Can you take etodolac with ibuprofen: Etodolac and ibuprofen Drug Interactions
Etodolac and ibuprofen Drug Interactions
This report displays the potential drug interactions for the following 2 drugs:
Edit list (add/remove drugs)
Interactions between your drugs
Using ibuprofen together with etodolac is generally not recommended. Combining these medications may increase the risk of side effects in the gastrointestinal tract such as inflammation, bleeding, ulceration, and rarely, perforation. Gastrointestinal perforation is a potentially fatal condition and medical emergency where a hole forms all the way through the stomach or intestine. You should take these medications with food to lessen the risk. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact. Your doctor may also be able to recommend medications to help protect the stomach and intestine if you are at high risk for developing serious gastrointestinal complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Switch to professional interaction data
Drug and food interactions
No interactions were found. This does not necessarily mean no interactions exist. Always consult your healthcare provider.
Therapeutic duplication warnings
Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition.
This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit.
It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy,
and can have potentially adverse consequences.
The recommended maximum number of medicines in the ‘nonsteroidal anti-inflammatories’ category to be taken concurrently is usually one.
Your list includes two medicines belonging to the ‘nonsteroidal anti-inflammatories’ category:
Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication.
This information does not take the place of talking to your doctor.
Always check with your healthcare provider to determine if any adjustments to your medications are needed.
Drug Interaction Classification
|Major||Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderate||Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|Minor||Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.|
|Unknown||No interaction information available.|
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Which Is Better for Arthritis Pain?
Ibuprofen and etodolac are two types of non-steroidal anti-inflammatory drugs (NSAIDs) used to treat arthritis pain. Being of the same pharmaceutical class, there’s much that they have in common. Both reduce inflammation and pain sensation, easing the severity of symptoms. That said, there are also a number of crucial differences.
Etodolac, a prescription-only generic drug previously sold under the discontinued brand name Lodine, is typically only indicated for osteoarthritis and rheumatoid arthritis. Ibuprofen is available in numerous over-the-counter (OTC) and prescribed forms and takes on a wider range of pain, including arthritis.
As with any medication, it’s important to be careful when using etodolac and ibuprofen, as they can interact with other drugs or supplements. In particular, the chances of adverse effects increase if these two drugs—or any two NSAIDs—are taken together. It’s important to understand how to use these drugs safely.
FatCamera / E+ / Getty Images
How Etodolac and Ibuprofen Are Similar
Like all NSAIDs, both etodolac and ibuprofen prevent the activity of enzymes called cyclooxygenases (COX), which help your body produce prostaglandins. These hormone-like chemicals are essential for pain and swelling in the body, so inhibiting their activity eases symptoms. Each is often prescribed for rheumatoid arthritis and osteoarthritis.
Since etodolac and ibuprofen function in this way, their side effects are also similar. While there are more for etodolac, common side effects of both include:
- Gas and/or bloating
- Ringing in the ears
Not only that, severe side-effects for these drugs, which include allergic reactions such as breathing difficulties, facial swelling, and hives, among others, are also identical.
How Etodolac and Ibuprofen Are Different
Though there are similarities between these NSAIDs, there are also a number of key differences. Here’s a quick breakdown:
- Availability: Ibuprofen, sold under a wide range of names, including Motrin, Advil, Midol, and others, comes in both over-the-counter and prescribed formulations. In contrast, etodolac is only available with a prescription in faster-acting and more slow-release forms.
- Indications: While some doctors may prescribe etodolac for other painful conditions, it’s approved only for the management of osteoarthritis and rheumatoid arthritis. Ibuprofen is indicated for a wider range of conditions, including everything from headache, menstrual pain, toothaches, and others.
- Half-lives: Etodolac has a much longer half-life—the time it takes for half of the substance to be metabolized—of six to eight hours, which means people will need fewer pills to manage pain and other symptoms. Ibuprofen, in contrast, gets to this point between one and three hours.
- Typical dosages: For arthritis, etodolac doses range from 300 milligrams two to three times a day, to one 400- to 1,000-milligram tablet daily. Higher and more frequent doses of ibuprofen achieve the same effect: 400 to 800 milligrams three to four times a day.
- Safe populations: While both of these drugs are considered generally safe for adults, forms of ibuprofen are safe for those as young as 6 months old. Etodolac, however, isn’t recommended for those under 6 years old.
Which Is Better for Treating Arthritis Pain?
What makes arthritic conditions difficult is that there is no outright cure for them. Treatment of these conditions is a matter of long-term management of symptoms, of which ibuprofen and etodolac may both play a part. But it’s important ask: Is one better than the other?
The answer is a little complicated, though etodolac seems to have an edge. A formative, double-blind study conducted in 1997 directly comparing the two for rheumatoid arthritis found them to be equally effective for the first two months, with ibuprofen showing less efficacy over the long run. For up to three years of therapy, etodolac offered better management of symptoms.
However, it should also be noted that ibuprofen has consistently been found to be among the safest of NSAIDs, and certainly safer than etodolac. Especially in moderate doses, it’s been shown to lead to relatively few adverse events. No doubt, this is why this medication is so widespread and has such a long history.
Is It Safe to Take Ibuprofen With Etodolac?
Whenever you’re prescribed a medication, it’s important to be aware of what, if any, other drugs, supplements, or herbs you can safely take at the same time. This is especially important when managing chronic conditions like arthritis, as you may need to take medications for a long period of time.
When taking any NSAID, using another one at the same time significantly increases the chance of adverse side effects. This would certainly be the case if you tried to mix ibuprofen and etodolac, which is why the Food and Drug Administration (FDA) specifically warns against doing so.
If you’re taking prescription or over-the-counter medications for your arthritis and still struggling with pain and inflammation, be sure to let your doctor know. The management of chronic conditions often requires a multifaceted approach.
The use of NSAIDs, though common and widespread, comes with risks. Most significantly, according to the FDA, there is a chance that this class of drugs can lead to heart attack and stroke in the following cases:
- Duration of use: Doctors have documented cardiovascular effects within two weeks of starting NSAIDs, and this risk rises with prolonged use.
- Higher doses: Chances of stroke and heart attack also grow with higher concentrations and dosages of NSAIDs.
- Present conditions: NSAIDs have been found to increase the risk of adverse cardiovascular events even in those with no history of heart problems. Those with heart disease or other issues have a higher likelihood of developing these severe reactions.
In addition, NSAIDs can also affect gastrointestinal health, leading to intestinal bleeding, stomach ulcers, and perforation of ulcers. The risk of any of these occurring rises with age, and prompt medical attention is necessary if they arise.
Finally, the use of ibuprofen, etodolac, or other NSAIDs may also lead to:
- Skin reactions: Rashes and other skin conditions may be signs of adverse reactions.
- Liver damage: Taking medications like ibuprofen or etodolac can also damage the liver, leading to jaundice (yellowing of skin and eyes), liver failure, fatigue, nausea, flu-like symptoms, and others.
- Heart failure: Use can also cause insufficient heart-pumping activity, leading to swelling, shortness of breath, and sudden weight gain.
- Fetal toxicity: NSAIDs like ibuprofen and etodolac may also be problematic in pregnancy after 30 weeks. Those who take them after 20 weeks need to be carefully monitored to ensure safety.
When to Call Your Doctor
Some side-effects of NSAID use are so dangerous as to constitute medical emergencies. If you experience any of the following, call for help as soon as you can:
- Breathing difficulties
- Rapid heartbeat
- Chest pain
- Swelling in the abdomen, hands, feet, ankles, and legs
- Skin rashes, blisters, hives
- Fever and chills
- Jaundice (yellowing of skin and eyes)
- Abdominal pain
- Loss of appetite
- Cloudy urine
- Pain while urinating
- Sudden weight gain
A Word From Verywell
Managing osteoarthritis or rheumatoid arthritis is challenging, but you’re far from alone if you experience these conditions. As common and widespread as these conditions are, it’s important to remember that there are many effective means of managing them, of which ibuprofen and etodolac both have their utility.
If you take these NSAIDs—or any other medication—it’s absolutely essential to understand how they work and how to use them safely. The secret weapon against arthritis is something we all have: knowledge.
The more you know about your condition and your approach to treatment, the better off you’ll be. Never hesitate to ask your doctor about your options.
Tp24.it ,le notizie di Trapani, Marsala, Mazara, Alcamo e Belice
Trapani, Mister Italia 2021 Joseph Lantillo testimonial per il Comune
Dal titolo di Mister Italia 2021 a punto di riferimento per i giovani trapanesi…
Sicily’s Mount Etna taller than ever after six months of activity
Mount Etna’s southeastern crater has grown in height after six months of.. .
L’Italia in fiamme, le vittime del lavoro e le armi in Afghanistan
L’Italia è in fiamme. Non solo nello Stivale, anche Grecia e…
Ritrovato in mare il corpo di un giovane di 28 anni di Palermo
È stato ritrovato in mare a due miglia da Isola delle Femmine il…
Favignana: oggi sono state salvate 11 persone e soccorse 3 imbarcazioni
Undici persone salvate e tre natanti da diporto soccorsi dalla Guardia. ..
Positivo all’aeroporto di Palermo … riconosciuto da una passeggera
Singolare episodio accaduto all’aeroporto di Palermo Punta Raisi.
La Sicilia brucia, il video choc: gente in fuga, animali bruciati vivi
Arrivano immagini choc dalla Sicilia che ancora oggi brucia.
Coronavirus: Sicilia ancora prima per contagi e morti.
E salgono i ricoveri
Anche oggi la Sicilia è la prima Regione in Italia per contagi e…
Calcio, il Trapani acquista un centrocampista
Continua spedita la campagna acquisti del nuovo Trapani calcio. Vito Lupo, classe ’90, è stato tesserato dalla società…
Valderice in festa per i fratelli Ala e Ussem Zoghlami
Valderice in festa per i fratelli i Ala e Ussem Zoghlami, reduci dai trionfi di Tokyo.
Il sindaco ha voluto rendere…
Bus navetta a Castellammare, agevolazioni Tari a Paceco, finanziamento per Partanna
Bus navetta per il centro storico di Castellammare del Golfo fino al al 23 settembre. In funzione dalle ore 20…
Covid nel Trapanese, sono 1300 gli attuali positivi. I dati di oggi
Sono 1300 gli attuali positivi al Covid in provincia di Trapani, 93 in più rispetto a ieri, secondo il…
Pantelleria: gli eventi della settimana di Ferragosto tra cultura e musica
Cultura e spettacoli caratterizzeranno la settimana di ferragosto a Pantelleria.
Giovedì 12 agosto alle…
San Vito Lo Capo, in sicurezza la Torre dell’Impiso e l’ingresso nella Riserva dello Zingaro
L’intervento che la Struttura contro il dissesto idrogeologico, guidata dal governatore Nello Musumeci, ha. ..
Trapani, un esemplare di poiana comune salvato dai “Randagi del Sud”
Un esemplare di poiana comune, una razza protetta, è stato recuperato e salvato dall’associazione…
Caldo record in Sicilia, Siracusa con 48,7 gradi città più calda d’Europa
La Sicilia è la regione più calda d’Europa. E’ record a Siracusa con 48,7 gradi registrati oggi. Il dato…
Marsala, domani un sit-in di protesta per i turni pomeridiani al Sirtori
Un sit-in piazza Loggia, domani, giovedì per mettere fine ai turni pomeridiani degli studenti del Sirtori…
Garibaldi” partecipa al progetto Erasmus “Butterfly effect with european culture”
L’ITET “G.Garibaldi” partecipa al progetto Erasmus + KA227 “BUTTERFLY EFFECT WITH…
Marsala, Don Gianluca Romano diventa eremita
Don Gianluca Romano diventa eremita.
Giovedì 12 agosto 2021, alle ore 19,30 nella Parrocchia Maria Ss. Della Cava in contrada Ciavolo a…
Marsala, il degrado e le sterpaglie a fuoco a Birgi e i rifiuti in via Trapani
Degrado, incuria, rifiuti e sterpaglie che vanno a fuoco continuano ad essere una costante in molte zone del territorio…
Ad Alcamo e Calatafimi si vota il 10 e 11 Ottobre
L’assessore alle Autonomie locali della Regione Siciliana, Marco Zambuto, ha firmato il decreto di. ..
Lo Stagnone di Marsala, i parcheggi abusivi tra vigne e uliveti e al “Borgo della Pace”
Dove ci sono eventi che attirano tante persone ci sono anche i parcheggi e purtroppo anche i parcheggiatori…
Favignana, trova in strada oltre mille euro e consegna la somma ai Carabinieri
Trova in strada, per terra, oltre mille euro, e consegna la somma ai Carabinieri. Accade a Favignana.
Gli eventi di oggi nel Trapanese: Annalisa a Petrosino, le Dionisiache a Segesta, Alcart ad Alcamo
Questa sera con inizio alle ore 21,30 il concerto di Annalisa, uno degli appuntamenti di punta dell’Estate. ..
Sicilia, 3200 controlli e tre indagati dalla Polfer
Tre indagati, 3.181 persone controllate, 24 treni presenziati, 268 pattuglie impegnate nei servizi di vigilanza…
Coronavirus, Sicilia in allarme. Verso il “giallo” dal 16 Agosto. Ripristinati tutti i reparti Covid
Crescono, tra i non vaccinati, i contagi e i ricoveri in Sicilia. Si va verso la “zona gialla”…
Continua fino a fine Agosto ad Erice la mostra “Festina lente”
Continua la mostra personale dell’artista trapanese Massimiliano Errera dal titolo FESTINA…
Positivo al Covid rifiuta il ricovero, si aggrava e muore
Un uomo di 48 anni è morto ieri nell’ospedale di Copertino (Lecce) a causa di un arresto cardiaco. ..
