Anti-inflammatory drugs for joints are the main treatment for diseases of cartilage and connective tissue. They slow down the progression of the disease, help fight exacerbations, relieve painful symptoms. The scheme of taking the drug can be different - they are taken in courses, or as needed to alleviate the condition. Non-steroidal anti-inflammatory drugs (NSAIDs) are produced in various dosage forms - ointments and gels for topical use, tablets and capsules, as well as injectable preparations for intraarticular administration.

Anti-inflammatory drugs (NSAIDs) - the principle of action

This group of drugs is very extensive, but they are all united by a common principle of action. The essence of this process is that non-steroidal anti-inflammatory drugs for the treatment of joints interfere with the mechanism of the formation of the inflammatory process. The enzyme cyclooxygenase is responsible for the synthesis of so-called inflammatory mediators. It is she who is inhibited by drugs from the NSAID group, interrupting the chain of development of the inflammatory reaction. They prevent pain, fever and local swelling.

But there is another important feature of the action of non-steroidal anti-inflammatory drugs. There are two types of cyclooxygenase enzyme. One of them (COX-1) is involved in the synthesis of inflammatory mediators, and the second (COX-2) is involved in the synthesis of the protective layer of the stomach wall. NSAIDs act on both types of this enzyme, causing both of them to be inhibited. This explains the side effect common to these drugs, which consists in damage to the mucous membrane of the digestive organs.

According to their effect on COX-2 drugs are divided into selective and non-selective. The development of new NSAIDs aims to increase the selectivity of their effect on COX-1 and eliminate the effect on COX-2. Currently, a new generation of NSAIDs has been developed, which have almost complete selectivity.

The three main therapeutic effects of drugs in this group are anti-inflammatory, antipyretic and analgesic. In diseases of the joints, it is the anti-inflammatory effect that comes to the fore, and the analgesic effect is no less significant. The antipyretic effect is less important and practically does not manifest itself in the new generation of anti-inflammatory nonsteroidal drugs that are used to treat joint diseases.

Classification of anti-inflammatory drugs

Taking into account the peculiarities of the structure of the active substance, all NSAIDs can be divided into several groups:

Non-selective NSAIDs (affect mainly COX-1)

These include the following tools:

• Aspirin;
• Ketoprofen;

Non-selective NSAIDs (equally affecting COX-1 and COX-2).

• Lornoxicam;
• Lorakam.

Selective NSAIDs (inhibit COX-2)

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

Some of these drugs have a strong anti-inflammatory effect, others are more antipyretic (Aspirin, Ibuprofen) or analgesic (Ketorolac) effect.

Indications for the use of NSAIDs

knee arthritis is one of the causes

In diseases of the joints, nonsteroidal drugs are prescribed according to several schemes, depending on the dosage form and stage of the disease. The list of diseases for which NSAIDs are prescribed is quite long - these are arthritis of various etiologies, including autoimmune, most arthrosis, the recovery period after injuries of the joints and muscular apparatus.

With exacerbation of chronic diseases of the joints, non-steroidal anti-inflammatory drugs are used in a complex manner. They are prescribed in the form of a course of tablets and ointments, in a serious condition, the treatment is supplemented by intra-articular injections. Outside of exacerbation and in acute conditions, they are used as needed if symptoms of inflammation of the joints occur.

Side effects

Non-steroidal anti-inflammatory drugs have many side effects, so be sure to read the instructions before taking them. The most common side effects are:

• provocation of a stomach or duodenal ulcer,
• dyspepsia,
• dysfunction of the nervous system,

They are especially pronounced in medicines in tablets, suppositories and solutions for intramuscular injections. Local remedies (ointments and intra-articular injections) do not have such an effect.

Another common group of side effects is the effect on the hematopoietic system. NSAIDs have a blood-thinning effect, and this effect must be taken into account when taking these drugs so as not to harm your health. A more dangerous effect on the blood system is expressed in the inhibition of hematopoietic processes. It is manifested by a gradual decrease in the number of formed elements in the blood - first anemia develops, then - thrombocytopenia, subsequently - pancytopenia.

In addition, there are other side effects caused by the chemical characteristics of the drugs, they are indicated in the instructions for use. Due to the large number of side effects, you should consult your doctor before taking NSAIDs for the treatment of joints.

Contraindications

Contraindications to the use of NSAIDs in diseases of the joints stem from their side effects and relate primarily to tablet forms. They are not prescribed to patients during an exacerbation of diseases of the gastrointestinal tract, as well as to patients with diseases of the blood system - anemia of various origins, clotting disorders, leukemia and leukemia.

NSAIDs should not be administered simultaneously with drugs that reduce blood clotting (heparin), and it is also not recommended to take the same drug in different dosage forms - this leads to increased side effects. First of all, this applies to drugs containing ibuprofen and diclofenac.

In addition, it is possible to develop an allergic reaction to drugs of the NSAID group. Its intensity is not related to the dosage form, and appears with the same frequency when taking tablets, using ointments and injecting into the joints. Sometimes allergies can take very severe forms, for example, aspirin asthma - an asthmatic attack when using the drug. An allergic reaction to NSAIDs can be cross-reactive, so care should be taken when taking drugs.

Ointments with NSAIDs for joint diseases

Ointments are the most common dosage form that is used for joint pain. Their popularity is due to the fact that the effect of the ointment comes quickly enough, and the side effects are minimal. The ointment can be used to relieve acute pain and in the recovery period after injuries. But if a course of injections is prescribed, then the ointments are usually canceled.

The most popular drugs in the form of ointments are Diclofenac and preparations based on it (Voltaren), Dolobene, and others. Most of them can be bought at the pharmacy without a doctor's prescription. You can use such products for a long time without harm to health.

Non-steroidal anti-inflammatory drugs in tablets for diseases of the joints

NSAIDs in tablets are prescribed for joint lesions, osteochondrosis, systemic connective tissue diseases with articular syndrome. They are used in courses, several times a year, prescribed in the acute period. But the main task of NSAID tablets is to prevent the exacerbation of diseases.

This dosage form is most effective for the treatment of diseases of the joints and spine, but has the greatest number of contraindications. In addition to the conditions listed above, tablets containing NSAIDs should not be used for liver diseases - fibrosis, cirrhosis, hepatitis, liver failure. In diseases of the kidneys, accompanied by a decrease in the filtration rate, a reduction in dosage or frequency of administration is required.

