Movalis for the treatment of intervertebral disc herniations: effectiveness and contraindications

Movalis is the best and most effective of the meloxicam drugs. This means that all other drugs containing meloxicam as a chemical compound came later, and Movalis was the leader, or the first original drug from Boehringer Ingelheim. Movalis is highly effective for spinal hernias; it reduces pain and allows the patient to regain freedom of movement.

How does Movalis work? Does it cure a hernia or not? How should it be used, what side effects might it have, and how much does this medicine cost? These and other questions will be answered in this material. This article is written in simple language and is intended for people without medical education.

pharmachologic effect

Manufacturer: Boehringer Ingelheim, Germany
Release form: tablets and suspension for internal use, solution for intramuscular administration and rectal suppositories

Active ingredient: meloxicam

Synonyms: Artrosan, Amelotex, Movasin, Mirlox, Movix, Melox, Meloxicam-Teva, Meloxicam Stada, Melbek, Genitron and others

The medicine has antipyretic, anti-inflammatory and analgesic effects.

Movalis selectively reduces the activity of the enzyme cyclooxygenase-2, which regulates the synthesis of prostaglandins at the site of inflammation. The drug has virtually no effect on cyclooxygenase-1, which protects the gastric mucosa and regulates renal blood flow.

This selectivity explains the minimization of unwanted side effects of the drug on the stomach and kidneys, characteristic of other nonsteroidal anti-inflammatory drugs (NSAIDs).

Release form

The drug is available in:

• tablet form (active substance dosage 7.5 mg (package No. 20) and 15 mg (package No. 10 or No. 20));
• solution for injection 10 mg/ml (ampoules 1.5 ml, package No. 5);
• rectal suppositories 7.5 and 15 mg (package No. 6);
• suspension 1.5 mg/ml (100 ml bottle).

The tablets have a flat-cylindrical shape and beveled edges. One side is marked with the company logo, the other has a fault line. The color of the tablets is from pastel yellow to lemon yellow; roughness on the surface is allowed.

The solution is yellow with a greenish tint, transparent.

The suppositories are smooth, yellowish-green, and have a funnel-shaped depression at the base.

The suspension is a viscous substance of yellowish-green color.

The manufacturer does not produce external therapy products (ointment, gel).

Indications for use of Movalis

Movalis is prescribed for diseases accompanied by inflammation, fever and pain:

• osteoarthritis;
• arthrosis;
• rheumatoid arthritis;
• arthropathy;
• neuralgia;
• sciatica;
• ankylosing spondylitis;
• other inflammatory and degenerative diseases of the musculoskeletal system and musculoskeletal system.

Before you start using Movalis, you should carefully study the instructions for use. It lists in detail all contraindications and possible side effects of the drug, as well as unwanted interactions with other medications.

For example, the drug is contraindicated for stomach ulcers, severe renal, cardiac and liver failure, pregnancy, breastfeeding and other conditions of the body.

Movalis should be taken with caution in case of many diseases, for example, diabetes mellitus, peripheral artery disease, hyperlipidemia, coronary heart disease.

Caution should be used simultaneously with methotrexate and other anti-inflammatory drugs, anticoagulants, diuretics and other drugs.

Meloxicam in the treatment of chronic diseases of the musculoskeletal system

Millions of people suffer from pain in the joints and spine due to various rheumatic diseases; pain in the periarticular tissues and muscles accompanies many diseases or occurs as an independent suffering. The most common diseases associated with chronic pain syndrome are rheumatoid arthritis (RA), spondyloarthropathy (SA) and osteoarthritis (OA). At various periods of life, pain due to damage to components of the musculoskeletal system occurs in 20–45% of the world's population, more often in women than men, and in older age groups [1].

The chronic nature of the pain syndrome of most rheumatic diseases is due to the development of inflammation in the synovium of the joints due to the overproduction of a large number of proinflammatory agents, modulation of the function of immunocompetent cells and their proliferation, and the destructive action of proteases [2]. Even OA, a disease that is usually classified as degenerative joint disease, is also characterized by the development of synovitis and is an indication for the prescription of drugs that stop the inflammatory process. Pain syndrome inevitably accompanies inflammation in the joint, although its intensity does not always correlate with the severity of inflammation.

Anti-inflammatory therapy for chronic inflammatory arthropathies is carried out for a long time, since in diseases such as RA, SA, spontaneous remissions are practically absent. Therefore, patients are forced to take medications that reduce pain and inflammation for many months and years. The need for long-term therapy imposes requirements for symptomatic treatment on the rapid development of the effect, the severity of the effect, and tolerability during long-term use.

Treatment of patients with OA is complicated by the elderly age of most patients, the presence of concomitant diseases and the need for concomitant therapy. All of these factors are risk factors for the development of complications of anti-inflammatory drugs. The problem of comorbidity in OA always worries clinicians. In recent years, new data have been emerging on the frequency of concomitant pathologies in patients with diseases of the musculoskeletal system, primarily in patients with OA. According to a survey of more than 9000 patients in Serbia [3] (Fig. 1), concomitant pathology was detected in more than 60% of patients.