Lotta alla droga
Sicilia, pacco di marijuana non arriva al destinatario. Trovato in un’azienda di trasporto
Un pacco contenente 100 grammi di marijuana è stato travato dai Finanzieri di Carini, nel magazzino di…
“Qui non si chiede il green pass”. Ci sono anche due locali di Trapani, ma …
Due attività commerciali di Trapani si sono ritrovate, all’insaputa dei loro titolari, nella mappa che…
Salute e Benessere
Trapani, aperte le iscrizioni al corso BLSD
Prenderà il via, a Trapani, il prossimo mese di ottobre il corso BLSD, organizzato dall’Ente di formazione Primo soccorso Trapani. Diretto da…
L’Ass.ne Amici della Musica presenta Riccardo Randisi trio in Broadway 2.0. Il 13 agosto a Marsala
Venerdì 13 agosto, alle 21, al Parco Lilybeo di Marsala (Baglio Tumbarello), Riccardo Randisi trio feat Kate…
Sicilia, giallo per la morte di una donna. Uccisa dal filo di una ciabatta elettrica
E’ giallo a Palermo per la morte di una donna. Una 33enne è stata trovata priva di vita in un appartamento di…
Erice, presentazione della pubblicazione sul Castello della Colombaia
Giovedì 12 Agosto, alle ore 17.30, negli spazi della sala conferenze di palazzo Sales a Erice, nell’ambito…
30.000 lavoratori siciliani fuorisede tornati a casa grazie allo smart working
Smart e remote working sono stati per molti un’occasione per riorganizzare la propria vita, anche da un…
Formazione: a Settembre in Sicilia partono più di mille corsi
Sono stati pubblicati tutti i decreti di finanziamento per l’attivazione dei corsi di formazione…
Reintegrato in azienda lavoratore licenziato per non aver comunicato il possibile contagio Covid
La Corte d’appello di Palermo ha reintegrato in azienda un dipendente licenziato per non aver informato il datore…
Salvo Messana neo responsabile Iv Sicilia per l’emergenza Covid
La crisi pandemica che sta attraversando la Sicilia non è ancora chiusa, purtroppo con i contagi in crescita e…
In provincia di Trapani il coordinamento (provvisorio) di Sinistra Italiana
Dopo la chiusura della fase congressuale conclusasi con la conferma a segretario nazionale di Nicola Fratoianni e dopo…
Pallavolo, la schiacciatrice Gaia De Marco torna all’A29 GesanCom
Un Agosto trascinante dal punto di vista sportivo quello della A29 GesanCom Fly Volley Marsala. Il Dream Team…
A comparison of the effects of etodolac and ibuprofen on renal haemodynamics, tubular function, renin, vasopressin and urinary excretion of albumin and α-glutathione- S -transferase in healthy subjects: a placebo-controlled cross-over study
Non-steroidal anti-inflammatory drugs (NSAIDs) are known to be potentially nephrotoxic agents. NSAIDs inhibit the enzyme cyclo-oxygenase and thereby block the prostaglandin synthesis in the kidneys. Cyclo-oxygenase exists in two isoforms (COX-1 and COX-2). It has been proposed that NSAIDs with preferential COX-2 selectivity have fewer renal side effects than drugs with preferential COX-1 selectivity. Etodolac is a relative selective inhibitor of COX-2, while ibuprofen has a higher potency against COX-1 than COX-2.
In this study, we compared the effects of etodolac and ibuprofen on renal function, plasma renin, plasma arginine vasopressin and the urinary excretion of albumin and alpha-glutathione-S-transferase (alpha-GST).
In a randomised, double-blind, three-way crossover study with placebo, we compared the effects of 2 weeks of treatment with ibuprofen and etodolac on renal haemodynamics [glomerular filtration rate (GFR), renal plasma flow (RPF) and filtration fraction (FF)], tubular function and plasma concentrations of the hormones renin (PRC) and arginine vasopressin (AVP) in 18 healthy subjects. In addition, we examined the effects on the urinary excretion of albumin and alpha-GST as markers of renal injury.
No differences were found between the three treatments, placebo, ibuprofen and etodolac, in the effects on GFR, RPF, FF, free water clearance, urinary output or fractional excretion of potassium and sodium. However, ibuprofen, in contrast to etodolac, caused a significant decrease in both lithium clearance (-16% versus placebo) and the fractional excretion of lithium (-17% versus placebo), suggesting an increase in the reabsorption in the proximal tubuli. PRC was reduced significantly by ibuprofen (-32% versus placebo) but not etodolac. None of the drugs changed AVP. Fourteen days of treatment with ibuprofen caused a significant decrease (-47% versus placebo) in the urinary excretion of alpha-GST, while no changes were seen after etodolac. None of the drugs changed the urinary excretion of albumin.
In conclusion, a 14-day administration of etodolac or ibuprofen in therapeutic doses did not affect the renal haemodynamics, the net excretion of electrolytes or the urinary excretion of albumin in healthy subjects. However, ibuprofen, in contrast to etodolac, caused a reduction in PRC, suggesting that COX-1 is involved in basal renin release in humans. Furthermore, ibuprofen decreased lithium excretion suggesting that COX-1 is involved in the re-absorption of sodium and/or water in the proximal tubuli. The reduction in the urinary excretion of alpha-GST by ibuprofen may be caused by an inhibition of the detoxification enzyme by ibuprofen. Overall the study indicates that only small differences in the effects of the two drugs on renal function in healthy subjects exist during a treatment period of 2 weeks.
My doctor recently started me on lithium and told me there are lots of drug interactions with this m
My doctor recently started me on lithium and told me there are lots of drug interactions with this medication. My pharmacist is very good at telling me about interactions with prescription medications but how do I know which non-prescription or over-the-counter medications to avoid?
Great question! First, if you have any questions regarding non-prescription medications (also known as over the counter medications) or herbal medications, your pharmacist can help answer those questions for you. Pharmacists are experts on both prescription and non-prescription medications. Never be afraid to ask your pharmacist a question; we love to help.
Your doctor is right about lithium having many drug interactions. It is always important that you let ALL your doctors, including dentists and pharmacists, know you are taking lithium in order to avoid potential drug interactions.
As for over-the counter medications that can interact with lithium, the most common drug interactions with lithium are with the Nonsteroidal Anti-Inflammatory Agents (NSAIDs) that are often used to treat aches and pains. When combined with lithium, NSAIDs can increase lithium levels in the blood resulting in an increased risk for serious adverse effects like confusion, tremor, slurred speech, and vomiting. Examples of non-prescription NSAIDs include:
- Ibuprofen (Advil® or Motrin®)
- Naproxen (Naprosyn®, Aleve®)
There are also many prescription NSAIDs such as the following:
- Celecoxib (Celebrex®)
- Diclofenac (Voltaren® or Cataflam®)
- Etodolac (Lodine®)
- Indomethacin (Indocin®)
- Ketoprofen (Orudis®)
- Ketorolac (Toradol®)
- Meloxicam (Mobic®)
- Nabumetone (Relafen®)
- Oxaprozin (Daypro®)
- Piroxicam (Feldene®)
- Tolmetin (Tolectin®)
In general, it is best to avoid the NSAIDS listed above when taking lithium. Certainly, they should not be used frequently or on a regular basis without consultation with your doctor(s).
If you do need a pain reliever while taking lithium, acetaminophen (Tylenol®) is a safe alternative. Sulindac (Clinoril®), a prescription pain reliever, can also be used as an alternative.
Also, too much caffeine can decrease the effectiveness of lithium and possibly increase your symptoms.
When buying any non-prescription medication it is very important to look at the active ingredients on the package. Many non-prescription medications, such as those used to treat the cold and flu, contain multiple active ingredients and may interact with your medication. For example, Advil Cold and Flu® contains ibuprofen which can increase your lithium level. Also, read the labeling information on all non-prescription medications; this may help avoid drug interactions. When reading the active ingredients list on non-prescription medications or when in doubt about any drug interaction, ask your pharmacist!
Back to questions
Prescription Nonsteroidal Anti-Inflammatory Medicines
Nonsteroidal anti-inflammatory drugs (NSAIDs) are medicines you can take for pain relief. They are often sold over-the-counter (OTC). This means you can buy them without a prescription from your doctor. Some common brand names are Advil, Motrin, or Aleve. But these medicines are available by prescription, as well.
Path to improved health
How do prescription NSAIDs work?
NSAIDs stop a certain kind of enzyme in your body from working. These are called cyclooxygenase enzymes (also called COX enzymes). COX enzymes speed up your body’s production of hormone-like substances called prostaglandins. Prostaglandins irritate your nerve endings and cause you to feel pain. They are also part of the system that helps your body control its temperature.
By reducing the level of prostaglandins in your body, NSAIDs help relieve pain from conditions like arthritis. They also help reduce inflammation (swelling), lower fevers, and prevent blood from clotting.
There are 2 classes of prescription NSAIDs: traditional and COX-2 inhibitors.
Traditional NSAIDs include:
- mefenamic Acid
COX-2 inhibitors include:
If you need to take a prescription NSAID, your doctor will help you find one that is right for you.
What’s the difference between traditional NSAIDs and COX-2 inhibitors?
You have 2 types of COX enzymes in your body: COX-1 and COX-2. Researchers believe that one of the jobs of COX-1 enzymes is to help protect your stomach lining. The COX-2 enzyme doesn’t play a role in protecting your stomach.
Traditional NSAIDs stop both COX-1 and COX- 2 enzymes from doing their jobs. When COX-1 enzymes are blocked, pain and inflammation is reduced. But the protective lining of your stomach is also reduced. This can cause problems such as upset stomach, ulcers, bloating, and bleeding in your stomach and intestines.
COX-2 inhibitors only stop COX-2 enzymes from working. The COX-2 enzyme doesn’t help to protect your stomach. So COX-2 inhibitors may be less likely to irritate your stomach or intestines.
Things to consider
Like all medicines, prescription NSAIDs can cause side effects. However, the side effects usually are not severe and are not experienced very often.
Common side effects of prescription NSAIDs may include:
- excess gas
- extreme weakness or fatigue
- dry mouth
Serious, but rare, side effects of prescription NSAIDs may include:
- Allergic reaction. This could include difficulty breathing, hives, and swelling of the lips, tongue, or face.
- Muscle cramps, numbness, or tingling.
- Rapid weight gain.
- Black, bloody, or tarry stools.
- Bloody urine or bloody vomit.
- Decreased hearing or ringing in the ears (also called tinnitus).
- Jaundice (the yellowing of the skin and the whites of the eyes).
- Abdominal cramping.
In addition to the side effects listed above, people taking a COX-2 inhibitor may be at risk for:
- Swelling or water retention.
- Skin rash or itching.
- Unusual bruising or bleeding.
- Difficulty sleeping (insomnia).
Call your doctor as soon as possible if your side effects become severe.
Is it safe to take NSAIDs for a long period of time?
People who take NSAIDs increase their risk of developing severe bleeding in their stomachs. They may also be at risk for heart attacks and strokes. These risks get worse if they take higher doses. It also gets worse if they take these medicines for a long period of time. If you need to take pain medicine for longer than a week, you should discuss this risk with your family doctor. You may want to explore other pain treatment options.
What is a drug interaction?
If you use 2 or more medicines at the same time, the way your body processes each one can change. When this happens, the risk of side effects from each one increases. Each medicine may not work the way it should. This is called a drug-drug interaction. For example, NSAIDs thin the blood. If you take a blood thinning medicine such as warfarin and you take an NSAID, there could be a drug-drug interaction. Vitamins and herbal supplements can affect the way your body processes medicines, too.
Certain foods or drinks can also prevent your medicine from working the way it should. Or they can make side effects worse. This is called a drug-food interaction. For example, if you’re taking a traditional NSAID, drinking alcohol can increase your risk of liver disease or stomach bleeding.
Drug-drug interactions and drug-food interactions can be dangerous. Be sure that your doctor knows all of the medicines you are taking. This includes OTC and prescription medicines, vitamins, and herbal supplements. Also, talk to your doctor before you take any new OTC or prescription medicine, vitamin, or supplement.
It’s important to take medicines exactly as your doctor prescribes. Ask your doctor whether you need to avoid any foods or drinks while using a prescription NSAID.
Questions to ask your doctor
- What is the difference between an OTC NSAID and a prescription NSAID?
- What is the best NSAID for me?
- What are the side effects?
- How long is it safe for me to take a prescription NSAID?
- Are there any drug-drug or food-drug interactions I need to watch out for?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Before Your Procedure | UI Health
Before Your Procedure
Please arrange a ride from the clinic for injections performed on site.
Take your medications on the day of the procedure, especially blood pressure and diabetes medications.
If you are having sedation:
- Inform our scheduler
- Do not eat anything for 8 hours prior to the injection
- You can drink Gatorade or apple juice up to two hours before the injection
Please tell us if you have an infection, are on antibiotics, have a new rash, or have an open wound. We will reschedule your injection once the infection is resolved.
Please tell us if you take any of these:
- If you are taking Aspirin for heart health and have NEVER had a heart attack, stroke, or blood clot, (ASPIRIN HAS NOT BE PRESCRIBED BY A DOCTOR), then you can stop it for FOUR days prior to the procedure. Also ask the doctor when you can restart the medications.
- If you are taking Aspirin because you have had a heart attack, stroke, or a blood clot, you will have to discuss stopping the medication with your primary care doctor, neurologist or cardiologist. We will need a note from your doctor documenting the plan for aspirin
- There are some procedures we will do while you are on aspirin and others that we won’t do. There is an increased of bleeding if these injections are done on aspirin. You should inform us if your doctor does NOT want you to stop the aspirin.
- Cervical or neck injections cannot be done while on aspirin- Please discuss with your pain doctor
- Lumbar or lower back injections can be done while on aspirin but may increase your risk of bleeding.
- Sacroiliac joint injection and facet injections can be done on aspirin
- Peripheral joint injections: Hips/knee/shoulder can be done on aspirin
- Full dose Aspirin may be reduced to 81mg for injections except neck- Discuss with your MD
- If there are any concerns, we should see you for a follow-up appointment after discussing this with your doctor
- There are some procedures we will do while you are on aspirin and others that we won’t do. There is an increased of bleeding if these injections are done on aspirin. You should inform us if your doctor does NOT want you to stop the aspirin.
