Candles voltaren or indomethacin which is better. Non-steroidal anti-inflammatory drugs of systemic action. Contraindications and side effects

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

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

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

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

However, one should be frank - the glory of the "gold standard" among NSAIDs was won not by the abstract diclofenac, but by the original drug created by the Swiss company Ciba-Gaigi. This drug, currently manufactured by Novartis, is still widely used throughout the world, and it was used in most of the known clinical studies of NSAIDs involving the appointment of diclofenac as a reference drug.

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

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

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

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

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

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

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

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

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

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

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

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

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

Aceclofenac has been used in clinical practice since the late 1980s, and according to 2004 data, more than 75 million people in the world were treated with it. There are currently 18 different aceclofenac preparations on the pharmacological market: Aceclofar (AE); Aceflan (BR); Air Tal (BE); Airtal (CL, ES, PT); Airtal Difucrem (ES); Aital (NL); Barcan (DK, FI, NO, SE); Beofenac (AT, DE); Berlofen (AR); Biofenac (BE, GR, NL, PT); Bristaflam (AR, CL, MX); Falcol (ES); Gerbin (ES); Locomin (CH); Preservex (GB); Proflam (BR); Sanein (ES); Sovipan (GR). In Russia, aceclofenac has been registered since 1996 and is used under the brand name "Aertal".

The evidence base for the efficacy and safety of aceclofenac is well presented in Dolley M. (2001). This work is probably the largest meta-analysis evaluating the results of 13 RCTs with active control (n = 3574), as well as observational, cohort and non-randomized studies (total 142746 patients). Aceclofenac has been shown to be effective in reducing pain in rheumatic and non-rheumatic diseases, improving function and activity in osteoarthritis and dorsopathy, and influencing the number of inflamed joints and morning stiffness in rheumatoid arthritis and ankylosing spondylitis. At the same time, the therapeutic effect of this drug is not less, and in some situations somewhat higher, compared with diclofenac, ketoprofen, ibuprofen and naproxen.

The largest number of well-designed studies on the efficacy and safety of aceclofenac is associated with the treatment of OA. In this disease, aceclofenac successfully compared with paracetamol, piroxicam, naproxen and diclofenac (Table).

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

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

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

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

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

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

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

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

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

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

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

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

Currently, we have little data to assess the risk of developing cardiovascular complications that occur while taking aceclofenac. Perhaps the only major analysis on this issue is a large-scale case-control study conducted by Finnish scientists Helin-Salmivaara A. et al. (2006). The authors assessed the relative risk of myocardial infarction with the use of various n-NSAIDs, using data on 33309 episodes of this dangerous complication (138949 controls). Aceclofenac was associated with a lower risk of myocardial infarction - RR 1.23 (0.97-1.62) than indomethacin - 1.56 (1.21-2.03), ibuprofen - 1.41 (1.28-1.62). 1.55) and diclofenac - 1.35 (1.18-1.54).

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

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

On the other hand, at the moment the author does not have clear data on reducing the risk of dangerous gastrointestinal complications (such as bleeding, perforation and ulcers) while taking aceclofenac; neither does SAMM's large observational study. Unfortunately, there is no information on large comparative endoscopic studies of aceclofenac to determine the risk of developing the most important "surrogate marker" of gastrointestinal complications - endoscopic ulcers.

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

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

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

Unfortunately, in Russia there are only a few studies (for example, the work of Grishaeva T.P. and Balabanova R.M.) devoted to their own Russian experience in the use of aceclofenac. In our opinion, this drug undoubtedly deserves closer attention from Russian studies, as well as large-scale research of our own, which would make it possible to more accurately determine the advantages of using aceclofenac in Russian patients.

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

For literature inquiries, please contact the editor.