In a case-control study [4] conducted in the UK, when comparing the frequency of comorbidity in 11,375 patients with OA compared with 11,780 persons without OA, an increase in the frequency of OA was found: obesity by 2.25 times, gastritis by 1.98 times, phlebitis by 1.8 times, diaphragmatic hernia by 1.8 times, coronary heart disease (CHD) by 1.73 times, intestinal diverticulosis by 1.63 times. According to many authors, the most common comorbid conditions are arterial hypertension, coronary heart disease and diabetes [3–9]. On the one hand, they are well-known risk factors for intolerance to nonsteroidal anti-inflammatory drugs (NSAIDs). On the other hand, taking NSAIDs aggravates the course of arterial hypertension (AH), reduces the effectiveness of antihypertensive therapy, and can aggravate congestive heart failure (CHF) [10–13]. The increase in the frequency of NSAID-gastropathy in the elderly is well known (Fig. 2). Less covered in the literature is that taking NSAIDs doubles the risk of developing CHF and doubles the risk of hospitalization for CHF [12, 13], and in people with CHF, taking NSAIDs increases the risk of its increase by 10.5 times [ 12].

Thus, the requirements for drug therapy that can reduce the severity of inflammation and pain, taking into account the need for long-term use of drugs, are determined by the severity of the analgesic and anti-inflammatory effect and their safety.

Meloxicam, a selective cyclooxygenase-2 (COX-2) inhibitor, is widely used in medical practice. Meloxicam is a derivative of hydroxycamic acid and has a long half-life: the maximum concentration (Cmax) in plasma after taking 15 mg of the drug is reached after 7 hours, the half-life is 20–24 hours, so it is prescribed once a day at a dose of 7.5 or 15 mg, which is convenient for the patient. Meloxicam is structurally different from other COX-2 inhibitors, such as the coxibs, and binds to the top of the COX-2 channel rather than to the side of the enzyme like celecoxib. Meloxicam binds well to plasma proteins (99.5%) and easily penetrates into the synovial fluid, where its concentration is 45–57% of the plasma concentration [10].

The effectiveness of meloxicam was assessed in a number of large randomized clinical trials (RCTs) in OA (MELISSA studies, n = 9323; SELECT, n = 8656; in the USA, n = 774), RA (n = 894), ankylosing spondylitis (AS) ( n = 473) (Fig. 2, 3).

It has been shown that the effectiveness of meloxicam in the treatment of patients with OA is equal to the effectiveness of non-selective NSAIDs (diclofenac, piroxicam) [14], and the tolerability is much better [17, 18] (Fig. 4). The drug demonstrated equivalent effectiveness with non-selective NSAIDs in both RA and ankylosing spondylitis [15, 16].

Recently, a new parenteral form of meloxicam for intramuscular administration has been introduced into medical practice. The need to create this form is due to the fact that, due to the significant half-life of meloxicam, its concentration when taking the tablet form stabilizes in the patient’s blood only on days 3–4. Therefore, the parenteral form was developed to quickly relieve severe or acute pain. Pharmacokinetic studies have shown that intramuscular use of meloxicam leads to faster absorption of the drug than when administered orally; maximum plasma concentration is achieved within 1.5 hours after IM administration compared to 5–7 hours after oral administration [19]. In this case, 90% of Cmax is achieved within 30–50 minutes after injection. This increase in absorption determines the faster onset of action of meloxicam administered IM compared to oral administration (Fig. 5).

In order for IM administration to be considered as an alternative to the oral route of administration, very good local tolerability is required. However, many NSAIDs are poorly tolerated when administered intramuscularly, causing local tissue irritation and necrosis, often in combination with systemic adverse events [20]. When working on rabbits, it was shown that the local tolerability of meloxicam is better than that of other NSAIDs. After its intramuscular administration, no histopathological changes were detected, while when using piroxicam or diclofenac, a large area of ​​necrosis developed.

The advantage of using the IM form of meloxicam compared to the tablet form has been demonstrated in RA [20, 21], OA [21], and lumbar ischialgia syndrome [22]. A Russian multicenter study examining the effectiveness of the intramuscular form of meloxicam in the treatment of 670 patients with joint pathology (OA - 384 patients and RA - 286 patients) showed that the effect when meloxicam is administered into the muscle develops in most patients within the first hour after 1- injection, increases during the first three days and then continues to increase when switching to the oral form, so that by the end of the course of treatment, a significant decrease in pain (at rest and with movement) and improvement in function were obtained (Fig. 6).

This step-by-step method of prescribing meloxicam - intramuscular injection of the drug for three days and subsequent switching to tablet form can be especially useful in the treatment of arthrosis of the intervertebral joints and other causes of back pain (osteochondrosis), where the severity and severity of pain can be much greater than in OA of peripheral joints. When comparing the effectiveness and tolerability of parenteral forms of meloxicam and piroxicam in the treatment of acute pain in the shoulder joint in 599 patients, after 7 days the degree of pain reduction was equal in both groups of patients. However, meloxicam had a faster onset of action: in the first 3 days of therapy, pain decreased with injections of 7.5–15 mg of meloxicam in more patients than among those receiving injections of 20 mg of piroxicam [23].

This is explained by differences in the pharmacokinetics of these two drugs (meloxicam reaches stable plasma concentrations after 3–4 days, and piroxicam after 7–10 days). It should be borne in mind that piroxicam is one of the most poorly tolerated NSAIDs, the use of which in old age in patients with OA is highly undesirable, therefore piroxicam is usually used in the treatment of young people who do not have concomitant pathologies. A rapid reduction in spontaneous pain and pain during movement occurs when using the parenteral form of meloxicam in the treatment of exacerbation of lumbar ischialgic syndrome (radiculopathy, myofascial and muscletonic disorders) [22], when the speed of development of the effect is necessary not only because of the severity of pain, but also to prevent the development of the effect “secondary hyperalgesia” and chronicity of the pathological process. The administration of meloxicam intramuscularly made it possible to achieve a reduction in spontaneous pain by approximately 2 times 1 hour after the 1st injection, and pain during movement by more than 2 times, and after the 3rd injection by 77% and 78%, respectively.

