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Ксефокам или дексалгин что лучше

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17 августа 2019

Врач травматолог-ортопед высшей категории,
кандидат медицинских наук,
подполковник медицинской службы в запасе

Выполняю все виды операций по травматологии,
делаю артроскопические операции на суставах,
внутрисуставные инъекции.

г. Москва Многопрофильная клиника Тропарево
" Центр артроскопии и суставной хирургии" Ленинский проспект 131 тел. 8(495)438-20-20

ООО "Альбатрос плюс" г. Железнодорожный, ул. Колхозная д. 12 к. 2
тел. для записи — 8(495) 748-28-18, 8(495)522-62-55 (консультации по субботам с 12.00)

e-mail.ru: 32travma@rambler.ru 32travma@gmail.com

Центральная Клиническая Больница Российской Академии Наук г Москва Литовский бульвар 1А — весь спектр плановой и экстренной хирургической помощи, с применением современных методик и высокотехнологичного оборудования, а так же комфортные условия пребывания

Консультации, запись на обследование и лечение, либо другая интересующая информация по телефону- 89175456501

Консультирование пациентов на дому, гастроскопия, колоноскопия, бронхоскопия, различные виду ультразвуковой диагностики.
Возможность предоставления обследования и лечения в крупных онкологических центра(институт им Герцена, РОНЦ им Блохина

Исчерпывающая инструкция по применению к препарату Дексалгин

Вероятность появления проблем с суставами повышается после 40-50 лет. Многие люди в молодом возрасте уже ощущают первые признаки артрита.

Современная медицина предлагает лекарственные препараты, Дексалгин, в частности, обладающие противовоспалительным действием и снимающие боль вместе поражения.

Описание лекарства

Нестероидный препарат с действующим веществом декскетопрофена трометамол – соль пропановой (пропионовой) кислоты.

Дексалгин выпускают в виде раствора для инъекций или в таблетках. Кроме противовоспалительной и анальгетической активности оно обладает жаропонижающим действием.

Фармакокинетика средства

При инъекции максимальная концентрация действующего агента достигается через 10-45 мин. Похожий результат наблюдается при внутривенном и внутримышечном введении. Установлено отсутствие кумуляции препарата при повторной инъекции.

Действующее вещество эффективно связывается с белками кровяной плазмы. Объем распределения (Vd) – менее 0,25 л/кг, период полураспределения – ≈0,35 ч. Выведение препарата происходит через почки в результате связывания с глюкуроновой кислотой.

Примерно 1-2,7 ч составляет период полувыведения, у пожилых людей данное время удлиняется. Продолжительность действия 50 мг декскетопрофена трометамола – 48 ч. Эффект достигается через 30 мин после инъекции.

Показания к применению

Дексалгин применяется при многих заболеваниях опорно-двигательного аппарата, а также при устранении ряда болевых синдромов:

  • зубные, послеоперационные и посттравматические боли;
  • невралгия;
  • радикулит, в том числе ишиалгия;
  • костные опухоли;
  • болевые симптомы в почках;
  • болезненная менструация (альгодисменорея);
  • различные виды артрита;
  • остеохондроз, артроз.

Когда применение лекарства нежелательно?

Противопоказания к приему средства:

  • высокая чувствительность к действующему компоненту или прочим нестероидным противовоспалительным препаратам;
  • язвенное поражение желудка, двенадцатиперстной кишки, кишечника (особая форма колита), болезнь Крона (гранулематозное воспаление ЖКТ), кровотечение пищеварительной системы или подозрение на них;
  • антикоагулянтная терапия, различные нарушения коагуляции, в том числе геморрагический диатез;
  • заболевания печени и почек;
  • бронхиальная астма, тяжелая сердечная недостаточность, ишемическая болезнь;
  • аортокоронарное шунтирование для лечения болевого синдрома.

Формы выпуска

Дексалгин выпускается в двух видах:

  1. Для уколов – спиртосодержащий прозрачный раствор, включающий хлорид и гидроксид натрия (pH-7,4), как вспомогательные компоненты. В одной ампуле содержится 73,8 мг действующего вещества.
  2. Таблетки двояковыпуклой формы, содержит 36,9 мг активного компонента, сверху покрыта пленочной оболочкой.
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Инструкция по применению

Уколы Дексалгина быстро купируют острую боль. Их применяют краткосрочно (максимум 2 дня).

Далее пациент переводится на пероральный прием анальгетических препаратов.

Внутримышечная инъекция должна быть глубокой с медленным введением содержимого ампулы. Продолжительность ввода при внутривенной инъекции или инфузии должна составлять более 15 с или 10-30 мин, соответственно.

