Panoxen®

Brand Anglo-French Drugs & Industries Ltd

In stock 1898 Items

Available since: 2019-09-19

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Clinical Pharmacology

Panoxen is a combined drug and belongs to the group of nonsteroidal anti-inflammatory drugs designed to eliminate the symptoms and pain of inflammatory and degenerative diseases.

The drug has an effective antipyretic, analgesic and anti-inflammatory effect.

Diclofenac, as an active substance in the composition of Panoxen, has an anti-inflammatory effect, specifically eliminating prostaglandins in inflamed tissues and relieving pain in the foci of inflammation.

Paracetamol has an antipyretic effect, and together with other components of the drug relieves swelling and pain.

Panoxen as a combined drug has two mechanisms of analgesic action - peripheral and central.

The drug is effective against inflammatory diseases of non-infectious nature.

Indications

Panoxen appointed for inflammatory and degenerative diseases:

musculoskeletal system (rheumatism, lumbago, gout, arthritis, spondylitis, osteoarthritis, polyarthritis, osteochondrosis, etc.);
nervous system (inflammation of the sciatic nerve, neuralgia, myalgia).

A drug Panoxen effective as an analgesic for headaches, toothaches, sprains and bruises, renal colic, inflammatory diseases of the upper respiratory tract.

Composition

1 tablet contains:

Active substances: paracetamol 500 mg, diclofenac sodium 50 mg;

Excipients: corn starch - 290 mg, cellulose (acetylphthalyl cellulose) - 15 mg, diethyl phthalate - 2.5 mg, talc - 10 mg, magnesium stearate - 10 mg, titanium dioxide - 13 mg, microcrystalline cellulose - 70 mg, povidone K-30 - 18 mg, methyl paraben (methyl parahydroxybenzoate) - 17.5 mg, propyl paraben (propyl parahydroxybenzoate) - 4 mg.

Shell composition: TC 1005 tablet coating (white) - 28.5 mg (hypromellose - 5.5 mg, propylene glycol - 4.3 mg, talc - 10.8 mg, titanium dioxide - 7.98 mg).

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Dosage and Administration

Panoxen must be taken orally for half an hour before meals 1 tablet 2-3 times a day.

The daily dose of the drug should not exceed 3 pills of 50/500 mg.

Children from 12 years Panoxen administered in dosage based on body weight - 2 mg per 1 kg.

Patients with heart failure, kidney and liver diseases should reduce the dosage of the drug and monitor the functioning of the digestive tract.

With a long course of treatment, additional diagnostic procedures should be performed to detect hidden bleeding.

Panoxen in large doses can affect the level of glucose and uric acid in the blood.

Adverse reactions

From the digestive system: epigastric pain, nausea, vomiting, diarrhea, dyspepsia, flatulence, anorexia, increased activity of hepatic aminotransferases, gastritis, proctitis, bleeding from the gastrointestinal tract (vomiting with blood, melena, diarrhea mixed with blood), ulceration of the mucous membrane of the gastrointestinal tract (with bleeding or peritoneal peritoneum or blood impurities) without them), hepatitis, jaundice, abnormal liver function, stomatitis, glossitis, esophagitis, hemorrhagic colitis, exacerbation of ulcerative colitis or Crohn's disease, constipation, pancreatitis, fulminant hepatitis.

From the nervous system: headache, dizziness; drowsiness, disturbance of sensitivity (including paresthesia), memory disorders, tremor, convulsions, anxiety, cerebrovascular disorders, aseptic meningitis, disorientation, depression, insomnia, nightmares, irritability, mental disorders.

From the senses:vertigo, blurred vision (blurred vision, diplopia), hearing loss, tinnitus, taste disturbance.

From the urinary system: acute renal failure, hematuria, proteinuria, interstitial nephritis, nephrotic syndrome, papillary necrosis of the kidneys.

From the hemopoietic system: thrombocytopenia, leukopenia, anemia, incl. hemolytic or aplastic, agranulocytosis, methemoglobinemia.

Allergic reactions: urticaria, anaphylactic / anaphylactoid reactions (including marked reduction of blood pressure and shock), angioedema (including individuals).

Since the cardiovascular system: palpitations, chest pain, increased blood pressure, vasculitis, heart failure, myocardial infarction, allergic purpura.

On the part of the respiratory system: bronchial asthma (including shortness of breath), pneumonitis.

On the part of the skin: skin rash (including bullous), erythema, including multiforme and Stevens-Johnson syndrome, Lyell's syndrome, exfoliative dermatitis, pruritus, hair loss, photosensitization, purpura.

Other: swelling.

Panoxen contraindicated for appointment:

Contraindications

with hypersensitivity and intolerance to the components of the drug;
with a combination of bronchial asthma with a complicated ENT disease;
with hyperkalemia;
with hepatic and renal failure;
during the rehabilitation period after coronary bypass surgery;
with gastrointestinal ulcers;
at the age of 12 years.

With care Panoxen should be prescribed to patients with cardiovascular diseases, diabetes mellitus, porphyria, cerebrovascular diseases, glucose deficiency, as well as the simultaneous administration of oral drugs and antiplatelet agents.

