Non-steroidal anti-inflammatory drugs( NSAIDs, NSAIDs) are medicines that have analgesic( analgesic), antipyretic and anti-inflammatory effects.
The mechanism of their action is based on the blocking of certain enzymes( COX, cyclooxygenase), they are responsible for the production of prostaglandins - chemicals that contribute to inflammation, fever, pain.
The word "nonsteroidal", which is contained in the name of the group of drugs, emphasizes the fact that the drugs of this group are not synthetic analogues of steroid hormones - powerful hormonal anti-inflammatory drugs.
The most famous representatives of NSAIDs are aspirin, ibuprofen, diclofenac.
How does NSAID work?
If analgesics fight directly with pain, NSAIDs reduce both of the most unpleasant symptoms of the disease: both pain and inflammation. Most of the drugs in this group are nonselective inhibitors of the cyclooxygenase enzyme, suppressing the effect of both of its isoforms( varieties) - COX-1 and COX-2.
Cyclooxygenase is responsible for the production of prostaglandins and thromboxane from arachidonic acid, which in turn is obtained from the phospholipids of the cell membrane by the enzyme phospholipase A2.Prostaglandins among other functions are mediators and regulators in the development of inflammation. This mechanism was opened by John Wayne, who subsequently received the Nobel Prize for his discovery.
When are these drugs prescribed?
As a rule, NSAIDs are used to treat acute or chronic inflammation accompanied by pain. Particularly popular non-steroidal anti-inflammatory drugs have been received for the treatment of joints.
We list the diseases in which prescribe these drugs :
- acute gout;
- dysmenorrhea( menstrual pain);
- bone pain caused by metastases;
- postoperative pain;
- fever( fever);
- intestinal obstruction;
- renal colic;
- moderate pain due to inflammation or trauma to soft tissue;
- osteochondrosis;
- back pain;
- headache;
- is a migraine;
- arthrosis;
- rheumatoid arthritis;
- pain in Parkinson's disease.
NSAIDs are contraindicated in cases of erosive and ulcerative lesions of the gastrointestinal tract, especially at the stage of exacerbation, expressed violations of the liver and kidney function, cytopenia, individual intolerance, pregnancy. Patients with bronchial asthma should be administered with caution, as well as those who previously showed unwanted reactions when taking any other NSAIDs.
List of common NSAIDs for joint treatment
We list the most known and effective NSAIDs that are used for the treatment of joints and other diseases of when anti-inflammatory and antipyretic action is required:
- Aspirin;
- Ibuprofen;
- Naproxen;
- Indomethacin;
- Diclofenac;
- Celecoxib;
- Ketoprofen;
- This is a todalac.
- Meloksikam.
Some medications are weaker, less aggressive, others are designed for acute arthrosis, when urgent intervention is required to stop dangerous processes in the body.
What is the benefit of the new generation of NSAIDs
Adverse reactions are noted with prolonged intake of NSAIDs( for example, in the treatment of osteochondrosis) and are the lesions of the mucous membrane of the stomach and duodenum in the with the formation of ulcers and bleeding .This drawback of indiscriminate NSAIDs has led to the development of new generation drugs that block only COX-2( an inflammation enzyme) and do not affect the work of COX-1( protection enzyme).
Thus, new generation drugs are virtually devoid of ulcerogenic side effects( mucous membrane damage to the digestive tract) associated with prolonged intake of nonselective NSAIDs, but increase the risk of thrombotic complications
Of the shortcomings of the new generation products, one can note only their high price, which makes it inaccessible to many people.
A new generation of NSAIDs: a list and prices of
What is it? Non-steroidal anti-inflammatory drugs of the new generation operate much more selectively, they more inhibit COX-2, while COX-1 remains almost intact .This explains the relatively high effectiveness of the drug, which is combined with a minimum number of side effects.
List of popular and effective non-steroidal anti-inflammatory drugs of the new generation:
- Movalis .It has antipyretic, well-marked analgesic and anti-inflammatory effect. The main advantage of this remedy is that with regular supervision of the doctor it can take a rather long period of time. It is produced by meloxicam in the form of a solution for intramuscular injections, in tablets, suppositories and ointments. Meloxicam( Movalis) tablets are very convenient because they are long-lasting, and it is enough to take one pill during the day. Movalis, which contains 20 tablets of 15 mg is 650-850 rubles.