В последнем случае смешивают содержимое ампулы с 30–100 мл физраствора. Можно применять растворы лактата или глюкозы.

Особенности дозировки

Суточная доза препарата в виде инъекции составляет 150 мг. Оптимальной периодичностью является введение по 50 мг через 8-12 ч. В сложных случаях допускается сокращение интервала до 6 ч.

Если человек пожилого возраста, или у него нарушено нормальное функционирование печени, почек, то терапию начинают с более низких доз препарата (не более 50 мг в сутки). При пероральном приеме суточная доза 75 мг, то есть максимум 3 таблетки.

Случаи передозировки

Симптомами передозировки Дексалгина является головокружение, дезориентация, бессонница, тошнота, отсутствие аппетита.

К признакам избытка препарата в организме относятся абдоминальная (в области таза и живота) и головная боли. Проблему устраняют купированием симптомов, иногда применяют промывание желудка, диализ (метод очистки крови).

Концентрации, при которых возможна передозировка более 150 мг/сут для здоровых людей и 50 мг/сут для лиц с заболеваниями печени и/или почек.

Побочные действия препарата

При приеме Дексалгина доля нарушений функций ЖКТ в виде тошноты и рвоты и/или боль в зоне инъекции составляет 1–10%.

Реже (0,1–1%) наблюдается гиперемия, сыпь и/или дерматит кожи, снижение четкости зрения, сухость во рту, абдоминальная боль, диспепсия (нарушение пищеварения в желудке), диарея, запор, гематемезис (рвота с кровью).

В месте введения раствора может возникнуть воспалительная реакция. Возможно появление общего утомления и сонливости, ощущения жара или озноба, бессонницы, головокружения, потливости.

В редких случаях (0,01–0,1%) возникают обмороки, понижение или повышение артериального давления, нарушение работы сердца (тахикардия, экстрасистолия), анорексия, появление аррозии и язв в ЖКТ, анемия, шум в ушах, парестезия (онемение), периферический отек, поверхностный тромбофлебит.

Встречаются случаи появления брадипноэ (снижения дыхательной активности), желтухи, крапивницы, угревой сыпи, боли в спине, лихорадки.

Возможна усиленная активация печеночных ферментов, полиурия и почечные колики, сбои в менструальном цикле и функциях простаты, некоторые нарушения работы суставов, мышечные спазмы, изменение концентрации глюкозы в крови, повышение уровня триглицеридов (липидов). В анализе мочи иногда обнаруживается белок, кетоны.

В единичных случаях (менее 0,01%) возникает анафилактический шок, отек лица, поражение поджелудочной железы и/или печени, бронхиальные спазмы, диспноэ (учащение дыхания), нефрит, снижение уровня нейтрофилов и тромбоцитов.

Описаны отдельные примеры появления тяжелых кожных поражений (синдромов Стивенса-Джонсона и Лайелла), аллергических высыпаний, фотосенсибилизации, ангионевротического отека.

Взаимосвязь со здоровьем и состоянием пациента

Дексалгин снижает симптоматику инфекционных заболеваний. Поэтому при малейшем ухудшении самочувствия и подозрении на бактериальную инфекцию следует обратиться к врачу.

Применение данного средства противопоказано в детском возрасте, при беременности и в период лактации.

Его рекомендуют использовать осторожно при наличии системных аллергических заболеваний, в частности красной волчанки, проблемах с соединительной тканью и кроветворением, например, в случае гиповолемии.

После введения препарата может возникнуть асептический менингит, нарушения кроветворения: пурпура, апластическая (дефект образования некоторые типов клеток) и гемолитическая (разрушение эритроцитов) анемия, агранулоцитоз, гипоплазия костного мозга.

Одна ампула содержит 200 мг спирта, поэтому нежелательно управлять автотранспортом в период приема лекарства, тем более с учетом некоторых побочных эффектов (см. выше).

Лекарство не рекомендуется совмещать с алкоголем вследствие усиления токсического эффекта на печень.

Сочетание с другими препаратами

Прием Дексалгина приводит к снижению необходимости использования опиоидных анальгетиков на 30-45%.

При смешивании лекарства с Гидроксизином, Допамином, Пентазоцином, Петидином или Прометазином выпадает осадок.

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Допускается совместное введение с растворами Гепарина, Лидокаина, Морфина или Теофиллина при инъекции.

Значительно повышается риск появления кровотечений и язв ЖКТ, а также токсического эффекта при совмещении лекарства с:

  • другими нестроидными противоспалительными средствами, в том числе салицилатами;
  • пероральными антикоагулянтами тиклопидином и гепарином в высоких дозах;
  • литийсодержащими препаратами, гидантоинами, сульфаниламидными средствами;
  • Метотрексатом при высокой дозировке.

