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Aertal or ibuprofen, whichever is better. What is better aertal or nimesil Indomethacin and aertal one action or different

Almost everyone has experienced bone and joint pain in their lives. This problem is most acute, as a rule, in the elderly, as well as in professional athletes.

However, more and more often young people with joint pain after bruises or sprains turn to the polyclinic with similar complaints.

Compound

Aertal -, the main active ingredient of which is acyclofenac, a derivative of acetic acid.

Acyclofenac relieves inflammation, has antipyretic and analgesic properties. The specified effects are achieved by suppressing some of the receptors in the body that are responsible for the production of inflammatory mediators, that is, special substances that support this inflammation.

Acyclofenac in the composition of tablets is well absorbed in the stomach and practically unchanged excreted by the kidneys from the body. And the cream freely penetrates into the bloodstream through the outer skin.

Indications for use

"Aertal" is used in medicine both as a pain reliever and as a remedy. To suppress pain, the drug is used for shoulder arthritis, rheumatic tissue damage, as well as for acute toothache. As an effective remedy, "Aertal" is used for osteoarthritis, spondylitis and arrheumatoid arthritis.

Contraindications to taking the drug

The strictest ban on the use of "Aertal" is imposed in case of hypersensitivity, including to a number of other groups of non-steroidal anti-inflammatory drugs, pregnancy, childhood, tissue damage at the site of application of the cream, bronchial asthma and blood clotting disorders.

It is necessary to use "Aertal" with caution in case of lesions of the mucous membrane of the digestive tract, dysfunctions of the kidneys and liver, diabetes mellitus, hyperkalemia, acute rhinitis, urticaria.

During lactation, at the time of taking the drug, it is better to refuse breastfeeding.

Side effects

In the area of ​​the gastrointestinal tract, there may be nausea, vomiting, changes in stool, pain in the intestinal area, the development or progression of peptic ulcer disease, intestinal colic, flatulence.

As for the central nervous system, periodic headache and dizziness, sleep disturbances, memory loss, convulsions, irritability are possible.

In rare cases, the drug itself or a cheap analogue of "Aertal" can cause tinnitus, impaired hearing and vision, loss of orientation. Epidermal necrolysis, exudative erythema, anaphylactic shock, bronchial asthma, eczema, nephritis, tachycardia, hematuria are extremely rare.

During the period of treatment with the cream, urticaria, photosensitivity and slight skin irritation are possible.

In case of an overdose, gastric lavage and the adoption of sorbents are necessary. In any case, treatment should be carried out in a hospital under the supervision of specialists.

Interaction with other substances

It is undesirable to combine the reception of "Aertal" with the preparations of lithium, digoxin, as this uncontrollably increases the concentration of the active substance. When using diuretics, it is possible to reduce the effectiveness and develop hyperkalemia. When used several times at once, the risk of developing peptic ulcer disease increases. Acetylsalicylic acid reduces the concentration of "Aertal" and is the cause of bleeding.

With the combined use of "Aertal" and hypoglycemic drugs, the development of hypo- or hyperglycemia is likely. To exclude this, you should regularly take a blood sugar test.

With the simultaneous administration of anticoagulants, the risk of bleeding increases and monitoring of blood clotting indicators is necessary.

Oral contraceptives and an analogue of "Aertal" are taken with caution.

While taking the drug, you should completely abandon alcoholic beverages.

Application during pregnancy and lactation

In clinical studies "Aertal", analogs and other similar drugs were not involved. But it is known that the systematic use of non-steroidal anti-inflammatory drugs in the last trimester of pregnancy can lead to a decrease in tone and weak contractions of the uterine muscles. In turn, this inhibits the onset of labor and, in some cases, increases the duration of labor. The newborn may have prolonged pulmonary hypertension.

The drug itself and the Aertal analogue have no data on the presence of a teratogenic effect in humans. However, in experimental studies on rabbits, in some cases, morphological changes in the fetus were manifested.

There are also no data on the allocation of acyclofenac in milk. In studies on rats, the transmission of radioactive acyclofenac through milk has not been established.

In general, the drug and the cheap analogue of "Aertal" are prohibited for use during pregnancy and lactation. Only in exceptional cases is their admission allowed in the second trimester. The decision on the use of these funds is made only after a competent assessment of the intended benefits for the mother and the potential threat to the child.

Method of administration and dosage

"Aertal" tablets are prescribed for adults, one piece twice a day, without chewing and drinking plenty of plain water.

The cream is used only externally and should be avoided in the presence of pressure bandages. The product is applied three times a day with light massage movements. Pea "Aertal" is enough for about 5-7 square centimeters of skin surface.

No dose adjustment is necessary for elderly patients.

Special instructions for admission

If irritation or discomfort occurs when using the cream, it should be stopped immediately. Do not allow the cream to come into contact with the mucous membranes and eyes, apply only to intact skin, then wash your hands thoroughly with water.

With the systematic intake of pills, one should refuse to engage in potentially hazardous activities that require concentration of attention and speed of reaction, for example, driving a car, working with mechanisms.

During the period of drug treatment, it is necessary to monitor the blood picture, as well as the functions of the kidneys and liver.

To reduce the risk of developing complications in the gastrointestinal tract, "Aertal" should be taken in the lowest possible effective dose in a short course.

Release form and storage conditions

Film-coated tablets - 100 mg each. Cream in an aluminum tube - 60 g.

Store in a dry place at a temperature not exceeding 25 degrees.

How to replace "Aertal"? Analogs of this tool are common due to its relatively high price. The most popular are "Asenak", "Asefil", "Infenak", "Zerodol". Their main active ingredient is also acyclofenac, but the price is much lower due to the fact that domestic pharmacological companies are engaged in the production of these drugs.

All of these drugs have a dosage similar to "Aertal", side effects and contraindications. Please note that even if you have previously taken Aertal, the instructions for use (analogs) should be carefully studied.

If a person has a hypersensitivity to acyclofenac, an analogue of "Aertal" containing this substance in its composition is categorically not suitable for admission. You can choose a medicine with a different active ingredient, but with similar indications for use. Such funds include the famous "Voltaren", "Diclofenac", "Ketanov", "Olfen". All these drugs perfectly relieve pain, relieve the condition.

Quite popular is such an analogue of "Aertal" as "Movalis", the active ingredient of which is meloxicam. The latter has much fewer side effects and contraindications, but its price is just as high.

"Aertal": in the form of ointments and creams

Since there are much fewer negative and adverse reactions with external agents than with drugs taken orally, creams are very popular. Unlike tablets, they can also be used by patients with diseases of the stomach and intestines, liver, kidneys, peptic ulcer disease, as well as hypersensitivity of internal organs.

A popular remedy is "Aertal" cream, the analogs of which are no less effective. These include "Diclofenac", "Indomethacin", "Veral", "Diclogel", "Olfen", "Revmalin" and many others.

All of them belong to the group of non-steroidal anti-inflammatory drugs and are indicated for external use only.

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

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

Different drugs have these effects to varying degrees, so some drugs are better suited for long-term treatment of joint diseases, others are mainly used as analgesics and antipyretic drugs.

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

The main contraindications: individual naya intolerance, exacerbation of gastric ulcer and duodenal ulcer.

Important information for the patient:

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

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

Even over-the-counter pain relief medications cannot be used long-term. If they are required often, several times a week, a doctor's examination and treatment is necessary according to the recommendations of a rheumatologist or neurologist.

In some cases, with long-term use of funds of this group, additional intake of proton pump inhibitors that protect the stomach is required.

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

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

Rheumatoid arthritis (RA) is a severe autoimmune disease. Its leading syndrome is joint damage. But often with rheumatoid arthritis, general symptoms are also observed. This includes an increase in temperature.

Temperature increase

Fever is a symptom of rheumatoid arthritis. This is the body's response to the emerging immune inflammation, which is systemic in nature.

Fever in RA is usually accompanied by the following clinical manifestations:

• General impairment of well-being.
• Weakness and weakness.
• Increased fatigue.

Sick people often become lethargic and adynamic, especially at the peak of a rise in temperature.

Fever most often develops simultaneously with the first symptoms of joint damage, in the initial stage of the disease. At the same time, the thermometer shows higher numbers in the second half of the day and in the late afternoon. At the same time, patients also have general malaise. In the morning hours, the state of health is usually good.

The temperature reaction often occurs in the form of subfebrile condition, that is, the thermometer values ​​fluctuate within 37.1-38.0 °. However, sometimes true fever can also be observed with an increase in temperature to 38.5-39 °. With this type of autoimmune disease, such as Still's disease in adults, fever can be malignant, and the thermometer is kept in the range of 39-40 °.

Such an increase in temperature is difficult for patients, causing a sharp deterioration in health, weakness, headache.

Febrile syndrome in rheumatoid arthritis can persist from several weeks to 2-3 months. In addition to the general symptoms of malaise, it is accompanied by an increase in heart rate, sometimes an increase in blood pressure.

High fever in arthritis causes significant discomfort to sick people.

Treatment

high body temperature

As a rule, fever syndrome in rheumatoid arthritis rarely needs additional treatment, since drugs for treating the disease have antipyretic effects.

At the heart of both joint damage and an increase in body temperature is one pathological mechanism - an autoimmune reaction. It is she who causes all those symptoms that are characteristic of rheumatoid arthritis.

With drug suppression of immune inflammation, pain disappears and body temperature normalizes.

For the treatment of rheumatoid arthritis and, accordingly, the relief of fever, the following groups of drugs are used:

1. Non-steroidal anti-inflammatory drugs (NSAIDs).
2. Glucocorticosteroids (GCS).

Therapy of rheumatoid arthritis itself itself is carried out with other drugs - cytostatics, sulfonamides, D-penicillamine, gold preparations. However, their mechanism of action is different. They can eliminate fever by stopping the main pathological process, but only the above medications have an effective and rapid antipyretic effect.

NSAIDs

This is a well-known group of drugs. Their main action is to stop inflammation and all its inherent components:

• temperature rise;
• pain;
• edema.

NSAIDs have three main effects:

1. Eliminate inflammation.
2. Ease pain.
3. Reduces body temperature.

For different drugs, the severity of each effect is different. That is why analgin is most often used as an analgesic, and aspirin is most often used to fight fever.

Diclofenac is considered the gold standard for anti-inflammatory action in rheumatology.

The mechanism of action of NSAIDs is associated with the blockade of a special enzyme - cyclooxygenase (COX). It is of two types.

COX-1 and COX-2 inhibitors have a more pronounced therapeutic effect, however, they also have more side effects, while the probability of such complications in selective COX-2 inhibitors is much lower.

