopenia.

Special instructions

With long-term use of NSAIDs, the blood condition and the functioning of the liver and kidneys should be monitored, which is especially important for patients over 65 years of age. The drugs are used with extreme caution in patients suffering from high blood pressure and problems with the cardiovascular system, leading to fluid retention in the body.

It follows that this type of drug can mask the symptoms of infectious diseases and affect the ability to concentrate.

Which medications are best for children?

NSAIDs can be used in childhood for the treatment of inflammatory processes accompanied by swelling, high fever, inflammation of the lymph nodes and pain. The products should be used with extreme caution, as they can cause irritation of the gastric mucosa, allergies, problems with breathing, vision and hearing, and internal bleeding.

Mefenamic acid is used in the treatment of inflammatory diseases in children due to the absence of serious side effects, but at the same time they can provoke indigestion or constipation. To eliminate foci of inflammation and fever, use Aspirin.

Medicines are prescribed only by a doctor, who carefully regulates the dosage to prevent possible side effects.

Flaws

The main disadvantage of non-steroidal anti-inflammatory drugs is it is toxic to the gastrointestinal tract. Prostaglandins belonging to group E play a major role in gastroduodenal protection. When the concentration of prostaglandins in the gastric mucosa decreases under the influence of drugs, this protection is disrupted, causing ulcers, erosions and other lesions. Under the influence of NSAIDs, gastric ulcers develop in 30% of cases. They also have a destructive effect on the duodenal mucosa, increasing the risk of ulcers, perforations and bleeding.

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

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

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

Operating principle

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

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

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

Types by mechanism of action

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

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

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

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

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

List of NSAIDs

Basic non-selective NSAIDs

Acid derivatives:

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

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

Selective COX-2 inhibitors

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

Main indications, contraindications and side effects

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

Table. Non-steroidal anti-inflammatory drugs - indications

Property of a medical product	Diseases, pathological condition of the body
Antipyretic	High temperature (above 38 degrees).
Anti-inflammatory	Diseases of the musculoskeletal system - arthritis, arthrosis, osteochondrosis, muscle inflammation (myositis), spondyloarthritis. This also includes myalgia (often appears after a bruise, sprain or injury to soft tissues).
Painkiller	The drugs are used for menstrual pain and headaches (migraines), and are widely used in gynecology, as well as for biliary and renal colic.
Antiplatelet agent	Cardiac and vascular disorders: coronary heart disease, atherosclerosis, heart failure, angina pectoris. In addition, they are often recommended for the prevention of stroke and heart attack.

Nonsteroidal anti-inflammatory drugs have a number of contraindications that should be taken into account. The drugs are not recommended for treatment if the patient:

peptic ulcer of the stomach and duodenum;
kidney disease - limited intake is allowed;
blood clotting disorder;
the period of gestation and breastfeeding;
Severe allergic reactions to medications in this group have previously been observed.

In some cases, a side effect may occur, as a result of which the composition of the blood changes ("fluidity" appears) and the walls of the stomach become inflamed.

The development of a negative result is explained by inhibition of the production of prostaglandins not only in the inflamed lesion, but also in other tissues and blood cells. In healthy organs, hormone-like substances play an important role. For example, prostaglandins protect the lining of the stomach from the aggressive effects of digestive juice on it. Consequently, taking NSAIDs contributes to the development of gastric and duodenal ulcers. If a person has these diseases and still takes “prohibited” drugs, then the course of the pathology may worsen, even to the point of perforation (breakthrough) of the defect.

Prostaglandins control blood clotting, so a lack of them can lead to bleeding. Diseases for which examinations should be carried out before prescribing a course of NVPS:

hemocoagulation disorder;
diseases of the liver, spleen and kidneys;
varicose veins of the lower extremities;
diseases of the cardiovascular system;
autoimmune pathologies.

Side effects also include less dangerous conditions, such as nausea, vomiting, loss of appetite, loose stools, and bloating. Sometimes skin manifestations in the form of itching and small rashes are also recorded.

