Diclofenac ointment is a timely help in the treatment of many diseases. Ointment Diclofenac - instructions for use

Diclofenac is an ointment white color, with a slight specific odor, which is used as an analgesic and anti-inflammatory agent for people who suffer from joint pain.

It is also prescribed for those who suffer from rheumatism, traumatic bruises, sprains or tendons.

On this page you will find all the information about Diclofenac: complete instructions for use for this drug, average prices in pharmacies, complete and incomplete analogues of the drug, as well as reviews of people who have already used Diclofenac ointment. Want to leave your opinion? Please write in the comments.

Clinical and pharmacological group

NSAID for external use, a derivative of phenylacetic acid.

Terms of dispensing from pharmacies

The ointment can be bought without a prescription.

Prices

How much does diclofenac ointment cost? average price in pharmacies is at the level of 90 rubles.

Release form and composition

The drug Diclofenac for external use is available in the form of an ointment, gel. This is what the packaging looks like in the photo. The active substance of these funds is the same. When comparing drugs, note:

1. Ointment. Has concentration active substance 1% - 0.3 g per tube weighing 30 grams. The base is oily, easy to apply, does not stain clothes.
2. Gel. Produced with a saturation of 1 and 5%, it is quickly absorbed. With its use, complex treatment with the use of tablets, their dosage can be reduced. The composition with a concentration of 5% is contraindicated in violation of blood clotting.

The active ingredient, which contains the drug Diclofenac - sodium diclofenac (in Latin - diclofenac sodium). Among the components of the ointment there are auxiliary substances that provide its viscosity and medicinal qualities.

The composition of the drug includes:

• propylene glycol;
• polyethylene oxide 1500;
• dimethyl sulfoxide;
• polyethylene oxide 400.

Pharmacological effect

The use of Diclofenac ointment or gel as local remedy from pain spasms inflammatory is considered effective solution"painful issue" due to the action that the ointment has when topical application to the inflamed area:

• anti-inflammatory effect;
• analgesic action;
• anti-edematous effect.

The reliability of diclofenac-based ointments for rheumatic and joint pains is ensured by the fact that the drug acts on the focus of inflammation both at rest and during movements. Motor capabilities are significantly improved against the background of the use of the ointment because the feeling of morning stiffness in the joints is removed and the swelling disappears.

Indications for use

A wide spectrum of action of the ointment allows doctors to prescribe it for many diseases:

1) Inflammatory and degenerative diseases of the musculoskeletal system:

for the treatment of articular syndrome in rheumatism and during an exacerbation of gout;

• for treatment;
• against psoriatic arthritis;
• with osteoarthritis, radiculitis, inflammatory processes in the ligaments, tendons;
• for treatment , lumbago.

2) Post-traumatic inflammation of the musculoskeletal system, as well as soft tissues:

• for the treatment of damaged ligaments;
• with dislocations, bruises.

3) Muscle pain of non-rheumatic/rheumatic origin.

Contraindications

These funds in both forms are not used when:

• pregnancy;
• breast-feeding;
• hypersensitivity to NSAIDs in general or specifically to diclofenac sodium;
• bronchospasm in history;
• allergic reactions after taking acetylsalicylic acid and other NSAIDs previously observed;
• impaired integrity of the skin;
• childhood up to 6 years old.

As for pregnancy, Diclofenac gel, ointment are prohibited in the third trimester. In the first two, it can be used for treatment according to indications, if the benefit to the mother outweighs the risk to the fetus. But this decision is made by the doctor.

Use during pregnancy and lactation

Contraindicated in the III trimester of pregnancy due to the possibility of reducing the tone of the uterus and / or premature closure ductus arteriosus fetus.

Application in the I and II trimesters of pregnancy is possible in cases where potential benefit to the mother outweighs the potential risk to the fetus or infant.

Use during lactation ( breastfeeding) is contraindicated.

Instructions for use

The instructions for use indicate that for external use, the amount of Diclofenac ointment depends on the size of the painful area. A single dose depends on the dosage form used and the age of the patient.

Gel, ointment, spray for external use:

• Adults and children over the age of 12 years should apply the drug to the skin over the area of ​​inflammation 3-4 times / day, children aged 6 to 12 years - up to 2 times / day.
• The duration of use depends on the indications and the effectiveness of the treatment. After 2 weeks of using the drug, the patient should consult a doctor.

