"Hyalurom", "Ostenil", "Intraject" or "Noltrex"?

There are a lot of drugs for intra-articular injections on the market, and all of them, according to the manufacturers, have almost magical properties. Each of them effectively treats arthrosis - relieves pain and restores mobility. Only the effects of one of the synovial fluid prostheses for some reason disappear after six months, while the other lasts many times longer. In this article we will analyze Gialurom, Ostenil, Intraject and Noltrex according to objective criteria and comments from their developers.

Not all liquid endoprostheses are equally effective

Comparison of the characteristics of liquid endoprostheses "Hialurom", "Ostenil", "Intraject" and "Noltrex"

Ostenil implant for intra-articular injections 20 mg/2 ml No. 1

Compound

Active ingredients: sodium hyaluronate, mannitol, water for injection,
Excipients: sodium chloride, sodium hydrogen phosphate, sodium dihydrogen phosphate

Pharmacokinetics

Ostenil - restores the viscoelastic properties of synovial fluid.

Synovial fluid (SF) plays a critical role in joint homeostasis. In addition to nourishing cartilage tissue (the latter does not contain blood vessels), SF protects it mechanically due to its unique viscoelastic properties. These characteristics of SF are imparted by its main stromal component, hyaluronic acid.

An important link in the pathogenesis of osteoarthritis is a decrease in the volume and viscosity of the fluid, which leads to an increase in the mechanical load on the articular cartilage, their gradual destruction, and, consequently, the occurrence of pain and limitation of joint mobility. To restore synovial balance, intra-articular injection of exogenous hyaluronic acid is indicated.

Highly purified hyaluronic acid, obtained by bacterial fermentation, is a hypoallergenic substance. Rationally selected molecular weight promotes both the restoration of the viscoelastic properties of synovial fluid and the production of endogenous hyaluronic acid. Mannitol is an antioxidant that helps maintain the therapeutic effect after a single injection of the medical device Ostenil® Plus for six months or more.

Indications for use

Intra-articular administration of Ostenil is indicated for pain and limited mobility due to degenerative-dystrophic and traumatic changes in the hip, knee and other synovial joints.

Contraindications

Hypersensitivity to one of the ingredients.

Directions for use and doses

Intra-articular. May only be used by a physician.

It is injected into the cavity of the affected joint once. According to indications, treatment can be supplemented with 12 injections with an interval of 14 days. Injections can be performed into other joints at the same time.

If there is effusion in the joint, you should first evacuate it, provide rest to the joint and use cold therapy or intra-articular administration of a corticosteroid drug. Treatment with the medical device Ostenil can begin 23 days after these procedures.

The contents and outer surface of a filled syringe with a medical device Ostenil are sterile as long as the integrity of the packaging and the syringe closure system are not compromised. The closure system consists of a security cap, a luer lock and a tamper-evident cap.

Before the injection you must:

1. Remove the filled syringe with the medical device Ostenil Plus from the sterile packaging.
2. To protect against unauthorized opening of the syringe, bend the cap in one direction or the other so that the jumpers securing it break.
3. Carefully remove the lid together with the protective cap upwards.
4. Attach the required size (1825 G) sterile needle and secure it by turning it slightly.
5. Before injection, release any air bubbles from the syringe if any.

Storage conditions

At a temperature of 2-25 C (do not freeze)

Best before date

2 years

special instructions

The drug with signs of damage to the sterile packaging or syringe, as well as with an expired expiration date (indicated on the box), cannot be used.

Conditions for dispensing from pharmacies

Available with prescription

Side effects

After intra-articular insertion of the product, local secondary effects such as pain, warmth, redness and swelling may be observed. Applying ice to the punctured joint for 5-10 minutes can stop such phenomena.

Use during pregnancy and breastfeeding

Not recommended for use in children, pregnant and lactating women.