Application using the example of the main drugs of the NSAID group

Let's look at the most popular and effective medications.

Preparation	Route of administration (form of release) and dosage						Application note
	external		through the gastrointestinal tract		injection
	ointment	gel	pills	candles	IM injection	Intravenous administration
Diclofenac (Voltaren)	1-3 times (2-4 grams per affected area) per day		20-25 mg 2-3 times a day	50-100 mg 1 time per day	25-75 mg (2 ml) 2 times a day	—	The tablets should be taken without chewing, 30 minutes before meals, with plenty of water.
Ibuprofen (Nurofen)	Strip 5-10 cm, rub 3 times a day	Gel strip (4-10 cm) 3 times a day	1 tab. (200 ml) 3-4 times a day	For children from 3 to 24 months. (60 mg) 3-4 times a day	—	2 ml 2-3 times a day	The drug is prescribed to children if their body weight exceeds 20 kg
Indomethacin	4-5 cm of ointment 2-3 times a day	3-4 times a day, (strip – 4-5 cm)	100-125 mg 3 times a day	25-50 mg 2-3 times a day	30 mg – 1 ml solution 1-2 r. per day	60 mg – 2 ml 1-2 times a day	During pregnancy, Indomethacin is used to reduce the tone of the uterus to prevent premature birth.
Ketoprofen	Strip 5 cm 3 times a day	3-5 cm 2-3 times a day	150-200 mg (1 tablet) 2-3 times a day	100-160 mg (1 suppository) 2 times a day	100 mg 1-2 times a day	Dissolve 100-200 mg in 100-500 ml saline solution	Most often, the drug is prescribed for pain in the musculoskeletal system.
Ketorolac	1-2 cm of gel or ointment – 3-4 times a day		10 mg 4 times a day	100 mg (1 suppository) 1-2 times a day	0.3-1 ml every 6 hours	0.3-1 ml in a stream 4-6 times a day	Taking the drug may mask the signs of an acute infectious disease
Lornoxicam (Xefocam)	—	—	4 mg 2-3 times a day or 8 mg 2 times a day	—	Initial dose – 16 mg, maintenance dose – 8 mg – 2 times a day		The medication is used for moderate to severe pain syndrome
Meloxicam (Amelotex)	—	4 cm (2 grams) 2-3 times a day	7.5-15 mg 1-2 times a day	0.015 g 1-2 times a day	10-15 mg 1-2 times a day	—	For renal failure, the permissible daily dose is 7.5 mg
Piroxicam	2-4 cm 3-4 times a day		10-30 mg 1 time per day	20-40 mg 1-2 times a day	1-2 ml 1 time per day	—	The maximum permissible daily dosage is 40 mg
Celecoxib (Celebrex)	—	—	200 mg 2 times a day	—	—	—	The drug is available only in the form of capsules coated with a coating that dissolves in the gastrointestinal tract
Aspirin (acetylsalicylic acid)	—	—	0.5-1 gram, take no more than 4 hours and no more than 3 tablets per day	—	—	—	If you have previously had allergic reactions to Penicillin, then Aspirin should be prescribed with caution.
Analgin	—	—	250-500 mg (0.5-1 tablet) 2-3 times a day		250 - 500 mg (1-2 ml) 3 times a day		In some cases, Analgin may have drug incompatibility, so mixing it in a syringe with other medications is not recommended. It is also banned in some countries

Attention! The tables indicate dosages for adults and adolescents whose body weight exceeds 50-50 kg. Many drugs are contraindicated for children under 12 years of age. In other cases, the dosage is selected individually, taking into account body weight and age.