A complete list of anti-inflammatory drugs can be found on Wikipedia. Among the most famous of them is Diclofenac in tablets. Of the more modern drugs of the new generation - Xefocam, Celecoxib and Movalis. New drugs are safer, but have another negative point - high cost. Tablets should be taken after meals or with meals.

NSAIDs in solutions for intra-articular injections

This dosage form is prescribed for severe disease and for the relief of severe exacerbation. It is used by courses that are held only in a medical institution. Intra-articular injections allow the most effective delivery of the active substance to the site of inflammation. But they require high qualifications from the doctor who conducts them, since they are associated with a risk of damage to the ligament of the joint.

Diclofenac, Movalis, Ksefokam and other drugs are available in injectable form. They are used to treat lesions of large joints, most often the knee, less often the elbow. Intra-articular injections are not prescribed for lesions of the joints of the hands and feet, as well as for diseases of the spine. This is due to the fact that the technical difficulties of administering the drug make this method of treatment almost impossible.

Intra-articular injections are considered a rather complex medical manipulation, and must be carried out in a treatment room, as they require sterility to avoid infection and highly qualified medical staff.

List of the best anti-inflammatory drugs

Let us consider in more detail the features of the use of the most popular drugs from the NSAID group.

(Voltaren, Naklofen, Olfen, Diklak, etc.)

Diclofenac and preparations based on it are produced in the form of tablets, capsules, ointments, gels, suppositories, injection solutions. These drugs exhibit a powerful anti-inflammatory effect, quickly relieve pain, lower the temperature and alleviate the patient's condition. A high concentration of the active ingredient in the blood is noted within 20 minutes after taking the drug.

Like most drugs from the NSAID group, they have a negative effect on the gastrointestinal tract, I have a fairly extensive list of contraindications and side effects, so they should be used only as directed by a doctor, in short courses. The standard daily dose of Diclofenac in tablets for adult patients is 150 mg, it is divided into 2-3 doses. Local forms (ointments, gels) are applied to the affected area with a thin layer up to 3 times a day.

Indomethacin (Metindol)

It has the same therapeutic effect as Diclofenac. Available in the form of tablets, capsules, ointment, gel, rectal suppositories. But this drug has many more pronounced side effects, so it is now rarely used, giving preference to more modern drugs.

A drug from the group of oxycams, with a pronounced analgesic, anti-inflammatory and antipyretic effect. Available in the form of capsules, tablets, ointments, creams, suppositories. It is used to treat gout, arthritis, joint and muscle pain, as well as in preparation for the IVF procedure.

Like other NSAIDs, it has an extensive list of side effects associated with damage to the digestive tract, impaired hematopoiesis, and reactions from the nervous system. Therefore, the drug should be used only as directed by a doctor. The analgesic effect of taking Piroxicam tablets persists throughout the day. The standard dose of the drug for an adult is up to 40 mg per day.

Lornoxicam (Xefocam, Lorakam, Larfix)

The drug has a pronounced anti-inflammatory effect, quickly copes with excruciating pain syndrome. Does not show antipyretic action. The drug is used to treat postoperative pain, algomenorrhea, in the treatment of osteoarthritis and rheumatoid arthritis.

Available in the form of tablets and powder, intended for the preparation of a solution for injection. The recommended dose for oral administration is up to 4 tablets per day in 2 divided doses. For injection into a muscle or vein, a single dose of the drug is 8 mg, the solution is prepared immediately before administration.

When using the drug, the likelihood of complications in people with gastroenterological pathologies increases, therefore, the drug is not used for diseases of the gastrointestinal tract, as well as during pregnancy, lactation, pathologies of the heart, liver and in childhood.

Meloxicam (Movalix, Revmoxicam, Melox)

Drugs based on enolic acid belong to the class of selective COX-2 inhibitors. In this regard, they cause fewer side effects from the digestive organs and do not provoke toxic damage to the kidneys and liver. Meloxicam tablets, rectal suppositories and injections in ampoules are produced.

Indications for the use of the drug are diseases of the joints of an inflammatory and degenerative nature with a pronounced pain syndrome - spondyloarthritis, osteoarthrosis and arthritis. As a rule, in the first days of treatment, the drug is used in the form of intramuscular injections, after the acute inflammatory process subsides, they switch to taking Meloxicam in tablet form (1 tablet twice a day).

Nimesulide (Nimesil, Nimesin, Remesulide)

The drug belongs to the group of highly selective COX-2 inhibitors, has a powerful anti-inflammatory effect, which is complemented by antipyretic and analgesic properties. Nimesulide is produced in the form of tablets, granules for suspension and in the form of a gel for topical use. A single dose of the drug in tablets is 100 mg, taken twice a day.

The gel is applied to the affected area several times a day (3-4), lightly rubbing. Suspension with a pleasant orange flavor can be prescribed to children from 12 years of age. The drug is intended for the treatment of post-traumatic and postoperative pain, degenerative joint lesions (accompanied by inflammation), bursitis, tendonitis.

In addition, Nimesulide is prescribed for atralgia, myalgia, painful periods, as well as for the relief of headache and toothache. The drug can have a toxic effect on the liver and kidneys, therefore, in diseases of these organs, the dose of the drug must be reduced.

Celecoxib (Revmroxib, Celebrex)

A drug from the group of coxibs, used in the treatment of inflammatory diseases of the joints, acute pain syndrome, menstrual pain. Available in the form of capsules, which may contain 100 or 200 mg of the active substance. It shows a pronounced analgesic and anti-inflammatory effect, while, if not exceeding the therapeutic dose, it has practically no negative effect on the gastrointestinal mucosa.

The maximum allowable daily dose of the drug is 400 mg divided into 2 doses. With prolonged use of Celecoxib in high doses, side effects develop - ulceration of the mucosa, disorders of the hematopoietic system and other undesirable reactions from the nervous, cardiovascular and genitourinary systems.

(Zerodol)

The action of the drug is similar to Diclofenac, it is available in the form of tablets containing 100 mg of the active substance. Adults are advised to take 1 tablet twice a day. The drug is intended for the treatment of gout, arthritis of various etiologies, osteoarthritis and spondylitis.

This medication is much less likely than other NSAIDs to provoke erosive lesions of the gastrointestinal tract, but its administration may be accompanied by a number of side effects from the digestive, nervous, hematopoietic, and respiratory systems. With extreme caution, the drug is prescribed for pathologies of the liver, kidneys, diabetes mellitus, ischemia, arterial hypertension and other conditions, a list of which is given in the instructions for the drug.