However, some and other drugs are currently successfully used in the treatment of rheumatoid arthritis, especially if it proceeds with an increase in body temperature. Moreover, it is NSAIDs that are the first-line drugs in the treatment of this disease.

Non-selective COX inhibitors

Despite the increased risk of side effects, non-selective COX inhibitors are widely prescribed by rheumatologists for the management of fever and pain in RA. These drugs have been known for a long time and have proven themselves well. In general, they are well tolerated, and the likelihood of complications can be reduced with the help of gastroprotective agents and dosage control.

Non-selective COX inhibitors include:

• diclofenac;
• aceclofenac;
• dexketoprofen.

These drugs are widespread in the pharmaceutical market, over-the-counter, and for the most part have an affordable price for many patients.

Diclofenac

Diclofenac has a pronounced antipyretic and anti-inflammatory agent, it also eliminates pain. This medicine is available not only in the form of tablets, it is presented in a significant number of forms - injections, ointments, gels, capsules and suppositories.

In pharmacies, diclofenac can be found under the following trade names:

• Diklak;
• Dicloberl;
• Voltaren.

Among its side effects, the most dangerous are ulcerogenic and blood thinning. This means that against the background of constant medication, an ulcer may form in the gastrointestinal tract or bleeding may develop. These negative effects are especially dangerous in old age, as they occur imperceptibly and increase rapidly.

However, for patients with RA, diclofenac is often a real salvation, especially when they have severe pain and febrile syndrome. Against the background of treatment, unpleasant manifestations quickly disappear.

Aceclofenac

Aceclofenac is similar in structure to diclofenac. However, its safety profile is significantly higher. This medication is well tolerated and rarely causes abdominal pain, ulceration, and other unpleasant symptoms. It also has anti-inflammatory and antipyretic properties and can be used to combat fever in RA.

In pharmacies, this drug is better known under the names Aertal and Diclotol.

In terms of effectiveness and duration of action, aceclofenac is inferior to diclofenac, but this is compensated by the better tolerance of the drug.

Dexketoprofen

Dexketoprofen is the active ingredient of the well-known drug Dexalgin. Most doctors and patients are familiar with it due to its analgesic effect, and therefore the drug is widely prescribed after surgery. However, Dexalgin also has anti-inflammatory and antipyretic effects and is often used in the treatment of rheumatoid arthritis.

It quickly and effectively relieves the symptoms of RA - fever and pain. At the recommended dosage, Dexalgin is well tolerated and rarely affects blood clotting or ulceration. However, this drug is not indicated for long-term use. As a rule, the course of treatment with dexketoprofen does not exceed a week.

The medicine is produced in the form of injections and tablets. The disadvantages of Deksalgin include its considerable cost.

Selective COX-2 inhibitors

Selective COX-2 inhibitors have been developed in order to minimize the likelihood of complications - bleeding and mucosal erosions, which are common with all NSAIDs.

However, even the drugs of this group failed to completely get rid of such side effects. All of them - to one degree or another - are capable of causing specific complications.

There is also an opinion that the developed selectivity affected the severity of anti-inflammatory and antipyretic effects. It is difficult to agree with this, since the majority of selective COX-2 inhibitors are comparable in therapeutic effect to diclofenac or dexketoprofen.

The main niche for the use of such drugs are patients with risk factors for the development of bleeding and gastropathy, for whom traditional therapy is contraindicated.

Selective inhibitors also have their drawbacks, one of which can be considered a higher cost. This factor is important for patients, since rheumatoid arthritis therapy is a lifelong process.

The most commonly used selective COX inhibitors are:

• nimesulide;
• meloxicam;
• celecoxib.

Nimesulide

Nimesulide is a medicine that is widely known for its antipyretic and analgesic effects. However, the drug also has a pronounced anti-inflammatory effect.

In terms of the strength of action, nimesulide is not inferior to diclofenac and is actively prescribed by rheumatologists for many autoimmune diseases.

In the pharmaceutical market, it is sold under the following trade names:

• Nimesil;
• Nimulide;
• Nimid;
• Nise.

The original drug is not cheap, but generics are readily available to most patients. However, you should be aware that in recent years, the number of counterfeits of this popular medicine has increased.

Rheumatoid arthritis and high fever are direct indications for the appointment of nimesulide. It is rapidly absorbed and begins to have analgesic and anti-inflammatory effects. Improvement of well-being with such treatment occurs quickly enough.

Nimesulide for relief of RA symptoms is indicated for all patients over 65 years of age, with a history of peptic ulcer disease and gastrointestinal bleeding. It comes in the form of tablets and suspensions for ease of use.

Side effects when taking it include abdominal pain and allergic reactions. There is also evidence that a high dosage of nimesulide adversely affects the kidneys.

Meloxicam

Meloxicam has gained a lot of popularity in recent years. Due to the appearance of a huge number of analogues, its cost has become more affordable. He is familiar to patients as Movalis, Melox, Revmoxicam, Moviks, Revmalgin.

The drug belongs to highly effective means of fighting fever, pain and inflammation. High fever in rheumatoid arthritis often requires a strong but safe medication. These include meloxicam.

Patients with diseases of the gastrointestinal tract, especially gastritis and ulcers, note its good tolerance. Symptoms such as abdominal pain, heartburn, nausea while taking it are rare.

Also, the drug has a significantly reduced ulcerogenic and blood-thinning effect, due to which it is prescribed in older age groups and in patients with concomitant gastrointestinal diseases.

Celecoxib

Celecoxib has been developed as the most effective anti-inflammatory and antipyretic effect for the treatment of rheumatologic diseases. When it appeared on the pharmaceutical market, the price of the drug was quite high.

In terms of the strength of action, celecoxib (Celebrex) is not inferior to diclofenac and nimesulide. However, during clinical studies and long-term observations, an unfavorable effect of this drug on the cardiovascular system was noted, which significantly limited the use of Celebrex. The second limiting factor is the high price.

Glucocorticosteroids

Glucocorticosteroids are not direct antipyretic drugs. And fever is not included in the list of indications for their use.

However, these hormones are very effective in fighting inflammation, the components of which include fever.

Thus, against the background of GCS treatment in rheumatoid arthritis, fever quickly stops along with pain and joint swelling.

Previously, glucocorticoids were used in cases of severe disease, but modern rheumatology considers them as basic therapy drugs. GCS not only eliminate the main unpleasant symptoms of rheumatoid arthritis, they suppress the immune response and thereby inhibit the development and progression of the disease.

Long-term, regular use of these hormones is an essential part of RA treatment. Most often, rheumatologists use the following medications:

• methylprednisolone (Metipred).
• triamcinolone (Polcortolone).

These GCS are designed for continuous use, so their side effects are minimized. And yet, long-term hormonal therapy for rheumatoid arthritis is fraught with the following complications for patients:

1. The formation of erosions and ulcers in the gastrointestinal tract.
2. Bleeding.
3. Obese.
4. Steroid diabetes.
5. Osteoporosis.
6. Cushing's syndrome.

Glucocorticoids can be combined with non-steroidal anti-inflammatory drugs to increase the effectiveness and quickly achieve results, however, the side effects of the drugs are cumulative.

RA and related diseases

High fever in RA is not always a manifestation of autoimmune inflammation. It may well be the result of a concomitant infectious disease. It should be remembered that inflammatory fever is more common in the first months of rheumatoid arthritis. In the future, with adequate treatment, the temperature will return to normal and no longer bother the patient.

The infectious nature of an increase in temperature in rheumatoid arthritis can be assumed by the following features:

1. The appearance of her cold season.
2. The period of an epidemic of influenza or ARVI.
3. History of contact with a sick person.
4. The appearance of symptoms uncharacteristic for RA - sore throat, ears, runny nose, cough, frequent urination, discoloration of urine.

An infectious disease in rheumatoid arthritis has its own characteristics of treatment.

Treatment of infectious fever

If a fever is accompanied by such manifestations, it is imperative to see a therapist for a diagnosis. At high temperatures, antipyretic drugs can be taken to relieve the condition before the doctor's examination. However, care must be taken when doing this.

Only NSAIDs can be used as antipyretic drugs. Since most patients with RA receive basic GCS therapy, their side effects can add up. This means that to lower the temperature, it is better to use selective COX-2 inhibitors, which have a lesser effect on the blood system and the state of the gastrointestinal tract.

An effective physical method for treating fever is to massage your body with warm water. It is important that it is exactly warm, and not cold, otherwise such a procedure will lead to vasospasm, and hyperthermia will intensify. It also eases the condition and improves well-being by drinking plenty of tea, compote, fruit drink, water.

GCS for infections

Although corticosteroids are anti-inflammatory drugs and effectively eliminate fever, they are prohibited from using them to relieve fever in infectious diseases. This is due to the immunosuppressive effect of drugs. This means that against the background of their treatment, the body's defenses will not be able to cope even with a common cold. And instead of lowering the temperature, you can get an even greater rise in it.

High fever in RA requires proper therapy. Only a doctor can select and control it. Self-medication for this disease is unacceptable.

Diclofenac and Ksefokam, along with other representatives of the large group of NSAIDs, have the ability to inhibit the activity of cyclooxygenase (an enzyme that promotes the synthesis of prostaglandins). This property of drugs leads to the elimination of pain and inflammation in the patient's body. In addition, Xefocam helps to increase the level of endorphins.

Forms of issue

Diclofenac sodium is the main active ingredient in Diclofenac. Its form of release: eye drops, suppositories, injection solution, tablets, ointment and gel.

Xefocam is made on the basis of the active ingredient lornoxicam. This drug is significantly inferior to Diclofenac in terms of the number of manufactured forms and is only in the form of tablets containing 4.8 mg of the active ingredient and a lyophilized powder used for the manufacture of solutions for intravenous and intramuscular injections.

Indications

Diclofenac and Xefocam help to cope with high body temperature, inflammation in the body and pain.

Diclofenac and Ksefokam show a good effect when:

• febrile conditions
• joint diseases
• pathologies of the musculoskeletal system of a non-rheumatic nature
• neurological diseases (neuralgia, radiculitis, sciatica)
• renal and hepatic colic
• pain syndrome of various origins
• dysmenorrhea

There were no significant differences between Diclofenac and Ksefokam in terms of contraindications and side effects. However, the difference still exists not only in the form of release.

Benefits of Xefocam

Ksefokam, along with Piroxicam, Meloxicam, Lornoxicam, Tenoxicam, belongs to the most innovative group of NSAIDs.

