Movalis: indications, instructions for use and reviews from experts

Movalis is a non-steroidal anti-inflammatory drug that has a complex effect on all manifestations of inflammation. Gives anti-inflammatory, analgesic and antipyretic effect. The drug relieves unpleasant subjective sensations, and also breaks pathogenetic chains in the development of inflammatory reactions of various origins and localization. The main mechanism of action of meloxicam on inflammatory mediators is inhibition of prostaglandin synthesis.

Release form and composition

The drug Movalis is available in the form of tablets, injection solution and rectal suppositories. Each release form is more effective for certain pathologies.

Movalis tablets 15 mg, 10 or 20 pieces - contain the active ingredient meloxicam in an amount of 15 mg, as well as excipients: lactose monohydrate - 20 mg, sodium citrate dihydrate - 30 mg, MCC (microcrystalline cellulose) - 87.3 mg, povidone K25 - 9 mg, colloidal silicon dioxide - 3 mg, crospovidone - 14 mg, magnesium stearate - 1.7 mg.

Movalis tablets 7.5 mg, 10 pieces - contain the active ingredient meloxicam in an amount of 7.5 mg, as well as excipients: lactose monohydrate - 23.5 mg, sodium citrate dihydrate - 15 mg, MCC (microcrystalline cellulose) - 102 mg, povidone K25 - 10.5 mg, colloidal silicon dioxide - 3.5 mg, crospovidone - 16.3 mg, magnesium stearate - 1.7 mg.

Rectal suppositories Movalis 15 mg, 6 pieces - each suppository contains 15 mg of meloxicam and excipients: Suppocire BP solid fat, polyethoxylated ricin oil, hydrogenated.

Rectal suppositories Movalis 7.5 mg, 6 pieces - contain 7.5 mg of meloxicam and excipients: Suppocire BP solid fat, polyethoxylated ricin oil, hydrogenated.

Movalis injection solution 15 mg/1.5 ml, 3 or 5 ampoules - this release form includes meloxicam 15 mg, as well as excipients: meglumine, poloxamer 188, sodium chloride, sodium hydroxide E524, glycine E640, glycofurol, water for injection, sterile, up to 1.5 ml.

Oral suspension Movalis 7.5 mg/5 ml - 5 ml of the drug contains the active ingredient meloxicam 7.5 mg, as well as excipients: colloidal silicon dioxide - 50.00 mg, hyaetellose - 5.00 mg, sorbitol - 1750 .00 mg, glycerol - 750.00 mg, xylitol - 750.00 mg, sodium dihydrogen phosphate dihydrate - 100.00 mg, sodium saccharinate - 0.50 mg, sodium benzoate - 7.50 mg, citric acid monohydrate - 6.00 mg, raspberry flavor - 10.00 mg, purified water - 2463.50 mg.

Movalis price: how much do ampoules, suspension, suppositories and tablets cost?

The average price of Movalis in injections in Ukraine is 270 UAH. The price of Movalis in tablets of 15 mg is 340 UAH, the cost of tablets of 7.5 mg is 255 UAH. The price of Movalis candles is also within the range of 270-340 UAH.

The difference between the cost of medicine in Kharkov, Dnepropetrovsk or Kyiv is insignificant.

The average price of Movalis ampoules in Russian pharmacies is 650 rubles; you can buy suppositories in Moscow for an average of 500-600 rubles. The cost of the injection solution is 665-720 rubles, 15 mg tablets are 750 rubles, 7.5 mg tablets are 640 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Movalis solution for intramuscular injection.
  15mg/1.5ml 1.5ml 5 pcs. Boehringer Ingelheim Spain SA RUB 860 order
• Movalis solution for intramuscular injection. 15mg/1.5ml 1.5ml 3 pcs.Boehringer Ingelheim Spain SA

  630 rub. order

• Movalis tablets 15 mg 20 pcs. Boehringer Ingelheim Ellas AE

  RUR 725 order

• Movalis tablets 15 mg 10 pcs. Boehringer Ingelheim Ellas AE

  RUR 498 order

• Movalis tablets 7.5 mg 20 pcs. Boehringer Ingelheim Ellas AE

  RUR 594 order

Pharmacy Dialogue

• Movalis (tab. 15 mg No. 20) Boehringer Ingelheim

  RUR 851 order

• Movalis (tab. 15 mg No. 10) Boehringer Ingelheim

  580 rub. order

• Movalis (amp. 1.5 ml No. 3) Boehringer Ingelheim

  RUR 728 order

• Movalis (amp. 1.5 ml No. 5) Boehringer Ingelheim

  RUR 981 order

• Movalis (tab. 7.5 mg No. 20) Boehringer Ingelheim

  RUR 712 order

  Read also:  Sodium tetraborate solution: what is it, how and what is it used for?

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Pharmacy24

• Movalis 7.5 mg No. 20 tablets Boehringer Ingelheim Pharma GmbH & Co. KG/Boehringer Ingelheim Ellas A.E., Nimechina/Greece
  309 UAH.order
• Movalis 15 mg/1.5 ml N5 solution for injection

  185 UAH order

• Movalis 15 mg No. 10 tablets Boehringer Ingelheim Pharma GmbH & Co. KG/Boehringer Ingelheim Ellas A.E., Nimecchina/Greece

  220 UAH order

• Movalis 15 mg No. 20 tablets Boehringer Ingelheim Pharma GmbH & Co. KG/Boehringer Ingelheim Ellas A.E., Nimecchina/Greece

  403 UAH order

PaniPharmacy

• Movalis ampoule Movalis solution for injection 15 mg ampoule 1.5 ml No. 5 Spain, Boehringer Ingelheim Espana

  227 UAH order

• Movalis tablets Movalis tablets 15 mg No. 10 Germany, Boehringer Ingelheim Pharma

  268 UAH order

• Movalis tablets Movalis tablets 15 mg No. 20 Germany, Boehringer Ingelheim Pharma

  437 UAH. order

• Movalis tablets Movalis tablets 7.5 mg No. 20 Germany, Boehringer Ingelheim Pharma

  317 UAH. order

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pharmachologic effect

Pharmacodynamics

Movalis contains meloxicam, the main effect of which is the ability to block the synthesis and release of prostaglandins at each stage of their biochemical transformation. The ability to block COX-2, which is one of the main mediators of acute phase inflammation, stands out separately.