Rofecoxib

This is a modern remedy from the category of highly selective COX-2 inhibitors, which have practically no negative effect on the gastrointestinal mucosa and kidneys. It is used as a strong analgesic and anti-inflammatory agent for most inflammatory and degenerative lesions of the musculoskeletal system. In addition, the medication is prescribed for migraine, neuralgia, lumbago, osteochondrosis, pain syndrome with muscle and ligament injuries.

This universal remedy is often included in the scheme of complex treatment of thrombophlebitis, diseases of the genitourinary system, is used in ophthalmology, for diseases of the ENT organs or for dental problems (stomatitis, pulpitis). With severe pain syndrome, you can take up to 4 tablets at a time. With caution, the drug is prescribed for bronchial asthma, in early pregnancy, during lactation. This medication has much fewer contraindications and side effects than other anti-inflammatory drugs.

Combined NSAIDs

New generation anti-inflammatory drugs combine a combination of an active ingredient with vitamins or other active ingredients that enhance their therapeutic effect. We present to your attention a list of the most popular drugs of combined action:

• Flamidez (diclofenac + paracetamol);
• Neurodiclovit (diclofenac + vitamins B1, B6, B12);
• Olfen-75 (diclofenac + lidocaine);
• Diclocaine (lidocaine + diclofenac in low dosage);
• Dolaren gel (diclofenac + flax oil + menthol + methyl salicylate);
• Nimid Forte (nimesulide + tizanidine);
• Alit (soluble tablets containing nimesulide and muscle relaxant dicycloverine);

This is not a complete list of combined anti-inflammatory drugs that are used to treat joints and degenerative lesions of the musculoskeletal system. For each patient, the doctor selects a treatment regimen individually, taking into account many factors. Drugs from the NSAID group have many contraindications and can cause a number of undesirable side reactions from various organs and systems.

Therefore, you can not self-medicate! Only a specialist can recommend the optimal remedy, taking into account the clinical picture of the disease, the severity of symptoms, comorbidities, and determine the required dosage of the drug and the duration of the course of treatment. This will help to avoid unwanted complications, will alleviate the patient's condition and speed up recovery.

Who to contact?

Depending on the nature of the pathology, the following specialists can deal with the treatment of a patient with joint diseases: a neurologist, a general practitioner, an orthopedist or a rheumatologist. It is these doctors who have the right to prescribe drugs from the NSAID group for the treatment of specialized diseases.

If the intake of anti-inflammatory drugs has led to the occurrence of adverse reactions, such narrow specialists as a gastroenterologist, cardiologist, allergist, nephrologist can join the treatment of the patient. If the patient is forced to take NSAIDs for a long time, be sure to consult a nutritionist and choose the best diet that will protect the gastric mucosa from damage.

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

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

How NSAIDs work

If analgesics are designed to fight 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 inhibit the effects of both of its isoforms (species) - COX-1 and COX-2.

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

When are NSAIDs used?

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

We list the diseases for which these medicines are prescribed:

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

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

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

Consider the most effective and well-known NSAIDs that are used to treat joints and other diseases when required. antipyretic and anti-inflammatory effect:

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

Some medical drugs 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 NSAIDs of a new generation

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

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

Of the minuses of new generation drugs, only their high cost can be distinguished, which makes them inaccessible to most people.

What are new generation NSAIDs?

Anti-inflammatory non-steroidal drugs of the new generation act much more selectively, they are more inhibit COX-2, with COX-1 remaining almost unaffected. This can explain the rather high efficiency of the drug in combination with a minimum of side effects.

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

• Ksefokam. A drug that is based on Lornoxicam. Its characteristic feature is the fact that the drug has an increased ability to relieve pain. According to 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 antipyretic, well-pronounced anti-inflammatory and analgesic effect. The main advantage of this drug is that with the constant supervision of a doctor, it can be used for quite a long time. Meloxicam is made 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 lasting effect, and it is enough to use one tablet throughout the day.
• Nimesulide. It has been 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 is minimal or completely absent.

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

By chemical origin, these drugs come with non-acid and acid derivatives.

Acid preparations:

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

Non-acid drugs:

• Sulfonamide derivatives;
• Alcanones.

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

The strength of the anti-inflammatory effect medium doses, the drugs are arranged in the following sequence (top of the most powerful):

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

By analgesic effect drugs are listed in the following order:

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

The most commonly used NSAIDs listed above are in chronic and acute diseases accompanied by inflammation and pain. As a rule, anti-inflammatory nonsteroidal drugs are used to treat joints and relieve pain: injuries, arthrosis, arthritis, etc.

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

Any new drug for the patient should be prescribed at the beginning in the minimum dose. With normal tolerance after a few days increase the daily dose.

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

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

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

NSAIDs should be treated for minimum possible time and minimum doses.

Use in pregnancy

It is undesirable to use drugs of the NSAID group during pregnancy, especially in the third trimester. Although there are no direct teratogenic effects, 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 successfully used in women with antiphospholipid syndrome.

Description of non-steroidal anti-inflammatory drugs Movalis

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

It has a pronounced anti-inflammatory effect, which makes it possible to use it in rheumatoid arthritis, ankylosing spondylitis, osteoarthritis. Protects cartilaginous tissue, is not devoid of antipyretic and analgesic properties. Used for headache and toothache.

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

COX-2 inhibitor, which has a pronounced analgesic and anti-inflammatory action. When used in therapeutic doses, it almost does not have a negative effect on the gastrointestinal mucosa, since it has a rather low degree of affinity for COX-1, and therefore does not cause a violation of the synthesis of constitutional prostaglandins.

It is one of the most effective non-hormonal drugs. In arthritis, it reduces swelling of the joints, relieves pain and has a strong anti-inflammatory effect. When using a medical product, you need to be careful, because it has a large list of side effects. In pharmacology, the drug is manufactured under the names Indovis EU, Indovazin, Indocollir, Indotard, Metindol.

It combines the ability to effectively reduce pain and temperature, relative safety, because medicines based on it can be bought without a prescription. Ibuprofen is used as an antipyretic drug, including and for newborns.

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

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

Form of production - capsules, tablets, gel, suppositories, injection solution. In this preparation for the treatment of joints, both a high anti-inflammatory effect and high analgesic activity are perfectly combined.