In order for the drug to work as quickly as possible and not cause harm to health, you should adhere to the well-known rules:

Ointments and gels are applied to the painful area, then rubbed into the skin. Before putting on clothes, you should wait until it is completely absorbed. It is also not recommended to take water treatments for several hours after treatment.
Tablets must be taken strictly as directed, without exceeding the daily allowance. If pain or inflammation is too severe, then you should inform your doctor about this so that another, stronger drug can be selected.
Capsules should be washed down with plenty of water without removing the protective shell.
Rectal suppositories work faster than tablets. Absorption of the active substance occurs through the intestines, so there is no negative or irritating effect on the walls of the stomach. If the drug is prescribed to a child, then the young patient should be placed on his left side, then carefully insert the suppository into the anus and squeeze the buttocks tightly. Make sure that the rectal medication does not come out for ten minutes.
Intramuscular and intravenous injections are given only by a medical professional! Injections must be given in the manipulation room of a medical institution.

Although many non-steroidal anti-inflammatory drugs are available without a prescription or some pharmacies may not require one, you should always consult with your doctor before taking them. The fact is that the action of this group of medications is not aimed at treating the disease, but at relieving pain and discomfort. Thus, the pathology begins to progress and stopping its development once identified is much more difficult than it would have been done before.

Joint pain significantly complicates life and prevents you from living fully. Painful processes do not go away on their own. Therefore, treatment is accompanied primarily by anti-inflammatory drugs. Their list is quite wide. In structure, they differ from others in the absence of steroid hormones, which allows the medicine to be taken by a wide group of patients.

Non-steroidal anti-inflammatory drugs are used to treat large and small joints, as well as ligaments. The disease is accompanied by swelling, pain and hyperthermia. At the same time, prostaglandins are formed in the body - substances that activate the production of hormones in the blood. As a result of the effect on blood vessels, body temperature rises, and inflammatory reactions intensify, which leads to arthritis, osteochondrosis and other unpleasant diseases.

The enzyme cyclooxygenase (COX) is blocked by the non-hormonal action of NSAIDs. Swelling and redness decrease, temperature returns to normal, inflammation subsides.

NSAIDs have a positive effect on diseases:

relieve inflammation;
have analgesic properties;
effectively lower the temperature;
have an antiaggregation effect - eliminate platelet aggregation.

Do not forget that immunosuppressant medications help in the treatment of rheumatism, but have a depressing effect on the immune system as a whole.

Classification of drugs

It is worth noting that COX is divided into two types. The first produces prostaglandin, which protects the mucous membrane of the stomach and intestines from damage. And the second connects prostaglandins, which increase the temperature.

Therefore, drugs are usually differentiated into two parts:

selective (they inhibit COX2);
non-selective.

The latter, in turn, are also grouped. Some affect both COXs equally, others affect COX1.

The first ones are prescribed for acute respiratory viral infections, after operations, for injuries, infections, others save from rheumatism and sore joints, and have anti-inflammatory properties.

Indications for the use of NSAIDs for the treatment of joints

Anti-inflammatory drugs are safe with short-term use and without contraindications.

Medicines are used for chronic and acute inflammatory processes:

migraine;
injuries;
arthritis, rheumatism, ankylosing spondylitis;
toothache;
gout;
renal and hepatic colic;
inflammatory diseases of the spine, muscles, musculoskeletal system, joints and bones;
radiculitis, sciatica, neuralgia;
painful critical days;
infections;
metastases in cancer.

List of non-steroidal anti-inflammatory drugs

Acetyl salicylic acid (aspirin).

In practice for over a hundred years. Prescribed to combat ARVI and relieve headaches. Used together with other substances for the treatment of osteoarthritis. But in case of acute inflammation, aspirin is replaced with more powerful medications.

Diclofenac.

Available in tablets, suppositories, gel and solution for injection. The popular pain reliever is absorbed within twenty minutes and relieves fever.

Ibuprofen.

Release form: suppositories, tablets. It is easy to carry and has a low price tag. Prescribed for neuralgia, bursitis, hematomas, sprains, influenza, ARVI, rheumatoid arthritis, gout, ankylosing spondylitis, osteoarthritis, febrile conditions. Ibuprofen has many analogues in different price categories.

Nimesulide.

When using it, the temperature normalizes, the body becomes mobile as a result of pain relief. The ointment is applied to the arthritic area. There may be slight redness, this is how the effect of the drug is manifested.

Indomethacin is one of the strongest drugs with an analgesic effect.