The advantages of Xefocam include:

• The presence of more pronounced, in comparison with Diclofenac, analgesic and anti-inflammatory effects. Xefocam is the only NSAID drug with an analgesic effect that is identical to that of morphine. This property allows you to take a drug to eliminate pain in a small dosage compared to other NSAIDs;
• The occurrence of undesirable effects from the gastrointestinal tract during treatment with Ksefokam is minimized.

• The price of the drug, in comparison with Diclofenac, is an order of magnitude higher. However, the long duration of the effect of Xefocam on the patient's body and its effect compensates for this weak side;
• Release form - lyophilized powder in some cases makes it difficult to use the drug at home.

The compatibility of Xefocam with Diclofenac with complex therapy is not excluded. However, combining several NSAIDs increases the risk of side effects.

Xefocam, in comparison with Diclofenac, is a less popular remedy. However, the drug is well tolerated by patients and in some cases is much more effective than many NSAIDs.

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

Aertal - instructions for use, analogs, reviews and release forms (100 mg tablets, powder for suspension, cream or ointment) of a drug for the treatment of lumbago, rheumatoid arthritis in adults, children and pregnancy

In this article, you can read the instructions for using the drug Aertal. The reviews of website visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Aertal in their practice are presented. A big request is to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, which may not have been declared by the manufacturer in the annotation. Aertal's analogs in the presence of existing structural analogs. Use for the treatment of lumbago, rheumatoid arthritis and arthrosis in adults, children, as well as during pregnancy and lactation.

Aertal is a non-steroidal anti-inflammatory drug (NSAID). It has anti-inflammatory, analgesic and antipyretic effects. It inhibits the synthesis of prostaglandins and thus affects the pathogenesis of inflammation, pain and fever.

In rheumatic diseases, the anti-inflammatory and analgesic effect of aceclofenac contributes to a significant decrease in the severity of pain, morning stiffness, swelling of the joints, which improves the functional state of the patient.

Aceclofenac + excipients.

It is rapidly and completely absorbed after oral administration. Binding to plasma albumin by 99%. Penetrates into synovial fluid, where its concentration reaches 57% of the plasma concentration. It is metabolized to an insignificant extent. Its main metabolite found in plasma is 4'-hydroxyaceclofenac. It is excreted by the kidneys mainly in the form of hydroxy derivatives (about 2/3 of the administered dose).

Relief of inflammation and pain syndrome with:

• lumbago;
• toothache;
• scapular periarthritis;
• rheumatic lesions of soft tissues.

• rheumatoid arthritis;
• osteoarthritis (arthrosis);
• ankylosing spondylitis.

Film-coated tablets 100 mg.

Powder for preparation of oral suspension 100 mg.

Cream for external use (sometimes mistakenly called ointment).

Other forms, be it injections in ampoules or in solution, do not exist at the time of the description of the drug in the reference book.

Instructions for use and reception scheme

Adults are prescribed orally 100 mg (1 tablet) 2 times a day, morning and evening.

The tablets should be swallowed whole with plenty of liquid.

• nausea, vomiting;
• diarrhea;
• pain in the epigastric region;
• intestinal colic;
• dyspepsia;
• flatulence;
• anorexia;
• constipation;
• erosive and ulcerative lesions;
• bleeding and perforation of the gastrointestinal tract (hematemesis, melena);
• stomatitis (including aphthous);
• fulminant hepatitis;
• headache;
• dizziness;
• sleep disturbances (insomnia or drowsiness);
• excitation;
• sensitivity disorders;
• disorientation;
• impairment of memory, vision, hearing, taste sensations;
• noise in ears;
• convulsions;
• irritability;
• tremor;
• depression;
• anxiety;
• skin rash;
• hives;
• bronchospasm;
• eczema;
• erythroderma;
• vasculitis;
• pneumonitis;
• Stevens-Johnson syndrome;
• Lyell's syndrome;
• anaphylactic shock;
• peripheral edema;
• interstitial nephritis;
• hematuria, proteinuria;
• leukopenia, thrombocytopenia, agranulocytosis, hemolytic anemia, aplastic anemia;
• tachycardia;
• arterial hypertension;
• congestive heart failure;

• erosive and ulcerative lesions of the gastrointestinal tract in the acute phase;
• gastrointestinal bleeding or suspicion of it;
• a history of bronchospasm, urticaria, rhinitis after taking acetylsalicylic acid or other NSAIDs (complete or incomplete acetylsalicylic acid intolerance syndrome - rhinosinusitis, urticaria, nasal mucosa polyps, bronchial asthma);
• the period after coronary artery bypass grafting;
• severe liver failure or active liver disease;
• disorders of hematopoiesis and coagulation;
• severe renal failure, progressive kidney disease;
• confirmed hyperkalemia;
• pregnancy;
• lactation period (breastfeeding);
• children and adolescents up to 18 years old;
• hypersensitivity to aceclofenac or other components of the drug.

Application during pregnancy and lactation

The drug is contraindicated for use during pregnancy and during breastfeeding.

There are no clinical data on the use of the drug Aertal during pregnancy. Regular use of non-steroidal anti-inflammatory drugs (NSAIDs) in the 3rd trimester of pregnancy can lead to a decrease in tone and weaker contractions of the uterus. The use of NSAIDs can lead to premature closure of the botalle duct in the fetus and, possibly, to prolonged pulmonary hypertension in the newborn, delayed onset of labor and an increase in the duration of labor.

In human epidemiological studies, no data has been obtained indicating embryotoxicity of NSAIDs. However, in experimental studies on rabbits with the introduction of aceclofenac (10 mg / kg per day), in some cases, morphological changes in the fetus were observed. There are no data on the presence of a teratogenic effect in rats.

There are no data on the excretion of aceclofenac in human breast milk. In experimental studies with the introduction of radioactive 14C-aceclofenac to lactating rats, no noticeable transfer of radioactivity into milk was observed.

During the period of treatment with the drug, systematic monitoring of the peripheral blood picture, liver and kidney function, and examination of feces for the presence of blood should be carried out.

Due to the important role of prostaglandins in maintaining renal blood flow, special care should be taken when prescribing patients with heart or renal failure, the elderly taking diuretics, and patients with reduced BCC (for example, after major surgery). If aceclofenac is prescribed in such cases, it is recommended to monitor renal function.

In patients with hepatic impairment, kinetics and metabolism differ from those in patients with normal liver function.

To reduce the risk of developing adverse events from the gastrointestinal tract, the minimum effective dose should be used in the smallest possible short course.

Patients taking the drug should refrain from drinking alcohol.

Influence on the ability to drive vehicles and use mechanisms

Patients suffering from dizziness and other disorders of the central nervous system during the period of taking the drug Aertal should refrain from activities that require increased concentration of attention and speed of psychomotor reactions (driving vehicles and working with dangerous mechanisms).

With simultaneous use with the drug Aertal, an increase in plasma concentrations of digoxin, phenytoin, lithium is possible.

With simultaneous use with the drug Aertal, it is possible to reduce the effectiveness of diuretics and antihypertensive drugs.

The simultaneous use of potassium-sparing diuretics and the drug Aertal can lead to the development of hyperglycemia and hyperkalemia.

With the simultaneous administration of the drug Aertal and glucocorticosteroids (GCS) or other NSAIDs, the risk of side effects from the digestive system increases.

While taking the drug Aertal and selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline) increases the risk of bleeding from the gastrointestinal tract.

Simultaneous administration of the drug Aertal can increase the nephrotoxic effect of cyclosporine.

Against the background of the simultaneous administration of Aertal and hypoglycemic drugs, the development of both hypo- and hyperglycemia is possible (control of blood glucose levels is necessary).

Taking the drug Aertal within 24 hours before or after using methotrexate can lead to an increase in the concentration of methotrexate in plasma and to an increase in its toxic effect.

With simultaneous use with acetylsalicylic acid, a decrease in the concentration of aceclofenac in blood plasma is possible.

With the simultaneous use of antiplatelet agents and anticoagulants, the risk of bleeding increases (regular monitoring of blood coagulation indicators is required).

Analogs of the drug Aertal

Structural analogues for the active substance:

Analogues for the provided therapeutic effect (means for the treatment of rheumatoid arthritis):

Systemic NSAIDs

In terms of the amount of prescriptions, this is one of the most demanded groups of drugs in medical practice. Despite approximately the same mechanism of action, NSAIDs have their own characteristics in many aspects of their use.

The main mechanism of the therapeutic action of NSAIDs is well understood and widely known in the medical and pharmaceutical environment. Recall that it consists in inhibiting isoform-2 of the enzyme cyclooxygenase (COX-2), which leads to the suppression of the synthesis of mediators of inflammation and pain (primarily prostaglandins) in the focus of the inflammatory process. The reasons for dividing the drugs of the group into the 1st and 2nd generations are no less known: some drugs (1st generation) affect both the "pathological" COX-2 (it is formed in the focus of inflammation), and the "physiological" COX-1 (it formed normally and regulates the production of natural gastroprotective factors), others (2nd generation) are more selective in relation to COX-2. Since all these are well-known facts, in recent years the main attention of scientists has been focused on the study of indicators of the comparative safety of NSAIDs, as well as insufficiently studied mechanisms of their anti-inflammatory and analgesic action.

The main indications for prescribing NSAIDs include:

• pains of various origins: musculoskeletal, headache, toothache, dysmenorrhea, etc .;
• inflammatory diseases of the musculoskeletal system;
• rheumatic diseases;
• feverish conditions.

We add that acetylsalicylic acid in small doses is traditionally used as an antithrombotic agent (in this article we will not touch upon this scope of NSAIDs).

Currently, NSAIDs are represented on the Russian pharmaceutical market by several dozen drugs, the most numerous of which are "classic" non-selective drugs of the 1st generation.

CRITERIA FOR SELECTING THE DRUG

When deciding on the appointment of a specific NSAID, doctors start from many "problem conditions":

• the strength of the therapeutic effect;
• the specificity of various oral dosage forms;
• safety and tolerance indicators;
• additional therapeutic features of individual drugs.