С особой осторожностью следует использовать с:

  1. Диуретиками (повышается вероятность появления острой почечной недостаточности).
  2. Метотрексатом при дозировке ниже 15 мг в неделю, зидовудином (возможно развитие гематологической токсичности).
  3. Пентоксифиллином, низкомолекулярным гепарином (риск возникновения кровотечений).

Использование Дексалгина снижает гипотензивный эффект β-адреноблокаторов; увеличивает нефротоксичность циклоспорина и такролимуса; повышает риск возникновения кровотечений в сочетании тромболитиками; приводит к накоплению сердечных гликозидов при их приеме. Пробенецид препятствует выведению декскетопрофена трометамола.

Прием Мифепристона заканчивают за 8–12 сут перед использованием Дексалгина, так как последний предположительно снижает эффективность первого. В экспериментах на животных установлено, что сочетание с ципрофлоксацином провоцирует развитие конвульсий.

Экспертное мнение

Многие специалисты указывают в своих отзывах эффективность Дексалгина. В отдельных комментариях медики и фармацевты еще раз напоминают о необходимости избегать передозировки.

Говорят пациенты

Независимо от проблемы болезненные месячные, зубная или суставная боль многие пациенты указывают в своих отзывах: “Дексалгин мне действительно помог ”. Однако есть и истории об отсутствии положительного эффекта.

Некоторые люди, принимающие препарат, указывают: “У меня в качестве побочного эффекта появилась крапивница”, “Я испытывала головокружение” или “Применяла Дексалгин, но не получила эффекта при лечении невралгии”.

Есть примеры эффективного действия Дексалгина при таком заболевании суставов, как гонартроз 2 степени.

Советы по приему от пациентов

Некоторые пациенты указывают: “Мне препарат помогает максимум на 8 ч”. Данное утверждение соответствует характеристике средства.

Необходимо строго следовать дозировкам, которые указаны в инструкции по применению и следить за периодичностью приема Дексалгина. Пациенты советуют гипертоникам принимать данное лекарство с осторожностью.

Преимуществами препарата являются: сильный анальгетический эффект, универсальность, легкость расчета при пероральном приеме, низкий процент побочных эффектов. Недостатки: отсутствие результата в некоторых случаях, побочные эффекты.

Покупка и хранение средства

В аптеках предлагают блистеры по 10 таблеток в количестве 1, 3 или 5.

Для лечения суставов наши читатели успешно используют СустаЛайф. Видя, такую популярность этого средства мы решили предложить его и вашему вниманию.
Подробнее здесь…

Ампулы сделаны из темного стекла, объединены в упаковку по 5 шт. и содержат 2 мл раствора препарата. Цена 10 таблеток Дексалгина начинается от 300 руб., 5 ампул можно приобрести за 480 руб., одна продается за 64-97 руб.

Условия хранения стандартные – защита от попадания света и перегревания свыше 25оС, место должно быть недоступно для детей. Срок годности – 5 лет. Отпускается по рецепту.

Чем можно заменить препарат?

Аналогами Дексалгина (Германия) являются такие нестроидные препараты, как:

  • Депиофен (Испания);
  • Растель (Турция);
  • российский аналог Фламадекс (Московская область) более доступен для пациентов.

Сравнение лекарств

Противовоспалительные средства хоть и относятся к одной группе препаратов, но крайне отличаются по своим эффектам и побочному действию. Ксефокам и Мовалис являются одними из достаточно популярных противовоспалительных препаратов, часто применяются в схожих ситуациях, но обладают значительными отличиями, которые кроются еще в их механизме действия.

Состав

В Ксефокаме действующим веществом является лорноксикам. В состав Мовалиса входит мелоксикам.

Механизм действия

Существует два типа противовоспалительных средств: стероидные и нестероидные. Первые являются аналогами стероидных гормонов человека и крайне сильно подавляют воспаление, аллергические реакции, но и обладают широчайшим спектром побочных эффектов. Нестероидные противовоспалительные препараты (НПВС) аналогами гормонов не являются – они блокируют активность фермента циклооксигеназы-2 (ЦОГ-2), участвующей в образовании биологически активных соединений, вызывающих повышение температуры, болевые ощущения, покраснение и прочие признаки воспалительной реакции.

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Мовалис

Мовалис блокирует только активность «плохой» ЦОГ-2, слабо влияя на другую, «хорошую», ЦОГ-1. Последняя играет важную роль в образовании защитных компонентов слизистой оболочки желудка, предотвращающих его самопериваривание под действием соляной кислоты.

