Home Salon Ortofen or indomethacin which is better. Indomethacin: instructions for use. III. use of selective NSAIDs

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Ortofen or indomethacin which is better. Indomethacin: instructions for use. III. use of selective NSAIDs

Base Interactions (Diclofenac)

Increases the concentration in the blood of lithium, digoxin, indirect anticoagulants, oral antidiabetic drugs (both hypo- and hyperglycemia are possible), quinolone derivatives. Increases the toxicity of methotrexate, cyclosporine, the likelihood of side effects of glucocorticoids (gastrointestinal bleeding), the risk of hyperkalemia against the background of potassium-sparing diuretics, reduces the effect of diuretics. Plasma concentration decreases with the use of acetylsalicylic acid.

Interactions from trade names (Rapten Rapid)

Sugar-coated tablets, 12.5 mg
Lithium, digoxin. With simultaneous use of diclofenac potassium may increase the concentration of lithium or digoxin in the blood plasma.
Diuretic and antihypertensive agents. Diclofenac potassium, as well as other NSAIDs, when taken simultaneously with diuretic or antihypertensive agents (for example, beta-blockers, ACE inhibitors), may reduce the severity of the antihypertensive effect. The simultaneous use of potassium-sparing diuretics can lead to an increase in the level of potassium in the blood serum.
NSAIDs and corticosteroids. The simultaneous use of diclofenac potassium and other systemic NSAIDs or corticosteroids may increase the incidence of adverse events from the gastrointestinal tract.
Anticoagulants and inhibitors of platelet aggregation. Special care is required, since the risk of bleeding increases when diclofenac potassium is taken concomitantly with these drugs.
Antidiabetic drugs. In clinical studies, it has been established that the simultaneous use of diclofenac and oral antidiabetic drugs is possible, while the effectiveness of the latter does not change. However, isolated cases of the development of both hypoglycemia and hyperglycemia are known, which required a change in the dose of antidiabetic drugs during the use of diclofenac potassium.
Methotrexate. Caution should be exercised when prescribing NSAIDs less than 24 hours before or after taking methotrexate, etc.; in such cases, the concentration of methotrexate in the blood may increase and its toxic effect may increase.
Cyclosporine. The effect of NSAIDs on the synthesis of PG in the kidneys may enhance the nephrotoxicity of cyclosporine.
Antibacterial agents, quinolone derivatives. There are separate reports of the development of seizures in patients receiving both quinolone derivatives and NSAIDs.
Antacids (eg aluminum hydroxide and magnesium hydroxide). They can slow down the absorption of diclofenac potassium, but do not affect the total amount of the drug absorbed.
Selective serotonin reuptake inhibitors. Concomitant therapy with selective serotonin reuptake inhibitors (eg citalopram, fluoxetine, paroxetine, sertraline) is accompanied by an increased risk of gastrointestinal bleeding.
Interactions with food. The level of absorption of diclofenac potassium decreases when taken with food. For this reason, it is not recommended to take the drug during or immediately after a meal.
Coated tablets, 50 mg
Increases the concentration of digoxin, methotrexate, lithium preparations and cyclosporine in plasma. Reduces the effect of diuretics, against the background of potassium-sparing diuretics, the risk of hyperkalemia increases, against the background of anticoagulants, thrombolytic agents (alteplase, streptokinase, urokinase) - the risk of bleeding (often in the gastrointestinal tract). Reduces the effects of antihypertensive and hypnotic drugs.
Increases the likelihood of side effects of other NSAIDs and GCS (bleeding in the gastrointestinal tract), methotrexate toxicity and cyclosporine nephrotoxicity (by increasing the effect of potassium diclofenac on PG synthesis in the kidneys).
Acetylsalicylic acid reduces the plasma concentration of the drug.
Simultaneous use with paracetamol increases the risk of developing nephrotoxic effects of diclofenac potassium.
Reduces the effect of hypoglycemic agents.
Cefamandol, cefoperazone, cefotetan, valproic acid and plicamycin increase the incidence of hypoprothrombinemia.
Gold preparations increase the effect of potassium diclofenac on PG synthesis in the kidneys, which increases nephrotoxicity.
Simultaneous administration with ethanol, colchicine, corticotropin and St. John's wort increases the risk of bleeding in the gastrointestinal tract.
Diclofenac potassium enhances the effect of drugs that cause photosensitivity.
Drugs that block tubular secretion increase the plasma concentration of diclofenac potassium, thereby increasing its toxicity.