Efficiency

Consider the most common criteria for the effectiveness of NSAIDs, which are taken into account in a particular clinical case:

• analgesic / anti-inflammatory action. Due to the dose-dependence of the effects of NSAIDs, their use in various clinical models, the lack of a single standard for assessing efficacy, differences in drug metabolism, the task of ranking drugs in a group according to the severity of the analgesic and anti-inflammatory effect is extremely difficult. Nevertheless, among NSAIDs, several molecules can be distinguished that have a proven pronounced analgesic effect: ketorolac (Ketanov, Ketorol, etc.), aceclofenac (Aertal), lornoxicam (Ksefokam), ketoprofen (Artrozilen, Ketonal, etc.), etc. however, ketorolac is characterized by a relatively weak anti-inflammatory activity. The other named drugs, for example, aceclofenac (Aertal), have a higher degree of anti-inflammatory effect;
• antipyretic effect. A number of NSAIDs are used to reduce fever in the setting of infectious diseases. The hypothermic effect of NSAIDs is due to inhibition of the transmission of excitation in the thermoregulatory center of the hypothalamus. Ibuprofen preparations are most commonly used to relieve fever. At the same time, other NSAIDs also have a no less pronounced antipyretic effect: diclofenac, aceclofenac, nimesulide, etc.

Features of dosage forms

One of the important criteria for choosing NSAIDs is the rate of onset of the analgesic and anti-inflammatory effect. In some cases, a quick effect is needed - to relieve acute pain, in others - on the contrary, long-term, for example, with mild chronic pain. For this parameter, the following breakdown of NSAIDs can be made:

• "Fast-acting" drugs (rapid). On the market, in addition to the "standard" tablet forms, there are modified oral forms of NSAIDs: diclofenac potassium salt (Voltaren Rapid, Rapten Rapid), ibuprofen in the form of L-arginine salt (Faspik) and lysine (Nurofen Express), dexketoprofen trometamol (Dexalgin), etc. These salt forms have altered physicochemical, pharmacodynamic and pharmacokinetic parameters, allowing for an accelerated action of the active component. The Xefocam Rapid tablet (lornoxicam), in turn, has a microgranule system, due to which the speed of onset of action is equivalent to that of intramuscular administration. The use of soluble forms of NSAIDs, for example, in the form of granules / powder for the preparation of a suspension, also allows you to achieve a rapid effect. Until recently, a very limited number of drugs were produced in this form: Nimesil (nimesulide), Voltaren Rapid (diclofenac). However, Aertal has recently appeared on the pharmaceutical market in the form of a sachet. The soluble form of Aertal is intended for the treatment of acute pain;
• long-acting tablets (retard). Despite the great relevance of long-acting drugs, there are not so many of them on the market today. The most widespread are prolonged forms of diclofenac (Voltaren tablets 100 mg), ketoprofen (Ketonal tablets of prolonged action 100 mg) and indomethacin (Metindol retard tablets 75 mg);
• mixed forms (rapid / retard). A number of drugs are available in capsules that contain both "quick" action granules and slow-release granules of the active substance: Ketonal DUO (ketoprofen), Naklofen Duo, SwissJet Duo (diclofenac).

OTC drugs include only a few NSAIDs - acetylsalicylic acid, ibuprofen, naproxen, as well as a number of combined drugs with these substances.

Safety indicators

Effects on the digestive system. The problem of the safe use of NSAIDs is especially relevant for the elderly, as well as those who have to take NSAIDs for a long time (for example, in chronic rheumatic diseases). The most common and common side effect of NSAIDs is gastrointestinal damage (NSAID gastropathy). According to the results of large meta-analyzes of the safety assessment of NSAIDs, the most “negative” drugs for the gastrointestinal tract can be identified - these are ketorolac, naproxen, etc. with the corresponding indicator of truly selective NSAID celecoxib.

Effects on the cardiovascular system (CVS). It has been proven that one way or another, all NSAIDs are capable of negatively affecting CVS. On the one hand, most of them exhibit an antiplatelet effect (“thinning” the blood), but on the other hand, they reliably contribute to an increase in blood pressure (due to inhibition of COX in the kidneys). Truly selective NSAIDs from the "coxibs" group, possessing an undoubtedly high profile of gastrointestinal safety, at the same time, due to the lack of antiplatelet action, can lead to hypercoagulability. In this regard, they are inferior to other subgroups of NSAIDs;

Drug interactions. NSAIDs can enhance the effect of indirect anticoagulants and oral hypoglycemic agents. At the same time, they weaken the effect of antihypertensive drugs, increase the toxicity of antibiotics-aminoglycosides, digoxin and some other drugs, which is of significant clinical significance.

Application in pediatrics. The World Health Organization (WHO) officially recognizes only ibuprofen as an NSAID that fully meets the criteria for safety and efficacy in pediatric practice and recommends their use in children. This drug can be used from 3 months of age orally in the form of a suspension and from 6 years of age - in the form of tablets for children at a dose of 200 mg.

There is a lot of controversy about the advisability of using nimesulide in pediatrics. However, today many pediatricians use it as a reserve drug when ibuprofen and acetaminophen do not adequately manage fever and pain. Suspension of nimesulide 50 mg / 5 ml according to the instructions can be used from 2 years of age, 50 mg tablets - from 7 years.

Pregnancy and lactation. Both non-selective and selective NSAIDs can adversely affect fetal development as well as the natural course of labor. The decision on the use of NSAIDs in a pregnant woman in each specific case is possible only after consulting the obstetrician-gynecologist who is in charge of this patient.

The concentration of NSAIDs in milk is low. Nevertheless, their appointment to lactating women is undesirable because of the potential threat to the health of the baby. For health reasons, it is possible to use non-selective NSAIDs with a short half-life, approved for early childhood (ibuprofen).

One of the proven ways to reduce the gastrotoxicity of NSAIDs is to take them together with proton pump inhibitors. The first combination drug naproxen and esomeprazole has recently appeared on the market.

Therapeutic features of individual NSAIDs

Indomethacin is an effective, but at the same time one of the most toxic NSAIDs. Indomethacin more than other NSAIDs impairs renal blood flow, therefore it can significantly weaken the effect of diuretics and antihypertensive drugs. The drug is effective for ankylosing spondylitis and an acute attack of gout, but it has been proven that in patients with prolonged use, the destruction of the articular cartilage accelerates.

Diclofenac (Voltaren et al.), Called the "benchmark" NSAID therapy, is one of the most widely used drugs in the world. Diclofenac combines high anti-inflammatory activity with good tolerance for long-term use, therefore it is widely used in rheumatology. However, it can have a negative effect on the stomach and liver;

Lornoxicam (Ksefokam) is one of the most powerful analgesic and anti-inflammatory drugs, therefore it is indicated for moderate to severe pain syndrome. At the same time, ksefokam is less gastrotoxic than "oxicams" of the 1st generation (for example, piroxicam); in general, lornoxicam corresponds to diclofenac in terms of safety profile. It is used for trauma, postoperative period, as well as for rheumatic diseases.

Meloxicam (Movalis, Mirlox, etc.) is an intermediate generation between non-selective and modern selective NSAIDs ("coxibs"). The drug causes significantly less adverse reactions from the gastrointestinal tract and kidneys than indomethacin, ketorolac, etc., but is inferior in gastrointestinal safety to "coxibam" and aceclofenac. The fact is that in small doses meloxicam behaves like a truly selective NSAID, but with an increase in the dose to the upper therapeutic level, its selectivity in relation to COX-2 decreases;

Ketorolac (Ketanov, Ketorol, etc.) - the clinical value of the drug consists in a powerful analgesic effect, in the degree of which it surpasses many other NSAIDs. It has been found that 30 mg of ketorolac, administered intramuscularly, is approximately equivalent to 12 mg of morphine. At the same time, due to the pronounced gastrotoxicity, the drug is not recommended to be used in a course of more than 5–7 days, therefore its main function in practice is reduced to the relief of acute pain syndrome.

Aceclofenac (Aertal) is a moderately selective NSAID, similar in structure to diclofenac, which many people now call the new "gold standard" NSAID therapy. Unlike diclofenac, aceclofenac inhibits primarily COX-2 (98%), while the activity of COX-1 decreases only by 50%. Aceclofenac also inhibits the synthesis of a number of pro-inflammatory cytokines. Aertal today can be considered one of the most successful in terms of the ratio of effectiveness and safety of drugs from the NSAID group: it is used both for the relief of acute pain and for long-term treatment of chronic diseases of the musculoskeletal system.

Celecoxib (Celebrex) is a representative of a new generation of NSAIDs (selective COX-2 inhibitors). Selectively violates the formation of prostaglandins involved in the formation of an inflammatory reaction, and does not affect the production of prostaglandins, which regulate renal blood flow and the integrity of the gastrointestinal mucosa. Does not interfere with the synthesis of thromboxane, therefore, does not have an antiplatelet effect. Has a pronounced anti-inflammatory and analgesic effect. The main purpose of the drug is to treat pain in chronic diseases of the musculoskeletal system.

Thus, the choice of NSAIDs is not an easy task, as it often seems at first glance. Representatives of the group, despite their widespread prevalence, have a number of dangerous side effects that must always be taken into account when on vacation. And today, the first place is taken by drugs that, in addition to proven effectiveness, have a high safety profile.

Ksefokam

Instructions for use:

Prices in online pharmacies:

Ksefokam is an anti-inflammatory and analgesic drug used to relieve pain and symptomatic treatment of rheumatic diseases.

pharmachologic effect

The active ingredient in Ksefokam is lornoxicam.

The anti-inflammatory effect of the drug is due to the ability of lornoxicam to inhibit the synthesis of prostaglandins, which are one of the regulators of biochemical processes in the body, and also to suppress the release of free radicals that are involved in provoking inflammatory processes.

After oral administration of Ksefokam, the maximum concentration of the drug in the blood can be observed after 1-2 hours. Ksefokam injections act faster - the maximum concentration is noted after 15 minutes.

About 1/3 of the metabolites of larnoxicam are excreted in the urine, and 2/3 - in the bile. The half-life of Ksefokam is 4 hours, it does not depend on the concentration level of the drug. Ksefokam, reviews confirm, does not cause drug dependence and addiction.

Indications for use of Ksefokam

Ksefokam tablets are prescribed for:

• moderate and severe pain of various origins: myalgia, pain in the spine, cancer;
• rheumatic diseases for the symptomatic treatment of inflammation and pain.

Ksefokam injections are advisable for short-term treatment of postoperative pain and pain caused by an acute attack of sciatica (pain in the leg as a result of damage to the sciatic nerve) or lumbago (lumbago in the lower back).

Contraindications

According to the instructions, Ksefokam is not prescribed for:

• blood clotting disorders;
• ulcerative colitis, stomach or duodenal ulcers in the acute stage;
• severe kidney disease;
• significant violations of hepatic functions;
• hemorrhagic stroke;
• dehydration, hypovolemia (decrease in blood volume);
• bronchial asthma;
• hearing loss;
• heart failure;
• deficiency of glucose-6-phosphate dehydrogenase.

