Diclofenac sodium suppositories rect. 0.05 g each No. 10 (5x2)

Analogues of the drug according to ATC codes:

VOLTAREN EMULGEL DICLOVIT DICLOGEN PLUS DICLORAN PLUS DICLOFENAC DICLOFENAC DICLOFENAC DICLOFENAC-ACOS DICLOFENAC-ACRI DICLOFENACOL CHONDROFEN All

Diclofenac suppositories - indications for use

By prescribing the drug, doctors aim to stop the inflammatory process and reduce its symptoms. In most cases, the drug is used to treat various types of pathology of the supporting apparatus.

According to the instructions accompanying Diclofenac suppositories, the indications for their use are as follows:

• chronic polyarthritis;
• arthrosis;
• Bekhterev's disease;
• neuritis and neuralgia;
• acute attacks of gout;
• lumbago;
• sciatica;
• rheumatic lesions of soft tissues;
• pain syndromes: headache, neuralgia, myalgia, biliary and renal colic, post-traumatic pain syndrome accompanied by inflammation;
• gynecological diseases: inflammatory processes in the pelvis (adnexitis), algodismenorrhea;
• infectious diseases of the ENT organs (during complex therapy): otitis media, pharyngitis, tonsillitis.

Release form, composition and packaging

Gel for external use 5% is colorless or slightly yellowish, transparent, homogeneous and free of bubbles, with a characteristic odor of isopropyl alcohol.

Excipients: isopropyl alcohol, macrogol-7-glyceryl cocoate, hypromellose, aromatic oil, purified water.

50 g - aluminum tubes (1) - cardboard boxes. 100 g - aluminum tubes (1) - cardboard boxes.

Stock

dyucha speech:
diclofenac;

1 suppository containing diclofenac sodium 0.05 g;

additional speech:

hard fat.

Medicine form.

Rectal suppositories.

Main physical and chemical authorities:

suppositories white with a slightly chewy color.

Pharmacotherapeutic group.

Non-steroidal anti-inflammatory and anti-rheumatic agents.

ATX code M01A B05.

Pharmacological power.

Pharmacodynamics.

Diclofenac sodium exhibits an anti-inflammatory and analgesic effect due to the suppression of the biosynthesis of prostaglandins, kinins and other mediators of inflammation and pain, changes in capillary permeability and stabilization m infused onto lysosomal membranes.

During a course of treatment for illnesses of the musculoskeletal system, the drug intensively penetrates into empty joints, resulting in less pain in the joints at rest and during the hour of pain, an increased volume of bones, and a change in wound stiffness. And the swelling of the corners. A lasting effect is achieved after 1-2 days of treatment. In case of post-traumatic or post-operative inflammation, it causes a slight change in the pain syndrome, changing the inflammation and swelling of the wound.

Pharmacokinetics.

When diclofenac sodium is administered rectally, it is absorbed into the rectal mucosa. The maximum concentration in blood plasma is reached after 1–2 years. The average period becomes 2 years old. Approximately 70% of the administered dose is excreted from the body in the form of metabolites, less than 1% – in the same form, in the form of feces.

Clinical characteristics.

Showing.

• Inflammatory and degenerative forms of rheumatism: rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, including spondyloarthritis;
• pain syndromes on the side of the ridge;
• rheumatic illness of soft tissues of the forehead;
• post-traumatic and post-operative pain syndromes, accompanied by inflammation and swelling, acute after dental and orthopedic operations;
• gynecological illnesses, which are accompanied by pain syndrome and inflammation, such as primary dysmenorrhea and adnexitis;
• migraine attacks;
• severe gout attacks;
• as an additional treatment for severe inflammatory illnesses of the ENT organs, which are accompanied by painful disorders, such as pharyngotonsillitis, otitis.

Similar to the fundamental therapeutic principles, the main illness is treated with basic therapy. Fever itself is not an indication for taking the drug.

Contraindicated.

