What are the potential risks of combining indomethacin and ibuprofen. How do these medications interact in the body. When should you avoid taking these drugs together. What are safer alternatives recommended by healthcare providers.

Understanding Indomethacin and Ibuprofen: An Overview

Indomethacin and ibuprofen are both nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used to treat pain, inflammation, and fever. While they belong to the same drug class, they have some key differences:

• Indomethacin is typically prescribed for conditions like arthritis, gout, and bursitis
• Ibuprofen is available over-the-counter and used for general pain relief and fever reduction
• Indomethacin tends to be more potent but also carries a higher risk of side effects
• Ibuprofen is generally considered safer for short-term use in most people

Understanding how these medications work individually is crucial before considering their combined use.

The Risks of Combining Indomethacin and Ibuprofen

Taking indomethacin and ibuprofen together is generally not recommended due to the increased risk of adverse effects. The main concerns include:

• Heightened risk of gastrointestinal issues like ulcers and bleeding
• Increased chance of cardiovascular problems
• Potential for kidney damage, especially with prolonged use
• Amplified side effects like dizziness, headaches, and fluid retention

Are there any situations where combining these medications might be necessary? In rare cases, a doctor may prescribe both under close supervision for severe inflammatory conditions. However, this is the exception rather than the rule.

Gastrointestinal Risks: A Major Concern

The gastrointestinal tract is particularly vulnerable when combining NSAIDs like indomethacin and ibuprofen. Potential complications include:

• Stomach irritation and inflammation
• Peptic ulcers
• Gastrointestinal bleeding
• In severe cases, perforation of the stomach or intestines

Why does this happen? NSAIDs inhibit the production of protective stomach mucus and reduce blood flow to the stomach lining. Taking two NSAIDs simultaneously amplifies these effects, significantly increasing the risk of damage.

Recognizing Signs of GI Complications

If you’ve taken both medications, be alert for symptoms such as:

• Severe stomach pain or cramping
• Black, tarry stools
• Vomiting blood or material that looks like coffee grounds
• Persistent nausea or loss of appetite

These symptoms require immediate medical attention, as they may indicate serious gastrointestinal complications.

Cardiovascular Considerations When Combining NSAIDs

Both indomethacin and ibuprofen can affect cardiovascular health, particularly when used long-term or in high doses. Combining them may amplify these risks:

• Increased blood pressure
• Higher risk of heart attack and stroke
• Fluid retention and edema
• Worsening of existing heart conditions

Who is most at risk for cardiovascular complications? Individuals with a history of heart disease, high blood pressure, or other cardiovascular risk factors should be especially cautious about using multiple NSAIDs.

Monitoring Cardiovascular Health

If you must take both medications under medical supervision, your doctor may recommend:

• Regular blood pressure checks
• Periodic blood tests to assess kidney function
• Watching for signs of fluid retention, like swelling in the legs or feet
• Immediate reporting of any chest pain, shortness of breath, or irregular heartbeat

Kidney Function and NSAID Combinations

The kidneys play a crucial role in filtering medications from the body. Combining indomethacin and ibuprofen can put extra stress on these vital organs:

• Both drugs can reduce blood flow to the kidneys
• This may lead to acute kidney injury, especially in vulnerable individuals
• Long-term use of multiple NSAIDs can contribute to chronic kidney disease

How can you protect your kidneys if you need to take NSAIDs? Staying well-hydrated, using the lowest effective dose for the shortest time possible, and regular kidney function monitoring can help mitigate risks.

Alternatives to Combining Indomethacin and Ibuprofen

Given the risks associated with taking indomethacin and ibuprofen together, healthcare providers often recommend alternatives:

• Using a single NSAID at the lowest effective dose
• Combining an NSAID with acetaminophen for enhanced pain relief
• Exploring non-pharmacological pain management techniques
• Considering topical NSAID formulations to reduce systemic exposure

What are some non-drug approaches to pain management? Physical therapy, acupuncture, and mindfulness techniques can be effective for many types of chronic pain without the risks associated with medication interactions.

Acetaminophen as a Safer Alternative

Acetaminophen (Tylenol) works differently than NSAIDs and can often be safely combined with either indomethacin or ibuprofen. Benefits include:

• Effective pain relief without increasing anti-inflammatory effects
• Lower risk of gastrointestinal side effects
• No impact on blood clotting, unlike NSAIDs

However, it’s crucial to stay within recommended dosage limits to avoid liver damage.

When Might Combining NSAIDs Be Considered?

While generally discouraged, there are rare instances where a healthcare provider might consider prescribing both indomethacin and ibuprofen:

• Severe, acute inflammatory conditions unresponsive to single-drug therapy
• Short-term use in carefully monitored hospital settings
• As part of a rotating medication schedule to manage chronic pain

In these cases, close medical supervision is essential to monitor for adverse effects and adjust treatment as needed.