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

A lot of pathological changes occurring in the body accompany the pain syndrome. To combat such symptoms, NSAIDs, or remedies, 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 it 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 various 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. 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:

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.
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.
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.
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:

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

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

Salicylates. This group of NSAIDs contains drugs: Aspirin, Diflunisal, Lysine monoacetylsalicylate.
Pyrazolidins. Representatives of this category are drugs: Phenylbutazone, Azapropazone, Oxyphenbutazone.
Oxycams. These are the most innovative NSAIDs of the new generation. List of drugs: Piroxicam, Meloxicam, Lornoxicam, Tenoxicam. Medicines are not cheap, but their effect on the body lasts much longer than other NSAIDs.
Derivatives of phenylacetic acid. This group of NSAIDs contains funds: Diclofenac, Tolmetin, Indomethacin, Etodolac, Sulindac, Aceclofenac.
Anthranilic acid preparations. The main representative is the medicine "Mefenaminat".
Propionic acid agents. This category contains many excellent NSAIDs. List of drugs: Ibuprofen, Ketoprofen, Benoxaprofen, Fenbufen, Fenoprofen, Thiaprofenic acid, Naproxen, Flurbiprofen, Pirprofen, Nabumeton.
Derivatives of isonicotinic acid. The main medicine "Amizon".
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 apply 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:

osteoarthritis;
rheumatoid arthritis;
ankylosing spondylitis.

This drug has a number of contraindications. In addition, the medicine is not intended for children under 18 years of age. Particular caution 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.

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

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

How do NSAIDs work?

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

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

When are these drugs prescribed?

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

We list the diseases for which these drugs are prescribed:

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

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

List of Common NSAIDs for Joint Treatment

We list the most well-known and effective NSAIDs that are used to treat joints and other diseases when an anti-inflammatory and antipyretic effect is needed:

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

What is the advantage of new generation NSAIDs

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

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

Of the shortcomings of new generation drugs, only their high price can be noted, which makes it inaccessible to many people.

New generation NSAIDs: list and prices

What it is? New generation non-steroidal anti-inflammatory drugs act much more selectively, they inhibit COX-2 to a greater extent, while COX-1 remains practically untouched. This explains the rather high efficiency 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 an antipyretic, well-marked analgesic and anti-inflammatory effect. The main advantage of this remedy is that, with regular medical supervision, it can be taken for a fairly long period of time. Meloxicam is available as a solution for intramuscular injection, in tablets, suppositories and ointments. Meloxicam (Movalis) tablets are very convenient in that they are long-acting, and it is enough to take one tablet during the day. Movalis, which contains 20 tablets of 15 mg, costs a rub.
Ksefokam. A drug based on Lornoxicam. Its distinguishing feature is the fact that it has a high ability to relieve pain. 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. Ksefokam, which contains 30 tablets of 4 mg, costs a rub.
Celecoxib. This drug greatly alleviates the patient's condition with osteochondrosis, arthrosis and other diseases, relieves pain well and effectively fights inflammation. Side effects on the digestive system from celecoxib are minimal or absent at all. Price, rub.
Nimesulide. It has been used with great success in the treatment of vertebrogenic back pain, arthritis, etc. Removes inflammation, hyperemia, normalizes temperature. The use of nimesulide quickly leads to a reduction in pain and improved mobility. It is also used as an ointment for application to the problem area. Nimesulide, which contains 20 tablets of 100 mg, costs a rub.

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

Classification

How are NSAIDs classified and what are they? By chemical origin, these drugs come with acidic and non-acidic derivatives.

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

Effectiveness of medium doses

According to the strength of the anti-inflammatory effect of medium doses, NSAIDs can be arranged in the following sequence (the strongest ones are at the top):

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

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 to relieve pain and treat joints: arthritis, arthrosis, injuries, etc.

Not infrequently, 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 an antipyretic effect.

What dosage to choose?

Any new drug for this patient should be prescribed first at the lowest dose. With good tolerance 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 tendency to increase single and daily doses of drugs characterized by the best tolerance (naproxen, ibuprofen), while maintaining restrictions on the maximum doses of aspirin, indomethacin, phenylbutazone, piroxicam. In some patients, the therapeutic effect is achieved only when using very high doses of NSAIDs.

Side effects

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

Violation of the nervous system - mood changes, disorientation, dizziness, apathy, tinnitus, headache, blurred vision;
Changes in the work of the heart and blood vessels - palpitations, increased blood pressure, swelling.
Gastritis, ulcer, perforation, gastrointestinal bleeding, dyspeptic disorders, changes in liver function with an increase in liver enzymes;
Allergic reactions - angioedema, erythema, urticaria, bullous dermatitis, bronchial asthma, anaphylactic shock;
Renal failure, impaired urination.

Treatment with NSAIDs should be carried out for the shortest possible time and at the lowest effective doses.

