Arcoxia for spinal hernia: effectiveness and contraindications

This is a relatively new drug that has found its use in various pathologies of the musculoskeletal system, including discogenic complications of osteochondrosis, that is, protrusions and herniated discs. When should Arcoxia be used for a herniated disc? What medications can be replaced with this drug, what effect will be from using this drug, and what should a patient without a medical education know for the sake of his safety if the doctor prescribed this medicine to him, but did not give him the details? This and some other questions will be discussed in this material, but first you need to answer the most important question: can Arcoxia radically cope with a spinal hernia, that is, cure it completely?

The effectiveness of the drug for spinal hernia

Unfortunately, neither Arcoxia nor any other tablet drug or injectable drug is capable of ridding the patient of protrusion and hernia of any part of the spine. Let's say more: not a single type of physiotherapy, massage, manual therapy, or exercise therapy can get rid of a hernia. A hernia cannot be removed by swimming, traction, or other, even exotic, techniques.

Hernia on MRI.

If a hernial protrusion has already formed and the outer layers of the intervertebral disc are destroyed, then such a hard cartilaginous defect can only be eliminated through surgery. Modern minimally invasive neurosurgical operations make it possible to quickly and painlessly eliminate the hernia itself, and, as a result, relieve the patient from excruciating pain, muscle spasms, conductive neurological symptoms, such as numbness and crawling, weakness in the limbs.

We can say that neurosurgery completely cures a person from problems associated with hernial protrusion, since it eliminates the cause of back pain. Science does not stand still, and highly effective operations are performed not only in the USA and Great Britain, but also in Eastern European countries, for example in the Czech Republic. Czech neurosurgeons have achieved high results, which do not differ from the world level in terms of long-term results of surgical interventions. All other methods that relate to therapeutic or conservative treatments directly address the cause, that is, they do not affect the hernia. Their task is to temporarily eliminate or reduce unpleasant symptoms such as pain and the chronic muscle spasm that is caused by this pain. And the most effective drugs are considered to be drugs from the NSAID group (non-steroidal anti-inflammatory drugs). Arcoxia also belongs to them. Why is this tool considered modern and new? Many will be surprised to learn that the rather expensive drug Arcoxia relieves pain even somewhat worse than the old, long-known and cheap drug Diclofenac. Let's look at this in more detail.

Comparison of side effects of Arcoxia and Dilaxa

Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.

Dilaxa has more adverse effects than Arcoxia. This implies that the frequency of their occurrence is low in Dilaxa and low in Arcoxia. Frequency of manifestation is an indicator of how many cases of an undesirable effect from treatment are possible and registered. The undesirable effect on the body, the strength of influence and the toxic effect of drugs are different: how quickly the body recovers after taking it and whether it recovers at all. When using Dilaxa, the body's ability to recover faster is higher than that of Arcoxia.

A little history

The history of the creation of effective drugs is constantly updated with new facts, since scientific and technological progress does not stand still. Nonsteroidal anti-inflammatory drugs are so named because they are not analogues of steroid hormones. It is known that steroid hormones, for example, dexamethasone or prednisolone, have the strongest anti-inflammatory effect, and this makes it possible to create potent drugs, for example, Diprospan or Kenalog for intra-articular administration. However, hormones have a large number of side effects, especially when used in tablets. Steroid diabetes mellitus, osteoporosis, and edema may develop. Immunity decreases, the patient may develop a fungal infection against the background of long-term immunosuppression caused by steroids.

Therefore, non-steroidal drugs have firmly occupied their niche for the treatment of various inflammatory diseases. The main points of application of NSAIDs are the reduction of body temperature, or antipyretic effect, pain relief, and reduction of inflammation. The leaders in the manifestation of antipyretic effect can be considered ibuprofen and paracetamol (Nurofen and Panadol), we will not dwell on them.

Ketorolac, which is well known to Russians under the name Ketanov, has very powerful analgesic activity. But well-known drugs such as Voltaren, diclofenac, indomethacin, meloxicam, and etoricoxib, the culprit of this article, have a powerful and pronounced anti-inflammatory effect. The last medicinal substance is Arcoxia, only by INN, or international nonproprietary name.