Ibuprofen should be stopped TWO days prior to the injection
There are some procedures we will do while you are on ibuprofen and others that we won’t do. There is an increased of bleeding if these injections are done on ibuprofen.
- Cervical or neck injections CANNOT be done while on ibuprofen
- Lumbar or lower back injections can be done while on ibuprofen but may increase your risk of bleeding.
- Sacroiliac joint injection and facet injections can be done on ibuprofen
- Peripheral joint injections: Hips/knee/shoulder can be done on ibuprofen
3. Other Anti-inflammatories:
- Diclofenac, Voltaren, Cambia, Solaraze, Zipsor, Pennsaid, Cataflam, Flector – stop for 1 day
- Midol, Aleve, Naprelan, Naprosyn, Anaprox, Ec-Naprosyn, Select, and Naproxen:- stop for 4 days
- Meloxicam- stop for 4 days
- Etodolac (Lodine)- stop for 2 days
4. Coumadin, Lovenox, Ticlid, Plavix, Heparin, Fondaparinux, Xeralto, Pradaxa, Eliquis, Aggrenox, Persantin, Fragmin
- Make an appointment to discuss this with us before stopping the above medication
- We will NOT perform any injections while you are on any of the above medications
Memorial Sloan Kettering Cancer Center
This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.
Trade names: USA
Trade names: Canada
NU-Etodolac [DSC]; TARO-Etodolac
- This drug may increase the risk of heart and blood vessel problems, such as heart attack and stroke.These effects can be deadly. This risk may be increased if you have heart disease or have risk factors for such diseases. However, the risk may be increased even for people who do not have or are not at risk of developing heart disease. The risk may arise during the first weeks of using this drug and may increase with higher doses or with long-term use. This drug should not be used immediately before or after coronary artery bypass surgery.
- This drug may increase the likelihood of severe and sometimes fatal stomach or intestinal problems such as ulcers or bleeding. The risk is increased in the elderly and in people who have previously had ulcers or bleeding in the stomach or intestines. Such violations can occur suddenly.
What is this drug used for?
- Used to treat some types of arthritis.
- Used to relieve pain.
What should I tell my doctor BEFORE taking this drug?
- If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
- If you are allergic to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.
- If you have any of the following health problems: gastrointestinal bleeding or kidney problems.
- If you have any of the following health conditions: Heart failure (weak heart) or have recently had a myocardial infarction.
- If you are taking NSAIDs, a salicylate such as aspirin, or pemetrexed.
- If you are taking phenylbutazone.
- If you are unable to get pregnant or are checking if you are able to get pregnant.
- If you are pregnant, plan to become pregnant, or become pregnant while taking this drug. If you take this drug after 20 weeks of pregnancy, it can cause fetal harm.If you are between 20 and 30 weeks pregnant, take this drug only as directed by your doctor. Do not use this drug after 30 weeks of pregnancy.
This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.
Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical condition and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.
What do I need to know or do while taking this drug?
- Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
- With long-term use of the drug, a blood test must be performed. Talk to a medical professional.
- This drug may interfere with some laboratory tests. Tell all healthcare providers and laboratory staff that you are taking this drug.
- The use of this type of drugs has been associated with high blood pressure. Monitor your blood pressure as directed by your doctor.
- Consult a physician before drinking alcohol.
- If you smoke, consult your doctor.
- Do not take the drug in higher doses than the doctor prescribed. Taking more than the prescribed amount of the drug increases the risk of serious side effects.
- Do not take this drug for longer than your doctor prescribed.
- If you have asthma, consult your doctor. You may be more sensitive to the drug.
- There is an increased likelihood of bleeding. Be careful and avoid injury. Use a soft toothbrush and electric shaver.
- The risk of developing heart failure is increased with the use of drugs of this kind. People with heart failure have an increased risk of myocardial infarction, hospitalization for heart failure, and death. Consult your doctor.
- People who have had myocardial infarction and are taking drugs of this kind have an increased risk of recurrence of myocardial infarction and death due to heart problems.People who took drugs of this kind after their first heart attack were also more likely to die one year after myocardial infarction compared with those who did not take these drugs. Consult your doctor.
- If you are taking aspirin to prevent myocardial infarction, consult your doctor.
- Liver dysfunctions have been reported while taking drugs of this kind. Sometimes these cases were fatal.Call your doctor right away if you have signs of liver dysfunction, such as dark urine, tired feeling, lack of appetite, nausea or abdominal pain, light colored stools, vomiting, yellow skin or eyes.
- Severe and sometimes fatal reactions have occurred with other drugs of this nature. In most cases, this reaction was accompanied by symptoms such as fever, rash, inflammation of the lymph nodes, and dysfunction of various organs such as the liver, kidneys, blood, heart, muscles, joints and lungs.If you have any questions, please consult your doctor.
- If you are 65 years of age or older, use this drug with caution. You may have more side effects.
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as this drug, can interfere with egg release (ovulation). This can negatively affect your ability to get pregnant. As a rule, the ovulation process is restored after you stop taking this drug. Consult your doctor.
- Tell your doctor if you are breastfeeding. It is necessary to consult if the drug poses any risk to the child.
What side effects should I report to my doctor immediately?
WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your healthcare professional or get medical attention right away if you have any of the following signs or symptoms, which may be associated with serious side effects:
- Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
- Signs of bleeding such as vomiting or coughing up blood; vomiting like coffee grounds; blood in the urine; black, red, or tarry stools; bleeding from the gums; non-cyclic vaginal bleeding; bruising that occurs or increases for no reason; bleeding that you cannot stop.
- Signs of kidney problems, including lack of urination, change in urine volume, blood in the urine, or rapid weight gain.
- Signs of elevated potassium levels such as a feeling of disturbed heartbeat, confusion, feeling weak or dizzy, feeling light-headed, feeling numb or tingling, or shortness of breath.
- Signs of high blood pressure, such as very severe headache, or dizziness, or loss of consciousness, or blurred vision.
- Shortness of breath, sudden weight gain, or swelling of the arms or legs.
- Chest pain or pressure or heart palpitations.
- Weakness on one side of the body, difficulty speaking or thinking, trouble maintaining balance, drooping one side of the face, or blurred vision.
- Feeling extremely tired or weak.
- Ringing in the ears.
- Flu-like symptoms.
- Swelling of the gland.
- Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis). This can lead to serious and permanent health problems and sometimes death. Get immediate medical attention if you experience symptoms such as redness, skin swelling with blistering or scaling (with or without a high fever), redness or irritation of the eyes, and ulceration in the mouth, throat, nose, or eyes.
What are some other side effects of this drug?
Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:
- Constipation, diarrhea, abdominal pain, nausea or vomiting.
- Feeling dizzy, tired, or weak.
This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.
You can report side effects to the National Health Office.
You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https: // www.fda.gov/medwatch.
What is the best way to take this drug?
Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.
All forms of issue:
- Take with or without food. Take with food if the medicine causes nausea.
- Take this drug with a full glass of water.
Extended release tablets:
- Swallow whole.Do not chew, break, or crush.
What should I do if a dose of a drug is missed?
All forms of issue:
- If you are taking this medication regularly, take the missed dose as soon as you can.
- If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
- Do not take 2 doses at the same time or an additional dose.
- In most cases, this drug is used as needed. Do not take this medicine more often than prescribed by your doctor.
How do I store and / or discard this drug?
- Store at room temperature in a dry place. Do not store in the bathroom.
- Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
- Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.
General information on medicinal products
- If your health does not improve or even worsens, see your doctor.
- You should not give your medicine to anyone and take other people’s medicines.
- Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
- A separate patient instruction sheet is attached to the product. Please read this information carefully. Reread it each time you replenish your supply.If you have questions about this drug, talk with your doctor, pharmacist, or other healthcare professional.
- If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.
Use of information by the consumer and limitation of liability
This information should not be used to make decisions about taking this or any other drug.Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug.This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.
© UpToDate, Inc.and its affiliates and / or licensors, 2021. All rights reserved.
90,000 Etodolac vs Ibuprofen: Differences, Similarities and What’s Best for You – Drug Vs. Friend
Drug Vs. Friend
Drug Review and Main Differences | Treatment conditions | Efficiency | Insurance coverage and cost comparison | Side Effects | Drug Interactions | Warnings | Frequently Asked Questions
No one wants to live with discomfort or pain for an extended period of time, or at all for that matter.Fortunately, prescription and over-the-counter pain relievers are available at your local pharmacy. Although they are not as powerful as opioid pain relievers, which require more medical examination and prescription, NSAIDs such as etodolac or ibuprofen are effective for treating mild to moderate pain.
Also known as nonsteroidal anti-inflammatory drugs, NSAIDs block the production of prostaglandins. Your body can respond to certain diseases by producing prostaglandins, which are chemicals that cause pain, inflammation, and fever.NSAIDs block prostaglandin-producing enzymes – COX-1 and COX-2 – to control the body’s inflammatory response and reduce pain.
Etodolac and ibuprofen are NSAIDs. However, they have several important differences.
What are the main differences between etodolac and ibuprofen?
Etodolac is sometimes known by its (now discontinued) trade name Lodine. It is available as a generic drug and can only be obtained with a doctor’s prescription.
Etodolac has a half-life of six to seven hours and reaches peak blood concentrations one to two hours after ingestion. It is usually taken two to three times a day for arthritis pain. There is also an extended-release etodolac tablet that has a longer half-life, about eight hours, and can be taken once a day.
Ibuprofen is a more common NSAID available over the counter (OTC). Higher doses of ibuprofen are also available with a doctor’s prescription.Popular ibuprofen brands include Advil, Motrin, and Midol.
I’ll show on drug test
Ibuprofen peaks in blood within one to two hours after ingestion. However, unlike etodolac, ibuprofen has a shorter half-life, approximately two hours. Prescription ibuprofen comes in pills that are usually taken three to four times a day. The over-the-counter version comes in oral tablets, capsules, and liquid suspensions.
|Main differences between etodolac and ibuprofen|
|Brand / generic status||Generic available (brand discontinued)||Brands and generics available|
|What is a brand?||Lodin||Advil, Motrin, Midol|
|In what form (s) is the drug included?|| Oral Capsules
Oral Tablet, Extended Release
| Oral Capsules
| For pain: 200 to 400 mg every 6 to 8 hours as needed.Do not exceed the maximum dose of 1200 mg per day.
For osteoarthritis or rheumatoid arthritis: immediate release 300 mg two to three times daily or 400-500 mg twice daily. Extended release 400 to 1000 mg once daily. Do not exceed the maximum dose of 1200 mg per day.
| For pain: 200 to 400 mg every 4-6 hours as needed. Do not exceed the maximum dose of 1200 mg per day unless directed by your doctor.
For osteoarthritis or rheumatoid arthritis: 400 to 800 mg three to four times a day.Do not exceed the maximum dose of 3200 mg per day.
|How long does a typical treatment take?||The duration of treatment depends on the state of health, the severity of the pain, and other factors. Treatment can be short term or long term.||The duration of treatment depends on the state of health, the severity of the pain, and other factors. Treatment can be short term or long term.|
|Who usually takes this medicine?||Adults and children 6 years and older||Adults and children 6 months and older|
Conditions treated with etodolac and ibuprofen
Etodolac and ibuprofen are intended to relieve pain.They are usually taken to relieve mild to moderate acute pain during dental procedures, migraines, or muscle pain (myalgia).
Etodolac and ibuprofen are particularly useful and FDA approved for the treatment of pain and inflammation in osteoarthritis and rheumatoid arthritis. Stronger medications are usually needed to treat more severe joint pain or bone pain associated with arthritis. In some cases, children over the recommended age may also be treated with these NSAIDs for juvenile idiopathic arthritis.
Over-the-counter ibuprofen is indicated for the treatment of fever and menstrual cramps (primary dysmenorrhea). An injectable form of ibuprofen called NeoProfen is used to treat patent ductus arteriosus (PDA) in premature babies.
|Juvenile idiopathic arthritis||yes||yes|
Are etodolac or ibuprofen more effective?
Both etodolac and ibuprofen are effective NSAIDs for pain relief.They both block the enzymes cyclooxygenase (COX) to control inflammation and reduce pain in people with arthritis. However, the effect of etodolac lasts a little longer. Therefore, some people may prefer etodolac due to its lower intake frequency.
In a double-blind study comparing etodolac and ibuprofen, 1,446 patients with rheumatoid arthritis received 150 mg of etodolac twice daily, 500 mg of etodolac twice daily, or 600 mg of ibuprofen four times daily. Both doses of etodolac were found to be similar in effectiveness to the dose of ibuprofen.In terms of side effects, those who took etodolac experienced less indigestion, rashes, and stomach bleeding than those who took ibuprofen. However, this could be related to the amount of medication the patients were giving.
While no other clinical trials have directly compared etodolac and ibuprofen, various studies have compared other NSAIDs with etodolac or ibuprofen. One meta-analysis showed that the maximum daily dose of diclofenac is more effective than the maximum daily dose of ibuprofen, naproxen, and celecoxib (but the lowest effective dose of NSAIDs is always recommended).Another meta-analysis found that some NSAIDs such as piroxicam and azapropazone have a high risk of toxicity while low doses of ibuprofen have a low risk of toxicity. In general, it can be said that NSAIDs tend to differ in safety rather than effectiveness.
Due to the large number of pain management options, it is important to consult with your doctor to determine the best treatment option. A doctor or health care provider can provide appropriate medical advice for certain conditions.
Coverage and cost comparison for etodolac and ibuprofen
Generic pills of etodolac are usually covered by Medicare and insurance plans. If you have a medical condition such as arthritis, insurance is likely to cover this pain relief. The average retail price of etodolac can vary by dose, but you can pay around $ 50 for etodolac using a SingleCare coupon at participating pharmacies.