Use during pregnancy

It is not recommended to use drugs of the NSAID group 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 ductus arteriosus (Botalla) and renal complications in the fetus. There are also reports of premature births. Despite this, aspirin in combination with heparin has been successfully used in pregnant women with antiphospholipid syndrome.

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

Movalis

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

It has a pronounced anti-inflammatory effect, which allows it to be taken in osteoarthritis, ankylosing spondylitis, rheumatoid arthritis. It is not devoid of analgesic, antipyretic properties, protects cartilage tissue. It is used for toothache, headache.

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

Celecoxib

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

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

Indomethacin

Refers to the most effective means of non-hormonal action. In arthritis, indomethacin relieves pain, reduces swelling of the joints and has a strong anti-inflammatory effect.

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 agent, 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.

diclofenac

Perhaps one of the most popular NSAIDs, created back in the 60s. Release form - tablets, capsules, injection, suppositories, gel. In this remedy for the treatment of joints, both high analgesic activity and high anti-inflammatory properties are well combined.

Produced under the names Voltaren, Naklofen, Ortofen, Diklak, Diklonak P, Wurdon, Olfen, Dolex, Dicloberl, Klodifen and others.

Ketoprofen

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

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

Aspirin

Acetylsalicylic acid reduces the ability of blood cells to stick together and form blood clots. When taking Aspirin, the blood thins, and the vessels expand, which leads to relief of a person's condition with headaches 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

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

Alternative drugs: chondroprotectors

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

The composition of the most effective chondroprotectors includes 2 substances - glucosamine and chondroitin.

Which is better ibuprofen or indomethacin?

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

Impact on the body

Ibuprofen and Indomethacin are used for such disorders:

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

Mode of application

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

The maximum daily dose of Indomethacin for an adult is not more than 200 mg. Ibuprofen is taken at a dosage of 200 to 800 mg per day, depending on the severity of the symptoms.

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

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

Another difference in cost, Indomethacin costs a little more than Ibuprofen. However, this difference is very small.

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

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

Paracetamol is a drug that also belongs to the group of painkillers. It has an antipyretic and anti-inflammatory effect, like Ibuprofen with Indomethacin.

Which remedy is more effective?

It is impossible to unequivocally answer which is better Ibuprofen or Indomethacin. These medicines are equally good at coping with pain. Since they belong to the same group, they have a similar mechanism of action.

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

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which is better indomethacin or ibuprofen

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

Calls to the studio:

>then what is the difference between them? ?

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

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

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

> smeared my knees, it helped.

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

Diclofenac, indomethacin, piroxicam, ibuprofen

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

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

Fortunately, there is no need to take separate pills for pain and inflammation. These effects are combined in "one bottle" - in the so-called NSAIDs (non-steroidal anti-inflammatory drugs). You have already read the names of the most popular of them. All of them are derived from acetylsalicylic acid, or aspirin. This drug, which appeared at the very end of the 19th century, replaced salicylic acid, which helped with joint diseases, but caused stomach ulcers and bleeding. And now aspirin is practically not used for these purposes either - safer drugs have appeared.

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

Unfortunately, in Russia it is impossible to accurately collect such statistics, - says Natalya Chichasova, Professor of the Department of Rheumatology at the Moscow Medical Academy. THEM. Sechenov. - But the data of American colleagues seem real to us.

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

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

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

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

In Russia, unlike Western countries, old NSAIDs remain the main means for the treatment of joint diseases, says Natalia Chichasova. - This can be explained by various reasons, including the behavior of doctors. When they receive little money, they tend to project their problems onto their patients. As a result, doctors often do not tell patients that there are more expensive and safer treatments.

Non-steroidal anti-inflammatory drugs

Before you start taking medication, consult your doctor. Using medicines without a doctor's advice can harm your body. Do not self-medicate

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

Before you start using any drug, carefully read the instructions for it and act according to the recommendations. The simultaneous use of two or three types of NSAIDs is strongly discouraged. The risk of side effects increases, and the effectiveness of the drugs does not increase.
The use of most drugs of the NSAID group affects the organs of the gastrointestinal tract, liver, kidneys and the cardiovascular system. Long-term use of such drugs can adversely affect the work of these organs, lead to new diseases. In the presence of peptic ulcer of the stomach and duodenum, gastritis, colitis, as well as in the case of a cure earlier of these diseases, the use of anti-inflammatory drugs is unacceptable.

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

Do not use suppositories in case of hemorrhoids, cracks or polyps in the rectum.

