Common educational space in European countries. Topic: Formation of a unified educational and cultural space in Europe and individual regions of the world

Non-narcotic analgesics

Elimination of endodontic pain is multifactorial and is aimed at reducing the peripheral and central components of hyperalgia through the combined use of endodontic procedures and pharmacotherapy. The main class of medications for endodontic pain are non-narcotic analgesics, which include NSAIDs and acetaminophen. NSAIDs have been shown to be very effective in relieving inflammatory pain due to their binding to plasma proteins and increased delivery to inflamed tissues through extravasation of plasma proteins. Although these drugs are traditionally thought to produce analgesia through a peripheral mechanism, it is likely that the CNS is an additional target of their action. NSAIDs inhibit prostaglandin synthesis by blocking the enzyme cyclooxygenase (COX), which has two isoforms, COX-1 and COX-2. Some investigators have proposed that a splice variant of COX-1 (i.e., COX-3) is predominantly expressed in the CNS and is the primary site of action of acetaminophen. However, recent studies have revealed that the antipyretic and analgesic effects of acetaminophen do not involve COX-3 inhibition, they likely act through the effects of active metabolites on cannabinoid receptors in the CNS, and these metabolites appear to work through calcium channel blocking (Ca v 3.2) .

Numerous NSAIDs are available to relieve pain and inflammation (Table 4-4). Unfortunately, relatively few studies (especially in endodontic pain) have directly compared NSAIDs with respect to analgesia and risk of side effects. Lack of comprehensive comparative studies in endodontics means that can only be given general recommendations, and clinicians need to familiarize themselves with these medications. Ibuprofen is generally considered the prototype of modern NSAIDs and has documented efficacy and safety. Other NSAIDs may have certain advantages over ibuprofen. For example, etodolac (i.e. Lodin) has less irritant effect on the gastrointestinal tract, and ketoprofen (Orudis) has shown in some studies a slightly greater analgesic effect than ibuprofen. Intranasal formulations of ketorolac tromethamine (Sprix) are now available and provide significant pain relief in patients with endodontic pain within 30 minutes of administration. According to recent studies, in addition to COX inhibition, ketorolac and diclofenac inhibit peripheral N-methyl-D-aspartate receptors, which may contribute to their analgesic effect. The advantage of NSAIDs is their well-founded effectiveness for pain of inflammatory origin.

Everyone knows that inflammation is one of the body’s most basic reactions to any damage to our body. At a time when dental pathologies occur inside the body, coupled with inflammatory processes, many doctors recommend the additional use of anti-inflammatory drugs.

Anti-inflammatory drugs used in dentistry

The modern world forces us to live by its own rules. But only many people point-blank refuse to use them for their intended purpose, although this can only bring a large number of advantages and benefits. Everyone seems to be well aware that there is a great need to maintain oral hygiene in perfect condition. For this purpose, there are a large number of special products on sale that will make this process easier for you: sprays, rinses, creams and much more. You need to brush your teeth at least twice a day, and the most important thing is that for this process you must choose the right one. toothpaste, which is ideal for your type of teeth and gums. Don’t ruin your life from the very beginning; it’s better to spend money on a suitable toothpaste than to later experience unpleasant sensations from treatment of your teeth and gums.

But people who take excellent care of their oral cavity are not always able to avoid painful sensations and the occurrence of an inflammatory process. In order not to expose your body maximum number discomfort and problems, try to find out from your dentist about what medications will help you get rid of inflammation, and in the best case scenario, also relieve pain to the maximum.

Of course, you, as a patient, should not only listen to the dentist’s recommendation, but also independently study the information about this medicine, which was recommended to you by a specialist. You should be aware of all the consequences that may occur while taking medications.

The dentist has every right to prescribe the use of anti-inflammatory drugs medicines in the following cases:

• The occurrence of toothache;
• Presence of periodontitis;
• Manifestation of pathology of the oral mucosa.

This kind of medicine can easily and simply have an effect on the body, and it does not matter at what stage the inflammation is. In this case, in a short time, inflammation can be reduced to a minimum, or it can be cured “in the bud.” At this point in time, all anti-inflammatory drugs can be divided into two categories: steroidal and non-steroidal.

The damaging effects of oral parts most often occur when the plaque microbe is present within the body. Remember that absolutely any inflammatory process will be accompanied by not entirely pleasant sensations, most often pain. The longer the pain process drags on, the more damage will be done to your dental tissues.

Most often, when the doctor cannot completely remove dental plaque, the prompt use of anti-inflammatory drugs is required. In the dental field, both general and local agents can be used.

Drug differences

If a patient is prescribed an antibacterial drug, it will primarily contribute to a complete reduction harmful microorganisms inside the body. It will also follow from this that the activity of developing inflammation will occur much more calmly, and in some cases will stop altogether. Some people confuse this category of medications with antibiotics, and therefore are completely afraid to take medications prescribed by a doctor. It is worth remembering that antibiotics can have the maximum effect Negative influence to disrupt the functioning of the body's microflora. As a result of taking such medications, the body can give rise to new diseases in the oral cavity (dysbacteriosis, thrush, and a general decrease in immunity).

At this point in time, several groups of drugs have been developed that can influence both only one phase of the inflammatory process in the body, and several at once. These are the drugs that were received common name anti-inflammatory drugs. This category of drugs should be prescribed by a doctor, since only he will be able to fully initially assess the entire course of inflammation in the body.

Changes are constantly taking place in the pharmaceutical market of anti-inflammatory drugs, and all this is only due to the fact that manufacturers are faced with an insufficient effect from the drugs, which means they are developing something of better quality and effectiveness. In the same way, the review of drugs also includes numerous side effects, the effect of which on the body is sometimes too significant.

Anti-inflammatory drugs

The category of anti-inflammatory drugs can include both steroidal and non-steroidal drugs. These include various enzyme preparations and vitamins of groups A, C, P, E (they have high level antioxidant properties), heparin ointment and much more.

Steroid drugs

This category of drugs includes glucocorticoids. They can be considered the main hormones of the adrenal cortex. The impact of this type of medication is immediate on three phases of the inflammatory process.

Steroid drugs have big amount beneficial properties, such as:

• The ability to competently stabilize cell membranes. Access to lysosomal enzymes is closed. They are the ones that destroy the structure of bacteria, but when there are too many of them, they begin to affect tissue structures. Therefore, with the help of these medications you can significantly protect your oral mucosa. The level of the inflammatory process decreases, the pain threshold becomes almost invisible.
• The hydrolysis of proteins, as well as partially fats and carbohydrates, is inhibited. All this completely interrupts the process of necrosis of cells that have undergone any damage.
• The production of arachidonic acid slows down, just like many of its derivatives. In the process of inflammation, these acids are involved in the literal sense, which is why, with a decrease in the level of their influence, painful sensations will become an order of magnitude less.
• Medicines in this category can influence the synthesis of hyaleronic acid, which easily normalizes the order of blood distribution in the right directions. It is this acid that is the main component in the intercellular substance, which means that when using such drugs, the chances of swelling of the mucous membrane tissues are reduced.
• The level of permeability of the walls of numerous blood vessels. The consequence of this is also a reduction in the occurrence of edema in the tissues of the mucous membrane.

Nonsteroidal anti-inflammatory drugs

The category of non-steroidal anti-inflammatory drugs is most often used in the field of periodontics. The main effect of these drugs is the normalization of the working process of capillaries, as well as the establishment of microcirculation. They are used to treat diseases such as gingivitis and periodontitis.

Often in dentistry, non-steroidal anti-inflammatory drugs are used to apply special therapeutic dressings. This creates periodontal pockets. This type of drugs primarily includes paracetamol, ortofen, ketorod and many others.

