What are Aertal tablets for?
The active ingredient of Aertal is aceclofenac. This is an anti-inflammatory drug with an analgesic effect. The tablets are taken for severe pain in the joints and tissues; the drug is especially often used for toothache, when it is not possible to quickly get to the dentist. In addition, sudden pain in the lumbar region can also be easily eliminated by taking the Aertal tablet.
Food intake does not affect the absorption and activity of the components. For severe and persistent pain, take the drug twice a day, one tablet. Exceeding the daily dose is not recommended to avoid negative reactions.
Indications for use
Symptomatic treatment:
- rheumatoid arthritis;
- osteoarthritis;
- ankylosing spondylitis.
To relieve inflammation and pain in:
- lumbago;
- toothache;
- humeroscapular periarthritis;
- rheumatic lesions of soft tissues.
The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use, and does not affect the regression of the disease.
What is Aertal powder from?
Powder is a type of dosage form. It is intended for preparing a suspension. A single dose of the drug is packaged in a sachet. The advantage of using the powder is its rapid absorption. The tablet requires time to be broken down and processed in the gastrointestinal tract, and the powder, once in the stomach, begins to be absorbed into the blood without waiting for delivery to the intestines. The active substance contained in the tablets is contained in the same volume in one sachet.
Another advantage of using powder is the ability to accurately adjust the dose. For example, people with kidney or liver failure need to reduce the single dose by half. By dividing the contents of the package into two parts, it is easy to prepare a suspension of the desired concentration.
What is Aertal ointment for?
Ointment is a form for topical use. It is applied to damaged joints or areas of the body. Indications for use are bruises, sprains, dislocations, torticollis, or shooting sharp pain in the lower back.
The ointment is applied in a small amount to the sore spot and thoroughly rubbed into the tissue with massaging movements. Once in the body, the drug is absorbed into the blood, from where it is distributed throughout the body. As additional components, the ointment contains liquid paraffin and wax, which make its consistency soft and elastic.
Aertal or Xefokam: which is better?
Ksefokam, like Airtal, is an anesthetic drug. Its activity is primarily observed in rheumatoid arthritis, osteoarthritis and other types of joint and bone pain. However, unlike Airtal, Xefocam is based on another active substance - lornoxicam, which does not in any way affect the level of inflammation and the patient’s body temperature. The drug is suitable for symptomatic use and relief of sudden pain.
Adverse reactions for both drugs are identical. Long-term use can cause anemia, thrombocytopenia, insomnia, and depression. When choosing between medications, you need to pay special attention to individual intolerance to the components, and the need to relieve inflammation and normalize the temperature.
Both drugs are contraindicated during pregnancy and breastfeeding, since their active ingredients are instantly and almost completely absorbed into the blood. These drugs are also not prescribed to patients under 18 years of age. Bronchial asthma is a direct contraindication to the use of both drugs, since both of them can cause bronchospasm.
The use of aceclofenac in patients with acute back pain - effectiveness and safety
Kamchatnov P.R., Radysh B.B., Mikhailova N.A., Kutenev A.V.
Low back pain (LBP) is an extremely common clinical syndrome. Depending on factors such as body weight, the nature and regularity of physical activity, age, etc., LBP occurs in 70-90% of adults. There are nonspecific LBP, compression of the spinal root (radiculopathy), as well as LBP caused by specific lesions of the spine. Depending on the duration, there are acute (lasting less than 4 weeks), subacute (from 4 to 12 weeks) and chronic (lasting more than 12 weeks) LBP.
Nonspecific LBP is caused by osteoarthritis, osteochondrosis, and changes in periarticular tissues. It usually has a benign course and regresses or decreases significantly within 4-6 weeks [30]. The most common cause of root compression is a herniated disc. Rarely (less than 1%) LBP is caused by compression fractures due to osteoporosis, ankylosing spondylitis, tumors, and infectious processes.
Establishing a diagnosis is helped by a detailed clarification of the anamnesis - the peculiarities of the occurrence of pain, the factors that provoke its appearance and ensure its reduction, the identification of concomitant somatic diseases that can lead to damage to the spine, spinal cord membranes, and nervous structures [3].
