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Non-steroidal anti-inflammatory drugs (NSAID)


Rheumatoid diseases are : inflammatory rheumatoid diseases (rheumatic fever, rheumatoid arthritis, psoriatic arthritis , spondilo-arthritis, lupus erythematosus, scleroderma, etc), degenerative rheumatoid diseases (hondrosis, osteoarthritis, osteohondrosis, spondilitis and spondilo-arthritis), then fibromyalgia, bursitis, tendonitis, tendovaginitis, paniculitis, etc. The most usually used drugs are non-steroidal anti-inflammatory drugs and specific anti-rheumatic drugs.

Non-steroidal anti-inflammatory drugs include various agents which have different chemical structures

Most of these drugs have three major effects – anti-inflammatory effect-modification of the inflammatory reaction; analgesic effect – pain soothing and antipyretic effect-reduction of body temperature. Anti-inflammatory effect-reduction of the vasodilatation and edema. Accumulation of the inflammatory cells is not reduced. Analgesic effect-reduced creation of prostaglandin. The elimination of pain in headache is probably the result of the reduction of vasodilatation caused by prostaglandins. Antipyretic effect-it is partially the result of the reduction of prostaglandin responsible for the increase of the value to which the body temperature is adjusted in the hypothalamus as well as the increase of body temperature.

Generally, all these effects are related to the primary inhibitory effect on arachidonic cyclooxigenasis  and the inhibition of the production of prostaglandin and thromboxan, although certain aspects of the effect can be realized by different mechanisms; also, some of the drugs express other effects as well, in addition to those which are related to the anti-inflammatory process.

Common side effects: dyspepsia, diarrhea/constipation, sickness and vomiting, and in some cases, bleeding from the stomach and ulcerations, rash, urticaria , photosensitive reactions , acute renal failure, analgesic nephropastia, medulla and liver disorders.


Indometacin has a much expressed anti-inflammatory and anti-rheumatic effect, so it is mostly used in rheumatic diseases. However, it causes numerous side effects. Those are ulceration, bleeding in the stomach, headache, liver, kidney, blood count damage, and also retention of water and salt in the kidney, which increases blood pressure. It is used in the treatment of inflammatory rheumatic diseases- rheumatoid arthritis, spondilo-arthritis, degenerative diseases of the joints such as osteoporosis. Also, indometricin is used in the treatment of acute uremic arthritis , bursitis, capsulitis, tendonitis, tendosinovitis, sinovitis and periarthritis.


It is used in the form of tablets, dragees and stoppers. In smaller dosage, it is used mostly in the elimination of pains (injuries, toothaches, headaches, menstrual pains, etc.) and in soothing the inflammation in rheumatism, as well as reduction of body temperature. In higher dosage, it is used in the reduction of the symptoms of rheumatoid arthritis, osteoarthrosis, spondilosis, acute gicht attack, etc. It is also used in the reduction of posttraumatic pains.
It is one of the most popular non-steroidal anti-rheumatics and its use is great. However, it can cause bleeding and ulcerations in the stomach.


It possesses a very important anti-inflammatory effect, and as for the antipyretic effect, it is similar to acetyl-salicylic acid. That is why, it is used in the treatment of numerous rheumatic diseases- rheumatoid arthritis, spondilo-arthritis.

Side effects are milder than in indometacin, and this drug is ore secure in the long-lasting treatment.


By its effect, it is very similar to acetyl-salicylic acid and it is used in the treatment of rheumatic diseases. As for side effects, it can usually come to gastric side effects (ulcerations and bleeding), as well as headache, dizziness, insomnia, irritability, tiredness, vomiting, numbness of the neck and blurred consciousness. Long-lasting use of this drug can lead to the serious damage of the liver and the kidneys.


It is similar to ibuprofen. It has a good anti-inflammatory and analgesic effect, especially in rheumatic diseases. Also, it can be used in different painful states (post-operational pain, menstruation, pain in the osseous metastases, pain after an injury, etc.).