The transdermal patch is used in the form of applications on the skin:

• For adults, elderly patients and adolescents over 15 years of age, the patch is glued to the skin over the painful area for 24 hours. During the day, only 1 patch is allowed.
• In the treatment of soft tissue injuries, the patch is used for no more than 14 days, and in the treatment of diseases of the muscles and joints - no more than 21 days, unless there are special recommendations from the doctor.

If there is no improvement in the condition after 7 days and if you feel worse, you should consult a doctor.

Side effects

The resulting side effects depend on individual sensitivity, the size of the dose used and the duration of treatment.

Possible allergic skin reactions skin rash, burning, redness). At long-term use ointment and / or the use of large amounts, systemic side effects may occur: gastrointestinal tract(pain in epigastric region, nausea, flatulence, loss of appetite); from the central nervous system (headache, dizziness, drowsiness); from the side respiratory system(bronchospasm, systemic anaphylactic reactions, including shock), photosensitivity.

When any side effects or if an overdose is suspected, stop using the ointment and consult a doctor.

Overdose

Due to the low systemic absorption during the application of the ointment, overdose is unlikely.

special instructions

1. Apply only to undamaged areas of the skin.
2. Avoid during use long stay in the sun.
3. Avoid contact with eyes, mucous membranes or open wounds.
4. Should not be used under airtight (occlusive) dressings.
5. Caution required when applying a large number drug on large surfaces sensitive skin over an extended period of time. When used with other dosage forms of diclofenac, the total maximum daily dose should be taken into account.

drug interaction

May enhance the effect of drugs that cause photo-sensitization.

Use with caution with other drugs known to be hepatotoxic, e.g. antibiotics, antiepileptic drugs.

Clinically significant interaction with other medicinal products is unlikely due to negligible systemic absorption.

Diclofenac (diclofenac) ointment. Its properties are anti-inflammatory. Ointment for external use of white color (a yellowish tint is possible), with a slight odor, the presence of mother-of-pearl stains is possible.

The concentration of the active substance of diclofenac sodium salt 1%, which is 1 g per 100 grams. Auxiliary substances are dimethyl sulfoxide (another name for dimexide), polyethylene oxide 400 and 1500, propylene glycol, succinic acid.

Produced in aluminum tubes with a capacity of 30 g, which are placed one at a time in a cardboard box.

Indications

Diclofenac, by its properties, is indicated for use in inflammatory and degenerative diseases from the side musculoskeletal system organs:

• Namely, subtypes of arthritis: psoriatic, rheumatoid, Bechterew's disease, deforming osteoarthritis, and various;
• With rheumatic diseases of soft tissues - tendovaginitis, bursitis;
• As an anti-inflammatory agent for post-traumatic inflammation of the joints and ligaments - as a result of sprains, bruises;
• For removal pain syndrome and swelling that occurs with diseases of the muscles, spine and joints (for example, with radiculitis, osteoarthritis, with muscle pain).

Contraindications

Diclofenac ointment is contraindicated:

• If there are anamnestic data on the phenomena of bronchial obstruction, urticaria after taking acetylsalicylic acid or other NSAIDs;
• There are erosive and ulcerative lesions of the gastrointestinal tract (in the acute phase);
• During the III trimester of pregnancy;
• During the lactation period (since it is not known about the observations of the use of the drug during lactation);
• IN pediatric practice(up to 6 years);
• In case of violation of the integrity of the skin.

Diclofenac ointment should be used with caution in hepatic porphyria (especially during exacerbation), erosive and ulcerative lesions of the gastrointestinal tract according to history, severe violations of the liver and kidneys, in the presence of decompensated CHF, bronchial asthma, in the I and II trimesters of pregnancy (only after consulting a specialist) and patients over 65 years of age.

Mode of application

Ointment for external use.

For adults (in pediatrics over 12 years old), Diclofenac ointment is applied in a thin layer over the area of ​​​​inflammation 3 times a day, lightly massaging the skin. The required amount of ointment depends on the size of the painful area. A single dose of the drug is 2-4 g. Children aged 6 to 12 years should not be used more than 2 times a day, a single dose of ointment should not exceed 2 g.

After applying the ointment, wash your hands (if the hands are not the area where the ointment is applied). The duration of application depends on the indications and the observed effect. After 10 days of treatment with ointment, if self-treatment is ineffective, it is necessary to consult with your doctor.

