More than once at an appointment I came across a situation where a patient without any obvious cardiovascular pathology prescribed cardiomagnyl (or thromboASS, cardio aspirin, etc.), being sure that absolutely everyone at his age (that is, “after 45 -50 years"), this is exactly the kind of prevention of cardiovascular diseases that is needed. After all, the neighbor also drinks, they say on TV that it’s necessary, and so on...
Is it really necessary?
The fact is that modern recommendations for the treatment of cardiovascular diseases (CVD) speak of the need for lifelong use of aspirin by those people who have already suffered any cardiovascular events. These include heart attack, stroke, transient ischemic attacks. As for the use of aspirin by people who do not have a history of any cardiovascular diseases, including those listed above, today the routine administration of aspirin (or other antithrombotic drugs) to such patients is not recommended due to the lack of evidence supporting First of all, the safety of such prophylaxis in this category of patients.
The most common side effect when taking aspirin is a negative effect on the gastric mucosa. Also, with its long-term use, the risk of bleeding of various localizations (gastrointestinal, hemorrhoidal, nasal, etc.) increases, and this fact cannot be neglected, because in certain situations such bleeding can become life-threatening.
In this regard, before prescribing aspirin to a patient, the doctor must assess the benefits and risks of taking it. In patients who have had a heart attack or stroke, the benefits of prophylactic aspirin have been shown to outweigh the possible risk of bleeding and are therefore recommended. And the role of aspirin in people who have no history of either one has not been fully studied. The scientific data that we have today indicate that there is no clear benefit from such prevention and, at the same time, an increased risk of bleeding of various locations. However, the issue remains poorly understood; large studies are ongoing, and we are waiting for their results.
As for patients of older age groups who have any risk factors for the development of cardiovascular diseases (arterial hypertension, high blood cholesterol, etc.), patients with diabetes mellitus, the situation is approximately the same: it has not yet been revealed that The benefit of taking aspirin outweighs the risk of bleeding in such patients, and therefore its use cannot be recommended routinely.
What are chondroprotectors
These drugs are quite expensive and need to be taken for a long time. However, medications cannot cure either shoulder arthrosis, gonarthrosis, or coxarthrosis. Their main purpose is to protect and restore articular cartilage.
There are three generations of chondroprotectors, each subsequent of which is more advanced and effective:
- 1st generation – medicines of natural origin. They are made from cartilage tissue and bone marrow of animals and fish. The most popular drugs are Alflutop, Rumalon and Arteparon.
- 2nd generation – these are synthetic monodrugs. “Structum”, “Chondroxid”, “Mukosat” are made on the basis of chondroitin sulfate, “Dona” and “Sinatra” are glucosamine.
- 3rd generation - these are complex synthetic drugs that combine chondroitin sulfate and glucosamine, for example “Teraflex”, “Arthra” or “Artron”.
There is also a 4th generation, in which chondroprotectors are combined with drugs from other groups, for example, non-steroidal anti-inflammatory drugs (Teraflex Advance).
"Teraflex" is one of the most popular third-generation chondroprotectors
Mucosat
The domestic drug mucosate (the active ingredient is chondroitin sulfate) is a regulator of metabolic processes in cartilage tissue and is used in the treatment of degenerative diseases of the spine and joints. Due to their invariably progressive nature, these diseases represent the most acute problem of modern medicine. Degenerative pathologies of the musculoskeletal system have become almost commonplace, especially among older people. To date, a whole methodological “pool” of non-surgical methods for treating these pathologies has been developed, including parenteral and intra-articular injections, taking glucocorticosteroids, mucopolysacchorides, etc. In degenerative joint diseases, the articular cartilage is primarily affected, where, as a result of metabolic disorders, a deficiency of chondroitin sulfate develops, the main polysaccharide of cartilage tissue, which supplies the cartilage with water and helps it realize its shock-absorbing function. In addition, chondroitin inhibits the activity of enzymes that have a destructive effect on cartilage and has an anti-inflammatory effect. For this reason, against the background of a lack of chondroitin, the mechanical properties of cartilage deteriorate: strength, elasticity, resistance, which leads to its inflammation and gradual destruction. In this regard, it seems quite logical to prescribe drugs from the group of chondroprotectors, which include chondroitin sulfate. And today the choice of the latter is greater than ever. But there is one critically important nuance here: the bioavailability of tableted chondroitin preparations does not exceed 10–13%. Therefore, injectable chondroprotectors, among which mucosat occupies a prominent place, are of particular importance.