1

In a retrospective analysis of 519 outpatient records of patients with acute and chronic pulpitis, chronic generalized catarrhal gingivitis and chronic generalized periodontitis, the structure and frequency of prescription of systemic NSAIDs were studied. It was shown that drugs of this group were prescribed in 19% of cases. Of the huge number of NSAIDs, only 5 INNs were recommended to patients. The most frequently prescribed drugs were nimesulide (34%), ibuprofen (24%) and ketoprofen (16%). Systemic NSAIDs are prescribed by dental therapists mainly for analgesic purposes: patients with acute and chronic pulpitis receive them in 55% of cases. The anti-inflammatory properties of drugs are not used actively enough: for periodontal pathology they are recommended only in 15% of cases. When prescribing NSAIDs, dental therapists make mistakes: there are cases of recommending drugs to persons who have contraindications for their use (pathology of the gastrointestinal tract, liver, kidneys). Thus, the use of NSAIDs in therapeutic dentistry requires optimization: this can be achieved through intensification educational events(seminars, conferences, lectures, etc.) for doctors on these issues.

therapeutic dentistry

retrospective study

1. Badokin V.V. Non-steroidal anti-inflammatory drugs in the practice of a polyclinic doctor: clinical pharmacology of ketoprofen // Handbook of a polyclinic doctor. - 2007. - No. 4. - P. 53-56.

2. Kamchatnov P.R. Ketoprofen: effectiveness and safety of use in patients with low back pain / P.R. Kamchatnov, G.S. Salnikova, A.V. Chugunov // Directory of a polyclinic doctor. - 2010. - No. 2. - P. 54-57.

3. Karateev A.E. Nimesulide: safety issues and the possibility of long-term use // Farmateka. - 2009. - No. 4. - P. 17-25.

4. Karateev A.E. Safety of nimesulide: emotions or balanced assessment? / A.E. Karateev, V.G. Barskova // Consilium medicum. - 2007. - T. 9. - No. 2. - P. 60-64.

5. Aggarwal V. Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis / V. Aggarwal, M. Singla, A. Rizvi, S. Miglani // J. Endod. -2011. - Vol. 37. - No. 4. - R. 445-449.

6. Arslan H. Effectiveness of tenoxicam and ibuprofen for pain prevention following endodontic therapy in comparison to placebo: a randomized double-blind clinical trial / H. Arslan, H. Topcouglu, H. Aladag // J. Oral. Sci. - 2011. - Vol. 53. - No. 2. - P. 157-161.

7. Committee on the Safety of Medicines, Medicines Control Agency. Ketorolac: new restrictions on dose and duration of treatment // Current Problems in Pharmacovigilance. - 1993. - Vol. 19. - P. 5-8.

8. Garcia-Rodriguez L. Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other non-steroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs / L. Garcia-Rodriguez, C. Cattaruzzi, M. Troncon, L. Agostinis // Arch.Intern.Med. - 1998. - Vol. 158. - No. 1. - P. 33-39.

9. International Society of drug Bulletins “Nimesulide must be withdrawn worldwide due to serious liver damage”: Press release, 20 Dec. 2007 // Pharmed Trade News. - 2008. - Vol. 4. - No. 18. - P. 2.

10. Kim D. The effect of aspirin on gingival crevicular fluid levels of inflammatory and anti-inflammatory mediators in patients with gingivitis / D. Kim, K. Koszeghy, R. Badovinac et al. // J. Periodontol. - 2007. - Vol. 78. - No. 8. - P. 1620-1626.

Introduction

Systemic nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in dental practice abroad in the complex treatment of endo- and periodontal diseases. In the first case, NSAIDs are used primarily to prevent pain that occurs after endodontic interventions, as well as to increase the effectiveness of blockade of the inferior alveolar nerve with local anesthetics for irreversible pulpitis. In case of periodontal pathology, NSAIDs are used in addition to mechanotherapy to improve treatment results.

In domestic dentistry there is insufficient data reflecting the use of systemic NSAIDs in such cases.

An indispensable method for obtaining an idea of ​​the use of drugs in real clinical practice and judging the rationality of the prescriptions made is pharmacoepidemiological analysis.

Purpose of the study: to analyze the structure and frequency of prescription of systemic NSAIDs by dental therapists in the city of Ufa.

Materials and methods. Design: Retrospective descriptive cross-sectional pharmacoepidemiological study.

An analysis of 519 outpatient records of patients (244 men and 295 women) observed in dental clinics in Ufa from 2008 to 2011 was carried out.

Inclusion criteria: outpatient records of adult therapeutic patients with inflammatory endo- and periodontal diseases (acute and chronic pulpitis, chronic generalized catarrhal gingivitis and chronic generalized periodontitis).

The selection of primary medical documentation for the study was carried out by randomization using the random numbers. The sample was representative (included an equal number of outpatient records of patients with the above-mentioned diagnoses from each district of the city), which made it possible to extrapolate the results obtained to the general population of persons with the designated nosologies. Grouping of data from outpatient records was carried out using Excel and Access for Windows XP.

Results and discussion. The characteristics of the patients included in this study are presented in Table 1.

Table 1 - Characteristics of patients included in the study

The results obtained in our study showed that the total frequency of recommendations of systemic NSAIDs by dental therapists was 17% (90 people). The frequency of prescriptions of drugs from the group depending on the nosology is presented in Table 2.

Table 2 - Frequency of prescription of systemic NSAIDs by outpatient dental surgeons for various nosologies

Diagnosis	Total Human		Number of people receiving NSAIDs
	abs. number	% of total number of patients	abs. number	% of total number of patients
Acute and chronic pulpitis
Chronic generalized catarrhal gingivitis
Chronic generalized periodontitis

As can be seen from Table 2, systemic NSAIDs are prescribed by therapeutic dentists mainly for analgesic purposes: patients with acute and chronic pulpitis receive them in 55% of cases. The anti-inflammatory properties of drugs, from our point of view, are not used actively enough: for example, in chronic generalized periodontitis, systemic NSAIDs are recommended only in 15% of cases, and in chronic catarrhal gingivitis they are not prescribed at all.

The full list of systemic NSAIDs prescribed in outpatient dental surgery included 10 items (ketorolac, nimesulide, ketoprofen, ibuprofen, metamizole sodium, diclofenac, indomethacin, acetaminophen, meloxicam and lornoxicam). Of these, the last 5 drugs were used in isolated cases, and therefore were combined into separate group"other". That is, in fact, only 5 NSAIDs are prescribed to patients, which, in our opinion, does not fully realize the potential capabilities of the class.

Identified in our previous studies low level dentists' knowledge of the pharmacology of anti-inflammatory drugs is reflected in their prescriptions. Thus, there were recommendations for NSAIDs for people with gastrointestinal, liver and kidney pathologies. General structure Prescriptions of systemic NSAIDs by outpatient dental therapists are shown in Fig. 1.

Rice. 1. General structure of prescriptions for systemic NSAIDsoutpatient dental therapists.

The structure of NSAID prescriptions depending on nosology is shown in Table 3.

Table 3 - Structure of prescriptions of NSAIDs by therapeutic dentists depending on nosology

A drug	Frequency of drug prescription for this disease (%)
	Acute and chronic pulpitis	Chronic generalized catarrhal gingivitis	Chronic generalized periodontitis
Ibuprofen
Ketoprofen
Ketorolac
Nimesulide
Metamizole sodium and metamizole-containing drugs

As can be seen from the presented images, in the structure of prescriptions of systemic NSAIDs by dental therapists, the leading drugs are nimesulide, ibuprofen and ketoprofen.

The attitude towards nimesulide in the world is ambiguous. There are many reports of hepatotoxic reactions induced by it (sometimes with fatal outcomes). Nimesulide is used in approximately 50 countries of the world; it is not registered in more than 150. These include the USA (where it was synthesized), Great Britain, Canada, Denmark, Australia, New Zealand and Japan. In 2002, Finland and Spain stopped selling the drug after reports of hepatotoxicity. Ireland and Singapore banned the use of nimesulide in 2007. The press release of the International Society of Drug Bulletins (dated December 20, 2007) states: “Nimesulide should be withdrawn from circulation worldwide due to serious liver damage that develops against its background. In cases where taking an NSAID is necessary, it is better to use a drug with an optimal benefit-risk ratio, such as ibuprofen. The International Society of Medicine Bulletins does not accept the fact that nimesulide remains approved in some countries in Europe and the world. This NSAID has neither therapeutic benefit nor greater gastrointestinal safety than other drugs in the group, while its use exposes patients to an increased risk of fatal liver damage."