Radiological examination (CT and MRI) is the main method of instrumental diagnosis of LBP. Tomographic examination is indicated to exclude specific causes of pain in patients with increasing pain, in the presence of neurological deficits, and in cases of severe somatic diseases. Radiography does not allow obtaining reliable information about the presence and size of a herniated intervertebral disc, the true size of the spinal canal in case of stenosis, etc. If indicated, radioisotope scintigraphy is used, which makes it possible to identify local accumulation of radiopharmaceuticals in the lesions, densitometry, and ultrasound examination.
Treatment
Complete and early elimination of pain is desirable in order to actively involve the patient in the process of treatment and rehabilitation, explain to the patient the benign nature of the disease, and teach him methods of preventing exacerbation. Ensuring an optimal level of daily physical activity is important. Excessive immobilization is undesirable not only in patients with isolated LBP, but also in most patients with radiculopathy. Early activation of the patient is of exceptional importance in preventing the development of depressive disorders and the formation of pain behavior [38].
In accordance with European recommendations for the treatment of patients with acute LBP, the first-line drug for its relief is paracetamol. In terms of analgesic effect, it is equivalent to acetylsalicylic acid and is comparable to or slightly inferior to most nonsteroidal anti-inflammatory drugs (NSAIDs). The anti-pain effect is realized due to the inhibition of cyclooxygenase activity in peripheral tissues and the central anti-inflammatory effect.
Experimental study of aceclofenac
NSAIDs are widely used - non-selective cyclooxygenase (COX) inhibitors, which have high analgesic and anti-inflammatory activity. This group includes aceclofenac (Aertal), a derivative of phenylacetylic acid (2-[2,6 - dichlorophenyl) amino] phenylacetoacetic acid), which is close in structure to diclofenac. In addition to inhibition, COX inhibits the expression of cell adhesion molecules (in particular, L-selectin), suppresses the adhesion of neutrophils to the endothelium, providing a pronounced anti-inflammatory effect [16], also due to the activation of the synthesis of interleukin-1 receptor antagonists and the suppression of the formation of nitric oxide [27].
Aceclofenac itself has a moderate inhibitory effect on COX types 1 and 2, however, under conditions of local inflammation by polymorphonuclear leukocytes and monocytes, aceclofenac is partially metabolized into diclofenac and 4-hydroxydiclofenac, due to which COX activity is inhibited [43].
Aceclofenac is able to prevent the degeneration of cartilage tissue. In the experiment, it demonstrated chondroprotective properties, providing interleukin-1-mediated suppression of the production of metalloproteinases, which stimulated the synthesis of proteoglycans by chondrocytes [4]. In a culture of cartilage tissue cells from patients with osteoarthritis, the use of aceclofenac was accompanied by an increase in the synthesis of proteoglycans and hyaluronic acid [6]. Aceclofenac, while ensuring the preservation of cartilage tissue, does not significantly affect the proliferation of tendon cells, without causing their hyperplasia.
Clinical effectiveness of aceclofenac
To date, considerable experience has been accumulated in the use of aceclofenac in patients with articular pathology. Analysis of the effectiveness of the drug in inflammatory diseases and in relieving pain syndromes allowed us to establish its anti-inflammatory effect, equivalent to ketoprofen, indomethacin and diclofenac in patients with rheumatoid arthritis, diclofenac and piroxicam for osteoarthritis of the knee joint, and indomethacin and naproxen for ankylosing spondylitis.
It is believed that the analgesic activity of 100 mg of aceclofenac in its duration of action exceeds that after taking 650 mg of paracetamol [8].
The authors of a review devoted to the analysis of the use of aceclofenac for the relief of acute pain syndromes (pathology of the ENT organs, dental, gynecological diseases, LBP) noted the high effectiveness of the drug [24]. The results of a double-blind, randomized study of the effectiveness of aceclofenac (200 mg/day) and paracetamol (3000 mg/day) in patients with osteoarthritis of the knee joint (168 patients included, treatment duration - 6 weeks) showed greater effectiveness of aceclofenac with better tolerability [5 ].