Precautions for Necessary Combination Use

If combination therapy is deemed necessary, doctors may recommend:

• Taking medications with food to reduce stomach irritation
• Using gastroprotective agents like proton pump inhibitors
• Frequent check-ups to monitor for side effects
• Immediate discontinuation if any adverse reactions occur

The Importance of Medical Supervision and Communication

When it comes to managing pain and inflammation, open communication with healthcare providers is crucial. This includes:

• Informing your doctor about all medications you’re taking, including over-the-counter drugs and supplements
• Reporting any side effects or changes in your condition promptly
• Discussing your complete medical history to identify potential risk factors
• Asking about safer alternatives if you’re concerned about drug interactions

How can patients ensure they’re using NSAIDs safely? Keep a medication log, including dosages and timing, and bring this information to all medical appointments. This helps healthcare providers make informed decisions about your treatment plan.

The Role of Pharmacists in Medication Safety

Pharmacists are an excellent resource for understanding drug interactions:

• They can review your complete medication list for potential conflicts
• Provide advice on proper timing and dosing of medications
• Offer guidance on managing side effects
• Suggest over-the-counter alternatives when appropriate

Don’t hesitate to consult your pharmacist if you have questions about combining medications or managing pain safely.

Understanding Drug Interactions Beyond NSAIDs

While this article focuses on indomethacin and ibuprofen, it’s important to be aware of other potential drug interactions:

• NSAIDs can interact with blood thinners, increasing bleeding risk
• Certain antidepressants may increase the risk of gastrointestinal bleeding when combined with NSAIDs
• Diuretics used for high blood pressure can be less effective when taken with NSAIDs

How can patients keep track of all potential interactions? Utilize online drug interaction checkers and always consult with healthcare providers before starting new medications.

The Future of Pain Management

Research into safer pain management options is ongoing. Some promising areas include:

• Development of NSAIDs with lower risk profiles
• Exploration of novel pain pathways for targeted therapies
• Advancements in non-pharmacological pain management techniques
• Personalized medicine approaches to tailor treatments to individual patients

As our understanding of pain mechanisms and drug interactions evolves, we can expect more effective and safer options for managing pain and inflammation in the future.

In conclusion, while indomethacin and ibuprofen are both effective medications individually, their combination poses significant risks. Always consult with healthcare professionals before combining any medications, and explore safer alternatives when possible. By staying informed and communicating openly with your medical team, you can effectively manage pain while minimizing the risk of adverse effects.

Advil and indomethacin Interactions – Drugs.com

This report displays the potential drug interactions for the following 2 drugs:

• Advil (ibuprofen)
• indomethacin

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Interactions between your drugs

Using ibuprofen together with indomethacin 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.

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Drug and food interactions

No alcohol/food interactions were found. However, 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:

• Advil (ibuprofen)
• indomethacin

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks.
Always consult your healthcare provider before making changes to your medications or dosage.

See also

• Advil drug interactions
• Advil uses and side effects
• Indomethacin drug interactions
• indomethacin uses and side effects
• Drug Interactions Checker

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Effect of Premedication with Indomethacin and Ibuprofen on Postoperative Endodontic Pain: A Clinical Trial

Iran Endod J. 2016 Winter; 11(1): 57–62.

Published online 2015 Dec 24. doi: 10.7508/iej.2016.01.011

,^a,^b,^b,^a and ^b,*

Author information Article notes Copyright and License information Disclaimer

Introduction:

Post-endodontic pain is one of the main problems for both patients and dentists. The purpose of this study was to compare the effectiveness of premedication with indomethacin and ibuprofen for management of postoperative endodontic pain.

Methods and Materials:

In this clinical trial, mandibular molars with irreversible pulpitis were endodontically treated in 66 patients. The medicines were prepared similarly in the form of capsules containing 400 mg ibuprofen (group A), 25 mg indomethacin (group B) and placebo (group C). The patients were given one capsule 1 h before the start of treatment. Patients recorded their pain measured by a visual analogue scale (VAS) at medication time, during treatment and 8, 12 and 24 h after treatment. The data were analyzed using the chi-square, repeated measures ANOVA, paired t-test, Tamhane and Pearson correlation coefficient.

Results:

Ibuprofen and indomethacin significantly reduced the postoperative pain in comparison with placebo during treatment and 8 h after treatment; however, there were no significant differences between them 12 and 24 h after treatment.

Conclusion:

Premedication with ibuprofen and indomethacin can effectively control short term post-operative pain; the lower incidence of side effects and greater analgesic power of ibuprofen make it a superior choice.