There are also opposing opinions. So, Karateev A.E. and Barskova V.G. (2007), believe that data on the high hepatotoxicity of nimesulide are exaggerated and are based on an analysis of spontaneous reports, the number of which depends on the opinion of the medical community and external information influences. According to the results of research by Karaeev A.E. (2009), the use of nimesulide in patients with psoriatic arthritis does not cause negative dynamics of biochemical parameters indicating damage to liver cells or cholestasis.

The second place after nimesulide in frequency of prescription by dental therapists was occupied by ibuprofen (24%). The use of the drug in therapeutic dentistry, in our opinion, is justified not only by its pronounced anti-inflammatory and analgesic activity, but also by its high safety profile. Among all NSAIDs, ibtsuprofen in low doses is considered the standard of safety regarding the risk of gastrointestinal complications.

Ketoprofen was in third place in the structure of prescriptions for therapeutic dentists. The drug has a rapid and powerful analgesic effect, as well as high anti-inflammatory activity, which approaches that of the “gold standard” - diclofenac. The gastrotoxicity of the drug is low, the relative risk of gastric bleeding against its background is 3.2. According to many authors, ketoprofen is one of the most effective and safe modern NSAIDs.

Ketorolac was prescribed by dental therapists for acute and chronic pulpitis. The “popularity” of the drug in these situations, from our point of view, is due to the pronounced analgesic effect of the latter.

However, in addition to information about the effectiveness of ketorolac, the literature is replete with information about high frequency serious side effects associated with its use, namely ulceration of the gastrointestinal tract, perforation of peptic ulcers and bleeding (including gastric and postoperative).

Following reports of 97 fatalities associated with ketorolac worldwide between 1990 and 1993, it was withdrawn from the market in some countries and its permitted dosage and maximum duration of use were reduced in others. Post-marketing studies of ketorolac revealed a relationship between gastrointestinal bleeding and the average daily dose of the drug, as well as with a duration of therapy of more than 5 days.

According to L.A. Garcia-Rodriguez et al. (1998), ketorolac is 5 times more gastrotoxic compared to other NSAIDs; the relative risk of gastric bleeding against its background is the highest among the drugs in the group and is 24.7. An increased risk of these side effects is observed with both oral and intramuscular administration of ketorolac and is noted already in the first week of its administration. The results obtained, according to the authors, unfavorably characterize ketorolac from a benefit-risk point of view compared to other NSAIDs.

Positive aspects, identified during the analysis process, was, in our opinion, a low percentage of prescriptions of metamizole sodium and metamizole-containing drugs (3%), the unsafety of which can hardly be doubted by anyone.

conclusions

1. Systemic NSAIDs are prescribed by therapeutic dentists mainly for analgesic purposes: patients with acute and chronic pulpitis receive them in 55% of cases. The anti-inflammatory properties of drugs are not used actively enough: in chronic generalized periodontitis, systemic NSAIDs are recommended only in 15% of cases, and in chronic catarrhal gingivitis they are not prescribed at all.
2. Prescriptions of NSAIDs in therapeutic dentistry do not fully realize the potential capabilities of the group: in practice, patients are prescribed drugs of only 5 INN.
3. The leading positions in terms of frequency of recommendations by dental therapists are occupied by nimesulide, ibuprofen and ketoprofen.
4. When prescribing NSAIDs, dentists make mistakes: there are cases of recommending drugs to persons who have contraindications for their use (pathology of the gastrointestinal tract, liver, kidneys).
5. The use of NSAIDs in therapeutic dentistry requires optimization: this can be achieved by intensifying educational activities for doctors on these issues.

Reviewers:

• Zarudiy F.A., Doctor of Medical Sciences, Professor, Head. course of clinical pharmacology at the State Budgetary Educational Institution of Higher Professional Education "BSMU" of the Ministry of Health and Social Development of Russia, Ufa.
• Agletdinov E.F., Doctor of Medical Sciences, Professor of the Department of Biological Chemistry of the State Budgetary Educational Institution of Higher Professional Education "BSMU" of the Ministry of Health and Social Development of Russia, Ufa.

Bibliographic link

Samigullina L.I. PHARMACOEPIDEMIOLOGICAL ANALYSIS OF OUTPATIENT PRESCRIPTIONS OF NSAIDS IN THERAPEUTIC DENTISTRY // Contemporary issues science and education. – 2012. – No. 2.;
URL: http://science-education.ru/ru/article/view?id=5838 (access date: 04/06/2019). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"

To relieve toothache, you can use tablets of two groups - analgesics (Ibufen, Nimesil) and non-steroidal anti-inflammatory drugs (Ketonal, Komistad). You can take them in case of severe toothache to provide first aid, and then consult a dentist for treatment. It is better not to take tablets for toothache immediately before visiting a doctor, or if there is acute inflammation in the oral cavity, which can hide symptoms and complicate diagnosis. There are separate medications for children, adults, and pregnant women that are suitable for relieving pain of various origins. It is recommended to take medications such as Ketonal or Ibufen immediately when a symptom appears, as they help relieve pain and at the same time reduce the inflammatory process.

Let's look at the main groups of analgesic and non-steroidal anti-inflammatory drugs (NSAIDs) that can be taken for severe toothache in children and adults.

Among the anti-inflammatory drugs, it is worth highlighting Ketonal, Nurofen, Voltaren, Nise, Ketanov, Xefocam. Complex drugs Sedalgin, Pentalgin, Tempalgin also help with pain.

Nurofen and Ketonal tablets

The medicine Nurofen has a pronounced analgesic effect and helps with severe toothache in children and adults. It is less effective than Ketonal tablets in terms of pain relief, and is more aimed at relieving the inflammatory process and reducing fever. Preparations Nurofen, Ketonal can be taken in case of acute pain of unknown etiology, as well as in the case of chronic periodontitis or periodontal disease. Nurofen can also be taken for pain after tooth extraction or surgical interventions in the oral cavity. The use of Nurofen is quite effective in treating children; it is indicated from the age of three months.

Analgesic Ketonal is one of the most powerful analgesics in dental practice and has a pronounced analgesic effect. Ketonal is allowed to be taken by children over 12 years of age and by adults with severe acute or chronic pain.

The main indications for the use of Ketonal tablets for adults and children include:

• postoperative period (tooth extraction, implantation);
• acute symptoms of pulpitis and periostitis;
• inflammation of the oral cavity, stomatitis with severe pain.

NSAID Voltaren

Anti-inflammatory non-steroidal tablets for toothache Voltaren are used in dental practice more often to relieve inflammation in the pathology of the temporomandibular joint, when it is necessary to relieve moderate chronic symptoms.

Drinking them in the postoperative period or in case of severe pain from pulpitis is ineffective and it is better to take the analgesic Ketonal.

Ketanov and Nise - popular but useless drugs

Anti-inflammatory drugs Nise and Ketanov have recently been prescribed less and less frequently for pain relief in adults. This is due to the toxicity and narrow focus of the tablets. Nise will not be able to relieve pain and remove even the slightest inflammation, but stomach problems can be expected if you take several tablets. Also, the product is not prescribed for children and pregnant women.

The popularity of Ketanov and Nise is explained only by the cheapness and availability of medicines.

Strong painkillers

The main drugs that help with toothache in children and adults are Nimesil, Analgin, Ibuprofen.

Toothache powder Nimesil is recommended as first aid; it has a pronounced analgesic effect and helps relieve toothache in an adult. The remedy can be taken against acute pain or chronic pain.

How to effectively relieve symptoms with Nimesil powder?

1. You can drink the solution from 12 years of age;
2. Take the solution after meals;
3. The solution needs to be prepared at one time;
4. The powder is diluted in warm water and drunk immediately.

The most effective drugs against acute symptoms are Pentalgin and Analgin; they relieve severe pain in pulpitis and caries, but are not effective in the case of inflammatory periodontal diseases.