"Hyalur"

Hyalurome is a Romanian drug, a viscous sterile liquid for intra-articular injections for arthrosis and deforming osteoarthritis. The package contains a disposable glass syringe in transparent film, with a sterile needle and a protective cap. The manufacturer recommends using it for arthrosis and arthritis, as well as for osteochondrosis - for faster restoration of articular intervertebral tissue. In addition, indications include deficiency of synovial fluid, diagnostic arthroscopy and other surgical interventions on the joint.

Note!

For the treatment of arthrosis of small joints, the manufacturer recommends administering not 2, but 1 ml. "Gialurom" comes in a 2 ml package. According to the instructions, it is forbidden to use leftover medication - each syringe is intended for one injection. This means that if only one small joint is to be treated, half the contents of the syringe will not be useful.

During administration, patients report pain. Local reactions persist for 1-3 days. During this period, it is necessary to provide complete rest to the joint, and also apply cooling compresses if necessary.

After the administration of "Hyalurom" you need complete rest for up to three days.

Ostenil Plus syringe implant viscoelastic for intra-articular injection 40mg/2ml 2%

Compound:

Viscoelastic sterile implant for intra-articular injection (isotonic solution with pH 7.3) in a 2 ml syringe 1 ml

sodium hyaluronate 20 mg

mannitol 5 mg

water for injection up to 1 ml

excipients: sodium chloride; sodium hydrogen phosphate; sodium dihydrogen phosphate

Characteristics: A transparent solution of native highly purified sodium hyaluronate obtained by bacterial fermentation. Does not contain animal proteins. The medical product Ostenil® Plus contains mannitol, which prevents the depolymerization (destruction) of hyaluronic acid by free radicals, which helps prolong the therapeutic effect. The high safety profile of the medical device Ostenil® Plus is confirmed by biocompatibility studies.

Pharmacological action - restoring the viscoelastic properties of synovial fluid.

Indications: Degenerative-dystrophic and traumatic changes in the hip, knee and other synovial joints, accompanied by pain and limited mobility.

Use during pregnancy and breastfeeding: Not recommended for use in children, pregnant and lactating women.

Directions for use and dosage:

Intra-articular. May only be used by a physician.

Ostenil Plus is injected into the cavity of the affected joint once. According to indications, treatment can be supplemented with 1-2 injections with an interval of 14 days. Injections can be performed into other joints at the same time.

If there is effusion in the joint, you should first evacuate it, provide rest to the joint and use cold therapy or intra-articular administration of a corticosteroid drug. Treatment with the medical device Ostenil® Plus can begin 2-3 days after these procedures.

The contents and outer surface of a filled syringe with a medical device Ostenil Plus are sterile as long as the integrity of the packaging and the syringe closure system are not compromised. The closure system consists of a security cap, a luer lock and a tamper-evident cap.

Before the injection you must:

— Remove the filled syringe with the medical device Ostenil® Plus from the sterile packaging.

— Bend the cap to protect against unauthorized opening of the syringe in one direction or the other so that the jumpers securing it break.

— Carefully remove the lid together with the protective cap.

— Attach the required size (18–25 G) sterile needle and secure it by turning it slightly.

— Before injection, release any air bubbles from the syringe, if any.

Before use, consultation with a specialist is required. The method of administration and dosage regimen of a particular drug depend on its release form and other factors. The optimal dosage regimen is determined by the doctor. Storage mode, interactions and side effects are indicated in the instructions.

"Ostenil"

"Ostenil" is a sterile solution of sodium hyaluronate, a highly purified biopolymer. No animal proteins are used in production, which completely eliminates allergic reactions to protein. A viscoelastic implant is indicated for degenerative and traumatic changes in the joints. It restores the lubricating, filtering and shock-absorbing properties of synovial fluid.

According to research results, the severity of pain after completing a course of Ostenil injections is reduced by an average of 55% after 3 months. The clinical effect develops after the first manipulation and persists for a period of at least six months. Is 55% enough to lead a normal lifestyle? The question is rhetorical.