• Hypersensitivity to any other word or to any other word of the drug;
• history of bleeding or perforation of the intestinal tract associated with prior treatment with non-steroidal anti-inflammatory drugs (NSAIDs);
• an active form of viral illness/bleeding or a history of recurrent viral illness/bleeding (two or more episodes of diagnosed viral illness or bleeding);
• remaining trimester of gestation;
• inflammation of the intestines (for example, Crohn's disease or viral colitis);
• liver failure (Child-Pyu class C) (liver cirrhosis and ascites);
• nitric deficiency (glomerular filtration rate (GFR) <15 ml/xv/1.73 m2);
• severe congestive heart failure (NYHA II-IV);
• relief of perioperative pain during coronary artery bypass grafting (or use of a piecemeal blood circulation device);
• Ischemic heart disease in patients who may have angina pectoris or myocardial infarction;
• cerebrovascular disease in patients who have suffered a stroke or may have episodes of transient ischemic attacks;
• disease of the peripheral arteries;
• diclofenac sodium, as well as other NSAIDs, are contraindicated in patients who are susceptible to taking acetylsalicylic acid or other NSAIDs due to attacks of bronchial asthma, urticaria, angioedema, acute rhinitis or nasal polyps;
• proctitis

Interactions with other medicinal drugs and other types of interactions.

Low-value interactions include those that were avoided when diclofenac was infused in the form of enteric tablets and/or in other dosage forms.

Lithium. After one-hour administration, diclofenac can increase the concentration of lithium in blood plasma. It is recommended to monitor the age of blood syringes.

Digoxin. Over one-hour administration, diclofenac can increase the concentration of digoxin in blood plasma. Monitoring of digoxin levels in blood serum is recommended. Diuretics and antihypertensive agents. As with other NSAIDs, concomitant use of diclofenac with diuretics and antihypertensive agents (for example, β-blockers, angiotensin converting enzyme (ACE) inhibitors) may result in a decrease in their antihypertensive effect. the effect of inhibiting the synthesis of vasodilating prostaglandins. Thus, such a combination should be avoided, and patients, especially those of summer age, must endure arterial pressure under close scrutiny. Patients are required to maintain proper hydration, and monitoring of thyroid function is also recommended after initiation of concomitant therapy and on a regular basis thereafter, especially with diuretics and inhibitors. ACE inhibitors are associated with an increased risk of nephrotoxicity.

Drugs known to cause hyperkalemia. Concomitant treatment with potassium-sparing diuretics, cyclosporine, tacrolimus or trimethoprim may be associated with increased levels of potassium in blood serum, so patients should be monitored closely more often.

Anticoagulants and antithrombotic properties. Concomitant stagnation may increase the risk of bleeding, so it is recommended to proceed with caution. Although clinical studies do not indicate the effect of diclofenac on the activity of anticoagulants, there is also evidence of an increased risk of bleeding in patients who are immediately treated with diclofenac and anticoagulants. Therefore, to ensure that daily changes in the dosage of anticoagulants are not required, close monitoring of such patients is recommended. Like other NSAIDs, diclofenac in high doses may temporarily inhibit platelet aggregation.

Other NSAIDs, including selective cyclooxygenase-2 inhibitors and corticosteroids. Acute administration of diclofenac and other NSAIDs or corticosteroids may increase the risk of scutulointestinal bleeding or ulcers. A trace of the uniqueness of one-hour stagnation of two or more NSAIDs.

Selective inhibitors of renal serotonin storage (SSRI). Concomitant use of NSAIDs and NSAIDs may increase the risk of splanchnic-intestinal bleeding.

Antidiabetic drugs. Clinical studies have shown that diclofenac can be combined with oral antidiabetic agents without altering their therapeutic effect. There is information about the development of both hypoglycemia and hyperglycemia in such episodes, which necessitated the need to change the dose of antidiabetic agents during the period of insulation of diclofenac. For these reasons, it is recommended to control the level of glucose in the blood during combination therapy.

There are also clear reports of episodes of metabolic acidosis during one-hour ingestion with diclofenac, especially in patients with already impaired function of the drug.

Methotrexate. Diclofenac may inhibit the clearance of methotrexate in the narcotic tubules, resulting in increased levels of methotrexate. Slid Drymumvati of the Obrazhnosti at the recognized NPZP, turning on Diclofenac, more than 24 years old, more than 24 years before the gap of methotrexate, desiccals in such vipads, the concentration of methotrexate in the bloods of the yoga toxic, Serious toxicities have been reported when methotrexate and NSAIDs, including diclofenac, were administered beyond 24 years. This interaction is mediated through the accumulation of methotrexate as a result of impaired nitric excretion in the presence of NSAIDs.

Cyclosporine. The infusion of diclofenac, like other NSAIDs, on the synthesis of prostaglandins in women can enhance the nephrotoxicity of cyclosporine, in connection with which diclofenac can be stagnated in low doses, which is not necessary for patients, as cyclosporine does not stagnate. Tacrolimus. When NSAIDs are congested with tacrolimus, there may be a risk of nephrotoxicity, which may be mediated through the narcotic antiprostaglandin effects of NSAIDs and the calcineurin inhibitor, in association with this trace. and in low doses, in patients who do not need to take cyclosporine.

