Anti-inflammatory ointments with bruises

With a soft tissue injury, the integrity of the subcutaneous tissue, and, consequently, of small vessels, including conductive lymph, is compromised. Puffiness, bruising in the area of trauma indicate a potential danger of developing a local inflammatory process that can be stopped with the help of external medicines. Anti-inflammatory ointments with bruises are used both as a monotherapy, immediately after injury, and after a day after the primary cooling of the injury site, as it is necessary in the treatment of bruises.

Often, ointments with PVNP (anti-inflammatory non-steroid drug) or other components, have both a cooling or warming-up, inflammatory effect. Such combined external means are extremely effective and can be used not only for soft tissue contusions (bruises), but also as a treatment for other closed injuries.

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Indications for use

Anti-inflammatory ointments, as a rule, contain a component from the category of NSAIDs - non-steroidal anti-inflammatory drugs, whose action is directed to pathoimmune inflammatory processes in connective and soft tissues. Indications for the use of such drugs are due to the universal mechanism, the chemical-pharmaceutical property of external NSAIDs to systemically affect non-infectious inflammatory foci. Anti-inflammatory ointments with bruises have such an effect on soft tissues, subcutaneous fat and vessels:

• Anti-inflammatory action - suppression of inflammation in the phase of exudation, decrease in edema.
• Anesthetic effect - ointment reduces mild and moderate painful sensations, the effect is more pronounced in muscles, soft tissues, to a lesser extent in joints, mucus, tendons. Ointments are ineffective in visceral pain.
• Antiaggregatory action - suppression of platelet aggregation, especially if the ointment contains salicylates.

Imunosuppression - decrease in permeability of small vessels and capillaries

Indications for use of anti-inflammatory ointments with bruises:

• Contusions of a closed type without compromising the integrity of the skin.
• Stretching of muscles, ligaments.
• Dystrophic, degenerative diseases of the musculoskeletal system.
• Inflammatory process in the joints.
• Radiculopathy.
• Inflammatory process in synovial joint bag (bursitis).
• Myalgia, myositis.
• Fasciitis.
• Extra-articular rheumatism.
• Aponeurosis.
• Tendovaginitis.
• Osteoarthritis.
• Osteochondrosis.

Post-traumatic edema of non-skeletal tissues of the musculoskeletal system.

Pharmacodynamics

NSAIDs in the form of ointments can differ in chemical structure, but the principle of pharmacodynamics is practically identical. More than 75% of anti-inflammatory ointments with NSAIDs have an anti-peritic, analgesic effect due to their ability to suppress mediators of the inflammatory process.

The group of drugs classified as non-steroidal anti-inflammatory drugs includes such active ingredients as:

• Derivatives of salicylates are acetylsalicylic acid, mesalazine.
• Indole, indomethacin.
• Diclofenac is phenylacetic acid.
• Ibuprofen is propionic acid.
• Oxyksam - piroxicam.

Almost all of them suppress the activity and production of cyclooxygenase (COX), block the compound of prostaglandins, having a pronounced anti-inflammatory effect. In addition, inflammation is removed by reducing the permeability of the walls of small vessels and capillaries, activating local circulation, reducing the production of histamine, slowing the production of ATP. Thus, the energy supply of the inflammatory process stops, and the slowing of the production of bradykinin leads to a reduction in pain.

The apparent decrease in inflammatory symptoms is noticeable after 3 days after the start of using the ointment with NSAIDs, the anti-edematous effect is visible after 3-4 days.

Recent studies have revealed that the body produces two variants of cyclooxygenase - COX-1 and COX-2 - that are well inhibited by non-steroidal anti-inflammatory substances. These isoenzymes differ somewhat in function. TSOG-1 is responsible for the production of prostaglandins, which control the integrity and density of the deep layers of tissues, as well as for the activity of platelets, in part for microcirculation of blood. COX-2 takes a direct part in the synthesis of lipid active substances (prostaglandins), which are mediators of the inflammatory process. Thus, the pharmacodynamic properties of ointment forms of NSAIDs depend on the active substance in them is the main one and on how actively it works with COX.

There is a classification that determines the pharmacodynamics of external agents that have an anti-inflammatory effect

High degree of selectivity in relation to COX-1	Indomethacin Salicylates Ketoprofen Piroxicam
The average degree of selectivity of COX-1	Ibuprofen Diclofenac Naproxen
Moderate degree of COX-2 selectivity	Nimesulide

Pharmacokinetics

The pharmacokinetics of practically all external agents is characterized by its weak absorbing property. The degree of absorption is determined by such factors:

• Periodicity of application (2 or 4 times a day).
• Time of action of the remedy (from 30 minutes to 3 hours).
• Area, area of ointment application.
• Hydrophilicity of the active substance.
• Lipophilicity of the active component of the ointment.
• The form of the external agent - gel, ointment, emulsion, cream.