- Xsefokam .A drug based on Lornoxicam. Its distinctive feature is the fact that it has a high ability to stop the pain syndrome. According to this parameter, it corresponds to morphine, but it is not addictive and does not have an opiate-like effect on the central nervous system. Xefokam, which contains 30 tablets of 4 mg worth 350-450 rubles.
- Celecoxib .This drug greatly facilitates the patient's condition with osteochondrosis, arthrosis and other diseases, relieves pain syndrome and effectively fights inflammation. Side effect on the digestive system from the side of celecoxib is minimal or absent altogether. The price is 400-600 rubles.
- Nimesulide .With great success is used to treat vertebrogenic back pain, arthritis, etc. Removes inflammation, hyperemia, normalizes temperature. Using nimesulide quickly leads to less pain and better mobility. It is also used as an ointment for application to the problem site. Nimesulide, which contains 20 tablets of 100 mg is 120-160 rubles.
Therefore, in cases where long-term use of non-steroidal anti-inflammatory drugs is not required, older medications are used. However, in some cases this is just a compulsory situation, since few people can afford to take this medication course.
Classification of
How is NSAID classified, and what is it? According to chemical origin, these drugs are with acidic and non-acidic derivatives.
Acidic NSAIDs :
- Oksikamy - piroxicam, meloxicam;
- NSAIDs based on indoacetic acid - indomethacin, etodolac, sulindac;
- Based on propionic acid - ketoprofen, ibuprofen;
- Salicyiplates( based on salicylic acid) - aspirin, diflunizal;
- Derivatives of phenylacetic acid - diclofenac, aceclofenac;
- Pyrazolidines( pyrazolonic acid) - analgin, metamizole sodium, phenylbutazone.
Non-acidic NSAIDs :
- Alkanones;
- Derivatives of sulfonamide.
Also non-steroidal preparations differ in the form and intensity of the effect - analgesic, anti-inflammatory, combined.
Average Dose Effectiveness
By the strength of , the anti-inflammatory effects of of the average doses of NSAIDs can be located in the following sequence( at the top are the strongest):
- Indomethacin;
- Flurbiprofen;
- Diclofenac sodium;
- Piroxicam;
- Ketoprofen;
- Naproxen;
- Ibuprofen;
- Amidopyrine;
- Aspirin.
For the analgesic effect of , the average doses of NSAIDs can be arranged in the following sequence:
- Ketorolac;
- Ketoprofen;
- Diclofenac sodium;
- Indomethacin;
- Flurbiprofen;
- Amidopyrine;
- Piroxicam;
- Naproxen;
- Ibuprofen;
- Aspirin.
As a rule, the above medicines are used for acute and chronic diseases, accompanied by pain and inflammation. Most often, non-steroidal anti-inflammatory drugs are prescribed for pain relief and arthritis treatment: arthritis, arthrosis, injuries, etc.
Not seldom NSAIDs are used for pain relief for headaches and migraines, dysmenorrhea, postoperative pain, renal colic, etc. Due to the inhibitory effect on the synthesis of prostaglandins, these drugs also have antipyretic effect.
What dosage should I choose?
Any new drug for a given patient should be prescribed first in the smallest dose. With good tolerability after 2-3 days, the daily dose is increased.
Therapeutic doses of NSAIDs are in a wide range, and in recent years there has been a trend towards an increase in single and daily doses of drugs with the best tolerability( naproxen, ibuprofen), while maintaining limits on the maximum doses of aspirin, indomethacin, phenylbutazone, piroxicam. In some patients, the therapeutic effect is achieved only by using very high doses of NSAIDs.
Side effects of
Prolonged use of anti-inflammatory drugs in high doses can cause:
- Nervous system disruption - mood change, disorientation, dizziness, apathy, tinnitus, headache, blurred vision;
- Heart and Vessel Changes - palpitations, increased blood pressure, swelling.
- Gastritis, ulcer, perforation, gastrointestinal bleeding , dyspeptic disorders, changes in liver function with increased activity of hepatic enzymes;
- Allergic reactions - angio edema, erythema, urticaria, bulezny dermatitis, bronchial asthma, anaphylactic shock;
- Renal insufficiency , impaired urination.
Treatment of NSAIDs should be performed within the minimum time allowed and at the lowest effective doses.