Note!

The results of a study conducted by leading rheumatologists at the Institute of Rheumatology of the Russian Academy of Medical Sciences and several rheumatology centers are thought-provoking. A course of treatment with Ostenil consisting of three or five injections led to significant improvement only among 65-70% with gonarthrosis. Efficiency remained throughout the year in only 45-50% of subjects. The only good news is that the treatment did not produce serious adverse reactions, which means the drug is safe. How great its benefits are - the numbers speak for themselves.

And one more interesting point. In the instructions for the drug, the manufacturer recommends that doctors prescribe analgesics or anti-inflammatory drugs to patients during the first few days of treatment for osteoarthritis. It can be assumed that the pain syndrome after the introduction of a liquid endoprosthesis will be more noticeable than we would like.

Full course of treatment with Ostenil - 5 injections, or 5 weeks, or about 18,000 rubles

Ostenil plus solution for intra-articular administration 20 mg/ml 2 ml N1 syringe

Description of the drug Composition and release form 1 ml of isotonic solution (pH 7.3) contains 20 mg of sodium hyaluronate

excipients: sodium chloride, sodium hydrogen phosphate, sodium dihydrogen phosphate, mannitol, water for injection;

1 filled syringe - 40 mg/2 ml in sterile packaging.

Pharmacological action

Ostenil Plus is a sterile viscoelastic implant for intra-articular injection.

Hyaluronic acid (HA) is a natural polymer that provides the viscoelastic properties of synovial fluid. In a normal joint, it is highly concentrated on the superficial layer of articular cartilage, as well as on the superficial layers of the synovial membrane. In synovial fluid, HA acts as a lubricant and shock absorber, an energy storage agent between opposing cartilage, a semipermeable barrier that regulates metabolic exchanges between cartilage and synovial fluid, an agent that controls cell movement, and a viscoelastic shield around synoviocytes and adjacent nerve endings.

During degenerative processes in the joints, such as osteoarthritis, the viscoelasticity of the synovial fluid is noticeably reduced, which negatively affects its lubricating and shock-absorbing functions. As a result, the mechanical load on the articular cartilage increases, which leads to their destruction and, consequently, pain and limited mobility in the joint.

Ostenil Plus is a transparent solution of native highly purified sodium hyaluronate obtained by fermentation. The product does not contain animal proteins, which reduces the risk of an allergic reaction.

Mannitol minimizes free radical activity, thereby ensuring the stability of the molecular structure of sodium hyaluronate.

The high safety profile is confirmed by biocompatibility tests.

Indications

Pain and limited mobility due to degenerative-dystrophic and traumatic changes in the knee and other synovial joints.

Directions for use and doses

Ostenil Plus is injected into the cavity of the affected joint once. According to indications, treatment can be supplemented with one or two injections with an interval of 14 days. Several joints can be treated at the same time.

If there is effusion in the joint, before treatment it is recommended to evacuate it, provide rest to the joint, apply ice and/or intra-articular injection of a corticosteroid drug. Treatment with Ostenil can begin 2-3 days after these procedures.

The contents and outer surface of a pre-filled Ostenil Plus syringe remain sterile until the package is torn. Remove the pre-filled syringe from the package, remove the cap from the syringe, insert the desired needle (18-25 G) and secure it by twisting slightly. Release any air bubbles from the syringe before injecting.

Contraindications

Hypersensitivity to the components of the drug.

Ostenil Plus is not recommended for use in children, pregnant and lactating women. It is not recommended for use in active rheumatoid arthritis and ankylosing spondylitis.

Side effect

Local secondary effects such as pain, warmth, redness and swelling may occur in the joint treated with Ostenil. Applying ice to the sore joint for 5-10 minutes immediately after the injection will reduce discomfort.

special instructions

General precautions for intra-articular injections must be observed. Ostenil Plus should be injected exactly into the joint cavity.