A multicenter, randomized, double-blind study was devoted to a comparative study of the effectiveness of aceclofenac (200 patients received 100 mg 2 times a day) and diclofenac (197 patients, 50 mg 3 times a day) for osteoarthritis of the knee joint [42]. As a result of a 12-week course of treatment in both groups, there was significant significant relief of pain and an increase in range of motion in the affected joints. However, a more pronounced effect and early normalization of joint mobility were recorded with the use of aceclofenac. A larger number of patients noted improvement after taking aceclofenac (71 and 59% after taking diclofenac), while the frequency of side effects with its use was significantly lower (1.0 and 6.6%). Similar results were obtained in a comparative multicenter study of aceclofenac and diclofenac in a similar group of patients with osteoarthritis of the knee joint [12]. The differences in the effectiveness of the drugs were not so pronounced, however, the frequency of side effects when taking aceclofenac was 5.9%, diclofenac - 11.5%, and an increase in the level of aminotransferases, which caused drug withdrawal, was observed in 0.6% of patients receiving aceclofenac, and in 3.0% of patients taking diclofenac.
A 12-week randomized, multicenter, double-blind study compared the effectiveness of aceclofenac (100 mg 2 times/day, 190 patients) and naproxen (500 mg 2 times/day, 184 patients) in patients with osteoarthritis of the knee joint [23]. There were no significant differences in the effectiveness of the drugs between the groups, however, the frequency of side effects was lower in the group of patients receiving aceclofenac (34 cases in 24 patients - 12.6%) compared to patients receiving naproxen (43 cases in 30 patients - 16.6%). 3%), and the differences also concerned gastrointestinal complications. A comparison of the effectiveness of aceclofenac (100 mg 2 times / day, 123 patients) and piroxicam (20 mg / day, 117 patients) was carried out in patients with osteoarthritis of the knee joint [31] during an 8-week randomized, multicenter, double-blind study. The effectiveness of the drugs turned out to be comparable, but the effect of using aceclofenac occurred earlier (in the 2nd week) compared to piroxicam (in the 4th week). Side effects were observed in 24 and 33 patients, respectively, despite the fact that detection of occult blood in feces was half as common after taking aceclofenac.
As part of a 6-month multicenter, double-blind study, 170 patients received aceclofenac (100 mg 2 times/day) and diclofenac (50 mg 3 times/day) [29]. Reduction of pain and improvement of movements occurred in both groups, however, motor disorders were relieved to a greater extent in patients receiving aceclofenac (17 and 22%, respectively).
Data from clinical studies (pronounced analgesic effect, good tolerability), as well as the unique effect of the drug on inflammatory mediators, speaks in favor of considering aceclofenac as the drug of choice for long-term therapy of patients with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and some other chronic degenerative lesions joints [33].
The pronounced anti-inflammatory and analgesic effects of aceclofenac led to the study of its effectiveness in patients with LBP. One of the first such studies was devoted to comparing the effectiveness of aceclofenac (135 patients, 100 mg 2 times a day) and tenoxicam (138 patients, 20 mg once a day) in patients with ankylosing spondylitis [39]. The study was multicenter, double-blind and lasted 12 weeks. Both drugs demonstrated high efficacy and comparable tolerability.
A multicenter, randomized, double-blind study compared the effectiveness of aceclofenac (100 mg 2 times/day) and diclofenac resinate (75 mg 2 times/day) in patients with acute nonspecific LBP [36]. The study included 227 patients; the course of treatment was 10 days. The timing and quality of pain relief were comparable in both groups, however, the use of aceclofenac was characterized by a significantly lower number of side effects.
Portability
Widespread, especially long-term, use of non-selective COX inhibitors is associated with a high risk of gastric bleeding. Due to the relatively low risk of gastrointestinal complications, the possibility of using selective COX-2 inhibitors is of great interest. A number of large randomized clinical trials performed in a double-blind manner have convincingly proven that selective COX-2 inhibitors have a significantly lower risk of gastrointestinal damage compared to non-selective drugs. Convincing results were obtained in the CLASS and VIGOR studies [7,37]. Aceclofenac inhibits the formation of COX-2 to a greater extent, as a result of which the incidence of serious gastrointestinal complications with its use is significantly lower than that of other NSAIDs (piroxicam, indomethacin, tenoxicam and ketoprofen) [19].