The safety of meloxicam in the treatment of major rheumatological diseases of the joints and spine was assessed in a 1999 meta-analysis [24], which included data from 10 studies (Fig. 7).

According to a meta-analysis of the results of 10 published studies, meloxicam had advantages over diclofenac, piroxicam and naproxen:

• in terms of the number of complications from the gastrointestinal tract: risk reduction by ~36%;
• in terms of the frequency of withdrawal due to complications from the gastrointestinal tract: risk reduction by ~41%;
• in terms of the frequency of perforations, ulcers, bleeding from the upper gastrointestinal tract: risk reduction by ~ 48%;
• in terms of the incidence of dyspepsia: risk reduction by ~27%.

Randomized clinical trials have shown the high safety of meloxicam. Over the past decade, extensive experience has been gained in the use of meloxicam in real clinical practice, when treatment is carried out on patients of all ages, with concomitant and sometimes severe diseases, and receiving various medications, which complicates the implementation of analgesic and anti-inflammatory therapy.

Presented by Zeidler H. et al. [25] data on the results of treatment of 13,307 patients with joint pathology in routine medical practice in Germany make it possible to assess the place of meloxicam in the opinion of 2,155 doctors. The majority of patients (60%) received other NSAIDs before prescribing meloxicam: in 43.2% of cases their prescription was not effective, and in every 5th patient it was intolerable. In this group of patients, the frequency of adverse reactions leading to drug discontinuation when taking meloxicam 7.5 mg/day was 0.7% and 15 mg/day - 0.6%; the development of complicated gastrointestinal ulcers was noted in 2 out of 8652 patients receiving meloxicam 7.5 mg/day, and in another 2 out of 4448 patients with a daily dose of meloxicam 15 mg. Let us recall that the use of non-selective NSAIDs leads to the development of ulcers of the upper gastrointestinal tract in 12–19% of cases, and complicated ulcers in approximately 0.4% of cases [26]. Moreover, in many patients (up to 80%), the occurrence of ulcerative damage to the gastrointestinal mucosa occurs painlessly [26], which prevents the timely administration of gastroprotective therapy.

In a pharmacoeconomic study of the safety of meloxicam in patients with risk factors for the development of NSAID gastropathy, compared with other NSAIDs [27], obvious evidence was obtained of significantly better tolerability of meloxicam (Table 1),

including the frequency of bleeding from the upper gastrointestinal tract (Fig. 8).

The problems of NSAID gastropathy are quite often discussed in the literature. Data on kidney complications are less frequently reported. Non-selective NSAIDs cause a decrease in the level of renal prostaglandins, which leads to impaired Na excretion, fluid retention, development of arterial hypertension or worsening of its course. At the same time, the effectiveness of antihypertensive drugs decreases, which dictates the need for careful monitoring of blood pressure and dose adjustment of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and diuretics. According to the results of pathological and anatomical studies, interstitial nephritis is observed in 60–100% of patients with RA who are forced to take full therapeutic doses of non-selective NSAIDs for years.

The development of acute renal failure (ARF) is possible. A thorough analysis of the risk of developing acute renal failure in elderly patients was carried out in the USA [28]. According to the program for assessing the effectiveness and safety of drugs prescribed between 1999 and 2004. in persons over 65 years of age, the side effects of NSAIDs were assessed when taken for 6 months or more. Patients receiving two NSAIDs simultaneously were excluded from the study. Of 183,446 patients with a mean age of 78 years, AKI leading to hospitalization occurred in 870 patients. The most common NSAID prescribed to this group of patients was celecoxib, which was taken by every third patient. In table Table 2 shows the relative risk and 95% confidence interval of the development of acute renal failure when taking various NSAIDs in comparison with celecoxib.

A significant increase in the risk of developing acute renal failure by 50% and 100% was obtained for ibuprofen and indomethacin, respectively. The table shows that meloxicam has the lowest risk of developing acute renal failure among the selective and non-selective NSAIDs analyzed.

Both of these summaries are of undoubted interest to clinicians, since they are based not on the results of scientific research, but on the basis of reports from practicing physicians.

In recent years, another aspect of the safety of NSAIDs has been discussed - the possibility of aggravating the course of cardiovascular diseases. Theoretically, the increase in thrombogenic risk of selective cyclooxygenase type 2 inhibitors may be due to their inhibition of prostaglandin-I2 (“antithrombogenic” prostaglandin), a relative increase in the synthesis of thromboxane A2 (“thrombogenic” prostaglandin) when used in patients with RA or systemic lupus erythematosus, that is for diseases in which the risk of thrombosis is increased. Following evidence of a slight increase in the risk of cardiovascular disease with rofecoxib [29], a number of additional studies have been conducted on the effects of NSAIDs on cardiovascular function.

In 2001, the results of a meta-analysis of the results of treatment with meloxicam in 27,000 patients were reported [30]. According to these data, the incidence of cardiovascular adverse reactions during treatment with meloxicam was not higher than when using non-selective NSAIDs. There is a report of a trial study of the use of meloxicam 15 mg intravenously for acute coronary syndrome in 60 patients receiving standard treatment with Aspirin and Heparin, compared with 60 patients receiving the same doses of Aspirin and Heparin without meloxicam. It turned out that the addition of meloxicam to standard therapy when assessing the outcome of acute coronary syndrome (angina recurrence, myocardial infarction (MI) or death) led to a decrease in the frequency of negative outcomes from 38.3% to 15% during hospital stay and from 48. 3% to 26.7% 90 days after treatment [31].