Analgin can be taken infrequently; it helps with acute manifestations of caries, pulpitis, and after tooth extraction. The product can be drunk once a day, but no more, as it affects kidney function.

Ibuprofen is a medicine from the group of non-steroidal anti-inflammatory drugs, but its main effect is aimed at pain relief. It can be taken after 12 years, the maximum daily dose is 1300 mg, which is divided into several doses. The list of diseases for which you can take Ibuprofen is quite wide, including many dental pathologies: acute pain due to pulpitis, temporomandibular joint disease, carious cavities, gingivitis, periodontitis, periodontitis and periodontal disease.

Analgesics in dentistry

What other anti-inflammatory drugs can be taken for dental diseases?

1. Airtal is an anti-inflammatory drug with antipyretic and analgesic effects, helps to relieve severe acute and chronic toothache;
2. Askofen is a non-narcotic analgesic that helps with severe pain of various etiologies, but the drug has an impressive list of contraindications, therefore it should not be taken if you have diseases of the gastrointestinal tract, kidneys, liver, cardiovascular system, joints or during pregnancy;
3. Spazmalgon is used for symptoms of varying severity; it is especially effective for pulpitis, trigeminal neuritis;
4. Citropak is an anti-inflammatory analgesic used for pain and inflammation;
5. Solpadeine - the medicine can be taken for infectious pathologies of the oral cavity with fever, inflammation;
6. Nisitis – relieves pain, relieves inflammation, reduces temperature, is prescribed in case of pain of various etiologies.

The use of the presented tablets at home should be agreed with a doctor, but if you urgently need to relieve symptoms and there is no way to ask a doctor, it is recommended to take drugs such as Nimesil or Ibuprofen.

All drugs in this group are inhibitors of the enzyme cyclooxygenase (COX), which acts on arachidonic acid to form important mediators of inflammation and pain - prostaglandins and thromboxanes. Most representatives of this group of drugs non-selectively inhibit both forms of the enzyme: type I cyclooxygenase (COX-I), which is constitutively present in many cells, as well as type II cyclooxygenase (COX-I), induced by inflammation and pain. One of the main side effects of NSAIDs is their ulcerogenic effect, caused by a decrease in the production of gastroprotective prostaglandins in the gastric mucosa, which is associated with inhibition of COX-1 activity.

A newer representative of NSAIDs, the drug celecoxib (Celebrex), is a highly selective COX-P inhibitor, and therefore does not cause ulceration in the stomach.

In dentistry, this group of drugs is used orally, as well as parenterally for toothache, neuralgia and myalgia of the maxillofacial area, arthritis of the temporomandibular joint, lupus erythematosus and other collagenoses. Tromethamine ketorolac has the maximum analgesic effect (for some pains it is only 3 times inferior to morphine), however, as an analgesic, this drug is not recommended for long-term (more than 5 days) use due to a possible ulcerogenic effect on the stomach, even with parenteral administration.

When taking high doses of salicylates (acetylsalicylic acid, etc.), the possibility of bleeding (reduced production of thromboxane A2) and reversible toxic effects on the auditory nerve should also be taken into account. Pyrazolone derivatives with long-term use can cause inhibition of hematopoiesis (agranuloitosis, aplastic anemia), which can manifest as ulceration of the oral mucosa.

Mafenamine sodium salt and benzydamine are used as local analgesics and anti-inflammatory drugs in dentistry, which also inhibit COX, locally reduce the production of prostaglandins and reduce their edematous and algogenic effects. Systemic toxicity is not observed with local use of these agents.

Aminophenazone(Aminophenazone). Synonyms: Amidopyrinum, Amidazophen.

pharmachologic effect: has antipyretic, analgesic and anti-inflammatory effects. Unlike narcotic analgesics does not have a depressing effect on the respiratory and cough centers, does not cause euphoria and symptoms of drug dependence.

Indications: in an outpatient clinic, it is prescribed to relieve pain of various origins (myositis, arthritis, neuralgia, headache and toothache, etc.) and for odontogenic inflammatory processes.

Mode of application: orally 0.25-0.3 g 34 times a day (maximum daily dose - 1.5 g).

Side effect : with individual intolerance, the development of anaphylactic reactions and the appearance of skin rashes is possible. Causes inhibition of hematopoietic organs (agranulocytosis, granulocytopenia).

Contraindications: individual intolerance and diseases hematopoietic system.

Release form: powder, tablets of 0.25 g in a package of 6 pcs. Amidopyrine is part of complex tablets (Pyranal, Pirabutol, Anapirin), which are prescribed depending on the pharmacological action of the components included in their composition. When taking combination tablets, you may experience Side effect characteristic of their constituent components.

Storage conditions: in a place protected from light. List B.

Acetylsalicylic acid(Acidum acetylsalicylicum). Synonyms: Aspirin, Plidol 100/300, Acenterin, Anapyrin, Apo-Asa, Aspilyte, Acylpyrin, Colfarit (Colfarit), Magnyl (Magnyl), Novandol (Novandol).

pharmachologic effect: non-steroidal anti-inflammatory drug. It has antipyretic, analgesic and anti-inflammatory effects, and also inhibits platelet aggregation. The main mechanism of action of acetylsalicylic acid is the inactivation of the enzyme cyclooxygenase, as a result of which the synthesis of prostaglandins is disrupted.

Indications: in dental practice it is prescribed for pain syndrome of weak and moderate intensity of various origins (arthritis of the temporomandibular joint, myositis, trigeminal and facial neuralgia, etc.) and as a symptomatic remedy in the treatment of odontogenic inflammatory diseases.

Mode of application: prescribed orally 0.25-1 g after meals 34 times a day. Take with plenty of liquid (tea, milk).

Side effect: possible nausea, anorexia, epigastric pain, diarrhea, allergic reactions, with long-term use - dizziness, headache, reversible visual impairment, tinnitus, vomiting, disorders of rheological properties and blood clotting, ulcerogenic effects.

Contraindications: peptic ulcer of the stomach and duodenum, individual intolerance, blood diseases, renal dysfunction, pregnancy (I and III trimesters). For children under 2 years of age, the drug is prescribed only for life Indications m. Prescribe with caution for liver diseases.

Release form: acetylsalicylic acid - tablets 0.1; 0.25; 0.5 g.

Aspirin - film-coated tablets, 325 mg, in a package of 100 pcs.

Plidol - tablets of 100 mg, in a package of 20 pieces and 300 mg, in a package of 500 pieces.

Acenterin - enteric tablets 500 mg, 25 pcs. in a package.

Anopyrine - “buffer” tablets, enteric-coated, 30, 100 and 400 mg, in packs of 10 and 20 pcs.

Apo-Asa - 325 mg tablets, 1000 pcs. in a package.

Acylpirin - tablets 500 mg, 10 pcs. in a package.

Aspilyte - film-coated tablets, 325 mg, in a package of 100 pcs.

Colfarit - 500 mg tablets, 50 pcs. in a package.

Magnil - tablets of 500 mg, in packages of 20, 50 and 100 pcs.

Novandol - 300 mg tablets, 10 pcs. in a package.

Storage conditions: at room temperature, protected from light.

Benzydamine(Benzydamine). Synonyms: Tantum, Tantum verde.

pharmachologic effect: representative of a new class of non-steroidal anti-inflammatory drugs of the indazoles group for local and systemic use. Anti-inflammatory analgesic effects are due to a decrease in the synthesis of prostaglandins and stabilization of the cell membranes of neutrophils, mast cells, erythrocytes and platelets. Benzidamine does not irritate tissues and does not have an ulcerogenic effect when used systemically. When applied to mucous membranes, it promotes reepithelialization.

Indications: when used systemically, it is indicated as an anti-inflammatory and analgesic agent in surgery, orthopedics, dentistry, otorhinolaryngology, gynecology, and pediatrics.