The tolerability of aceclofenac was studied in a 12-month prospective, open-label, multicenter study, SAMM [20]. Of 10,142 patients suffering from rheumatoid arthritis, ankylosing spondylitis and osteoarthritis, 2 groups were formed: the first (n=7890) consisted of patients receiving aceclofenac (100 mg 2 times a day), the second (n=2252) - diclofenac (according to 75 mg 2 times/day). The duration of treatment was 168 and 170 days, respectively. The total number of side effects, as well as the number of patients who stopped treatment due to intolerance, turned out to be significantly lower in the group receiving aceclofenac. The incidence of gastrointestinal reactions was 10.6 and 15.2%, respectively. The incidence of nausea, abdominal pain and diarrhea leading to discontinuation of treatment was 46, 65 and 41% lower, respectively, in the group of patients taking aceclofenac.
A slightly later Pan-European study included 23,407 patients with inflammatory and degenerative joint diseases [25]. Significant improvement, according to both patients and treating physicians, occurred in 84% of patients receiving aceclofenac, while 90% of them remained adherent to treatment. The results of the study made it possible to recommend aceclofenac for the relief of both acute and chronic pain syndromes.
Almost at the same time, a review of the results of studying the effectiveness of aceclofenac was published, obtained in the course of studies of different designs with various comparator drugs (diclofenac, naproxen, piroxicam, indomethacin, tenoxicam and ketoprofen) - a total of about 150 thousand patients [13]. The drug was noted to be sufficiently effective for relieving pain or inflammation with a course of treatment lasting from 2 to 6 months. along with a low incidence of side effects.
A large-scale study was carried out in the UK to establish the incidence of gastrointestinal and other complications due to the use of non-steroidal anti-inflammatory drugs [34]. The authors compared the risk of developing various complications due to oral administration of aceclofenac (200 mg/day), meloxicam (7.5 and 15 mg/day) and rofecoxib (25 mg/day). It was found that the frequency of side effects (number of cases/106 daily doses of the drug sold in the country) was 8.7 for aceclofenac (CI 6.1 - 12.0), 24.8 for meloxicam (CI 23.1-26.6) and 52.6 (CI 49.9-55.4) for rofecoxib. The use of aceclofenac was associated with a significantly lower incidence of gastrointestinal bleeding and abdominal pain. When taking aceclofenac, a significantly lower number of gastrointestinal complications, cases of abdominal pain, and hepatotoxicity were observed compared with rofecoxib. In general, it turned out that the best tolerability was observed with aceclofenac.
The use of selective COX-2 inhibitors is associated with an increased risk of cardiovascular complications, primarily acute myocardial infarction and an increase in systemic blood pressure [28,44]. However, this property of the drugs has not been confirmed in all studies. Thus, an observation of more than 30 thousand patients with osteoarthritis and rheumatoid arthritis who received diclofenac (150 mg/day) or eotricoxib (60-90 mg/day) established an almost identical risk of thrombotic complications when taking them [9]. The study cited above [34] recorded a significantly lower incidence of thrombotic complications and cases of increased blood pressure compared to meloxicam and rofecoxib.
Pharmacokinetics of aceclofenac
When administered orally, aceclofenac is quickly and completely adsorbed in the intestine and after 1.5-2 hours reaches its maximum concentration in the blood. The drug does not have cumulative activity, and its pharmacokinetics does not depend on the age of the patients. Prescribed orally 100 mg 2 times/day.
Contraindicated in case of exacerbations of gastric and duodenal ulcers, a history of the “aspirin triad,” or hematopoietic disorders of unknown etiology. The drug should not be used in the third trimester of pregnancy; its use in the first and second trimesters of pregnancy, as well as during lactation, is possible after a careful assessment of the benefit-risk ratio. The use of aceclofenac in children and adolescents under the age of 18 is not recommended.