Side effects

Side effects from the use of Diclofenac ointment can occur as local reactions: eczema, photosensitivity, contact dermatitis(redness, itching, swelling of a specific area of ​​the skin, development of vesicles, peeling).

There is a slight likelihood of systemic reactions: generalized skin rash, allergic reactions (up to Quincke's edema).

Overdose

In connection with low level absorption into the systemic circulation of the active substance of the ointment when applied to the skin makes an overdose almost impossible.

special instructions

There are a number special instructions for diclofenac ointment.

• The drug should be applied exclusively to intact skin surface, while carefully avoiding contact with open wounds.
• After application, the imposition of an occlusive dressing is not allowed.
• Diclofenac ointment should not be allowed to get into the eyes and mucous membranes.
• When applied to a large area of ​​the skin for a significant period of time, the risk of developing systemic side effects, characteristic of all NSAID formulas, increases.
• When using the ointment in conjunction with other dosage forms of the active substance (diclofenac), the maximum allowable daily dose in each case should be taken into account.
• Before using Diclofenac ointment, patients with gastric ulcer and duodenal ulcer, bronchial asthma, rhinitis, impaired liver, kidney or hematopoietic system function, as well as the simultaneous use of other NSAID formulas, should consult a healthcare professional.
• The use of Diclofenac ointment does not affect the function of driving a vehicle or working with complex mechanisms.

drug interaction

The use of Diclofenac ointment may enhance the effect of the use of drugs that cause photosensitivity. Meaningful therapeutically pharmacological interaction with others medicines not described. Do not use concomitantly with any topical preparations at the same time.

Storage conditions

The ointment is stored in refrigerators at temperatures not exceeding 15°C. Shelf life 4 years.

Analogues

In fact, diclofenac in ointment form of 1% is active substance for many ointments, the original drug is. However, there are many different manufacturers of this drug under the Diclofenac brand, sometimes the name of the company is added to the name (Diclofenac-Akos, Diclofenac-MFF, diclofenac-Akrikhin). Also analogs are ointments Ortofen, Dicloran, Diklonak, etc.

Price

The drug is released as a non-prescription drug. Prices vary greatly depending on the manufacturer and are on average from 45-50 to 250 rubles.

There are contraindications, see complete instructions. Before using Diclofenac ointment, consult a specialist!

DICLOFENAC

International non-proprietary name

diclofenac

Dosage form

Gel for external use, 5%

Compound

100 g of gel contains

active substance - diclofenac sodium 5.0 g,

Excipients: ethanol, propylene glycol, carbopol, methyl parahydroxybenzoate, trolamine, lavender oil, purified water

Description

Homogeneous, white or white with a yellowish or creamy tint gel with a specific odor

Pharmacotherapeutic group

Non-steroidal anti-inflammatory drugs (NSAIDs) for topical use. diclofenac

ATX code М02АА15

Pharmacological properties

Pharmacokinetics

The drug is used to eliminate pain and reduce swelling associated with the inflammatory process. When applied topically, it causes the weakening or disappearance of pain in the joints at rest and during movement. Reduces morning stiffness and swelling of the joints, increases range of motion.

Pharmacodynamics

The active component of the drug diclofenac is a non-steroidal anti-inflammatory drug (NSAID), which has pronounced analgesic (pain reliever) and anti-inflammatory properties. Indiscriminately inhibiting cyclooxygenase types 1 and 2, it disrupts the metabolism of arachidonic acid and the synthesis of prostaglandins, which are the main link in the development of inflammation.

Indications for use

Post-traumatic soft tissue inflammation, e.g. due to sprains, strains and bruises

Rheumatic diseases of soft tissues (tenosynovitis, bursitis, damage to periarticular tissues)

Pain and swelling associated with diseases of the muscles and joints ( rheumatoid arthritis, osteoarthritis, radiculitis, lumbago, sciatica, muscle pain rheumatic and non-rheumatic origin)

Dosage and administration

Outwardly. For adults and children over 12 years of age, the drug is applied to the skin 2-3 times a day and gently rubbed. The required amount of the drug depends on the size of the painful area. A single dose of the drug is up to 2 g (about 4 cm with a fully open neck of the tube).

After applying the drug, hands must be washed.

