Inflammation, Infiltration, Necrosis, Abscess and Nicolau Syndrome after Injection of Nonsteroidal Anti-inflammatory Drugs: What is the Reason?
Aleksandr Urakov *
Department of Modeling and Synthesis of Technological Processes, Institute of Applied Mechanics of the Udmurt Federal Research Center of the Ural Branch of the Russian Academy of Sciences, Izhevsk, Russia and Department of General and Clinical Pharmacology, Izhevsk State Medical Academy, Izhevsk, Russia.
Natalya Urakova
Department of General and Clinical Pharmacology, Izhevsk State Medical Academy, Izhevsk, Russia and Department of Obstetrics and Gynecology, Izhevsk State Medical Academy, Izhevsk, Russia.
*Author to whom correspondence should be addressed.
Abstract
It has been established that some nonsteroidal anti-inflammatory drugs (NSAIDs) when administered through injectable preparations have a local irritating effect, even though the preparations are considered high-quality. It seems that this local irritant action is not related to any specific pharmacological action but with the physicochemical properties of the preparation that grossly violate the homeostasis of the tissues. It seems that the local complications at injection sites can be caused by the nonspecific properties of the injectable preparations: denaturing (cauterizing), hypertonic and acidic activity. Each such property, or their combination, has a locally irritating effect, which can cause abscess, necrosis, and acute aseptic inflammation of reversible or irreversible nature, that follows immediately after subcutaneous or intramuscular administration, a condition named “Nicolau Syndrome”. Conversely, injectable preparations of NSAIDs having isotonic or hypotonic osmolarity associated with a neutral or weakly alkaline pH (about pH 7.4), produce a minimal short-term reversible local inflammatory effect and do not cause Nicolau Syndrome after administration.
Keywords: NSAIDs, injection, local complications, abscess, Nicolau syndrome, nonsteroidal anti-inflammatory drugs