Arcoxia fights inflammation

It is known that the main symptoms of inflammation are a local increase in temperature or a local feeling of heat, swelling of soft tissues, soreness, redness of the skin, as well as dysfunction. Almost all of these symptoms occur during exacerbation of osteochondrosis, when the patient has a hernia, perhaps with the exception of redness of the skin, because inflammation occurs in the depths. But even there there is an analogue of redness - this is plethora in the area of ​​inflammation caused by the pressure of the hernia on the soft tissue. Modern drugs from the NSAID group stop all these symptoms, affecting the mechanism of inflammation.

The key enzyme that is blocked by all these drugs turns out to be cyclooxygenase (COX). It is its activity that underlies the launch of the inflammatory cascade, and if a drug causes a decrease in its activity, or a pharmaceutical blockade, then the development of inflammation is also blocked. Therefore, all of the above symptoms are either mildly expressed or absent altogether. Accordingly, the patient experiences improvement, despite the fact that the protrusion or hernia remains in its place.

However, it's not that simple. It turns out that the enzyme cyclooxygenase comes in two types, and only the second type (COX-2) causes inflammation. ITS complex structure is shown in the photo.

The first type is associated with the normal function of the mucous membrane of the stomach and duodenum. The first, crude drugs from the NSAID group suppressed both types of this enzyme, were non-selective COX inhibitors, and therefore had a very harmful effect on the gastric mucosa. And, perhaps, the rather crude drug Diclofenac can be considered the leader in the number of complications manifested by erosive gastritis and even peptic ulcers and bleeding. Despite the fact that it is very unsafe, it is very potent, and therefore is still loved by doctors and patients.

But still, not only efficiency is important, but also safety. Therefore, drugs began to be created that inhibit only the second type of cyclooxygenase. These are modern effective drugs meloxicam, ketoprofen, nimesulide and others. Many people know such medications as Movalis, Ketonal, Nimesil. All these drugs are used for protrusions and hernias, relieve acute and chronic back pain, improve range of motion and improve quality of life. Then a whole class of NSAIDs appeared, which were called coxibs. They have been introduced into clinical practice since the nineties of the last century, and the first representative was celecoxib, or Celebrex. One of the most modern and effective drugs is Arcoxia, or etoricoxib.

The principle of action of the drug

Arcoxia is not only a selective inhibitor of cyclooxygenase type 2, but it also exhibits a high degree of selectivity. Almost 95% is a connection with the desired isoform of the enzyme. That is why this drug is safe and can be used even in patients with compromised mucous membranes of the stomach and duodenum, that is, in patients with various forms of gastritis and even gastric ulcers, albeit during a period of remission and covered with certain drugs (Omeprazole). Etoricoxib, or Arcoxia, has the ability to inhibit cyclooxygenase in a dose-dependent manner. However, it does not have any effect on the first type of enzyme, which is affected by very “ancient” drugs, such as Diclofenac.

After taking a standard dose of Arcoxia, maximum plasma concentration occurs within an hour. The drug is processed, or metabolized, in the liver, and even its metabolites do not affect cyclooxygenase type 1.

Analogues in other forms

In addition to tablets and capsules, there are analogues of Arcoxia in other dosage forms: ointments and injections for intravenous and intramuscular administration.

Dynastat

Dynastat, like Arcoxia, inhibits COX-2, but is used mainly for analgesia in patients with minor surgical interventions, as well as for the elimination of postoperative pain.

The main advantage of the drug is its rapid analgesic effect, which develops within 15 minutes after intravenous administration, and 20-25 minutes after intramuscular administration.

Dynastat is available in a bottle with powder for further preparation of the solution. Perekoksib, as the active ingredient of Dynastat, has the greatest ability to retain water in the body among all other coxibs, therefore it is completely contraindicated for people with chronic renal and heart failure, as well as for patients receiving diuretic therapy, as this leads to a decrease in the effectiveness of the drugs.

Indications for use of the drug

Medicines should also be used with great caution in therapy for people with arterial hypertension, since not only an increase in blood pressure is possible, but also the development of corresponding vascular pathology. Considering the above factors, it is worth noting that Dynastat should be used only for short-term analgesia, and not as a means of systemic therapy.

