medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-1-46-50medsovet-2897Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYБезопасность использования мелоксикама в клинической практикеSafe use of meloxicam in clinical practiceСасЕ. И.SasE. I.

д.м.н., профессор 2-й кафедры (терапии усовершенствования врачей) Федерального государственного бюджетного военного образовательного учреждения высшего образования «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской Федерации

Dr. of Sci. (Med), Professor of the 2nd Department (Therapy of Advanced Medical Education) of the Federal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defence of the Russian Federation

doctorsas@rambler.ruГриневичВ. Б.GrinevichV. B.

д.м.н., профессор, заведующий 2-й кафедрой (терапии усовершенствования врачей) Федерального государственного бюджетного военного образовательного учреждения высшего образования «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской Федерации

Dr. of Sci. (Med), Professor, Head of the 2nd Department (Therapy of Advanced Medical Education) of the Federal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defense of the Russian Federation

grinevich_vb@mail.ruФедеральное государственное бюджетное военное образовательное учреждение высшего образования «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской Федерации; Федеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный педиатрический медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defense of the Russian Federation$ Federal State Budgetary Educational Institution of Higher Education «St. Petersburg State Pediatric Medical University» of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное бюджетное военное образовательное учреждение высшего образования «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской ФедерацииРоссияFederal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defense of the Russian FederationRussian Federation201905032019014650Copyright © Сас Е.И., Гриневич В.Б., 20192019Сас Е.И., Гриневич В.Б.Sas E.I., Grinevich V.B.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2897

Нестероидные противовоспалительные препараты (НПВП) – средства терапии острой и хронической боли, связанной преимущественно с воспалительными изменениями, вследствие чего данная группа препаратов широко используется в неврологии, ревматологии, травматологии и т. д. Механизм действия препаратов связан с воздействием на циклооксигеназу-2 (ЦОГ-2) и блокадой синтеза провоспалительных простагландинов (ПГ), а также воздействием на ЦОГ-1 и подавлением синтеза цитопротективных ПГ, что определяет возможность возникновения побочных эффектов со стороны желудочно-кишечного тракта (ЖКТ). В настоящее время применение НПВП ориентировано не столько на повышение эффективности, сколько на большую их безопасность. Создание ЦОГ-2-селективных ингибиторов (мелоксикам) и ЦОГ-2-высокоселективных (коксибов) позволило при сохранении высокой эффективности значительно снизить риск осложнений со стороны ЖКТ. Так, профиль безопасности мелоксикама, преимущественно ингибирующего ЦОГ-2, оценен в целой серии исследований. В частности, два больших проспективных контролируемых исследования – MELISSA и SELECT – доказали, что мелоксикам обладает меньшей токсичностью в отношении ЖКТ, чем традиционные НПВП. Таким образом, можно сделать обоснованное заключение о высокой эффективности мелоксикама, не уступающей таковой по сравнению с неселективными НПВП, при хорошей переносимости и безопасности препарата в отношении ЖКТ.

Non-steroidal anti-inflammatory drugs (NSAIDs) – means of treatment of acute and chronic pain associated primarily with inflammatory changes, so this group of drugs is widely used in neurology, rheumatology, traumatology, etc. The mechanism of action of the drugs is associated with the effect on cyclooxygenase-2 (COG-2) and blockade of proinflammatory prostaglandins (PG) synthesis, as well as the effect on COG-1 and suppression of cytoprotective PG synthesis, which determines the possibility of side effects from the gastrointestinal tract (GIT). Now application of NPVP is focused not so much on increase of efficiency, as on their big safety. Creation of COG-2-selective inhibitors (meloxicam) and COG-2-high selective inhibitors (coxybes) allowed to reduce significantly the risk of complications from gastrointestinal tract while maintaining high efficiency. Thus, the safety profile of meloxicam, mainly inhibiting COG-2, is estimated in a whole series of studies. In particular, two large prospective controlled trials - MELISSA and SELECT - proved that meloxicam is less toxic to gastrointestinal tract than traditional NSAIDs. Thus, a reasonable conclusion can be made about the high efficacy of meloxicam, which is not inferior to that of non-selective NSAIDs, with good tolerability and safety of the drug against gastrointestinal tract.

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The authors declare that there are no conflicts of interest present.