Which medicine is better, “Nise” or “Nurofen”

Nise

The active substance is nimesulide . Available in the form of tablets and gel. It has anti-inflammatory, antipyretic and analgesic effects. The analgesic effect is observed 15 minutes after administration. The maximum concentration of the substance in the blood plasma is observed after 30 minutes.

The drug is able to inhibit the formation of enzymes that destroy cartilage tissue. It also reduces the release of histamine and eliminates bronchospasm. Therefore, it can be used for bronchial asthma.

The maximum concentration of the drug in the body is observed after 2 hours . Penetrates well into body tissues and fluids. When using the gel, the components penetrate well into muscle and joint tissue. It is found in the blood in small doses. A persistent therapeutic effect is observed after 4 weeks of regular use. Indications for use of tablets:

Arthritis.
Osteoarthritis.
Osteochondrosis.
Thrombophlebitis.
Toothache and headache.
Fever

Indications for use of the gel:

Rheumatoid and psoriatic arthritis.
Osteochondrosis.
Lumbago syndrome.
Bursitis.
Sciatica.
Sprains and bruises.

Contraindications are:

Exacerbation of peptic ulcer disease.
Allergic reaction to the components of the drug.
Pregnancy and breastfeeding.
Children under 12 years old.
Liver and kidney failure.

It should be taken with caution in case of diabetes mellitus, hypertension and lupus erythematosus. After taking the pills, drowsiness , so you should refrain from driving.

Adults and children over 12 years of age are recommended to take 1 tablet 2 times a day. It is better to take before meals with water. If discomfort occurs, tablets are taken at the end of the meal. The maximum dose per day is 400 mg . If renal function is impaired, the dose is reduced. If, while taking the tablets, symptoms associated with liver dysfunction appear, the drug is discontinued. After two weeks of use, it is necessary to do a biochemical blood test to check liver function indicators.

The gel has a pronounced analgesic effect. It is applied to the painful area 2-3 times a day, in a thin layer, without rubbing. The amount of gel may vary depending on the size of the affected area. Do not apply under bandages or on areas with damaged skin.

Nurofen

Active ingredient: ibuprofen . Available in the form of tablets and gel. There are also syrup and suppositories for children. Has anti-inflammatory and analgesic effects. To a lesser extent, antipyretic effect is observed. The substance is absorbed into the body within 30-60 minutes . Penetrates into synovial tissue, but does not penetrate into the articular cavities. Most of it is excreted through the kidneys, the rest through the intestines.

The indications are:

Joint diseases.
Pain syndrome.
Fever.
Toothache, headache and migraine.

The gel is recommended for use for:

Back pain.
Myalgia and neuralgia.
Injuries (bruises and sprains).
Arthritis.

For children's syrups and suppositories, the indications are the same. In addition, children are allowed to use it for acute respiratory infections, flu, childhood infections and reactions to vaccinations.

Contraindications are:

Ulcers in the gastrointestinal tract and bleeding.
Heart failure.
Hypertonic disease.
Individual intolerance to the components of the drug.
Liver and kidney disorders.
Hemophilia.
Intracranial hemorrhages.
Pregnancy and lactation period.

Adults and children over 12 years of age are prescribed 1 tablet 3-4 times a day after meals. The gel is applied 4 times a day . Apply a thin layer to the affected area and rub well into the skin. The interval between applications should be at least 4 hours .

The dosage of syrup for children is calculated from the formula 5-10 ml per 1 kg of body weight . As an antipyretic, it is taken for no more than three days, and as an analgesic - no more than five. Suppositories are administered rectally, 3-4 times a day, one piece at a time .

NSAIDs and triptans for migraine: separately or together?

