Diclofenac

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Dosage and Administration

Adverse reactions

Often - 1-10%; sometimes 0.1–1%; rarely 0.01–0.1%; very rarely - less than 0.01%, including some cases.
On the part of the digestive system: often - epigastric pain, abdominal cramps, nausea, vomiting, diarrhea, dyspepsia, flatulence, anorexia, increased activity of aminotransferases; rarely - gastritis, bleeding from the gastrointestinal tract (vomiting with blood, melena, diarrhea with blood), gastrointestinal ulcers (with or without bleeding or perforation), hepatitis, jaundice, abnormal liver function; very rarely - stomatitis, glossitis, dry mucous membranes (including the mouth), esophageal damage, diaphragm-like intestinal strictures (nonspecific hemorrhagic colitis, exacerbation of ulcerative colitis or Crohn's disease), constipation, pancreatitis, fulminant hepatitis.
On the part of the nervous system: often - headache, dizziness; rarely - drowsiness; very rarely - a violation of sensitivity, incl. paresthesias, memory disorders, tremor, convulsions, anxiety, cerebrovascular disorders, aseptic meningitis, disorientation, depression, insomnia, nightmarish dreams, irritability, agitation, mental disorders.
From the senses: often - vertigo; very rarely - visual impairment (blurred vision, diplopia), hearing loss, tinnitus, taste impairment.
On the part of the urinary system: very rarely - acute renal failure, hematuria, proteinuria, interstitial nephritis, nephrotic syndrome, papillary necrosis, edema.
From the side of blood formation organs: very rarely - thrombocytopenia, leukopenia, eosinophilia, hemolytic and aplastic anemia, agranulocytosis.
Allergic reactions: anaphylactic / anaphylactoid reactions, including a pronounced decrease in blood pressure and shock; very rarely - angioedema (including faces). The drug contains methyl parahydroxybenzoate and propyl parahydroxybenzoate, which can cause allergic reactions.
Since the cardiovascular system: very rarely - heartbeat, tachycardia, extrasystole, chest pain, increased blood pressure, vasculitis, heart failure, myocardial infarction.
On the part of the respiratory system: rarely - cough, bronchial asthma (including shortness of breath); very rarely - pneumonitis, laryngeal edema.
Dermatological reactions: often - skin rash; rarely - urticaria; very rarely - bullous rash, eczema, erythema multiforme, Stevens-Johnson syndrome, Lyell's syndrome, exfoliative dermatitis, pruritus, hair loss, photosensitization, purpura, incl. allergic.

Contraindications

- complete or incomplete combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses and intolerance to acetylsalicylic acid and other NSAIDs (including a history of);
- the period after coronary artery bypass surgery;
- erosive and ulcerative changes of the gastric or duodenal mucosa, active gastrointestinal bleeding;
- inflammatory bowel disease in the acute phase (UC, Crohn's disease);
- cerebrovascular bleeding or other bleeding and impaired hemostasis;
- severe liver failure or active liver disease;
- severe renal failure (CC less than 30 ml / min), including confirmed hyperkalemia, progressive kidney disease;
- decompensated heart failure;
- inhibition of bone marrow hematopoiesis;
- III trimester of pregnancy;
- lactation period (breastfeeding);
- children's age (up to 18 years);
- hypersensitivity to diclofenac.
Precautions should be prescribed the drug Naklofen Duo for ischemic heart disease, cerebrovascular diseases, dyslipidemia / hyperlipidemia, diabetes mellitus, peripheral artery diseases, smoking, QC less than 60 ml / min, anamnestic data on the development of ulcerative lesions of the gastrointestinal tract, infection caused by Helicobacter pylori syrup use of NSAIDs, frequent use of alcohol, severe somatic diseases, induced porphyria, epilepsy, diverticulitis, systemic diseases of the connective tissue, a significant decrease in the BCC (including le massive surgical intervention), elderly patients (administered in lower doses), including: receiving diuretics, weakened patients and patients with low body weight, in the I and II trimesters of pregnancy, with concomitant therapy with the following drugs: anticoagulants (for example, warfarin), antiplatelet agents (for example, acetylsalicylic acid, clopidogrel), oral glucocorticoids (for example, prednisolone), selective serotonin reuptake inhibitors (for example, citalopram, fluoxetine, paroxetine, sertraline).

Drug interactions

With the simultaneous use of diclofenac increases the plasma concentration of digoxin, methotrexate, lithium preparations and cyclosporine.
Diclofenac reduces the effect of diuretics, against the background of potassium-saving diuretics increases the risk of hyperkalemia.
When taking diclofenac on the background of anticoagulants, antiplatelet and thrombolytic drugs (alteplaza, streptokinase, urokinase) increases the risk of bleeding (usually from the gastrointestinal tract).
With simultaneous use of diclofenac reduces the effect of antihypertensives and hypnotic drugs.
Diclofenac increases the likelihood of side effects of other NSAIDs and GCS (bleeding from the gastrointestinal tract), the toxicity of methotrexate and cyclosporine nephrotoxicity.
Acetylsalicylic acid reduces the concentration of diclofenac in the blood. Simultaneous use with paracetamol increases the risk of the development of the nephrotoxic effects of diclofenac.
When taken with the use of diclofenac hypoglycemic agents, hypo-or hyperglycemia may occur. With this combination of means, it is necessary to control the level of sugar in the blood;
Cefamandol, cefoperazone, cefotetan, valproic acid and plykamycin when used simultaneously with diclofenac increase the incidence of hypoprothrombinemia.
Cyclosporine and gold preparations increase the effect of diclofenac on the synthesis of prostaglandins in the kidneys, which is manifested by an increase in nephrotoxicity.
Selective serotonin reuptake inhibitors increase the risk of bleeding from the gastrointestinal tract against the simultaneous use of diclofenac.
The simultaneous appointment of diclofenac with ethanol, colchicine, corticotropin and St. John's wort preparations increases the risk of bleeding in the gastrointestinal tract.
Drugs that cause photosensitization, increase the sensitizing effect of diclofenac to ultraviolet radiation.
Drugs that block tubular secretion, increase plasma concentration of diclofenac, thereby increasing its toxicity.
When taken together with diclofenac antibacterial drugs from the quinolone group, there is a risk of seizures.

Special instructions

Overdosage

• Brand name: Naklofen Duo
• Active ingredient: Diclofenac
• Dosage form: modified release capsules
• Manufacturer: Krka dd Novo mesto AO
• Country of Origin: Slovenia