Antibacterial quinolones. There are data about the development of the trial in patients who were immediately treated with similar quinolone and NSAIDs. This can be done in patients with or without a history of epilepsy and a history of seizures. Therefore, caution should be exercised when administering quinolone to patients who are already treating NSAIDs.

Phenytoin. When administering phenytoin concomitantly with diclofenac, it is recommended to monitor plasma phenytoin concentrations in relation to increased infusion of phenytoin.

Colestipol and cholestyramine. These drugs may cause interference or changes in the administration of diclofenac. Therefore, it is recommended to administer diclofenac 1 year before or 4–6 years after colestipol/cholestyramine administration.

Cardiac glycosides. Acute depletion of cardiac glycosides and NSAIDs in patients may worsen heart failure, reduce GFR and increase the level of glycosides in blood plasma.

Mifepristone. NSAIDs should not be ingested for 8–12 days after administration of mifepristone; remaining NSAIDs may alter the effect of mifepristone.

Strong CYP2C9 inhibitors. Be careful when diclofenac is ingested with potent CYP2C9 inhibitors (such as voriconazole), as these may lead to a significant increase in maximum plasma concentrations and exposure to diclofenac in inherited from its metabolism.

Inductors CYP2C9.

It is also necessary to be careful when diclofenac is ingested with CYP2C9 inducers (for example, rifampicin), as this can lead to a significant change in plasma concentrations and exposure to diclofenac.

Features of stagnation.

Zagalni

Gut-intestinal lesions, bleeding or perforation can occur at any time during the course of NSAID ingestion, regardless of the fact that they are COX-2-selective, due to the absence of pre-chewing symptoms or a history of swelling.

In order to minimize unwanted effects, maintain the minimum effective dose for a short period of time.

Placebo-controlled studies showed increased risk of development of thrombotic cardiovascular and cerebrovascular complications when administered with selective COX-2 inhibitors. This risk strongly correlates with the COX-1/COX-2 selectivity of other NSAIDs, but remains unknown.

The difference between one-hour administration of Diclofenac sodium and systemic NSAIDs, such as selective cyclooxygenase-2 inhibitors, is due to the lack of evidence of a synergistic effect and an association with potential additive side effects ects.

Based on the current daily clinical data from long-term treatment with the maximum dose of diclofenac, the possibility of such an increase in risk cannot be turned off. Do not report such data, before administering diclofenac, conduct a thorough assessment of the joint measles-rhiz in patients with clinically confirmed coronary heart disease, cerebrovascular damage, occlusion diseases of the peripheral artery or significant risk factors (for example, arterial hypertension, hyperlipidemia, blood diabetes, chickens). Through this mechanism, the minimum effective dose should be administered over a short period of time.

Caution is necessary for patients of the summer age. Zocrem, it is recommended to use the lowest effective dose for weakened patients of summer age or with low body weight. At the ridki vipades, Yak I, at the fast of the NPZP, can be instructed by the Alergіchychi reaction, in that number anathylactic/anathylacta -dimensional reacts, and the diclofenaca without avert. Due to its pharmacodynamic effects, diclofenac sodium, like other NSAIDs, may mask the signs and symptoms of infection.

Floating onto the grass path

When all NSAIDs, including diclofenac, were ingested, episodes of intestinal hemorrhage (vomiting blood, melania), bleeding or perforation, which may be fatal and which may occur at any time during the process, were recorded. and treatment if signs or presence of pre-chewing symptoms or a previous history of serious ulcers on the side of the scolio-intestinal tract (SCT). These findings may lead to more serious consequences in late-life patients. If patients are discontinuing diclofenac, they should be careful about the occurrence of intestinal bleeding, or if the infection has developed, the drug must be injected.

As with other NSAIDs, including diclofenac, for patients with symptoms that indicate damage to the side of the thyroid gland, medical attention and special care are required. The risk of bleeding, bleeding or perforation in the CT increases with increased doses of NSAIDs, including diclofenac, and in patients with a history of bleeding, especially with complications in the appearance of bleeding or perforation, and in patients with a history of bleeding or perforation. cents of the summer century.

Summer age patients may have an increased incidence of adverse reactions with chronic NSAIDs, especially bowel bleeding and perforation, which can be fatal. To reduce the risk of such toxic influx on the SCT, treatment should be started and maintained with the lowest effective doses.