The effect of the drug is specific, so COX-1 is not inhibited, which reduces the number of side effects. The highest intensity of exposure is observed at the site of inflammation, and not in peripheral tissues.

It is noted that due to the confirmed high specificity, Movalis does not cause the classic side effect of non-steroidal anti-inflammatory drugs in the form of an effect on platelet aggregation, which avoids an increased risk of bleeding.

Pharmacokinetics

The drug has high bioavailability - 90%, absorption occurs completely in the intestine. The maximum concentration in blood plasma is achieved 5-6 hours after oral administration and 2-3 hours after the injection. Moreover, the bioavailability of injection forms is 100%. Absorption of the drug does not depend on food intake.

Meloxicam quickly passes into a chemically bound form, having a high affinity for proteins, in particular albumins. The binding rate is 99%. Active forms of the drug penetrate into the synovial fluid of the joint capsules, where the concentration is reduced by half compared to blood plasma. With prolonged and systematic use, the concentration in the synovial fluid increases.

The biotransformation of meloxicam occurs mainly in the liver with the participation of cytochromes of the CYP 2C9 and CYP 3A4 families. The toxicity of the drug does not increase during its metabolism; the 4 main metabolites are pharmacologically inactive and are excreted in the urine. Elimination occurs in feces and urine, about 5% of the substance is excreted unchanged.

Movalis

Active substance:

Meloxicam*

Pharmgroup:

NSAIDs. Oxycams

Average price in pharmacies

Name	Manufacturer	average price
Movalis 0.0075 n20 tab	BOEHRINGER INGELHEIM	655.00
Movalis 0.015 n10 tab	BOEHRINGER INGELHEIM	535.00
Movalis 0.015 n20 tab	BOEHRINGER INGELHEIM	769.00
Movalis 0.015/1.5ml n3 amp solution IM	BOEHRINGER INGELHEIM	666.00
Movalis 0.015/1.5ml n5 amp solution IM	BOEHRINGER INGELHEIM	902.00

Analogs for the active substance: Amelotex Arthrozan Bi-xicam Lem M-Kam Mataren MELBEC Melbek forte Melox Meloxam Meloxicam Meloxicam DS Meloxicam Pfizer Meloxicam Sandoz Meloxicam STADA Meloxicam-Prana Meloxicam-Teva Meloflam Meloflex Rompharm Mesipol Mixol-Od Mirlox Movasin Read also:  Dimia, 3 mg+0.02 mg, set of tablets, film-coated tablets, 28 pcs. Movix Exen-Sanovel

Application area: Obstetric and gynecological pain Ankylosing spondylitis Pain syndrome Pain syndrome in the postoperative period Pain syndrome in the postoperative period after orthopedic surgery Pain syndrome of inflammatory origin Pain syndrome of non-oncological origin Pain syndrome after diagnostic procedures Pain syndrome after diagnostic interventions Pain syndrome after surgery Pain syndrome after surgical interventions Pain syndrome after orthopedic surgery Pain syndrome after injuries Pain syndrome after removal of hemorrhoids Pain syndrome after surgery Pain syndrome due to inflammation of non-rheumatic nature Pain syndrome in inflammatory lesions of the peripheral nervous system Pain syndrome in diabetic neuropathy Pain syndrome in osteoarthritis Pain syndrome in osteoarthritis Pain syndrome in acute inflammatory diseases of the musculoskeletal system Pain syndrome in acute inflammatory diseases of the musculoskeletal system Pain syndrome in acute inflammatory diseases of the musculoskeletal system Pain syndrome due to tendon pathology Pain syndrome in rheumatic diseases Pain syndrome due to smooth muscle spasms Pain syndrome due to smooth muscle spasms (renal and biliary colic, intestinal spasms, dysmenorrhea) Pain syndrome due to spasms of smooth muscles of internal organs Pain syndrome due to spasms of smooth muscles of internal organs (renal and biliary colic, intestinal spasms, dysmenorrhea) Pain syndrome due to injuries Pain syndrome during injuries and after surgery Pain syndrome in chronic inflammatory diseases of the musculoskeletal system Pain syndrome in chronic inflammatory diseases of the musculoskeletal system Pain syndrome in chronic inflammatory diseases of the musculoskeletal system Pain syndrome in duodenal ulcer Pain syndrome with gastric ulcer Pain syndrome in gastric and duodenal ulcers Painful sensations Read also:  Effervescent tablets "Supradin": instructions for use, course of administration, reviews Pain during menstruation Pain syndromes Painful conditions Painful tired legs Sore gums when wearing dentures Tenderness of cranial nerve exit points Painful, irregular periods Painful dressings Painful muscle spasm Painful tooth growth Diseases of the spinal column Joint diseases Ankylosing spondylitis Ankylosing spondylitis-Marie-Strumpell disease Pain Pain in the lower extremities Pain in the area of ​​the surgical wound Pain in the postoperative period Body pain Pain after diagnostic interventions Pain after orthopedic surgery Pain after surgery Pain after cholecystectomy Flu pain Pain due to diabetic polyneuropathy Pain from burns Pain during sexual intercourse Pain during diagnostic procedures Pain during therapeutic procedures Pain due to colds Pain due to sinusitis Pain from injuries Shooting pains Traumatic pain Pain Pain in the postoperative period Pain after diagnostic interventions Pain after sclerotherapy Pain after surgery Postoperative pain Postoperative and post-traumatic pain Post-traumatic pain Pain when swallowing Pain in infectious and inflammatory diseases of the upper respiratory tract Pain from burns Rheumatoid arthritis pain Pain from traumatic muscle injury Pain from injuries

Indications for use of Movalis

The medicine is used to relieve symptoms of inflammation, including fever, pain, local swelling, and redness. The drug is especially effective in the symptomatic treatment of diseases of the musculoskeletal system, degenerative diseases of the skeleton and muscular system, with causalgic pain and other diseases. The main diseases that are indications for the use of Movalis, as well as dosages to achieve maximum therapeutic effect, are listed below. It is not recommended to exceed the dosage of 15 mg/day. Indications:

1. Movalis for osteochondrosis is indicated for use in tablet form at 15 mg/day; with a decrease in symptoms, the dose can be reduced to 7.5 mg/day.
2. Movalis for ankylosing spondylitis can be used at a dosage of 15 mg/day orally, but in patients with an increased risk from the cardiovascular system, the therapeutic dose should start at 7.5 mg/day and increase if necessary under the supervision of the attending physician.
3. Movalis for neuralgia of any origin can be used symptomatically to relieve pain at a dose of 7.5 mg/day, one tablet once a day.
4. Movalis for lower back pain is recommended only when local painkillers are not effective. In this case, a dose of 7.5 mg/day is recommended.
5. For pinched nerves, Movalis is indicated for pain relief at a dose of 7.5 mg/day; you can use one tablet or one rectal suppository of 7.5 mg, respectively.
6. Movalis for a spinal hernia with progressive pain syndrome, lumbago or lumbar ischialgia, an injection of Movalis 7.5 mg once or 15 mg tablet forms is indicated.
7. Movalis for radiculitis is used in doses of 7.5 or 15 mg per day; if this dosage form is not effective, you can use injections of 15 mg once a day. The course of injection treatment should not last more than 3 days with a maximum daily dose of 15 mg.
8. Movalis for arthritis, including rheumatoid origin, is used at 15 mg/day, one 15 mg tablet once in the morning or two 7.5 mg tablets in the morning and evening. In the presence of an acute attack of rheumatoid arthritis, injections may be used, but only in cases where tablet forms and suppositories cannot be used or are not effective. Movalis injections are limited to one injection of 15 mg/day.

The justification for using Movalis should be determined by a physician based on the specific pathological condition that can be treated. Dose adjustments are made based on the patient's feedback on how they feel, the reduction of symptoms, or the presence of adverse reactions.

Indications

If you carefully study the official instructions for Movalis, it will not be written anywhere about protrusions and hernias. But it is enough for us that the indications include a disease of the musculoskeletal system and acute back pain. Protrusions and hernias in the form of exacerbation fit well into this definition. What other indications exist for the use of Meloxicam? We can briefly list them:

• all inflammatory rheumatic diseases of connective tissue, such as spondyloarthritis, rheumatoid and psoriatic arthritis;
• osteoarthritis with an inflammatory component;
• glenohumeral periarthritis;
• compression of the nerve roots is what causes protrusions and hernias. Compression radiculopathy is manifested by acute, piercing pain in the back and leg (sciatica, lumbago, radiculitis);
• various plexites.

Movalis is also used for acute periods of sports injury, for sprained ligaments.

Contraindications

It is not recommended to take meloxicam in patients with developed sensitization to the components of the drug. Contraindicated in patients who have developed symptoms of asthma, swelling, nasal breathing problems or urticaria after taking non-steroidal anti-inflammatory drugs, including derivatives of acetylsalicylic and enolic acids. Taking Movalis is contraindicated:

1. During the third trimester of pregnancy, the use of drugs based on meloxicam can lead to impaired blood circulation in the fetus, the development of cardiopulmonary failure, pathology of the urinary system, in particular progressive renal failure. During this same period, the medicine can have a detrimental effect on the course of labor.
2. Pathology of the gastrointestinal tract, in the presence of gastric bleeding or perforation of an ulcer, especially if they are caused by the systematic use of a non-steroidal anti-inflammatory drug. A history of gastrointestinal bleeding requires recalculation of the dose and use of other classes of drugs.
3. Severe liver failure is a direct contraindication, since the drug undergoes biotransformation with the participation of cytochromes and other liver enzymes. Taking Movalis for functional liver failure can lead to the development of complications.
4. Severe renal failure without dialysis. It should be borne in mind that during peritoneal dialysis or hemodialysis the drug can be prescribed with caution, as its elimination will occur.
5. Ages under 16 years are a direct contraindication to the use of Movalis due to the peculiarities of biotransformation and distribution of the drug, as well as the development of immediate allergic reactions in this age category. It is impossible to select a safe dose for use in such patients without the risk of adverse reactions.
6. Disorders of the blood coagulation system, which are manifested by the presence of bleeding that is difficult to stop, a history of cerebrovascular bleeding and are confirmed by the results of laboratory tests.
7. Severe heart failure.
8. Simultaneous use of anticoagulants.

Indications and contraindications

Movalis is used in the following cases:

• symptomatic therapy of chronic osteoarthritis in the acute stage;
• therapeutic treatment of rheumatoid arthritis;
• Ankylosing spondylitis and other acquired joint diseases that cause acute pain.

Studies and numerous reviews confirm the effectiveness and optimal tolerability of the drug.

Like any drug, Movalis has a number of contraindications. Before starting treatment with Movalis, you should consult your doctor. Thus, you should not take the drug for the following diseases and conditions:

1. Individual intolerance and hypersensitivity to the components of the substance.
2. Bronchial asthma. Hay fever. Allergic reactions (urticaria, intolerance to acetylsalicylic acid).
3. Peptic ulcer of the stomach or duodenum, erosive gastritis in the acute stage.
4. Kidney and liver failure.
5. Heart failure.
6. Age up to 12 years.
7. Pregnancy (any trimester), lactation.

Movalis can be treated with caution in the following cases:

• inflammatory diseases of the gastrointestinal tract during exacerbation;
• diabetes;
• hyperlipidemia (metabolic pathology);
• peripheral arterial disease;
• elderly and senile age;
• smoking and alcoholism;
• long-term use of anticoagulants and selective inhibitors.

Side effects

Side effects are classified depending on the affected organs and systems, as well as by frequency of occurrence in a similar way: very common (1 case out of 10), frequent (1 case out of 100); uncommon (1 in 1000), rare (1 in 10,000), very rare (less than 1 in 10,000), unknown (no exact data on the frequency of occurrence).

From the immune system: infrequently - allergic reactions, urticaria, angioedema, polymorphic rash of allergic origin; unknown - anaphylactic reactions, anaphylactic shock.

From the mental side: rarely - mood swings, nightmares; unknown - disorientation, insomnia.

From the nervous system: often - headache; rarely - dizziness, drowsiness.

From the sensory systems: rarely - ringing in the ears, blurred vision, blurred vision; infrequently - dizziness, conjunctivitis.

From the cardiovascular system: infrequently - increased blood pressure; rarely - palpitations; unknown - heart failure associated with the use of non-steroidal anti-inflammatory drugs.

From the respiratory system: rarely - asthma in patients with allergies to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs; unknown - cough.