Key Words: Ibuprofen, Indomethacin, Irreversible Pulpitis, Non-Steroidal Anti-Inflammatory Drugs, Post-Endodontic Pain

Appropriate anesthesia and successful control of postoperative endodontic pain is one of the major challenges in endodontic treatment specially in teeth with irreversible pulpitis [1]. Despite the advances in root canal treatment and increase in the awareness about periapical inflammation and pulpitis, postoperative endodontic pain can be a major problem for both patient and dentist. More than 40% of endodontic patients reported various degrees of pain after endodontic treatment [2, 3]. Generally postoperative endodontic pain is contributed to the inflammatory mediators that activate sensitive nociceptors and lead to central and peripheral hyperalgesia mechanisms [4]. Among inflammatory mediators, prostaglandins have crucial function in pathogenesis of periradicular and pulpal diseases [5].

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and indomethacin are effective in reducing the pain in endodontic treatments and are commonly prescribed for this reason [6]. Studies show that analgesic and anti-inflammatory effect of NSAIDs has been caused by inhibiting cyclooxygenase pathway and subsequently reduce the pain inducing role of arachidonic acid metabolites such as prostaglandin and thromboxane [7].

Nevertheless recent investigations propose that this class of drugs has other effects embracing inhibition of cytokine synthesis or major cellular signaling pathways of inflammatory responses [7-9]. Rudimentary investigations prove that premedication with NSAIDs such as flurbiprofen, ibuprofen, tenoxicam, or rofecoxib can decrease the amount of post-operative pain more efficiently than placebo [10-12].

Premedication with NSAIDs will diminish the inflammatory process before its onset in endodontic treatment [13]. Gopikrishna et al. [11] showed that single dose prophylactic prescription of rofecoxib (50 mg) or ibuprofen tablet (600 mg) significantly relieves the postoperative endodontic pain. In another study by Arslan et al. [12] prophylactic prescription of ibuprofen (200 mg) and tenoxicam (20 mg) significantly reduced the postoperative endodontic pain. However, Attar et al. [14] has shown that there was no significant difference in postoperative endodontic pain between patients who took ibuprofen tablet, ibuprofen liquigel (400 mg) and placebo, preoperatively.

Indomethacin is not routinely prescribed for endodontic treatment but because of its extensive anti-inflammatory effect, it is commonly used to relieve muscle and joint pain [15]. Likewise Parirokh et al. [16] demonstrated the effectiveness of indomethacin and ibuprofen on increasing the depth of inferior alveolar nerve block. However, many studies have evaluated the effectiveness of prophylactic premedication with ibuprofen on postoperative endodontic treatment [11, 12, 14].

No study has compared the effectiveness of prophylactic premedication with ibuprofen and indomethacin on pain relieve after endodontic procedures. Therefore the aim of this clinical trial was to compare the effects of premedication with indomethacin and ibuprofen on postoperative endodontic pain.

A total of 66 patients aging 19 to 30 years were chosen based on the results of the pilot study to achieve 95% confidence interval (two-side) and 90% power (n=22). Samples were selected randomly by table of random numbers in each three groups for this double-blind, placebo-controlled, parallel-group, single-dose randomized controlled clinical trial. Each patient consented to a protocol reviewed and approved by the Medical Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (Grant No.: 46210).

At first, patients completed a quantitative questionnaire and marked the severity of their pretreatment pain on a 100-mm visual analogous scale (VAS).

Inclusion and exclusion criteria were considered for this study. Patients who had first or second mandibular molars with irreversible pulpitis and reported spontaneous pain at least 30 mm on VAS, with normal radiographic view, without any lesion or sinus tract (acute periapical abscess) and exhibit a long response to electric pulp testing (Analytic Technology, Redmond, WA, USA) and cold testing with Endo-Ice frozen gas (Coltene/Whaledent Inc., Mahwah, NJ, USA), were included. Patients had to complete and sign an informed consent.

Volunteers were excluded if they were younger than 17 years of age and older than 50, if they took any analgesic during the last 12 h or used to consume medicines interfering with NSAIDs, if they were allergic to NSAIDs or lidocaine or had systemic disease, if were in pregnancy or nursing phase, if they had teeth with periapical lesion or acute periapical abscess, aggressive periodontal disease, or non-restorable/previously treated teeth, or had pain in more than one tooth, and if they failed to comprehend the protocol of the study or sign the informed consent.

Determination of pulp status was done according to dental history, clinical findings and radiographic signs. Patients were randomly assigned to 3 equal groups (n=22). With a double blind design, medicines were administered in all groups 1 h before endodontic procedure; group A [400 mg ibuprofen tablet (Hakim Pharmacy Co, Tehran, Iran)], group B [25 mg indomethacin (Hakim Pharmacy Co, Tehran, Iran) and group C (placebo, starch powder) which were all prepared in similar capsules. The dentist and patients were not aware of the capsule contents (double-blind design).

Inferior alveolar nerve block injection was done using 1.8 mL of 2% lidocaine with 1:80000 epinephrine (Darupakhsh, Tehran, Iran). Ten min later, preoperative pain was recorded on VAS. The teeth were isolated using rubber dam and access cavities were prepared. Working length was determined with Root ZX apex locator (J. Morita USA, Inc., Irvine, CA, USA) and confirmed with periapical radiographs. Cleaning and shaping was done using the passive step-back technique.