For such patients, as well as for those who require concomitant treatment with medications, low doses of acetylsalicylic acid (ASA) or other medications, which are very likely to be used, risk of unfavorable action on the CCT, then look at the nutrition about stagnation of combination therapy for stagnation drugs (for example, proton pump inhibitors or misoprostol).

Patients with a history of bowel toxicity, especially in the summer, should be advised of any non-essential abdominal symptoms (especially bleeding in the GCT). Precautions are also necessary for patients who need to immediately eliminate medications that can increase the risk of infection or bleeding, such as systemic corticosteroids, anticoagulants (for example, warfarin), antithrombotic agents (for example, ASK) or SIZZS.

Float on the stove

Close medical supervision is required in cases where Diclofenac sodium must be prescribed to patients with impaired liver function, and parts of their liver may be damaged. As with other NSAIDs, including diclofenac, the presence of one or more liver enzymes may be affected.

This occurred very often during clinical follow-up with diclofenac (in approximately 15% of patients), but was very rarely accompanied by clinical symptoms. Most of these drops are associated with increased limit values. Often (in 2.5% of cases) there was a slight increase (≥3 to <8 above the upper limit of the norm), while the frequency of significant displacement (≥8 times above the upper limit of the norm) was less than 1%. In significant clinical findings, in 0.5% of patients, elevated levels of liver enzymes were accompanied by clinically significant liver damage. After the preparation has been injected, the level of liver enzymes has returned to the output value.

Before treatment with Diclofenac sodium, it is necessary to regularly monitor the functions of the liver. If the function of the liver is impaired, clinical signs or symptoms may be associated with progressive illnesses of the liver, or if other manifestations are avoided (for example, osinophilia, syphilia), administration of the drug Diclofenac sodium to the drug.

In addition to elevated levels of liver enzymes, there have been reports of severe liver reactions, including hepatitis and hepatitis, liver necrosis and liver failure, which in some cases are fatal. idok.

Illnesses such as hepatitis may resolve without prodromal symptoms. Caution is necessary in cases where Diclofenac sodium is administered to patients with hepatic porphyria, due to the likelihood of provoking an attack.

Swimming into nirk

The importance of prostaglandins in supporting high blood flow requires treatment with high doses of NSAIDs, including diclofenac, often (1-10%) leading to swelling and arterial hypertension.

Splinters during treatment of NSAIDs, including diclofenac, have been reported to cause swelling and swelling, with particular attention given to patients with impaired heart function or low arterial hypertension In the anamnesis, patients of summer age, patients who are taking concomitant therapy with diuretics or drugs that can be infused on the function of niro, as well as in patients with a corresponding decrease in the post-occupying volume for any reason, for example, before or after a serious surgical procedure. In such cases, monitoring of neurological function is recommended as a precautionary approach. The application of therapy means turning to the stage of blowing the bath.

Float onto the skin

Serious skin reactions (some of them fatal), including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis. In patients at greatest risk for the development of these reactions, these reactions are prevented during the beginning of the course of therapy: the appearance of the reaction is observed in most cases during the first month of treatment. Diclofenac sodium should be taken at the first appearance of skin rashes, mucous membrane infections, or when any other signs of hypersensitivity appear.

As with other NSAIDs, in some cases allergic reactions may occur, including anaphylactic/anaphylactoid reactions, which can be caused by diclofenac without prior infusion.

Systemic bloodworm (SCHV) and mixed diseases of contaminated tissue

In patients with SHF and contaminated tissue contaminants, there may be an increased risk of developing aseptic meningitis.

Cardiovascular and cerebrovascular effects

Patients with diagnosed cardiovascular diseases (for example, heart failure, diagnosed ischemic heart disease, peripheral artery disease) or uncontrolled arterial hypertension should take Diclofenac sodium It is not recommended.

For patients with a history of arterial hypertension and/or congestive heart failure of mild or moderate severity, it is necessary to carry out similar monitoring and follow these recommendations , fragments in association with congested NSAIDs, including diclofenac, episodes of blocking and swelling have been recorded. Clinical and epidemiological data indicate that diclofenac administration, especially at high doses (150 mg per dose) and during trival administration, may be associated with a slight increase in the risk of developing to arterial thrombotic conditions (for example, myocardial infarction or stroke).

Diclofenac is not recommended for patients with uncontrolled arterial hypertension, congestive heart failure, persistent ischemic heart disease, diseases of the peripheral arteries and/or cerebrovascular disease. Oh, if necessary, stagnation is possible only after a thorough assessment of the rhiziku-coristia dose of no more than 100 mg per dose. A similar assessment should be carried out before the start of long-term treatment of patients with risk factors for the development of cardiovascular diseases (for example, with arterial hypertension, hyperlipidemia, blood diabetes and the patient ntam, how to scorch).