Because ibuprofen is sold without a prescription, some forms may not be covered by insurance plans.However, most Medicare Part D and insurance plans must cover prescription ibuprofen pills, depending on the treatment regimen. In general, ibuprofen is more affordable than etodolac. Use the SingleCare coupon for ibuprofen if you have a prescription from your healthcare provider.
|Usually covered by insurance?||yes||Yes (prescription pills)|
|Usually covered by Medicare Part D?||yes||yes|
|Standard dosage||300 mg 2-3 times a day||400-800 mg 3-4 times a day|
|Typical Medicare co-pay||0– US $ 76||US $ 0-22|
|SingleCare cost||US $ 40-80||US $ 4-24|
Common side effects of etodolac versus ibuprofen
Most common side effects NSAIDs, including etodolac and ibuprofen, are nausea, indigestion (indigestion), constipation, diarrhea, and abdominal or abdominal pain.In addition to gastrointestinal side effects, NSAIDs can also cause dizziness, swelling of the hands or feet (edema), headache, rashes, and ringing in the ears (tinnitus). Most of the side effects of etodolac and ibuprofen are mild and go away on their own.
Serious side effects of NSAIDs may include allergic reactions, such as severe rash or anaphylaxis, from active or inactive ingredients. Other serious side effects include gastrointestinal side effects such as stomach bleeding and peptic ulcers.Check with your healthcare professional if you notice blood in your stools, weight loss, or severe abdominal pain.
|Nausea||yes||1% –10%||yes||1% –3%|
|Abdominal pain||yes||yes||1% –3%|
|Indigestion||yes||1% –10%||yes||1% –3%|
|Constipation||yes||1% –10%||1% –3%|
|Diarrhea||yes||1% –10%||yes||1% –3%|
|Dizziness||yes||1% –10% yes||1% –3%|
|Edema||yes||1% –10%||yes||1% –3%|
|Headache||yes||1% –10%||yes||1% –3%|
|Rash||yes||1% –10%||yes||1% –3%|
|Tinnitus||yes||1% –10%||yes||1% –3%|
|Aspirin 90 268||antiplatelet||yes||Yes|
|Angiotensin-converting enzyme (ACE) inhibitor||yes||yes|
| Losartan |
|NSAID||Number of daily doses|| Relative risk per million person-years (95% CI) 90 260|
|Celecoxib||357 873 149||3.48 [0.10; 19.37]|
|Diclofenac||1 514 709 881||4.46 [1.45; 10.41]|
|Ketoprofen||899 161 612||4.67 [0.96; 13.64]|
|Naproxen||647 295 878||5.35 [0.64; 19.35]|
|Nimesulide||1 356 255 833||5.64 [2.43; 11.11]|
|Ibuprofen||1 219 162 429||5.77 [2.77; 10.61]|
|Indomethacin||80 584 130||13.10 [0.39; 72.98]|
|Niflumic acid||62 794 037||14.44 [0.43; 80.41]|
|Etodolac||70 791 098||22.46 [0.67; 125.1]|
|Ketorolac||38 652 374||58.31 [7.00; 210.8]|
|Total||8 461 912 281||4.37 [3.02; 6.10]|
Ways to further improve the effectiveness and safety of NSAID therapy
Despite the high efficacy of the selected systemic NSAIDs, their anti-inflammatory and analgesic effect may be insufficient, and increasing the dose in some cases is fraught with an increase in the risk of adverse reactions.How to ensure the required level of analgesic and anti-inflammatory action without impairing the safety profile of therapy? The answer to this question can be the use of topical NSAIDs, which makes it possible to increase the effectiveness of therapy without compromising safety indicators. However, in this light, another question becomes relevant: “Is the therapy with local NSAIDs really effective enough?”, Or in this case the placebo effect is more important?
The full scale of the influence of the placebo effect on the well-being of patients is perfectly illustrated by the results of a study of the effectiveness of paracetamol in acute back pain .The study involved 1652 patients who were randomized into three groups: patients of the 1st group regularly used paracetamol at 4000 mg / day, the 2nd – used paracetamol on demand, depending on the intensity of pain – up to 4000 mg / day, 3 th – received a placebo. The results were quite surprising – both regular use of paracetamol and on demand did not affect the recovery period for back pain compared with placebo. Thus, paracetamol was found to be as effective as placebo.
Therefore, in order to analyze the effectiveness of a particular drug, it is important to take into account the results of studies with sufficiently large patient samples. Attention is drawn to a review conducted by scientists at the University of Oxford , during which the results of 86 clinical studies (more than 10 thousand patients) of the use of topical NSAIDs were analyzed. According to this review, topical NSAIDs are effective in treating acute and chronic pain. Also interesting in light of the study of the efficacy and safety profile of topical NSAIDs in pain are the results of the Cochrane meta-analysis, which combined the data obtained in 7688 patients in 32 studies .Thus, a direct comparison did not show differences in efficacy between systemic and local NSAIDs, while the incidence of gastrointestinal adverse reactions with the use of local NSAIDs was comparable to that in patients receiving placebo. Thus, in the absence of systemic adverse reactions, the analgesic efficacy of local NSAIDs is comparable to the efficacy of systemic NSAIDs. One of the most effective topical NSAIDs with an overall favorable safety profile is ketoprofen, as evidenced by the results of a number of studies.Thus, in the course of a large clinical study, it was shown that ketoprofen is the most effective local NSAID in relieving pain . According to the data obtained, ketoprofen is significantly more effective than other local NSAIDs in terms of the integral indicator of the effectiveness of NNT therapy (numbers needed to treat), namely: 58% better than ibuprofen; 80% better than piroxicam and 92% better than diclofenac. Thus, with topical administration, ketoprofen is almost 2 times more effective than topical diclofenac.
Such advantages in the analgesic and anti-inflammatory efficacy of ketoprofen for topical application are due not only to the activity of the molecule, but also to its ability to penetrate into the tissues of the joints and periarticular structures.
The advantage of ketoprofen in comparison with other topical NSAIDs is also confirmed by the results of a study by Japanese authors , which examined topical NSAIDs in modern dosage forms of gels and patches. Thus, ketoprofen preparations for topical use have been identified as the most promising.According to the authors of the study, ketoprofen has a higher anti-inflammatory and analgesic activity associated with both the pharmacological characteristics of the molecule and its better penetration through the skin.
A natural question arises as to why ketoprofen is characterized by a favorable safety profile, because if the drug penetrates well through the skin, then the concentration in the blood plasma should also be high. However, this is not the case, since ketoprofen selectively accumulates in the area of application of therapeutic properties – in the tissues of the joints.Thus, it has been shown that the concentration of ketoprofen in blood plasma is about 100 times lower than in the tissues of the joint . It is noteworthy that ketoprofen does not affect the synthesis of the articular cartilage matrix – proteoglycans, even in osteoarthritically altered articular cartilage . And in young cartilage at a concentration of 10 M ketoprofen even increases the synthesis of cartilage matrix.
Thus, ketoprofen is a reasonable choice in combination with systemic diclofenac or nimesulide. According to evidence-based medicine, the drug demonstrates a high efficacy and a favorable safety profile, while not exerting a negative effect on articular cartilage, which is of key importance for long-term use.Ketoprofen reaches the focus of pain and inflammation in the required concentration, providing analgesic and anti-inflammatory effects. At the same time, the concentration of the drug in the blood plasma remains very low and does not cause the development of systemic adverse reactions even in the case of prolonged therapy.
When choosing NSAIDs to relieve pain and inflammation, it is necessary to take into account the effectiveness and safety of the drug, as well as the risk of developing certain adverse reactions in a particular patient:
- For low cardiovascular and gastrointestinal risks, any NSAID may be the drug of choice, but primarily diclofenac, which remains the gold standard in anti-inflammatory therapy.
- The drug of choice in the treatment of pathology of the musculoskeletal system, in particular OA, is nimesulide.
- In the presence of cardiovascular pathology, the drug of choice is nimesulide or diclofenac in combination with acetylsalicylic acid.
- To enhance the clinical effects of systemic NSAIDs, it is advisable to add local NSAIDs, primarily ketoprofen, which demonstrates high efficacy and low risk of systemic adverse reactions, which is comparable to placebo .
- 1. Laufer S., Gay S., Brune K. (2003) Inflammation and Rheumatic Diseases: The molecular basis of novel therapies. Georg Thieme Verlag, New York.
- 2. Visha M.G. (2013) Selective Cox-2 inhibitor. Int. J. Pharm. Sci Interv., 3 (2): 28-33.
- 3. Olsen A. M. S., Gislason G. H., McGettigan P. et al. (2015) Association of NSAID use with risk of bleeding and cardiovascular events in patients receiving antithrombotic therapy after myocardial infarction.Jama, 313 (8): 805-814.
- 4. Bresalier R.S., Sandler R.S., Quan H. et al. (2005) Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N. Engl. J. Med., 352 (11): 1092-1102.
- 5. Fanelli A., Ghisi D., Aprile P.L., Lapi F. (2017) Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications. Therapeutic Advances in Drug Safety, p.173-182.
- 6. Bhala N., Emberson J., Merhi A. et al. (2013) Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: metaanalyses of individual participant data from randomized trials. Coxib and traditional NSAID Trialists (CNT) Collaboration. Lancet 382 (9894): 769-779.
- 8. Fitzgerald G.A., Patrono C. (2001) The coxibs, selective inhibitors of cyclooxygenase-2.N. Engl. J. Med., 345 (6): 433-442.
- 9. Brune K., Patrignani P. (2015) New insights into the use of currently available non-steroidal anti-inflammatory drugs. J. Pain Res. 8: 105.
- 10. Walter M.F., Jacob R.F., Day C.A. et al. (2004) Sulfone COX-2 inhibitors increase susceptibility of human LDL and plasma to oxidative modification: comparison to sulfonamide COX-2 inhibitors and NSAIDs. Atherosclerosis, 177 (2): 235-243.
- 11.Solomon S.D., McMurray J.J., Pfeffer M.A. et al. (2005) Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. N. Engl. J. Med., 352 (11): 1071-1080.
- 12. Simon L.S. (2000) Are the biologic and clinical erfects of the COX-2-specific inhibitors an advance compared with the effects of traditional NSAIDs? Curr. Opin. Rheumatol. 12: 163-170.
- 13. Smith W.L., Langen B.R. (2001) Why there are two cyclooxygenase isoenzymes.J. Clin. Invest. 107: 1491–95.
- 14. Wallace J.L. (1999) Distribution and expression of cyclooxygenase (COX) isoenzymes, their physiological roles, and the categorization of nonsteroidal anti-inflammatory drugs (NSAIDs). Am. J. Med. 107 (6A): 11-16.
- 15. Wallace J. L., Bak A., McKnight W. et al. (1998) Cyclooxygenase-1 contributes to inflammatory responses in rats and mice: implications for gastrointestinal toxicity. Gastroenterology 15: 101-109.
- 16. Dey I., Lejeune M., Chadee K. (2006) Prostaglandin E 2 receptor distribution and function in the gastrointestinal tract. British J. Pharmacol. 149 (6): 611-623.
- 17. Hecken A., Schwartz J. I., Depré M. et al. (2000) Comparative inhibitory activity of rofecoxib, meloxicam, diclofenac, ibuprofen, and naproxen on COX-2 versus COX-1 in healthy volunteers. J. Clin. Pharmacol., 40 (10): 1109-1120.
- 18. Hawkey C., Kahan A., Steinbrück K. et al. (1998) Gastrointestinal tolerability of meloxicam compared to diclofenac in osteoarthritis patients. International MELISSA Study Group. Meloxicam Large-scale International Study Safety Assessment. British J. Rheumatol., 37 (9): 937-945.
- 19. Lanas A., García-Rodríguez L.A., Arroyo M.T. et al. (2006) Risk of upper gastrointestinal ulcer bleeding associated with selective COX-2 inhibitors, traditional non-aspirin NSAIDs, aspirin, and combinations.Gut. Dec. 55 (12): 1731-1738.
- 20. Barracchini A., Franceschini N., Amicosante G. et al. (1998) Biochemistry: Can Non-steroidal Anti-inflammatory Drugs Act as Metalloproteinase Modulators? An In-vitro Study of Inhibition of Collagenase Activity. J. Pharm. Pharmacol., 50 (12): 1417-1423.
- 21. Holgate S.T., Peters-Golden M., Panettieri R.A. et al. (2003) Roles of cysteinyl leukotrienes in airway inflammation, smooth muscle function, and remodeling.J. Aller. Clin. Immunol. 111 (1): 18-36.
- 22. Burnett B.P., Levy R.M. (2012) 5-Lipoxygenase Metabolic Contributions to NSAID-Induced Organ Toxicity. Advances in Therapy, 29 (2): 79–98.
- 23. Shuba N.M., Voronova T.D., Pilipenko A.V. (2015) Study of the effectiveness of nimesulide and its effect on individual pathogenetic links in the practice of a family doctor. Family Medicine, 2: 41–45.
- 24. Shuba N.M., Voronova T.D., Krilova A.S. 90 098 (2017) Differentiation of children before treatment of osteoarthritis with comorbid pathology.Ukr. rheumatol. zhurn., 2 (68): 6-16.
- 25. Williams C. M., Maher C. G., Latimer J. et al. (2014) Efficacy of paracetamol for acute low-back pain: a double-blind, randomized controlled trial. Lancet 384 (9954): 1586-1596.
- 26. Moore R. A., Tramer M. R., Carroll D. et al. (1998) Quantitive systematic review of topically applied non-steroidal anti-inflammatory drugs. BMJ 316 (7128): 333-338.
- 27. Derry S., Moore R. A., Rabbie R. (2012) Topical NSAIDs for chronic musculoskeletal pain in adults.Cochrane Database Syst. Rev. 9: CD007400.
- 28. Mason L., Moore R. A., Edwards J. E. et al. (2004) Topical NSAIDs for acute pain: a meta-analysis. BMC family practice, 5 (1): 10.
- 29. Komatsu T., Sakurada T. (2012) Comparison of the efficacy and skin permeability of topical NSAID preparations used in Europe. Eur. J. Pharmac. Sci., 47 (5): 890-895.
- 30. Ballerini R, Casini A, Chinol M et al. (1986) Study on the absorption of ketoprofen topically administered in man: comparison between tissue and plasma levels.Int. J. Clin. Pharmacol. Res., 6 (1): 69-72.