It is manufactured under the names Naklofen, Voltaren, Diklak, Ortofen, Vurdon, Diklonak P, Dolex, Olfen, Klodifen, Dicloberl, etc.

Chondroprotectors - alternative drugs

Very common for joint treatment use chondroprotectors. People often do not understand the difference 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 composition of the most effective chondroprotectors are two substances - chondroitin and glucosamine.

Anti-inflammatory nonsteroidal drugs are excellent helpers during the treatment of many diseases. But we must not forget that they only remove the negatively affecting symptoms on well-being, the treatment of diseases directly is carried out by other methods and drugs.

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

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

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

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

In addition, these hormone-like substances, reaching the cerebral cortex, affect the center responsible for thermoregulation. Thus, impulses are given 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 starting 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 suffering to a person, unpleasant sensations, are stopped.

Types behind the mechanism of action

NSAIDs are classified according to their chemical structure or mechanism of action. The long-known drugs of this group were divided into types according to their chemical structure or origin, since then the mechanism of their action was still unknown. Modern NSAIDs, on the contrary, are usually classified according to the 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 immediately on both types of enzymes. These drugs block COX-1 enzymes, which, unlike COX-2, are constantly present in our body, performing various important functions. Therefore, exposure to them can 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 affect the gastrointestinal tract so negatively, but at the same time, the load on the cardiovascular system is greater (they can increase pressure).
• selective NSAID COX-1 inhibitors. This group is small, since almost all drugs that affect COX-1 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 been confirmed only in animals, and they are also sometimes referred to as COX-1. It is believed that their production is slightly slowed down by paracetamol.

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

Major non-selective NSAIDs

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

Acetylsalicylic acid (aspirin) is the first known NSAID, discovered back in 1897 (all others appeared after the 1950s). In addition, it is the only agent capable of irreversibly inhibiting COX-1 and has also been shown to stop platelets from sticking together. 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 NVPS is constantly expanding and pharmacy shelves regularly receive new generation drugs that can simultaneously lower the temperature, relieve inflammation and pain in a short period of time. Due to the mild and gentle effect, the development of negative consequences in the form of allergic reactions, as well as damage to the organs of the gastrointestinal tract and urinary system, is minimized.

Table. Non-steroidal anti-inflammatory drugs - indications

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

This can be explained by their actions:

• Anti-inflammatory;
• Antipyretic;
• Analgesic.

Suitable for symptomatic treatment, since most diseases are accompanied by precisely the listed manifestations. Over the past few years, new drugs in this direction have appeared, and most of them have efficacy, prolonged action, and good tolerability.

What it is?

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

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

Now we will look at them in more detail.

The effect of these drugs

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

PGs have the following focus:

1. Local expansion of blood vessels, due to which there is a decrease in edema, exudation, and the speedy healing of damage.
2. Reduce pain.
3. Contribute to lowering heat, due to the action on the hypothalamic centers of regulation.
4. Anti-inflammatory action.

Indication for use

Medicines of this group, as a rule, prescribed for acute and chronic pathologies, in the clinic of which there is pain and inflammation.

Most often, drugs in this group are prescribed for:

1. Rheumatoid arthritis is a chronic inflammation of the joints.
2. Osteoarthritis is a non-inflammatory chronic joint disease of unknown etiology.
3. Inflammatory arthropathy: ankylosing spondylitis; psoriatic arthritis; Reiter's syndrome.
4. Gout is the deposition of urate in body tissues.
5. Dysmenorrhea - menstrual pain.
6. Bone cancer with pain.
7. Migraine pains. B
8. Pain observed after surgery.
9. Slight pain with injuries and inflammation.
10. Heat.
11. Pain syndrome in diseases of the urinary system.

Release forms

NSAIDs are produced in the following forms:

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

Classification of non-steroidal anti-inflammatory drugs

There are several classifications of the described group.

By chemical structure:

1. Salicylic acid derivatives- Aspirin.
2. Pyrazolone derivatives- Analgin.
3. Anthranilic acid derivatives- Sodium mefenaminate.
4. Propionic acid derivatives- representative of the group - Ibuprofen. Read more here: ibuprofen instructions for use.
5. Acetic acid derivatives- in this group Diclofenac-sodium. Read more about the article Diclofenac instructions for use.
6. Oxycam derivatives– representatives of Piroxicam and Meloxicam.
7. Derivatives of isonicotinic acid- this includes Amizon.
8. Derivatives of coxibs- in this group Celecoxib, Rofecoxib.
9. Derivatives of other chemical groups- Mesulides, Etodolac.
10. Combined drugs- Reopirin, Diclocaine.

All drugs in this group are divided into 2 types:

• Type 1 cyclooxygenase inhibitors;
• Type 2 cyclooxygenase inhibitors.

List of first generation drugs

List of second generation drugs

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

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

List of the most effective NSAIDs

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

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

A lot of pathological changes occurring in the body accompany the pain syndrome. To combat such symptoms, NSAIDs, or non-steroidal anti-inflammatory drugs, have been developed. They perfectly anesthetize, relieve inflammation, 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 drugs are much less likely to cause unpleasant reactions, but they remain effective drugs for pain.

Impact principle

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

COX-1 is responsible for the production of prostaglandins. They protect the gastric mucosa from unpleasant effects, affect 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.

Such an action of NSAIDs as inhibition of COX-1 carries many side effects.

New developments

It is no secret that the drugs of the first generation of NSAIDs had an adverse effect on the gastric mucosa. Therefore, scientists have set themselves the goal of reducing undesirable effects. A new release form has been 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 allowed to reduce the irritating effect on the gastric mucosa. However, the unpleasant mechanism of damage to the walls of the digestive tract still remained.

This forced chemists to synthesize completely new substances. From previous drugs, they are fundamentally different mechanism of action. NSAIDs of the new generation 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 the gastric mucosa.

The anti-inflammatory effect is due to a decrease in the permeability of the walls of blood vessels, as well as a decrease in the production of a variety of inflammatory mediators. Due to this effect, irritation of the nerve pain receptors is minimized. The influence on certain centers of thermoregulation located in the brain allows the latest generation of NSAIDs to perfectly lower the 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 drugs give an excellent antipyretic effect. Their effect on the body can be compared with the effect of narcotic analgesics. In addition, they provide analgesic, anti-inflammatory effects. The use of NSAIDs reaches a wide scale in the clinical setting and in everyday life. Today it is one of the most popular medical drugs.