The risk of developing acute myocardial infarction with selective and non-selective NSAIDs was assessed in three populations in three countries (UK, Canada and USA) [32]. The aim of the study was to evaluate the risk of MI in patients taking COX-2 inhibitors, meloxicam and other NSAIDs compared with diclofenac; check the comparability of data for three populations; A total of 60,473 NSAID-treated cases and 248,768 control cases were analyzed. The following results were obtained:

• Meloxicam was associated with a reduced risk of MI in one cohort, but no effect was found in two cohorts (although the relative risk was reduced in both studies).
• In one cohort, naproxen was associated with a reduced risk of MI, and in two, the risk was slightly increased.
• In two cohorts, the risk of MI was slightly increased with rofecoxib compared with diclofenac.
• In one cohort, a small increase in risk was found for ibuprofen compared with diclofenac.
• No differences were found between celecoxib and diclofenac.
• In the GPRD (UK), no significant differences were found, although the relative risk for meloxicam was below 1.0 and for naproxen it was slightly increased.
• The RAMQ (Canada) found a small statistically significant increase in risk with rofecoxib and a decrease in risk with meloxicam and naproxen.
• The US VA found a small but statistically significant increase in risk for rofecoxib, naproxen and ibuprofen and a decrease in risk for meloxicam.

The risk of developing MI in patients with current use of prescription NSAIDs (meloxicam, celecoxib and rofecoxib) compared with current use of diclofenac is presented in

.

Thus, according to the results of RCTs and post-registration studies of meloxicam:

• Its distinct analgesic and anti-inflammatory activity has been revealed in chronic diseases of the joints and spine, as well as in acute pain syndromes (lumbar ischialgia).
• High gastrointestinal tolerability, previously identified in double-blind controlled studies, was confirmed based on the results of real clinical practice in the treatment of many thousands of patient cohorts.
• Large-scale pharmacoepidemiological studies confirm the low risk of severe gastrointestinal side effects previously established in controlled clinical trials and meta-analysis.
• There was no increase in the incidence of cardiovascular toxicity.

These data are confirmed by the IMPROVE study [33], which assessed the “therapeutic success” of meloxicam in OA. The endpoints used to assess “therapeutic success” were: completion of the study without switching to another NSAID, or completion of the study and no need to take an NSAID. Meloxicam was prescribed to 662 patients and other NSAIDs to 647 patients. The end point was reached by 67% of the group of patients taking meloxicam and 45% of patients from the comparison group (p < 0.0005) (Fig. 9).

Treatment cancellation due to adverse reactions occurred in 12% and 20% of patients, respectively, and due to lack of effect - in 16% and 28% of patients. Patients' adherence to taking meloxicam indicates the high effectiveness of this drug.

Literature

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10. Warksman JC Nonselective nonsteroidal anti-inflammatory drugs and cardiovascular risk: are they safe- // Ann. Rharmacother. 2007, 41: 1163–1173.
11. Savenkov M.P., Brodskaya S.A., Ivanov S.N., Sudakova N.I. Effect of non-steroidal anti-inflammatory drugs on the antihypertensive effect of ACE inhibitors // Breast Cancer. 203, No. 19: 1056–1059.
12. Page J., Henry D. Consumption of NSAIDs and the development of congestive heart failure in elderly patients // Arch. Int. Med. 2000, 160: 777–784.
13. Heerdink ER, Leufkens HG, Herings RMC et al. NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics // Arch. Int. Med. 1998, 158: 1108–1112.
14. Yocum D., Fleischmann R., Dalgin P. et al. Safety and efficacy of meloxicam in the treatment of osteoarthritis: a 12-week, double-blind, multiple doses, placebo-controlled trial. The Meloxicam Osteoarthritis Investigators // Arch. Int. Med. 2000. V. 160. P. 2947–2954.
15. Lemmel EM Efficacy of meloxicam in the treatment of rheumatoid arthritis: a 12-week, double-blind, placebo-controlled trial // J. Rheum. 1997, 24: 282–290.
16. Dougados M., Gueguen A., Nakache J.-P. et al. Ankylosing spondilitis: what is the optimal duration of a clinical study- A one-year versus 6-weeks nonsteroidal antiinflammatory drug trial // Rheumatology. 1999. V. 38. P. 235–244.
17. Hawkey C., Kahan A., Steinbruck K. et al. Gastrointestinal tolerance of meloxicam compared to diclofenac in osteoarthritis patients. International MELISSA Study Group. Meloxicam Large-scale International Study // J. Rheum. 1998, 37: 937–945.
18. Dekueker J., Hawkey C., Kahan A. et al. Improvement in gastrointestinal tolerance of the selective cyclooxigenase (COX)-2 inhibitor meloxicam compared with piroxicam: results of the Safety Large-scale Evaluation of COX-inhibiting Therapies (SELECT) trial in osteoarthritis // J. Rheum. 1998, 37: 946–951.
19. Davies NM, Skjodt NM Clinical pharmacokinetics of meloxicam: a cyclo-oxygenase-2 preferential nonsteroidal anti-inflammatory drug // Clin. Pharmacokinet. 1999, V. 36: 115–126.
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N. V. Chichasova , Doctor of Medical Sciences, Professor

Research Institute of Rheumatology RAMS , Moscow

Contact information about the author for correspondence

Movalis - instructions for use

Movalis is used before or after meals orally, intramuscularly or rectally 1 time per day. A single dose, depending on the type and degree of the disease, as well as the age of the patient, varies from 7.5 to 15 mg.

