Why do doctors prefer NSAIDs - what to consider when prescribing?

Non-steroidal anti-inflammatory drugs have been used in clinical practice for many years to relieve pain. This is a large class of drugs, among which ibuprofen and nimesulide stand out. In this article, we will tell you what is special about these drugs and why they often become the drugs of choice for relieving pain.

INDICATIONS FOR USE

NSAIDs are most often symptoms of rheumatoid arthritis, osteoarthritis, myalgia, headache, toothache, menstrual pain, and others. The general principle of action of NSAIDs is to block the enzyme cyclooxygenase (COX), which is involved in the synthesis of prostaglandins - substances responsible for the occurrence of pain, inflammation and fever. The most frequently prescribed NSAIDs include paracetamol, ibuprofen, diclofenac, nimesulide, acetylsalicylic acid and many others. It is important to note that NSAIDs should be used under the supervision of a doctor, especially if a long course of treatment is planned or the patient has problems with the gastrointestinal tract and cardiovascular system, since this class of drugs can damage the gastric mucosa and affect blood rheology as side effects. As an example of the most well-known and effective NSAIDs, we will consider ibuprofen and nimesulide.

IBUPROFEN

Ibuprofen has analgesic, anti-inflammatory and antipyretic properties. It is prescribed to relieve symptoms of various conditions, including rheumatoid arthritis (including juvenile RA or Still's disease), osteoarthritis, ankylosing spondylitis, osteoarthrosis and other non-rheumatoid (seronegative) arthropathies.

In addition, ibuprofen is indicated for the treatment of non-rheumatic inflammatory processes of the periarticular tissues, such as "frozen shoulder" (inflammation of the joint lining), bursitis, tendinitis, tendovaginitis and low back pain; to relieve pain syndrome due to muscle and ligament damage. Ibuprofen is often prescribed to relieve pain due to dysmenorrhea, dental, headache or postoperative pain.

How does ibuprofen work?

Like all NSAIDs, ibuprofen blocks cyclooxygenase, in particular its isoforms COX-1 and COX-2. This leads to a decrease in the formation of prostaglandins, and as a result - a reduction in inflammation, pain and fever. It is important to note that blocking COX-1 can adversely affect the mucous membrane of the stomach and intestines, causing dyspeptic disorders, since this enzyme plays a protective role in maintaining the integrity of the mucous membrane. This should be taken into account when prescribing ibuprofen for a long course (longer than 7 days) or in high doses, especially if the patient already has problems with the gastrointestinal tract.

Ibuprofen is part of the drugs "Forsil Express" and "Forsil Light", 200 mg and 400 mg, respectively. These drugs are manufactured by NIKA PHARM.

"Forsil Express" and "Forsil Light" have an analgesic, anti-inflammatory, antipyretic effect. "Forsil Express" and "Forsil Light" are used to relieve migraine-like headaches, toothache, back pain, neuralgia, painful menstruation, rheumatic and muscle pain, and these drugs also relieve the symptoms of colds and flu.

What drugs is it undesirable to use ibuprofen with?

The simultaneous use of ibuprofen with the following drugs should be avoided:

Acetylsalicylic acid (aspirin).

Concomitant therapy with ibuprofen and acetylsalicylic acid is generally not recommended, so as not to aggravate possible side effects (except for doses up to 75 mg / day). In case of combined therapy, there is a high risk that ibuprofen will competitively inhibit the effect of low-dose acetylsalicylic acid on platelet aggregation.

Corticosteroids.

The risk of gastrointestinal ulcers and gastrointestinal bleeding increases.

Antiplatelet drugs and some selective serotonin reuptake inhibitors (SSRIs).

The risk of gastrointestinal bleeding also increases.

Antihypertensive and diuretic drugs.

Ibuprofen and NSAIDs in general can reduce the effectiveness of drugs in these groups.

Anticoagulants. NSAIDs can enhance the effect of drugs that reduce blood clotting, such as warfarin. When prescribed simultaneously with anticoagulant and thrombolytic drugs, the risk of bleeding increases.

Cardiac glycosides.

When taken simultaneously, NSAIDs may worsen heart failure, cause a decrease in the glomerular filtration rate, and increase the concentration of glycosides in the blood plasma.

Lithium.

There is evidence that NSAIDs can potentially cause an increase in the concentration of lithium in the blood plasma.

Methotrexate.

There is evidence that NSAIDs can potentially cause an increase in the concentration of methotrexate in the blood plasma.

Cyclosporin.

Increased risk of nephrotoxicity.

Mifepristone.

NSAIDs should not be used for 8-12 days after taking mifepristone, since NSAIDs can reduce the effect of mifepristone.

Tacrolimus.

When taking NSAIDs and tacrolimus simultaneously, the risk of nephrotoxicity may increase.

Zidovudine.
Concomitant use of NSAIDs and zidovudine may increase hematotoxicity. There is evidence of an increased risk of hemarthrosis and hematomas in HIV-positive patients with hemophilia who received concomitant treatment with zidovudine and ibuprofen.

Quinolone antibiotics.
Animal studies have shown that NSAIDs may increase the risk of seizures associated with quinolone antibiotics. Patients taking NSAIDs and quinolones concomitantly are at increased risk of seizures.

Cyclosporine and gold preparations.
Enhance the effect of ibuprofen on prostaglandin synthesis in the kidneys, which increases the risk of nephrotoxicity. Ibuprofen increases the plasma concentration of cyclosporine and the likelihood of its hepatotoxic effects.

Oral antidiabetic agents.
Ibuprofen enhances the effect of oral hypoglycemic drugs, sulfonylureas and insulin, which may increase the risk of hypoglycemia. Given all of the above, a course of ibuprofen medications is prescribed by a doctor after a thorough examination of the patient's medical history and with further monitoring of his condition.

NIMESULIDE

Nimesulide is a non-steroidal anti-inflammatory drug that has analgesic, anti-inflammatory and antipyretic properties. Nimesulide is used to relieve the symptoms of various conditions such as osteoarthritis, rheumatoid arthritis, myalgia, headache, toothache, menstrual pain and other types of pain. It can also be used to reduce temperature during fever.