Available in the form of ointments, suppositories, tablets. Although the medicine is cheap, this does not prevent it from having an incomparable effect on arthritic and arthritic joints. Before use, consult a doctor due to the impressive list of side effects.

Meloxicam belongs to the group of NSAIDs.

Available in tablets and solution for intramuscular administration. Pharmacological action – analgesic, anti-inflammatory with antipyretic effect. Indicated for symptomatic therapy to reduce pain and inflammation. Treats osteoarthritis, rheumatoid arthritis, ankylosing spondylitis. It is allowed to use meloxicam under the supervision of a specialist even for several years. Long-term exposure allows you to take one tablet during the day. The substance can be purchased under various names - Movalis, Melbek, Melox, Artrosan, Mesipol, Mataren, etc.

Some drugs, under the strict supervision of a doctor, are allowed to be taken by pregnant women in case of vital need, and in no case in the third trimester.

The doctor may prescribe:

diclofenac;
ibuprofen;
aspirin;
ketorolac;
indomethacin;
naproxen.

Taking medications on your own is prohibited.

New generation NSAIDs for the treatment of joints

Medical technology does not stand still. Every day, hundreds of scientists are trying to develop new pills and modernize time-tested ones. Non-steroidal anti-inflammatory drugs have not been spared either. New generation drugs act more selectively and thoroughly suppress inflammation. The most important thing here is the absence of a serious effect on the gastrointestinal tract and cartilage tissue.

List of new generation non-steroidal anti-inflammatory drugs

Among the useful “potions”, the most effective was Movalis with the active ingredient in the form of meloxicam. For arthrosis, a real lifesaver. Long-term use has virtually no effect on the functioning of the stomach and intestines. Analogs work in the same area - Melbek, Mesipol, Mirlox.

The drug Xefocam has the ability to extend the effect of the panacea, so that patients do not feel pain for about twelve hours. Most importantly, Xefocam is not addictive, and its ability to relieve pain is comparable to morphine. However, the high cost does not allow everyone to purchase the drug for their first aid kit. Available with a doctor's prescription.

The antioxidant Nimesulide blocks the action of substances that break down collagen and cartilage tissue. Arthrosis of the joints is treatable, the pain subsides, and the inflammation goes away. Sold in granules for solution, tablets, and gel form.

Celecoxib was originally called Celebrex. Release form: capsules 200 and 100 mg. The pronounced fight against arthrosis and arthritis does not affect the functioning of the gastrointestinal tract, the mucous membrane remains normal.

Etoricoxib is marketed under the brand name Arcoxia. Taking up to 150 mg per day does not affect the functioning of the intestines and stomach. The average dose for arthrosis is approximately 30-60 mg per day.

The cost of medications varies. On the advice of a doctor, the patient can buy a more expensive drug or its analogue, depending on the contraindications and side effects. The products relieve unbearable pain and eliminate inflammation. After taking them, another treatment should be prescribed.

General rules of application

There is no point in taking on a medication guide on your own. Contacting a specialist will help you understand the methods and rules of treatment. To do this, you need to prepare all statements about previous or concomitant diseases and take tests so that the doctor can select the right treatment.

The tablets are taken immediately after meals with half a glass of water or low-fat milk for absorption and protection of the gastrointestinal tract from harmful effects. At the same time, bifidobacteria should be taken.

If long-term use is planned, then start with a minimum dose, gradually increasing the amount.

Side effects of non-steroidal anti-inflammatory drugs

Allergy.
Bronchospasms.
Dyspeptic disorders.
Impaired renal function (nephropathy, blood vessels narrow).
Ulcerogenic effect (development of erosion or stomach ulcers).
Increased blood activity in the liver.
Miscarriages.
In rare cases, bleeding disorders.

Contraindications to the use of NSAIDs

Any, even the most harmless medicine has contraindications. NSAIDs have several:

pregnancy;
individual intolerance;
disorders of the kidneys and liver;
peptic ulcers of the gastrointestinal tract and duodenum;
thrombo- and leukopenia.

