Dicloberl Retard 100mg 20 capsules — Made in Germany — Free Delivery
(Dicloberl Retard)
Availability: In Stock
Free Shipping!
If your country is on the checkout list, we deliver to you.
US and the Rest of the World: 9 to 20 business days
Delivery Timeframes:
Europe: 7 to 18 business daysUS and the Rest of the World: 9 to 20 business days
Description Dicloberl Retard 100mg 20 capsules — Made in Germany — Free Delivery
Pharmacological properties
Pharmacodynamics. Diclofenac - the active substance of the preparation dicloberl, is a non-steroidal compound with pronounced antirheumatic, antipyretic, analgesic and anti-inflammatory properties. The main mechanism of action of diclofenac, established under the experimental conditions, is the inhibition of the biosynthesis of prostaglandins. prostaglandins play an important role in the genesis of inflammation, pain and fever.
In vitro, diclofenac sodium at concentrations equivalent to those achieved in the treatment of patients does not inhibit the biosynthesis of proteoglycans in cartilage tissue.
In rheumatic diseases, the anti-inflammatory and analgesic effect of the preparation Dikloberl contributes to a significant decrease in the severity of pain (both at rest and during movement), morning stiffness, swelling of the joints and thereby improving the patient's functional state.
In the presence of inflammation caused by trauma or surgery, Dicloberl quickly eliminates both spontaneous pain and pain during movement, and also reduces inflammatory tissue edema and edema in the area of the surgical wound. When combined with opioids to eliminate postoperative pain, Dicloberl significantly reduces the need for opioids.
In clinical studies, it was found that diclofenac also exhibits a pronounced analgesic effect with moderate and severe pain sensations of non-rheumatic origin.
Pharmacokinetics. Analysis of unchanged diclofenac and its hydroxylated metabolites excreted in the urine showed that the amount of released and absorbed diclofenac is the same as in the case of an equivalent dose of diclofenac sodium in the form of enteric-coated tablets. However, the systemic bioavailability of diclofenac (released from the preparation Dicloberl retard) averages 82% of the corresponding indicator after ingestion of the enteric Dicloberl tablet in the same dose. As a result of the slow release of the active substance from the preparation Dicloberl retard, the Cmax achieved in the blood plasma is lower than after the use of enteric coated tablets. The average peak concentration of 0.4 or 0.5 µg / ml (1.25 or 1.6 µmol / L) is achieved on average within 5-6 hours after using a 75 or 100 mg tablet. Average peak plasma concentrations of 1.48 ± 0.65 mcg / ml (1.5 mcg / ml = 5 mcmol / l) are achieved on average 2 hours after administration of a 50 mg tablet. Food intake does not clinically affect the absorption and systemic bioavailability of the preparation Dicloberl. On the other hand, an average plasma concentration of 13 ng / ml (40 nmol / l) can be observed 24 hours (16 hours) after the use of diclofenac sodium in a prolonged form of 75 mg. The amount of absorbed active substance is linearly dependent on the dose of the preparation. After the introduction of 75 mg of diclofenac by intramuscular injection, absorption begins immediately, and the average Cmax in blood plasma is reached after 20 minutes. Since about half of diclofenac is metabolized during the first pass through the liver (first pass effect), the AUC after the use of the Dicloberl retard capsule is almost half that in the case of parenteral administration of an equivalent dose of the preparation. After repeated use of the preparation Dikloberl retard, the pharmacokinetic parameters do not change. Subject to the recommended intervals between doses of individual doses of the preparation, cumulation is not observed. The corresponding concentrations are 22 or 25 ng / ml (70 or 80 nmol / l) when using diclofenac in a prolonged form 75 mg 2 times a day.
Distribution. 99.7% of diclofenac binds to serum proteins, mainly albumin (99.4%). The volume of distribution is 0.12–0.17 l / kg. Diclofenac penetrates into the synovial fluid, where its Cmax is observed 2-4 hours later than in the blood plasma. Apparent T1 / 2 from the synovial fluid - 3-6 hours. 2 hours after reaching Cmax in the blood plasma, the concentration of the active substance in the synovial fluid is higher than in the blood plasma, and remains higher for 12 hours.