Normal saline and 2% sodium hypochlorite were used as irrigants. Then canals were dried with paper points and obturation of the canals was accomplished by gutta-percha (Gapadent Co Ltd, Tianjin, China) and AH-26 sealer (Dentsply, Tulsa Dental, Tulsa, OK, USA) using the lateral condensation technique within 0.5-0.1 mm of radiographic apex.

Pain severity was again measured on the 100-mm VAS and was recorded. Instruction for using VAS and a questionnaire was given to the patients before medication. Patients were asked to record their pain score before administration of medicine and 10 min after local anesthesia. Furthermore postoperative pain was written down at 8, 12 and 24 h after endodontic treatment. Also the patient completed Hospital and Anxiety Depression (HAD) scale questionnaire [17] for evaluating their depression and anxiety effect on postoperative endodontic pain (). Patients were also asked to record the possible side effects of the taken medicine and were assigned to record the consumption of additional analgesics.

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HAD scale questionnaire

The data were collected and statistically analyzed using the chi-square, ANOVA, paired T-test, Tamhane and Pearson correlation coefficient using the SPSS software (Statistical Package for Social Science, SPSS, version 18.0, SPSS, Chicago, IL, USA). The level of significance was set at 0.05.

shows the patients’ demographic data. There were no significant differences in distribution of age (P=0.36), gender (P=0.17), background depression (P=0.29) and anxiety (P=0.11).

Table 1

Distribution of patients in groups

Group	Gender (%)		Mean (SD) of age (years)	Mean (SD) of depression	Mean (SD) of anxiety
	Male	Female
Ibuprofen	40. 9	59.1	23.8 (2.9)	8.9 (1.8)	9.4 (1.7)
Indomethacin	31.8	68.2	23.8 (2.9)	8.5 (2.2)	8.2 (2.3)
Placebo	59.1	40.9	23. 8 (2.9)	8 (1.8)	9.1 (1.7)
P -value	0.179		0.364	0.293	0.114

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ANOVA analysis showed a significant difference in pain before endodontic treatment and 8 h after treatment (P=0.000) but there were no significant differences between the groups before treatment (P=0.67), and 12 h (P=0.80) and 24 h (P=0.27) after treatment.

In fact, in ibuprofen group the severity of pain decreased after 8 and 12 h (P=0. 23), whereas there were no significant differences in amount of pain in indomethacin group (P=0.14). Also in placebo group the severity of pain significantly increased (P=0.001). Also pairwise comparisons revealed that during the time of operation and 8 h after treatment ibuprofen (P<0.001) and indomethacin (P=0.001) groups had significantly lower pain scores than placebo. Mean VAS scores were plotted in relation to time after administration of the medicine ().

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Mean time-related pain scores recorded on VAS

Postoperative pain initiates a few hours after root canal therapy [17]. For relieving this pain, patients need analgesics and dentists should be able to prevent it. Pain control during and after endodontic treatment is one of the most important issues in endodontics [18].

Post-endodontic pain is often attributed to the inflammatory process as well as additional central mechanisms [19, 20]. Endodontic pain is noticeably different from pain induced by other dental procedures because of the presence of inflammation and pain before treatment [14]. Neuroplastic changes in the medullary dorsal horn can be caused by preexisting pulpal pain following acute inflammation related to anatomic structures [21].

A 5-fold increase in the discharge rate of dorsal horn neuron and up to a 3-fold increase in the size of the receptive field of A-delta fibers as a result of continuous peripheral nociceptive barrage from inflamed pulp have been shown in animal models [22, 23].

Postoperative pain is the result of periapical inflammatory reactions; so NSAIDs may be useful in controlling it [11]. Premedication with NSAIDs can reduce postoperative pain [10, 11, 13, 24, 25]. Some chemicals such as benzodiazepines, non-opioid analgesics and opioids have been utilized prophylactically to decrease post endodontic pain, among which, NSAIDS, especially ibuprofen have a noticeable role [26]. NSAIDs inhibit prostaglandin synthesis by decreasing the activity of the cyclooxygenase 1 and 2 (COX-1 and COX-2). Many NSAIDs like ibuprofen, aspirin [27], flurbiprofen [28], ketorolac [29, 30], and etodolac [31], have shown to produce a significant reduction in dental pain using clinical trials.

COX pathway can be blocked by prophylactic prescription of NSAIDs before treatment, so pain sensation will be reduced after RCT [13]. Because of this, investigators have found that preoperative prescription of NSAIDs decreased pain level a few hours after root canal therapy [10, 11, 13].