It is necessary to periodically assess the patient's need for relief of symptoms and response to therapy, especially when the duration of therapy becomes more than 4 days.

Patients should be informed of the need to monitor for signs and symptoms of serious arterial thromboembolic disease (eg, chest pain, shortness of breath, weakness, slurred speech), which may occur without warning. In the event of such a phenomenon, the patient is guilty of immediately contacting the doctor.

It is possible to prescribe diclofenac to patients with significant risk factors for cardiovascular diseases (for example, arterial hypertension, hyperlipidemia, celiac diabetes, chicken) only after clinical assessment, etc. or in doses up to 100 mg per dose, if the duration of therapy becomes more than 4 days. Remnants of the cardiovascular risk of diclofenac can grow with higher doses and treatment, which must be contained for a short period of time and at the lowest effective dose. It is important to periodically review the patient's intake of stasinated diclofenac to improve symptoms and response to therapy. Patients over 65 years of age should be treated with caution.

Influx into hematological indicators

In case of chronic use of this drug, as well as other NSAIDs, monitoring with regular blood tests is recommended.

Diclofenac sodium may reverse platelet aggregation. Care must be taken for patients with impaired hemostasis, hemorrhagic disease or hematological disorders.

History of asthma

In patients with asthma, seasonal allergic rhinitis, swelling of the nasal mucosa (or nasal polyps), chronic obstructive pulmonary diseases or chronic respiratory infections (especially those associated with with allergic, rhinitis-like symptoms) reactions to NSAIDs are more likely to occur, such as exacerbation of asthma (so-called intolerance to analgesics/analgesic asthma), Quincke's disease or kropiv'yanka. In connection with these patients, special guarded entry is recommended (preparedness until emergency assistance is given). There are also patients with allergic reactions to other words, such as hissing, itching, or kropivyanka.

Like other drugs that inhibit the activity of prostaglandin synthetase, diclofenac sodium and other NSAIDs can provoke the development of bronchospasm in congested patients who suffer from bronchial asthma or with a history of bronchial asthma.

Suspension during pregnancy or breastfeeding.

Vaginism.

Subject to absolute consumption, diclofenac cannot be used in the 1st or 2nd trimester of pregnancy. In the 1st and 2nd trimesters of pregnancy, Diclofenac sodium can be prescribed only if the measles for the mother exceeds the potential risk for the fetus and only in the minimum effective dose, the effectiveness of treatment The fault is as short as possible, as much as possible. Like other NSAIDs, the drug is contraindicated in the third trimester of gestation (possible suppression of the uterus and premature closure of the arterial ducts in the fetus).

Inhibition of prostaglandin synthesis may have a negative impact on vacancy and/or development of the embryo/fetus. Data from epidemiological studies indicate an increase in the risk of pregnancy loss and/or the development of cardiac vascular disease and gastroschisis after administration of an inhibitor of prostaglandin synthesis in the early stages of gestation. The absolute risk of cardiac-vascular diseases increases from less than 1% to approximately 1.5%.

It is not excluded that the risk increases with the dose and severity of the treatment. It has been shown that in animals, administration of an inhibitor of prostaglandin synthesis leads to increased post-implantation loss and mortality of the embryo/fetus.

In addition, in animals that suppressed the inhibitor of prostaglandin synthesis during organogenesis, an increased frequency of various developments was recorded, including in the cardiovascular system. Since Diclofenac sodium is used by women who are pregnant or pregnant in the first trimester of pregnancy, the dose of the drug is low, and the duration of treatment is short.

During the third trimester of pregnancy, all inhibitors of prostaglandin synthesis can be added to the pregnancy as follows:

• Cardiovascular toxicity due to early closure of the arterial duct and pulmonary hypertension;
• Impaired nitric function, which can progress to nicoric deficiency with oligohydroamniosis.

Influx on the mother and newborn, as well as similar aspects of pregnancy:

• possible bleeding, antiplatelet effect, which can be avoided at very low doses;
• galmuvaniya quickly uterus, which should be carried out before trimming or refurbishment of the canopies.

Also, Diclofenac sodium is contraindicated during the third trimester of gestation.

Breastfeeding period.

Like other NSAIDs, diclofenac is excreted in breast milk in small quantities. In combination with this suppository, Diclofenac sodium should not be mixed with women during their breastfeeding period, in order to avoid unnecessary influx during pregnancy. Since care is necessary in life, it is necessary to transfer the child to a piece of benefit.