Biotransformation of diclofenac is carried out partly by glucuronization of the unchanged molecule, but mainly by single and multiple hydroxylation and methoxylation, which leads to the formation of several phenolic metabolites (3 - hydroxy, 4 - hydroxy, 5 - hydroxy, 4 ՛, 5-dihydroxy- and 3-hydroxy-4-methoxy-diclofenac), most of which are conjugated with glucuronic acid. Two of these phenolic metabolites are pharmacologically active, but to a significantly lesser extent than diclofenac.
Excretion. The total systemic clearance of diclofenac from blood plasma is 263 ± 56 ml / min. The final half-life in blood plasma is 1–2 hours. The half-life of 4 metabolites, including 2 pharmacologically active ones, is also short and amounts to 1–3 hours. One of the metabolites, 3 - hydroxy-4 - methoxydiclofenac, has a longer half-life in blood plasma. However, this metabolite is completely pharmacologically inactive.
About 60% of the taken dose of the preparation is excreted in the urine in the form of glucuronic conjugates of the intact molecule of the active substance and in the form of metabolites, most of which are also converted into glucuronic conjugates. Less than 1% of diclofenac is excreted unchanged. The remaining doses of the preparation are excreted in the form of metabolites through bile, with feces.
Pharmacokinetics in certain groups of patients. The effect of the patient's age on absorption, metabolism and excretion of the preparation has not been determined.
In patients with impaired renal function who received therapeutic doses, no accumulation of unchanged active substance was detected. In patients with creatinine clearance of 10 ml / min, the calculated equilibrium concentrations of hydroxylated metabolites in blood plasma were approximately 4 times higher than in healthy individuals. Ultimately, however, all metabolites were excreted in the bile.
In patients with chronic hepatitis or compensated liver cirrhosis, the pharmacokinetics and metabolism of diclofenac are similar to those in patients without liver disease.
Indications
Relief of pain and inflammation of varying degrees in various conditions, including joint pathology: rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, acute gout attacks; acute musculoskeletal diseases such as periarthritis (eg periarthritis of the shoulder scapula), tendinitis, tendovaginitis, bursitis; other pathological conditions caused by trauma, including fractures, back pain, sprains, dislocations, orthopedic, dental and other minor surgical interventions.
Application
The dose should be selected individually, starting with the minimum effective dose, and should be used as soon as possible.
The recommended initial dose of diclofenac for adults is 75-150 mg / day (1 capsule of Dicloberl retard 100 mg), depending on the severity of the symptoms of the disease. With long-term therapy, as a rule, it is sufficient to use 1 capsule of Dikloberl retard 100 mg / day. If the symptoms of the disease are most pronounced during the night or in the morning, Dikloberl retard should be used in the evening. The daily dose should not exceed 150 mg. The capsules should be swallowed whole, without chewing, with some liquid, preferably with meals.
Children. Dicloberl is not recommended for use in children.
Elderly patients. There were no clinically significant changes in pharmacokinetics when using Dicloberl retard in elderly patients. But in elderly patients, NSAIDs should be prescribed with extreme caution, as they are more prone to adverse reactions. It is recommended to use the minimum effective dose in elderly patients or patients with low body weight, as well as in patients who need constant monitoring to detect possible gastrointestinal bleeding when using NSAIDs.
Contraindications
Hypersensitivity to the active substance or any other component of the preparation; acute stomach or intestinal ulcer; gastrointestinal bleeding or perforation; high risk of postoperative bleeding, bleeding disorders, hemostasis disorders, hematopoietic disorders or cerebrovascular bleeding; a history of bleeding or perforation of the gastrointestinal tract associated with previous NSAID treatment; a history of active gastric ulcer / bleeding or recurrent stomach ulcer / bleeding history (2 or more separate episodes of diagnosed ulcer or bleeding); inflammatory bowel disease (eg Crohn's disease or ulcerative colitis); iii trimester of pregnancy; liver failure; renal failure; congestive heart failure (nyha ii – iv); ischemic heart disease in patients with angina pectoris, myocardial infarction; cerebrovascular disease in stroke patients or who have episodes of transient ischemic attacks; peripheral arterial disease; treatment for perioperative pain with coronary artery bypass grafting (or using a heart-lung machine); Like other NSAIDs, diclofenac is also contraindicated in patients in whom the use of ibuprofen, acetylsalicylic acid or other NSAIDs provokes attacks of BA, angioedema, urticaria, or acute rhinitis.
Side effects
The following side effects include events that have been reported with short-term or long-term use of the preparation.