Ксефокам

Ксефокам блокирует активность как ЦОГ-2, так и ЦОГ-1, что обуславливает его пагубное воздействие на желудочно-кишечный тракт при длительном приеме. Помимо этого, Ксефокам снижает способность тромбоцитов склеиваться друг с другом и образовывать тромбы. Этот его эффект может быть как полезен (например, у пожилых людей для снижения риска инсультов, инфарктов), так и создавать лишние проблемы (удлиняет время кровотечения при геморрое, травмах, язвенной болезни желудка и т.д.).

Показания

Ксефокам применятся при:

  • Устранении болевого синдрома в связи с травмами, лечебными манипуляциями, воспалительными заболеваниями и т.д.;
  • В качестве симптоматической терапии при ревматической патологии:
  • Ревматоидный артрит – аутоиммунное поражение хрящей мелких суставов;
  • Обострение подагры – отложение солей мочевой кислоты в суставах;
  • Болезнь Бехтерева – аутоиммунное поражение межпозвоночных суставов;
  • Прочие хронические заболевания суставов с болевым синдромом (остеоартрит, остеоартроз и пр.).
  • Остеоартрит;
  • Остеоартроз;
  • Ревматоидный артрит;
  • Болезнь Бехтерева;
  • Любые болевые ощущения в костях, суставах и мышцах.

Противопоказания

Ксефокам нельзя использовать при:

  • Непереносимости препарата или других НПВС;
  • Бронхиальной астме;
  • Нарушениях свертываемости крови любого происхождения;
  • Любых хронических или острых кровотечениях, в т.ч. язвенном поражении желудочно-кишечного тракта;
  • Выраженной сердечной, печеночной или почечной недостаточности;
  • Беременности и кормлении грудью;
  • Возрасте до 18 лет.
  • Непереносимость самого препарата или других НПВС;
  • Бронхиальная астма;
  • Любые хронические или острые кровотечения, в т.ч. язвенное поражение желудочно-кишечного тракта;
  • Выраженная сердечная, печеночная или почечная недостаточность;
  • Беременность и период кормления грудью;
  • Возраст до 12 лет.

Побочные действия

Ксефокам может вызвать:

  • Расстройство пищеварения;
  • Аллергические реакции;
  • Уменьшение количества клеток крови;
  • Повышение артериального давления;
  • Гастрит, язву желудка – при длительном приеме.

Побочные эффекты Мовалиса:

  • Головная боль;
  • Перепады настроения;
  • Расстройство пищеварения;
  • Повышение артериального давления.

Формы выпуска и цена

  • Таблетки по 8 мг:
  • 10 шт. – 185 р;
  • 12 шт. – 325 р;
  • 30 шт. – 525 р;
  • Раствор для инъекций 8 мг, 5 флаконов – 705 р.
  • Цены на Мовалис:

    • Таблетки:
    • 7,5 мг, 20 шт. – 650 р;
    • 15 мг, 10 шт. – 535 р;
    • 15 мг, 20 шт. – 745 р;
  • Раствор для инъекций 15 мг в ампулах по 1,5 мл:
    • 3 шт. – 640 р;
    • 5 шт. – 870 р.
    • Ксефокам или Мовалис – что лучше?

      Мовалис является одним из наиболее эффективных НПВС для лечения болевого синдрома при хронических заболеваниях суставов. Препарат оказывает достаточно сильный эффект, редко вызывая побочные явления при длительном приеме. Ксефокам принимать более недели не рекомендуется в связи с риском осложнений (развитие язвы желудка, кровотечений), зато он прекрасно подходит для устранения острой боли при травмах, приступах подагры, после оперативных вмещательств.

      Мовалис или Ксефокам – что лучше? Отзывы врачей

      Специалисты про Мовалис:

      • Мовалис показывает хороший эффект при умеренном по силе болевом синдроме;
      • Если болевой синдром выражен сильно, то можно найти более эффективные препараты;
      • Мовалис это препарат для лечения ревматологических заболеваний. В остальных сферах применять его бессмысленно.

      Врачи про Ксефокам:

      • Благодаря быстрому эффекту и наличию инъекционной формы Ксефокам можно использовать у больных с обширными травмами для облегчения состояния;
      • Многие пациенты жалуются на боли в животе уже на 3 – 4 день приема препарат. Лучше его пить вообще однократно при сильных болях;
      • Хоть препарат и не плох, но можно найти эффективнее и дешевле НПВС, например, Кеторолак.
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