A positive impact is noted with the following factors:

1. Diseases of the musculoskeletal system. With various sprains, bruises, arthrosis, these drugs are simply irreplaceable. NSAIDs are used for osteochondrosis, inflammatory arthropathy, arthritis. The drug has an anti-inflammatory effect in myositis, herniated discs.
2. Strong pains. The drugs are quite successfully used for biliary colic, gynecological ailments. They eliminate headaches, even migraines, kidney discomfort. NSAIDs are successfully used for patients in the postoperative period.
3. Heat. The antipyretic effect allows the use of drugs for ailments of a diverse nature, both for adults and children. Such medicines are effective even in fever.
4. thrombus formation. NSAIDs are antiplatelet agents. This allows them to be used in ischemia. They are a preventive measure 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 name the exact number. Having appeared on the market, NSAIDs quickly gained wide popularity. Drugs have replaced opioid analgesics. Because they, unlike the latter, did not provoke respiratory depression.

The classification of NSAIDs implies a division into two groups:

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

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

1. Salicylates. This group of NSAIDs contains drugs: Aspirin, Diflunisal, Lysine monoacetylsalicylate.
2. Pyrazolidins. Representatives of this category are drugs: Phenylbutazone, Azapropazone, Oxyphenbutazone.
3. 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.
4. Derivatives of phenylacetic acid. This group of NSAIDs contains funds: Diclofenac, Tolmetin, Indomethacin, Etodolac, Sulindac, Aceclofenac.
5. Anthranilic acid preparations. The main representative is the medicine "Mefenaminat".
6. Propionic acid agents. This category contains many excellent NSAIDs. List of drugs: Ibuprofen, Ketoprofen, Benoxaprofen, Fenbufen, Fenoprofen, Thiaprofenic acid, Naproxen, Flurbiprofen, Pirprofen, Nabumeton.
7. Derivatives of isonicotinic acid. The main medicine "Amizon".
8. Pyrazolone preparations. The well-known remedy "Analgin" belongs to this category.

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

Side effects

NSAIDs of the new generation, the list of which is given above, have an effective effect on the body. However, they practically do not affect the functioning of the gastrointestinal tract. These drugs are distinguished by another positive point: NSAIDs of the new generation do not have a devastating effect on cartilage tissue.

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

The main side effects can be:

• dizziness;
• drowsiness;
• headache;
• fatigue;
• increased heart rate;
• increase in 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.

At the same time, damage to the gastric mucosa is not observed when taking new NSAIDs. The drugs do not cause an exacerbation of the ulcer with the occurrence of bleeding.

Phenylacetic acid preparations, salicylates, pyrazolidones, oxicams, alkanones, propionic acid and sulfonamide drugs have the best anti-inflammatory properties.

From joint pain most effectively relieve medications "Indomethacin", "Diclofenac", "Ketoprofen", "Flurbiprofen". These are the best NSAIDs for osteochondrosis. The above drugs, with the exception of the drug "Ketoprofen", have a pronounced anti-inflammatory effect. This category includes the tool "Piroxicam".

Effective analgesics are Ketorolac, Ketoprofen, Indomethacin, Diclofenac.

Movalis has become the leader among the latest generation of NSAIDs. This tool is allowed to be used for a long period. Anti-inflammatory analogues of an effective drug are the drugs Movasin, Mirloks, Lem, Artrozan, Melox, Melbek, Mesipol and Amelotex.

The drug "Movalis"

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

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

However, you should know that there are 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, child feeding;
• severe heart failure.

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

Adult patients diagnosed with osteoarthritis are recommended to use 7.5 mg per day. If necessary, this dose can be increased by 2 times.

With rheumatoid arthritis and ankylosing spondylitis, the daily norm is 15 mg.

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

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

The opinion of consumers about the drug

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

In addition, the medicine perfectly relieves various pains - toothache, headache. Patients pay particular attention to the impressive list of side effects. While taking NSAIDs, the treatment, despite the warning of the manufacturer, 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, effectively relieves the inflammatory process. No adverse effects on the digestive system have been identified.

The indications for use given in the instructions are:

This drug has a number of contraindications. In addition, the medicine is not intended for children under 18 years of age. Particular caution must be observed in people who are 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

Quite conflicting reviews about this medicine. 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 a cardiotoxic effect, which is quite unfavorable for the heart.

The drug "Nimesulide"

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

The remedy is used for:

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

In this case, the drug 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 in 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. With extreme caution should take the drug "Nimesulide" people who have arterial hypertension, impaired functioning of the kidneys, vision or heart.

The average price of a medicine is 76.9 rubles.

A variety of anti-inflammatory drugs are prescribed to relieve inflammation in the lesions. Medicines of this purpose are especially important for diseases that are characterized by a chronic progressive inflammatory process, which can lead to disability.

Types of anti-inflammatory drugs

Anti-inflammatory drugs are one of the main components of treatment:

• rheumatoid arthritis;
• osteoarthritis;
• osteochondrosis;
• gout;
• rheumatism;
• hernia of the spine;
• neuralgia;
• renal and biliary colic;
• myositis;
• injuries and sprains;
• some cardiac, gynecological diseases.

Prohibited or limited anti-inflammatory drugs for:

• peptic ulcer;
• blood clotting disorders;
• pregnancy and lactation;
• allergies to these drugs;
• some kidney diseases;
• cardiovascular diseases;
• varicose disease;
• autoimmune pathology.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs for treatment are used in complex therapy for inflammation in bone, muscle and joint tissue. The peculiarity of these drugs is their non-specificity - they relieve the inflammatory process of any genesis in any localization. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs in the world because they also act as pain relievers.

The first NSAID in the history of pharmaceuticals was aspirin, which was obtained from willow bark in the 18th century. Based on salicylic acid, other, more modern drugs are also produced with a similar effect and, unfortunately, with similar side effects - a negative effect on the health of the stomach and duodenum, liver and circulatory system. To reduce the likelihood of negative consequences after taking non-steroidal anti-inflammatory drugs of this type, doctors do not recommend exceeding the permitted dosage.

NSAIDs of a new type based on other components have a more pronounced anti-inflammatory effect and prolonged action, but at the same time they cause various complications much less often even with long-term use. Such drugs include Meloxicam, Piroxicam (derivatives of oxicam), Nabumeton, Diclofenac (derivatives of phenylacetic acid), Ibuprofen, Ketotifen (derivatives of propionic acid) and some others.