Avoid injections into blood vessels or adjacent tissues, as well as into the joint capsule!

Do not use the drug if the pre-filled syringe or sterile packaging is damaged.

During the first few days of treatment, oral analgesic or anti-inflammatory drugs may be recommended.

Storage conditions

Store at a temperature not exceeding 25°C. Do not freeze.

"Intraject"

“Intraject” is another liquid endoprosthesis, now made in Russia, for the treatment of moderate and moderate osteoarthritis. The manufacturer positions it as a means for the regeneration of cartilage tissue. Clinical studies have confirmed positive dynamics in the severity of pain in patients with grade 2-3 gonarthrosis, an improvement in general condition and an increase in the thickness of hyaline cartilage.

By and large, the drug "Intraject" is not much different from the previous ones, with the exception of a shorter shelf life (two years instead of three) and some other points.

The instructions indicate such a rare but dangerous complication as septic arthritis . The latter is accompanied by a local inflammatory reaction, increased body temperature and severe joint pain. Despite the fact that the manufacturer emphasizes “including those not related to the use of Intraject,” such references are still alarming and make us think that such cases have been recorded.

Another limitation specified in the instructions is incompatibility with quaternary ammonium salts, primarily benzalkonium chloride. This means that when using this drug it is prohibited to use antiseptics of this composition, which is a good idea for the patient to make sure of before administering a liquid endoprosthesis in a clinical setting.

In the instructions for Intraject we read: there have been cases of anaphylactic reactions to the drug

"Noltrex"

Noltrex is another endoprosthesis, a synovial fluid substitute, made in Russia. Of all the above-mentioned drugs, it is of synthetic origin, which gives it undeniable advantages. The components of the endoprosthesis, which do not include hyaluronic acid, as in other medications, are not broken down by enzymes in the human body, so the gel remains inside the joint for a long time and provides a long-lasting effect.

It is thanks to its synthetic nature that Noltrex is a completely hypoallergenic drug and is perfectly compatible with the tissues of the human body. Another feature of it is its record molecular weight, more than 10 million Da, thanks to which it is not removed from the joint for a very long time.

"Noltrex" is an inexpensive but very effective synthetic endoprosthesis with long-lasting action

A little about the price

Let's highlight:

• To keep osteoarthritis of the hip or knee under control with the help of the German drug “ Ostenil ” (costing only 3,500 rubles per injection!), you will have to fork out 10-18 thousand rubles every six months. That is, you will need from 20 to 36 thousand rubles , since the effect lasts on average only for 6-8 months.
• Treatment with Romanian “ Hyalurom ” will cost 15 thousand rubles per course - that is, about 30 thousand rubles per year .
• The Russian “ Intraject ” itself cannot be called cheap. A course of treatment with the drug costs 5,800 rubles. the injection will also cost at least 18 thousand rubles, and it will also probably have to be repeated twice a year, which means this amount is doubled - 36 thousand rubles.
• With Noltrex , which, according to some patients, costs not so little (from 3,100 rubles), you can save money. Even if the course consists of 4 injections, it will cost a little more than 12 thousand rubles . The effect will last for at least a year, meaning no additional investment is required.

Of course, it is “more prestigious” to treat arthrosis with an advanced German or popular Romanian drug. Many patients are skeptical about Russian developments, and this is still a tribute to the past. Today, some domestic medicines are not only not inferior to imported ones, but upon closer examination they even surpass them. See for yourself.

Advantages of Noltrex over the drugs Hyalurom, Ostenil and Intraject

• Due to its higher molecular weight, Noltrex lasts longer - up to two years (usually from a year to one and a half). It is impossible to get such a result from Hyalurom, Ostenil or Intraject.
• For a full course, sometimes 1-3 injections are enough, while preparations based on sodium hyaluronate must be administered at least 3 times, and in some cases 4-5.
• The cost of treating arthrosis of the knee, hip or elbow with Noltrex is significantly lower than with any other drug (about 12 thousand rubles for 4 injections, although two or three injections are often enough).

