This is a milder anti-inflammatory drug causing less irritation of the stomach and other adverse effects. This drug is available in combination with paracetamol as well as dextropropoxyphene. It is widely used to relieve pain and inflammation of the joints and muscles, mild to moderate pain of menstrual cramps, dental surgery, and athletic injuries as sprains and strains. The recommended daily dosage is 1,200 to 1,600 mg to be given in 3 to 4 divided parts.
It should be taken after meals.
Those allergic to aspirin, are likely to be allergic to this drug also.
It should not be taken by patients of peptic ulcer, or liver or kidney disease.
It should be used cautiously by patients of asthma. It has been reported to cause bronchoconstriction. It is also not recommended for those suffering from hypertension or heart disease.
If symptoms of allergic reaction occur, stop the drug and consult the doctor.
Naproxan (Naprogyn, Artragen), Naproxan Sodium (Xenobid)
Naproxan is effective and relatively less toxic. Besides that the duration of its action is longer. The drug can be taken in a dose of 125 to 250 mg, two times a day with meals. The adverse effects of this drug are the same as those of ibuprofen.
Mefenamic Acid (Meftal)
Mefenamic acid has properties like those of aspirin and can cause gastro-intestinal side effects including severe diarrhoea in some cases. Mefenamic acid is taken in a dose of 250 to 500 mg, three times a day.
Ketoprofen (Ostofen, Profenid)
This is a newer drug and supposed to be more effective than ibuprofen, but can cause all the side-effects as ibuprofen. The recommended daily dose of ketoprofen is 50mg, 2 to 3 times a day.
This drug is given in a dose of 100 mg, twice a day. This drug is less irritant to the stomach than the drugs described earlier. The most common adverse effect is a headache. In rare cases it may cause skin rash and bone marrow depression.
Ketorolac Tromethamine (Ketorol)
It is more effective when used for short-term (5 days) management of pain of moderate severe intensity. Its initial dose is 30 to 6Q mg IM (intramuscular), to be followed by 15 to 30 mg every 6 hours.
Diclofenac Sodium (Voveran, Relaxyl, Flexyl, Diclomol)
This is a potent anti-inflammatory drug but has a short duration of action. Its sustained release preparation YOYERAN-SR (100 mg) is given once daily. Its adverse effects OCCur in about 20 per cent of the patients in the form of distress in the stomach. In some patients it may cause gastric ulceration.
Piroxicam (TOLDIN, PIROX)
It has a long duration of action and is given in a dose of 20 mg, once daily. The adverse effects are related to the stomach. It may also cause dizziness, headache, ringing in the ears, and skin rashes.
Note: The use of corticosteroids is discussed in the chapter on ‘Corticosteroids’, for nimesulide (Nimegesic) and other COX-2 inhibitors see chapter on ‘Pain Relievers’.
Hundreds of combinations of drugs containing pain-relievers, anti-inflammatory drugs, sedatives, and corticosteroids are available in the market. These combinations are always more expensive and apparently less effective than the individual drugs. In our opinion, a patient should take the appropriate individual drug rather than expose himself to the hazards of several drugs together, and at the same time, avoid unnecessary expense.
Local Pain Relieving Preparations
A number of drugs are now available as local gels, creams, ointments and liniments (need rubbing) for relief of sport injuries, sprains and joints paints. These are given in the table given below.
It is believed that these preparations have local effects and lack significant effects on other body organs. It appears that tall claims are made for their effects by manufacturers. A simple oil of winter green (methyl salicylate), camphor in oil or warm/hot fomentation may also provide comparably equal relief. A slight massage can increase warmth and blood flow that also contribute to relief. Nevertheless they are useful in common joint disorders such as osteoarthritis, sprains, backache and pains arising from soft tissues sue as muscles and tendons. These should never be applied on broken skins, abrasions or tears.
Rheumatoid Arthritis: Role of Disease Modifying Drugs.
Rheumatoid arthritis is a disease in which joints of fingers, wrist and foot are affected. If not treated then crippling deformities and restriction of movements may occur. In order to prevent these complications now a days different kind of drugs are used which attack the underlying root cause of immune disturbances. These drugs modify the course of disease and are called as Disease Modifying Antirheumatic Drugs (DMARDs).