Steroid anti-inflammatory drugs

Medicines included in the group of hormonal anti-inflammatory drugs are more potent than non-steroidal ones. These funds are produced on the basis of the adrenal hormone - cortisol. The mechanism of action of steroid drugs is the local suppression of the immune system. There are more side effects and contraindications for this group of drugs than for NSAIDs, and they are prescribed for:

• severe allergic reaction on the skin;
• rheumatoid arthritis;
• inflammation of the vessels;
• hepatitis;
• myositis;
• shock states.

Steroidal anti-inflammatory drugs are contraindicated in:

• pregnancy and breastfeeding;
• the presence of a bacterial or viral infection;
• the likelihood of bleeding;
• immunodeficiency;
• significant erosion of the joints;
• taking blood-thinning medications;
• already made three injections of steroid drugs.

Combined anti-inflammatory drugs

Combined anti-inflammatory drugs are drugs that combine several components, thereby significantly enhancing the therapeutic effect of these drugs. The most commonly used anti-inflammatory component of combined preparations is diclofenac, and it is combined with vitamins, paracetamol, lidocaine and other active substances.

Anti-inflammatory drugs - list

Only a doctor is able to correctly select anti-inflammatory drugs in each individual case. Non-steroidal anti-inflammatory drugs block the body's enzymes responsible for the production of prostaglandins, substances that cause pain and inflammation. It is impossible to use different drugs of this group to enhance the action - this will cause an increase in side effects. The use of steroidal anti-inflammatory drugs without a doctor's prescription can provoke hypertension, blood clotting disorders, masculinization of the body in women, and osteoporosis.

Anti-inflammatory pills

Painkillers and anti-inflammatory pills are the most purchased medicines. This form is convenient for use, so the most popular drugs are almost always available in the form of tablets:

• - is prescribed for severe pain in the muscles, joints, spine;
• Celecoxib - effective for arthrosis, osteochondrosis;
• - indicated for arthritis, osteoarthritis, spondyloarthritis;
• Ibuprofen - is prescribed for an average pain syndrome with back pain, inflammation of the periosteum, fever.

Anti-inflammatory injections

Preparations in the form of injections have their analgesic and anti-inflammatory effect much faster than tablets. In addition, the injection can be made in close proximity to the focus of inflammation, which will significantly speed up the flow of the drug into the inflamed tissues. Anti-inflammatory drugs for joints, muscles, bone tissue are most in demand:

• Xefocam, Movalis - effective for arthrosis, are also available in the form of tablets;
• Diclofenac - recommended for osteochondrosis, radiculitis, lumbago, inflammation of bone tissue, are also available in the form of tablets;
• Nurofen, Ketonal - effective for various inflammations, have few contraindications and side effects;
• Hydrocortisone, Kenalog, - steroid drugs, used as an emergency aid for severe inflammation and serious pain syndrome (replace opiates), are injected directly into the inflamed focus.

Anti-inflammatory suppositories

An infection that has penetrated the female reproductive organs and caused thrush, inflammation of the cervix or fibroma requires the use of anti-inflammatory vaginal suppositories, since the health of a woman and her offspring depends on the timeliness and quality of treatment. Rectal anti-inflammatory suppositories are used if necessary to cure the focus of inflammation in the rectum and organs located nearby. In addition, treatment with suppositories reduces the risk of side effects. List of anti-inflammatory suppositories:

• , Diclofenac, Ibuprofen, Paracetamol, Movalis, Voltaren, Flamax - used to relieve inflammation in the rectum or vagina, as well as cystitis, neuralgia, neuritis and when it is impossible to use anti-inflammatory drugs in other forms;
• Longidaza - vaginal suppositories are used in the treatment of inflammation of the pelvic organs;
• Fluomizin, Terzhinan - used for the treatment of endometritis, adnexitis;
• Ultraproct, Proctosedil - a steroid drug used for hemorrhoids, fissures, paraproctitis;
• - immunomodulatory and anti-inflammatory suppositories, used for inflammation of the rectum and after surgery to accelerate healing.

Anti-inflammatory ointments

Ointment is an effective form of preparation for external use, in some cases ointments are used for insertion into the vagina or rectum. Commonly used components of non-steroidal anti-inflammatory ointments are diclofenac, ibuprofen, ketoprofen. Anti-inflammatory ointments:

• Ortofen, Nurofen, Ketonal, Meloxicam - non-steroidal drugs for the treatment of inflammation externally, bypassing the gastrointestinal tract.
• Sinalar, Momat, Akriderm - steroidal anti-inflammatory ointments, are prescribed by doctors in cases where local immunity suppression is necessary - for skin diseases, shock states, hepatitis, allergies, pathologies of muscles, joints, vascular disorders.

Anti-inflammatory cream

The list of non-steroidal anti-inflammatory drugs in the form of a cream includes the names of many drugs that are available in the form of ointments. The cream is a more convenient form for external application, and the active substances are the same for all anti-inflammatory drugs. Names of anti-inflammatory creams:

• Ketoprofen, Artrosilene, Indovazin, Diclovit - non-steroidal creams used to treat skin diseases, joints;
• Momat, Akriderm - steroid drugs used to treat allergies, arthritis.

Anti-inflammatory gels

Gel - another form of preparations for external use, it is easily absorbed and does not leave a greasy film. List of anti-inflammatory drugs in the form of a gel:

• Sinalar, Bematetasone - steroid drugs for the treatment of skin diseases, allergies, accompanied by itching;
• Diclak-gel, Voltaren, Fastum-gel, Finalgel, Indovazin - are used to treat pain and inflammation in muscles and joints.

Eye anti-inflammatory drops

Eye anti-inflammatory drops are used to treat ophthalmic diseases. These anti-inflammatory drugs are produced both with and without steroids. Many eye drops can be purchased only after obtaining a prescription from a doctor, since only a qualified specialist can take into account all individual indications and contraindications.

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

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

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

• painkillers;
• antipyretic;
• anti-inflammatory.

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

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

Excursion into history

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

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

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

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

How do NSAIDs work?

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

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

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

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

Serious disadvantage

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

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

Nonsteroidal anti-inflammatory drugs and fever

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

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

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

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

Classification of non-steroidal anti-inflammatory drugs

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

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

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

Salicylates

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

Propionic acid derivatives

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

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

Acetic acid derivatives

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

Selective COX-2 inhibitors

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

Other non-steroidal anti-inflammatory

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

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

When are NSAIDs used?