From the gastrointestinal tract: often - dyspepsia, nausea, vomiting, abdominal pain, constipation, flatulence, diarrhea; uncommon - gastrointestinal bleeding, stomatitis, gastritis, belching; rarely - colitis, ulcer, esophagitis, abnormal laboratory tests of liver function; very rarely - hepatitis; unknown - liver failure.

From the skin and subcutaneous fat: infrequently - angioedema, itching, rash; rarely - Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria; very rarely - bullous dermatitis, erythema multiforme; unknown - photosensitivity, exfoliative dermatitis.

From the urinary system: uncommon - sodium and water retention, changes in electrolyte balance (hypokalemia), increased creatinine and/or urea in the blood plasma as a marker of decreased renal function; very rarely - acute renal failure; unknown—impaired urinary frequency.

General disorders and disorders at the injection site: often - hardening and pain at the injection site; infrequently - swelling.

Movalis tablets 15 mg No. 10

Movalis tablets 15 mg No. 10

Instructions for use

Movalis tab. 15 mg No. 10

Dosage forms

tablets 15mg

Synonyms

Amelotex Arthrozan Bi-xicam Melbek Melbek forte Melox Meloxicam MELOXICAM AVEXIMA Meloxicam DS Meloxicam Canon Meloxicam Stada Meloxicam-OBL Meloxicam-Prana Meloxicam-Teva Meloflex Rompharm Mesipol Mirlox Movasin Oxycamox Group Anti-inflammatory drugs - oxicams International nonproprietary name Meloxicam Composition Active ingredient - meloxicam 15 mg. Manufacturers Boehringer Ingelheim Espana S.A (Spain) Pharmacological action Pharmacodynamics. The drug is a non-steroidal anti-inflammatory drug (NSAID), belongs to enolic acid derivatives and has anti-inflammatory, analgesic and antipyretic effects. The pronounced anti-inflammatory effect of meloxicam has been established in all standard models of inflammation. The mechanism of action of meloxicam is its ability to inhibit the synthesis of prostaglandins, known mediators of inflammation. Meloxicam in vivo inhibits the synthesis of prostaglandins at the site of inflammation to a greater extent than in the gastric mucosa or kidneys. These differences are due to more selective inhibition of cyclooxygenase-2 (COX-2) compared with cyclooxygenase-1 (COX-1). Inhibition of COX-2 is thought to mediate the therapeutic effects of NSAIDs, whereas inhibition of the constitutively present isoenzyme COX-1 may be responsible for gastric and renal side effects. The selectivity of meloxicam for COX-2 has been confirmed in various test systems, both in vitro and in vivo. The selective ability of meloxicam to inhibit COX-2 was demonstrated when using human whole blood as a test system in vitro. It was found that meloxicam (in doses of 7.5 mg and 15 mg) more actively inhibited COX-2, having a greater inhibitory effect on the production of prostaglandin E2 stimulated by lipopolysaccharide (reaction controlled by COX-2) than on the production of thromboxane, which is involved in the coagulation process blood (reaction controlled by COX-1). These effects were dose dependent. Ex vivo studies have shown that meloxicam (at doses of 7.5 mg and 15 mg) has no effect on platelet aggregation and bleeding time. In clinical studies, gastrointestinal (GIT) side effects were generally less common with meloxicam 7.5 and 15 mg than with other NSAIDs compared. This difference in the frequency of side effects from the gastrointestinal tract is mainly due to the fact that when taking meloxicam, such phenomena as dyspepsia, vomiting, nausea, and abdominal pain were observed less frequently. The incidence of upper gastrointestinal perforations, ulcers and bleeding associated with meloxicam use was low and dose dependent. Pharmacokinetics. Absorption. Meloxicam is completely absorbed after intramuscular administration. Relative bioavailability compared to oral bioavailability is almost 100%. Therefore, when switching from injection to oral forms, dose selection is not required. After administration of the drug 15 mg of the drug intramuscularly, a peak plasma concentration of about 1.6 - 1.8 μg / ml is achieved within approximately 60 - 96 minutes. Distribution. Meloxicam binds well to plasma proteins, especially albumin (99%). Penetrates into synovial fluid, the concentration in synovial fluid is approximately 50% of the concentration in plasma. The volume of distribution is low, approximately 11 L. Interindividual differences range from 7 to 20%. Metabolism. Meloxicam is almost completely metabolized in the liver to form 4 pharmacologically inactive derivatives. The main metabolite, 5′-carboxymeloxicam (60% of the dose), is formed by oxidation of an intermediate metabolite, 5′-hydroxymethylmeloxicam, which is also excreted, but to a lesser extent (9% of the dose). In vitro studies have shown that the CYP2C9 isoenzyme plays an important role in this metabolic transformation; the CYP3A4 isoenzyme is of additional importance. Peroxidase is involved in the formation of the other two metabolites (constituting, respectively, 16% and 4% of the drug dose), the activity of which probably varies individually. Excretion. It is excreted equally through the intestines and kidneys, mainly in the form of metabolites. In unchanged form, less than 5% of the daily dose is excreted in feces; in urine, unchanged, the drug is found only in trace amounts. The