Usage during pregnancy
It is not recommended to use NSAIDs during pregnancy, especially in the third trimester. Although no direct teratogenic effects have been identified, it is believed that NSAIDs can cause premature closure of the arterial( Botallova) duct and kidney complications in the fetus. There is also information about premature birth. Despite this, aspirin in combination with heparin is successfully used in pregnant women with antiphospholipid syndrome.
According to recent data from Canadian researchers, the use of NSAIDs at up to 20 weeks of pregnancy was associated with an increased risk of miscarriage( miscarriage) [6].According to the results of the study, the risk of miscarriage increased 2.4 times, regardless of the dose of the drug taken.
Movalis
The leader among non-steroidal anti-inflammatory drugs can be called Movalis, which has an extended period of action and is allowed for prolonged use.
Has a pronounced anti-inflammatory effect, which allows taking it with osteoarthritis, ankylosing spondylitis, rheumatoid arthritis. It is not deprived of analgesic, antipyretic properties, it protects cartilaginous tissue. It is used for toothache, headache.
Determination of dosage, method of taking( tablets, injections, suppositories) depends on the severity, type of the disease.
Celecoxib
A specific inhibitor of COX-2, which has a pronounced anti-inflammatory and analgesic effect. When used in therapeutic doses, there is practically no adverse effect on the mucosa of the gastrointestinal tract, since COG-1 has a very low affinity, therefore, there is no violation of the synthesis of constitutional prostaglandins.
As a rule, celecoxib is taken at a dosage of 100-200 mg per day in 1-2 divided doses. The maximum daily dose is 400 mg.
Indomethacin
Refers to the most effective non-hormonal agents. In arthritis, indomethacin relieves pain, reduces puffiness in the joints and has a strong anti-inflammatory effect.
The price of the drug, regardless of the form of release( tablets, ointments, gels, rectal suppositories) is quite low, the maximum cost of tablets is 50 rubles per package. When using the drug, you need to be careful, as it has a considerable list of side effects.
In pharmacology, indomethacin is available under the names of Indovazin, Indovis EU, Metindol, Indotard, Indocollir.
Ibuprofen
Ibuprofen combines relative safety and the ability to effectively reduce temperature and pain, so preparations based on it are sold without a prescription. As an antipyretic agent ibuprofen is used, including for newborns. It is proved that it lowers the temperature better than other non-steroidal anti-inflammatory drugs.
In addition, ibuprofen is one of the most popular non-prescription analgesics. As an anti-inflammatory drug, it is not prescribed as often, nevertheless the drug is quite popular in rheumatology: it is used to treat rheumatoid arthritis, osteoarthritis and other joint diseases.
The most popular trade names for ibuprofen are Ibuprom, Nurofen, MIG 200 and MIG-400.
Diclofenac
Perhaps one of the most popular NSAIDs created back in the 60s. Form release - tablets, capsules, solution for injection, suppositories, gel. In this agent for the treatment of joints, both the high pain resistance and high anti-inflammatory properties are well combined.
Available under the names of Voltaren, Naklofen, Orthofen, Diklak, Diklonak P, Wurdon, Olfen, Doleks, Diclobert, Clodifen and others.
Ketoprofen
In addition to the above drugs, a group of drugs of the first type, nonselective NSAIDs, ie, COX-1, includes a remedy such as ketoprofen. Its strength is close to ibuprofen, and is available in the form of tablets, gel, aerosol, cream, solutions for external use and for injections, rectal suppositories( suppositories).
Buy this product can be under the trade names Artrum, Febrofid, Ketonal, OKI, Arthrosilen, Fastum, Bystrum, Flamax, Fleksen and others.
Aspirin
Acetylsalicylic acid reduces the ability to glue blood cells together and form clots. With Aspirin, the blood thinens, and the vessels dilate, which leads to relief of the condition of a person with headache and intracranial pressure. The action of the drug reduces the energy supply in the focus of inflammation and leads to the attenuation of this process.4
Children under 15 years of age Aspirin is contraindicated, since there may be a complication in the form of extremely severe Reye syndrome, in which 80% of the sick die. The remaining 20% of surviving babies may be prone to epilepsy and mental retardation.
Alternative drugs: chondroprotectors
Quite often, chondroprotectors are prescribed for the treatment of joints. People often do not understand the difference between NSAIDs and chondroprotectors. NSAIDs quickly relieve pain, but they have a lot of side effects. And chondroprotectors protect the cartilaginous tissue, but they need to be taken by courses.
The composition of the most effective chondroprotectors includes 2 substances - glucosamine and chondroitin.