NSAIDs and Novalgin® - are they compatible?


Non-steroidal anti-inflammatory drugs or non-steroidal anti-inflammatory drugs (NSAIDs) are drugs that relieve symptoms of inflammatory processes such as pain, relieve swelling and, to varying degrees, lower fever.

As pain relievers, NSAIDs are initially included in the group of non-opioid analgesics. This means that non-steroidal anti-inflammatory drugs (NSAIDs) develop their analgesic effects by suppressing biochemical processes and not, like the group of opioids, cause pain inhibition at the opioid receptors in the body.

NSAIDs are not only pain-relieving (analgesic) but also anti-inflammatory (anti-inflammatory). They are therefore often used in rheumatism therapy (anti-inflammatory drugs) and belong to the group of anti-inflammatory drugs (non-steroidal) that do not belong to the steroid hormones. In contrast, cortisol and cortisol-like drugs are known as steroidal anti-inflammatory drugs.

The mechanism of action of non-opioid analgesics is not uniform. Most non-opioid analgesics work by blocking the synthesis of inflammatory tissue hormones (Prostaglandins) that are formed when tissue is damaged.
These tissue hormones are formed by certain enzymes, the so-called Cyclooxygenases (COX), which are divided into a COX-1 and a COX-2.

The substances that are classically known as nonsteroidal anti-inflammatory drugs (NSAIDs) are acids that accumulate and act particularly in inflamed tissue. These acidic anti-inflammatory analgesics include, for example, acetylsalicylic acid (e.g. Aspirin®, ASS-ratiopharm®), diclofenac (e.g. Voltaren®, Diclofenac-ratiopharm®) and ibuprofen (e.g. Nurofen®, Ibu-Hexal®).

Novalgin® with the active ingredient Metamizole on the other hand belongs to the group of non-acidic anti-inflammatory analgesics.
In contrast to the acidic NSAIDs, these are largely distributed evenly in the body and hardly accumulate in inflamed tissue. This makes the non-acidic anti-inflammatory analgesics good for therapy independent of inflammation Pain (e.g. after surgery, injuries or Tumor pain) suitable.

These active ingredients are also very good for pain and fever can be used, but an anti-inflammatory effect is not to be expected in therapeutic doses. In addition, the undesirable effects of acidic analgesics (such as Asprin® and co.) On the kidney like acute and chronic Kidney failure not to be expected with the non-acidic pain relievers. These non-acidic analgesics include coxibs (e.g. Celebrex®), paracetamol (e.g. Perfalgan®) and metamizole (Novalgin®).

Mechanism of action

Novalgin® is mainly used for fever.

The exact mechanism of action of Novalgin® has not yet been conclusively clarified, but like NSAIDs it seems to work by inhibiting the enzymes COX-1 and COX-2 (cyclooxygenases).
In contrast to NSAIDs, Novalgin® appears to be im central nervous system to directly influence the perception of pain, as the active ingredient is partly also in the Spinal cord and ins brain can penetrate.

The active ingredient metamizole in the drug Novalgin® has, in contrast to the classic nonsteroidal anti-inflammatory drugs (NSAIDs), an additional one antispasmodic (spasmolytic) effect. For this reason, Novalgin® is often used in pain therapy Colic the biliary and urinary tract used.

Side effects

An advantage of using Novalgin® in contrast to typical NSAIDs (such as acetylsalicylic acid) is that it is very well tolerated by the stomach and Stomach ulcers (Ulcers) practically never occur.
Stronger ones, however, are more common Drops in blood pressure if the injection is too fast.
A Side effect of Novalgin® is the so-called Agranulocytosis. This is a dangerous disruption of the white blood cells (more precisely: the granulocytes) in the bone marrow.
Symptoms of agranulocytosis can be fever, chills, local and later generalized Infections (Sepsis).
The frequency of agranulocytosis when Novalgin® is administered is, however, controversial; it appears to be a very rare complication.
Overall, Novalgin® seems to be even better tolerated than the more frequently used non-steroidal ones Anti-inflammatories (NSAIDs). Even so, Novalgin® is due to the risk of developing agranulocytosis in some countries not allowed among others in Sweden, England and the USA. In Germany, Austria, Switzerland and other countries, Novalgin® and the active ingredient metamizole are used very often, especially for colic-related pain. Novalgin® is in Germany prescription only.

Novalgin® is the most powerful pain reliever drug among the weak painkillers (i.e. the non-opioid analgesics). If other weaker drugs like NSAIDs or Paracetamol inadequate or cannot be used, Novalgin® is a proven pain reliever.

Interaction between Novalgin® and NSAIDs

Novalgin® is a drug with the active ingredient Metamizole. Novalgin® belongs to the group of Pyrazolones, Which pain reliever and antipyretic Act. Metamizole, thus also Novalgin®, is prescription only and may only be taken under medical advice. NSAIDs or non-steroidal anti-inflammatory drugs are also drugs anti-inflammatory and antipyretic Have an effect. They belong to the group of Non-opioid analgesics. The group of NSAID drugs includes among others aspirin, Ibuprofen and Diclofenac.

Of the Active ingredient des Novalgins®, Metamizol, is a non-selective cyclooxygenase inhibitor. It has an inhibiting effect on them Prostaglandin synthesis. Prostaglandins play an important role in the mediation of pain and the transmission of hormones.

aspirin, which belongs to the NSAIDs, has as Active ingredient acetylsalicylic acid or ASS called. The effect of the ASS is similar to that of metamizole on one irreversible inhibition of cyclooxygenases. ASA also inhibits the formation of Thromboxane what leads to the Reduced risk of developing thrombosis. This antithrombotic effect is mainly used in the elderly and for Heart attack prophylaxis utilized.

Metamizole is common at acute and chronic pain used. Chronic pain in particular often occurs in patients with a Comorbidity (additional occurrence of diseases to an underlying disease) or patients in advanced age on . These often also instruct increased cardiovascular problem and are often in long-term treatment with ASA.

Since both the Active ingredient metamizole and ASA act on the cyclooxygenases, it can come to that Novalgin® the binding of ASA prevents platelet COX-1 (cyclooxygenase). As episode can the Inhibition of platelet aggregation of aspirin can be completely inhibited or reduced, what does aspirin mean no secured thrombosis prophylaxis represents more. You should be careful with the Taking of Novalgin® if you've ever been a intolerance to other pain relievers such as diclofenac or ibuprofen. You should get the Taking of Novalgin® interrupt immediately as soon as you have a Agranulocytosis (Reduction of white blood cells) or one Thrombocytopenia (Decrease in blood platelets) occurs.

Dosage forms

Novalgin® is available in various dosage forms as tablet, Effervescent tablet, Drops, Suppositories and Solution for injection for administration into the vein (intravenous) or into the muscle (intramuscular).