average half-life varies from 13 to 25 hours. Plasma clearance averages 7 - 12 ml/min after a single dose. Meloxicam demonstrates linear pharmacokinetics in doses of 7.5 - 15 mg when administered intramuscularly. Insufficiency of liver and/or kidney function. Insufficiency of liver function, as well as mild renal failure, do not have a significant effect on the pharmacokinetics of meloxicam. The rate of excretion from the body is significantly higher in patients with moderate renal failure. Meloxicam binds less well to plasma proteins in patients with end-stage renal failure. In end-stage renal failure, an increase in volume of distribution may result in higher concentrations of free meloxicam, so in these patients the daily dose should not exceed 7.5 mg. Elderly patients. Elderly patients compared to young patients have similar pharmacokinetic parameters. In elderly patients, the average plasma clearance during steady-state pharmacokinetics is slightly lower than in younger patients. Elderly women have higher AUG (area under the concentration-time curve) values ​​and a longer half-life compared to younger patients of both sexes. Side effects The following describes side effects that were considered possible to be associated with the use of the drug. Within systemic organ classes, the following categories are used according to the frequency of side effects: very often (> 1/10); often (> 1/100, < 1/10); uncommon (> 1/1,000, < 1/100); rare (> 1/10,000, < 1/1,000); very rare (< 1/10,000); not installed. Disorders of the blood and lymphatic system: infrequently - anemia; rarely - leukopenia, thrombocytopenia, changes in the number of blood cells, including changes in the leukocyte formula. Immune system disorders: uncommon - other immediate hypersensitivity reactions; not established - anaphylactic shock, anaphylactoid/anaphylactic reactions. Mental disorders: rarely - mood changes; not established - confusion, disorientation. Nervous system disorders: often - headache; infrequently - dizziness, drowsiness. Visual, hearing and labyrinthine disorders: infrequently - vertigo; rarely - conjunctivitis, visual impairment, including blurred vision, tinnitus. Disorders of the heart and blood vessels: infrequently - increased blood pressure, a feeling of a “rush” of blood to the face; rarely - palpitations. Respiratory system disorders: rarely - bronchial asthma in patients with allergies to acetylsalicylic acid and other NSAIDs. Gastrointestinal disorders: often - abdominal pain, dyspepsia, diarrhea, nausea, vomiting; uncommon - hidden or obvious gastrointestinal bleeding, gastritis, stomatitis, constipation, bloating, belching; rarely - gastroduodenal ulcers, colitis, esophagitis; very rarely - perforation of the gastrointestinal tract. Disorders of the liver and biliary tract: Uncommon - transient changes in liver function tests (for example, increased activity of transaminases or bilirubin); very rarely - hepatitis. Disorders of the skin and subcutaneous tissues: infrequently - angioedema, itching, skin rash; rarely - toxic epidermal necrolysis, Stevens-Johnson syndrome, urticaria; very rarely - bullous dermatitis, erythema multiforme; not established - photosensitivity. Renal and urinary tract disorders: uncommon - changes in renal function (increased levels of creatinine and/or urea in the blood serum), urinary disorders, including acute urinary retention; very rarely - acute renal failure. General disorders and disorders at the injection site: often - pain and swelling at the injection site; infrequently - swelling. Concomitant use with drugs that suppress bone marrow (for example, methotrexate) may cause cytopenia. Gastrointestinal bleeding, ulceration, or perforation can be fatal. As with other NSAIDs, the possibility of interstitial nephritis, glomerulonephritis, renal medullary necrosis, and nephrotic syndrome cannot be excluded. Indications for use: Initial period of treatment of pain syndrome and short-term symptomatic therapy of rheumatoid arthritis, osteoarthritis (arthrosis, degenerative joint diseases), ankylosing spondylitis. Contraindications Hypersensitivity to the active ingredient or auxiliary components of the drug. There is a possibility of cross-sensitivity from acetylsalicylic acid to other NSAIDs; Hypersensitivity (including to other non-steroidal anti-inflammatory drugs), complete or incomplete combination of bronchial asthma, recurrent nasal polyposis or paranasal sinuses and intolerance to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (including a history); Erosive and ulcerative lesions of the stomach and duodenum in the acute stage or recently suffered; Inflammatory bowel diseases - Crohn's disease or ulcerative colitis in the acute stage; severe liver and heart failure; severe renal failure (if hemodialysis is not performed, creatinine clearance is less than 30 ml/min, and also with confirmed hyperkalemia), progressive kidney disease; active liver disease; active gastrointestinal bleeding, recent cerebrovascular bleeding or established diagnosis of diseases of the blood coagulation system; age under 18 years; pregnancy; lactation period; therapy of perioperative pain during coronary artery bypass grafting; Concomitant therapy with anticoagulants, as there is a risk of intramuscular hematoma formation. Directions for use and dosage

