Diclofenac - instructions for use, reviews, analogs and forms of release (tablets 25 mg, 50 mg, 100 mg, injections, candles, ointment, gel and eye drops) drugs for the treatment of inflammation and pain in adults, children and pregnancy

In this article, you can read the instructions for using the drug Diclofenac. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Diclofenac in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Diclofenac in the presence of existing structural analogues. Use to treat inflammatory diseases of various organs and pain syndrome in adults, children, as well as during pregnancy and lactation.

Diclofenac - has anti-inflammatory, analgesic, analgesic and antipyretic effect. Indiscriminately inhibiting cyclooxygenase 1 and 2, disrupts the metabolism of arachidonic acid, reduces the amount of prostaglandins in the inflammatory focus. In rheumatic diseases, the anti-inflammatory and analgesic effect of diclofenac significantly reduces the severity of pain, morning stiffness, swelling of the joints, which improves the functional state of the joint. In injuries, in the postoperative period, diclofenac reduces pain and inflammatory edema. Like all NSAIDs, the drug has anti-aggregative activity. With topical application reduces swelling and pain in inflammatory processes of non-infectious etiology.

Pharmacokinetics

Absorption - fast and complete, the food slows the absorption rate for 1-4 hours. Changes in the pharmacokinetics of diclofenac against the background of repeated administration are not noted, diclofenac does not accumulate. 65% of the administered dose is excreted as metabolites by the kidneys; less than 1% is unchanged, the rest of the dose is excreted as metabolites with bile.

Indications

• Inflammatory and degenerative diseases of the musculoskeletal system, including rheumatoid, psoriatic, juvenile chronic arthritis, ankylosing spondylitis (Bechterew's disease), arthrosis, gouty arthritis, bursitis, tendovaginitis. The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use, the progression of the disease is not affected.
• Pain syndrome: headache (including migraine) and toothache, lumbago, sciatica, ossalgia, neuralgia, myalgia, arthralgia, radiculitis, with oncological diseases, post-traumatic and postoperative pain syndrome, accompanied by inflammation.
• Algodismenorea: inflammatory processes in the small pelvis, including adnexitis.
• Infectious and inflammatory diseases of the ENT - organs with severe pain syndrome (as part of complex therapy): pharyngitis, tonsillitis, otitis media.
• Locally - injuries to the tendons, ligaments, muscles and joints (for pain and inflammation removal during stretching, dislocations, bruises), localized forms of soft tissue rheumatism (pain and inflammation elimination).
• In ophthalmology - non-infectious conjunctivitis, post-traumatic inflammation after penetrating and non-penetrating injuries of the eyeball,pain syndrome with the use of excimer laser, during the operation of removal and implantation of the lens (pre- and postoperative prophylaxis of miosis, cystoid edema of the optic nerve).

Forms of release

The tablets covered with a cover, soluble in an intestine (25 mg, 50 mg, prolonged 100 mg).

Candles 50 mg and 100 mg.

In ampoules, injections a solution for intramuscular injection of 25 mg / ml.

Ointment for external use 1%, 2%.

Gel for external use 1%, 5%.

Eye drops 0.1%.

Instructions for use and dosage

The dosage regimen is set individually, taking into account the indications and severity of the condition. Inside, in / m, in / in, rectally, topically (skin, instillation in the conjunctival sac). The maximum single dose is 100 mg.

Inside: adults - 75-150 mg / day in several doses; retard-forms - once a day (if necessary - up to 200 mg / day). When the clinical effect is achieved, the dose is reduced to a minimum maintenance dose. Children aged 6 years and older and adolescents are prescribed only tablets of usual duration of action at the rate of 2 mg / kg / day.

As an initial therapy (for example in the postoperative period, in acute conditions) in / m or / in.In / m - 75 mg / day (in severe cases, 75 mg twice a day with a break of several hours) for 1-5 days. Later on they switch to taking tablets or suppositories.

Rectal: 50 mg 1-2 times a day.

Nakozhno: gently rub into the skin 2-4 gels or ointments 2-4 times a day; After application, wash hands.

Instillation (eye form of the drug, drops): instilled in the conjunctival sac 1 drop 5 times for 3 hours before the operation, immediately after the operation - 1 drop 3 times, then - 1 drop 3-5 times a day for the required for time management; other indications - 1 drop 4-5 times a day.

Side effect

• sensation of bloating;
• diarrhea, nausea, constipation, flatulence;
• peptic ulcer with possible complications (bleeding, perforation);
• gastrointestinal bleeding without ulcers;
• vomiting;
• jaundice;
• melena, the appearance of blood in the feces;
• defeat of the esophagus;
• aphthous stomatitis;
• necrosis of the liver;
• cirrhosis;
• pancreatitis (including with concomitant hepatitis);
• cholecystopancreatitis;
• colitis;
• headache, dizziness;
• sleep disturbance, drowsiness;
• depression, irritability;
• aseptic meningitis (more often in patients with systemic lupus erythematosus and other systemic diseases of connective tissue);
• convulsions;
• general weakness;
• noise in ears;
• a taste disorder;
• itching;
• skin rash;
• alopecia;
• hives;
• eczema;
• toxic dermatitis;
• nephrotic syndrome;
• proteinuria;
• oliguria;
• hematuria;
• Anemia (including hemolytic and aplastic anemia);
• leukopenia;
• thrombocytopenia;
• eosinophilia;
• agranulocytosis;
• cough;
• bronchospasm;
• increased blood pressure;
• anaphylactoid reactions, anaphylactic shock (usually develops rapidly);
• swelling of the lips and tongue;
• itching, erythema, rashes, burning with local use.