With local application of ointment (5-10% concentration), its absorption is very low and does not have a pronounced effect on internal organs and systems. Ointments containing NSAIDs slowly overcome the skin barrier, stay in the subcutaneous tissue or synovial tissue, most often there and concentrating. Possible metabolic decomposition of the main active components occurs in shallow layers of soft tissues, then in an insignificant amount in the liver, the products of biotransformation are mainly excreted by the kidney. In some studies, with the use of anti-inflammatory drugs, cases of salicylate and phenylbutazone concentration in the blood plasma have been described, but this is possible only with a long course of treatment with ointments, which in principle is not practiced with bruises.

Anti-inflammatory ointments with bruises, a list

Many ointments with an anti-inflammatory effect are based on the same active substance, but have different names, as determined by the pharmaceutical manufacturing companies. Such synonymous medicinal products may have an identical therapeutic effect, but may differ from each other in the concentration of the main active ingredient, as well as in their additional ingredients.

External means containing NSAIDs are divided into subgroups depending on the active substance:

1. Ibuprofen.
2. Salicylates.
3. Diclofenac.
4. Piroxicam.
5. Indomethacin.
6. Nimesulide.
7. Ketoprofen.

List of ointments, gels with anti-inflammatory effect:

• The Dolgit.
• Ibuprofen (gel or ointment).
• Nurofen gel.
• Artrum gel.
• Bystrumgel.
• Voltaren.
• Diklak gel.
• Diklovit.
• Dolobien gel.
• Dicloran gel.
• Diclofenac (gel, ointment).
• Indovazin.
• Nize gel.
• Nimoolite.
• Finalgel.
• Indomethacin ointment.
• Orthofen Ointment.
• Voltaren.
• Ben-Gay.
• Orthoflex ointment.
• Fastum gel.
• Deep the relic.
• Ketoprofen gel.
• Butadione ointment.
• Fibrofide.
• Piroxicam gel.
• F-gel.
• Naklofen gel.
• Ketonal Shel.
• Ultrafastin.

[5],

How to use anti-inflammatory ointments with bruises?

How to apply an ointment with an anti-inflammatory component is described either in the instructions, or in the doctor's prescription. Typically, the method of administration and dose are as follows:

• A small strip of ointment (5-10 cm) is applied to the cleared skin at the site of the injury.
• The product is rubbed into the area of damage with light massage movements.
• Ointment should be applied 2-4 times a day (depending on the form of damage) or on the appointment of a doctor.
• The course of treatment - no more than 7 days, rarely it lasts 10 days with complex combined injuries.
• If the symptomatology does not subside after the application of the remedy, atypical signs (redness, itching, swelling) appear, the ointment should be removed with a dry cloth and consult a doctor to replace the drug or carry out a diagnosis to detect a possible hidden trauma.
• If the injury is defined as extensive, severe, accompanied by intense pain, the application of an anti-inflammatory ointment is supplemented by taking oral analgesic drugs.
• When applying the ointment, make sure that it does not get on the mucous membranes of the mouth or eyes.
• Ointment with PVNP is not applied to a skin area with a diameter of more than 10-15 centimeters.

Usually, anti-inflammatory external drugs do not require procedures in the form of compresses or squeezing bandages. Air access to the site of injury after application of the ointment is desirable, since it provides a more active absorption of the agent.

Use during pregnancy

Any drug containing NSAIDs is not indicated in the therapy of pregnant women. A possible exception may be an ointment form, but even it is administered with caution, since the active active substance of the preparation can penetrate into the bloodstream and overcome the placental barrier in small amounts.

The use of many drugs during pregnancy is considered dangerous and is not recommended for use. Ointments or gels with anti-inflammatory action can be used only if their potential benefit exceeds possible risks and complications. The same principle is valid during lactation. The categorical contraindication to the application of external anti-inflammatory drugs is the third trimester of gestation, starting from the 25-26th week. A bruise in pregnant women is treated with cold, a squeezing bandage on the first day of the injury, then external means containing plant components are shown. Independent selection and application of ointments with active medicinal components during pregnancy are prohibited.

Contraindications for use

Despite the fact that external medicines are not able to completely overcome the barrier of skin, absorbed into the bloodstream and have a pronounced systemic effect, they have their contraindications for use. Depending on the main active substance, contraindications may be as follows:

1. Diclofenac:
   • Diseases of the blood, a violation of the process of hematopoiesis.
   • With caution in exacerbating the YaBZ (peptic ulcer disease), especially with prolonged use of the ointment.
   • Wounds, scratches, cuts.
   • Eczema, dermatitis.
   • Pregnancy and the period of breastfeeding.
   • Age to 5-6 years.
   • Individual intolerance to diclofenac.
2. Ibuprofen:
   • Intolerance to salicylates, "aspirin" asthma.
   • Exacerbation of liver disease, kidney.
   • Exacerbation of the gastrointestinal tract.
   • Age is up to 10 years.
   • An allergy in history, hives.
   • Violation of the integrity of the skin, wounds, scratches.
   • With caution in allergic rhinitis.
   • Pregnancy and lactation.
3. Indomethacin:
   • Diseases of the central nervous system (CNS).
   • Exacerbation of diseases of the digestive tract, kidney or liver.
   • Children under 10 years.
   • Pregnancy and lactation.
   • Inflammatory process of infectious etiology.
4. Ketoprofen:
   • Infected wounds.
   • Dermatitis.
   • Eczema.
   • Children under 12 years.
   • Individual intolerance to ketoprofen.
   • During pregnancy or lactation only on strict indications.
5. Nimesulide:
   • Age to 2 years.
   • Pregnancy, lactation.
   • Infectious diseases of the skin.
   • Dermatitis.
   • Wounds, cuts, scratches.
6. Piroxicam:
   • Obviously renal failure.
   • Children under 12 years.
   • Pregnancy.
   • Lability of the circulatory system, with caution in the face.
   • Lactation.
   • Individual intolerance of piroxicam.

Any gel, ointment containing NSAIDs should be used with caution, preferably on the advice of a doctor or pharmacist.

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Side effects

Virtually all non-steroidal anti-inflammatory drugs, regardless of their form, have side effects of varying severity. Ointments, gels in connection with their specific form and external application are considered the safest way to neutralize local inflammation in soft tissues, so their side effects are less pronounced and can be: •

• NSAID-gastropathy provided long-term use (more than 14 days).
• Exacerbation of symptoms in renal failure due to a certain degree of inhibition of renal cyclooxygenase.
• Bronchospasm.
• Edema at the site of application.
• Itching itch.
• Hyperemia in the area of injury.
• Rash.
• Hives.
• Rarely - angioedema.

The most common side effects occur when applying an ointment containing salicylates and dimethyl sulfoxide, the most rare complication in the use of external agents with NSAIDs is an immediate allergic reaction (Quincke's edema).

Overdose

Overdosing the application of an ointment containing an anti-inflammatory component is almost impossible. The drug slowly penetrates into the subcutaneous tissue, does not enter the bloodstream, so its overdose is unlikely and does not occur in clinical practice. The likelihood that an anti-inflammatory ointment can have a side effect is possible only in the case of an excessively thick layer when applied to the skin, as well as for too frequent or prolonged use of the drug - more than 4 times a day and use more than 2 weeks. It should be remembered that many gels, ointments do not combine with each other, so the external drug with NSAIDs should be applied separately or 2-3 hours after the application of another drug substance.

Interactions with other drugs

It is not recommended to experiment independently with the combination and combination of all kinds of external means. Anti-inflammatory ointments, as a rule, are prescribed one day after the injury, in the first days, cold and a compressive bandage are shown. In addition, interaction with other drugs is due to the crossing of active substances, at which an allergic reaction of an immediate type can develop, at best, the drug will not work or will have low activity, at worst, side effects and complications are possible.

There are also positive aspects of the interaction of NSAIDs with other drugs:

1. Means containing diclofenac:
   • With menthol - intensifies the irritating, cooling and analgesic effect.
   • With salicylates - activation of anti-inflammatory action.
2. Ibuprofen with caffeine - an increase in the analgesic effect.
3. Indomethacin with a routine, trokserutinom - strengthening of anti-edematous effect and angioprotective action in a zone of damage.

It should be noted that many ointments that remove inflammation are not combined with ultraviolet radiation, so after their application, you can not sunbathe, visit the solarium, even after the course of treatment for 14 days.

Storage conditions

Pharmaceutical manufacturing companies always indicate the storage conditions of the drug on the factory packaging. Cream, ointment, gel is a form of medicine that requires storage at room temperature (not above 20 degrees Celsius). If the ointment consists of several components, it includes menthol, it is possible to store the drug in the refrigerator. Gels, emulsions with NSAIDs should be kept in a dark, dry place to avoid disruption of consistency, ointments are also sensitive to heat and sunlight. Rule number 1 - to keep medicines in any form, be it pills or ointment, in a zone inaccessible to children, is mandatory.

Shelf life

The following information should be indicated on the factory packaging of the ointment:

• Name of the product, its active substance and other components.
• The name of the manufacturer, the country where the drug is manufactured.
• Series and date of release.
• The amount of the drug in grams.
• Method of application of the preparation.
• Shelf life and date of the final sale.
• Precautions when using drugs.
• Conditions for leave, sale - OTC or prescription drug.

The shelf life of anti-inflammatory ointments should not exceed 3 years. Unused timely preparation should be disposed of, its application can cause side effects or complications.

Anti-inflammatory ointments with bruises are widely used not only in medical practice, but also as a method of self-treatment of mild trauma. Such a great popularity of outdoor products that relieve local inflammation is due to many factors, including therapeutic effectiveness and the opportunity to purchase an ointment without a doctor's prescription, practically in any pharmacy in any locality. In addition, the patient always has the opportunity to choose a remedy, as they say "by wallet," the modern pharmaceutical industry provides a lot of analogs. The main thing is that an ointment with anti-inflammatory action helps to quickly cope with the pain and other discomfort manifestations of the injury.