Osteoarthritis: 7.5 mg per day. If necessary, this dose can be increased to 15 mg per day. Rheumatoid arthritis: 15 mg per day. Depending on the therapeutic effect, this dose may be reduced to 7.5 mg per day. Ankylosing spondylitis: 15 mg per day. Depending on the therapeutic effect, this dose may be reduced to 7.5 mg per day. In patients with an increased risk of adverse reactions, it is recommended to begin treatment with a dose of 7.5 mg per day. In patients with severe renal failure on hemodialysis, the dose should not exceed 7.5 mg per day. General recommendations. Since the potential risk of adverse reactions depends on the dose and duration of treatment, the lowest possible dose and duration of use should be used. The maximum recommended daily dose is 15 mg. Combined use. The drug should not be used simultaneously with other NSAIDs. The total daily dose of the drug used in different dosage forms should not exceed 15 mg. Teenagers. The maximum dose in adolescents is 0.25 mg/kg. As a general rule, the drug should only be used in adolescents over 12 years of age and adults. The total daily dose should be taken in one dose, during meals, with water or other liquid.

Overdose There is insufficient data on cases associated with drug overdose. Symptoms characteristic of an NSAID overdose are likely to be present in severe cases: drowsiness, disturbances of consciousness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, acute renal failure, changes in blood pressure, respiratory arrest, asystole. Treatment: no known antidote. In case of drug overdose, symptomatic therapy should be used. Cholestyramine is known to accelerate the elimination of meloxicam. Interaction Other prostaglandin synthesis inhibitors, including glucocorticoids and salicylates - concomitant use with meloxicam increases the risk of ulcers in the gastrointestinal tract and gastrointestinal bleeding (due to synergistic action). Concomitant use with other NSAIDs is not recommended. Anticoagulants for oral administration, heparin for systemic use, thrombolytic agents - simultaneous use with meloxicam increases the risk of bleeding. In case of simultaneous use, careful monitoring of the blood coagulation system is necessary. Antiplatelet drugs, serotonin reuptake inhibitors - concomitant use with meloxicam increases the risk of bleeding due to inhibition of platelet function. In case of simultaneous use, careful monitoring of the blood coagulation system is necessary. Lithium preparations - NSAIDs increase plasma lithium levels by reducing its excretion by the kidneys. The simultaneous use of meloxicam with lithium preparations is not recommended. If simultaneous use is necessary, careful monitoring of plasma lithium concentrations is recommended throughout the course of lithium use. Methotrexate - NSAIDs reduce the secretion of methotrexate by the kidneys, thereby increasing its plasma concentration. The simultaneous use of meloxicam and methotrexate (at a dose of more than 15 mg per week) is not recommended. In case of simultaneous use, careful monitoring of renal function and blood count is necessary. Meloxicam may increase the hematological toxicity of methotrexate, especially in patients with impaired renal function. Contraception - There is evidence that NSAIDs may reduce the effectiveness of intrauterine contraceptive devices, but this has not been proven. Diuretics - the use of NSAIDs in case of dehydration of patients is accompanied by the risk of developing acute renal failure. Antihypertensive drugs (beta-blockers, angiotensin-converting enzyme inhibitors, vasodilators, diuretics). NSAIDs reduce the effect of antihypertensive drugs due to inhibition of prostaglandins, which have vasodilating properties. Angiotensin-II receptor antagonists, when co-administered with NSAIDs, increase the reduction in glomerular filtration, which can thereby lead to the development of acute renal failure, especially in patients with impaired renal function. Cholestyramine, by binding meloxicam in the gastrointestinal tract, leads to its faster elimination. NSAIDs, by acting on renal prostaglandins, may enhance the nephrotoxicity of cyclosporine. When using drugs together with meloxicam that have a known ability to inhibit CYP2C9 and/or CYP3A4 (or are metabolized with the participation of these enzymes), the possibility of pharmacokinetic interaction should be taken into account. The possibility of interaction with antidiabetic drugs for oral administration cannot be excluded. With the simultaneous use of antacids, cimetidine, digoxin and furosemide, no significant pharmacokinetic interactions were identified. Special instructions Pregnancy and lactation. The use of the drug is contraindicated during pregnancy. It is known that NSAIDs pass into breast milk, so the use of the drug during breastfeeding is contraindicated. As a drug that inhibits cyclooxygenase/prostaglandin synthesis, Movalis may have an effect on fertility and is therefore not recommended for women planning pregnancy. Meloxicam may delay ovulation. In this regard, in women who have problems conceiving and are undergoing examination for similar problems, it is recommended to stop taking the drug. Patients suffering from diseases of the gastrointestinal tract should be monitored regularly. If ulcerative lesions of the gastrointestinal tract or gastrointestinal bleeding occur, the drug must be discontinued. Gastrointestinal ulcers, perforation or bleeding may occur during treatment at any time, either in the presence of warning symptoms or a history of serious gastrointestinal complications, or in the absence of these signs. The consequences of these complications are generally more serious in older people. When using NSAIDs, serious skin reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis may develop. Therefore, special attention should be paid to patients reporting the development of adverse events from the skin and mucous membranes, as well as hypersensitivity reactions to the drug, especially if such reactions were observed during previous courses of treatment. The development of such reactions is observed, as a rule, during the first month of treatment. If the first signs of skin rash, changes in mucous membranes or other signs of hypersensitivity appear, discontinuation of use should be considered. Cases have been described when taking NSAIDs to increase the risk of developing serious cardiovascular thrombosis, myocardial infarction, angina, possibly fatal. This risk increases with long-term use of the drug, as well as in patients with a history of the above diseases and those predisposed to such diseases. NSAIDs inhibit the synthesis of prostaglandins in the kidneys, which are involved in maintaining renal perfusion. The use of NSAIDs in patients with reduced renal blood flow or reduced circulating blood volume may lead to decompensation of latent renal failure. After discontinuation of NSAIDs, renal function usually returns to baseline levels. Those most at risk for developing this reaction are elderly patients, patients with dehydration, congestive heart failure, cirrhosis of the liver, nephrotic syndrome or acute renal impairment, patients concomitantly taking diuretics, ACE inhibitors, angiotensin II receptor antagonists, and patients who have undergone major surgical procedures that lead to hypovolemia. In such patients, diuresis and renal function should be carefully monitored when initiating therapy. The use of NSAIDs in combination with diuretics can lead to sodium, potassium and water retention, as well as a decrease in the natriuretic effect of diuretics. As a result, predisposed patients may experience increased signs of heart failure or hypertension. Therefore, such patients should be closely monitored and adequate hydration maintained. Before starting treatment, a kidney function test is necessary. In case of combination therapy, renal function should also be monitored. When using the drug (as well as most other NSAIDs), episodic increases in serum transaminase activity or other indicators of liver function are possible. In most cases, this increase was small and transitory. If the detected changes are significant or do not decrease over time, the drug should be discontinued and the detected laboratory changes should be monitored. Weakened or malnourished patients may be less able to tolerate adverse events and should therefore be monitored closely. Like other NSAIDs, the drug can mask the symptoms of an underlying infectious disease. As a drug that inhibits cyclooxygenase/prostaglandin synthesis, the drug may have an effect on fertility and is therefore not recommended for women who have difficulty conceiving. In this regard, in women undergoing examination for this reason, discontinuation of the drug is recommended. In patients with mild or moderate renal impairment (creatinine clearance more than 25 ml/min), no dose adjustment is required. In patients with liver cirrhosis (compensated), no dose adjustment is required. Influence on the ability to drive a car and other mechanisms. No special clinical studies have been conducted on the effect of the drug on the ability to drive a car or use machinery. However, when driving or operating machinery, the possibility of dizziness, drowsiness, visual impairment or other disorders of the central nervous system should be taken into account. During the treatment period, patients must be careful when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions. Storage conditions Store in a place protected from light, out of reach of children at a temperature not exceeding 30 C.

Overdose

In case of an overdose of the drug Movalis, no specific manifestations are observed. If the permissible dosage of 15 mg/day is exceeded, the likelihood of developing side effects of meloxicam significantly increases.

The main signs of overdose are general malaise, weakness, nausea, vomiting, pain in the epigastric region, defecation disorders, loss of appetite, sweating, tremor, drowsiness or insomnia, itching, palpitations, tachycardia, increased symptoms of the underlying disease.

Overdose cannot be treated due to the lack of a specific antidote. It is recommended to evacuate gastric contents, take absorbent drugs or prokinetics, drink large amounts of fluid, and stimulate the gag reflex. It is worth considering that the elimination and metabolism of meloxicam can be accelerated by taking cholestyramine.

Contraindications and side effects

Like all potent drugs, Movalis has a number of contraindications for use:

• individual intolerance;
• pregnancy;
• breastfeeding period;
• exacerbation of stomach ulcers;
• severe kidney pathologies;
• presence of internal bleeding;
• acute ulcerative colitis;
• uncontrolled heart failure;
• blood clotting disorder;
• Crohn's disease;
• allergic dermatitis that occurs as a reaction to treatment with other NSAIDs;
• bronchial asthma;
• age up to 15 years.