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

List of funds:

There are 2 types of NSAIDs: inhibitors of COX-1 and COX-2 (cyclooxygenases of the first and second types). Type 1 inhibitors include: aspirin, diclofenac, ibuprofen, indomethacin, ketoprofen.

Aspirin or acetylsalicylic acid

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

The beginning of the treatment of osteoporosis usually begins with aspirin, but with the advent of new and more effective drugs, this drug loses in terms of its impact on the human body. In patients with a blood disorder, aspirin should be taken with caution, as the drug slows down the blood clotting process.

diclofenac

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

Diclofenac is available as tablets, ointments and injections. The most commonly used drugs are known as: Voltaren, Diklak, Diklonak P, Naklofen, Ortofen, Dolex, Vurdon, Olfen, Dicloberl, Clodifen and others.

Ibuprofen

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

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

Indomethacin

Indomethacin - refers to the most effective means of non-hormonal action. In arthritis, indomethacin relieves pain, reduces swelling of 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 must be careful, as it has a long list of side effects.

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

Ketoprofen

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

In a pharmacy, you can buy ketoprofen under the names Artrozilen, Fastum, OKI, Flamax, Bystrum, Artrum, Febrofid, Ketonal, Flexen.

COX-2 inhibitors

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

Patients with diseases of the cardiovascular system are advised to take drugs of this group with caution, since complications in this area of the body are possible. Regularly measure blood pressure, in case of increase - contact your doctor.

Meloxicam

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

Movalis

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

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

Celecoxib

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

Nimesulide

Nimesulide - like all drugs of the COX-2 group, is well tolerated by the body, has analgesic and anti-inflammatory effects. A distinctive feature of nimesulide is the inhibition of the action of substances that destroy cartilage and collagen fibers.

An indispensable drug in the treatment of arthrosis. The tool is known under the following names: Aulin, Nimegesik, Aktasulid, Nimika, Flolid, Aponin, Kokstral, Nimid, Prolid, Rimesid, Nise, Mesulid - tablets, granules, gels.

Etoricoxib

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

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

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

You should always remember about the side effects of any medication, carefully read the instructions and follow the rules and regimen for taking medications.

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

How do NSAIDs work?

When are these drugs prescribed?

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

We list the diseases for which these drugs are prescribed:

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

List of Common NSAIDs for Joint Treatment

We list the most well-known and effective NSAIDs that are used to treat joints and other diseases when an anti-inflammatory and antipyretic effect is needed:

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

What is the advantage of new generation NSAIDs

Of the shortcomings of new generation drugs, only their high price can be noted, which makes it inaccessible to many people.

New generation NSAIDs: list and prices

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

Movalis. It has an antipyretic, well-marked analgesic and anti-inflammatory effect. The main advantage of this remedy is that, with regular medical supervision, it can be taken for a fairly long period of time. Meloxicam is available as a solution for intramuscular injection, in tablets, suppositories and ointments. Meloxicam (Movalis) tablets are very convenient in that they are long-acting, and it is enough to take one tablet during the day. Movalis, which contains 20 tablets of 15 mg, costs a rub.
Ksefokam. A drug based on Lornoxicam. Its distinguishing feature is the fact that it has a high ability to relieve pain. 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. Ksefokam, which contains 30 tablets of 4 mg, costs a rub.
Celecoxib. This drug greatly alleviates the patient's condition with osteochondrosis, arthrosis and other diseases, relieves pain well and effectively fights inflammation. Side effects on the digestive system from celecoxib are minimal or absent at all. Price, rub.
Nimesulide. It has been used with great success in the treatment of vertebrogenic back pain, arthritis, etc. Removes inflammation, hyperemia, normalizes temperature. The use of nimesulide quickly leads to a reduction in pain and improved mobility. It is also used as an ointment for application to the problem area. Nimesulide, which contains 20 tablets of 100 mg, costs a rub.

Classification

How are NSAIDs classified and what are they? By chemical origin, these drugs come with acidic and non-acidic derivatives.

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

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

Effectiveness of medium doses

According to the strength of the anti-inflammatory effect of medium doses, NSAIDs can be arranged in the following sequence (the strongest ones are at the top):

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

What dosage to choose?

Any new drug for this patient should be prescribed first at the lowest dose. With good tolerance after 2-3 days, the daily dose is increased.

