Abstract
This review presents the most common disease entities in which combinations of NSAIDs and spasmolytic drugs are used to reduce pain. The benefits of fixed-dose combination products (FDCs) are that they improve the response in people with insufficient monotherapy. Using the synergy or additive effect of drugs, it is possible to obtain a significant therapeutic effect and faster action with the use of smaller doses of individual drugs. In addition, one active ingredient may counteract adverse reactions from the other. Another essential aspect of the use of FDCs is the improvement of medical adherence due to the reduction in the pill burden on patients. It is also possible to develop a fixed-dosed combination product de novo to address a new therapeutic claim and be protected by patents so that the manufacturer can obtain exclusive rights to sell a particular FDC or a formulation thereof. The proposed fixed-dose combinations should always be based on valid therapeutic principles and consider the combined safety profile of all active substances included in the medicinal product. This review aims to identify which combinations of NSAIDs and spasmolytics have been developed and tested and which combinations are still under development.
Highlights
The pharmacotherapy of pain is often based on the need for polytherapy
When using non-steroidal anti-inflammatory drugs (NSAIDs) to treat pain, it should be remembered that they exhibit a ceiling effect— producing no more substantial analgesic effect after exceeding a specific dose, usually the maximum dose recommended in the summary of product characteristics [13]
Most NSAIDs are considered safe in pregnancy, but their use is not recommended in the last 6–8 weeks; they may prolong pregnancy by inhibiting prostaglandin synthesis and problems that may arise in the fetus and mother due to reduce the production of platelets and disrupt clotting processes [25]
Summary
The pharmacotherapy of pain is often based on the need for polytherapy. There are many advantages of combined pain pharmacotherapy, including, above all, the possibility of obtaining an additive or synergistic effect. Most NSAIDs are considered safe in pregnancy, but their use is not recommended in the last 6–8 weeks; they may prolong pregnancy by inhibiting prostaglandin synthesis and problems that may arise in the fetus and mother due to reduce the production of platelets and disrupt clotting processes [25]. They should be used with caution in asthmatics; the possibility of causing or exacerbating the course of the disease has been demonstrated [26]. The available scientific studies confirm the benefits of the combined administration of antispasmodic drugs and non-steroidal anti-inflammatory agents (NSAIDs) with analgesics and in the treatment of pain accompanying smooth muscle spasms of the urogenital system (renal colic, dysmenorrhea), gastrointestinal tract (intestinal colic, irritable bowel syndrome) and pathways cholecystitis (cholecystitis, cholangitis) [34,35,36,37]
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