When using different forms of the drug on the same day, the daily dose should not exceed 15 mg.

The solution for intramuscular use is approved from 18 years of age. Tablets, suspension and suppositories can be used from the age of 12. In exceptional cases, up to 12 years of age, Movalis can be used in the form of a suspension. The dose will depend on the child's body weight.

Movalis can be used only as prescribed by a doctor; it can be purchased in pharmacies only with a prescription.

Contraindications

The use of Movalis is prohibited in the following cases:

• active gastrointestinal bleeding, recent cerebrovascular bleeding or established diagnosis of diseases of the blood coagulation system;
• concomitant therapy with anticoagulants, because there is a risk of intramuscular hematoma formation;
• severe liver failure;
• severe heart failure;
• severe renal failure (if hemodialysis is not performed, CC <30 ml/min, and also with confirmed hyperkalemia);
• active liver disease;
• erosive and ulcerative lesions of the stomach and duodenum in the acute phase or recently suffered;
• inflammatory bowel diseases (Crohn's disease or ulcerative colitis in the acute phase);
• therapy of perioperative pain during coronary artery bypass grafting;
• pregnancy;
• lactation period (breastfeeding);
• age under 18 years;
• hypersensitivity to the active substance or auxiliary components of the drug.
• hypersensitivity (including to other NSAIDs), complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose or paranasal sinuses, angioedema or urticaria caused by intolerance to acetylsalicylic acid or other NSAIDs (including a history) due to existing potential for cross-sensitivity.

Movalis should be used with caution in old age

Use with caution if you have:

• history of gastrointestinal diseases (presence of Helicobacter pylori infection);
• congestive heart failure;
• cerebrovascular diseases;
• dyslipidemia/hyperlipidemia;
• diabetes;
• peripheral arterial disease;
• renal failure (creatinine clearance 30-60 ml/min);
• IHD;
• elderly age;
• long-term use of NSAIDs;
• smoking;
• frequent drinking of alcohol;
• concomitant therapy with the following drugs: anticoagulants, oral corticosteroids, antiplatelet agents, selective serotonin reuptake inhibitors.

Contraindications for use in pediatrics:

• tablets - age up to 16 years;
• d/i solution - age up to 18 years;
• candles - age up to 12 years;
• suspension - age up to 12 years (for juvenile arthritis, the restriction for use is age up to 2 years).

Analogues of Movalis

Analogues of Movalis are drugs containing the active ingredient Meloxicam. These are its synonyms, differing only in manufacturers and excipients. In pharmacies there are analogues of Movalis in tablets, ampoules and suppositories.

Preparations with other active substances from the NSAID group are also considered substitutes for Movalis. Prices for analogues are presented in the table.

In addition to Movalis analogues, there are drugs from other pharmacological groups that have different therapeutic effects, but are used for the same diseases as a complex treatment.

Such drugs include Milgamma and Combilipen - these are B vitamins with lidocaine.

Diprospan is a corticosteroid anti-inflammatory drug, Sirdalud and Mydocalm relax the muscles around sore joints, Alflutop is a chondroprotector that stimulates the restoration of cartilage tissue.

All these drugs are not analogues; they should be used in the complex treatment of diseases of the musculoskeletal system of a degenerative and inflammatory nature.

Price

Movalis, which has a unique formula of the active substance, has a significant drawback - its high cost, so it is important to know the price level of its generics, which can now be easily ordered and purchased in the online store. The table shows information about the pharmacy chain in Moscow:

Movalis or Meloxicam – which is more effective?

Manufacturer: Kanonpharma, Dalkhimfarm, Slavyanskaya Pharmacy, Russia
Release form: tablets, solution for intramuscular injection

Active ingredient: Meloxicam

Synonyms: Artrosan, Amelotex, Movasin, Mirlox, Movix, Melox, Melbek, Genitron

Meloxicam is the main active substance contained in Movalis. The drug is not just an analogue of Movalis, it is an international non-proprietary name under which any manufacturer has the right to produce drugs. Meloxicam comes in injections and tablets.

The difference between the drugs lies in the composition of the auxiliary components. The pharmacological action and indications are the same as those of Movalis and its other synonyms (Amelotex, Artrosan, Melbek, Movasin and others).

Almost every well-known pharmaceutical manufacturing company has its own Meloxicam. Some people call it that, and some manufacturers patent their unique name for brand recognition.

Movalis is Meloxicam, produced by Boehringer Ingelheim and no one else has the right to call their Meloxicam that way.

Compound

The drug contains the active substance meloxicam , as well as the following auxiliary components:
Movalis tablets: sodium citrate, lactose monohydrate, MCC, povidone, anhydrous colloidal silicon dioxide, magnesium stearate, crospovidone.

Ingredients of the injections: meglumine, glycofurol, poloxamer 188, glycine, sodium hydroxide, sodium chloride, purified water.

Movalis suppositories: basis for the manufacture of suppositories suppositir BP, cremophor RH40 (polyethylene glycol glyceryl hydroxystearate).

Movalis suspension: colloidal silicon dioxide, hyaetellose, sorbitol , glycerol , xylitol; benzoate, saccharinate and sodium dihydrogen phosphate dihydrate; citric acid monohydrate, raspberry flavor, purified water.

Movalis or Diclofenac – which is better?

Manufacturer: Microgen, Dalkhimpharm, Biokhimik, Biosynthesis, MPZ, Russia/Kadila Pharmaceuticals, India
Release form: tablets, injection solution, suppositories, cream and gel

Active ingredient: Diclofenac

Synonyms: Voltaren, Diclak, Ortofen, Diclovit, Diclogen, Diclonate, Dicloran, Naklofen

Analogue Diclofenac is a non-steroidal anti-inflammatory drug of non-selective action.