Ibuprofen safely blocks COX-1 and COX-2 enzymes and has analgesic and anti-inflammatory action [32]. For reduction of postoperative pain, 50 to 80 mg doses of ibuprofen should be used; however, Derry et al. [33] proposed that 200 and 400 mg ibuprofen had better efficacy.

Gopikrishna et al. [11] showed that single dose prophylactic prescription of rofecoxib (50 mg) or ibuprofen tablet (600 mg) significantly reduced postoperative endodontic pain. In another study by Arslan et al. [12] prophylactic administration of ibuprofen (200 mg) and tenoxicam (20 mg) significantly reduced the postoperative endodontic pain.

Clinical recommendation about NSAIDs was supported by systematic reviews [6, 34]. These drugs should be the medicine of choice in patients who can tolerate them [6].

Blood level of ibuprofen increase 1 to 2 h after ingestion and its absorption occurs immediately after oral administration [35]. Indomethacin as an NSAID has strong anti-inflammatory effects that are used for reduction of moderate to severe pain levels [15]. Generally indomethacin has not been used commonly in endodontic treatment. However, Parirokh et al. [16] have evaluated the effectiveness of indomethacin and ibuprofen on increasing the depth of inferior alveolar nerve block in molar teeth with irreversible pulpitis.

So in this study, according to the strong analgesic effect of indomethacin, the probability of its effect on reduction of post-endodontic pain was assessed. But, all side effects of indomethacin should be considered before its prescription [15].

In this study the patients were monitored for 24 h. They didn^’t report side effects. This may either show a reasonable case selection or that a single dose of either medication is unlikely to cause significant problems for the patients.

Despite the previously mentioned efficacy of indomethacin, ibuprofen may be a better choice because it is not only a strong analgesic, but also has fewer side effects compared to indomethacin [6]. The analgesic effect of NSAIDs is dose-dependent and so are its side effects [6].

Our results showed that patients treated with ibuprofen and indomethacin significantly had lower pain ratings during treatment and at 8 h after treatment in comparison with placebo. However, the 12-h pain rating in these two groups were significantly higher than 8-h ratings. This could be attributed to the half-life of their metabolites, which is between 4 to 6 h. All groups gave similar pain ratings at 12 and 24 h after treatment.

Gospikrishna et al. [11] and Arslan et al. [12] declared that the analgesic effect of ibuprofen in comparison with placebo was significant at 4, 6 and 8 h after treatment while there were no significant differences after 12 h.

Due to the maximal analgesic effect of ibuprofen and indomethacin their effects did not last more than 8 h [11]. Moreover pain reduction 12 h after endodontic treatment in the placebo group may conclude that endodontic treatment combined with placebo medication may reduce pain 12 h after the initiation of treatment [12, 14]. These results emphasize on earlier investigations evaluating the reduction in pain after 12 h in patients undergone single visit endodontic treatment.

The measurement of pain is difficult because pain perception is subjective and variable which is regulated by multiple physical and psychological factors [36]. Many studies have suggested that pain conditions to be associated with self-reports of psychological distress and psychiatric disorders [37]. Also depression and anxiety symptoms are reported to be associated with reports of increased pain [38-42].

Prophylactic administration of 400 mg ibuprofen in a single-dose provides effective reduction of post-operative pain lasting for 8 h.

The authors would like to thank the Vice Chancellor of Research in Shahid Sadoughi University of Medical Sciences, Yazd, Iran for financial support.

Conflict of Interest: ‘None declared’.

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Proper intake of NSAIDs – City Clinical Hospital No. 9, Chelyabinsk

NSAID abbreviation – does that mean anything to you? If not, then we suggest broadening your horizons a little and finding out what these mysterious four letters stand for. Read the article – and everything will become absolutely clear. We hope that it will be not only informative, but also interesting!

NSAIDs stands for non-steroidal anti-inflammatory drugs – drugs are very popular and in demand nowadays, because they are able to simultaneously eliminate pain and relieve inflammation in various organs of our body.

If until now you have never had the need to take NSAIDs – this can be considered almost a miracle. You are one of the rare lucky ones, really, your health can be envied! NSAIDs – this, we are ahead of the next question and immediately talk about the decoding of the word “non-steroidal”, which means that these drugs are non-hormonal, i.e. do not contain any hormones. And this is very good, because everyone knows how unpredictable and dangerous hormonal drugs can be.

Most popular NSAIDs

If you think that NSAIDs are drugs whose names are rarely spoken in everyday life, then you are mistaken.

Many people do not even realize how often we have to use non-steroidal anti-inflammatory drugs to cure various ailments that have accompanied the human race since the expulsion of Adam and Eve from paradise.

Read the list of such remedies, for sure some of them are in your home first aid kit. So, NSAIDs include drugs such as: Aspirin, Amidopyrine, Analgin, Piroxicam, Bystrumgel, Diclofenac, Ketoprofen, Indomethacin, Ketorol, Naproxen, Ketorolac, Flurbiprofen, Voltarengel, Nimesil, Diclofenac, Ibuprofen, Indopan, Ipren, Upsarin UPSA, Ketanov, Mesulide, Movalis, ” Nise”, “Nurofen”, “Ortofen”, “Trombo ACC”, “Ultrafen”, “Fastum”, “Finalgel”.