The duration of treatment depends on the indications and the effect noted. After 2 weeks of using the drug, you should consult your doctor.

Side effects

Often

Generalized skin rash

Rarely

Eczema, photosensitivity, contact dermatitis (itching, redness, swelling of the treated area of ​​the skin, papules, vesicles, peeling)

Very rarely

Allergic reactions (urticaria, angioedema, bronchospastic reactions)

Contraindications

Hypersensitivity to diclofenac or other components of the drug, acetylsalicylic acid or other non-steroidal anti-inflammatory drugs

Tendency to the occurrence of attacks of bronchial asthma, urticaria or acute rhinitis when using acetylsalicylic acid or other non-steroidal anti-inflammatory drugs ("aspirin" asthma)

Violation of the integrity of the skin - pregnancy (III trimester) and lactation - children's age 12 years

Drug Interactions

The drug may enhance the effect of drugs that cause photosensitivity. Clinically significant interactions with other drugs have not been described.

special instructions

Carefully: hepatic porphyria (exacerbation), erosive and ulcerative lesions of the gastrointestinal tract, severe violations of the liver and kidneys, chronic heart failure, bronchial asthma, blood clotting disorders (including hemophilia, prolongation of bleeding time, tendency to bleed), elderly age, pregnancy I and II trimester.

The gel should only be applied to intact skin, avoiding contact with open wounds. After application, an occlusive dressing should not be applied. Do not allow the drug to come into contact with the eyes and mucous membranes.

With prolonged use of large amounts of the drug, the occurrence of side effects characteristic of NSAIDs cannot be ruled out.

Features of influence medicinal product on the ability to manage vehicle or potentially dangerous mechanisms

Not identified

Overdose

Symptoms: extremely low systemic absorption active ingredients The drug when used externally makes an overdose almost impossible. In case of accidental ingestion of large amounts of ointment (more than 20 g), systemic adverse reactions characteristic of NSAIDs.

Diclofenac is a white ointment with a slight specific odor, which is used as an analgesic and anti-inflammatory agent for people who suffer from joint pain. It is also prescribed for those who suffer from rheumatism, traumatic bruises, sprains or tendons.

Instructions for use

Instructions for use Diclofenac ointment is quite simple. This drug should be applied to the inflamed area with a very thin layer, while gently massaging it. After that, it is not necessary to apply an occlusive dressing. You should also make sure that the ointment does not get into the eyes.

The use of Diclofenac ointment does not guarantee the complete elimination of pain!

For more accurate use and dosages, as well as the duration of treatment with this drug, you can learn from the instructions for use of Diclofenac gel, or consult your doctor about this.

Indications for use

Diclofenac gel is indicated for people who suffer from:

• Arthrosis, arthritis of the knee, ankle, hip joints;
• Viral and bacterial conjunctivitis;
• sports injuries;
• Stretching and bruising of the muscles and ligamentous apparatus;
• Deforming osteoarthritis.

Diclofenac is prescribed as an anti-inflammatory and analgesic drug. Before using it, you should consult and consult with your doctor to confirm the indications for the use of Diclofenac.

Contraindications for use

This drug contraindicated in people who are pregnant or breastfeeding, suffer from chronic liver disease, or kidney failure, peptic ulcer duodenum and stomach, blood diseases. As well as children under six years of age, and in violation of the integrity of the skin. There are other reasons why this ointment should not be used. These include chronic illness respiratory tract, bronchial asthma and hematopoietic disorders.

Side effect

The drug is well tolerated, but side effects sometimes appear. These include irritation of the skin - itching, redness, satiation, itching. Headache, nausea, dizziness, discomfort in the epigastric region, diarrhea. With such side effects, you should reduce the dose and consult your doctor. But data side effects occur very rarely.

Among the side effects can be identified - itching, rash, redness!

special instructions

Diclofenac ointment should only be applied to intact skin, avoiding contact with open wounds. When using this gel with other dosage forms of Diclofenac, do not forget to take into account the maximum dose that is acceptable for a person per day.
Remember that when applying Diclofenac gel to large areas of the skin, the risk of side effects that are characteristic of NSAIDs increases.