Side effects

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

Violation of the nervous system - mood changes, disorientation, dizziness, apathy, tinnitus, headache, blurred vision;
Changes in the work of the heart and blood vessels - palpitations, increased blood pressure, swelling.
Gastritis, ulcer, perforation, gastrointestinal bleeding, dyspeptic disorders, changes in liver function with an increase in liver enzymes;
Allergic reactions - angioedema, erythema, urticaria, bullous dermatitis, bronchial asthma, anaphylactic shock;
Renal failure, impaired urination.

Treatment with NSAIDs should be carried out for the shortest possible time and at the lowest effective doses.

Use during pregnancy

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

Movalis

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

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

Celecoxib

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

Indomethacin

Refers to the most effective means of non-hormonal action. In arthritis, indomethacin relieves pain, reduces swelling of the joints and has a strong anti-inflammatory effect.

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

Ibuprofen

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

diclofenac

Produced under the names Voltaren, Naklofen, Ortofen, Diklak, Diklonak P, Wurdon, Olfen, Dolex, Dicloberl, Klodifen and others.

Ketoprofen

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

Aspirin

Alternative drugs: chondroprotectors

The composition of the most effective chondroprotectors includes 2 substances - glucosamine and chondroitin.

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2 comments

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

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

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Safe analogues of Diclofenac - tablets, ointments, injection solutions

Despite the high therapeutic efficacy of Diclofenac, in some patients, taking it causes undesirable side effects. When choosing a replacement, the doctor must take into account the safety of medicines, the frequency of dosages used and the duration of the therapeutic course. Diclofenac analogues may be structural or similar in clinical action. Neuropathologists, rheumatologists, traumatologists prefer drugs from the group of non-steroidal anti-inflammatory drugs.

Characteristic features of non-steroidal anti-inflammatory drugs

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

decrease in the severity of pain syndrome;
relief of the inflammatory process and swelling;
elimination of fever.

In medical practice, analogues of Diclofenac are distinguished by composition and therapeutic effect. Such a classification is necessary for the quick selection of an NSAID replacement if it is intolerable or if an excessive number of side effects occur. Structural analogues of Diclofenac include Diclogen, Ortofen, Dicloberl, Voltaren, Diklak, Naklofen. They are of interest, first of all, to patients, since the cost of drugs can vary significantly. For example, the price of Ortofen ointment is rubles, and you will have to pay at least 200 rubles for a package of Voltaren gel.

Structural analogs of Diclofenac

Analogues of Diclofenac on the rendered action

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

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

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

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

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

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

Comparison of clinical effects of analogues

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

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

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

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

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

Even “neglected” joint problems can be cured at home! Just remember to rub it on once a day.

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

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

The most popular analogues from the NSAID group

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

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

In the United States, a randomized clinical trial was conducted in which 1309 patients, mostly women, took part. The average age of the volunteers was 64 years, and the duration of the chronic disease was about 9 years. One group of patients took Meloxicam, and the second group was treated with Diclofenac, Naproxen, Piroxicam, Ibuprofen. The results of the study showed that treatment with Meloxicam was successful in 66.8% of people, and the use of Diclofenac and analogues brought relief to only 45% of volunteers.

Meloxicam

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

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

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

Ibuprofen

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

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

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

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

Nimesulide

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

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

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

Overview of analogues from the NSAID group

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

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

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

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

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

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

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

How to forget about pain in the joints?

Joint pain limits your movement and life...
You are worried about discomfort, crunching and systematic pain ...
Perhaps you have tried a bunch of medicines, creams and ointments ...
But judging by the fact that you are reading these lines, they did not help you much ...

Want to get the same treatment, ask us how?

Diclofenac is harmful And what is better to take?

But diclofenac, unlike many other drugs, anesthetizing, does not lead to the destruction of the articular surfaces. Also good in this regard are piroxicam and meloxicam (Movalis), ibuprofen (but it is very weak).

In principle, this only matters with constant and long-term use. If a few days, and during meals, then it's okay.

And diclofenac can be used as a gel (topically) and as a suppository. don't eat it.

It's not good to make fun of other people's diseases, it's a sin. I don’t even want to say what it can result in.

Which is better Indomethacin or Diclofenac?

What is better Indomethacin or Diclofenac you can find out from your doctor or by studying the instructions for their use. However, having information about medicines will not be superfluous and may be needed at any time.