With the simultaneous use of other drugs with aceclofenac, it is possible to increase the plasma concentrations of digoxin, phenytoin, lithium and reduce the effectiveness of diuretics and antihypertensive drugs. When taking aceclofenac and corticosteroids or other NSAIDs, the risk of developing side effects from the gastrointestinal tract increases. When used with acetylsalicylic acid, a decrease in the concentration of aceclofenac in the blood plasma is possible. With the simultaneous use of indirect anticoagulants, the risk of bleeding increases.
The presented information about the effectiveness and tolerability of aceclofenac (Aertal) allows us to consider it as the drug of choice in patients with acute back pain.
Literature
1. Badokin V.V. Efficacy and safety of aceclofenac in patients with osteoarthritis. RMJ. 2007; 13: 392-397. 2. Neverov V.A., Kurbanov S.Kh. Restorative treatment of degenerative-dystrophic diseases of large joints. Vestn. hir. them. I.I. Grekova 2004;163(2):97-108. 3. Nikiforov A.S., Konovalov A.N., Gusev E.I. Clinical neurology. In 3 volumes - Moscow: “Medicine”, 2002. 4. Akimoto H, Yamazaki R, Hashimoto S et al. A major metabolite of aceclofenac 4'hydroxy aceclofenac suppresses the interleukin-1 induced production of promatric metalloproteinases and release of sulfated-glycosaminoglycans from rabbit articular chondrocytes. Eur J Pharmacol 2000; 401(3): 429-436. 5. Batlle-Gualda E., Roman Ivorra J., Martin-Mola E. et al. Aceclofenac vs paracetamol in the management of symptomatic osteoarthritis of the knee: a double-blind 6-week randomized controlled trial. Osteoarthritis Cartilage. 2007; 15(8):900-908. 6. Blot L., Marcelis A., Devogelaer J.-P., Manicourt D.-H. Effects of diclofenac, aceclofenac and meloxicam on the metabolism of proteoglycans and hyaluronan in osteoarthritic human cartilage. British Journal of Pharmacology 2000; 131: 1413 – 1421. 7. Bombardier C., Laine L., Reicin A. et al.. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med 2000; 343:1520-8. 8. Brogden R., Wiseman L. Aceclofenac. A review of its pharmacodynamic properties and therapeutic potential in the treatment of rheumatic disorders and in pain management. Drugs. 1996; 52(1): 113-124. 9. Cannon C., Curtis S., FitzGerald G. et al. Cardiovascular outcomes with etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) program: a randomized comparison. Lancet. 2006; 18; 368(9549):1771-1781. 10. Carrabba M., Paresce E., Angelini M. et al. A comparison of the local tolerability, safety and efficacy of meloxicam and piroxicam suppositories in patients with osteoarthritis: a single-blind, randomized, multicentre study. Curr Med Res Opin. 1995;13(6):343-55. 11. Clare J., Tate S., Nobbs M., Romanos M. Voltage-gated sodium channels as therapeutic targets. Drug Discov Today 2000; 5:506-520. 12. Diaz C., Rodriquez de la Serna A., Geli C., Gras H. Efficacy and tolerance of aceclofenac versus diclofenac in the treatment of knee osteoarthritis. A multicenter study. Eur J Rheumatol Inflamm 1996; 16: 17-22. 13. Dooley M., Spencer C., Dunn C. Aceclofenac: a reappraisal of its use in the management of pain and rheumatic disease. Drugs. 2001;61(9):1351-1378. 14. Dougados M., Gueguen A., Nakache J.-P. et al. Ankylosing spondylitis: what is the optimal duration of a clinical study? A one year versus a 6 weeks non-steroidal anti-inflammatory drug trial. Rheumatology 1999;38:235-244 15. Gilbert F, Grant A, Gillan M et al. Scottish Back Trial Group. Low back pain: influence of early MR imaging or CT on treatment and outcome-multicenter randomized trial. Radiology. 2004; 231: 343-351. 16. Gonzalez-Alvaro I., Carmona L., Diaz-Gonzalez F. et al. Aceclofenac, a new nonsteroidal antiinflammatory drug, decreases the expression and function of some adhesion molecules on human neutrophils. J Rheumatol. 1996; 23(4): 723-729. 