Dosing of the drug

This drug is not recommended for children under six years of age. For adults and children over twelve years of age, apply the drug in a thin layer on the damaged joint or over the focus of inflammation no more than three to four times a day, gently massaging. Children from six to twelve years of age should apply the gel no more than twice a day. A single dose of the drug should not exceed two grams.
After applying the drug, be sure to wash your hands thoroughly. If the use of Diclofenac gel exceeds the maximum available time (more than fourteen days), you should consult your doctor.

The price of the drug

The price of Diclofenac ointment is very affordable for ordinary people. Its cost is about forty rubles. It may be slightly different from the prices in pharmacies, it depends on where you live.

Diclofenac ointment can easily help you get rid of muscle and joint pain that so often haunts almost all people, especially in old age. Pain in inflammatory processes may differ in kind. They can be either long-term or short-term. No matter what kind of pain is inherent in a person, it reduces him propulsion system and makes it very difficult to live a normal life. These pains need to be fought, and the sooner you start treating this ailment, the better. In this case, Diclofenac ointment can help you. This drug, interacting with the site of the lesion, significantly reduces pain, which are caused inflammatory processes and also eliminates swelling and hyperemia of tissues.

If you apply the ointment in the evening, then by morning the swelling will almost completely subside, the pain will not be so sharp.

Diclofenac ointment will help get rid of pain in musculoskeletal system, which are typical for athletes, the elderly, and for those who have simply undergone physical activity.

Why endure pain that depresses and does not allow you to enjoy life, if you can just buy an ointment that will help you get rid of these unpleasant factors.

Surely every person had to deal with such troubles in life as joint pain, sprains after an active workout.

Unpleasant sensations cause considerable discomfort, fettering and restricting movement, a person is deprived of the opportunity to conduct the usual, active image life. Diclofenac ointment becomes a real salvation in such situations.

Properties of Diclofenac ointment

The ointment is a derivative of phenylacetic acid and has anti-inflammatory, antipyretic and analgesic effects.

Due to the presence of special analgesic components in the ointment, after applying the product to the skin, an analgesic effect is quickly felt, swelling is also eliminated and joint mobility is restored.

Ointment Diclofenac has a number of advantages in comparison with similar drugs: quickly and well absorbed, does not leave greasy stains, has a high penetrating power.

Compound

The ointment is sold in aluminum tubes with a volume of 30 grams. One package of the drug contains:

• diclofenac sodium - 0.3 grams;
• polyethylene oxide;
• dimexide;
• propylene glycol.

The ointment is white in color, has a slight specific smell.

What diseases are indicated for use?

In diseases of a rheumatic nature, the ointment effectively eliminates discomfort in the joints. A significant improvement is felt, both at rest and in the process of movement.

With the help of the drug, you can get rid of the stiffness of movements that occurs in the morning, puffiness and restore normal motor function.

In addition, the ointment prevents the formation of substances that provoke the development of the inflammatory process.

Specialists use Diclofenac in the treatment of many diseases.

1. Inflammatory and degenerative pathologies of the musculoskeletal system:
   • articular syndrome with rheumatism;
   • exacerbation of gout;
   • arthritis;
   • osteoarthritis;
   • radiculitis;
   • inflammatory processes in ligaments and tendons;
   • sciatica;
   • lumbago.
2. Inflammatory processes of the musculoskeletal system and soft tissues caused by injuries:
   • ligament damage;
   • dislocations;
   • bruises.
3. Pain in the muscles of various origins.

Contraindications

The drug has a number of contraindications, which must be taken into account when prescribing and using:

• allergic reactions to individual components of the drug (diclofenac, acetylsalicylic acid) or ointment in general;
• bronchial asthma;
• stomach ulcer;
• peptic ulcer of the duodenum;
• rhinitis;
• pregnancy and lactation;
• children under the age of six.

How to apply the drug: instructions for use

The use of the ointment is allowed only externally. Before using the drug, you must carefully study the instructions.

The volume of ointment the size of a large cherry (four grams) is enough to treat a skin area from 400 to 800 square centimeters. Maximum daily dosage Diclofenac is eight grams.

The scheme of application of the remedy is determined individually, first of all, the area of ​​​​the painful zone is taken into account. For adults, two to four grams four times a day is acceptable. Children need two grams of ointment three to four times a day. For children aged 6 to 12 years, the number of procedures cannot exceed two times.

The ointment is applied in a thin layer, in the area of ​​​​inflammation it is important to gently rub the drug. During the day, you can apply the ointment no more than three times. After completing the procedure, hands should be washed thoroughly. If the ointment is used to treat finger joints, such as arthrosis of the fingers, you do not need to wash your hands.