- 31. Wilbrink B., van der Veen M. J., Huber J. et al. (1991) In vitro influence of ketoprofen on the proteoglycan metabolism of human normal and osteoarthritis cartilage. Inflam. Res, 32 (3): 154-159.
Fur coat Neonila Mikhailovna
04112, Kiev, st. Dorogozhitskaya, 9
National Medical Academy
named after P.L. Shupika
90,000 How to relieve cat pain? What medications are dangerous for cats?
Relieving a cat’s pain is not easy.Because pain relievers commonly prescribed to humans and dogs can be toxic to cats, pet owners ask themselves, “What pain relievers will be most safe and effective for cats?”
First, pet owners need to be aware of the dangers associated with a range of pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), that can be found in almost every home. The most common NSAIDs are aspirin and ibuprofen for humans and carprofen, etodolac, and deracoxib for cats.Cats are extremely sensitive to the side effects of NSAIDs, so this class of drugs should be used with extreme caution (if at all) and always under the close supervision of a veterinarian.
Why are NSAIDs harmful to cats?
NSAIDs work by inhibiting the enzyme cyclooxygenase, which is responsible for the production of prostaglandins. Prostaglandins promote inflammation, fever, and pain, but they also have many other functions in the body, including maintaining adequate blood flow in the kidneys, forming a layer of mucus that protects the lining of the gastrointestinal tract from stomach acid, and forming normal blood clots.
Cats are about 2-5 times more sensitive to NSAIDs than dogs. Because of this:
- Doses of these drugs given to cats are significantly lower than those commonly used.
- These medications are only given to cats for a short period of time.
- Medication intervals are much longer in cats than in humans or dogs.
90,017 NSAIDs are generally only used in cats when safer forms of pain relief are not sufficient.
If these guidelines are not followed, or even if they are followed, the cat may develop vomiting, diarrhea, loss of appetite, impaired liver and kidney function, bleeding disorders, and may die regardless of treatment.
For the full slideshow on Are pain relievers safe for cats? visit the petMD website!
90,000 Oral composition containing s (+) – ibuprofen, and a method for its preparation.
1.An organoleptically acceptable oral pharmaceutical composition comprising S (+) – 2- (p-isobutylphenyl) propionic acid, substantially free of R (-) – 2- (n-isobutylphenyl) propionic acid, and an acid component.
2. The pharmaceutical composition according to claim 1, characterized in that the acid component contains one or more acids selected from: citric acid, tartaric acid, malic acid, fumaric acid, lactic acid, adipic acid, ascorbic acid, aspartic acid, d-erythroascorbic acid, glutamic acid, succinic acid.
3. A pharmaceutical composition according to claim 1, further comprising an organoleptically acceptable pharmaceutical carrier.
4. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in powder or granular form.
5. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of a liquid.
6. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of chewable tablets.
7. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of an effervescent preparation.
8. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of lozenges.
9. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in a rapidly disintegrating solid form.
10. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of a chewable preparation used for veterinary medicine.
11. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of a chewing gum.
12. A method for preparing an organoleptically acceptable oral pharmaceutical composition by mixing an active component and a target additive, characterized in that the active component is S (+) – 2- (n-isobutylphenyl) -propionic acid, practically free of R (- ) -2- (p-isobutylphenyl) -propionic acid, as a target additive – an acid component and convert it into a form suitable for oral administration.
1 This invention relates to new compositions of ibuprofen. In particular, this invention relates to organoleptically acceptable solid oral compositions of S (+) ibuprofen. For the purposes of this description, organoleptically acceptable compounds, substances and compositions are those that can contact the taste buds of the mouth of the recipients and which are usually acceptable to the recipient’s sensations, in particular to the taste. In particular, organoleptically acceptable compositions of this invention are those solid oral compositions in which the S (+) ibuprofen component should not have the unpleasant bitter taste commonly associated with racemic ibuprofen mixtures.As used herein, the term pharmaceutical composition includes both therapeutic and prophylactic compositions and refers to compositions for use in the veterinary field as well as for use in the treatment of humans. This invention relates to organoleptically acceptable compositions of ibuprofen. Racemic mixtures of ibuprofen, widely used as an analgesic and antipyretic agent, are believed to be generally bitter and not palatable enough for most uses in which the recipient tastes the ibuprofen mixture.Some flavors such as chocolate, banana, orange, lemon, licorice flavors, root vegetable flavors with nutmeg, etc. Odorless and raspberry flavoring have been suggested for bitter-tasting drugs, but they are usually not reliable in masking unpleasant tastes. Bitter taste is usually difficult to successfully mask if it does not mimic the expected natural flavor of the flavoring agent. For this reason, bitter tasting pharmaceuticals such as ibuprofen in particular have not attempted to be applied to many oral dosage forms such as chewable tablets and oral liquids.Rapidly dissolving dosage forms are described in US Pat. Nos. 4,305,502 and 4,371,516 (both issued to Gregory et al.), They disintegrate in water within seconds and therefore disintegrate rapidly in the saliva of the mouth. Such dosage forms are usually limited for use with drugs that have a neutral taste or taste that is only mildly unpleasant and which can be masked by flavoring agents. US Pat. No. 4,835,186 (Reuter et al.), 4,835,187 (Reuter et al.) And 4,835,188 (Ho et al.) discloses spray-dried ibuprofen compositions in which the ibuprofen is coated and formed into small particles that can pass through the mouth without leaving an unpleasant taste. Ibuprofen is marketed under the name Advil by Wyeth-Ayerst Laboratories, a Division of American Home Products Corporation Wyeth-Ayerst Laboratories also sells Children’s Advil Suspension, which is a fruit-flavored sucrose-sweetened liquid suspension for oral use …Ibuprofen is -2- (pisobutylphenyl) -propionic acid, also known as -methyl-4- (2-methylpropyl) benzeneacetic acid; p-isobutylhydratropic acid or 2- (4-isobutylphenyl) propionic acid having the structure shown below: Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) known to have analgesic and antipyretic activities. It is used in the treatment of pain and inflammation associated with a variety of conditions, including runny nose, toothaches, headaches, back pain, menstrual cramps (Dymennorhea), muscle aches and pains associated with premenstrual syndrome (Premenstrual Syndrom), rheumatoid arthritis and osteoarthritis. and also as an antipyretic agent.Like other NSAIDs, ibuprofen has become widely used in prescription and proprietary formulations for the treatment of pain associated with inflammation, both minor and chronic. One of its drawbacks, however, is that it has an unpleasant bitter taste, which limits its applicability in many oral dosage forms. As mentioned above, methods of mitigating this limitation include attempting to mask the bitter taste by using flavors and / or sweetening media, or by coating (coating) the ibuprofen with substances that prevent it from contacting the taste buds (tubercles) during oral administration.By reducing the bitterness, these solutions do not make the use of oral ibuprofen formulations organoleptically acceptable to all ibuprofen users. In addition, these steps increase the preparation time and cost of preparing many oral ibuprofen compositions. It has been found that the S (+) stereoisomer of ibuprofen, which is also referred to herein 3 as (+) – 2- (p-isobutylphenyl) propionic acid, the ibuprofen eutomer or the eutomer (active enantiomer) of ibuprofen, does not have the unpleasant bitter taste that, is known to possess racemic ibuprofen.It is therefore now understood, and within the scope of the invention, that the use of a single S (+) stereisomer of ibuprofen, referred to herein as the eutomer of ibuprofen, substantially free of its R (-) form, allows a wide variety of ibuprofen compositions to be provided, preferably in oral dosage forms. which are pharmaceutically and organoleptically acceptable for oral administration. Not only does this knowledge enable the person skilled in the art to create organoleptically acceptable ibuprofen compositions, but it is done in such a way that no additional coating or flavor masking steps are required for the ibuprofen component.In many cases, the coating technique for pharmaceutical substances is imperfect, leaving a portion of the compound in question available to the taste buds. Likewise, in chewable formulations, the grinding action of the teeth can pierce the coated particles in the formulations, releasing some unpleasant tasting substance. By virtue of the ingredient in an acceptable flavor base, the compositions of this invention eliminate the chance of unexpected release of unpleasant substances.This improvement not only improves the marketability and reduces the cost of producing such compositions, but can also induce the recipient to follow the prescribed dosage regimen. In view of this knowledge, the present invention includes organoleptically acceptable oral compositions comprising, in whole or in part, the S (+) stereoisomer of ibuprofen. These oral compositions include those orally administered compositions in which the active ingredients or drugs of the composition are typically carried by the taste and odor receptors of the recipient.Such compositions include, but are not limited to, organoleptically acceptable liquid ibuprofen solutions, suspensions, emulsions, syrups, colloids, sachets, tablets, including chewable, buccal or sublingual (sublingual) tablets, powders or granular formulations, effervescent compositions, wafers, troches, or lozenges, pastes, foams, toothpastes and gels. Due to the use of NSAIDs in veterinary medicine, compositions that are organoleptically acceptable to animals, in particular companion animals such as cats and dogs, may fall within the scope of this invention.In its simplest form, the present invention includes the organoleptically acceptable compound 000046 4 positions of ibuprofen, which include the ibuprofen eutomer itself. This compound can be taken orally by itself to relieve the symptoms described above. The ibuprofen eutomer can be taken with water, fruit juices, soft drinks, milk, or other liquids or drinks that are used to facilitate oral administration of the drug. Other simplified forms of administration may include the introduction of the eutomer into food, which can then be consumed in the usual way.These food-related or drinking-related routes of administration may be preferred by any recipient, especially children. Preferably, the compositions of this invention containing the ibuprofen eutomer also contain an acidic component in an amount sufficient to maintain the pH of the composition below 7, preferably from about 2 to about 6, eg below 5.0. Additional examples include cases where the pH is from about 3.0 to about 3.5; about 2.5 to about 3.5; and about 5.0 to about 5.2.Pharmaceutically acceptable acids for use in these compositions include, but are not limited to, commonly used edible acids such as citric acid, tartaric acid, malic acid, fumaric acid, lactic acid, adipic acid, ascorbic acid, aspartic acid, d-erythroascorbic acid, glutamic acid and succinic acid. The compositions containing the ibuprofen eutomer of the present invention can be used in the manner and dosage suggested for ibuprofen tablets and capsules currently on the market.It should be understood by one of ordinary skill in the art that ibuprofen, like other NSAIDs, can differ in response from individual to individual. Therefore, the recommended initial therapeutic dose should be one that is likely to be effective for the majority of recipients, the dosage being adjusted after beneficial and harmful effects on the recipient have been identified. The ibuprofen eutomer of this invention should be administered at the lowest dose that can provide the desired physiological result.It may contain a single dose of 5 to 10 mg, as in infants (up to 12 months), up to 1 g or more for older adults, preferably from about 50 mg to about 800 mg, most preferably from about 100 to about 400 mg of the eutomer. ibuprofen for minor pain relief. Suggested dosages for pain relief associated with chronic problems (diseases) can range from about 600 to 3200 mg per day with regimens of 300 mg four times 5 a day (qid), or 400 mg, 600 mg, or 800 mg three times ( t.i.d.) or twice a day (b.i.d.). The person skilled in the art understands that a medical professional of average skill should directly prescribe this compound, using the composition of the present invention, in accordance with the need and medical situation for each patient individually, and that the maximum daily dose can be increased by a medical professional in excess of 3200 mg per day. if necessary and if tolerated by the patient. It will be appreciated that, despite the indicated amount of the ibuprofen eutomer listed in the following examples, compositions with any dose of the ibuprofen enantiomer described above may be formulated.Although the ibuprofen eutomer of the present invention does not impart undesirable off-flavor to the compositions in which it is used, the compositions described herein may include sweetening or flavoring agents to increase overall odor, taste and desirability of the composition. Such sweeteners can include all pharmaceutically acceptable sweeteners, including, but not limited to, molasses, glycine, corn syrup, sugars such as sucrose, glucose, fructose and confectionery sugar, sorbitol, saccharin, sucrose, sodium saccharin, calcium saccharin, aspartame (preferably under the trade name NutrasweetR, Nutrasweet Company, Deerfield, Illinois), stevioside, neohesperidyl dihydrochalcone, glycyrse, perillaldehyde, xylitol, dextrose, mannitol, and lactose.The compositions provided herein may also include an organoleptically acceptable pharmaceutically acceptable carrier, for example, pharmaceutically acceptable excipients, fillers, diluents, lubricants, disintegrants, suspending or stabilizing agents, and binders, including, but not limited to, magnesium stearate, sodium lauryl sulfate, microcrystalline cellulose, polyvinylpyrrolidone, gelatin, alginic acid, arabic gum, sodium citrate, complex silicates, calcium carbonate, glycine, dextrin, sucrose, sorbitol, dicalcium phosphate, calcium sulfate, lactose, kaolin, mannitol, sodium chloride, talc ( e.g. corn starch, potato starch or starch grits) and powdered sugar.In simple form, the compositions of this invention may include powdered or granular dosage compositions containing the ibuprofen eutomer. For example, the eutomer can be taken orally by itself, in powder or granular form. The recipient can place such a powdery or granular lump 000046 6 in the mouth and wash it off with a liquid or solid food. Due to the relatively small volume of S (+) ibuprofen present in the dosages described herein, it would be preferable to include one or more organoleptically acceptable powdered pharmaceutical ingredients in a powder or granular dosage form.They can be compounds with additional pharmaceutical activities, or fillers, sweeteners, etc. described herein. It should be borne in mind that in this way can be entered any dose of the eutomer of ibuprofen, and the volume of additional components is limited only by the amount that is acceptable to the recipient. When this S (+) stereoisomer of ibuprofen is used, organoleptically acceptable oral liquid dosage forms of ibuprofen, most often with an acidic component, can be formulated and used.Such liquid compositions can be obtained on a water basis. These oral fluids can be comprised of any of the oral liquid compositions using the ibuprofen eutomer, including simply mixing the required dose of the ibuprofen eutomer into commonly consumed amounts of effervescent drinks and drinks, including, for example, but not limited to, sparkling or still water, fruit juices, coffee, tea, soft drinks and milk. Such liquid compositions further preferably contain an acidic component such as described herein in an amount sufficient to maintain the pH of the liquid composition below 7, preferably from about 2 to about 6, for example below 5.0.Additional examples include cases where the