17. Harreby M., Nygaard B., Jessen T. et al. Risk factors for low back pain in a cohort of 1389 Danish school children: an epidemiologic study. Eur Spine J. 1999; 8(6): 444-450. 18. Harris A. Handicapped and Impaired in Great Britain, Part I. London, England: Social Survey Division, Office of Population Census and Surveys. Her Majesty's Stationary Office; 1971. 19. Henrotin Y, De Leval H, Mathy-Hartet M et al. In vitro effects of aceclofenac and its metabolites on the production by chondrocytes of inflammatory mediators. Inflamm Res 2001; 50: 391-399. 20. Huskisson E., Irani M., Murray F. A large prospective open-label, multicentre SAMM study, comparing the safety of aceclofenac in patients with rheumatic disease. Eur J Rheumatol Inflamm 2000; 7:1-7. 21. Koes B., van Tulder W., Thomas S. Diagnosis and treatment of low back pain. BMJ 2006;332;1430-1434. 22. Koleck M. Mazaux, J. Rascle N. et al. Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: A prospective study. European Journal of Pain. 2006; 10:1-11. 23. Korsanoff D., Frerick H., Bowdler J., Montull E. Aceclofenac is a well-tolerated alternative to naproxen in the treatment of osteoarthritis. Clin Rheumatol 1997; 16 (1): 32-8. 24. Legrand E. Aceclofenac in the management of inflammatory pain. Expert Opin Pharmacother. 2004; 5(6): 1347-1357. 25. Lemmel E., Leeb B., De Bast J., Aslanidis S. Patient and physician satisfaction with aceclofenac: results of the European Observational Cohort Study (experience with aceclofenac for inflammatory pain in daily practice). Aceclofenac is the treatment of choice for patients and physicians in the management of inflammatory pain. Curr Med Res Opin. 2002;18(3):146-153. 26. Li Y., Gorassini M., Bennett D. Role of persistent sodium and calcium currents in motoneuron firing and spasticity in chronic spinal rats. Neurophysiology 2004; 91:767-783. 27. Maneiro E., Lopez-Armada M., Fernandez-Sueiro J. et al. Aceclofenac increases the synthesis of interleukin 1 receptor antagonist and decreases the production of nitric oxide in human articular chondrocytes. J Rheumatol. 2001; 28(12): 2692-2699. 28. Mukherjee D., Nissen S., Topol E. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA. 2001; 286:954-9. 29. Pasero G., Marcolongo R., Serni U. et al. A multi-centre, double-blind comparative study of the efficacy and safety of aceclofenac and diclofenac in the treatment of rheumatoid arthritis. Curr Med Res Opin. 1995;13(6):305-315. 30. Pengel L., Herbert R., Maher C., Refshauge K. Acute low back pain: systematic review of its prognosis. BMJ. 2003; 327: 323-326. 31. Perez Busquer M., Calero E., Rodriguez M. et al. Comparison of aceclofenac with roxicam in the treatment of osteoarthritis. Clin Rheumatol 1997; 16 (2): 154-59. 32. Pincus T., Burton A., Vogel S., Field A. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002; 27: 109-120. 33. Reginster J., Paul I., Henrotin Y. What is the role of aceclofenac in the therapeutic arsenal against chronic osteoarthritis pathologies? Rev Med Liege. 2001; 56(7): 484-488. 34. Raber A., Heras J., Costa J. et al. Incidence of spontaneous notifications of adverse reactions with aceclofenac, meloxicam, and rofecoxib during the first year after marketing in the United Kingdom. Therapeutics and Clinical Risk Management 2007:3(2) 225-230 35. Rudwaleit M., Metter A., Listing J., Sieper J. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum. 2006; 54: 569-78. 36. Schattenkirchner M., Milachowski K. A double-blind, multicentre, randomized clinical trial comparing the efficacy and tolerability of aceclofenac with diclofenac resinate in patients with acute low back pain. Clin Rheumatol. 2003; 22(2): 127-135. 37. Silverstein F., Faich G., Goldstein J. et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 2000; 284:1247-55. 38. van Tulder M., Becker A., Bekkering T. et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J (2006) 15(Suppl. 2):S169-S191. 