Yes, they are all NSAIDs. The list turned out to be long, but, of course, far from complete. Nevertheless, it gives an idea of ​​the variety of modern non-steroidal anti-inflammatory drugs.

Some historical facts

The first primitive NSAIDs were known to people in ancient times. For example, in ancient Egypt, willow bark, a natural source of salicylates and one of the first non-steroidal anti-inflammatory drugs, was widely used to relieve fever and pain. And even in those distant times, healers treated their patients suffering from joint pain and fever with decoctions of myrtle and lemon balm – they also contain salicylic acid.

In the middle of the 19th century, chemistry began to develop rapidly, which gave impetus to the development of pharmacology. At the same time, the first studies of the compositions of medicinal substances obtained from plant materials began to be carried out. Pure salicin from willow bark was synthesized in 1828 – this was the first step towards the creation of the familiar “Aspirin” to all of us.

But it will take many more years of scientific research before this medicine is born. A grand event happened in 1899 year. Doctors and their patients quickly appreciated the benefits of the new drug. In 1925, when a terrible influenza epidemic hit Europe, Aspirin became a savior for a huge number of people.

And in 1950, this non-steroidal anti-inflammatory drug hit the Guinness Book of Records as the anesthetic with the largest sales volume. Well, later pharmacists created other non-steroidal anti-inflammatory drugs (NSAIDs).

What diseases are treated with non-steroidal anti-inflammatory drugs?

The spectrum of application of NSAIDs is very wide. They are very effective in the treatment of both acute and chronic diseases accompanied by pain and inflammation.

Nowadays, research is in full swing to study the effectiveness of these drugs in the treatment of diseases of the heart and blood vessels. And today almost everyone knows that they can be used for pain in the spine (NSAIDs for osteochondrosis are a real salvation).

Here is a list of disease states, in the event of which the use of various non-steroidal anti-inflammatory drugs is indicated: Fever. Headaches, migraines. Renal colic. Rheumatoid arthritis. Gout. Arthrosis. Osteoarthritis. Dysmenorrhea. Inflammatory arthropathies (psoriatic arthritis, ankylosing spondylitis, Reiter’s syndrome). Pain syndrome postoperative. Pain syndrome from mild to moderate severity with injuries and various inflammatory changes.

Classification of NSAIDs according to their chemical structure

Reading this article, you already had the opportunity to make sure that there are a lot of non-steroidal anti-inflammatory drugs. To navigate among them at least a little better, let’s classify these funds.

First of all, they can be divided as follows: a group – acids and a group of NSAIDs – non-acid derivatives.

The first include: – Salicylates (you can immediately recall the “Aspirin”). – Derivatives of phenylacetic acid (“Aceclofenac”, “Diclofenac”, etc.). – Pyrazolidines (metamisole sodium, known to most of us as Analgin, Phenylbutazone, etc.) – Oxicams (Tenoxicam, Meloxicam, Piroxicam, Tenoxicam) – Indoleacetic acid derivatives (Sulindak) , “Indomethacin”, etc.) – Derivatives of propionic acid (“Ibuprofen”, etc.)

The second group is: – Sulfonamide derivatives (“Celecoxib”, “Nimesulide”, “Rofecoxib”). – Alkanones (“Nabumeton”).

Classification of non-steroidal anti-inflammatory drugs according to their effectiveness

The use of NSAIDs in osteochondrosis and in the treatment of other joint diseases can literally work wonders. But, unfortunately, not all drugs are the same in their effectiveness. The undisputed leaders among them can be considered: “Diclofenac”, “Ketoprofen”, “Indomethacin”, “Flurbiprofen”, “Ibuprofen” and some other drugs.

The listed medicines can be called basic; i.e. on their basis, new NSAIDs can be developed and supplied to the pharmacy network, but under a different name and often at a higher price. In order not to waste your money, study the next chapter carefully.

The information contained in it will help you make the right choice. What you need to pay attention to when choosing an NSAID medicine is, for the most part, excellent modern drugs, but when you come to the pharmacy, it is better to be aware of some of the nuances. What? But read it! For example, you are faced with a choice of what is better to buy: Diclofenac, Ortofen or Voltaren. And you are trying to ask the pharmacist which of these drugs is better. Most likely, you will be advised the one that is more expensive. But the fact is that the composition of these drugs is almost identical. And the difference in names is explained by the fact that they are produced by different companies, which is why the brands differ from each other.

The same can be said, for example, about “Metindol” and “Indomethacin” or “Ibuprofen” and “Brufen”, etc. To understand the confusion, always look carefully at the packaging, because the main active ingredient of the drug must be indicated there. facilities. Only it will be written, most likely, in small letters.