It is produced by many Russian and foreign manufacturers under different trade names, since Diclofenac is the international non-proprietary name of the active substance. It can be used instead of Movalis in injections.

The price of Diclofenac in ampoules is ten times lower than the price of Movalis. But diclofenac negatively affects the gastric mucosa, therefore, when it is prescribed for osteochondrosis and other similar diseases, drugs are additionally prescribed that reduce the secretion of gastric juice.

Movalis or Xefocam – which is better?

Manufacturer: Takeda, Austria and Germany
Release form: tablets, lyophilisate for the preparation of injection solution

Active ingredient: Lornoxicam

Synonyms: Xefocam Rapid, Zornica, Lornoxicam Canon

The Xefocam analogue is a drug from the NSAID group; unlike Movalis, it is non-selective towards cyclooxygenase 1 and 2. It is more effective than Movalis in acute pain syndrome, but has more pronounced side effects, so it can be used for a short time. This analogue is not suitable for the treatment of chronic diseases.

Treatment of osteochondrosis with drugs

For patients with osteochondrosis in the acute period, complete rest and exclusion of any physical activity at the site of the lesion are indicated. To create a comfortable position and fix the affected area, special bandages and clamps are used. Patients with osteochondrosis in the neck area are advised to wear a special collar, which ensures the correct position of the vertebrae of the neck during treatment. In case of thoracic and lumbar osteochondrosis, the patient is prescribed rest and bed rest.

To treat osteochondrosis, take NSAID medications

Drug therapy for this disease includes taking drugs such as Diclofenac, Ketolarak and other drugs included in the NSAID group. If there is severe pain, the patient needs to take analgesics, for example, Flupirtine. If the pain is caused by severe muscle tension, the patient is prescribed drugs - muscle relaxants.

"Movalis" is a drug that is often used in the treatment of osteochondrosis.

Movalis or Arcoxia – which is more effective?

Manufacturer: Merck, Netherlands
Release form: film-coated tablets

Active ingredient: Etoricoxib

Synonyms: Bixitor, STREGA, Ethoriax, Atorica

The Movalis analogue Arcoxia is a selective cyclooxygenase-2 antagonist, that is, it acts only at the site of inflammation and does not affect the stomach, kidneys or platelets. In this regard, Arcoxia is safer than other NSAIDs.

The drug has an analogous therapeutic effect and is used for the same diseases.

What is more effective, Movalis or Arcoxia, depends on the degree of the disease. The question of replacement is decided by the doctor.

About the disease

Osteochondrosis, a disease that affects intervertebral discs and cartilage, is quite widespread today. With the development of pathology, intervertebral discs are most often affected, which makes the daily life of such patients very difficult, because the condition of the intervertebral discs determines the mobility of the ridge, flexibility, and, most importantly, the ability to withstand heavy loads. During stress on the spine, it is the discs between the vertebrae that act as shock absorbers.

The development of osteochondrosis is the cause of the presence of certain malfunctions in the human body, which together leads to the development of this pathology.

Causes.

1. Mineral metabolism in the human body is disrupted. The amount of minerals that enter the body significantly reduces the amount of substances sufficient for the body to function normally. Such failures can occur during periods of rapid and active growth, as well as in the presence of severe overloads. The cause may also be improper distribution of physical activity, or improper execution of movements: both physical exercise and everyday activities.
2. Blood circulation in the spine is impaired, which causes insufficient nutrition of the intervertebral discs. The cause of this process can be scoliosis, as well as a sedentary and sedentary lifestyle.
3. “Fraying” of intervertebral discs and the formation of intervertebral hernia.
4. Due to the prolapse of the intervertebral disc and the formation of a hernia, the vertebrae begin to fray, forming osteophytes.

Osteochondrosis can develop as a consequence of other pathologies of the spinal column

According to statistics, almost 80% of the adult population around the world suffer from a pathology such as osteochondrosis. This disease can manifest itself in adolescence or even childhood. Research shows that boys are more susceptible to this disease than girls. Almost all people over twenty years of age have osteochondrosis to a greater or lesser extent. Osteochondrosis can manifest itself not only as lower back pain, but also as pathologies of the internal organs of a person.

Types and stages of pathology

There are a large number of types of localization of this disease. Lumbosacral osteochondrosis is the most common type of this disease and occurs in every second patient with this pathology. A quarter of all cases occur with cervical osteochondrosis . Slightly more than 10% of patients experience osteochondrosis, which affects several parts of the spine at once . This form of osteochondrosis is considered the most severe and rare.

Movalis or Amelotex – which is better?

Manufacturer: Sotex, Russia
Release form: tablets, solution for intramuscular injection, rectal suppositories, gel for external use

Active ingredient: Meloxicam

Synonyms: Artrosan, Movalis, Movasin, Mirlox, Movix, Melox, Melbek, Genitron and others

An analogue of Amelotex is Meloxicam, which is produced by the domestic company Sotex. It replaces not only Movalis tablets and injections, but is also an analogue of Movalis suppositories.

Amelotex is one of the few Meloxicams produced in the form of an external gel. It has the same anti-inflammatory, analgesic and antipyretic effects.

The Amelotex analogue is used for the same inflammatory and degenerative diseases.