B Indomethacin (text from instructions)⇒ Diclofenac (found him)

Reduces the diuretic effect of potassium-sparing, thiazide and loop diuretics. Increases (mutually) the risk of side effects (primarily gastrointestinal lesions) of other NSAIDs. Increases the plasma concentration of digoxin, methotrexate and Li + preparations, which can lead to an increase in their toxicity. Sharing with paracetamol increases the risk of nephrotoxicity. Ethanol, colchicine, glucocorticoids and corticotropin increase the risk of bleeding in the gastrointestinal tract. Enhances the hypoglycemic effect of insulin and oral hypoglycemic drugs; enhances the effect of indirect anticoagulants, antiplatelet agents, fibrinolytics (alteplase, streptokinase and urokinase) and increases the risk of bleeding. Against the background of the use of potassium-sparing diuretics, the risk of hyperkalemia increases. Reduces the effectiveness of uricosuric and antihypertensive drugs (including beta-blockers); enhances the side effects of mineral and glucocorticoids, estrogen. Cyclosporine and gold preparations increase nephrotoxicity (by suppressing PG synthesis in the kidneys). Cefamandol, cefoperazone, cefotetan, valproic acid - increase the incidence of hypoprothrombinemia and the risk of bleeding. Antacids and cholestyramine reduce the absorption of indomethacin. Increases the toxicity of zidovudine (due to inhibition of metabolism), in newborns increases the risk of developing toxic effects of aminoglycosides (etc. Reduces renal clearance and increases blood concentration). Myelotoxic drugs increase the manifestations of hematotoxicity.

Common Interactions Between Diclofenac and Indomethacin

Diclofenac and Indomethacin belong to the same pharmaceutical group:

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.

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:

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.

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 pack. 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.

Ibuprofen

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

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

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

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.

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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.

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.

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 expression;
cupping 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 is 30-40 rubles, and you will have to pay at least 200 rubles for packaging.

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.

Meloxicam;
Nimesulide;
Ketoprofen;
Ketorolac;
Metamizole;
Perekoxib;
Phenylbutazone;
Indomethacin;
ibuprofen;
Acetylsalicylic acid;
Piroxicam.

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 accumulate rapidly in 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

In terms of the degree of anti-inflammatory action, all NSAIDs are significantly inferior to those capable of inhibiting 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 turned out to be identical for all NSAIDs, and they reduced only subfebrile temperature values, in contrast to the hypothermic agent Chlorpromazine;
antiaggregatory 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;
immunosuppressive effect expressed moderately 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.

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 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.

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

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

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 30-50 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 agent for viral and bacterial respiratory infections, juvenile arthritis (, rheumatoid).

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. His goal was to establish the rate of onset of analgesic and anti-inflammatory effects in patients with acute. The duration of admission was 7 days, during which the condition of patients was constantly monitored. According to the results obtained, comparisons of the clinical efficacy of arresting an attack

Overview of analogues from the NSAID group

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

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 balms with chondroprotectors and even glucocorticosteroids. The greatest anti-inflammatory efficiency is typical for such drugs:

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

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.

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.

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 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.

Piroxicam or diclofenac which is better

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

Rationale for the choice of the most commonly used NSAIDs in inflammatory diseases

Ukrainian Pharmaceutical Academy, Kharkov.

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

Given the wide spread of inflammatory diseases, adequate regulation of this pathological process is of great importance. Non-steroidal anti-inflammatory drugs are now widely used to correct inflammation.

World practical medicine and pharmacy has a huge arsenal of highly effective NSAIDs. According to the WHO, drugs of this group take the 2nd place after antibiotics in terms of their mass use. According to foreign medical literature, the average consumption of NSAIDs per inhabitant per year is: in Switzerland - 25 g, Australia - 40 g, Denmark - 24 g, USA - 10 g, England - 30 g. used by about 30 million patients.

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

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

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

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

Comparative evaluation of the effectiveness of this group of drugs according to their individual pharmacological indicators is important for the optimal selection and use of them in individual pharmacotherapy, as well as for the search and implementation of new effective and non-toxic NSAIDs into medical practice.

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

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

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

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

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

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

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

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

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

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

Thus, it can be concluded that in this experiment, the drugs piroxicam, oxaglucamine and meloxicam showed the greatest anti-inflammatory activity. Diclofenac and indomethacin had an approximately equal decongestant effect during the day. Glucosamine showed a weak anti-inflammatory effect in this model. The values of its anti-exudative activity during the day were statistically insignificant in relation to the control.

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

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

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

piroxicam > diclofenac > meloxicam > indomethacin > oxaglucamine.

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

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

Indomethacin, diclofenac, piroxicam and meloxicam (average anti-exudative activity - 61.4%, 41.2%, 72.6% and 36.6%, respectively) had a pronounced anti-exudative activity during the entire study period (2 hours) on the edema model, provoked by prostaglandin.

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

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

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

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Safe analogues of Diclofenac - tablets, ointments, injection solutions

Characteristic features of non-steroidal anti-inflammatory drugs

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

Structural analogs of Diclofenac

Analogues of Diclofenac on the rendered action

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

Comparison of clinical effects of analogues

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.

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

The most popular analogues from the NSAID group

Meloxicam

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

Ibuprofen

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

Nimesulide

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

Overview of 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).

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).

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 ...