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

Compound

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

Diclofenac (diclofenac) contains diclofenac sodium, release form: tablets, ointments, gels, rectal suppositories, injection and eye drops.

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

Indications

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

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

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

Indications for the appointment of Diclofenac and Indomethacin as an adjuvant may be cystitis, prostatitis, adnexitis, colds and some ENT diseases.

Contraindications and unwanted effects

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

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

Numerous undesirable manifestations of Diclofenac and Indomethacin are almost identical and manifest themselves in a possible negative effect on the digestive, nervous, cardiovascular, urinary systems, as well as on the sense organs. Allergic reactions in the form of rashes on the skin and their redness are not excluded.

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

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

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

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

Meloxicam or Diclofenac or Indomethacin - which is better?

Injuries of the musculoskeletal system;

Pain syndrome of moderate severity;

Neuralgia of various localization;

Connective tissue diseases;

Infectious diseases of the internal organs.

Stomach ulcer;

Anemia conditions of various origins;

Childhood and adolescence;

Hypersensitivity to acetylsalicylic acid;

Popular analogues of the drug Diclofenac

Pain in the muscles and joints is not only an unpleasant symptom, but also a serious threat to human health. It is important to note such a manifestation of various diseases in time and begin treatment. Diclofenac, which belongs to the group of non-steroidal anti-inflammatory drugs, is considered one of the effective pain relievers. But for various reasons, the use of this drug may be prohibited, then it becomes necessary to use Diclofenac analogues.

Voltaren

The most popular analogue of Diclofenac is Voltaren. This analogue of Diclofenac, used in injections, gels, tablets, is so similar that some patients who have encountered these drugs perceive the names as synonyms. But still there is a slight difference in them, Voltaren is a medicine of a foreign manufacturer, due to the fact that it is somewhat better absorbed, it is taken to the rank of more effective drugs. And also Voltaren has another advantage, the effect obtained from it lasts longer, which in especially severe cases becomes simply a salvation for the patient.

With the use of this drug as a treatment, you must be extremely careful, because, like other tablets, Voltaren has a number of contraindications. If there is a need to replace Diclofenac, it is initially necessary to consult with your doctor and find out whether you can replace it with a foreign analogue or not. Despite all the factors, Diclofenac also has its own plus, this drug is much cheaper.

Meloxicam

Meloxicam is used as an analgesic, antipyretic and anti-inflammatory agent. They can be purchased at a pharmacy in the form of tablets of several types with different concentrations of the active substance. And also as analogues of the Diclofenac suppositories used, since also in this form, for more serious cases, a solution for injections is sold. As for the dosage of the drug, Meloxicam cannot be used independently without consulting the attending physician and his recommendations regarding the use of the drug. The dosage depends on the disease, the stage of its development and the pain that the patient feels.

Diseases in which Meloxicam is effective:

And also this medicine is used in a number of other diseases. Meloxicam is distinguished by its good absorption. A big plus of the drug is that even long-term use does not affect the level of concentration of the drug in the body.

As for contraindications, they are about the same as in the treatment of other non-steroidal anti-inflammatory drugs, among the most popular are:

intolerance to the active substance or one of the components of the drug;
problems with the digestive tract, in particular stomach or duodenal ulcers;
renal failure, which occurs in a chronic form;
pregnant women and those who are breastfeeding;
children under the age of 15.

Given a number of contraindications, the patient himself must understand the seriousness of replacing one drug with another, and before replacing it, he will need to undergo a series of examinations, if any. Usually Diclofenac analogues have similar contraindications, so you should not look for safer drugs on your own.

Although this drug can be called a substitute for Diclofenac tablets, its effect on the body will be significantly different from other drugs. Usually analogues of Diclofenac are almost completely identical, the mechanism of action of Nise is somewhat different, it can be called selective. This has its advantages, but also its disadvantages.

In terms of its effectiveness, Diclofenac is much stronger, its substitute in the form of Nise will also give its effect, but it is better to use it for pains of lesser intensity. It may seem to many that there is no point in using a less effective drug, especially if the price and frequency of taking the drug does not change. Non-steroidal anti-inflammatory drugs are different in that they have a huge number of side effects, especially for pills that affect the digestive system. For this reason, many patients have to balance between eliminating joint pain and not harming their body. Nise has similar properties as Diclofenac, but at the same time it has much fewer side effects, this becomes the main reason for the replacement.