Artrin

Artrin contains the mucopolysaccharide chondroitin sulfate, the main task of which is to slow down the resorption of bone tissue and reduce the loss of calcium in it. Artrin is available in the form of an ointment for external use for inflammatory and degenerative joint diseases.

Instructions for use of ointment

The drug has analgesic properties, but most importantly, the ability to reduce joint destruction, and thanks to its regenerative abilities, it also restores the production of synovial fluid, thereby preventing the abrasion of articular surfaces. The drug is convenient for everyday use, however, it has a number of contraindications, including:

• allergic intolerance to ointment components;
• the presence of any skin disorders at the injection site;
• pregnancy and the entire period of lactation;
• age up to 18 years.

Chondroxide

As in Artrin, the main active component of the ointment is chondroitin. Chondroxide is an original Russian drug, not a generic. In terms of therapeutic properties, it is not inferior to Artrin, however, a significant number of clinical studies conducted give reason to assume greater safety than the generic.

Action of chondroxide

Unlike Arcoxia, which relieves inflammation through the arachidonic acid system, Chondroxide acts on the joint locally, with virtually no effect on the condition of the kidneys, liver, gastrointestinal tract, and blood system. Contraindications for use are allergic reactions to the drug, as well as any skin lesions at the site of intended application.

Indications and contraindications

Like other drugs from the NSAID group, etoricoxib is indicated for the treatment of pathologies of the musculoskeletal system. These are various forms of osteoarthritis, severe inflammation in systemic pathology (rheumatoid and ankylosing spondylitis). Arcoxia is also indicated as a symptomatic treatment of pain associated with inflammation in gouty arthritis and complicated forms of osteochondrosis.

Arcoxia copes with pain and inflammation, but breaking the inflammatory mechanism and reducing symptoms does not at all mean eliminating the cause of inflammation. Therefore, this drug should best be prescribed in short courses, in the first days after the onset of acute pain in the back or in the lumbar spine.

Contraindications for use are:

• a universal combination of bronchial asthma, sinus polyposis and aspirin intolerance;
• history of ulcerative bleeding;
• active condition of erosive gastritis or gastric and duodenal ulcers;
• exacerbation of inflammatory bowel diseases such as Crohn's disease or ulcerative colitis;
• hemorrhagic syndrome and hemophilia, decreased blood clotting;
• severe renal and liver failure;
• high blood pressure numbers.

Arcoxia is contraindicated during pregnancy and breastfeeding, as well as for children and adolescents, boys and girls under 16 years of age. The drug can be used, but with caution in the presence of a history of ulcers, Helicobacter pylori infection, in persons suffering from diabetes mellitus and chronic alcoholism, as well as in persons taking anticoagulants, such as Warfarin, or antiplatelet agents, such as Curantil, clopidogrel or acetylsalicylic acid.

The cheapest similar products

For a patient who is looking for Arcoxia analogues, it is important that they are not only cheaper, but also correspond to the original release form - soluble powders, capsules, ointments or tablets. Tablet forms have many advantages over others, especially if systemic and long-term use of drugs is necessary.

The main features of such drugs are their safety (no need for injections) and high bioavailability, since the membranous membrane protects the active substance from destruction before entering the gastrointestinal tract.

Celebrex

A German drug that belongs to the coxibs group. The effect of the drug is due to its effect on cyclooxygenase-2 and further inhibition of the formation of E2 prostaglandins. Unlike Arcoxia, Celebrex is produced not in tablets, but in capsules, which allows you to fit a larger amount of drugs into one unit.

Features of the drug use

Also, the capsule shell protects its contents from premature dissolution, delivering the substance directly to the duodenum for further absorption. The drug is prescribed to patients with rheumatoid arthritis and ankylosing spondylitis, and is also used in the treatment of primary dysmenorrhea.

Diclofenac

Diclofenac is a derivative of phenylacetic acid. Unlike Arcoxia, the drug acts on all three cyclooxygenases and other processes in the synthesis of arachidonic acid, thereby disrupting the formation of prostaglandins E2 and E2-alpha, leukotrienes, thromboxane and other lysosomal enzymes.

The drug has an anti-inflammatory, pyrolytic, analgesic effect, but its main application is in rheumatology. The low cost of Diclofenac allows it to be used as a systemic therapy for rheumatoid arthritis, gout, bursitis, as well as post-traumatic pain syndrome. The drug is manufactured in India by Shreya Life Sciences.