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

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

Operating principle

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

Types by mechanism of action

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

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

List of NSAIDs

Basic non-selective NSAIDs

Acid derivatives:

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

Selective COX-2 inhibitors

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

Main indications, contraindications and side effects

Table. Non-steroidal anti-inflammatory drugs - indications

Property of a medical product	Diseases, pathological condition of the body
Antipyretic	High temperature (above 38 degrees).
Anti-inflammatory	Diseases of the musculoskeletal system - arthritis, arthrosis, osteochondrosis, muscle inflammation (myositis), spondyloarthritis. This also includes myalgia (often appears after a bruise, sprain or injury to soft tissues).
Painkiller	The drugs are used for menstrual pain and headaches (migraines), and are widely used in gynecology, as well as for biliary and renal colic.
Antiplatelet agent	Cardiac and vascular disorders: coronary heart disease, atherosclerosis, heart failure, angina pectoris. In addition, they are often recommended for the prevention of stroke and heart attack.

Nonsteroidal anti-inflammatory drugs have a number of contraindications that should be taken into account. The drugs are not recommended for treatment if the patient:

peptic ulcer of the stomach and duodenum; kidney disease - limited intake is allowed; blood clotting disorder; the period of gestation and breastfeeding; Severe allergic reactions to medications in this group have previously been observed.

In some cases, a side effect may occur, as a result of which the composition of the blood changes ("fluidity" appears) and the walls of the stomach become inflamed.

Prostaglandins control blood clotting, so a lack of them can lead to bleeding. Diseases for which examinations should be carried out before prescribing a course of NVPS:

hemocoagulation disorder; diseases of the liver, spleen and kidneys; varicose veins of the lower extremities; diseases of the cardiovascular system; autoimmune pathologies.

Application using the example of the main drugs of the NSAID group

Let's look at the most popular and effective medications.

Preparation	Route of administration (form of release) and dosage						Application note
	external		through the gastrointestinal tract		injection
	ointment	gel	pills	candles	IM injection	Intravenous administration
Diclofenac (Voltaren)	1-3 times (2-4 grams per affected area) per day		20-25 mg 2-3 times a day	50-100 mg 1 time per day	25-75 mg (2 ml) 2 times a day	-	The tablets should be taken without chewing, 30 minutes before meals, with plenty of water.
Ibuprofen (Nurofen)	Strip 5-10 cm, rub 3 times a day	Gel strip (4-10 cm) 3 times a day	1 tab. (200 ml) 3-4 times a day	For children from 3 to 24 months. (60 mg) 3-4 times a day	-	2 ml 2-3 times a day	The drug is prescribed to children if their body weight exceeds 20 kg
Indomethacin	4-5 cm of ointment 2-3 times a day	3-4 times a day, (strip – 4-5 cm)	100-125 mg 3 times a day	25-50 mg 2-3 times a day	30 mg – 1 ml solution 1-2 r. per day	60 mg – 2 ml 1-2 times a day	During pregnancy, Indomethacin is used to reduce the tone of the uterus to prevent premature birth.
Ketoprofen	Strip 5 cm 3 times a day	3-5 cm 2-3 times a day	150-200 mg (1 tablet) 2-3 times a day	100-160 mg (1 suppository) 2 times a day	100 mg 1-2 times a day	Dissolve 100-200 mg in 100-500 ml saline solution	Most often, the drug is prescribed for pain in the musculoskeletal system.
Ketorolac	1-2 cm of gel or ointment – 3-4 times a day		10 mg 4 times a day	100 mg (1 suppository) 1-2 times a day	0.3-1 ml every 6 hours	0.3-1 ml in a stream 4-6 times a day	Taking the drug may mask the signs of an acute infectious disease
Lornoxicam (Xefocam)	-	-	4 mg 2-3 times a day or 8 mg 2 times a day	-	Initial dose – 16 mg, maintenance dose – 8 mg – 2 times a day		The medication is used for moderate to severe pain syndrome
Meloxicam (Amelotex)	-	4 cm (2 grams) 2-3 times a day	7.5-15 mg 1-2 times a day	0.015 g 1-2 times a day	10-15 mg 1-2 times a day	-	For renal failure, the permissible daily dose is 7.5 mg
Piroxicam	2-4 cm 3-4 times a day		10-30 mg 1 time per day	20-40 mg 1-2 times a day	1-2 ml 1 time per day	-	The maximum permissible daily dosage is 40 mg
Celecoxib (Celebrex)	-	-	200 mg 2 times a day	-	-	-	The drug is available only in the form of capsules coated with a coating that dissolves in the gastrointestinal tract
Aspirin (acetylsalicylic acid)	-	-	0.5-1 gram, take no more than 4 hours and no more than 3 tablets per day	-	-	-	If you have previously had allergic reactions to Penicillin, then Aspirin should be prescribed with caution.
Analgin	-	-	250-500 mg (0.5-1 tablet) 2-3 times a day		250 - 500 mg (1-2 ml) 3 times a day		In some cases, Analgin may have drug incompatibility, so mixing it in a syringe with other medications is not recommended. It is also banned in some countries