pH is from about 3.0 to about 3.5; about 2.5 to about 3.5; and about 5.0 to about 5.2. Due to the relatively small volume occupied by a single dose of the ibuprofen eutomer and the accompanying acidic component, it is preferable to include these substances in a small, easily edible amount of one or more pharmaceutically and organoleptically acceptable substances, such as those described herein. In one preferred embodiment of the oral fluid of this invention, the oral fluid comprises from about 0.8 to about 4% of the enantiomer of ibuprofen based on the total volume weight of the composition, from about 0.1 to about 2% suspension stabilizing agents based on the total volume weight of the composition. , from about 20 to about 70% by weight of one or more flavors based on the total weight of the composition, from about 30 to about 70% water based on the total volumetric weight of the composition, wherein the composition containing 7 contains a pharmaceutically and organoleptically acceptable food acid such as citric acid or phosphoric acid, in an amount from 0.1 to about 2% by volume.Preferably, the suspending agents include xanthanic acid, microcrystalline cellulose, sodium carboxymethyl cellulose and polysorbate 80. Examples 1 and 2 describe how two such compositions can be prepared. Example 1 (Table 1) Ingredient Percent Grams per w / v 15 L Xanthan Gum 0.15 22.5 Microcrystalline 0.75 112.5 Cellulose Sodium Benzoate, NF (Nf) Citric Acid, Monohydrate, USP Sucrose, NF Corn Syrup Eutomer ibuprofen Sodium carboxymethyl cellulose, USP Polysorbate 80, NF Red FDC 40 Color, Disodium edetate, USP Artificial lime-scented oil Phosphoric acid, d.j. A first portion of this liquid oral composition can be prepared by first loading the sorbitol solution and portions of the glycerin into a jacketed stirrer reactor. Then the component – sodium carboxymethyl cellulose is poured into the solution and stirred for 10 minutes until the mixture is completely moistened. The mixture should then be heated to about 70 ° C and stirred until the resin is completely hydrated, after which the mixture is cooled to 45 ° C and the polysorbate 80 component is added.Stirring is continued while cooling the mixture to 30 ° C. The ibuprofen enantiomer is slowly poured into the mixture and stirring is continued for 15 minutes. Then, the obtained second part, by placing the required amount of water in a container equipped with a propeller-type stirrer, and slowly adding xanthan gum, is hydrated by stirring at high speed for 25 minutes. This follows after charging into a separate mixing vessel equipped with a propeller-type stirrer, water in an amount equivalent to about 30 to 40% by volume of 8 of the total charge (4500 to 6000 ml).Then, microcrystalline cellulose is poured onto water and mixed at medium speed for 30 minutes until the cellulose is completely dispersed. The required amount of xanthan gum solution from the aforementioned first part is added to the cellulose suspension with stirring for 15 minutes or until a uniform suspension is obtained. Then add slowly sucrose with stirring for 15 minutes or until the sucrose particles are no longer visible. Colorants such as the aforementioned RedEDC 40 Color can be added and mixed until the colorants are completely dispersed therein.This is followed by the addition of the slurry from the aforementioned first part and slow mixing for 15 minutes. Sodium benzoate, edetate disodium, citric acid and flavoring agents are then added and the mixture is stirred for 5 minutes after each addition. Phosphoric acid is added with stirring until the composition reaches a pH of about 3.0 to about 3.5. The final composition should be balanced with water and stirred until the composition is homogeneous.Example 2. The composition of a liquid composition for oral administration using S (+) ibuprofen is presented in table. 2. Ingredient Xanthan gum Microcrystalline cellulose Sodium benzoate, NF Citric acid aqueous, USP Sucrose, NF Glycerin, USP Sorbitol solution, USP Ibuprofen eutomer Sodium carboxymethylcellulose, USP Polysorbate 80, NF Red dye) (RedFDCP Sodium dye) (RedFDCPate Artificial lemon-scented oil Phosphoric acid, (qs) 9 This preparation can be obtained by measuring a solution of sorbitol and glycerin in a jacketed stirred reactor.Sodium carboxymethyl cellulose is poured into this solution, stirring for 10 minutes or until its particles are completely moistened. The resulting mixture is then heated to about 70 ° C and stirred until the resin is completely hydrated, after which the mixture is cooled to 45 ° C and polysorbate 80 is added. Stirring is then continued while the mixture is cooled to 30 ° C. Then slowly the ibuprofen eutomer is added and stirring is continued for 15 minutes to give an ibuprofen suspension as indicated below.The second solution, which may be referred to as a xanthan gum solution, is prepared as a 1% by weight solution of xanthan gum in water. The xanthan gum should be added slowly to the water and mixed at high speed for approximately 25 minutes. A separate mixing vessel equipped with a stirrer is charged with a volume of water equivalent to 30 to 40% of the total charge volume (4500 to 6000 ml). The microcrystalline cellulose is then poured onto water and mixed at medium speed for 30 minutes or until the microcrystalline cellulose is completely suspended.The required amount of xanthan gum solution is then added to the microcrystalline cellulose suspension with stirring for 15 minutes or until a uniform suspension is formed. The sucrose is then added to the second solution with stirring for 15 minutes or until the sucrose particles are no longer visible. Coloring agents can then be added. Then add the required amount of ibuprofen suspension slowly and mix for 15 minutes. Then sodium benzoate, disodium edetate and citric acid are added sequentially and stirred for 5 minutes after each addition.The hydrochloric acid component is added with stirring until the composition reaches a pH of about 2.5 to about 3.5. The remaining water is then added with stirring until a homogeneous composition is formed. Example 3. Chewable tablets containing the ibuprofen eutomer. It will be appreciated that chewable tablets containing the ibuprofen eutomer and falling within the scope of this invention include chewable tablet compositions known in the art to be pharmaceutically and organoleptically acceptable.These compositions should include: a) the ibuprofen eutomer in the dosage amounts specified herein; b) from about 5 to about 400 mg, preferably from about 10 to about 200 mg, of a solid acidifying component, such as the edible acid components specified herein; and c) from about 50 mg to about 5 g, preferably from about 100 mg to about 1 g, a pharmaceutically and organoleptically acceptable excipient such as dextrates, maltodextrins, lactose, modified food starches, aluminum stearate, gum base and compressed sugars food grade, as well as other substances suitable as a filler and carrier.Optionally, such chewable tablet compositions can contain up to about 100 mg of pharmaceutically acceptable glidants or lubricants. An example of such a chewable tablet is discussed below: Table 3 Ingredients Quantity Loading for w / tablet 1000 tablets, kg Eutomer ibuprofen – 200 mg 0.200 mg per Citric acid, 0.030USP Theoretical tablet weight 916.6 mg Method of preparing chewable tablets of eutomer ibuprofen Precautions: all operations should be carried out at a relative humidity not exceeding 30% and at a temperature not exceeding 27 C (80F).Chewable tablets of this composition can be prepared by mixing ibuprofen eutomer, sorbitol, citric acid, polyethylene glycol 9000 and spearmint flavor in a blender for 10 minutes. This newly formed mixture is then passed through a mill using a No. 14 sieve, medium speed, knife passes. Then, magnesium stearate is added to the mixture and the mixture is stirred for about one minute. This formulated mixture is then compressed into tablets of a predetermined weight using a 5/8 inch flat, round bevel die and die set.The organoleptically acceptable ibuprofen eutomer compositions of this invention 11 also include effervescent or foaming compositions. These compositions include any pharmaceutical formulation that uses the ibuprofen eutomer in an effervescent composition, in particular a composition comprising an effervescent or foaming combination of an organoleptically acceptable acid such as a food grade acid and a carbonate. Pharmaceutically acceptable acids used in these formulations include, but are not limited to, citric acid, tartaric acid, malic acid, fumaric acid, adipic acid, ascorbic acid, aspartic acid, derythroascorbic acid, glutamic acid, and succinic acid.Glycine can also be used as part of the acidic component, if desired, but it is most preferred that glycine does not constitute the majority of the acidic component. Most preferably, to create an effervescent solution with a pH below 7, more preferably below 6, the acidic component of these effervescent compositions is superior to the carbonate component. The carbonate can be any effervescent or foaming carbonate that is pharmaceutically and organoleptically acceptable, including, but not limited to, sodium bicarbonate, potassium carbonate, sodium carbonate, calcium carbonate, aluminum carbonate, magnesium carbonate, etc.n. It is understood that the acidic and carbonate components of these compositions may include one or more suitable acids or carbonates. In its broadest sense, the effervescent or foaming compositions of this invention comprise the active eutomer of ibuprofen plus any active amounts of acidic and carbonate components. Preferably, portions of these three components comprise: a) the required amount of ibuprofen eutomer, b) from about 0.5 to about 50% by weight of the acidic component, and c) from about 0.5 to 50% by weight of the carbonate component.For example, a single dose of this drug may include: a) 50-800 mg of (+) – 2- (p-isobutylphenyl) propionic acid, b) 1-8 g citric acid, or an equivalent amount of one or more of the acceptable acids specified herein, and c) 1-8 g sodium bicarbonate or an equivalent amount of one or more of the acceptable carbonates specified herein. It will be apparent to those skilled in the art that the components of these compositions may vary depending on the required dosage of the drug, the required effervescence or foaming, and the pH of the liquid to which the composition will be added.12 In addition, it is understood that, in addition to these three components, the effervescent or foaming compositions of this invention may include any additional pharmaceutically and organoleptically acceptable components, including, but not limited to, fillers, flavoring agents, coloring agents, sweeteners, binders, pharmaceutically acceptable enhancers. the smell of the product, perfume, etc. These compositions may also include other pharmaceutically active agents such as analgesics, antihistamines, antacids, anti-bloating agents, etc.e. Examples of effervescent and foaming compositions encompassed by this invention include the following: Effervescent Ibuprofen Eutomer Powders One hundred dose batches of effervescent or foaming powder of this invention may be prepared by mixing together any of the following combinations with or without additional components. Example 4. a) 1,000 to 80,000 mg of ibuprofen eutomer b) 100 g of tartaric acid c) 100 g of sodium bicarbonate Example 5. a) 1,000 to 80,000 mg of ibuprofen eutomer d) 100 g of ammonium carbonate Example 7.a) 1000 to 80,000 mg of ibuprofen eutomer h) 5 g of carboxymethylcellulose Effervescent tablets of ibuprofen eutomer Example 8. For the manufacture of one thousand tablets of 200 mg, the ingredients are taken in the amount indicated in Table 4. micronized powder is a powder with a particle size, preferably less than 50 microns. Method of obtaining. Precautions: after stage 1, all processes are carried out in an environment with a relative humidity that does not exceed 30%. 1. Dry the compounds specified in points 1, 2, 3 and 4 at 105 C for 4 hours.2. Mix the compounds specified in points 1, 2, 3 and 4 to obtain a homogeneous powder. 3. Pass the mixture from Step 2 through a 60 mesh screen. 4. Pass the compound of step 5 through a 60 mesh sieve. 5. Add the screened compound from step 5 to the mixture from step 3 and mix until distributed. 6. Compress using a flat, beveled 5/8 inch punch and die into a 2.0 g tablet. Instructions for use: Place the required dose, 200 mg per tablet, in approximately three fluid ounces of water and wait until until the tablet disintegrates completely.Effervescent granules of ibuprofen eutomer. Example 9 Use the ingredients of Example 8 to make 1000 sachets or bags, replace the compound of Item 5 with Orange Flavored Dry Powder (from MacAndrew Forbes Co., Camden, NJ 08104) and replace Step 6 of Example 8 with the following two steps. Step 6 Place the powder from Step 5 in a fluidized bed column and, while the powder is suspended in air, add a sufficient amount of aqueous spray to form granules of approximately 10 mesh.Stage 7. Include heat to dry the granules and remove moisture to a relative humidity of not more than 25%, to be packed in sealed bags of 2.5 g each. Instructions for use. Add the required number of bags to approximately 3 ounces of water (3 x 28 g) and wait until all the granules have disintegrated for oral use. Rapidly Disintegrating Solid Dosage Forms Another form that the organoleptically acceptable compositions of this invention may take are the rapidly dissolving and disintegrating dosage forms described in US Pat. No. 4,371,516, the disclosure of which is referenced herein.These forms are preferably soluble solid forms, which are designed to disintegrate in a few seconds upon contact with liquids such as water or saliva from the mouth of recipients. These forms preferably disintegrate within 10 seconds on contact with liquids. Such compositions are especially useful for administering drugs to children or the elderly, or to others who may not be responsive to treatment and who may try to spit the drug out or hide the non-disintegrating form in their mouth until they throw it away. later.Although the process for preparing rapidly disintegrating solid dosage forms that are used in this invention is detailed in US Pat. -2- (n-isobutylphenyl) -propionic acid, referred to below as eutomer of ibuprofen. Example 10 75 individual, fast-disintegrating doses of 50 mg of ibuprofen eutomer can be prepared as follows: a) A hydrolyzed gelatin solution is prepared by dissolving 30.0 grams of gelatin B.R. in 1000 ml of purified water using heating and constant stirring. The resulting gelatinous solution is then autoclaved at 121 ° C. and 1.055 kg / cm 2 (15 p.s.i.) for one hour. The gelatin solution is then allowed to cool to room temperature. B) An aluminum mold containing 75 cylindrical depressions, each cavity having a diameter of about 0.5 cm and a depth of 1 cm, is cooled to about -192 ° C in liquid nitrogen in a stainless steel tray. become. 