Patients working in hazardous industries and driving vehicles during the period of treatment should limit their activities.

Drug interactions

Diclofenac

Increases plasma concentration of digoxin, lithium preparations reduces the effect of diuretics, against the background of potassium-saving diuretics increases the risk of hyperkalemia; against the background of anticoagulants, antiplatelet agents and thrombolytics (alteplaza, streptokinase, urokinase) increases the risk of bleeding (usually from the gastrointestinal tract).

Reduces the effects of hypotensive and hypnotic drugs.

Increases the likelihood of side effects of other NSAIDs and GCS (bleeding from the gastrointestinal tract), the toxicity of methotrexate and nephrotoxicity of cyclosporine (by increasing their concentration in plasma).

Acetylsalicylic acid reduces the concentration of diclofenac in the blood.

Reduces the effect of hypoglycemic agents.

Paracetamol increases the risk of the development of the nephrotoxic effects of diclofenac.

Cefamundol, cefoperazone, cefotetan, valproic acid and plykamycin 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.

The simultaneous use of ethanol, colchicine, corticotropin and preparations of Hypericum perforatum increases the risk of bleeding from the gastrointestinal tract.

Means that cause photosensitization, increase the sensitizing effect of diclofenac to UV radiation.

The means blocking tubular secretion, increase the concentration in the plasma of diclofenac, thereby increasing its effectiveness and toxicity.

Quinolone antibacterial agents increase the risk of seizures.

Paracetamol

Reduces the effectiveness of uricosuric drugs.

The simultaneous use of paracetamol in high doses increases the effect of anticoagulants (reduced synthesis of blood coagulation factors in the liver).

Inductors of liver microsomal enzymes (phenytoin, barbiturates, rifampin, phenylbutazone, tricyclic antidepressants), ethanol and hepatotoxic drugs increase the production of hydroxylated active metabolites, which makes it possible for severe intoxication to develop even with a small overdose.

Prolonged use of barbiturates reduces the effectiveness of paracetamol.

When taken simultaneously, ethanol contributes to the development of acute pancreatitis.

Inhibitors of microsomal liver enzymes (including cimetidine) reduce the risk of hepatotoxic action.

Long-term simultaneous use of paracetamol and NSAIDs increases the risk of "analgesic" nephropathy and papillary necrosis of the kidneys, the onset of end-stage renal failure.

Prolonged, simultaneous use of paracetamol in high doses and salicylates increases the risk of developing kidney or bladder cancer.

Diflunisal increases the plasma concentration of paracetamol by 50%, which increases the risk of developing hepatotoxicity.

Myelotoxic agents enhance the hematotoxicity of paracetamol.

Pregnancy and Lactation

The safety of the drug during pregnancy and during breastfeeding has not been established, therefore, the purpose of this category of patients is contraindicated.

Special instructions

To reduce the risk of adverse events from the gastrointestinal tract, the drug should be used in the minimum effective dose of the shortest possible course.

Due to the important role of prostaglandins in maintaining renal blood flow, special care should be taken when prescribing to patients with cardiac or renal failure, as well as in the treatment of elderly patients receiving diuretics, and patients who for some reason have decreased BCC (for example, after extensive surgery). When prescribing Panoxen in such cases, it is recommended to monitor renal function as a precautionary measure.

In order to quickly achieve the desired therapeutic effect, the drug is taken 30 minutes before a meal. In other cases, take before, during or after a meal in unchecked form, drinking plenty of water.

In patients with hepatic insufficiency (chronic hepatitis, compensated liver cirrhosis), kinetics and metabolism do not differ from similar processes in patients with normal liver function.

Against the background of the use of the drug, the results of laboratory tests are distorted in the quantitative determination of glucose and uric acid in plasma.

Influence on ability to drive motor transport and control mechanisms

Care must be taken when driving and other activities that require increased concentration and speed of psychomotor reactions.

Overdosage

Diclofenac

Symptoms:vomiting, gastrointestinal bleeding, epigastric pain, diarrhea, dizziness, tinnitus, lethargy, convulsions; rarely - increased blood pressure, acute renal failure, hepatotoxic effect, respiratory depression, coma.

Treatment:gastric lavage, activated carbon, symptomatic therapy aimed at eliminating increased blood pressure, renal dysfunction, seizures, gastrointestinal irritation, respiratory depression. Forced diuresis, hemodialysis are ineffective (due to the high degree of binding to plasma proteins and intensive metabolism).

Paracetamol

Symptoms:during the first 24 hours after administration - pallor of the skin, nausea, vomiting, anorexia, abdominal pain; violation of glucose metabolism, metabolic acidosis. Symptoms of abnormal liver function may appear 12-48 hours after an overdose. In severe overdose - liver failure with progressive encephalopathy, coma, death; acute renal failure with tubular necrosis (including in the absence of severe liver damage); arrhythmia, pancreatitis. Hepatotoxic effect in adults appears when taking 4 g or more.

Treatment:the introduction of SH-group donators and the precursor of the synthesis of glutathione - methionine within 8–9 hours after overdose and acetylcysteine - within 8 hours. The need for additional therapeutic measures (further introduction of methionine, iv injection of acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as from the time elapsed after its reception.