In dentistry, the drug benzydamine tantum verde is used topically (with confirmed clinical effectiveness) for symptomatic therapy for inflammatory diseases of the oral mucosa with pain syndrome - acute and chronic herpetic oral lesions of the mucous membrane, catarrhal stomatitis, recurrent aphthous stomatitis, lichen planus, desquamative glossitis, nonspecific forms of stomatitis, as well as for the treatment of periodontal disease, oral candidiasis (in combination with anti-candidiasis drugs), reducing pain after tooth extraction and with oral injuries.

Mode of application: locally - 15 ml of tantum verde solution is used to rinse the mouth 4 times a day. Do not swallow the solution when rinsing. The duration of treatment depends on the severity of the inflammatory process. For stomatitis, the approximate course duration is 6 days. Aerosol "Tantum Verde" is used to irrigate the oral cavity, 4-8 doses every 1.5-3 hours. This dosage form especially convenient for use in children and postoperative patients who are unable to rinse. For children aged 6-12 years, the aerosol is prescribed 4 doses, and for children under 6 years old - 1 dose for every 4 kg of body weight (no more than 4 doses) every 1.5-3 hours. Lozenges are prescribed 1 piece 34 times a day.

Systemically: Tantum tablets for oral administration are prescribed to adults and children over 10 years of age, no 1 piece (0.05 g) 4 times a day. Contraindications: when applied topically - individual intolerance to the drug. The rinse solution is not recommended for use in children under 12 years of age. Systemic use - pregnancy, lactation, phenylketonuria.

Side effect: When applied topically, numbness of the oral tissues or a burning sensation and allergic reactions are rarely observed.

Interaction with other drugs: not noted.

Release form:

1) mouth and throat rinse - 0.15% solution of benzydamine hydrochloride in a 120 ml bottle.

Other Ingredients: Glycerol, Saccharin, Sodium Bicarbonate, ethanol, methylparaben, polysorbitol;

2) aerosol in 30 ml bottles (176 doses), containing 255 mcg of benzydamine hydrochloride in 1 dose;

3) tablets for resorption in the oral cavity containing 3 mg of benzydamine hydrochloride (20 pieces per package);

4) tablets for oral administration containing 50 mg of benzydamine hydrochloride.

Storage conditions: at room temperature.

Diclofenac(Diclofenac). Synonyms: Diclonat P, Dicloreum, Apo-Diclo, Veral, Voltaren, Diclac, Diclobene, Diclomax, Diclomelan ( Diclomelan), Diclonac, Dicloran, Rewodina, Rheumafen.

pharmachologic effect: non-steroidal anti-inflammatory drug. It is the active substance of a large number of medications produced in the form of tablets (see synonyms).

It has anti-inflammatory, analgesic and moderate antipyretic effects due to inhibition of the synthesis of prostaglandins, which play a major role in the pathogenesis of inflammation, pain and fever.

Indications: pain syndrome after injuries, operations. Inflammatory swelling after dental surgery.

Mode of application: prescribed orally 25-30 mg 2-3 times a day (maximum daily dose - 150 mg). For children over 6 years of age and adolescents, the daily dose is 2 mg/kg body weight, divided into 3 doses.

Side effect: possible nausea, anorexia, pain in the epigastric region, flatulence, constipation, diarrhea, as well as dizziness, agitation, insomnia, fatigue, irritability; in predisposed patients - edema Contraindications: gastritis, peptic ulcer of the stomach and duodenum, hematopoietic disorders, pregnancy, increased sensitivity to diclofenac. Do not administer to children under 6 years of age.

: simultaneous administration with acetylsalicylic acid leads to a decrease in its concentration in plasma. Reduces the effect of diuretic substances.

Release form: retard tablets, in a package of 20 pieces (each tablet contains 100 mg of diclofenac sodium); solution for injection in ampoules of 3 ml, in a package of 5 pieces (in 1 ml - 50 mg of diclofenac sodium).

Dicloreum - tablets of 50 mg, 30 pcs in a package; retard tablets 100 mg, 30 pcs per pack; solution for injection, 3 ml in ampoules, in a package of 6 pieces (1 ml contains 25 mg of diclofenac sodium).

Storage conditions: in a dry, cool place.

Ibuprofen(Ibuprofenum). Synonyms: Apo-ibuprofen, Bonifen, Burana, Ibupron, Ibusan, Ipren, Marcofen, Motrin, Norswel , Paduden.

pharmachologic effect: has anti-inflammatory, antipyretic and analgesic properties. Its antipyretic effect is superior to phenacetin and acetylsalicylic acid. The latter is inferior to ibuprofen in terms of analgesic effect. The mechanism of action is associated with inhibition of prostaglandins. The analgesic effect occurs 1-2 hours after taking the drug. The most pronounced anti-inflammatory effect is observed after 1-2 weeks of treatment.

Indications: used for arthralgia of the temporomandibular joint of rheumatic and non-rheumatic origin (arthritis, deforming osteoarthritis), myalgia, neuralgia, postoperative pain.

Mode of application: prescribed orally after meals, 0.2 g 3-4 times a day. Daily dose - 0.8-1.2 g.

Side effect: possible occurrence of heartburn, nausea, vomiting, sweating, allergic skin reactions, dizziness, headache, gastric and intestinal bleeding, swelling, impaired color perception, dry eyes and mouth, stomatitis.

Contraindications: peptic ulcer disease of the stomach and duodenum, ulcerative colitis, bronchial asthma, parkinsonism, epilepsy, mental illness, pregnancy and lactation, hypersensitivity to ibuprofen. Use with caution in persons of operator professions, with disorders of blood clotting, liver and kidney function.

Interaction with other drugs: the drug enhances the effect of sulfonamides, diphenin, indirect anticoagulants.

Release form: 0.2 g tablets, film-coated. Storage conditions: in a dry place, protected from light. List B.

Indomethacin(Indometacinum). Synonyms: Indobene, Indomelan, Indomin, Indotard, Metindol, Elmetacin.

pharmachologic effect: has anti-inflammatory, antipyretic and analgesic properties. Its antipyretic effect is superior to phenacetin and acetylsalicylic acid. The latter is inferior to indomethacin in its analgesic effect.

Indications: recommended for arthritis and arthrosis of the temporomandibular joint of various origins; as a short-term addition to complex therapy of myalgia and neurology; for pain and inflammation after dental surgery. It can also be used for reactive hyperemia of the pulp after tooth preparation for fixed dentures or an extensive filling or inlay.

Mode of application: administered orally during or after meals 34 times a day, starting from 0.025 t. Depending on tolerability, the dose is increased to 0.1-0.15 g per day. The course of treatment is 23 months. For pulp hyperemia, the drug is used for 57 days. Can be used in the form of an ointment, which is rubbed into the joint area 2 times a day.

Side effect: possible appearance of stomatitis, ulcerations of the mucous membrane of the stomach, intestines, pain in the epigastric region, dyspepsia, gastric and intestinal bleeding, headache, dizziness, hepatitis, pancreatitis, allergic reactions, agranuloitosis, thrombocytopenia.

Contraindications: not recommended for gastroduodenal ulcers, bronchial asthma, blood diseases, diabetes, individual intolerance, during pregnancy and lactation, for mental illness, in childhood up to 10 years.

Interaction with other drugs: in combinations with salicylates, the effectiveness of indomethacin is reduced, and its damaging effect on the gastric mucosa is enhanced. The effect of the drug is enhanced when combined with glucocorticoids, pyrazolone derivatives.

Release form: tablets 0.025 g; tubes with 10% ointment. Storage conditions: in a dry, cool place. Ketoprofen. Synonyms: Ketonal, Pro-, fenid, Fastum.

pharmachologic effect: has anti-inflammatory, antipyretic and analgesic effects, inhibits platelet aggregation. The mechanism of action is associated with a decrease in the synthesis of prostaglandins. The anti-inflammatory effect was noted. begins by the end of the first week of treatment.

Indications: symptomatic treatment of inflammatory and inflammatory-degenerative joint diseases. Pain syndrome of various origins, including postoperative post-traumatic pain.