100 g ibuprofen eutomer, 20 g ob (obstetric) benzoic acid, 0.25 g yellow dye (F.D.C. Yellow5Coloring Agent), 0.5 g of Norda, spray dried orange flavor, is mixed with the gelatin solution and stirred continuously and, at the same time, 1/2 ml of this mixture is added with a hypodermic syringe to each cavity of the mold. The contents of the depressions are cooled. Then the mold is placed at room temperature under a vacuum of 0.3 mm Hg. Art. at night. The lyophilized formulations (each containing 50 mg of the enantiomer of ibuprofen) are then removed from the mold and stored under sealed conditions.Each composition should dissolve in a few seconds when taken orally or when added to a liquid. One of ordinary skill in the art will appreciate that the above techniques can be used to formulate rapidly disintegrating dosage forms of this invention containing a variety of individual doses of (+) – 2- (p-isobutylphenyl) propionic acid. These solutions may further include a variety of flavoring agents, sweetening agents, coloring agents, etc. to make the solutions more attractive to various recipients.In addition, other carrier materials can be used in place of the partially hydrolyzed gelatin. These include, but are not limited to, polysaccharides such as hydrolyzed dextran, alginates (eg sodium alginate), and dextrin, or mixtures thereof with each other or with other carrier materials, including gum arabic, polyvinyl alcohol, or polyvinyl pyrrolidine. For the preparation of rapidly disintegrating compositions, it is preferred that the (+) – 2- (p-isobutylphenyl) propionic acid used is in the form of a micronized powder in order to avoid the potential squeaky sensation of sand on disintegration of the compositions in the mouth of the recipient.More preferably, (+) – 2- (p-isobutylphenyl) propionic acid is in the form of a micronized powder containing particles of 50 microns or less. It is obvious to one skilled in the art that these compositions, due to the nature of this design, should disintegrate when exposed to moisture, or physical stress, or shock. Therefore, it should be borne in mind that these compositions should be handled with care and filled in containers that minimize the risk of premature deterioration, such as the packaging described in US Pat. No. 4,305,502.Examples 11 to 14 provide a list of combinations of (+) – 2- (p-isobutylphenyl) propionic acid and other components that can be added in the above manner to 1000 ml of gelatin solution or other suitable carriers. B) 30 g fructose c) 10 g benzoic acid Example 12 100 mg ibuprofen eutomer / dose. a) 200 g ibuprofen eutomer (yellow dye) c) 0.5 g Norda spray-dried orange flavor d) 25 g sucrose e) 20 g benzoic acid Example 13.200 mg ibuprofen eutomer / dose a) 400 g ibuprofen eutomer d) 15 g sucrose e) 40 g benzoic acid Example 14.400 mg ibuprofen eutomer / dose – without hydrolyzed gelatin a) 533.33 g ibuprofen eutomer d) 15 g aspartame e) distilled water up to 1000 ml f) 50 g benzoic acid This composition, which contains hydrolyzed gelatin as in the previous examples, can be obtained in recesses of a 220 x 330 mm PVC sheet containing 150 cylindrical recesses, each recess having a depth of about 0.7 cm and a diameter of about 1.4 cm, which is cooled with solid carbon dioxide.The composition can be prepared by suspending the ibuprofen eutomer in water containing sodium alginate, dextran and aspartame listed above using ultrasonic vibrations. Then 0.75 ml of the suspension is placed in each of the recesses of the PVC sheet, where the suspensions can be completely lyophilized into a rapidly disintegrating composition. Example 15 1 g ibuprofen eutomer / dose without hydrolyzed gelatin a) 1333.33 g ibuprofen eutomer f) distilled water up to 1000 ml g) 50 g benzoic acid Another example of a rapidly disintegrating solid composition can be prepared with the above components and carbon dioxide cooling the PVC – sheet as described in the previous example.This can be done by adding polyvinyl alcohol to about 500 ml of hot distilled water 17, which is then cooled. Then add polyvinylpyrrolidine, sucrose and Tween 80 and shake the mixture to dissolve all solids. The ibuprofen eutomer is added and the mixture is dispersed by ultrasonic vibrations. This mixture is then made up to a final volume of 1000 ml by the addition of distilled water. Next, 0.75 ml of this solution is added to each lyophilization well to the final solid composition.Buccal Compositions A buccal (buccal) composition containing the ibuprofen eutomer of this invention can be prepared using the steps set forth in US Pat. No. 4,764,378 (Keith et al.), Which is referred to herein. Most preferably, these buccal compositions contain an acidic component such as a micronized solid food grade acid. Such food-grade acid can be included in an amount of from about 0.1-2.0% by weight of the final buccal composition, although more acid can be added if necessary.Example 16. Compositions in the form of lozenges or lozenges. Compositions in the form of lozenges or lozenges containing the ibuprofen eutomer can be prepared for any of the dosages specified herein by methods known in the art. For example, such lozenges can be obtained by pressing and then drying by evaporating a concentrated syrup containing the ibuprofen eutomer, with added thickeners as needed, such as gum arabic or tragacanth. This type of flatbread is often referred to as a sugared flatbread or lozenge.Using the following ingredients and methodology, candied tortillas can be prepared for any dosage of ibuprofen eutomer specified herein. Below is a composition used to prepare lozenges containing 100 mg of ibuprofen eutomer. Ingredient Amount, g Sucrose Tartar Corn syrup Citric acid (fine powder sieved through a 100 mesh sieve) Ibuprofen eutomer These cakes can be prepared by adding the above sucrose, tartar (optional) and corn syrup to a vessel while stirring, followed by boiling to dissolve the sucrose and wine 18th stone.Heating of these components should be stopped when a strong boil is reached, which occurs at about 143 C (290 F), and when about 30% of the original volume has been removed by evaporation. These components should be mixed until the mass has cooled to approximately 138 C (280F). At this point, citric acid and the ibuprofen eutomer should be added to the resulting mass with stirring, until a homogeneous dispersion is obtained. When the contents have cooled to about 88 ° C (190F), the mass is rolled into a flagellum or columnar shape and cut into 4 g pieces.These pieces can then be placed on a grid to cool to room temperature. Faster disintegrating lozenges or lozenges can be prepared using 9200 g of compressed sugar such as Dipac regular commercial sugar (Domino Sugar Co., New York, NY) and the amounts of tartar (optional) described above, citric acid, and ibuprofen eutomer (or other preferred dose of ibuprofen enantiomer). These components can be homogenized by mixing and compressed into pellets of the desired size, such as the 4 g tablets described above.The compressed sugar, an equivalent amount of sucrose and lactose can be thoroughly mixed with a suitable binder such as sodium alginate in an amount of 525 g and a pharmaceutically acceptable granulating liquid to form a wet mass. This wet mass can be passed through a granulating mill and compressed into pellets of the desired size. From the description and examples provided herein, it will be apparent to those skilled in the art that S (+) – 2- (p-isobutylphenyl) propionic acid, the eutomer of ibuprofen, can be used to prepare a wide variety of organoleptically acceptable oral compositions without departing from the scope of the invention.Compositions for cleaning teeth. Dentifrice compositions known in the art may have S (+) ibuprofen, preferably with an additional acidic component included, to prevent or reduce osteoporosis and / or to promote regrowth of previously lost bone. It will be appreciated that dentifrices are believed to include any dental compositions that can be used to treat and maintain the teeth and tissues of the mouth. These include, but are not limited to, pastes, gels, powders, granular compositions, liquids, etc.e. An example of a toothpaste within the scope of this invention can be prepared by slowly adding the following non-aqueous components to water, followed by conventional mixing with a roller mill. Example 17 Component S (+) ibuprofen Magnesium Aluminum Silicate Citric acid Dicalcium phosphate Mint or other flavoring agent Sodium carboxymethyl cellulose Sodium lauryl sulfate Water Organoleptically acceptable dentifrices, within the scope of this invention, may include any of the known dentifrice compositions , preferably with an acidic component present or added.Compositions for pastes of this type may contain, for example, by weight 10-50% abrasive system, 0.5-10% thickeners, 10-80% humectant, 0.11% sweetener, 0.05-2% flavors, 0.0010 , 02% coloring agents, 1-7.5% surfactant, 0.1-0.8% antimicrobial preservatives and 0.01-5% acidifying agents. The abrasive components of these compositions include calcium pyrophosphate, hydrated silicon dioxide, insoluble sodium metaphosphate, organic polymers, alumina trihydrate, dicalcium phosphate dihydrate, anhydrous dicalcium phosphate, and calcium carbonate.Thickeners include silica airgel, fumed silica, silica precipitates, carboxymethyl cellulose, carboxyvinyl polymers, xanthan gum, and carrageenan. Humectants used include sorbitol, glycerin and polyethylene glycols. Used sweeteners include saccharin, xylitol, cyclamate, aspartame and thaumatin. Flavors can be modified to suit taste and market requirements, but include peppermint, spearmint, winter-lover, cinnamon and aniseed flavors, and natural oils.Any dyes approved for pharmaceutical purposes can be selected for inclusion in such compositions. Surfactants may include sodium lauryl sulfate, sodium lauryl sarcosinate, pluronix, tweens, sodium coco monoglyceride sulfate, sodium dodecyl benzene sulfonate, and dioctyl sodium sulfosuccinate. Antimicrobial agents and preservatives used in the art include parahydroxybenzoates, sorbic acid, and benzoic acid. Acidic components for 20 of these forms include food acids as defined herein, including lactic acid, citric acid, phosphoric acid, and tartaric acid.An example of such a dentifrice can be obtained from the following ingredients. Example 18 (Table 4) Ingredient Eutomer of ibuprofen Xerogel of silicon dioxide Airgel of silicon dioxide Sodium carboxymethyl cellulose Sorbitol Saccharin Sodium monofluorophosphate Sodium lauryl sulfate (29% solution) Aroma of Tutti Frutti (Virginia Dare, AK 27) Equal parts to Ethylparaben, To to minimize any possibility of demineralization of the tooth structure, it is believed that the pH of this composition should be not lower than 5.0.Sodium monofluorophosphate is an appropriate fluoride source used in this desired pH range. Chewing Gum Compositions Another organoleptically acceptable composition within the scope of this invention are types of chewing gum compositions. It is understood that these types of compositions can be prepared by incorporating the ibuprofen eutomer, most preferably together with a suitable acidic component, in any of the organoleptically acceptable chewing gum bases 21.An example of a chewing gum composition of the present invention can be prepared with the components set forth in Example 19 below (see end of description). A chewing gum composition is prepared by heating the above ingredients to a softened state, followed by separate stepwise addition of acidifier, sweetener, ibuprofen eutomer and flavor with stirring to obtain a homogeneous mixture after each addition. The final homogeneous chewing gum composition is then milled with a sizing machine and cut into 3 g pieces using finely ground powdered sucrose for ease of handling, followed by standard packaging and filling.It is understood that other chewing gum compositions may be used without departing from the scope of this invention, and that the components of the above composition may be replaced with equivalent amounts of other functional components, including those described herein, for use with other compositions. Veterinary Compositions It is further understood that the use of organoleptically acceptable compositions is important for veterinary use. While this is true of any mammal for which an NSAID may be recommended by a veterinarian, it is particularly true for companion animals such as dogs and cats where owners and caregivers have appreciated the relative ease of administration of rapidly administered oral dosage formulations. , as opposed to those compositions; to be introduced by means of mechanical retention methods.The veterinary compositions of this invention include any of the aforementioned solid or liquid dosage forms that can be given to animals. These compositions can be administered to food or drink for animals, or given as a separate pharmaceutical form. If given separately, it is recommended that the composition contains an ingredient, preferably a tasty ingredient, which is generally considered pleasing to the animal in question. For example, in the case of cats and dogs, it can be used as the main flavoring component of liver extract, seafood extract, poultry extract, dried liver, soy flour, sugar, liver oil, soybean pulp, fish meat, bones, yeast, pulp 22 wheat seeds and other known food bases or combinations thereof.Such ingredients can be used as flavoring agents in the above compositions and they can be used as fillers in place of the materials described herein. It will be appreciated that the percentages of ingredients in the animal-oriented oral compositions of this invention will be determined in large part by the size of the animal and the size of the composition desired. For example, a relatively small chewable tablet can be composed of a blended and compressed combination of the following ingredients: Example 20.Ingredient Weight% Ibuprofen eutomer 60 Main aroma component 15-25 Microcrystalline cellulose 10-20 Povidone K 29-32 2-6 Aluminum stearate 1-2 Lactic acid 0.1-2.0 To obtain a larger solid composition containing the required dose eutomer of ibuprofen, the number of components, if desired, can be increased as in the following composition. Example 21 Ingredient Weight% Ibuprofen eutomer 60 Base flavor component 35-45 Calcium phosphate dibasic 15-25 Microcrystalline cellulose 15-25 Povidone K 29-32 2-6 Aluminum stearate 1-2 Most preferably these compositions furthermore contain an acidic component such as a solid food acid.For example, an edible acid such as citric acid or malic acid can be present in an amount of 1-5% by weight of the composition, although the amount of the acidic component can be increased if desired. Another desirable solid composition that can be used for administration to animals may be formulated as follows. Example 22. Ingredient mg / tablet Eutomer ibuprofen 5-500 Whey, dry sweet 2000 Liver, dried 210 Yeast dry 50 Aluminum stearate, NF 50 Citric acid 30 Example 23. A dosage form in the form of a chewable tablet for use in pets can be obtained with the following components and in the following ways.While this example shows the preparation of 200 mg tablets containing the ibuprofen eutomer, it will be appreciated that any required dose can be incorporated into this type of composition. Table 7 Amount Amount / Steam Ingredients per tablet, tia 1000 tablets, g mg Eutomer ibu 200 200 profena 600 600 Sodium starch glycolate, NFU.S.P. lactose Dried 252 252 liver Dry yeast 62 62 Aluminum stearate 45 45 Fumaric acid 100 100 slots Chewable tablets of this composition can be prepared by mixing ibuprofen eutomer, sodium starch glycolate, spray dried lactose, fumaric acid, dried liver and dried yeast in a suitable mixer until a homogeneous mixture is obtained.Then 2/3 of the amount of aluminum stearate is added to the batch, such as about 10% of the mixture of the ingredients just described, with stirring until a uniform mixture is obtained. The remaining mass of ingredients is then added with mixing sufficient to evenly distribute the mass containing aluminum stearate. This mixture is then brought to a medium hardness and calibrated through a rotary granulator using a No. 10 sieve. The remainder of the aluminum stearate is then added to the granulated mixture with stirring.The final tablets of this composition can be compressed using a 1 1/16 inch flat die at 12 to 15 SCU hardness. Tablets of this type can be given either whole or broken into small pieces to deliver a lower dose. Based on the description provided herein, one skilled in the art can use S (+) ibuprofen to create a variety of organoleptically acceptable oral compositions without departing from the scope of this invention. 24 FORMULA OF THE INVENTION 1.An organoleptically acceptable oral pharmaceutical composition comprising S (+) – 2- (p-isobutylphenyl) propionic acid, substantially free of R (-) – 2- (nisobutylphenyl) propionic acid, and an acid component. 2. The pharmaceutical composition according to claim 1, characterized in that the acid component contains one or more acids selected from: citric acid, tartaric acid, malic acid, fumaric acid, lactic acid, adipic acid, ascorbic acid, aspartic acid, d- erythroascorbic acid, glutamic acid, succinic acid.3. The pharmaceutical composition of claim 1, further comprising an organoleptically acceptable pharmaceutical carrier. 4. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in powder or granular form. 5. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of a liquid. 6. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of chewable tablets. 7. The pharmaceutical composition according to any one of paragraphs.1-3, characterized in that it is in the form of an effervescent preparation. 8. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of lozenges. 9. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in a rapidly disintegrating solid form. 10. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of a chewable preparation used for veterinary medicine. 11. A pharmaceutical composition according to any one of claims 1 to 3, characterized in that it is in the form of a chewing gum.12. A method for preparing an organoleptically acceptable oral pharmaceutical composition by mixing an active component and a target additive, characterized in that S (+) – 2- (n-isobutylphenyl) -propionic acid, practically free of R (-) – 2, is used as the active component – (n-isobutylphenyl) -propionic acid, as a target additive – an acid component and convert it into a form suitable for oral administration. Ibuprofen eutomer, micronized Chicl Hydrogenated rosin glycerin ester Sucrose, fine powder Tolu balm Cinnamon oil Gum base Gum base Sweetener Acidifier Flavor
(PDF) Comorbidities in clinical practice. Algorithms for diagnostics and treatment
Russ.) Vinokur V.A., Grinevich V. B. , Ilyashevich IG, idr. Psychosomatic
disorders in the practice of the therapist: a guide for doctors.Ed.