Nimesulide

Nimesulide has a more pronounced analgesic effect compared to Arcoxia. It has a reversible inhibition of prostaglandin E2 not only at the site of inflammation, but also in the nociceptive system, reduces the conductivity of nerve fibers and helps reduce pain sensitivity.

Basic mechanisms of action of Nimesulide

In addition, there is a decrease in the synthesis of cytokinins, which is accompanied by a rapid anti-inflammatory reaction. Another feature of Nimesulide is its high bioavailability in children and the elderly, since the pharmacokinetics are practically independent of the condition of the kidneys and the creatinine index.

Doses for intervertebral hernia

The therapeutic dose, which effectively relieves pain in intervertebral hernias, is no more than 90 mg once a day, and after relief of acute pain, the drug is prescribed in a dosage of 60 mg once a day. The duration of therapy with Arcoxia should not exceed a week.

There is an immutable law regarding this drug, which can be applied to all drugs from the NSAID group. The dose should be as small as possible, and the treatment course should be as short as possible.

It should be mentioned that Arcoxia, like other drugs from the coxib group, are not available in ampoules for parenteral administration. Therefore, in case of acute back pain, especially on the first and second days, that is, during the debut of an intervertebral hernia, or its severe exacerbation, you can first use injectable drugs, the same Movalis or even Ketanov.

After two to three days of using injectable medications, you can switch to tablet medications, and here etoricoxib will be both a fairly powerful and safe drug.

Prices for the drug and its analogues

Below are the average prices in the Russian Federation for Arcoxia analogues.

Overdose and side effects, interactions with drugs

However, no one has yet managed to create a drug that would not have overdose symptoms and side effects. They are also found in various commercial varieties of etoricoxib. Quite often (from 1 to 10%) adverse reactions such as epigastric pain, nausea, loose stools, bloating and symptoms of gastric dyspepsia, that is, belching, occur. From the central nervous system, patients most often report dizziness, weakness and headache.

Sometimes there is palpitations and increased blood pressure. Frequent side effects are edema and fluid retention, as well as increased activity of ALT and AST in the blood plasma, that is, liver transaminases. With long-term treatment, patients may experience a flu-like syndrome, that is, fever with aching joints. All of the above common side effects occurred no more often than in 10% of cases. You should not think that if Arcoxia is a modern and safe drug, then you can take it and forget it. Among the side effects, increased blood pressure is quite common, so during treatment with the drug it is imperative to monitor blood pressure numbers, especially in patients with arterial hypertension.

Since there is an increase in transaminases, it is necessary to monitor the condition of the liver and kidneys, especially in patients with diseases of these organs. If transaminases, that is, ALT and AST levels, exceed the norm two times or higher, then the medicine must be discontinued.

It is prohibited to use this drug in combination with other drugs from the NSAID group, for example, Arcoxia + aspirin, or Arcoxia + Paracetamol, not to mention such very harmful combinations as Arcoxia plus Diclofenac or Movalis.

Finally, you need to remember that if the patient has such a side effect as drowsiness or dizziness, then he is recommended to refrain from driving vehicles and working with potentially dangerous machines and mechanisms.

Arcoxia is a drug that very rarely causes overdose symptoms, but if the dose is exceeded by 10 times or more, side effects may increase. There are also interactions of this medicine with other drugs, but this should be taken care of by the attending physician, having found out everything about what drugs the patient is taking. Special attention is required to such drugs as cardiac glycosides, rifampicin, oral contraceptives, cytostatics and immunosuppressants, and other drugs.

Comparison of the effectiveness of Arcoxia and Dilaxa

Dilaxa is more effective than Arcoxia - this means that the ability of the medicinal substance to provide the maximum possible effect is different.
For example, if the therapeutic effect of Dilaxa is more pronounced, then with Arcoxia it is impossible to achieve this effect even in large doses.

Also, the speed of therapy is an indicator of the speed of the therapeutic action; Dilaxa and Arcoxia are also different, as is bioavailability - the amount of a medicinal substance reaching the place of its action in the body. The higher the bioavailability, the less it will be lost during absorption and use by the body.