Mode of application: prescribed orally, at a daily dose of 300 mg in 23 doses. Maintenance dose - 50 mg 3 times a day. Apply a gel locally, which is applied to the affected surface 2 times a day, rubbed in for a long time and carefully, after rubbing in, you can apply a dry bandage.

Side effect: When treated with the drug, nausea, vomiting, constipation or diarrhea, gastralgia, headache, dizziness, and drowsiness may occur. When prescribing the gel, itching and skin rash at the site of application of the drug.

Contraindications: when taken orally - diseases of the liver, kidneys, gastrointestinal tract, pregnancy and lactation, age up to 15 years, hypersensitivity to ketoprofen and salicylates. With topical application of the gel - dermatoses, infected abrasions, wounds.

Interaction with other drugs: When administered simultaneously with anticoagulants, the risk of bleeding increases.

Release form: film-coated tablets, 100 mg, in packs of 25 and 50 pcs; retard tablets 150 mg, 20 pcs. in a package. Gel in tubes of 30 and 60 g (1 g contains 25 mg of active substance), cream in tubes of 30 and 100 g (1 g contains 50 mg of active substance).

Storage conditions: in a dry, cool place.

Ketorolac tromethamine(Ketorolac tromethamine). Synonym: Ketanov.

pharmachologic effect: a non-narcotic analgesic with a very strong analgesic effect and moderate anti-inflammatory and antipyretic properties. It is a derivative of pyrrolopyrole. In terms of analgesic activity, it surpasses all known non-narcotic analgesics; when administered intramuscularly and intravenously at a dose of 30 mg, it produces an analgesic effect equivalent to the effect of intramuscular administration of 12 mg of morphine. Inhibits the cyclooxygenase pathway of arachidonic acid metabolism, reducing the production of prostaglandins - mediators of inflammation and pain. Unlike narcotic analgesics, it has a peripheral effect and does not inhibit the central nervous system, breathing, cardiac activity and other autonomic functions. Does not cause euphoria and drug addiction. Ketorolac is not characterized by tolerance. Like other non-steroidal anti-inflammatory drugs, it inhibits platelet aggregation and prolongs the average bleeding time. The duration of action for intramuscular and oral administration is 46 hours.

Indications: used for short-term pain relief in cases of severe and moderate pain, after operations on the maxillofacial area, traumatic injuries to bones and soft tissues, toothache, including after dental interventions, arthrosis of the temporomandibular joint, cancer pain.

Mode of application: the first dose (10 mg) to relieve acute severe pain is administered intramuscularly. If necessary, a subsequent dose (10-30 mg) is administered every 45 hours. The maximum daily dose of the drug for any route of administration for adults is 90 mg; in elderly patients it should not exceed 60 mg. The maximum duration of use of ketorolac injections is 2 days. After relief of acute pain and for pain of moderate intensity, the drug can be administered orally at a dose of 10 mg (one tablet) every 46 hours. The duration of use for enteral administration should not exceed 7 days.

Side effect: Ketorolac is well tolerated. In rare cases, nausea, vomiting, diarrhea, headache, and sweating may occur. As with the use of other non-steroidal anti-inflammatory drugs, irritation of the gastric mucosa, exacerbation of peptic ulcer, and gastrointestinal bleeding are possible. These phenomena are characteristic mainly of enteral administration.

Contraindications: Do not prescribe during pregnancy, lactation, or in patients under 16 years of age. Contraindicated in case of gastric and duodenal ulcers, especially in the acute stage, individual intolerance to non-steroidal anti-inflammatory drugs, including “aspirin asthma”. Use with caution for liver and kidney diseases; dosage reduction is necessary.

Interaction with other drugs: goes well with morphine and other narcotic analgesics, which allows for postoperative pain to reduce the dosage of narcotic analgesics by 1/3. This combination does not enhance the inhibitory effect of narcotic analgesics on breathing. Ketorolac can potentiate the effects of indirect anticoagulants by displacing them from binding to plasma proteins. High doses of salicylates can increase the level of the free fraction of ketorolac in plasma and enhance its effect, requiring a reduction in the dosage of the drug.

Release form: film-coated tablets in a package of 10 pieces (1 tablet contains 10 mg of ketorolac tromethamine); ampoules and syringe tubes of 1 ml of solution containing 30 mg of ketorolac tromethamine.

Storage conditions: in a place protected from light at room temperature.

Metamizole sodium(Metamizoli sodium). Synonyms: Analginum, Baralgin M, Nebagin, Optalgin-Teva, Spasdolsin, Toralgin.

Formacological action: is a pyrazolone derivative. It has a pronounced analgesic and antipyretic effect. The analgesic effect is due to the suppression of the biosynthesis of a number of endogenous substances (endoperoxides, bradykinins, prostaglandins, etc.). It prevents the conduction of painful extero and proprioceptive impulses along the Gaulle and Burdach bundles and increases the threshold of excitability at the level of the thalamus. The antipyretic effect is due to the suppression of the formation and release of pyrogenic substances.

Indications: in dental practice it is prescribed as an analgesic (toothache, myositis, neuritis and neuralgia of the trigeminal and facial nerves, pain after tooth extraction and root canal filling, alveolitis and other odontogenic inflammatory diseases, postoperative period, painful medical procedures, etc.), anti-inflammatory and antipyretic for febrile conditions, including those of odontogenic origin. Used for premedication with other analgesics, tranquilizers and hypnotics.

Mode of application: when taken orally, a single dose for adults is 200-500 mg (maximum - 1 g); for children aged 23 years 100-200 mg, 57 years 200 mg, 8-14 years 250-300 mg. The frequency of administration is 2-3 times a day.

Intramuscularly or intravenously slowly, adults are prescribed 1-2 ml of a 25% or 50% solution 23 times a day. Children are prescribed parenterally at a dose of 50-100 mg per 10 kg of body weight. Long-term use of the drug requires monitoring of peripheral blood patterns.

Side effect: when used, skin rash, chills, dizziness may occur; changes in the blood (leukopenia, agranulocytosis) may be observed. When administered intramuscularly, infiltrates are possible at the injection site.

Contraindications: severe renal and liver dysfunction, blood diseases, increased sensitivity to pyrazolone derivatives. Use with caution during pregnancy and children in the first 3 months of life.

Release form: tablets of 0.5 g with a score for children, in a package of 10 pieces, analgin solution for injection in ampoules of 1 and 2 ml, 10 pieces in a package (1 ml - 250 mg of active substance).

Storage conditions: in a dry, cool room.

Mephenamine sodium salt (Mephenamine natrium).

pharmachologic effect: has a local anesthetic and anti-inflammatory effect, stimulates epithelization of the damaged oral mucosa.

Indications: used in the treatment of periodontal diseases and ulcerative lesions of the oral mucosa, as well as in the treatment of traumatic complications caused by various designs of dentures.

Mode of application: used in the form of a 0.1-0.2% aqueous solution for application 1-2 times a day or 1% paste, which is injected into the periodontal pockets after 1-2 days (for a course of 68 sessions). The solution and paste are prepared immediately before use. An isotonic sodium chloride solution and white clay are used as the basis for preparing the paste.

Side effect: When using solutions with a concentration higher than 0.3% or pastes with a concentration higher than 1%, irritation of the oral mucosa may occur.

Contraindications: individual intolerance.

Release form: powder 3 kg in plastic bags.

Storage conditions: in a dry place, protected from light. List B,

Nabumethon(Nabumetone). Synonym: Relafen.

pharmachologic effect: non-steroidal anti-inflammatory drug, inhibits prostaglandin synthesis. It has anti-inflammatory, analgesic and antipyretic effects.

Indications: in dentistry it is used as a symptomatic remedy in the complex treatment of diseases of the temporomandibular joint.

Mode of application: prescribed orally 1 g 1 time per day, regardless of meals.

Side effect: possible sleep disorders, headache and dizziness, blurred vision, shortness of breath, pain in the epigastric region, changes in the peripheral blood pattern, urticaria.

Contraindications: hypersensitivity to the drug and other NSAIDs, pregnancy and lactation, gastrointestinal diseases and renal dysfunction. Not for children

Interaction with other drugs: not prescribed with drugs that are highly bound to plasma proteins.