V.I.Simanenkov. SPb .: SpetsLit, 2008.335 p. ISBN: 978-5-29
43. Garganeeva NP, Petrova MM, Evsyukov AA, et al. The influence of depression on
the course of coronary heart disease and quality of life. 2014; 92 (12): 30-7. (In Russ.)
Garganeyeva N.P., Petrova M.M., Evsyukov A.A., Shtarik S. Yu. Et al. Influence
of depression on the features of the course of coronary heart disease and quality
life of patients. Clinical medicine.2014; 92 (12): 30-7.
44. Yakhno NN, Zakharov VV, Lokshina AB. Dementia. A guide for doctors. Third
edition. M .: MEDpress-inform, 2011.272 p. (In Russ.) Yakhno N.N., Zakharov V.V.,
Lokshina A. B. Dementia. A guide for doctors. 3rd edition. M .: MEDpress-
inform, 2011.272 pp. ISBN 978-5-98322-723-1.
45. Tkacheva ON, Cherdak MA, Mkhitaryan EA. Acetylsalicylic acid in the prevention
of ischemic stroke: ways to increase efficiency and safety.Russian Medical
Journal. 2017; (25): 1880-3. (In Russ.) Tkacheva O. N., Cherdak M. A., Mkhitaryan E. A.
Acetylsalicylic acid in the prevention of stroke: ways to improve the efficiency and safety. Ross. honey. Journal. 2017; (25): 1880-3.
46. Pase MP, Beiser A, Enserro D, et al. Association of Ideal Cardiovascular Health With
Vascular Brain Injury and Incident Dementia. Stroke. 2016; 47: 1201-6. doi: 10.1161 /
47 Petrova MM, Shnayder NA, Eremina OV. Cognitive dysfunction in arterial
hypertension patients. Cardiovascular Therapy and Prevention. 2008; 7 (2): 36-9. (In
Russ.) Petrova M. M., Schneider N. A., Eremina O. V. Characteristics of cognitive
disorders in patients with arterial hypertension. Cardiovascular therapy
and prophylaxis. 2008; 7 (2): 36-9.
48. Trubnikova OA, Kagan ES, Kupriyanova TV, et al. Neuropsychological status of
patients with stable coronary artery disease and factors affecting it.Complex
problems of cardiovascular diseases. 2017; 1: 112-21. (In Russ.) Trubnikova O.A.,
Kagan E.S., Kupriyanova T.V., Maleva O.V., Argunova Yu.A., Kukhareva I.N.
Neuropsychological status of patients with stable ischemic heart disease
and factors affecting it. Complex problems of heart-
cardiovascular diseases. 2017; 1: 112-21.
49. Russian clinical guidelines. Rheumatology. Ed. Nasonov EL. M.: GEOTAR-Media, 2017.
464 p. (In Russ.) Russian clinical guidelines. Rheumatology. Ed.
Nasonova E. L. M .: GEOTAR-Media, 2017.464 pp. ISBN 978-5-9704-4261-6.
50. Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovascular
disease risk management in patients with rheumatoid arthritis and other forms of
inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017 Jan; 76 (1): 17-
28.doi: 10.1136 / annrheumdis-2016-209775.
51. Wang H, Cheng Y, Shao D, et al. Metabolic syndrome increases the risk for
knee osteoarthritis: A meta-analysis. Evid Based Complement Alternat Med.
2016; 2016: 7242478. doi: 10.1155 / 2016/724247813.
52. Shin D. Association between metabolic syndrome, radiographic knee osteoarthritis,
and intensity of knee pain: Results of a national survey. J Clin Endocrinol Metab. 2014
Sep; 99 (9): 3177-83.doi: 10.1210 / jc.2014-1043.
53. Lim R, Holt A. Hepatitis B and C prophylaxis in patients receiving chemotherapy. Viral
Hepat Pract. 2014 Jul 1; 6 (1): 10-3.
54. Hanly JG, Fisk JD, McCurdy G, et al. Neuropsychiatric syndromes in patients
with systemic lupus erythematosus and rheumatoid arthritis. J Rheumatol.
2005; 32 (8): 1459-66.
55. Sundquist K, Li X, Hemminki K, Sundquist J. Subsequent Risk of Hospitalization
for Neuropsychiatric Disorders in Patients With Rheumatic Diseases.A Nationwide
Study From Sweden. Arch Gen Psychiatry. 2008; 65 (5): 501-7. doi: 10.1001 /
56. Harirforoosh S, Asghar W, Jamali F. Adverse Effects of Nonsteroidal Antiinflammatory
Drugs: An Update of Gastrointestinal, Cardiovascular and Renal Complications.
J Pharm Sci. 2013; 16 (5): 821-47. PMID: 24393558.
57. Harirforoosh S, Jamali F. Renal adverse effects of non-steroidal anti-
inflammatory drugs.Expert Opin Drug Saf. 2009 Nov; 8 (6): 669-81.
doi: 10.1517 / 14740330
58. Karateev AE, Nasonov EL, Ivashkin VT, et al. Rational use of nonsteroidal anti-
inflammatory drugs. Clinical guidelines. Scientific and practical rheumatology.
2018; 56: 1-29. (In Russ.) Karateev AE, Nasonov EL, Ivashkin VT, et al.
Rational use of non-steroidal anti-inflammatory drugs
paraty. Clinical guidelines.Scientific and practical rheumatology.
2018; 56: 1-29. doi: 10.14412 / 1995-4484-2018-1-29.
59. Nasonov EL, Yakhno NN, Karateev AE, et al. General principles of treatment
for musculoskeletal pain: interdisciplinary consensus. Scientific and practical
rheumatology. 2016; 54 (3): 247-65. (In Russ.) Nasonov E. L., Yakhno N. N.,
Karateev A. E. et al. General principles of treatment of musculoskeletal pain:
interdisciplinary consensus. Scientific and practical rheumatology.
2016; 54 (3): 247-65. doi: 10.14412 / 1995-4484-2016-247-265.
60. Scheiman J. NSAID-induced Gastrointestinal Injury: A Focused Update for Clinicians.
J Clin Gastroenterol. 2016 Jan; 50 (1): 5-10. doi: 10.1097 / MCG.0000000000000432.
61. Zakharova NV, Bakulin IG, Simanenkov VI, Maslygina AA. Review of the Maastricht
V / Florence consensus recommendations on the diagnosis and treatment of
25. Eikelboom J, Connolly S, Bosch J, et al.Rivaroxaban with or without Aspirin in
Stable Cardiovascular Disease. N Engl J Med. 2017; 377: 1319-30. doi: 10.1056 /
26. Bonaca M, Bhatt D, Cohen M, et al. Long-Term Use of Ticagrelor in Patients
with Prior Myocardial Infarction. N Engl J Med. 2015; 372: 1791-800. doi: 10.1056 /
27. Roffi M, Patrono C, Collet J-Ph, et al. 2015 ESC Guidelines for the management of
acute coronary syndromes in patients presenting without persistent ST-segment
elevation: Task Force for the Management of Acute Coronary Syndromes in Patients
Presenting without Persistent ST-Segment Elevation of the European Society of
Cardiology (ESC).Eur Heart J. 2016; 37 (3): 267-315. doi: 10.1093 / eurheartj / ehv320.
28. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the
management of stable coronary artery disease. The Task Force on the management
of stable coronary artery disease of the European Society of Cardiology. Eur
Heart J.2013Oct; 34 (38): 2949-3003. doi: 10.1093 / eurheartj / eht296.
29 Tuomilehto J, Rastenyte D, Birkenhäger W, et al. Effects of calcium-channel blockade
in older patients with diabetes and systolic hypertension.Systolic Hypertension
in Europe Trial Investigators. N Engl J Med. 1999; 340 (9): 677-84. doi: 10.1056 /
30. Nimmrich V, Eckert A. Calcium channel blockers and dementia. Br J Pharmacol.
2013; 169 (6): 1203-10. doi: 10.1111 / bph.12240.
31. Forette F, Seux M, Staessen JA, et al. Prevention of dementia in randomized double-
blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet.
1998; 352 (9137): 1347-51.PMID: 9802273.
32. Clinical recommendations for conducting electrophysiological studies, catheter
ablation and the use of anti-arrhythmic devices VNOA. M .: MAKS Press. 2013: 16-
554. (In Russ.) Clinical guidelines for the conduct of electrophysiology
studies, catheter ablation and the use of antiarrhythmic
VNOA devices. 3rd edition. M .: MAX Press. 2013: 16-554.
33. Schotten U, Verheule S, Kirchhof P, Goette A.Pathophysiological mechanisms of
atrial ﬁ brillation – a translational appraisal. Physiol Rev. 2011 Jan; 91 (1): 265-325.
doi: 10.1152 / physrev.00031.2009.
34. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management
of atrial fibrillation developed in collaboration with EACTS. The Task Force for the
management of atrial fibrillation of the ESC. Developed with the special contribution
of the EHRA of the ESC.Endorsed by the ESO. Eur Heart J.2016Oct 7; 37 (38): 2893-
962. doi: 10.1093 / eurheartj / ehw210.
35. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. ESC recommendations for
the treatment of patients with ventricular arrhythmias and the prevention of sudden
cardiac death 2015 Russian Journal of Cardiology. 2016; 21 (7): 5-86. (In Russ.) Priori
SG, Blomström-Lundqvist C, Mazzanti A et al. ESC recommendations for the treatment of
patients with ventricular arrhythmias and prevention of sudden cardiac death
2015.Russian journal of cardiology. 2016; 21 (7): 5-
86. doi: 10.15829 / 1560-4071-2016-7-5-86.
36. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS / EHRA / ECAS Expert Consensus
statement on catheter and surgical ablation of atrial fibrillation: recommendations
for patient selection, procedural techniques, patient management and follow-up,
definitions, endpoints, and research trial design. Europace … 2012; 14 (4): 528-606.
doi: 10.1093 / europace / eus027.
37. Miller ON, Tarasov AV, Dick IS, et al. Antiarrhythmic therapy in patients with
atrial fibrillation in chronic heart failure. Research “SPACE”. Practical Medicine.
2013; 3 (71): 145-52. (In Russ.) Miller ON, Tarasov AV, Dick IS, et al.
Antiarrhythmic therapy in patients with atrial fibrillation in chronic heart failure. Research “SPACE”. Practical
medicine.2013; 3 (71): 145-52.
38. Miller ON, Tarasov AV, Dick IS, Belyaeva IE. Relief of atrial fibrillation in the prehospital
and inpatient stages from the standpoint of evidence-based medicine. Consilium
Medicum [Cardiology]. 2016; 18 (10): 8-18. (In Russ.) Miller ON, Tarasov AV,
Dick IS, Belyaeva IE Relief of atrial fibrillation at the prehospital and stationary stages of evidence-based medicine. Consilium
Medicum [Cardiology].2016; 18 (10): 8-18.
39. Guide to cardiac arrhythmias. Ed. Chazov EI, Galitsyn SP. M .: GEOTAR-Media,
2010.416 p. (In Russ.) Guide to heart rhythm disturbances. Ed.
E.I. Chazova, S.P. Golitsina. M .: GEOTAR-Media, 2010.416 p. ISBN 978-5-
40. Pogosova N, Saner H, Pedersen SS, et al. Psychosocial aspects in cardiac
rehabilitation: from theory to practice. A position paper from the Cardiac Rehabilitation
Section of the European Association of Cardiovascular Prevention and Rehabilitation
of the European Society of Cardiology.Eur J Prev Cardiol. 2015; 22: 1290-306.
doi: 10.1177 / 2047487314543075.
41. Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a risk factor for
poor prognosis among patients with acute coronary syndrome: systematic review
and recommendations: a scientific statement from the American Heart Association.
Circulation. 2014; 129: 1350-69. doi: 10.1161 / CIR.0000000000000019.
42. Vinokur VA, Grinevich VB, Ilyashevich IG, et al.