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

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

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

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

This amazing aspirin!

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

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

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

Cardiac risks of non-steroidal anti-inflammatory drugs

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

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

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

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

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

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

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

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

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

Say a word about citramone ...

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

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

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

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

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

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

NSAIDs and… sex

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

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

Other side effects of NSAIDs

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

Impaired kidney function

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

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

photosensitivity

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

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

Hypersensitivity reactions

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

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

Non-steroidal anti-inflammatory during pregnancy

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

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

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

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

NSAIDs: accept or refuse?

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

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

NSAIDs in faces

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

Acetylsalicylic acid

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

• to lower body temperature.

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

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

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

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

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

Ibuprofen

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

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

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

Naproxen

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

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

Ketoprofen

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

Indomethacin

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

Ketorolac

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

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

diclofenac

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

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

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

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

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

Celecoxib

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

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

Meloxicam

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

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

Nimesulide

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

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

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

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

Osteoarthritis, rheumatoid arthritis and other diseases of the joints and spine, occurring with pain and inflammation.

Peculiarities: all drugs in this group act on a similar principle and cause three main effects: analgesic, anti-inflammatory and antipyretic.

In different drugs, these effects are expressed to varying degrees, so some drugs are better suited for the long-term treatment of joint diseases, others are mainly used as painkillers and antipyretics.

The most common side effects: allergic reactions, nausea, abdominal pain, erosion and ulcers of the mucous membrane of the gastrointestinal tract.

Main contraindications: individual intolerance, exacerbation of peptic ulcer of the stomach and duodenum.

Important information for the patient:

Drugs that have a pronounced analgesic effect and a significant number of side effects (diclofenac, ketorolac, nimesulide and others) can only be used as directed by a doctor.

Among non-steroidal anti-inflammatory drugs, a group of so-called "selective" drugs is distinguished, which are less likely to have side effects from the gastrointestinal tract.

Even over-the-counter pain relievers cannot be used long-term. If they are required frequently, several times a week, it is necessary to be examined by a doctor and treated according to the recommendations of a rheumatologist or neurologist.

In some cases, long-term use of this group of drugs requires additional intake of proton pump inhibitors that protect the stomach.