The use of Ksefokam is contraindicated in patients under 18 years of age, pregnant women and patients who are breastfeeding.

Instructions for use Ksefokam

For oral administration, Xefocam tablets containing 4 mg or 8 mg of lornoxicam are intended.

With moderate or severe pain, 16 mg of the drug is prescribed per day, divided into two doses. On the first day of treatment, if necessary, it is possible to use an additional 16 mg.

For rheumatic diseases, as well as for maintenance therapy, the Ksefokam drug instruction recommends taking 4-8 mg twice a day, depending on the patient's well-being.

Ksefokam injections can be administered intravenously (at least 15 seconds) and intramuscularly (at least 5 seconds). To prepare a solution for injection, take 8 mg of dry powder and dilute in 2 ml of solvent. Ksefokam injections are used for acute pain syndrome: the recommended dose is 8 mg, with an insufficient analgesic effect, 8 mg of the drug is re-administered. Supportive therapy involves the use of Ksefokam 2 times a day, 8 mg.

For patients with renal or hepatic insufficiency, diseases of the digestive tract, with a body weight of less than 50 kg, dose adjustment is not required.

Side effects

To the undesirable effects of Ksefokam, reviews and instructions include:

• headache, insomnia, dizziness, drowsiness, agitation, migraine, meningitis, hallucinations, neuritis (inflammation of the peripheral nerves);
• conjunctivitis, visual impairment, hearing loss, tinnitus;
• sweating, fluctuations in body weight, chills;
• palpitations, peripheral edema, increased blood pressure;
• abdominal pain, flatulence, vomiting, nausea, dysphagia (difficulty swallowing);
• intestinal and rectal bleeding, peptic ulcers, hepatitis, colitis (inflammation of the large intestine), pancreatitis (inflammation of the pancreas), glossitis (inflammation of the tongue), stomatitis, dry mouth, changes in liver function;
• renal failure, increased urine production, glomerulonephritis (inflammation of tiny filters in the kidneys, called glomeruli), crystalluria (the appearance of salt crystals in the urine), nephrotic syndrome (a condition with kidney damage), urinary dysfunction;
• skin rash, allergic rhinitis, shortness of breath, bronchospasm, esfoliative dermatitis (inflammation of the skin surface, expressed in its redness and peeling), angiitis (inflammation of the vessels of the subcutaneous tissue and the walls of the skin vessels).

In reviews of Ksefokam, you can find information about the negative effect of the drug on the ability of women to become pregnant, which is explained by the action of lornoxicam, aimed at inhibiting the synthesis of prostaglandins.

Additional Information

Ksefokam tablets and powder for solution preparation, subject to storage conditions, will be usable for 5 years. Ready-to-use Xefocam solution should be used throughout the day, after 24 hours it is considered unusable.

Ksefokam tab. p.p. 8mg n10

Ksefokam tablets 8 mg 10 pcs.

Ksefokam 8 mg n10 tab

Ksefokam 8mg No. 10 tablets

Ksefokam rapid tablets 8 mg 12 pcs.

Ksefokam rapid tab. p.p. 8mg n12

Ksefokam rapid 8mg No. 12 tablets

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!

I came again to ask for advice on my temperature problem. Today I visited the mammologist and hematologist. They said the problem was not their part. I did ultrasound examination of the mammary glands, abdominal cavity, and schatovidi. The doctor at the ultrasound scan said - an absolutely healthy person. The hematologist advised to get tested for HIV again. For half a day I have been studying the symptoms of this disease, but the similarity is only in fever and weakness. No rash, loose stools, swollen lymph nodes, weight loss (on the contrary, I am overweight). I'm just going crazy.

diluted with water for injection

I have two vertebral hernias, I'm tired of fighting, it gives me a lot in my leg! I started to prick texamen, in the beginning it helped, then there was no sense at all!

Now we have advised ksefokam, I have been injecting it for the second day, it’s a little easier! I inject it twice a day!

Please advise who has come across the drug and in general with hernias! I’m tired of going to the doctors, there’s no sense in it, only money sucks!

I had a temperature for a month. It turned out that the thyroid gland gives a temperature, passed the tests, TSH, T4, were not normal, the endocrinologist prescribed treatment, drank according to the scheme, everything returned to normal and the temperature disappeared. Check your thyroid

No, Xefocam is diluted with water for injection.

If your liver stopped working, death would occur within 24 hours.

Four dark chocolate wedges contain about two hundred calories. So if you do not want to get better, it is better not to eat more than two slices a day.

Scientists from the University of Oxford conducted a series of studies, during which they came to the conclusion that vegetarianism can be harmful to the human brain, as it leads to a decrease in its mass. Therefore, scientists recommend not to completely exclude fish and meat from your diet.

The liver is the heaviest organ in our body. Its average weight is 1.5 kg.

People who are used to regularly eating breakfast are much less likely to be obese.

In an effort to get the patient out, doctors often go too far. So, for example, a certain Charles Jensen in the period from 1954 to 1994. survived over 900 surgeries to remove neoplasms.

With a regular visit to the tanning salon, the chance of getting skin cancer increases by 60%.

The rarest disease is Kuru disease. Only representatives of the Fur tribe in New Guinea are ill with it. The patient dies of laughter. It is believed that eating the human brain is the cause of the disease.

The human stomach copes well with foreign objects and without medical intervention. It is known that even coins can dissolve gastric juice.

More than $ 500 million a year is spent on allergy drugs in the United States alone. Do you still believe that a way to finally defeat allergies will be found?

The cough medicine "Terpinkod" is one of the best sellers, not at all because of its medicinal properties.

Tooth decay is the most common infectious disease in the world, which even the flu cannot compete with.

The well-known drug Viagra was originally developed for the treatment of arterial hypertension.

74-year-old Australian resident James Harrison has donated blood about 1000 times. He has a rare blood group whose antibodies help newborns with severe anemia survive. Thus, the Australian saved about two million children.

In order to say even the shortest and simplest words, we use 72 muscles.

Prostatitis is an inflammatory process in the area of ​​the prostate gland. This is one of the most common diseases of the genitourinary system in men. How.

Which is better: Nimesil or Aertal?

Comparison of drugs

Both drugs are designed to relieve inflammation and relieve pain in various diseases.

Aertal

The drug is intended to relieve inflammation and alleviate the condition in patients with rheumatic diseases. Aceclofenac, the main active ingredient of Aertal, affects the peripheral nervous system. In this case, pain is relieved and joint stiffness is reduced due to the long-term presence of the body in one position.

The active ingredient is good for osteochondrosis, arthritis, rheumatism and other disorders. Often, patients are prescribed the drug in two forms: for external and internal administration. In this case, the therapy is complex and most effective.

Nimesil

This drug, like the previous one, has a directed effect on the removal of inflammatory processes of various kinds. Taking Nimesil is prescribed to relieve pain and alleviate the general condition.

Nimesil is used for such pains:

Comparison of drugs

Comparison of Nimesil or Aertal for some parameters is presented in the table below:

Medicinal product review - Aertal

Aertal is a drug that belongs to anti-inflammatory drugs.

Auxiliary ingredients: liquid paraffin, methyl parahydroxybenzoate, emulsion wax, propyl parahydroxybenzoate, water.

The drug contains an active substance - aceclofenac, which suppresses the activity of the enzyme acyclooxygenase, reduces the synthesis of inflammatory cytokines.

Due to the high activity of this component in soft tissues and the peripheral nervous system, aceclofenac eliminates pain, relieves swelling and morning stiffness in rheumatic diseases.

After taking the drug orally, it is rapidly absorbed in the gastrointestinal tract and its maximum concentration reaches one and a half to three hours. Aceclofenac has a high degree of binding to plasma proteins, has a high concentration in the synovial fluid. The drug is excreted by the kidneys.

Indication

• With osteoarthritis;
• Spine pain;
• Rheumatic diseases;
• Lumbago;
• Toothache;
• Periarthritis of the shoulder scapula;
• Osteoarthritis;
• Alkylosing spondylitis;
• Rheumatoid arthritis;
• To relieve pain in inflammatory diseases.

Dosage

The doctor should prescribe the dose of treatment and the course of therapy for each patient individually, depending on the nature of the disease and its complexity. Usually, patients are prescribed one tablet twice a day.

Side effects

When taking this drug in patients, the following side effects were noted:

From the gastrointestinal tract: indigestion, stomach pain, nausea, increased liver enzymes, impaired stool. Perhaps the development of pancreatitis, stomatitis, ulcerative lesions of the mucous membranes of the gastrointestinal tract, gastric bleeding.

CNS: irritability, headaches, convulsions, memory loss, dizziness, change in taste, insomnia, hearing loss, vision, tremor. Rarely - aseptic meningitis, edema, renal failure.

CVS: palpitations, ischemic disease, arterial pressure disorder, leukopenia, heart failure, thrombocytopenia, agranulocytosis.

Allergic reactions: itching, skin rash, bronchospasm, eczema, urticaria, erythroderma, sometimes anaphylactic shock.

This medicinal product is contraindicated.

Individual intolerance to the components of the drug.

Diseases of the gastrointestinal tract during an exacerbation or suspicion of ulcerative lesions of the mucous membranes of the gastrointestinal tract, renal impairment, hematopoiesis, blood clotting disorders.

You can not prescribe the drug to pregnant women and nursing mothers, children under 18 years of age.

With extreme caution, it is necessary to take the remedy for people with bronchial asthma, with impaired kidney function, liver, with gastrointestinal tract disease, coronary heart disease, with high blood pressure, with impaired cerebral circulation, patients who suffer from diabetes mellitus, patients in old age, patients who drink alcohol and smoke.

It should also be taken with caution by patients whose work is directly related to the control of dangerous mechanisms or driving a car, as the drug can cause dizziness.

Interaction

When taken simultaneously with digoxin, lithium preparations, phenytoin, the risk of developing their plasma concentrations is possible.

Aertal can reduce the activity of diuretics.

When taken together with potassium preparations, the risk of developing hyperkalemia, hyperkaliuria is possible.

When taken simultaneously with cyclosporine, the nephrotic effect of cyclosporine may increase.

The drug can change the level of glucose in the blood, therefore, patients suffering from diabetes mellitus need to adjust the dose of hypoglycemic drugs.

The drug can increase the plasma concentrations of methotrexate, so it is necessary to observe the interval between doses, it should be at least a day.

When taken together with acetylsalicylic acid, it can reduce plasma concentrations of aceclofenac.

Concomitant use with anticoagulants and antiaggens increases the risk of bleeding.

Aertal can increase the ultirogenic effect of glucocorticosteroids and other anti-inflammatory drugs.