Not all of the listed contraindications are absolute: in some cases, the use of the drug is possible, but with individual dose adjustment. Movalis in the form of tablets and suppositories can be given to children from 12 years of age with the permission of a doctor.

The product should not be taken together with alcohol and the following drugs:

• acetylsalicylic acid;
• anticoagulants;
• diuretics;
• antihypertensive drugs;
• products containing lithium salts.

Using Movalis without first consulting a doctor or violating the dosages specified in the instructions can lead to side effects and the appearance of the following negative symptoms:

• dizziness;
• intense headache;
• tachycardia;
• allergic rash, itching;
• abdominal pain;
• disruption of the digestive system;
• bleeding from any part of the gastrointestinal tract;
• drowsiness;
• swelling, especially in the legs;
• pressure surges.

An overdose of the drug can cause vomiting, convulsions, severe kidney damage and disruption of the heart until it stops completely. If side effects occur, Movalis should be stopped.

If the daily dose of the drug is greatly exceeded, you need to perform a gastric lavage with a weak solution of potassium permanganate or soda and immediately consult a doctor.

Interaction

The drug Movalis is capable of interacting with drugs at the pharmaceutical, pharmacokinetic and pharmacodynamic stages. Complex mechanisms of distribution and molecular effects on inflammatory mediators can lead to some unexpected effects that should be taken into account when taking the drug Movalis.

Milgamma and Movalis are used to relieve pain in osteochondrosis and a number of other diseases of the musculoskeletal system and bone tissue. It is not recommended to mix two medications in one syringe; this is fraught with interaction at the pharmaceutical stage and a chemical reaction between the components of the drugs. Injections of drugs should be carried out at different times, with an interval of at least 3 hours, but in general, the use of these drugs in combination has the desired therapeutic effect without dangerous consequences.

Combilipen and Movalis are recommended for use in the treatment of degenerative diseases of the nerve processes of various origins, which are accompanied by pain. B vitamins contained in the drug Combilipen enhance the effect of meloxicam-based drugs and cause an improvement in the patient’s well-being.

Diprospan and Movalis are not recommended for simultaneous use, as this significantly increases the risk of gastrointestinal bleeding and ulcer perforation due to synchronous inhibition of COX 1 and 2 - Diprospan is a glucocorticoid with a strong immunosuppressive effect, which also affects the gastric and intestinal mucosa.

Alflutop and Movalis can be prescribed simultaneously for the treatment of joint diseases, where Alflutop will produce a chondroprotective effect, and Movalis will relieve pain and inflammation. Also, taking them can normalize electrolyte disturbances caused by taking Movalis.

Movalis and Sirdalud, when used simultaneously, reduce each other's effects, being antagonists. Sirdalud is an adrenergic receptor agonist that reduces the effectiveness of non-steroidal anti-inflammatory drugs.

Movalis and Nimesil are contraindicated for simultaneous use due to inhibition of the same chains of prostaglandin synthesis, which increases the risk of complications and a decrease in the coagulant properties of the blood, which can lead to bleeding.

Movalis and Ketonal are contraindicated for simultaneous use, because Ketonal is a non-selective inhibitor of COX 1 and 2, which has a detrimental effect on the mucous membrane of the stomach and intestines, especially with the use of Movalis.

Movalis and Analgin, when used simultaneously, can cause hypothermia and changes in the blood system, in particular agranulocytosis.

Analogues of Movalis

There are many analogues of the drug Movalis in terms of their effect, which can be used to treat the same diseases. However, there are some differences in doses, indications and application features that need to be taken into account.

Which is better: Movalis or Diclofenac?

Diclofenac is in many ways more convenient to use due to the presence of other forms of release, especially gel. This allows Diclofenac to be used topically to relieve symptoms of inflammation. But the bioavailability of Movalis is much higher due to the ability to administer the drug intramuscularly. Movalis also penetrates better into the synovial fluid. When treating diseases of traumatic origin, bruises and injuries, it is recommended to use Diclofenac as a drug with fewer side effects. But in the treatment of rheumatological diseases, Movalis has an advantage.

Which is better: Movalis or Meloxicam?

The active ingredient of Movalis is Meloxicam, so their action is similar at the pharmacodynamics stage, but the pharmacokinetics of the drugs may differ due to the balanced composition of excipients that ensure the structural integrity of Movalis and its rapid accumulation in the blood serum. Elimination of drugs occurs in a similar way. For the most part, the difference between them is only in the release forms and dosage.

Which is better: Movalis or Amelotex?

They also have the same active ingredient - meloxicam. But the bioavailability in the case of Amelotex is several percent lower than that of Movalis, and the maximum dose in the blood serum increases more slowly. The indications and dosages of these drugs are identical. When taking Amelotex, bronchospasm is also possible, which is a rare side effect.

Which is better: Movalis or Arcoxia?

Arcoxia based on etoricoxib is a selective COX 2 inhibitor, which provides reduced side effects compared to non-selective inhibitors. The indications for use of these drugs are similar, but the release forms and dosages differ. Arcoxia also has a more pronounced analgesic effect, which is used to relieve acute postoperative pain syndrome. Etoricoxib in Arcoxia causes fewer side effects than Meloxicam if the permissible daily dosage is exceeded.

Which is better: Movalis or Mydocalm?

Mydocalm is a centrally acting muscle relaxant, which is strikingly different from Movalis in its mechanism of action. Indicated for the treatment of pathologies of the muscular system, while Movalis is more effective for the treatment of pathologies of bone tissue and joints. Also, the bioavailability of Mydocalm is several times lower and amounts to 20%, but the drug can be prescribed to patients with renal failure, because about 90% of metabolism and elimination occurs in the kidneys.

Which is better: Movalis or Nimesil?

Nimesil is more suitable for the treatment of headaches of any origin, pain from bruises and injuries, and reduction of temperature during systemic inflammation. But Nimesil therapy is not effective in the treatment of rheumatic pathology. The action of Nimesil occurs faster, but its elimination proceeds just as quickly.

Which is better: Movalis or Xefocam?

Xefocam is better suited for relieving pain of mild to moderate intensity, while the effect of the drug does not last long, although it begins within a few minutes after administration. Xefocam has a more pronounced analgesic effect than an anti-inflammatory one. Movalis, on the other hand, is a more complex drug that can relieve severe pain and relieve symptoms of inflammation, and with prolonged use it accumulates and the effect of the drug can last quite a long time.