But that is not all. Actually, it’s not that simple! The use of an NSAID analogue of some drug you are familiar with may unexpectedly cause an allergic reaction or side effects that you have never experienced before. What’s the matter here? The reason may lie in additional additives, about which, of course, nothing was written on the packaging. So, you need to study the instructions as well.

Another possible reason for the different results of analogue drugs is the difference in dosage. Ignorant people often do not pay any attention to this, but in vain. After all, small tablets can contain a “horse” dose of the active substance. Conversely, huge pills or capsules happen to be composed of as much as 90 percent fillers. Sometimes drugs are also produced in a retarded form, that is, as long-acting (prolonged) drugs. An important feature of such drugs is the ability to be absorbed gradually, so that their action can last for a whole day. Such a drug does not need to be drunk 3 or 4 times a day, a single dose will be enough. This feature of the drug should be indicated on the package or directly in the name. For example, “Voltaren” in a prolonged form is called “Voltaren-retard”.

List of analogues of known drugs

We publish this little cheat sheet in the hope that it will help you better navigate the many beautiful pharmacy packages. Let’s say you immediately need effective NSAIDs for arthrosis to relieve excruciating pain. You take out a cheat sheet and read the following list:

• Analogues of “Diclofenac”, in addition to the already mentioned “Voltaren” and “Ortofen”, are also “Diclofen”, “Dicloran”, “Diclonac”, “Rapten”, “Diclobene”, “Artrozan”, “Naklofen”.
• “Indomethacin” is sold under such brands as “Indomin”, “Indotard”, “Metindol”, “Revmatin”, “Indobene”, “Inteban”.
• Analogues of “Piroxicam”: “Erazon”, “Piroks”, “Roxicam”, “Pirocam”.
• Analogues of “Ketoprofen”: “Flexen”, “Profenid”, “Ketonal”, “Artrozilen”, “Knavon”.
• The popular and inexpensive “Ibuprofen” is found in the composition of drugs such as “Nurofen”, “Reumafen”, “Brufen”, “Bolinet”.

Rules for taking NSAIDs

Taking NSAIDs can be accompanied by a number of side effects, so it is recommended that you follow these rules when taking them:

1. Familiarization with the instruction and following the recommendations contained in it are mandatory!
2. When taking a capsule or tablet by mouth, take it with a glass of water to protect your stomach. This rule must be adhered to, even if you drink the most modern drugs (which are considered safer), because an extra precaution never hurts;
3. Do not lie down after taking the drug for about half an hour. The fact is that gravity will contribute to a better passage of the capsule down the esophagus;
4. It is better to refuse alcoholic beverages, since the combined NSAIDs and alcohol are an explosive mixture that can cause various stomach diseases.
5. You should not take two different nonsteroidal drugs on the same day – this will not increase the positive result, but most likely summarizes the side effects.
6. If the medicine does not help, consult your doctor, perhaps you have been prescribed too low a dose.

Side effects and nonsteroidal gastropathy

Now you have to find out what NSAID gastropathy is. Unfortunately, all NSAIDs have significant side effects. They have a particularly negative effect on the gastrointestinal tract. Patients may be disturbed by such manifestations as Nausea (sometimes very strong). Heartburn. Vomit. Dyspepsia. Bleeding gastrointestinal. Diarrhea. Ulcer of the duodenum and stomach.

All of the above troubles are NSAID-gastropathy. Therefore, doctors so often try to prescribe their patients the lowest possible doses of classic non-steroidal anti-inflammatory drugs. To minimize the harmful effects on the stomach and intestines, it is recommended that you never take such drugs on an empty stomach, but only after a large meal.

But problems with the digestive system are not all the side effects that some of the NSAIDs can give. Certain drugs can have a bad effect on the heart, as well as on the kidneys. Sometimes their reception can be accompanied by a headache and dizziness.

Another serious nuisance is that they have a destructive effect on intra-articular cartilage (of course, only with prolonged use). Fortunately, today there are new generation NSAIDs on the market, which are largely freed from these shortcomings.

New generation non-steroidal anti-inflammatory drugs

Over the past two decades, several pharmaceutical companies have simultaneously been intensively developing new modern NSAIDs, which, along with the effective elimination of pain and inflammation, would have as few side effects as possible.

The efforts of pharmacists were crowned with success – a whole group of new generation drugs, called selective, was developed. Imagine – these drugs under the supervision of a doctor can be taken in very long courses. Moreover, the terms can be measured not only in weeks and months, but even in years.

Medicines from this group do not have a destructive effect on articular cartilage, side effects are much less common and practically do not cause complications. New generation NSAIDs are drugs such as: “Movalis”. “Nise” (aka – “Nimulid”). “Arcoxia”. “Celebrex”.