Please note that Nise is contraindicated in children under 12 years of age. And also the drug has an effect on female fertility, so if a woman is going to become pregnant in the near future, then she should not take this drug. In this case, you should choose Diclofenac and consider its analogues as an option to replace the drug.

Movalis

If you are faced with the question of how to replace Diclofenac when long-term treatment is required, you should not look for a better option than Movalis. Diclofenac injections, due to a number of their contraindications and rather strong effects, are rarely used for long-term treatment of the disease, which cannot be said about this analogue of it. Movalis acts more gently, so it is often prescribed to those patients who do not easily need to relieve acute pain, but also carry out long-term treatment. The drug has a number of side effects, so before you notice Diclofenac in injections for Movalis, consult your doctor.

Dicloberl

This is another analogue of Diclofenac used in ampoules, but Dicloberl can also be purchased in the form of candles. As for the effect on the body, it is almost the same as the composition of the drugs. Dicloberl can be considered the most similar to Diclofenac, even for specialists it is difficult to draw a clear line of difference between these drugs. The main difference will be the manufacturer, Dicloberl is produced in Germany, which explains the high price of the medicine. Contraindications for use are the same, so it is worth resorting to replacement only in cases where it really makes sense.

Ketonal and Ortofen

Ketonal is a non-steroidal anti-inflammatory drug that is a derivative of propionic acid. Features of the drug are that it is used with a pronounced pain syndrome. Ketonal allows you to deal with pain in the joints and muscles faster and more efficiently, it does not have a negative effect on the articular cartilage itself. But if we consider it as a replacement for Diclofenac as an anti-inflammatory drug, this should be abandoned, in this case Ketonal is inferior. Similar analogues are most often used as an anesthetic, for example, Ketonal ointment helps with sprains.

Contraindications for use:

ulcers of the stomach and duodenum in the acute phase;
liver failure;
kidney failure;
heart failure;
problems with blood clotting;
children under 15;
pregnant women (especially the third trimester);
intake during breastfeeding;
sensitivity to one of the components of the drug.

The release form of Ortofen allows you to use it in ointments, tablets, you can buy ampoules for injection. With the help of Ortofen, pain and inflammation can be effectively eliminated; with prolonged use, it is better to refuse it. But, if there is a need to quickly and effectively cope with an attack of pain, this drug will become a temporary panacea. Tablets are absorbed fairly quickly and begin to act within the first half hour after taking the drug.

Such analogues of the drug Diclofenac have a huge number of side effects, in particular, people with diseases of the cardiovascular system should pay attention to this factor. This is often the reason why Ortofen should be discarded and not used as a substitute.

Indomethacin and Milgamma

Indomethacin is used not only as a medicine for diseases of the joints and muscles, it is used for colds. As for the treatment of diseases of the musculoskeletal system, it can be used for such diseases:

rheumatoid arthritis;
periarthritis;
osteochondrosis;
ankylosing spondylitis;
gout;
other diseases that are accompanied by an inflammatory process.

A large number of contraindications significantly narrows the range of application, because of its effect on the body, in most cases, doctors prescribe it in the form of gels rather than injections.

Milgamma, on the contrary, is prescribed more often in the form of injections. The peculiarity of this drug is that it contains B vitamins and it can act as a medicine for general strengthening. Please note that when mixing vitamin B1 and sulfate solutions, the vitamin completely decomposes. It is not recommended to use Milgamma for pregnant and lactating women, since studies have not been conducted on the effect of the drug on the development of the fetus and the likelihood of its penetration into breast milk. This medicine should not be taken as a treatment for children under 16 years of age.

A common option for prescribing Milgamma and Diclofenac as a complex treatment. Usually in such cases, Diclofenac is administered in the morning, and Milgamma at night. This approach allows you to treat the disease more effectively and speed up this process. In this case, the two drugs complement each other and it simply does not make sense to choose which one is better.

Despite the similar composition, similar effects and contraindications, you should not replace Diclofenac with other drugs on your own. There are many factors that influence which medicine will have a positive effect. The patient can learn about some of them only after passing a series of examinations, so it is not recommended to replace the medicine without consulting a doctor.

Which anti-inflammatory drug to prefer - Meloxicam or better Diclofenac or Indomethacin - which is better? Also, those who want to buy drugs will be interested in the indications for use and contraindications of these drugs. Therefore, especially for the readers of “Popular about Health”, I will consider the features of these drugs.