The drug slows down degenerative processes and promotes the restoration of cartilage tissue, providing, along with chondroprotective and anti-inflammatory effects, also an analgesic effect. Actively involved in metabolic processes, chondroitin sulfate mucosate replaces articular chondroitin sulfate, which by this time has already experienced all the “delights” of degenerative processes occurring in cartilage, inhibits the activity of harmful enzymes, prevents the release of free oxygen radicals, and has a beneficial effect on phosphorus-calcium metabolism. Anti-inflammatory and analgesic effects are realized mainly due to the suppression of the release of pain and inflammatory mediators into the synovial fluid by synoviocytes and macrophages. At the same time, mucosate restores the reproduction of synovial fluid, normalizing the processes of cellular nutrition and providing complete lubrication of the surfaces of the joint, which makes the latter more mobile and relaxed.
As clinical and post-marketing (after the drug enters the market) studies have shown, mucosate is a non-toxic drug that practically does not cause negative side reactions. The effect of taking the drug can be fully felt already 2-3 weeks from the start of chondroprotective pharmacotherapy. It is also important that the therapeutic effect obtained during treatment is stable and persists for a long period of time after discontinuation of the drug (about 3-6 months). Mucosat is administered intramuscularly, 1 ml every second day. If well tolerated, the dose can be doubled (usually after 4 injections). The course of treatment includes 25-30 injections with the possibility of repeating the course after six months.
What are synovial fluid grafts?
Synovial fluid prostheses are drugs with a completely different effect. They do not affect chondrocytes in articular cartilage and do not restore cartilage, as the manufacturers of chondroprotectors promise us. These medications:
- are injected into the joint and replenish the deficiency of synovial fluid, which acts as a lubricant;
- normalize the viscosity of the joint fluid and thereby improve its shock-absorbing properties;
- push mechanically rubbing surfaces apart and stop painful sensations almost immediately after insertion.
Most synovial fluid prostheses are made based on hyaluronic acid, which is native to our body. It remains inside the joint for 6-12 months and gives exactly this result, after which the course of injections must be repeated.
Synthetic drugs based on polymers, for example polyacrylamide Noltrex, are more effective. It is not recognized by the body's immune system, so it remains inside longer (up to 1.5 years). Moreover, the substance is hypoallergenic and does not cause rejection reactions or side effects.
"Noltrex" is a synthetic synovial fluid prosthesis of prolonged action.
Mukosat-Belmed solution for intramuscular administration 100 mg/ml in 2 ml ampoules No. 5x2
Name
Mukosat-Belmed solution for injection, ampoules of 2 ml.
Description
A clear, colorless or slightly yellowish solution with the odor of benzyl alcohol.
Main active ingredient
Chondroitin sulfate
Release form
Solution
Dosage
100 mg/ml.
pharmachologic effect
The drug has an anti-inflammatory and analgesic effect. Suppresses the activity of enzymes that cause degradation of articular cartilage. Anti-inflammatory and analgesic effects are achieved by reducing the release of inflammatory mediators and pain factors into the synovial fluid through synoviocytes and macrophages of the synovial membrane, as well as by suppressing the secretion of leukotriene B4 and prostaglandin E2. The use of the drug prevents compression of cartilage tissue, acts as a lubricant for articular surfaces, normalizes the production of joint fluid, improves joint mobility, and helps reduce pain intensity.
Indications for use
Relief of symptoms (from mild to moderate pain), with a gradual development of the effect, with adequately diagnosed osteoarthritis of the knee, hip joints, and osteochondrosis of the spine.
Directions for use and doses
The drug is intended for intramuscular administration. Do not administer intravenously. Adults and elderly patients. The drug is administered intramuscularly, 1 ml every other day. If well tolerated, the dose is increased to 2 ml, starting with the fourth injection. The course of treatment is 25-35 injections. Repeated courses - after 6 months. Use in children. Not used in children.
Use during pregnancy and lactation
The use of the drug during pregnancy and lactation is contraindicated.
Impact on the ability to drive vehicles and other potentially dangerous mechanisms
Does not affect.
Precautionary measures
In case of allergic reactions or hemorrhages, treatment should be discontinued. To achieve a stable clinical effect, at least 25 injections of the drug Mucosat-Belmed are necessary, but the effect persists for many months after the end of the course of treatment. 1 ml of solution contains 9 mg of benzyl alcohol, which can cause poisoning and pseudoanaphylactic reactions in infants and children under 3 years of age.
Interaction with other drugs
When used in combination with non-steroidal anti-inflammatory drugs, Mucosat-Belmed allows you to reduce the dose of non-steroidal anti-inflammatory drugs. The drug enhances the effect of indirect anticoagulants, antiplatelet agents, fibrinolytics, which requires more frequent monitoring of blood coagulation parameters when used together.