From the blood and lymphatic system: thrombocytopenia, pancytopenia, agranulocytosis, leukopenia, anemia (hemolytic anemia, aplastic anemia). The first signs may be fever, pharyngitis, superficial sores in the mouth, flu-like symptoms, severe lethargy, nosebleeds, and bleeding from the skin.
From the immune system: hypersensitivity reactions such as skin rash and itching, urticaria, anaphylactic and anaphylactoid reactions (including narrowing of the airways, respiratory arrest, heart palpitations, arterial hypotension and shock), angioedema, including edema of the face, tongue, internal swelling of the pharynx, allergic vasculitis and pneumonia.
Mental disorders: disorientation, depression, insomnia, irritability, nightmares, psychotic disorders, other mental disorders.
From the nervous system: headache, dizziness, agitation or drowsiness, anxiety, episodic dizziness, drowsiness, fatigue, paresthesia, memory impairment, convulsions, anxiety, tremor, aseptic meningitis, taste disturbances, stroke, confusion, hallucinations, impaired sensitivity, general malaise.
From the side of the organ of vision: visual impairment, blurred vision, diplopia, optic neuritis.
From the organ of hearing and labyrinth: vertigo, ringing in the ears, hearing impairment.
From the side of the cardiovascular system: palpitations, chest pain, heart failure, myocardial infarction, hypertension, arterial hypotension, vasculitis.
From the respiratory system, chest and mediastinal organs: BA (including shortness of breath), pneumonitis.
From the digestive system: nausea, vomiting, diarrhea, dyspepsia, abdominal pain, flatulence, anorexia, gastritis, gastrointestinal bleeding (bloody vomiting, melena, diarrhea mixed with blood), stomach or intestinal ulcers with or without bleeding or with perforation ( sometimes fatal, especially in elderly patients), colitis (including hemorrhagic colitis and exacerbation of ulcerative colitis or Crohn's disease), constipation, stomatitis (including ulcerative stomatitis), glossitis, esophageal dysfunction, diaphragmatic bowel stenosis, pancreatitis.
From the hepatobiliary system: increased levels of transaminases, hepatitis, jaundice, liver disorders, fulminant hepatitis, hepatonecrosis, liver failure.
Infections and infections: exacerbation of inflammation associated with infections (for example, the development of necrotizing fasciitis) has been reported with the systemic use of NSAIDs. This is possibly due to the mechanism of action of NSAIDs. If, when using the preparation Dikloberl, signs of infection have arisen or worsen, the patient is advised to immediately consult a doctor. It needs to be investigated whether this is the basis for antimicrobial / antibiotic therapy. Very rarely, when using diclofenac, symptoms of aseptic meningitis with neck stiffness, headache, nausea, vomiting, fever or confusion are noted. Patients with autoimmune diseases (systemic lupus erythematosus (SLE), mixed connective tissue disease) are considered prone.
Skin and subcutaneous tissue disorders: hair loss, manifestations of exanthema, eczema, erythema, erythema multiforme, Stevens-Johnson syndrome, Lyell's syndrome (toxic epidermal necrolysis), exfoliative dermatitis, photosensitivity reactions, purpura, including allergic, itching.
From the kidneys and urinary system: edema, especially in patients with hypertension or renal failure, acute renal failure, hematuria, proteinuria, interstitial nephritis, nephrotic syndrome, papillary necrosis of the kidney.
General disorders: edema.
On the part of the reproductive system and mammary glands: impotence.
Clinical research data and epidemiological data indicate an increased risk of thrombotic complications (for example, myocardial infarction or stroke) associated with the use of diclofenac, in particular in high therapeutic doses (150 mg / day) and with prolonged use.
Special instructions
General. to minimize side effects, treatment should be started at the lowest effective dose for the shortest period necessary to control symptoms.
The simultaneous use of the preparation Dicloberl with systemic NSAIDs, such as selective COX-2 inhibitors, should be avoided due to the lack of any evidence of a synergistic effect and due to potential additive side effects.
Caution is needed in elderly patients. In particular, it is recommended to use the minimum effective dose in debilitated elderly patients with low body weight.
As with other NSAIDs, allergic reactions, including anaphylactic / anaphylactoid reactions, may occur, even without prior exposure to diclofenac.
Due to its pharmacodynamic properties, Dicloberl, like other NSAIDs, can mask the signs and symptoms of infection.