The duration and treatment regimen is prescribed by the doctor individually in each case. clinical case, while the specialist controls the patient's condition, the body's reaction to the drug. However, the use of the ointment for more than two weeks is undesirable.

In order to enhance the effect, quite often doctors prescribe, in addition to the ointment, treatment with Diclofenac in other dosage forms. You should not make a decision on admission on your own, you should always consult with a specialist.

Application of ointment:

1. With bruises. In case of bruises, the ointment is used three times a day, applied directly to the site of injury. Maximum allowable single dose Diclofenac - 2 grams. The ointment eliminates pain and reduces swelling.
2. With osteochondrosis. The ointment should be applied two to four times three times a day. As a result, the functional ability of the joints and motor activity increase.
3. With sciatica and sprains. The standard scheme for applying Diclofenac to the skin: two to four grams two or three times a day. The ointment eliminates morning stiffness in movements, swelling and pain.

At long-term treatment Diclofenac may increase the activity of some liver enzymes. That is why experts recommend applying the ointment as little as possible and as rarely as possible. Do not allow the drug to get into the eyes and mucous membranes. It is strictly forbidden to apply ointment to open wounds.

Possible unwanted effects

Side effects that occur during the use of the ointment depend on certain factors:

• individual characteristics of the patient;
• degree of sensitivity to Diclofenac;
• dosages;
• duration of therapy.

Side effects are usually expressed as allergic reactions: rash on skin, itching, burning, slight redness.

More severe symptoms overdoses occur only with a long course of therapy in high doses.

1. From the gastrointestinal tract:
   • stomach ache;
   • nausea;
   • vomit;
   • loss of appetite;
   • increased flatulence.
2. From the side of the central nervous system:
   • headache;
   • dizziness;
   • feeling of sleepiness.
3. From the side of the respiratory organs:
   • bronchospasm;
   • anaphylactic shock.

With the manifestations of any, the most insignificant, side effects, it is necessary to stop treatment with Diclofenac and consult a doctor.

Diclofenac ointment during pregnancy

To date, there are no relevant clinical research that confirm or refute the safety of the drug for pregnant women. That is why the use of ointment during the period of bearing a baby is prohibited.

The ointment poses the greatest danger to later dates pregnancy (third trimester). Careless, uncontrolled use of Diclofenac can provoke early closure of the ductus arteriosus, which will lead to blood entering the lungs of the fetus, which are not yet functioning.

In addition, the use of ointment in the last stages of pregnancy leads to the suppression of labor.

Interaction with other drugs

The interaction of Diclofenac ointment with other medicines is unlikely, however, in some cases, certain complications are possible.

1. At simultaneous treatment Potassium-sparing diuretic may increase blood levels of potassium.
2. Simultaneous therapy with loop diuretics can lead to a decrease in the diuretic effect.
3. Treatment with several non-steroidal anti-inflammatory drugs increases the risk of side effects.
4. Simultaneous treatment with Diclofenac ointment and tablets leads to a significant increase in the content of lithium and digoxin in the blood plasma.

Gel or ointment, which is better

According to many experts, the gel has a more powerful analgesic and anti-inflammatory action. The gel also absorbs faster. Patients note that it is the gel that is more convenient to use.

Diclofenac gel has a higher concentration of the active substance - diclofenac. Thus, gel treatment makes it possible to exclude tablets from the therapy regimen and reduce the dose of the drug.

The photo shows: Diclofenac gel and Ortofen ointment (aka Diclofenac)

However, it cannot be unequivocally stated that the better ointments. High concentration diclofenac increases the risk of side effects and drug overdose. The gel has a longer list of contraindications, including bleeding disorders and a predisposition to bleeding.

Diclofenac gel, like ointment, is used to treat children over six years of age.

Price

The cost of Diclofenac ointment varies depending on the manufacturer and geographical point of sale.

In Moscow, a drug manufactured by Ozon, Russia can be purchased at a price of 22 rubles, and manufactured by Sintez AKOMP, Russia at a price of 37 rubles.

Analogues

Preparations based on Diclofenac:

Select the safest or most effective drug difficult, because each of them has side effects and contraindications. Only a doctor can choose an individual, most effective treatment regimen.