We will talk about some of their advantages using the example of Movalis. It is available both in traditional tablets (7.5 and 15 mg each), and in 15 mg suppositories, and in glass ampoules for intramuscular injection (also 15 mg each). This medicine acts very gently, but at the same time extremely effective: just one tablet is enough for the whole day. When a patient is shown long-term treatment for severe arthrosis of the hip or knee joints, Movalis is simply irreplaceable.

Different forms in which NSAIDs are available

Most of the popular non-steroidal anti-inflammatory drugs can be purchased and used not only in the form of tablets and capsules for oral administration, but also in ointments, gels, suppositories and injectable solutions. And this, of course, is very good, since such a variety makes it possible in some cases to avoid harm during treatment while obtaining a faster therapeutic effect.

Thus, NSAIDs of the new generation, used in the form of injections for arthrosis, have much less effect on the gastrointestinal tract. But there is a downside to this coin: when administered intramuscularly, almost all non-steroidal drugs are capable of producing a complication – necrosis of muscle tissue. That is why NSAID injections are never practiced for a long time.

Basically, injections are prescribed for exacerbation of inflammatory and degenerative-dystrophic diseases of the joints and spine, accompanied by severe unbearable pain. After the patient’s condition improves, it becomes possible to switch to tablets and external agents in the form of ointments.

Usually, doctors combine different dosage forms, deciding what and when can bring the greatest benefit to the patient. The conclusion suggests itself: if you do not want to harm yourself by self-treatment of such common ailments as osteochondrosis or arthrosis, seek help from a medical institution, that is where they will be able to help you.

Can NSAIDs be used during pregnancy

Doctors categorically do not advise pregnant women to take NSAIDs (especially this prohibition applies to the third trimester), as well as mothers who are breastfeeding. It is believed that drugs in this group can adversely affect the bearing of the fetus and cause various malformations in it.

According to some reports, such a harmless drug, according to many, like Aspirin, can increase the risk of miscarriage in the early stages. But sometimes doctors, according to indications, prescribe this drug to women (in a limited course and in minimal doses). In each case, the decision must be made by a medical specialist.

During pregnancy, women often have back pain and there is a need to solve this problem with non-steroidal anti-inflammatory drugs as the most effective and fast-acting. In this case, the use of “Voltaren gel” is acceptable. But – again – its independent use is possible only in the first and second trimester, in late pregnancy, the use of this strong drug is allowed only under the supervision of a doctor.

Conclusion

We told you what we knew ourselves about NSAIDs. Deciphering the abbreviation, the classification of drugs, the rules for taking them, information about side effects – this can be useful in life. But we want our readers to need medicines as rarely as possible. Therefore, at parting, we wish you good heroic health!

Ibuprofen in the treatment of patent ductus arteriosus in preterm and/or low birth weight infants

Review question

Is ibuprofen, compared with indomethacin, other cyclooxygenase inhibitors, placebo, or no intervention, for the repair of patent ductus arteriosus (PDA) safe and effective in improving rates of ductus occlusion and other important clinical outcomes in preterm and/or children with low birth weight?

Relevance

PDA is a common complication in very preterm (born premature) or very low birth weight babies. The PDA is an open vascular canal between the lungs and the heart (between the pulmonary artery and the aorta). After birth, it should close, but sometimes remains open due to the immaturity of the baby. PDA can lead to life-threatening complications. Previously, indomethacin, a drug that closes the PDA in most children, has been commonly used to correct PDA, but it can cause serious side effects, such as reduced blood flow to some organs. Another treatment option is ibuprofen.

Study profile

We searched scientific databases to identify randomized controlled trials (clinical studies in which people are randomly assigned to one of two or more treatment groups) in preterm infants (born before 37 weeks gestation), infants with low birth weight at birth (less than 2500 g) or premature and low birth weight infants with PDA. Treatment options were ibuprofen, indomethacin, another cyclooxygenase inhibitor, placebo, or no treatment. The evidence is current to 30 November 2017.

Main results

This review of 39 trials (2843 children) found that ibuprofen was as effective as indomethacin in closing the PDA, had fewer transient side effects on the kidneys, and reduced the risk of necrotizing enterocolitis, a serious disease that affects the intestines. It is not known whether ibuprofen has any significant long-term benefits or disadvantages in relation to the development of the child. More studies are needed with a long follow-up period up to 18 months of age and up to school entry age to decide which drug – ibuprofen or indomethacin – is the drug of choice for PDA closure.

Quality of evidence: When comparing intravenous and oral ibuprofen with intravenous and oral indomethacin, according to the GRADE scale (a method for assessing the quality of trials supporting each outcome), the quality of the evidence ranged from very low to moderate, but was moderate for important outcomes of ineffective pacing closure of the PDA, the need for surgical closure of the PDA, the duration of mechanical ventilation, the development of necrotizing enterocolitis, oliguria, and serum and plasma creatinine levels.