Overdose

In patients taking the drug in high doses, the following side effects were noted:

headache, nausea, abdominal pain, vomiting. Shown: rinse the stomach, take sorbents. Symptomatic treatment.

Storage

Store in a protected place from light, at temperature barriers.

Cheap analogues and substitutes for the drug Aertal in tablets, ointments, powders and ampoules

The Spanish-made drug Aertal refers to anti-inflammatory nonsteroidal drugs based on aceclofenac. The medication is an effective analgesic; it is used as an antipyretic medicine.

Average prices in pharmacies are 325–850 rubles.

Aertal should not be used during pregnancy, lactation, children under 18 years of age. There are other contraindications.

There are many pain relieving medications with identical mechanisms of action, but the active ingredient may differ. Close substitutes and cheap analogs of the drug often help out patients if it is impossible to treat with Aertal.

Analogs of Russian production

The table includes synonyms of Aertal from the number of non-steroidal anti-inflammatory drugs from a domestic manufacturer.

It has identical indications and contraindications, available in tablets.

On sale there is a gel, rectal suppositories, tablets, injection solution.

The remedy is used for diseases of the joints and the musculoskeletal system, accompanied by pain and inflammation.

The scope includes the treatment of rheumatoid arthritis, arthropathy, arthrosis, bursitis, spondylitis, tendinitis, radiculopathy.

Ukrainian substitutes

Ukrainian-made analogues of Aertal have a different composition of the drug, but the same indications for use.

The list contains medications that will tell you how to replace the drug:

• Revmoxicam. The best and cheapest drug for the treatment of rheumatological pathologies and joint diseases. The medicine is based on meloxicam. The average price is 110–245 rubles.
• Fort Gel. Non-steroidal anti-inflammatory drug with ketoprofen in the basis of the drug. It is used topically to relieve pain from bruises, injuries, and rheumatic diseases. The average price is 55–70 rubles.
• Diclofenac Sodium. Inexpensive Ukrainian close substitute for Aertal with the active ingredient diclofenac. It is produced in the form of an ointment, gel, cream, powder for dilution, suppositories, tablets, suspension.

Anesthetic and anti-inflammatory medication with antipyretic function. The average price is 20–110 rubles.

Belarusian generics

It is necessary to consider modern Belarusian generics of Aertal, which can act as an effective substitute for a cheap pain relieving and anti-inflammatory medication for rheumatic and other diseases.

It is used for osteoarthritis, rheumatoid arthritis, ankylosing spondyloarthritis, periarthritis of the shoulder scapula, to relieve pain.

Sold in capsules.

Indications for use: joint diseases, rheumatoid arthritis, ankylosing spondylitis.

The line of medication includes various forms of release from tablets to powders and suppositories.

Tablets, gel or suspension are used in the treatment of rheumatic and joint diseases, as well as to relieve acute pain syndrome.

The cheapest synonym for aertal with the active substance of the same name.

Available in tablets, you can also find a gel, ointment, cream, powder for injection, suspension.

The drug is used for pain relief, temperature reduction, as an anti-inflammatory agent.

Can be used in 2.3 trimesters of pregnancy, children from 3 months, breastfeeding.

Other foreign analogues

Below are the best imported drugs from the group of non-steroidal anti-inflammatory drugs.

1. Asinak. The medication is used to treat inflammatory diseases of the musculoskeletal system. The composition of the drug includes aceclofenac. Country of origin - India. The average price is 315-380 rubles.
2. Aceclone. The popular analogue of Aertal from the category of medicines with aceclofenac is cheaper. The indications are as follows: various types of arthritis, ankylosing spondylitis, gout, osteoarthritis. The drug is manufactured in India. The average price is 185–450 rubles.
3. Zerodol. Aceclofenac tablets. Anti-rheumatic non-steroidal agent with anti-inflammatory and antipyretic function. Country of origin - India. The average price is 90–150 rubles.
4. Voltaren. Emulgel based on diclofenac potassium salt, which has a pronounced analgesic and anti-inflammatory effect. Swiss medicine with various forms of release: gel, patch, ointment, tablets, injections in ampoules, suppositories, spray. The average price is 210-650 rubles.
5. Movalis. The drug treats arthrosis, arthritis and other rheumatological diseases of the musculoskeletal system and blood vessels. Tablets, injections and suspension contain meloxicam in the base. The medication is produced in Greece, Germany, Austria. The average price is 205-920 rubles.
6. Nimesil. One of the best inexpensive imported analogues of Aertal with nimesulide in the base. There are many forms of release: cream, gel, tablets, ointment, powder for preparing a drink, injection solution, suspension, spray, drops, vaginal and rectal suppositories.

Means of Italian or German production. The average price is 25-690 rubles.

Despite the free vacation in the pharmacy, self-selection of the medicine is not recommended. In order to permanently get rid of pain and eliminate not a symptom of the disease, but its cause, you need to consult a doctor.

Systemic non-steroidal anti-inflammatory drugs

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

Main indications:

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

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

The most common side effects: allergic reactions, nausea, abdominal pain, erosion and ulceration of the gastrointestinal mucosa.

The main contraindications: individual intolerance, exacerbation of gastric ulcer and duodenal ulcer.

Important information for the patient:

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

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

Even over-the-counter pain relief medications cannot be used long-term. If they are required often, several times a week, a doctor's examination and treatment is necessary according to the recommendations of a rheumatologist or neurologist.

In some cases, with long-term use of funds of this group, additional intake of proton pump inhibitors that protect the stomach is required.

Anti-inflammatory drugs for joints (NSAIDs): a review of remedies

The inflammatory process in almost all cases accompanies rheumatic pathology, significantly reducing the patient's quality of life. That is why one of the leading areas of therapy for joint diseases is anti-inflammatory treatment. This effect is possessed by several groups of drugs: non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids for systemic and local use, partly only as part of a comprehensive treatment, - chondroprotectors.

In this article, we will consider the group of drugs indicated first - NSAIDs.

Non-steroidal anti-inflammatory drugs (NSAIDs)

This is a group of drugs, the effects of which are anti-inflammatory, antipyretic and analgesic. The severity of each of them is different for different drugs. These drugs are called non-steroidal because they differ in structure from hormonal drugs, glucocorticoids. The latter also have a powerful anti-inflammatory effect, but at the same time they have the negative properties of steroid hormones.

The mechanism of action of NSAIDs

The mechanism of action of NSAIDs is their indiscriminate or selective inhibition (inhibition) of the varieties of the COX enzyme - cyclooxygenase. COX is found in many tissues of our body and is responsible for the production of various biologically active substances: prostaglandins, prostacyclins, thromboxane and others. Prostaglandins, in turn, are mediators of inflammation, and the more there are, the more pronounced the inflammatory process. NSAIDs, inhibiting COX, reduce the level of prostaglandins in tissues, and the inflammatory process regresses.

Scheme for the appointment of NSAIDs

Some NSAIDs have a number of rather serious side effects, while other drugs in this group are not characterized as such. This is due to the peculiarities of the mechanism of action: the effect of medicinal substances on various types of cyclooxygenase - COX-1, COX-2 and COX-3.

COX-1 in a healthy person is found in almost all organs and tissues, in particular, in the digestive tract and kidneys, where it performs its most important functions. For example, prostaglandins synthesized by COX are actively involved in maintaining the integrity of the gastric and intestinal mucosa, maintaining adequate blood flow in it, decreasing the secretion of hydrochloric acid, increasing pH, secretion of phospholipids and mucus, stimulating cell proliferation (reproduction). Drugs that inhibit COX-1 cause a decrease in the level of prostaglandins not only in the focus of inflammation, but throughout the body, which can entail negative consequences, which will be discussed below.

COX-2, as a rule, is absent in healthy tissues or is found, but in insignificant amounts. Its level rises directly during inflammation and in its very focus. Drugs that selectively inhibit COX-2, although they are often taken systemically, act precisely on the focus, reducing the inflammatory process in it.

COX-3 is also involved in the development of pain and fever, but it has nothing to do with inflammation. Certain NSAIDs affect precisely this type of enzyme and have little effect on COX-1 and 2. Some authors, however, believe that COX-3, as an independent isoform of the enzyme, does not exist, and it is a variant of COX-1: these questions need conducting additional research.

NSAID classification

There is a chemical classification of non-steroidal anti-inflammatory drugs, based on the structural features of the molecule of the active substance. However, biochemical and pharmacological terms are probably of little interest to a wide range of readers, so we offer you another classification, which is based on the selectivity of COX inhibition. According to her, all NSAIDs are divided into:

1. Non-selective (affect all types of COX, but mainly COX-1):

2. Non-selective, affecting equally on COX-1 and COX-2:

3. Selective (inhibit COX-2):

Some of the drugs listed above have practically no anti-inflammatory effect, but rather have an analgesic (Ketorolac) or antipyretic effect (Aspirin, Ibuprofen), so we will not talk about these drugs in this article. Let's talk about those NSAIDs, the anti-inflammatory effect of which is most pronounced.

Briefly about pharmacokinetics

Nonsteroidal anti-inflammatory drugs are administered orally or intramuscularly.

When taken orally, they are well absorbed in the digestive tract, their bioavailability is about%. They are better absorbed in an acidic environment, and a shift in the pH of the stomach to the alkaline side slows down absorption. The maximum concentration of the active substance in the blood is determined 1-2 hours after taking the drug.

When administered intramuscularly, the drug binds to blood proteins by 90-99%, forming functionally active complexes.

They penetrate well into organs and tissues, especially into the focus of inflammation and synovial fluid (located in the joint cavity). NSAIDs are excreted in the urine. The half-life varies widely depending on the drug.

Contraindications to the use of NSAIDs

It is undesirable to use drugs in this group under the following conditions:

The main side effects of NSAIDs

• ulcerogenic effect (the ability of drugs in this group to provoke the development of ulcers and erosions of the gastrointestinal tract);
• dyspeptic disorders (stomach discomfort, nausea and others);
• bronchospasm;
• toxic effects on the kidneys (impaired function, increased blood pressure, nephropathy);
• toxic effects on the liver (increased activity in the blood of hepatic transaminases);
• toxic effects on the blood (a decrease in the number of formed elements up to aplastic anemia, a violation of blood coagulation, manifested by bleeding);
• prolongation of pregnancy;
• allergic reactions (skin rash, itching, anaphylaxis).