Release form: Relafen [Smith Klein Beecham| : film-coated tablets, beige, in packs of 100 and 500 pieces (1 tablet contains 750 mg of nabumetone); film-coated tablets white, in packages of 100 and 500 pieces (1 tablet contains 500 mg of nabumetone).

Storage conditions: in a dry, cool place.

Naproxen(Naproxen). Synonyms: Apo-naproxen (Apo-pargohep), Daprox Entero (Daprox Entero), Naprobene (Naprobene), Apranax (Apranax), Naprios (Naprios), Pronaxen (Pronahep), Naprosyn (Narposyn), Sanaprox (Sanaprox).

pharmachologic effect: is a derivative of propionic acid, has anti-inflammatory, analgesic and antipyretic effects. Suppresses the synthesis of inflammatory mediators and prostaglandins, stabilizes lysosomal membranes, and prevents the release of lysosomal enzymes that cause tissue damage during inflammatory and immunological reactions. Relieves pain, including joint pain, reduces swelling. The maximum anti-inflammatory effect is achieved by the end of the 1st week of treatment. With long-term use it has a desensitizing effect. Reduces platelet aggregation.

Indications: used for arthritis, including the temporomandibular joint (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, articular syndrome due to gout, spinal pain), myalgia, neuralgia, traumatic inflammation of soft tissues and the musculoskeletal system. As aid used for infectious and inflammatory diseases of the ENT organs, headaches and toothaches.

Mode of application: prescribed for adults orally in a daily dose of 0.5-1 g, in two doses. The maximum daily dose is 1.75 g, the maintenance daily dose is 0.5 g. It is also used in the form of rectal suppositories at night (1 suppository containing 0.5 g of the drug). When administered rectally, toxic effects on the liver are eliminated.

Side effect: with prolonged use, dyspeptic symptoms are possible (pain in the epigastric region, vomiting, heartburn, diarrhea, bloating), tinnitus, dizziness. In rare cases, thrombocytopenia and granulocytopenia, Quincke's edema, and skin rash occur. When using suppositories, local irritation is possible.

Contraindications: fresh peptic ulcer of the stomach, “aspirin” asthma, hematopoietic disorders, severe dysfunction of the liver and kidneys. Use with caution during pregnancy. Not prescribed for children under one year of age.

Interaction with other drugs: reduces the diuretic effect of furosemide, potentiates the effect of indirect anticoagulants. Antacids containing magnesium and aluminum reduce the absorption of naproxen from the gastrointestinal tract.

Release form: tablets 0.125; 0.25; 0.375; 0.5; 0.75; 1 g; rectal suppositories of 0.25 and 0.5 g.

Storage conditions: List B.

Niflumic acid(Niflumic acid). Synonym: Donalgin.

pharmachologic effect: a nonsteroidal anti-inflammatory drug for oral administration that has anti-inflammatory and analgesic effects.

Indications: pain from jaw fractures, dislocations and subluxations of the temporomandibular joint, damage to the soft tissues of the maxillofacial area, periostitis, arthritis, osteoarthritis, painful joint dysfunction, as well as pain syndromes after tooth extraction, various dental procedures, etc.

Mode of application: prescribed orally, 1 capsule 3 times a day during or after meals. The capsule is swallowed whole without chewing. In severe cases, especially with exacerbation of chronic inflammatory processes, the daily dose can be increased to 4 capsules. After the onset of clinical improvement, the maintenance daily dose is 1-2 capsules per day.

Side effect: Nausea, vomiting, diarrhea, and sometimes stomach pain are possible.

Contraindications: pregnancy, liver disease, kidney disease, peptic ulcer of the stomach and duodenum. It is not recommended for children or those with hypersensitivity to the drug.

Interaction with other drugs: simultaneous use of donalgin and glucocorticosteroids allows you to reduce the dose of the latter. In patients taking indirect anticoagulants, it is necessary to constantly monitor the prothrombin index.

Release form: gelatin capsules, in a package of 30 pieces (1 capsule contains 250 mg of niflumic acid).

Storage conditions: in a dry, cool place.

Paracetamol(Paracetamol). Synonyms: Brustan, Dafalgan, Ibuclin, Calpol, Coldrex, Panadeine, Panadol, Plivalgin, Saridon, Solpadeine ), Tylenol, Efferalgan.

pharmachologic effect: is an analgesic, anti-inflammatory and antipyretic agent. Inhibits the synthesis of prostaglandins, which are responsible for the early stages of the inflammatory response and the sensation of pain. Inhibits the hypothalamic thermoregulation center, which manifests itself as an antipyretic effect. It is a metabolite of phenacetin, but differs from the latter in significantly less toxicity, in particular, it forms methemoglobin much less frequently and does not have a pronounced nephrotoxic property. Unlike other non-steroidal anti-inflammatory drugs (salicylates, oxicams, pyrazolones, propionic acid derivatives), it does not irritate the gastric mucosa and does not inhibit leukopoiesis.

Indications: used for arthritis and arthrosis of the temporomandibular joints, myalgia, neuralgia, inflammatory diseases of the dental system. Used for pain of low and moderate intensity due to inflammation, fever, infectious and inflammatory diseases, in combination with codeine (Panadeine) for migraines.

Mode of application: prescribed orally alone or in combination with phenobarbital, caffeine, etc. in tablets or powders for adults at a dose of 0.2-0.5 g, for children from 2 to 5 years old - 0.1-0.15 g, 6-12 years - 0.15-0.25 g per dose 23 times a day.

Side effect: generally well tolerated. With long-term use in high doses, hepatotoxic effects are possible. Rarely causes thrombocytopenia, anemia and methemoglobinemia, allergic reactions.

Contraindications: individual intolerance to the drug, blood diseases, severe liver dysfunction.

Interaction with other drugs: in combination with antispasmodics, it relieves spastic pain; with caffeine, codeine, antipyrine, the toxicity of paracetamol is reduced and the therapeutic effect of the components of the mixture is increased. In combination with phenobarbital, increased methemoglobinemia is possible. The combination with phenylephrine hydrochloride helps reduce swelling of the nasal mucosa during colds and flu.

The half-life of paracetamol increases with the simultaneous use of barbiturates, tricyclic antidepressants, as well as with alcoholism. Analgesic activity may decrease with long-term use of anticonvulsants.

Release form: tablets of 0.2 and 0.5 g. In addition to monocomponent paracetamol preparations, the most common paracetamol-containing commercial preparations are currently:

Panadol soluble (Panadol soluble) - tablets of 0.5 g;

Panadol baby and infant (Panadol baby end infant) - a suspension in bottles containing 0.024 g of paracetamol in 1 ml;

Panadol extra - tablets containing 0.5 g of paracetamol and 0.065 g of caffeine;

Panadeine - tablets of 0.5 g of paracetamol and 8 mg of codeine phosphate;

Solpadeine - soluble tablets containing 0.5 g of paracetamol, 8 mg of codeine phosphate, 0.03 g of caffeine.

Of these drugs in dentistry for pain of moderate intensity (pain after tooth extraction, with pulpitis, periodontitis), preference may be given to fast-acting and active drugs containing, in addition to paracetamol, codeine and caffeine - Panadeine and Solpadeine. Caffeine has the ability to enhance the analgesic effect of paracetamol and other non-narcotic analgesics. Codeine, being a weak agonist of opiate receptors, also significantly potentiates and prolongs the analgesic effect. The drugs are prescribed to adults 1-2 tablets up to 4 times a day. The drugs are safe, well tolerated and can be prescribed to patients with concomitant pathologies such as gastrointestinal diseases and bronchial asthma. They are contraindicated in severely impaired liver and kidney function, as well as in children under 7 years of age. Despite the minimal content of codeine, the possibility of addiction should be borne in mind.

Brustan: tablets containing 0.325 g of paracetamol and 0.4 g of ibuprofen. The drug is indicated for adults with pain of moderate intensity (traumatic pain, dislocations, fractures, postoperative pain, toothache). As an analgesic for adults, the drug is prescribed 1 tablet 34 times a day. Side effects: see Ibuprofen.