Contraindications
Hypersensitivity to any of the components of the drug, tendency to bleeding, thrombophlebitis, pregnancy, lactation (breastfeeding should be stopped during treatment). Children under 15 years of age (efficacy and safety have not been established). With caution: in case of bleeding disorders, diabetes mellitus, in people with increased body weight, in patients receiving a low-salt diet, children under 18 years of age, in case of impaired renal function, in women planning pregnancy.
Compound
For one ampoule: active substance: chondroitin sulfate - 200.0 mg; excipients: benzyl alcohol, water for injection.
Overdose
The drug does not exhibit toxicity even with a significant overdose. Symptoms: allergic reactions, hemorrhages at the injection site. In case of accidental acute overdose - symptomatic treatment. All activities are carried out against the background of the withdrawal of the drug Mucosat-Belmed.
Side effect
From the skin and subcutaneous fat: there have been reports of cases of erythema, urticaria, eczema, maculopapular rash, with or without itching and/or swelling. From the gastrointestinal tract: rare cases of nausea and vomiting have been reported. From the immune system: very rare cases of angioedema have been reported. Cases of bleeding at the injection site have been reported. Reporting adverse reactions. If you experience any unwanted reactions, consult your doctor. This also applies to any side effects that are not listed in this leaflet. You can also report adverse reactions to the information database on adverse reactions (actions) to drugs, including reports of ineffectiveness of drugs identified in the state (UE “Center for Expertise and Testing in Healthcare M3 RB”, website rceth.by) . By reporting adverse reactions, you can help provide more information about the safety of the drug.
Storage conditions
In a place protected from light at a temperature not exceeding 25 ° C. Keep out of the reach of children.
Buy Mucosat-Belmed solution for intramuscular injection. 100 mg/ml in amp. 2 ml in container pack No. 5x2 in the pharmacy
Price for Mukosat-Belmed solution for intramuscular injection 100 mg/ml in amp. 2 ml in container pack No. 5x2
Instructions for use for Mucosat-Belmed solution for intramuscular injection 100 mg/ml in amp. 2 ml in container pack No. 5x2
Are chondroprotectors as effective as we are told?
According to manufacturers, chondroitin and glucosamine restore cartilage tissue in the joint and protect it from destruction. They contain components that replicate the structure of hyaline cartilage, which explains this effect. To get any results, you need to take the drugs for a long time, several months.
Many patients note that even after a long period of use, chondroprotectors did not give any result at all. This is also confirmed by x-rays, in which the size of the joint space remained the same, and sometimes decreased.
Drugs with a chondroprotective effect only help people with early stages of arthrosis. At stages 2 and 3 of coxarthrosis or gonarthrosis, there is no result from them: stronger drugs are needed. In such cases, it is advisable to undergo a course of intra-articular injections of Noltrex or decide on endoprosthetics if the joint is severely damaged and conservative treatment does not help.
Proponents of chondroprotectors often remain silent about what side effects are possible after long-term use of these drugs. Watch the video on this topic and draw your own conclusions:
What the Research Says
Over the past few years, studies have regularly appeared that confirm poor results or their complete absence in the treatment of osteoarthritis with chondroprotectors.
- In 2006, an English medical journal published data that chondroitin, glucosamine, and any combination of them were not more effective than placebo. The studies were conducted on a group of patients of 1583 people.
- In 2007, American scientists concluded that chondroitin does not provide any improvement in the symptoms of arthrosis.
- In 2010, large-scale studies were carried out on a group of patients of 3800 people, which also equated the effect of chondroprotectors to placebo.
Chondroprotectors in many countries have already been equated to placebo - they don’t work
If chondroprotectors do not give the desired effect, then is it worth spending a lot of money on them and taking pills for many months, waiting for the result? Indeed, unlike this method, intra-articular injections of synovial fluid prosthesis give an almost instant effect. They pose no health risks in the short or long term. Therefore, many doctors in developed countries no longer recommend chondroprotectors to their patients, but immediately, after confirming the diagnosis, send them for injections.
When else should you not take aspirin?
- With high blood pressure.
Because taking it may increase the risk of hemorrhagic stroke in this case. If you have hypertension, you should take aspirin only when your blood pressure is adequately controlled.
- If you suspect a stroke.
If we are dealing with a suspected stroke (a person suddenly developed severe weakness in an arm or leg, speech, motor disturbances, the corner of the mouth is drooping, he cannot smile, etc.), in no case should aspirin be given in this situation. There are no objective signs that allow one to clearly differentiate between hemorrhagic (associated with cerebral hemorrhage) and ischemic (associated with blockage of a cerebral artery by an atherosclerotic plaque) type of stroke. And if the stroke is hemorrhagic, and we give such a person aspirin, then it’s scary to imagine how it could end...
All you need to do if you suspect a person is having a stroke is to lay him in a horizontal position, try to calm him down and call an ambulance as soon as possible.