Mataren

The domestic drug is characterized as an excellent remedy for local pain. Ingredients: meloxicam - 30 mg, capsicum tincture - 100 g. Available only in ointment and tablet formats. It is successfully used to treat pain in joint diseases and has an anti-edematous effect. Side effects: possible allergies, skin peeling. Contraindications: violation of the integrity and inflammation of the skin, sensitivity to the elements. Comparison of original and analogue:

Movalis or Mydocalm

Manufacturer: Gedeon Richter, Hungary
Release form: tablets, injection solution

Active ingredient: Tolperisone

Synonyms: Calmirex, Tolperisone, Tolisor

Mydocalm cannot be called an analogue of Movalis, since it is a muscle relaxant. But most inflammatory and degenerative diseases of the musculoskeletal system are accompanied by severe muscle spasm. This is where the muscle relaxant effect of mydocalm can come in handy. Therefore, doctors often prescribe Mydocalm along with Movalis and its analogues.

Movalis or Artrosan - which is better?

Manufacturer: Pharmstandard, Russia
Release form: tablets, solution for intramuscular injection

Active ingredient: Meloxicam

Synonyms: Amelotex, Movasin, Mirlox, Movix, Melox, Melbek, Genitron and others

The analogue of Artrosan is Meloxicam, produced by the domestic pharmaceutical industry, that is, it is the Russian analogue of Movalis in both ampoules and tablets.

The pharmacological action and indications are the same.

According to doctors, the analogue Artrosan does not work more effectively, but it is quite possible to replace the drug with it.

Movalis or Nimesil

Manufacturer: Berlin Chemie, Germany
Release form: granules for the preparation of suspension for oral administration

Active ingredient: Nimesulide

Synonyms: Nimesulid-Teva, Nise, Nimulid, Aktasulid, Naisulid, Prolid

The German analogue of Movalis is pleasant to use, since the finished suspension has an orange taste and smell.

Nimesil, although it contains a different active ingredient, is an analogue of Movalis in terms of therapeutic effect.

The mechanism of action and indications for use are the same.

Thanks to its liquid dosage form, the Nimesil analogue acts quickly and is effective for various pains - dental, menstrual, traumatic, and also accompanying various inflammatory diseases.

During pregnancy

Like other drugs that have the ability to inhibit the activity of COX-2 and Pg, meloxicam can have a negative effect on reproductive function. When planning pregnancy, it is recommended to stop treatment with Movalis.

Suppression of Pg synthesis negatively affects the development of pregnancy and/or fetal development. In particular, when a mother takes meloxicam in early pregnancy, the risk of miscarriages, as well as the occurrence of gastroschisis and heart defects in the child, . It is believed that the likelihood of this type of disorder increases with increasing duration of treatment and dose of the drug.

In the 1st and 2nd trimesters, the prescription of Movalis is possible for health reasons, but the dose prescribed to the woman should be minimal.

In the 3rd trimester, all Pg inhibitors pose a risk to the fetus:

• cardiorespiratory toxicity;
• renal dysfunction , which can develop into renal failure with oligohydramnios .

In addition, taking the drug in the last weeks of pregnancy can increase bleeding time, develop an antiplatelet effect , inhibit uterine contractions and, as a result, delay or prolong labor.

Due to the risk of meloxicam into breast milk, Movalis is not recommended for use during breastfeeding.

Movalis or Celebrex – which is better?

Produce

l: Pfizer, USA

Release form: capsules

Active ingredient: Celecoxib

Synonyms: Dilaxa, Coxib, Simcoxib

Celebrex is one of the relatively safe analogues of Movalis from the NSAID group, due to its selectivity of action on cyclooxygenase-2.

The Celebrex analogue is used for inflammatory diseases of the musculoskeletal system and the musculoskeletal system.

It is possible to use this analogue during pregnancy if the benefit does not outweigh the risk to the fetus.

Movalis or Artoxan

Manufacturer: Rotapharm, UK
Release form: lyophilisate for the preparation of injection solution complete with solvent

Active ingredient: Tenokiscam

Synonyms: Texamen, Texared, Tikotil, Tobitil

English analogue of Movalis in injections. It also has anti-inflammatory and antipyretic effects, as well as a pronounced pain reliever.

This analogue is used for inflammatory and degenerative diseases of the musculoskeletal system.

For mild to moderate pain syndrome due to myalgia, neuralgia, sciatica, dental and menstrual pain, and injuries.

Movalis or Aertal - which is better?

Manufacturer: Gedeon Richter, Hungary
Release form: tablets, powder for suspension for internal use, cream for external use

Active ingredient: Aceclofenac

Synonyms: Alental, Aceklagin, Asinak

Analogue of Movalis in terms of therapeutic effect. It is used for the same diseases - arthritis, arthrosis, neuralgia, injuries, as an anti-inflammatory and analgesic agent.

The cream has a local anesthetic effect.

Movalis or Voltaren

Manufacturer: Novartis, Switzerland
Release form: tablets, solution for intramuscular injection, suppositories, gel for external use, transdermal patch

Active ingredient: Diclofenac

Synonyms: Diclak, Ortofen, Diclovit, Diclogen, Diclonate, Dicloran, Naklofen

An analogue of Voltaren is the Swiss Diclofenac, a non-steroidal anti-inflammatory drug, widely prescribed by doctors in a variety of dosage forms.

Voltaren injections can be used instead of Movalis, after consulting with your doctor. In terms of price, it will be cheaper, and in terms of effectiveness it should not be inferior in the analgesic and anti-inflammatory effect for diseases of the musculoskeletal system.

In addition, you can combine Movalis in tablets or ampoules with topical Voltaren in the form of a gel or transdermal patch.