Plivalgin: tablets containing 0.21 g paracetamol, 0.21 g propyphenazone, 0.05 g caffeine, 0.025 g phenobarbital, 0.01 g codeine phosphate. The drug is indicated for pain of moderate intensity. Adults are prescribed a single dose of 2-6 tablets per day. Contraindicated in serious illnesses liver, blood diseases, pregnancy, lactation, hypersensitivity to the components of the drug.

Storage conditions: in a dry place, protected from light. Piroxicam. Synonyms: Apo-piroxicam, Piricam, Pirocam, Remoxicam, Sanicam, Hotemin, Erason, Feldene.

pharmachologic effect: is a derivative of the oxicam class, has anti-inflammatory, analgesic and antipyretic effects. Inhibits cyclooxygenase and reduces the production of prostaglandins, prostacyclins and thromboxane, reduces the production of inflammatory mediators. After a single use, the effect of the drug lasts one day. The analgesic effect begins 30 minutes after taking the drug.

Indications: used for arthralgia (rheumatoid arthritis, osteoarthritis, including arthritis of the temporomandibular joint, ankylosing spondylitis, gout), myalgia, neuralgia, traumatic inflammation of soft tissues and the musculoskeletal system, acute infectious and inflammatory diseases of the upper respiratory tract.

Mode of application: administered orally 1 time per day at a dose of 10-30 mg. In higher doses it can be used in acute severe cases, for example, during an attack of gout. In this case, it is possible to administer intramuscularly at a dose of 20-40 mg 1 time per day until the acute phenomena are relieved, after which they switch to maintenance therapy with tablets. The drug is also administered rectally in the form of suppositories of 20-40 mg 1-2 times a day.

Side effect: When taken orally in high doses, nausea, anorexia, abdominal pain, constipation, and diarrhea are possible. The drug can cause erosive and ulcerative lesions of gastrointestinal origin. Rarely observed toxic effects on the kidneys and liver, inhibition of hematopoiesis, adverse effects from the central nervous system - insomnia, irritability, depression. When used rectally, irritation of the rectal mucosa is possible.

Contraindications: erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, severe dysfunction of the liver and kidneys, “aspirin” asthma, hypersensitivity to the drug, pregnancy, lactation.

Interaction with other drugs: enhances side effects other non-steroidal anti-inflammatory drugs. The toxicity of piroxicam increases when taken simultaneously with indirect anticoagulants.

Release form: tablets of 0.01 and 0.02 g; solution in ampoules (0.02 g in 1 ml and 0.04 g in 2 ml). Rectal suppositories 0.02 g.

Storage conditions: list B.

Sulindak(Sulindac). Synonym: Clinoril.

pharmachologic effect: is a derivative of indeneacetic acid, an indene derivative of indomethacin. However, it is free from some of the side effects of this drug. In the body it forms an active metabolite - sulfide. It has anti-inflammatory, analgesic and antipyretic effects. Reduces the synthesis of prostaglandins and inflammatory mediators, reduces the migration of leukocytes to the inflammatory zone. Compared to salicylates, it is less likely to cause side effects from the gastrointestinal tract and does not cause headaches, which are typical when taking indomethacin. Reduces joint pain at rest and during movement, eliminates swelling. The maximum anti-inflammatory effect develops by the end of the 1st week of treatment.

Indications: see Piroxicam.

Mode of application: prescribed orally in a daily dose of 0.2-0.4 g in 1 or 2 doses. The maximum daily dose is 0.4 g. If necessary, reduce the dose. Take the drug with liquid or food. For acute gouty arthritis, the average duration of treatment is 7 days.

Side effect: As a rule, the drug is well tolerated. The most common disorders of the gastrointestinal tract are: nausea, anorexia, epigastric pain, constipation, diarrhea. In rare cases, erosive and ulcerative lesions of the stomach and bleeding occur. Possible disturbances in sleep, renal function, paresthesia, and changes in the blood picture.

Contraindications: do not use during pregnancy, lactation, in childhood (up to 2 years), with erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, “aspirin” asthma, individual intolerance to non-steroidal anti-inflammatory drugs.

Interaction with other drugs: increases the effect of indirect anticoagulants.

Release form: tablets 0.1; 0.15; 0.2; 0.3 and 0.4 g.

Storage conditions: list B.

Phenylbutazone(Phenylbutazone). Synonym: Butadionum.

pharmachologic effect: has analgesic, antipyretic and anti-inflammatory effects.

Its anti-inflammatory activity is significantly superior to amidopyrine and is one of the main non-steroidal anti-inflammatory drugs. Butadione is an inhibitor of prostaglandin biosynthesis, more powerful than acetylsalicylic acid.

Indications: used for the treatment of inflammatory diseases of periodontal tissues, for xerostomia in patients with rheumatism, lupus erythematosus, acute purulent-inflammatory diseases of the maxillofacial area, neuritis and neuralgia, arthritis of the temporomandibular joint, 1st and 2nd degree burns of a small area, inflammation of the skin at the site of intramuscular and intravenous injections, traumatic injuries of soft tissues.

Mode of application: prescribed orally and locally in the form of an ointment. Taken orally during or after meals. The dose for adults is 0.1-0.15 g 4-6 times a day. Maintenance daily dose - 0.2-0.3 g. Children from 6 months are prescribed 0.01-0.1 g 34 times a day (depending on age). The course of treatment lasts 25 weeks or more. Locally use “Butadiene Ointment” containing 5% butadione. The ointment is applied to the oral mucosa or injected into periodontal pockets for 20 minutes daily until exudative phenomena are eliminated.

Side effect: when taken orally, fluid retention, nausea, vomiting, pain in the stomach (associated with ulcerogenic effects), skin rashes and other allergic skin reactions, leukopenia and anemia, hemorrhagic manifestations are possible. Hematological changes and allergic reactions are indications for discontinuation of the drug.

Contraindications: peptic ulcer of the stomach and duodenum, diseases of the hematopoietic organs, leukopenia, liver and kidney dysfunction, circulatory failure, heart rhythm disturbances, hypersensitivity to pyrazolones.

Interaction with other drugs: combination use with other non-steroidal anti-inflammatory drugs is possible. Able to delay the release of various drugs (amidopyrine, morphine, penicillin, oral anticoagulants, antidiabetic drugs) by the kidneys. When prescribing butadione, it is recommended to limit the introduction of sodium chloride into the body.

Release form: tablets of 0.15 g, film-coated, in a package of 10 pieces (in 1 tablet - 50 mg of phenylbutazone): butadiene ointment 5% in tubes of 20 g.

Storage conditions: in a place protected from light.

Flurbiprofen(Flurbiprofen). Synonyms: Ansaid, Flugalin.

pharmachologic effect: has pronounced analgesic, anti-inflammatory and antipyretic activity. The mechanism of action is associated with inhibition of the enzyme cyclooxygenase and inhibition of prostaglandin synthesis.

Indications: symptomatic therapy for diseases of the temporomandibular joint and injuries of soft tissues of the maxillofacial area.

Mode of application: prescribed orally 50-100 mg 23 times a day with meals.

Side effect: Dyspepsia, heartburn, diarrhea, abdominal pain, headache, nervousness, sleep disorders, allergic skin reactions may occur.

Contraindications: diseases of the gastrointestinal tract in the acute phase, bronchial asthma, vasomotor rhinitis, intolerance to acetylsalicylic acid, as well as pregnancy and lactation. Use with caution for liver and kidney diseases, arterial hypertension, chronic heart failure.

Interaction with other drugs: when used together with anticoagulants, there is an increase in their effect, with diuretics - a decrease in their activity.

Release form: tablets of 50 and 100 mg, package of 30 pieces.

Storage conditions: in a dry, cool place.

Dentist's Guide to Medicines
Edited by Honored Scientist of the Russian Federation, Academician of the Russian Academy of Medical Sciences, Professor Yu. D. Ignatov