Fertility in women

Like other NSAIDs, Diclofenac sodium can negatively affect a woman’s fertility, so it is not recommended to prescribe the drug to women planning to become pregnant. For women who may have problems with conception or are undergoing investigation for infertility, consider the effectiveness of taking the drug.

In animals, based on similar data, it is impossible to exclude impaired fertility in males. The relevance of these data for people is unimportant.

This is due to the fluidity of the reaction during treatment with vehicles or other mechanisms.

Patients who, during treatment with the medicinal drug Diclofenac sodium, experience blurred vision, confusion, vertigo, drowsiness, damage to the side of the central nervous system, bloatiness or nausea, not due to keratinization by vehicles or other our mechanisms.

Method of congestion and dosage.

The dose of the drug depends on the nature, severity level and clinical progression of illness.

The drug should be administered at the lowest effective doses for a short period of time, during medical treatment of the skin of the patient.

Suppositories must be administered into the rectum, perhaps more closely, after cleansing the intestines.

The dose for adults should be 100–150 mg (2–3 suppositories) per dose. For mild symptoms, as well as standard therapy, a dose of 75*–100 mg per dose is sufficient.

*Vikoristovat suppositories with diclofenac in the prescribed dosage.

Divide the additional dose into 2-3 doses. To eliminate night pain or wound tightness, before taking the drug daily, take Diclofenac sodium as a rectal suppository before bedtime (the dose of the drug should not exceed 150 mg).

In case of primary dysmenorrhea, the dosage should be selected individually, including 50–150 mg per dosage (1–3 suppositories). The initial dose can be 50–100 mg per dose (1–2 suppositories), and if necessary, it can be increased over several menstrual cycles to a maximum of 150 mg per dose (3 suppositories). The drug should be started after the onset of pain symptoms have disappeared and continued for several days, depending on the dynamics of symptom regression.

To treat migraine attacks, start the course at a dose of 100 mg (2 suppositories) when the first signs of the attack appear. If necessary, you can take another 50 mg of diclofenac (1 suppository) on the same day. If necessary, the next day of treatment can be extended (the additional dose of the drug should not exceed 150 mg (3 suppositories), the dose should be divided into 3 doses).

Children are 14 years old

You can prescribe 50 mg (1 suppository).

Due to the increased concentration of the active ingredient Diclofenac sodium, suppository 50 mg, it is not recommended to administer to children and children under 14 years of age.

Summer age patients: although the pharmacokinetics of Diclofenac sodium does not change to any clinically significant level in summer age patients, NSAIDs need to be stabilized with special care However, such patients are more likely to develop undesirable reactions. It is recommended to take the lowest effective dose for zocrema, debilitated patients of summer age or patients with low body weight; Patients also need to be covered in case of bowel bleeding due to treatment of NSAIDs.

Impaired function of the nirok

Diclofenac sodium is contraindicated for patients with nitric deficiency (GFR <15 ml/xw/1.73 m2; section “Contraindications”).

No special studies have been carried out in patients with impaired function, so recommendations for dosage adjustment cannot be made. Use diclofenac sodium with caution in patients with impaired function (section “Peculiarities of congestion”).

Impaired liver function

Diclofenac sodium is contraindicated for patients with liver failure (section “Contraindications”).

Special studies have not been carried out in patients with impaired liver function, so recommendations for dose adjustment cannot be made. Use diclofenac sodium with caution in patients with mild to moderate impairment of liver function (section “Peculiarities of congestion”).

Children.

The medicinal form of the drug is given to children over 14 years of age.

Overdose.

Symptoms There is no typical clinical picture characteristic of diclofenac overdose. Overdosing can cause symptoms such as headache, nausea, vomiting, pain in the epigastric region, scutaneous bleeding, diarrhea, confusion, disorientation, restlessness, coma, drowsiness, vomiting or vomiting. Nitrogen deficiency and liver damage can occur in cases of severe intoxication.

Likuvannya. When necessary, treatment is more symptomatic. Supportive approaches and symptomatic treatment of the traces are due to the development of such complications as arterial hypotension, nitric deficiency, vasomia, disorders of the side of the cervical tract, as well as suppressed breathing.