The number of reports of adverse reactions of drugs of the NSAID group received in years

Features of NSAID therapy

Since the drugs of this group, to a greater or lesser extent, have a damaging effect on the gastrointestinal mucosa, most of them must be taken after a meal, washed down with a sufficient amount of water, and, preferably, with the parallel use of drugs to maintain the gastrointestinal tract. As a rule, this role is played by proton pump inhibitors: Omeprazole, Rabeprazole and others.

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

Persons with impaired renal function, as well as elderly patients, are usually prescribed a dose below the average therapeutic dose, since the metabolic processes in these categories of patients are slowed down: the active substance both has an effect and is excreted for a longer period.

Let's consider individual drugs of the NSAID group in more detail.

Indomethacin (Indomethacin, Metindol)

Release form - tablets, capsules.

It has a pronounced anti-inflammatory, analgesic and antipyretic effect. Inhibits the aggregation (sticking to each other) of platelets. The maximum concentration in the blood is determined 2 hours after ingestion, the half-life is 4-11 hours.

Assign, as a rule, inside pomg 2-3 times a day.

The side effects listed above for this drug are quite pronounced, therefore, it is currently used relatively rarely, yielding primacy to other, safer drugs in this regard.

Diclofenac (Almiral, Voltaren, Diklak, Dikloberl, Naklofen, Olfen and others)

Release form - tablets, capsules, injection, suppositories, gel.

It has a pronounced anti-inflammatory, analgesic and antipyretic effect. It is rapidly and completely absorbed in the gastrointestinal tract. The maximum concentration of the active substance in the blood is reached in a minute. Almost 100% absorbed with blood proteins and transported throughout the body. The maximum concentration of the drug in the synovial fluid is determined after 3-4 hours, the half-life of it from it is 3-6 hours, from blood plasma - 1-2 hours. It is excreted in urine, bile and feces.

As a rule, the recommended dose of diclofenac for adults is 2–3 mg by mouth. The maximum daily dose is 300 mg. The retard form, equal to 100 g of the drug in one tablet (capsule), is taken once a day. When administered intramuscularly, a single dose is 75 mg, the frequency of administration is 1-2 times a day. The preparation in the form of a gel is applied with a thin layer on the skin in the area of ​​the inflammation, the frequency of application is 2-3 times a day.

Etodolak (Aetol Fort)

Release form - capsules of 400 mg.

The anti-inflammatory, antipyretic and analgesic properties of this drug are also quite pronounced. It has moderate selectivity - it acts mainly on COX-2 in the focus of inflammation.

It is rapidly absorbed from the gastrointestinal tract when taken orally. Bioavailability is independent of food intake and antacids. The maximum concentration of the active substance in the blood is determined after 60 minutes. 95% bound to blood proteins. The plasma half-life is 7 hours. It is excreted from the body mainly in the urine.

It is used for urgent or long-term therapy of rheumatological pathology: osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, as well as in the case of pain syndrome of any etiology.

Contraindications are standard. Side effects are similar to those of other NSAIDs, however, due to the relative selectivity of the drug's action, they appear less often and are less pronounced.

Reduces the effect of some antihypertensive drugs, in particular, ACE inhibitors.

Aceclofenac (Aertal, Diclotol, Zerodol)

Available in the form of 100 mg tablets.

A worthy analogue of diclofenac with a similar anti-inflammatory and analgesic effect.

After oral administration, it is rapidly and almost 100% absorbed by the gastric mucosa. With the simultaneous intake of food, the rate of absorption slows down, but its degree remains the same. It binds to plasma proteins almost completely, in this form spreading throughout the body. The concentration of the drug in the synovial fluid is quite high: it reaches 60% of its concentration in the blood. The average half-life is 4-4.5 hours. It is excreted mainly by the kidneys.

Side effects should be noted dyspepsia, nausea, diarrhea, pain in the abdomen, increased activity of liver transaminases, dizziness: these symptoms are quite common, in 1-10 cases out of 100. Other undesirable reactions are much less common, in particular, stomach ulcers - less than one patient in 10,000.

It is possible to reduce the likelihood of side effects by prescribing the minimum effective dose to the patient as soon as possible.

It is not recommended to take aceclofenac during pregnancy and lactation.

Reduces the antihypertensive effect of antihypertensive drugs.

Piroxicam (Piroxicam, Fedin-20)

Release form - tablets of 10 mg.

In addition to anti-inflammatory, analgesic and antipyretic effects, it also has an antiplatelet effect.

Well absorbed in the gastrointestinal tract. Simultaneous food intake slows down the rate of absorption, but does not affect the degree of its effect. The maximum concentration in the blood is observed after 3-5 hours. The concentration in the blood is significantly higher with intramuscular administration of the drug than after taking it orally. It penetrates 40-50% into synovial fluid and is found in breast milk. Undergoes a number of changes in the liver. It is excreted in the urine and feces. The half-life is equal to hours.

The analgesic effect appears within half an hour after taking the pill and lasts for a day.

Dosages of the drug vary depending on the disease and range from 10 to 40 mg per day in one or more doses.

Contraindications and side effects are standard.

Tenoxicam (Texamen-L)

Release form - powder for preparation of solution for injection.

Apply intramuscularly to 2 ml (20 mg of the drug) per day. In acute gouty arthritis - 40 mg 1 time per day for 5 days in a row at the same time.

Enhances the effects of indirect anticoagulants.

Lornoxicam (Xefokam, Larfix, Lorakam)

Release form - tablets of 4 and 8 mg, powder for preparation of solution for injection, containing 8 mg of the drug.

Intramuscularly or intravenously, 8 mg is administered at a time. Frequency rate of injections per day: 1-2 times. The solution for injection must be prepared immediately before use. The maximum daily dose is 16 mg.

Elderly patients do not need to reduce the dosage of lornoxicam, however, due to the likelihood of adverse reactions from the gastrointestinal tract, persons with any gastroenterological pathology should take it with caution.

Meloxicam (Movalis, Melbek, Revmoxicam, Rekoksa, Melox and others)

The release form - tablets of 7.5 and 15 mg, solution for injection of 2 ml in an ampoule containing 15 mg of the active ingredient, rectal suppositories, also containing 7.5 and 15 mg of Meloxicam.

Selective COX-2 inhibitor. Less often than other drugs of the NSAID group, it causes side effects in the form of kidney damage and gastropathy.

As a rule, in the first few days of treatment, the drug is used parenterally. 1-2 ml of solution is injected deep into the muscle. When the acute inflammatory process subsides a little, the patient is transferred to the tablet form of meloxicam. Inside, it is used regardless of food intake, 7.5 mg 1-2 times a day.

Celecoxib (Celebrex, Revmoxib, Zitsel, Phlogoxib)

Release form - capsules of 100 and 200 mg of the drug.

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

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

Side effects are rare. In the case of long-term use of the drug in a high dosage, ulceration of the mucous membrane of the digestive tract, gastrointestinal bleeding, agranulocytosis and thrombocytopenia are possible.

Rofecoxib (Denebol)

Release form - solution for injection in 1 ml ampoules, containing 25 mg of active ingredient, tablets.

Highly selective inhibitor of COX-2 with pronounced anti-inflammatory, analgesic and antipyretic properties. Virtually no effect on the mucous membrane of the gastrointestinal tract and kidney tissue.

It is prescribed with caution in women in the 1st and 2nd trimesters of pregnancy, during lactation, for persons suffering from bronchial asthma or severe renal insufficiency.

The risk of developing side effects from the gastrointestinal tract increases with taking high dosages of the drug for a long time, as well as in elderly patients.

Etoricoxib (Arcoxia, Exineph)

Release form - tablets of 60 mg, 90 mg and 120 mg.

Selective COX-2 inhibitor. It does not affect the synthesis of prostaglandins in the stomach, it does not affect the function of platelets.

The drug is taken orally, regardless of food intake. The recommended dose directly depends on the severity of the disease and varies within 1 mg per day. Elderly patients do not need to adjust the dosage.

Side effects are extremely rare. As a rule, they are noted by patients taking etoricoxib for 1 year or more (for serious rheumatic diseases). The spectrum of undesirable reactions arising in this case is extremely wide.

Nimesulid (Nimegesic, Nimesil, Nimid, Aponil, Nimesin, Remesulid and others)

Release form - tablets of 100 mg, granules for preparation of a suspension for oral administration in a sachet containing 1 dose of the drug - 100 mg each, gel in a tube.

Highly selective inhibitor of COX-2 with pronounced anti-inflammatory, analgesic and antipyretic effects.

The drug is taken orally, 100 mg twice a day, after meals. The duration of treatment is determined individually. The gel is applied to the affected area, rubbing lightly into the skin. Frequency rate of application - 3-4 times a day.

When prescribing Nimesulide to elderly patients, dose adjustment of the drug is not required. The dose should be reduced in case of severe impairment in the patient's liver and kidney function. May have hepatotoxic effects, inhibiting liver function.

During pregnancy, especially in the 3rd trimester, it is strongly discouraged to take nimesulide. During breastfeeding, the drug is also contraindicated.

Nabumeton (Sinmeton)

Release form - tablets of 500 and 750 mg.

Non-selective COX inhibitor.

A single dose for an adult patient is 000 mg during or after a meal. In severe cases, the dose may be increased to 2 grams per day.

Side effects and contraindications are similar to those of other non-selective NSAIDs.

Not recommended if pregnant or breastfeeding.

Combined non-steroidal anti-inflammatory drugs

There are drugs containing two or more active substances from the NSAID group, or NSAIDs in combination with vitamins or other drugs. The main ones are listed below.