In order for the drug to work as quickly as possible and not cause harm to health, you should adhere to the well-known rules:

Ointments and gels are applied to the painful area, then rubbed into the skin. Before putting on clothes, you should wait until it is completely absorbed. It is also not recommended to take water treatments for several hours after treatment. Tablets must be taken strictly as directed, without exceeding the daily allowance. If pain or inflammation is too pronounced, then you should inform your doctor about this so that another, stronger drug can be selected. Capsules should be washed down with plenty of water without removing the protective shell. Rectal suppositories work faster than tablets. Absorption of the active substance occurs through the intestines, so there is no negative or irritating effect on the walls of the stomach. If the drug is prescribed to a child, then the young patient should be placed on his left side, then carefully insert the suppository into the anus and squeeze the buttocks tightly. Make sure that the rectal medication does not come out for ten minutes. Intramuscular and intravenous injections are given only by a medical professional! Injections must be given in the manipulation room of a medical institution.

Although non-steroidal anti-inflammatory drugs are available without a prescription, you should always consult with your doctor before taking them. The fact is that the action of this group of medications is not aimed at treating the disease, but at relieving pain and discomfort. Thus, the pathology begins to progress and stopping its development once identified is much more difficult than it would have been done before.

Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) are drugs that have analgesic (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:

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.

NSAIDs are contraindicated for erosive and ulcerative lesions of the gastrointestinal tract, especially in the acute stage, severe liver and kidney dysfunction, 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:

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

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 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 is it? 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 each, costs 650-850 rubles. 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 each, costs 350-450 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 400-600 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 each, costs 120-160 rubles.

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.

Acidic NSAIDs:

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.

Non-acid NSAIDs:

Alcanons; Sulfonamide 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):

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

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

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

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 to choose?

Any drug new to a given patient must be prescribed first in the lowest dose. 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 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

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 at a dosage of 100-200 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, Diklak, 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.

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

Impact principle

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

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

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

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

New developments

It is no secret that first-generation NSAIDs 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 effect of narcotic analgesics. In addition, they provide analgesic and anti-inflammatory effects. The use of NSAIDs is widespread in clinical settings and in everyday life. Today these are one of the popular medical drugs.

A positive effect is noted under the following factors:

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 for 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. High temperature. The antipyretic effect allows the drugs to be used for a variety of ailments by both adults and children. Such medications are effective even in cases of 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. Medicines are not cheap, but their effect on the body lasts much longer than other NSAIDs. Phenylacetic acid derivatives. 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 products. This category contains many excellent NSAIDs. List of drugs: “Ibuprofen”, “Ketoprofen”, “Benoxaprofen”, “Fenbufen”, “Fenoprofen”, “Tiaprofenic acid”, “Naproxen”, “Flurbiprofen”, “Pirprofen”, “Nabumeton”. Isonicotinic acid derivatives. 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; allergies.

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 has 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; ulcer 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.