Reviews about the drug

Reviews about Movalis are both positive and neutral, but the former still predominate. In most cases, this drug helped patients get rid of pain due to osteochondrosis. If this did not happen, then probably the problem was an individual intolerance to the components of this product.

In general, we can say that patients confirm the effectiveness of Movalis, therefore, its use will not be in vain.

Anton, 38 years old:

“Movalis tablets have a pronounced analgesic effect. My diagnosis is lumbar osteochondrosis. I used to inject Movalis with injections, but now I limit myself to short courses of tablets.

The price, of course, is much higher than that of drugs of this pharmacological group and there are also enough contraindications, but when you need to quickly relieve pain, I don’t know a better drug. To avoid side effects, I recommend always consulting with your doctor regarding timing and dosage. To insure my stomach, I drink it together with omez.”

Olga, 25 years old:

“One of the most well-tolerated anti-inflammatory drugs. Can be used in children and the elderly. There is also a drinking form (syrup), which is convenient when treating children and patients with swallowing disorders. True, it is expensive in comparison with drugs in this group.

It has many contraindications, like any non-steroidal anti-inflammatory drug, and therefore should be used as prescribed by a doctor.”

Review of the drug "Movalis"

Victor, 56 years old:

“I support it, it’s actually a very good drug. He quickly got me back on my feet when I had an inflamed hernia. Only three injections (one package) were enough. Of course, this is not a complete treatment, but relieving pain and inflammation during an exacerbation is the first and most important task.”

Alena, 31 years old:

“As far as I know, movalis is indicated for all kinds of arthritis, etc., but it saved me from toothache. I have excessive tooth sensitivity due to thin enamel. Clinics have tried a lot of things, including strengthening solutions and different coatings, but without much success. The doctor recommended several types of painkillers in case of severe pain with different price categories, as they say, “depending on taste and color.” In terms of price and quality, I was very pleased with Movalis. I haven’t noticed any side effects, but I only take it in emergency situations. There’s no point in getting carried away.”

Ketorol

Manufacturer: Dr. Reddis, India
Release form: tablets, solution for intravenous and intramuscular administration, gel for external use

Active ingredient: Ketorolac

Synonyms: Ketanov, Ketalgin, Ketolak, Ketocam

Ketorol is an analogue of Movalis in terms of pharmacological action and is used for severe and moderate pain syndromes of various origins. With a strong analgesic effect, the Ketorol analogue has pronounced side effects: with prolonged use it can cause stomach ulcers and internal bleeding, so it should not be used for more than 5 days.

Due to the lack of anti-inflammatory effectiveness and pronounced side effects, Ketorol, like Indomethacin or Ibuprofen, should not be used as an analogue of Movalis.

Side effects

Side effects - headache

As with therapy with other NSAIDs, while taking Movalis, there is a possibility of adverse reactions from the body:

• From the urinary system: edema, hypercreatininemia, increased urea concentration. In rare cases - interstitial nephritis, glomerulonephritis, renal medullary necrosis, nephrotic syndrome.
• From the digestive system: nausea, vomiting, belching, abdominal pain, constipation or diarrhea, flatulence, increased activity of “liver” transaminases, hyperbilirubinemia, stomatitis, erosive and ulcerative lesions of the gastrointestinal tract, gastrointestinal bleeding (hidden or obvious), perforation of the digestive tract canal, colitis, dyspepsia, gastroduodenal ulcer, esophagitis, gastritis, hepatitis.
• From the cardiovascular system: increased blood pressure, “flushes” of blood to the skin of the face and upper chest, palpitations.
• From the nervous system: dizziness, headache, drowsiness, mood lability, confusion, disorientation..
• From the hematopoietic organs: anemia, leukopenia, thrombocytopenia.
• Allergic reactions: skin rash, itching, blisters, erythema multiforme, Lyell's syndrome, bullous dermatitis, Stevens-Johnson syndrome, angioedema, hypersensitivity to UV radiation, urticaria, anaphylactoid reactions.
• Other: ringing in the ears, blurred vision, conjunctivitis.

Combination use of the drug Movalis and drugs that suppress the functioning of the bone marrow can provoke cytopenia (deficiency of one or more types of blood cells). If gastrointestinal bleeding, perforation or ulcer occurs during treatment with Movalis, this can lead to death.

When using a d/i solution, the following are possible:

• glomerular or interstitial nephritis;
• papillary necrosis;
• nephrotic syndrome;
• swelling and pain at the injection site.

Answers on questions

1. Movalis injections or tablets – which is better?

For acute pain, the injection method helps more quickly, then you can continue treatment with tablets. But if it is not possible to get an injection, you can take a pill in an acute condition, the effect will also come quite quickly.

1. Is Movalis an antibiotic or not?

No, Movalis does not contain any antibacterial components.

1. Movalis - prescription or not?

Yes, you can buy Movalis in pharmacies only with a prescription. Any replacement should be made only in consultation with your doctor.

Overdose

Acute overdose of NSAIDs is usually accompanied by lethargy, nausea, drowsiness, abdominal pain, and vomiting. With adequate supportive treatment, these symptoms are reversible.

In some cases, bleeding from the gastrointestinal tract may develop. Severe poisoning can provoke arterial hypertension , acute renal failure, liver dysfunction, respiratory depression, convulsions , coma , heart failure and cardiac arrest .

Also, the possibility of the patient developing anaphylactoid reactions cannot be excluded.

In case of an overdose of NSAIDs, symptomatic treatment is indicated for the patient. Studies have shown that taking 4 oral doses of cholestyramine twice a day allows meloxicam in the digestive canal and speed up its elimination.