It is the strongest NSAID of the propionic structure. It has an analgesic effect so it is the drug of choice in many serious and painful states –pain in the muscles, bones and joints, pain after an operation or tooth extraction, pain after injuries, sprain, headache and toothache. In gynecological diseases, it reduces pain and menstrual cramps. In addition to that, it is used in the treatment of rheumatic diseases.
Side effects are similar to those in other NSAID.


Those are NSAID of the new generation and new chemical structure. Those are rofecoxsib, celecoxib, valdecoxib and parecoxib. In contrast to other drugs, they are the inhibitors of only COX-2 (cyclooxigenase 2), enzyme which is responsible for the production of the mediator of the inflammation, pains and high temperature. They are used in the reduction of pains in rheumatoid arthritis and osteoarthritis. They are not recommendable to persons with bad heart status and cardiovascular problems.

Registered drugs

  • indometacin – INDOMETACIN (Belupo Croatia),
  • diclofenac - RAPTEN-K (Hemopharm Serbia), RAPTEN RAPID (Hemopharm Serbia), RAPTEN DUO (Hemopharm Serbia), DICLOFENAC (Hemopharm Serbia), DICLOFENAC (Habit Pharm Serbia), DICLOFENAC (Galenics Serbia), DICLOFENAC (Remevita Serbia), DICLOFENAC DUO (PharmaSwiss Serbia), DICLORAPID (PharmaSwiss Serbia), DICLOFENAC FORTE (Remevita Serbia), DICLOFENAC RETARD (Remevita Serbia), DICLOFENAC BMS (Bristol-Myers Squibb USA), DICLOFENAC RETARD (Remedica Cyprus), NACLOFEN DUO (Krka Slovenia), NACLOFEN RETARD (Krka Slovenia),
  • etodolak – ETOLAC (Alkaloid Macedonia),
  • acemetacin – RANTUDIL FORTE (Meda Manufacturing Germany),
  • ketorolak – ZODOL (Hemopharm Concern "Zorka Pharma" Serbia), TORADOL (Syntex Germany),
  • piroxicam – ROXIKAM (Zdravlje Serbia), REMOXICAM (Alkaloid Macedonia),
  • meloxicam – MOVALIS (Boehringer Ingelheim Pharma Austria), MELOXICAM (Ni Medic Serbia), MEDOXICAM (Medochemie Cyprus), MELOX FORT (Nobelfarma Ilac Sanayii ve Ticaret Turkey), MELOX (Nobelfarma Ilac Sanayii ve Ticaret Turkey),
  • ibuprofen – BRUFEN (Galenika Serbia), IBUPROFEN (Hemofarm Serbia), IBUPROFEN (Remevita Serbia), IBUPROFEN (Srbolek Serbia), IBUPROFEN (Remedica Cyprus), NUROFEN (Reckitt Benckiser Healthcare International Great Britain), NUROFEN ACTIVE (Reckitt Benckiser Healthcare International Great Britain), NUROFEN LIQUID (Reckitt Benckiser Healthcare International Great Britain), RUPAN (Medochemie Cyprus), UPFEN (Laboratories UPSA France),
  • naproxen – NAPROKSEN (Hemofarm Koncern "Zorka Pharma" Serbia), NAKSETOL (Hemofarm Koncern "Zorka Pharma" Serbia), NALGESIN FORTE (Krka Slovenia), NALGESIN S (Krka Slovenia), NAPROXEN (Polfarmex Poland),
  • ketoprofen - KETONAL LEK (Lek Farmaceutska Druzba Slovenia), KETONAL DUO (Lek Farmaceutska Druzba Slovenia),
  • flurbiprofen – FLUGALIN (Galenika Serbia),
  • tiaprofenic acid – TURGANIL (Jugoremedia Serbia),
  • oxaprozin – DAYRUN (CSC Pharmaceuticals Germany),
  • dexketoprofen – DEXOMEN (Berlin-Chemie Germany),
  • celecoxibab – CELEBREX (Pfizer Enterprises Luxemburg),
  • etoricoxibab – ARCOXIA (Merck Sharp & Dohme USA).

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