Contraindications

Hypersensitivity (including other NSAIDs), complete or incomplete combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses and intolerance to Acetylsalicylic acid (ASA) or other NSAIDs (including in anamnesis), erosive and ulcerative lesions of the stomach and 12-finger intestines, active gastrointestinal bleeding, inflammatory bowel disease, severe hepatic and heart failure; period after aortocoronary shunting; severe renal failure (creatinine clearance less than 30 ml / min), progressive kidney disease, active liver disease, confirmed hyperkalemia,Pregnancy (3 trimester), lactation period, children's age (up to 6 years - for tablets covered with enteric-coated 25 mg).

Hereditary lactose intolerance, impaired absorption of glucose-galactose, deficiency of lactase.

Carefully. Stomach ulcer and duodenal ulcer, ulcerative colitis, Crohn's disease, liver disease in history, hepatic porphyria, chronic heart failure, arterial hypertension, a significant decrease in the volume of circulating blood (BCC) (including after extensive surgery), elderly patients (including those receiving diuretics, weakened patients and patients with low body weight), bronchial asthma, simultaneous reception of GCS (including prednisolone), anticoagulants (including warfarin), antiplatelet agents ( clopidogrel), selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline), coronary artery disease, cerebrovascular disease, dyslipidemia / hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, chronic renal failure (CC 30- 60 ml / min), the presence of Helicobacter pylori infection, prolonged use of NSAIDs, alcoholism,severe physical illnesses.

Application in pregnancy and lactation

Contraindicated in the 3rd trimester of pregnancy. In the first and second trimester of pregnancy should be used according to strict indications and in the lowest dosage.

Diclofenac penetrates into breast milk. If it is necessary to prescribe the drug during lactation, breastfeeding should be discontinued.

special instructions

In patients with hepatic insufficiency (chronic hepatitis, compensated cirrhosis), the kinetics and metabolism do not differ from similar processes in patients with normal liver function. When performing long-term therapy, it is necessary to monitor liver function, the picture of peripheral blood, the analysis of feces for latent blood.

During the treatment period, it is possible to reduce the speed of mental and motor reactions, so it is necessary to refrain from driving motor vehicles and practicing other potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions.

Drug Interactions

Increases the concentration in the plasma digoxin, methotrexate, lithium and cyclosporine.

Reduces the effect of diuretics, against the background of potassium-sparing diuretics increases the risk of hyperkalemia; against the background of anticoagulants, thrombolytic agents (alteplase, streptokinase, urokinase) - the risk of bleeding (more often from the gastrointestinal tract).

Reduces the effects of hypotensive and hypnotics.

Increases the likelihood of side effects of other NSAIDs and glucocorticosteroids (bleeding in the gastrointestinal tract), toxicity of Methotrexate and nephrotoxicity of cyclosporine.

Acetylsalicylic acid reduces the concentration of diclofenac in the blood. Simultaneous use with Paracetamol increases the risk of developing nephrotoxic effects of diclofenac.

Reduces the effect of hypoglycemic agents.

Cefamandol, cefoperazone, cefotetan, valproic acid and plikamycin increase the incidence of hypoprothrombinemia.

Cyclosporine and gold preparations increase the effect of diclofenac on the synthesis of prostaglandins in the kidneys, which increases nephrotoxicity.

Simultaneous use with ethanol (alcohol), colchicine, corticotropin and preparations of St. John's wort increases the risk of bleeding in the gastrointestinal tract.

Diclofenac enhances the effect of drugs that cause photosensitivity.Drugs that block tubular secretion, increase the concentration in the plasma of diclofenac, thereby increasing its toxicity.

Antibacterial drugs from the quinolone group - the risk of seizures.

Analogues of the drug Diclofenac

Structural analogs for the active substance:

• Artrex;
• Beliefed;
• Voltaren;
• Voltaren Emulgel;
• Diklak;
• Diklobene;
• Dicluberl;
• Diqlovit;
• Diklogen;
• Diclomax;
• Diclomelan;
• Diclonac;
• Diclonate;
• Dicloran;
• Diclorium;
• Diclofen;
• Diclofenac of potassium;
• Diclofenac sodium;
• Diclofenac Sandoz;
• Diclofenac-AKOS;
• Diclofenac-Acry;
• Diclofenac-ratopharm;
• Diclofenac Long;
• Diclofenacol;
• Diphene;
• Dorosan;
• Naklof;
• Naklofen;
• Naklofen Duo;
• Sodium diclofenac;
• Orthophene;
• Orthofer;
• Orthoflex;
• Rapten Duo;
• Rapent Rapid;
• Revmavek;
• Redwood retard;
• Remetan;
• Sanfinak;
• SwissSet;
• Feloran;
• Flotac.

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