According to international recommendations, treatment of a migraine attack in most patients should begin with the use of a non-narcotic analgesic or non-steroidal anti-inflammatory drug (NSAID). Placebo-controlled studies in migraine have been conducted for acetylsalicylic acid (ASA) [1–4], ibuprofen [5,6], diclofenac [7–9], metamizole [10], phenazone [11], tolfenamic acid [12], paracetamol [13]. It has been shown that the combination of ASA with paracetamol and caffeine is highly effective for migraine and has advantages over separately used components [14–16]. Intravenously administered ASA relieves migraine attacks better than subcutaneously administered ergotamine [17]. The combination of ASA with metoclopramide was as effective as sumatriptan [18]. Effervescent ASA (1000 mg), ibuprofen (400 mg) and sumatriptan (50 mg) were equally effective for migraine [19,20]. A placebo-controlled study showed that the potassium salt of diclofenac in sachet form (50 and 100 mg) was as effective as sumatriptan (100 mg) in relieving migraine [9]. The selective COX type 2 inhibitor valdecoxib (20–40 mg) also reduced migraine pain [21]. The European Federation of Neurological Societies (EFNS) recommends the use of NSAIDs for the treatment of migraine, the effectiveness of which has been proven in randomized, double-blind, placebo-controlled studies [22] (Table 1). For the relief of migraine, NSAIDs with rapid accumulation in plasma (Tmax) and a short half-life (T1/2) are primarily recommended, which ensures the rapid development of analgesia and the safety of the drug upon repeated use. For this purpose, drugs have been created with modified physicochemical and pharmacokinetic properties, thanks to which rapid analgesia can be achieved (Table 2). Diclofenac, ketoprofen, ketorolac and ibuprofen are most commonly used for the treatment of migraine, since their analgesic activity is higher than that of other NSAIDs [23]. For example, after intramuscular administration of the sodium salt of diclofenac (75 mg) or after ingestion of a sachet of potassium salt of diclofenac (Voltaren-Rapid 50 mg), analgesia occurs on average after 15 minutes. The anise and menthol flavors included in the sachet improve the organoleptic properties of the drug and reduce nausea. A large randomized trial showed that in the treatment of many migraine attacks, the effectiveness of diclofenac potassium salt against headache was comparable to sumatriptan, and associated nausea and vomiting decreased significantly more often than with triptan [9] (Table 3). The clinical effectiveness of triptans for migraine has been demonstrated in large placebo-controlled studies, which are reflected in several published comparative analyses. Triptans are effective during any period of a migraine attack, but their early use increases the effectiveness of treatment [3,15,18]. The use of triptans in the aura phase before the onset of headache is ineffective. The accumulated experience of long-term use of triptans indicates that they should not be used more than 9 days a month, as this significantly increases the risk of transition from episodic migraine to chronic and contributes to the development of abusive headaches. Differences in the clinical effectiveness of triptans are determined not only by the pharmacological parameters of the drugs, but also by the individual sensitivity of the patient. In this regard, if there is no effect from using one triptan, you should not refuse to use another next time. An analysis of 53 studies shows that the effectiveness of triptans taken orally is approximately the same, and only eletriptan at a dose of 80 mg is more effective both overall and in the first 30 minutes. after taking the drug. A comparative analysis of the use of various dosage forms of triptans shows that intranasal and rectal use of these drugs is especially promising for concomitant vomiting. The European Federation of Neurological Societies (EFNS) recommends the use of triptans for the treatment of migraine, the effectiveness of which has been repeatedly proven in randomized, double-blind, placebo-controlled studies [22] (Table 4). Recently, the possibility and feasibility of the combined use of NSAIDs and triptans for the treatment of migraine has been actively discussed and studied. The results of a 2005 study showed that a fixed combination of sumatriptan (50 mg) and naproxen sodium (500 mg) was more effective in relieving migraine attacks than monotherapy with these drugs [24]. Headache relief at 2 hours was significantly greater in patients receiving the fixed combination of sumatriptan and naproxen (65%) than in patients receiving sumatriptan (49%) or naproxen (46%) monotherapy (p<0.01). Complete headache relief in this study was reported in 29% of those taking the fixed combination of sumartriptan and naproxen, 25% of those taking sumatriptan and 17% of those taking naproxen (p<0.001). The comparative effectiveness of rizatriptan (10 mg) and its combination with rofecoxib (25 mg) was studied in 56 patients with migraine. This open-label study showed no statistically significant difference between treatment groups in pain relief and associated symptoms of nausea, vomiting, photophobia, and sound sensitivity. However, the number of patients with headache relapses after its successful relief was significantly (p<0.001) lower in the group of patients taking a combination of rofecoxib and rizatriptan (20%) than in the group taking rizatriptan alone (53%). The authors found no differences between groups in the incidence of side effects [25]. Another study examined the comparative effectiveness of rizatriptan (10 mg) and its combination with rofecoxib (50 mg) and tolfenamic acid (200 mg) in the treatment of six consecutive migraine attacks in 45 patients. Complete pain relief after 2 hours was recorded in 37.9% of patients receiving rizatriptan monotherapy, 40.6% receiving combination treatment with rizatriptan and tolfenamic acid, and 62.9% receiving combination treatment with rizatriptan and rofecoxib. However, 4 hours after the treatment, there were no differences between the groups. The incidence of recurrence of migraine after successful relief was lower with the combined use of a triptan with NSAIDs (15.4% for the combination with rofecoxib and 7.7% for the combination with tolfenamic acid) than with rizatriptan monotherapy (50%) [26]. In 2007, a study was completed that confirmed the high effectiveness of the combination of sumatriptan (85 mg) and naproxen (500 mg) in the treatment of migraine attacks [27]. The authors of these and other studies suggest that the benefit of combining a triptan and an NSAID is due to the complex effects of these drugs on various mechanisms of migraine pathogenesis, as well as differences in the pharmacokinetics of these classes of drugs. The advisability of using NSAIDs during the aura phase, when triptans are not recommended, or early joint use in patients with severe migraine is emphasized. Thanks to the combined use of NSAIDs and triptans, it is possible to speed up the time of onset of analgesia, as well as prevent relapse of migraine (Fig. 1). The accumulated data allows us to formulate a number of provisions that will help increase the effectiveness of treatment of a migraine attack: 1. NSAIDs are effective for migraine and can be recommended for most patients as first-choice drugs. Administration of NSAIDs intramuscularly or in the form of a modified sachet provides a more rapid development of analgesia. If the patient cannot distinguish a migraine attack from a tension headache, then he should take an NSAID. 2. Triptans are highly effective treatments for migraine. They act on the main links in the pathogenesis of migraine and are not analgesics. They should not be taken during a migraine aura. Triptans are the first choice in patients who do not respond to NSAID therapy. There is individual sensitivity of patients to one or another triptan. 3. The combined use of NSAIDs and triptans can more effectively relieve headaches and prevent migraine relapse. 4. If nausea and vomiting are severe, NSAIDs and triptans should be avoided by mouth. Intranasal, rectal or intramuscular routes of administration are preferred.

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