Which is better: Movalis or Voltaren?

Voltaren is a drug based on diclofenac, which is convenient due to its rapid absorption, a wide selection of dosage forms, including for local use in the form of a gel, as well as a pronounced analgesic effect. The range of applications for Voltaren is much wider; it is used to treat surgical, neurological, and gynecological pathologies, while Movalis has a somewhat narrower range of applications.

Which is better: Movalis or Artrosan?

Both drugs are based on meloxicam and have the same doses to achieve the desired therapeutic effect. However, Artrosan can be used from 15 years of age, while Movalis - from 16 years of age.

Which is better: Movalis or Dexalgin?

Dexalgin has a different mechanism of action; it inhibits the conversion of arachidonic acid to thromboxanes and prostaglandins. A noticeable analgesic effect after administration occurs within half an hour and can last up to 6 hours. Dexalgin is also highly effective in the treatment of rheumatic diseases. It can be used to relieve toothache or pain during menstruation, for which Movalis cannot be used.

Which is better: Movalis or Aertal?

Aertal contains aceclofenac, which has a pronounced antipyretic, anti-inflammatory and analgesic effect. Unlike Movalis, Airtal non-selectively inhibits COX 1 and 2, which, when used systematically, can lead to a large number of side effects not characteristic of Movalis, such as bleeding and peptic ulcers.

Which is better: Movalis or Nimesulide?

Nimesulide is developed on the basis of Nimesil and differs only in a large selection of release forms. It is effective for short-term pain relief, but is not able to comprehensively influence the pathogenetic mechanisms that lead to rheumatic damage to organs and systems. The action of Nimesulide is more general and generalized; it can be used to relieve headaches and to achieve an antipyretic effect for colds and acute respiratory viral infections. The action of Movalis is more specific for damage to the musculoskeletal system.

Reviews about Movalis

Reading reviews on forums, you can see that the majority of patients who took Movalis give this drug a fairly high rating.

The medicine quickly accumulates in the body, is slowly eliminated, its bioavailability is higher than that of its analogues, and the variety of forms allows you to choose the most convenient one, depending on the indications and subjective sensations.

The drug has a relatively small range of undesirable side effects compared to other NSAIDs and proven high clinical effectiveness.

This allows it to be included in the complex therapy of many pathological conditions that accompany inflammatory and degenerative rheumatic diseases , as well as to be used to relieve pain in primary dysmenorrhea and fever .

Reviews of Movalis injections indicate that immediately entering the bloodstream after administration, the drug in this dosage form quickly relieves even severe excruciating pain.

Reviews of Movalis tablets are also mostly positive. The main advantage of this form of meloxicam is that it can be used for a long time (from 4 weeks to one and a half years) of time.

Compatibility of Movalis and alcohol

The simultaneous use of Movalis and alcohol is not recommended and may lead to a decrease in the desired therapeutic effect of the drug, the appearance or intensification of side effects and other undesirable consequences. Alcohol is an inhibitor of liver biotransformation enzymes, which are also involved in the metabolism of meloxicam. Because of this, competitive inhibition of cytochrome P450 and its subfamilies is possible, which will lead to increased hepatotoxicity of the drug and ethanol, a decrease in the rate of metabolism and elimination of the drug.

Alcohol's change in the rheological properties of blood, in particular the effect on the surface tension of the liquid fraction and changes in osmotic pressure, can lead to unpredictable pathophysiological effects on the part of the kidneys at the filtration stage. Movalis is excreted by the kidneys, so drinking alcohol may slow down the elimination of metabolites of the active substance from the body.

Data on the mechanisms of interaction between meloxicam and ethanol are incomplete; they may occur at the pharmacokinetic (distribution stage) and pharmacodynamic (final effect stage) stages. The results of such interactions may be unpredictable.

Price of the drug Movalis

The cost of a package of 10 tablets of Movalis with a concentration of 15 mg is on average 500 rubles, 20 pcs. - about 700 rub.

Tablets with the main active ingredient 7.5 mg cost from 700 to 800 rubles (20 pcs.)

Amelotex is cheaper. Ten tablets of 7.5 mg cost about 150 rubles.

Artrosan - 160 - 170 rubles (10/7.5), 180 rubles - 15 mg.

Liberum. 7.5 mg 20 tablets cost 90 rubles, 15 mg. 20 pcs. — 150 rub. The price of the drug Melox is the same.

The analogue of Meloxicam will cost even less. The cost of a blister of 20 tablets with a concentration of 7.5 mg is about 50 rubles, 15 mg. — 90 rub. The same price is for the analogue Movasin.

During pregnancy

The use of Movalis during pregnancy, lactation, and breastfeeding is strictly contraindicated. Due to the characteristics of the chemical structure and distribution in biological fluids, the components of the drug penetrate into breast milk.

Since Movalis affects the arachidonic acid cascade, COX and prostaglandins, there is an indirect effect of the drug on fertility. It reduces fertility and may cause delayed ovulation; therefore, the drug is not recommended when preparing for pregnancy. This should be taken into account when taking the medicine to women who are at the stage of planning pregnancy, as well as in the early stages. If you have taken the drug before, it is recommended to discontinue it.

In early pregnancy, prostaglandin synthesis inhibitors statistically significantly increase the chance of miscarriage by 1-1.5%. The risk directly correlates with the dose of the drug and the duration of its use.

There is evidence of the effects of meloxicam on the fetus in the third trimester, which can lead to manifestations of cardiopulmonary toxicity with the development of congenital defects and progressive renal failure in the child.

For the mother's body, meloxicam can be harmful due to the prolongation of contractions and their weakening, which leads to a delay in labor. Possible prolongation of postpartum bleeding time.

Analogs

If Movalis for some reason is not suitable for a particular patient, it can be replaced with analogues that have similar pharmacological effects:

• Meloxicam;
• Diclofenac;
• Nimesulide;
• Ibuprofen;
• Ketorolac;
• Meloflam;
• Mesipol;
• Bi-xicam;
• Mataren;
• Melbek;
• Amelotex;
• Movasin;
• Mydocalm;
• Milgamma;
• Voltaren;
• Arcoxia.

Drugs may differ not only in price and composition. The side effects and severity of the effect of analogues may also be different, so the selection of a substitute should be carried out by the attending physician.