Trade name of the drug	Price range (Russia, rub.)	Features of the drug, which is important for the patient to know
Active substance: diclofenac
Voltaren(Novartis)		A powerful pain reliever, mainly used for back and joint pain. It is undesirable to use for a long time, as the drug has numerous side effects. May adversely affect liver function, cause headache, dizziness and tinnitus. Contraindicated in "aspirin" asthma, disorders of hematopoiesis and blood coagulation processes. Do not use during pregnancy, breastfeeding and children under 6 years of age.
diclofenac(various manufacturers)
Naklofen(Krka)
Ortofen(various manufacturers)
Rapten Rapid(Stada)
Active substance: Indomethacin
Indomethacin(various manufacturers)	11,4-29,5	It has a powerful anti-inflammatory and analgesic effect. However, it is considered quite outdated, as it leads in the likelihood of developing a variety of side effects. It has many contraindications, including the III trimester of pregnancy, the age of up to 14 years.
Metindol retard(Polfa)	68-131,5
Active substance: diclofenac + paracetamol
Panoksen(Oxford Laboratories)	59-69	A powerful two-component pain reliever. It is used to reduce severe pain and inflammation in arthritis, osteoarthritis, osteochondrosis, lumbago, dental and other diseases. Side effects - like diclofenac. Contraindications are inflammatory bowel disease, severe hepatic, renal and heart failure, the period after coronary artery bypass grafting, progressive kidney disease, active liver disease, pregnancy, breastfeeding, childhood.
Active substance: Tenoxicam
Texamen(Mustafa Nevzat Ilach Sanai)	186-355	It has a powerful analgesic and anti-inflammatory effect, the antipyretic effect is less pronounced. A distinctive feature of the drug is a long duration of action: more than a day. Indications are radicular syndrome in osteochondrosis, osteoarthritis with inflammation in the joints, neuralgia, muscle pain. Has a number of side effects. Contraindicated in bleeding from the gastrointestinal tract, pregnancy and during breastfeeding.
Active substance: Ketoprofen
artrosilene(Dompe Pharmaceuticals)	154-331	A drug with a pronounced analgesic and anti-inflammatory effect. Does not adversely affect the condition of the articular cartilage. Indications for use are symptomatic therapy of various arthritis, osteoarthritis, gout, headache, neuralgia, sciatica, muscle pain, post-traumatic and postoperative pain, pain syndrome in oncological diseases, painful periods. It causes many side effects and has many contraindications, including the III trimester of pregnancy and breastfeeding. In children, age restrictions depend on the trade name of the drug.
Quickcaps(Medana pharma)	161-274
Ketonal (Lek. d.d.)	93-137
Ketonal duo(Lek. d. d.)	211,9-295
Oki (Dompe Pharmaceuticals)	170-319
Flamax(Sotex)	86,7-165,8
Flamax forte(Sotex)	105-156,28
Flexen(Italfarmaco)	97-397
Active substance: Dexketoprofen
Dexalgin(Berlin-Chemie/Menarini)	185-343	New powerful drug of short-term action. The analgesic effect occurs 30 minutes after taking the drug and lasts from 4 to 6 hours. Indications for use are acute and chronic inflammatory diseases of the musculoskeletal system (rheumatoid arthritis, spondylitis, arthrosis, osteochondrosis), pain during menstruation, toothache. Side effects and contraindications are similar to those of other drugs. In general, with short-term use according to indications and at recommended doses, it is well tolerated.
Active substance: Ibuprofen
Ibuprofen(various manufacturers)	5,5-15,9	It is most often used as an antipyretic drug and a remedy for relieving headaches. However, in large doses it can also be used for diseases of the spine, joints and to relieve pain after bruises and other injuries. Side effects from the gastrointestinal tract, hematopoietic organs, as well as headache, dizziness, insomnia, increased blood pressure and a number of other undesirable reactions are possible. It has many contraindications. Can not be used in the III trimester of pregnancy and while breastfeeding, in the I and II trimester it must be used with caution, only on the advice of a doctor. cha.
Burana (Orion Corporation)	46,3-98
Ibufen (Polfa, Medana pharma)	69-95,5
Moment (Berlin-Chemie/Menarini)	71,6-99,83
Nurofen(Reckitt Benckiser)	35,65-50
Nurofen Ultracap(Reckitt Benckiser)	116-122,56
Nurofen Express(Reckitt Benckiser)	102-124,4
Nurofen Express Neo(Reckitt Benckiser)	65-84
Faspik(Zambon)	80-115
Active substance: ibuprofen + paracetamol
Ibuklin(Dr. Reddy's)	78-234,5	Combined preparation containing two analgesic and antipyretic substances. It works more powerful than the same drugs taken separately. It can be used for pain in the joints and spine, injuries. However, it does not have a very pronounced anti-inflammatory effect, therefore, it is not recommended for long-term treatment in rheumatic diseases. It has many side effects and contraindications. Do not use in children under 12 years of age, as well as in the III trimester of pregnancy and while breastfeeding.
Brustan(Ranbaxi)	60-121
Next(Pharmstandard)	83-137
Active substance: Nimesulide
nise(Dr. Reddy's)	111-225	Selective analgesic drug, mainly used for back and joint pain. May also relieve period pain, headaches and toothaches. It has a selective effect, therefore it has less negative effect on the gastrointestinal tract. However, it has a number of contraindications and side effects. It is contraindicated during pregnancy and lactation; in children, age restrictions depend on the trade name of the drug.
Nimesulide(various manufacturers)	65-79
Aponil(Medochemi)	71-155,5
Nemulex(Sotex)	125-512,17
Nimesil(Berlin-Chemie/Menarini)	426,4-990
Nimika (IPKA)	52,88-179,2
Nimulid(Panacea Biotek)	195-332,5
Active substance: Naproxen
Nalgezin(Krka)	104-255	A powerful drug. It is used to treat arthritis, osteoarthritis, adnexitis, exacerbation of gout, neuralgia, sciatica, pain in the bones, tendons and muscles, headache and toothache, pain in cancer and after surgery. It has quite a few contraindications and can cause a variety of side effects, so long-term treatment is possible only under the supervision of a doctor.
Naproxen(Pharmstandard)	56,5-107
Naproxen-acry (Akrikhin)	97,5-115,5
Active substance: Naproxen + esomeprazole
Vimovo(AstraZeneca)	265-460	Combination preparation containing naproxen with analgesic and anti-inflammatory action and proton pump inhibitor esomeprazole. Developed in the form of tablets with sequential delivery of substances: the shell contains immediate-release magnesium esomeprazole, and the core contains sustained-release enteric-coated naproxen. As a result, esomeprazole is released in the stomach before naproxen dissolves, which protects the gastric mucosa from the possible negative effects of naproxen. Indicated for symptomatic relief in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis in patients at risk of developing gastric and duodenal ulcers. Despite good protective properties against the stomach, it can cause a number of other side effects. Contraindicated in severe liver, heart and kidney failure, gastrointestinal and other bleeding, cerebral hemorrhage and a number of other diseases and conditions. Not recommended in the III trimester of pregnancy, while breastfeeding and children under 18 years of age.
Active substance: Amtolmetin guacil
Nizilat(Dr. Reddy's)	310-533	A new non-steroidal anti-inflammatory drug with a minimal negative effect on the gastric mucosa. Despite a number of possible side effects, it was generally well tolerated by patients (including long-term use for 6 months). It can be used both for rheumatic diseases (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout, etc.), and for the treatment of pain syndromes of other origin. It has a lot of contraindications. Not applicable during pregnancy, breastfeeding and under the age of 18 years.
Active substance: Ketorolac
Ketanov(Ranbaxi)	214-286,19	One of the most potent analgesics. Due to the large number of contraindications and side effects, it should be used occasionally and only in cases of very severe pain.
Ketorol(Dr. Reddy's)	12,78-64
Ketorolac(various manufacturers)	12,1-17
Active substance: Lornoxicam
Xefocam(Nycomedes)	110-139	It has a pronounced analgesic and anti-inflammatory effect. Indicated for short-term treatment of pain, including rheumatic diseases (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout, etc.). It has many side effects and contraindications.
Xefokam Rapid(Nycomedes)	192-376
Active substance: Aceclofenac
Aertal(Gideon Richter)	577-935	It has a good anti-inflammatory and analgesic effect. It contributes to a significant reduction in the severity of pain, morning stiffness, swelling of the joints, does not adversely affect cartilage tissue. It is used to reduce inflammation and pain in lumbago, toothache, rheumatoid arthritis, osteoarthritis and a number of other rheumatological diseases. Causes many side effects. Contraindications are similar to those of Panoxen. Do not use during pregnancy, lactation and in children under 18 years of age.
Active substance: Celecoxib
Celebrex(Pfizer, Searl)	365,4-529	One of the most selective (selectively acting) drugs of this group, which has a minimal negative effect on the gastrointestinal tract. Indications for use are symptomatic treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis, back pain, bone and muscle pain, postoperative, menstrual and other types of pain. May cause swelling, dizziness, cough, and a number of other side effects. It has many contraindications for use, including class II-IV heart failure, clinically significant coronary heart disease, peripheral arterial disease and severe cerebrovascular disease. Not applicable during pregnancy, breastfeeding and under the age of 18 years.
Active substance: Etoricoxib
Arcoxia(Merck Sharp & Dome)	317-576	Potent selective drug. The mechanism of action, side effects and contraindications is similar to celecoxib. Indications for use are osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and acute gouty arthritis.
Active substance: Meloxicam
Amelotex(Sotex)	52-117	A modern selective drug with a pronounced anti-inflammatory effect. Indications for use are pain and inflammatory syndrome in osteoarthritis, osteochondrosis, rheumatoid arthritis and ankylosing spondylitis. It is not usually used for antipyretic purposes and for the treatment of other types of pain. It can cause a variety of side effects, but the negative effect on the gastrointestinal tract is less than that of non-selective drugs in this group. It has many contraindications, including pregnancy, lactation and children under 12 years of age.
Artrozan(Pharmstandard)	87,7-98,7
Bi-xicam(Veropharm)	35-112
Meloxicam(various manufacturers)	9,5-12,3
Mirloks(Polfa)	47-104
Movalis(Boehringer Ingelheim)	418-709
Movasin(Synthesis)	73,1-165

Remember, self-medication is life-threatening, consult a doctor for advice on the use of any medications.