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Nonsteroidal anti-inflammatory drugs: list and prices

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

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:

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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Antiviral drugs - inexpensive and effective

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Medical fields

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

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

Tablets

The number and duration of use of tablets varies according to the severity of the disease. Mostly, they are produced in 30 and 60 pieces. packaged. Coated with enteric coating. They are quickly absorbed by the body. Before taking, you must carefully read the instructions for the drug.

Ointment

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

Drops

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

suppositories

Rectal suppositories have been used in medical practice for a long time, they have a number of positive qualities needed in the treatment of pathological processes in the spine and joints. Candles release 50 mg and 100 mg. The package contains up to 10 suppositories. In addition to the main component of Indomethacin, the drug contains auxiliary substances: silicon dioxide, castor oil, solid fat, urea, polysorbate.

Indications

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

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

Through the medication in question, patients can eliminate arthritis, osteochondrosis, rheumatism and neuritis. Indomethacin is also used during thrombophlebitis therapy.

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

Doses, duration of treatment

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

Acute attacks - 0.05 g of the drug 3 times a day.
Prevention of the formation of exacerbations - 0.025 g 2 times a day.

The largest daily dose is 200 mg.

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

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

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

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

Contraindications

It is prohibited to use Indomethacin for the treatment of diseases of the joints and the musculoskeletal system if there are the following contraindications:

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

Side effects

In the treatment of joint diseases with Indomethacin, the following adverse effects occur:

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

With prolonged use of the drug, the formation of local negative manifestations is likely as burning, redness, itching and rashes, redness of the skin, and the appearance of allergies. When side effects appear, you need to contact a specialist without delay.

Price

Indomethacin is available for purchase at a pharmacy without a specialist prescription. The cost of a drug, the release of which is carried out in the form of suppositories, is 350 rubles. Tablets cost from 70 to 100 rubles. The price of the ointment varies between 90-120 rubles. The medicine should be stored in a dry place out of the reach of sunlight, with appropriate humidity and temperature conditions not exceeding 25 degrees. If all the instructions for storing Indomethacin are followed, its service life will be 3 years.

Analogues

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

anti-inflammatory;
antipyretic;
anesthetic.

This feature is due to their structure. In addition, NSAIDs tend to affect any inflammation, regardless of the factor that provoked it. But by no means every drug is equally effective on such manifestations of pathologies as fever, inflammation and pain.

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

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

arthrosis;
osteochondrosis;
muscle stretching;
dislocations and fractures.

Medications from this series are analogues of Indomethacin in action.

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

Indobene or Indomethacin - what is the difference?

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

The anti-inflammatory effect is formed by the 6-7th day of therapy. With topical use, discomfort disappears, swelling decreases. Side effects of the agent under consideration coincide with Indomethacin. The absorption of the drugs is also identical. The release of Indobene is produced as suppositories. The price of candles starts from 400 rubles.

Diclofenac or Indomethacin - which is better?

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

For external use it is known as Diclak-gel. In addition, it is released as an ointment. Suppositories are widely popular due to the reduced risk of NSAID side effects. Diclofenac rectal suppositories are sold in pharmacies under the name Dicloberl and Diclovit. They have the same structure, differ only in cost and manufacturer. Also act as an analogue of Indomethacin.

Diclofenac and Indomethacin do not actually differ in their contraindications. Various studies prove that Diclofenac is superior to Indomethacin in terms of medicinal properties. It relieves unpleasant symptoms in a shorter time.

The preparations under consideration are similar in their action, have a good effect and an affordable price. But, Diclofenac considers it a reference remedy among NSAIDs, and therefore it is prescribed much more often by doctors in the presence of diseases of the musculoskeletal system.

Ortofen or Indomethacin - what to choose for joint diseases?

Ortofen is a drug from the group of NSAIDs, a derivative of acetic acid. The active ingredient of the drug is diclofenac. It is prescribed for all pathologies of the spine, which are accompanied by inflammatory changes or pain:

Tumors of the spine;
Postoperative period as a result of surgical intervention on the spinal column;
Traumatism of the spine;
Herniated disc.

As well as Indomethacin, it is available in the form of tablets, ointments, gels and injections. However, the drugs differ in composition. The main active ingredient of Ortofen is diclofenac sodium. The manifestation of side effects in Indomethacin is higher than in Ortofen. In view of this, doctors are less likely to prescribe indomethacin for patients.

Ketanov or Indomethacin - which is stronger?

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

postoperative pain;
acute injuries of muscles, bones and soft tissues.

The advantages of Ketanov include a minimal effect on blood circulation and respiration, intestinal motility, and the absence of narcogenic potential. The tool is distinguished by high safety - the number of side effects during its use is much less than when using opiates. The agent under consideration is superior in analgesic actions to most NSAIDs. The anti-inflammatory efficacy of oral forms (tablets) is not the highest and is inferior in these qualities to Indomethacin, however, the analgesic effect will far exceed it. In addition, the regular use of narcotic analgesics is associated with the risk of drug addiction. For the price, the cost of Ketanov will be about twice that of Indomethacin.