Pharmacological group

All three drugs belong to the same category - non-steroidal anti-inflammatory drugs, which are very widely used in medical practice.

The active ingredient in all medicines is different. In the preparation Meloxicam, the active substance is represented by the chemical compound of the same name. Release form: rectal suppositories, tablets, solution.

The drug Diclofenac contains the active substance in the form of diclofenac sodium. The drug is available in the form of an ointment, gel, drops for oral administration and a solution for parenteral administration.

The drug Indomethacin contains the active ingredient of the same name and is available in the following dosage forms: tablets, suppositories, gel and ointment for external use. All anti-inflammatory drugs are dispensed according to a doctor's prescription.

Pharmacological action

All three drugs have anti-inflammatory, analgesic and antipyretic effects. Despite the fact that the active substance in all drugs is different, their effect is aimed at suppressing the biochemical reactions of synthesizing inflammatory mediators, primarily prostaglandins.

The anti-inflammatory effect is also due to the stabilization of lysosome membranes, which blocks individual biochemical reactions, the purpose of which is to damage cells and various organs.

It is also necessary to mention the presence of an antiplatelet effect, which is based on the suppression of platelet adhesion reactions, which improves the rheological characteristics of the blood, and contributes to the normalization of tissue respiration reactions.

With a decrease in the concentration of prostaglandins in peripheral tissues, the main symptoms of inflammatory diseases are suppressed: pain during exercise or at rest, redness, swelling, and impaired function of one or another part of the body.

All drugs have a fairly pronounced analgesic effect. This action is based on both suppression of inflammatory changes in tissues and a decrease in the activity of the pain center, which contributes to an increase in the pain threshold.

Long-term use of most non-steroidal anti-inflammatory drugs helps to suppress the synthesis of prostaglandins in the gastric mucosa, which often leads to the development of ulcers and bleeding. In this regard, Meloxicam compares favorably with the other two drugs, since its use is rarely accompanied by intestinal damage.

Diclofenac and Meloxicam - indications for use

The use of any form of these anti-inflammatory drugs is indicated in the following cases:

Arthritis with psoriasis;
Osteochondrosis;
Rheumatoid arthritis;
Injuries of the musculoskeletal system;
Pain syndrome of moderate severity;
Ankylosing spondylitis.

Before using any anti-inflammatory drug, you should visit your doctor and rule out the presence of contraindications.

Indomethacin - indications for use

Taking the drug Indomethacin, in addition to the conditions mentioned above, adds the following diseases:

Myalgia (pain in the muscles);
Painful periods;
Neuralgia of various localization;
Connective tissue diseases;
Infectious diseases of the internal organs.

The list of indications for the use of any of the anti-inflammatory drugs should not be considered complete. The specialist can prescribe such drugs at his own discretion.

Contraindications for use

Diclofenac, Indomethacin and Meloxicam have a similar list of contraindications for use:

Intestinal and stomach bleeding;
Stomach ulcer;
Crohn's disease;
Pregnancy;
Anemia conditions of various origins;
Childhood and adolescence;
Intolerance to components;
Hypersensitivity to acetylsalicylic acid;
severe renal failure;
lactation period;
Bronchial asthma.

Relative contraindications: smoking over the age of 35, alcohol dependence, lipid composition pathology, cerebrovascular disease, mental illness, epilepsy, Parkinson's disease, severe somatic diseases.

Similarities and differences between drugs

The severity of the pharmacological effects of all three drugs is approximately the same. As painkillers, they can be used in the presence of mild or moderate pain. Side effects are less pronounced in the drug Meloxicam.

The cost of the drug Diclofenac is the most democratic and is about 20 rubles per pack. The drug is produced in Russia by the pharmaceutical company Hemofarm.

The drug Meloxicam is the so-called generic, produced by the North Star enterprise, located in Russia. The cost of packaging the drug is also very low and is about 60 rubles.

Indomethacin is produced in Bulgaria by the pharmaceutical company Sopharma. The cost of packaging the drug is also low and ranges from 50 to 70 rubles. Thus, all three medicines are very budgetary.

Conclusion

Which drug to prefer, you need to ask your doctor. However, in most cases, preference should be given to European or American pharmaceutical manufacturers, which will positively affect the treatment, but negatively - the cost of the drug.