It is unlikely that such specific approaches, such as forced diuresis, dialysis or hemoperfusion, will be effective for the elimination of NSAIDs, including diclofenac, from the body, through connections in the significant world with proteins and int intensive metabolism. After 1 year of stagnation of the potentially toxic substance of the drug, the possibility of stagnation of the active vugillum is examined. In addition, in adult animals, the possibility of washing the pouch for 1 year after the potentially toxic drug has been allowed to stand. In rare or severe cases, it is necessary to administer diazepam internally. Depending on the patient's clinical status, other approaches may be indicated.

Adverse reactions.

On the side of the ShKT:

pain in the epigastric region, nausea, vomiting, diarrhea, dyspepsia, flatulence, anorexia, decreased appetite; gastritis; Schulculo-intestinal bleeding (vomiting, melena, diarrhea with houses of blood), vulgaris and intestinal tract, which may or may not be accompanied by bleeding, gastrointestinal stenosis or perforation (some lethal, especially in patients summer age), which can lead to peritonitis, proctitis ; very rarely widened - colitis (including hemorrhagic colitis, ischemic colitis and acute viral colitis or Crohn's disease), constipation, stomatitis (including viral stomatitis), glossitis, impaired function of the diaphragm, diaphragmatic disease severe intestinal stenosis, pancreatitis, chronic hemorrhoids.

On the side of the hepatobiliary system:

increased levels of transaminases; hepatitis, zhovtyanitsa, liver problems; Bliskavich hepatitis, liver necrosis, liver failure.

On the side of the nervous system:

headache, confusion; drowsiness, sleepiness; paresthesia, memory loss, seizures, restlessness, tremor, aseptic meningitis, loss of taste, stroke; confusion of information, hallucinations, impaired sensitivity, mental illness.

Mental disorders:

disorientation, depression, sleeplessness, restlessness, night sickness, psychotic disorders.

From the side of the organs:

loss of vision, blurred vision, diplopia, neuritis of the visual nerve.

From the side of the organs of hearing and the labyrinth of the ear:

vertigo; jingle in the wuhs, soothe your hearing.

On the side of the hematopoietic system:

thrombocytopenia, leukopenia, hemolytic anemia, aplastic anemia, agranulocytosis.

On the side of the immune system:

hypersensitivity, anaphylactic and anaphylactoid reactions (including arterial hypotension and shock), angioedema (including vepicular plaque).

On the side of the cardiovascular system:

heart failure, chest pain, heart failure, myocardial infarction, arterial hypertension, arterial hypotension, vasculitis, Conis syndrome.

On the side of the dichotomy system:

asthma (including asthma), bronchospasm, pneumonitis.

From the side of the skin and under the skin:

visipannya; kropiv'yanka; very rarely - sagging skin, eczema, erythema multiforme, Stevens-Johnson syndrome, Lyell's syndrome (toxic epidermal necrolysis), exfoliative dermatitis, hair loss, photosensitive reactions; purpura, including allergic, Henoch-Schönlein purpura, verbizh.

On the side of the thyroid system:

swelling of the veins, swelling, gastrointestinal ulceration, gastrointestinal insufficiency, hematuria, proteinuria, tubulointerstitial nephritis; nephrotic syndrome; papillary necrosis of the skin.

On the side of the reproductive system and milk vines:

very rarely – impotence.

Zagalni ruins and ruins at the place of introduction:

teasing at the place of introduction, bump.

Clinical and epidemiological data provide evidence of the risk of thrombotic complications (for example, myocardial infarction or stroke), associated with diclofenac administration, and zocrema in high-dose drugs. at these doses (150 mg per dose) and at trivalent congestion.

Zorov's destruction.

Such visual impairments as blurred vision, blurred vision and diplopia are effects in the class of NSAIDs and can be harmful after taking the drug. The most likely mechanism of visual impairment is the inhibition of the synthesis of prostaglandins and other compounds, which, by disrupting the regulation of retinal blood flow, contribute to the development of visual disorders. If such symptoms occur during treatment with diclofenac, it is necessary to conduct an ophthalmological examination to exclude other possible causes.

Term of attribution.

2 rocks.

DICLAC: DOSAGE

The drug is used externally.

For adults and children over 6 years of age, the drug is applied to the skin and lightly rubbed in, the frequency of use is 2-3 times a day. The required amount of the drug depends on the size of the affected area. A single dose of the drug is up to 2 g (about 4 cm with the neck of the tube completely open). After applying the drug, hands must be washed.

The duration of treatment depends on the indications and the observed effect. After 2 weeks of using the drug, the patient should consult a doctor.

Interaction with medications

All dosage forms of Diklak have antipyretic, antiphlogistic, decongestant, analgesic and antirheumatic properties. The principle of action of NSAIDs is due to the inhibition of the biosynthesis of prostaglandins, cytokines and other inflammatory mediators.