39. Villa Alcazar L., de Buergo M., Rico Lenza H., Montull Fruitos E. Aceclofenac is as safe and effective as tenoxicam in the treatment of ankylosing spondylitis: a 3 month multicenter comparative trial. Spanish Study Group on Aceclofenac in Ankylosing Spondylitis. J Rheumatol. 1996; 23(7):1194-1199. 40. Von Korff M., Saunders K. The course of back pain in primary care. Spine. 1996; 21: 2833-7283. 41. Wang G., Russell C., Wang S. State-dependent block of voltage-gated Na-channels by amitriptyline via the local anesthetic receptor and its implication for neuropathic pain. Pain 2004; 110:166-174. 42. Ward D., Veys E., Bowdler JM, Roma J. Comparison of aceclofenac with diclofenac in the treatment of osteoarthris. Clin Rheumatol 1995; 14: 656-62. 43. Yamazaki R., Kawai S., Matsuzaki T. et al. Aceclofenac blocks prostaglandin E2 production following its intracellular conversion into cyclooxygenase inhibitors. Eur J Pharmacol. 1997; 329(2-3): 181-187. 44. Zhao S., Burke T., Whelton A. et al. Comparison of the baseline cardiovascular risk profile among hypertensive patients prescribed COX-2-specific inhibitors or nonspecific NSAIDs: data from real life practice. Am J Manag Care. 2001; 8(15 Suppl): S392-400. Key words of the article: aceclofenac, patients, effectiveness, Application, acute
SOURCE RMJ JANUARY 26, 2010, VOLUME 18, NO. SPECIAL
Is it possible to take Aertal with alcohol?
Removing Airtal from the body puts a serious burden on the liver and kidneys. Alcohol, entering the blood at the same time as Aertal, can aggravate the condition of the filtering organs, because its presence puts additional stress on the liver. Alcoholism is a direct contraindication to the use of Aertal, as this can lead to organ dysfunction.
In addition, many alcoholic drinks are diuretics, which increases the load on the kidneys. If there is stagnation of fluid in the body and the simultaneous use of Aertal, intoxication is possible, since the initially taken dose of the drug will not be removed from the body before the patient takes the second tablet.
special instructions
Avoid using Airtal concomitantly with other NSAIDs, including selective COX-2 inhibitors.
Adverse events can be reduced by shortening the duration of treatment as much as possible and reducing the dose of the drug to the minimum necessary to achieve control of the symptoms of the disease.
Each sachet of Airtal, powder for oral suspension, 100 mg, contains 2.64 g of sorbitol, which can cause gastrointestinal disorders and diarrhea. Patients with rare hereditary fructose intolerance should not be prescribed this drug.
Airtal, powder for oral suspension, 100 mg, contains aspartame, a source of phenylalanine. Patients with phenylketonuria should note that each sachet contains 5.61 mg of phenylalanine.
You should refrain from driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions, because the drug may cause dizziness and other side effects that may affect these abilities.
How to replace the drug Airtal
The group of non-steroidal anti-inflammatory analgesics includes a whole list of drugs, including cheaper ones and those that have fewer contraindications in their description.
Paracetamol and ibuprofen are considered the safest. These substances, being part of many multicomponent drugs, relieve pain, normalize body temperature and reduce the intensity of the inflammatory process. Both paracetamol and ibuprofen are approved for use in children. The dosage form in the form of syrup allows use by children over 3 months. Ibuprofen is better for toothache and joint pain.
Paracetamol is aimed at combating headaches and muscle aches. For severe joint pain, Aertan can be replaced with Diclofenac. This active substance is sold in pharmacies. Under the same name it is found not only in the form of tablets, but also in the form of ointments, patches and ampoules for intramuscular administration. The extended-release formula of the tablets allows you to take one dose, which will relieve severe pain for 24 hours.