When choosing a drug for intra-articular injections, many are still guided by insignificant criteria. For some, the country of origin is a priority, for others, the cost of one injection is a priority. In fact, it is much more important to analyze the treatment regimen as a whole - with a future perspective, calculate the cost of treatment for the year, and study effectiveness statistics. The example of the comparison of popular liquid endoprostheses described above clearly shows the value of this particular approach.

Ostenil plus solution for intra-articular administration 20 mg/ml 2 ml N1 syringe in Zelenogradsky

Description of the drug Composition and release form 1 ml of isotonic solution (pH 7.3) contains 20 mg of sodium hyaluronate

excipients: sodium chloride, sodium hydrogen phosphate, sodium dihydrogen phosphate, mannitol, water for injection;

1 filled syringe - 40 mg/2 ml in sterile packaging.

Pharmacological action

Ostenil Plus is a sterile viscoelastic implant for intra-articular injection.

Hyaluronic acid (HA) is a natural polymer that provides the viscoelastic properties of synovial fluid. In a normal joint, it is highly concentrated on the superficial layer of articular cartilage, as well as on the superficial layers of the synovial membrane. In synovial fluid, HA acts as a lubricant and shock absorber, an energy storage agent between opposing cartilage, a semipermeable barrier that regulates metabolic exchanges between cartilage and synovial fluid, an agent that controls cell movement, and a viscoelastic shield around synoviocytes and adjacent nerve endings.

During degenerative processes in the joints, such as osteoarthritis, the viscoelasticity of the synovial fluid is noticeably reduced, which negatively affects its lubricating and shock-absorbing functions. As a result, the mechanical load on the articular cartilage increases, which leads to their destruction and, consequently, pain and limited mobility in the joint.

Ostenil Plus is a transparent solution of native highly purified sodium hyaluronate obtained by fermentation. The product does not contain animal proteins, which reduces the risk of an allergic reaction.

Mannitol minimizes free radical activity, thereby ensuring the stability of the molecular structure of sodium hyaluronate.

The high safety profile is confirmed by biocompatibility tests.

Indications

Pain and limited mobility due to degenerative-dystrophic and traumatic changes in the knee and other synovial joints.

Directions for use and doses

Ostenil Plus is injected into the cavity of the affected joint once. According to indications, treatment can be supplemented with one or two injections with an interval of 14 days. Several joints can be treated at the same time.

If there is effusion in the joint, before treatment it is recommended to evacuate it, provide rest to the joint, apply ice and/or intra-articular injection of a corticosteroid drug. Treatment with Ostenil can begin 2-3 days after these procedures.

The contents and outer surface of a pre-filled Ostenil Plus syringe remain sterile until the package is torn. Remove the pre-filled syringe from the package, remove the cap from the syringe, insert the desired needle (18-25 G) and secure it by twisting slightly. Release any air bubbles from the syringe before injecting.

Contraindications

Hypersensitivity to the components of the drug.

Ostenil Plus is not recommended for use in children, pregnant and lactating women. It is not recommended for use in active rheumatoid arthritis and ankylosing spondylitis.

Side effect

Local secondary effects such as pain, warmth, redness and swelling may occur in the joint treated with Ostenil. Applying ice to the sore joint for 5-10 minutes immediately after the injection will reduce discomfort.

special instructions

General precautions for intra-articular injections must be observed. Ostenil Plus should be injected exactly into the joint cavity.

Avoid injections into blood vessels or adjacent tissues, as well as into the joint capsule!

Do not use the drug if the pre-filled syringe or sterile packaging is damaged.

During the first few days of treatment, oral analgesic or anti-inflammatory drugs may be recommended.

Storage conditions

Store at a temperature not exceeding 25°C. Do not freeze.