Diclofenac has a stabilizing effect on cell membranes and also reduces the permeability of capillary walls, which prevents the leakage of intercellular fluid into soft tissues. NSAIDs inhibit the aggregation of blood plates, but do not affect the production of proteoglycans in connective tissue and cartilage.

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For rheumatic diseases, Diklak exhibits analgesic, antifever and antiphlogistic properties, due to which the patient’s well-being improves. Systematic administration of a non-steroidal analgesic leads to a reduction in joint swelling and pain during movement or at rest.

When using the medicine in tablet form or in the form of rectal suppositories, it is possible to quickly relieve pain of non-rheumatic origin. During the tests, it was found that Diklak reduces pain and blood loss in women during menstruation.

It is not recommended to combine Diclak with the following medications due to the possible increase in adverse reactions:

• potassium-sparing diuretics – increase the potassium content in the blood plasma, which can lead to seizures;
• anticoagulants – increase the likelihood of bleeding in the intestines;
• cyclosporine – enhances the nephrotoxic effect on detoxification organs.

It is also contraindicated to combine NSAIDs with quinoline antibiotics due to the risk of seizures and other undesirable effects.

This is a non-steroidal anti-inflammatory drug. After administration, the active component eliminates the inflammatory process by suppressing the production of specific mediators. Non-selectively suppresses COX 1 and 2. The effect of the drug also helps to lower body temperature during a febrile state. Use in the treatment of diseases of the musculoskeletal system and connective tissues helps eliminate swelling, pain and other unpleasant manifestations. Motor activity is normalized. Used in short-term symptomatic therapy.

Contraindications

• “aspirin” asthma;
• violation of the integrity of the skin;
• III trimester of pregnancy;
• lactation period (breastfeeding);
• children under 6 years of age;
• hypersensitivity to the components of the drug;
• hypersensitivity to acetylsalicylic acid or other NSAIDs.

The drug should be used with caution in case of hepatic porphyria (exacerbation), erosive and ulcerative lesions of the gastrointestinal tract, severe dysfunction of the liver and kidneys, chronic heart failure, bronchial asthma, in elderly patients, in the first and second trimesters of pregnancy.

Side effect

From the digestive system: > 1% - abdominal pain, feeling of bloating, diarrhea, nausea, constipation, flatulence, increased activity of liver enzymes, peptic ulcer with possible complications (bleeding, perforation), gastrointestinal bleeding; <1% - vomiting, jaundice, melena, blood in the stool, esophageal damage, aphthous stomatitis, dry mouth and mucous membranes, hepatitis (possibly fulminant), liver necrosis, cirrhosis, hepatorenal syndrome, changes in appetite, pancreatitis, cholecystopancreatitis, colitis .

From the central nervous system: > 1% - headache, dizziness; <1% - sleep disturbance, drowsiness, depression, irritability, aseptic meningitis (more often in patients with systemic lupus erythematosus and other systemic connective tissue diseases), convulsions, weakness, disorientation, nightmares, a feeling of fear.

From the senses: > 1% - tinnitus; <1% - blurred vision, diplopia, taste disturbance, reversible or irreversible hearing loss, scotoma.

Dermatological reactions: > 1% - skin itching, skin rash; <1% - alopecia, urticaria, eczema, toxic dermatitis, exudative erythema multiforme, incl. Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), photosensitivity, pinpoint hemorrhages.

From the urinary system: > 1% - fluid retention; <1% - nephrotic syndrome, proteinuria, oliguria, hematuria, interstitial nephritis, papillary necrosis, acute renal failure, azotemia.

From the hematopoietic system: > 1% - anemia (including hemolytic and aplastic anemia), leukopenia, thrombocytopenia, eosinophilia, agranulocytosis, thrombocytopenic purpura.

From the respiratory system: <1% - cough, bronchospasm, laryngeal edema, pneumonitis.

From the cardiovascular system: <1% - increased blood pressure, congestive heart failure, extrasystole, chest pain.

Allergic reactions: <1% - anaphylactoid reactions, anaphylactic shock (usually develops rapidly), swelling of the lips and tongue, allergic vasculitis.

Local reactions: with intramuscular injection - burning, infiltration, aseptic necrosis, necrosis of adipose tissue; with rectal administration - irritation of the rectal mucosa, mucous discharge mixed with blood, pain during defecation, rectal bleeding.

Other: worsening of infectious processes (development of necrotizing fasciitis, pneumonia).