• Dolaren. Contains 50 mg of diclofenac sodium and 500 mg of paracetamol. In this drug, the pronounced anti-inflammatory effect of diclofenac is combined with the striking analgesic effect of paracetamol. The drug is taken orally, 1 tablet 2-3 times a day after meals. The maximum daily dose is 3 tablets.
• Neurodiclovitis. Capsules containing 50 mg of diclofenac, vitamin B1 and B6, as well as 0.25 mg of vitamin B12. Here, the analgesic and anti-inflammatory effect of diclofenac is enhanced by B vitamins, which improve metabolism in the nervous tissue. The recommended dose of the drug is 1-3 capsules per day in 1-3 doses. Take the drug after meals with plenty of fluids.
• Olfen-75, produced in the form of a solution for injection, in addition to diclofenac in the amount of 75 mg also contains 20 mg of lidocaine: due to the presence of the latter in the solution, injections of the drug become less painful for the patient.
• Fanigan. Its composition is similar to that of Dolaren: 50 mg of sodium diclofenac and 500 mg of paracetamol. It is recommended to take 1 tablet 2-3 times a day.
• Flamidez. A very interesting drug that is different from others. In addition to 50 mg of diclofenac and 500 mg of paracetamol, it also contains 15 mg of serratiopeptidase, which is a proteolytic enzyme and has a fibrinolytic, anti-inflammatory and anti-edema effect. Available in the form of tablets and gel for topical use. The tablet is taken orally, after a meal, with a glass of water. As a rule, 1 tablet is prescribed 1-2 times a day. The maximum daily dose is 3 tablets. The gel is used externally, applying it to the affected area of ​​the skin 3-4 times a day.
• Maxigezik. The drug is similar in composition and action to Flamidez described above. The difference lies in the manufacturing company.
• Diplo-P-Pharmex. The composition of these tablets is similar to that of Dolaren. The dosages are the same.
• Dolar. The same.
• Dolex. The same.
• Oxalgin-DP. The same.
• Tsinepar. The same.
• Diclokain. Like Olfen-75, it contains diclofenac sodium and lidocaine, but both active ingredients are in half the dosage. Accordingly, it is weaker in action.
• Dolaren gel. Contains diclofenac sodium, menthol, linseed oil and methyl salicylate. All these components, to one degree or another, have an anti-inflammatory effect and potentiate the effects of each other. The gel is applied to the affected skin 3-4 times during the day.
• Nimid forte. Tablets containing 100 mg of nimesulide and 2 mg of tizanidine. This drug successfully combines the anti-inflammatory and analgesic effects of nimesulide with the muscle relaxant (muscle relaxing) action of tizanidine. It is used for acute pain caused by a spasm of skeletal muscles (in the popular way - with pinching of the roots). The drug is taken orally after a meal with plenty of liquid. The recommended dose is 2 tablets per day in 2 divided doses. The maximum duration of treatment is 2 weeks.
• Nizalid. Like nimid forte, it contains nimesulide and tizanidine in similar dosages. The recommended doses are the same.
• Alit. Soluble tablets containing 100 mg of nimesulide and 20 mg of dicycloverine, which is a muscle relaxant. It is taken orally after meals with a glass of liquid. It is recommended to take 1 tablet 2 times a day for no longer than 5 days.
• Nanogan. The composition of this drug and the recommended dosages are similar to those of the Alit drug described above.
• Oksigan. The same.

Cheap analogues of Aertal tablets, as well as cream, ointment and powder

Joint diseases are a pathology that forces patients to use anti-inflammatory pain relievers. The article talks about the effective drug Aertal and the features of choosing its inexpensive analogues, taking into account information about the medicine and reviews of doctors and patients.

Who is Aertal prescribed and why?

Aertal is a remedy for the treatment of joint diseases containing aceclofenac. Refers to non-steroidal anti-inflammatory drugs for systemic and local use. Suppresses the synthesis of prostaglandins, anti-inflammatory and pain relief.

It penetrates well into the joint fluid, provides a long-lasting effect. The drug is produced in Hungary in the form of tablets and powder for the preparation of a suspension with a single dose of 100 mg of aceclofenac and in the form of 1.5% cream.

Aertal in the form of oral forms is used to treat pathology of the musculoskeletal system and some conditions accompanied by pain, including:

• rheumatism, including extra-articular changes;
• osteoarthritis;
• rheumatoid arthritis;
• ankylosing spondylitis;
• toothache;
• primary dysmenorrhea;
• lumbodynia.

Aertal is taken 1 tablet or packet 1-2 times a day after or during meals. The powder is dissolved in warm water and drunk. The maximum daily dose is 200 mg.

Aertal is contraindicated for:

• hypersensitivity to aceclofenac, drug components or acetylsalicylic acid;
• after gastrointestinal bleeding or perforation due to taking NSAIDs;
• peptic ulcer of the stomach or duodenum;
• bleeding or hemostasis disorders;
• severe cardiac, severe renal and hepatic failure;
• with angina pectoris and after myocardial infarction or coronary artery bypass grafting.

The medicine is not used during breastfeeding, in the third trimester of pregnancy and in children under 18 years of age.

Side effects of Aertal are most often associated with unwanted effects on the digestive system.

There were acute erosions and ulcers, perforation of the wall of the digestive tract, bleeding, sometimes severe. Nausea with vomiting, loose stools, flatulence, abdominal pain, exacerbation of gastritis, and other dyspeptic manifestations are noted. There are allergic reactions, neurological disorders, anemia.

When treating with aceclofenac, the risk of myocardial infarction and stroke may increase. The cream is used topically in adults in the treatment of pain after injuries of the musculoskeletal system, in the complex therapy of lumbago, torticollis and periarthrosis. The product is applied to clean skin up to 3 times a day.

The cream is not used if there have been reactions of intolerance to its components.

The peculiarities of drug-drug interactions require caution in hypertension - aceclofenac reduces the effectiveness of some antihypertensive drugs. It is not used in combination with other NSAIDs, methotrexate, cardiac glycosides, lithium compounds, anticoagulants, fluoroquinolones.

Interactions are more related to oral forms of aceclofenac, with cream treatment restrictions are minimal.

The cost of Aertal is rubles for 20 tablets, a large package is more profitable - 60 tabs for 800 rubles. 20 packs of 100 mg will cost cut. The price of 60 grams of cream is 330 rubles. Many analogs are cheaper. Let's consider them.

How to replace Aertal?

In pharmacies, domestic preparations of aceclofenac are sold in the form of tablets and there is a large assortment of all forms of anti-inflammatory drugs with other active substances with similar efficacy.

Complete analogues of Aertal are represented by three tableted generic drugs of Russian production. In terms of composition, properties and usage, they are identical to the Hungarian generic (original product - Niplonac).

Their cost is much more affordable:

• Aceclofenac (CJSC "Berezovsky FZ") up to 100 rubles for 20 tablets;
• Alenthal (CJSC "VERTEX") 250 rubles for 20 tab;
• Aceclofenac (Sintez) - packs of 20 and 60 tabs for 220 and 550 rubles.

Some NSAIDs with other active substances can replace Airtal in cases where there are no drugs with aceclofenac.

When choosing a replacement for an anti-inflammatory drug, you need to understand that in different clinical situations, not all drugs will have the same effect. The severity of the analgesic and anti-inflammatory effect differs with different duration and nature of the pathological process.

Therefore, the replacement of prescription drugs, which include Aertal tablets and powder, with drugs with a different composition should be carried out by a doctor. On your own or with the help of a pharmacist, you can choose an aceclofenac drug that is suitable for the price and choose a replacement for the cream.

Pills and capsules

Aceclofenac can only be completely replaced with other prescription NSAIDs. Over-the-counter products such as Ibuprofen, Naproxen and Aspirin will not provide the desired effect. Meloxicam, diclofenac, celecoxib and ketoprofen will have a similar effect in chronic joint damage.

For acute pain, Ketorolac is an optimal substitute.

Meloxicam is an optimal remedy for patients with joint lesions, has chondroprotective properties. Available in tablets of 7.5 and 15 milligrams, taken 1 time per day. The drug can be used in remission of stomach ulcers.

Imported substitutes - medicines Meloxicam-Teva, Meloxicam Stada cost a cut for 10 tablets of 15 mg each or for 20 tabs of 7.5 mg each, the same dosage of a Russian drug from different manufacturers costs from 75 to 130 rubles.

Diclofenac is the most famous and very popular drug used for joint diseases due to its cheapness. Several years ago, it was considered the standard of anti-inflammatory therapy, now its use is limited due to side effects.

Has a pronounced side effect on the stomach, can cause thrombosis and lead to the development of heart attacks and strokes. Reduces the effectiveness of antihypertensive drugs when used together.

It is used in the form of tablets of 50 and 75 mg and capsules of 100 mg. The maximum daily dose is 150 milligrams. Imported drugs Dikloberl and Diklak 75 mg No. 10 - 70 rubles. Diclofenac of Russian production costs from 48 rubles. (100 mg 20 pcs.)

Ketoprofen - capsules and tablets of 50, 100 and 150 mg. Indiscriminate drug with good analgesic effect in chronic inflammation. 25 capsules of foreign Ketonal, 50 mg each, cost 100 rubles. Domestic Ketoprofen is 1.5-2 times cheaper.

Celecoxib is a selective anti-inflammatory agent, available in capsule form with a dosage of 100 and 200 mg. Does not show gastrotoxicity and can be used for stomach problems.

Affects the processes of conduction of excitation in the heart, therefore it is limitedly used in cardiac pathology. From cheap analogs, imported Dilax is available in rubles for 10 capsules and domestic Roucoxib-Routek at the same price.

Ketorolac is a drug with a predominant analgesic effect, the most effective of those listed in acute conditions - trauma, toothache, after surgery. The maximum effect is manifested in the first 3-5 days after injury or the appearance of pain.

It is not used for chronic pain (except for oncology). Tablets contain 10 mg of ketorolac, taken up to 4 times a day.

The most famous imported remedy is the Romanian Ketanov, the price of 10 tablets is 60 rubles. Domestic Ketorolac costs about 20 rubles.

Creams, ointments and gels

The choice is made among anti-inflammatory drugs based on ketoprofen, nimesulide and diclofenac with a similar analgesic effect:

• Fastum gel - contains 2.5% ketoprofen, 30 grams of gel cost 240 rubles, 100g - 550 rubles;
• Ketonal - 5% cream with ketoprofen, price 30 g - 300 rubles. There is a 2.5% gel, 50g costs 300 rubles;
• Bystrumgel is a Russian medicine with the same substance in a concentration of 2.5%, the cost of 30 grams is 190 rubles;
• Nise - 1% nimesulide gel, 20 g cost 175 rubles;
• Diclac gel containing 5% diclofenac, price 50 g - 270 rubles;
• domestic Diclofenac in the form of 1% gel and ointment, an inexpensive remedy with a price of 30 rubles per 30 grams, 5% gel costs 2-2.5 times more.

The most effective remedies are those with 5% ketoprofen and diclofenac.

Powders in sachets

When choosing a replacement for Aertal in powder form, the funds are compared with other components. The most popular NSAIDs in powders are the Italian drug Nimesil, which contains 100 mg of nimesulide. Its cost is 680 rubles for 30 packages.

Nimesulide has many restrictions on its use due to hepatotoxicity, in addition to the standard contraindications for NSAIDs, it cannot be used for liver diseases, alcoholism, colds and flu, and if the patient's body temperature rises, the drug should be canceled. In a number of countries that continue to use it, joint diseases were excluded from the indications.

In neighboring countries, there are drugs on sale Dexalgin-sachet (dexketoprofen) and Katafast (diclofenac potassium), the effectiveness and safety of which is higher than that of nimesulide.