Effects on the digestive tract. With all NSAIDs, including diclofenac, cases of gastrointestinal bleeding (cases of vomiting of blood, melena), ulceration or perforation have been reported, which can be fatal and occur at any time during treatment with or without warning symptoms or a previous history of serious events from the digestive tract. These phenomena usually have serious consequences in elderly patients. If patients receiving diclofenac develop symptoms of gastrointestinal bleeding or ulceration, the preparation should be discontinued.
As with other NSAIDs, including diclofenac, medical supervision and extreme caution are imperative for patients with symptoms suggestive of gastrointestinal disorders. The risk of bleeding, ulceration, or perforation in the digestive tract increases with increasing doses of NSAIDs, including diclofenac.
Elderly patients have an increased frequency of adverse reactions to the use of NSAIDs, especially in relation to gastrointestinal bleeding and perforation, which can be fatal.
To reduce the risk of such toxic effects on the digestive tract, treatment is started and maintained with low effective doses. For these patients, as well as those who require the concomitant use of medicines containing acetylsalicylic acid or other medicines in low doses, which are likely to increase the risk of unwanted effects on the digestive tract, a combination therapy with protective agents should be considered ( e.g. proton pump inhibitors or misoprostol). Patients with a history of gastrointestinal toxicity, especially the elderly, should report any unusual abdominal symptoms (especially bleeding in the digestive tract). Cautions are also needed for patients receiving concomitant medications that may increase the risk of ulcers or bleeding, such as systemic corticosteroids, anticoagulants (eg warfarin), antithrombotics (eg acetylsalicylic acid), or selective serotonin reuptake inhibitors.
Effects on the liver. Careful medical supervision is necessary when Dicloberl is prescribed to patients with impaired liver function, as their condition may worsen.
As with other NSAIDs, including diclofenac, the level of one or more liver enzymes may increase.
During long-term treatment with Dicloberl, regular monitoring of liver function and liver enzyme levels is prescribed as a precautionary measure. If liver dysfunction persists or worsens and if clinical signs or symptoms may be associated with progressive liver disease or if other manifestations are observed (eg eosinophilia, rash), the use of Dikloberl should be discontinued. The course of diseases such as hepatitis may be characterized by the absence of prodromal symptoms. Cautions are necessary if Dicloberl is used in patients with hepatic porphyria, due to the likelihood of provoking an attack.
Effects on the kidneys. Since cases of fluid retention and edema have been reported in the treatment of NSAIDs, including diclofenac, special attention should be paid to patients with impaired cardiac or renal function, a history of hypertension, elderly patients, patients receiving diuretic therapy or preparations that significantly affect renal function as well as patients with a significant decrease in extracellular fluid volume for any reason, for example, before or after major surgery. In such cases, monitoring of renal function is recommended as a precautionary measure. Discontinuation of therapy usually results in a return to the condition that preceded treatment.
Effects on the skin. In connection with the use of NSAIDs, including the preparation Dicloberl retard, serious skin reactions have been reported in very rare cases (some of them were fatal, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis). In patients, a high risk of developing these reactions was noted at the beginning of the course of therapy: reactions in most cases occur within the first month of treatment. The use of the preparation Dikloberl should be discontinued at the first appearance of skin rashes, mucosal lesions or any other signs of hypersensitivity.
Systemic lupus erythematosus and mixed connective tissue diseases. Patients with systemic lupus erythematosus and mixed connective tissue diseases may have an increased risk of developing aseptic meningitis.
Cardiovascular and cerebrovascular effects. For patients with a history of hypertension and / or congestive heart failure of mild to moderate severity, appropriate monitoring and adherence to recommendations is necessary, since cases of fluid retention and edema have been reported in connection with the use of NSAIDs, including diclofenac.
Clinical studies and epidemiological data indicate that the use of diclofenac, especially in high doses (150 mg / day) and with long-term treatment, may be associated with a slight increase in the risk of arterial thrombotic events (for example, myocardial infarction or stroke).
Diclofenac is not recommended for patients with uncontrolled hypertension, congestive heart failure, persistent coronary artery disease, peripheral arterial disease and / or cerebrovascular disease; if necessary, use is possible only after a careful assessment of the risk / benefit ratio only in a dosage of no more than 100 mg / day. Such an assessment should be performed before starting long-term treatment of patients with risk factors for cardiovascular events (for example, hypertension, hyperlipidemia, diabetes mellitus and smokers).
Patients should be informed about the possibility of serious thrombotic effects (chest pain, shortness of breath, weakness, speech impairment) that may develop at any time. In this case, you should immediately consult a doctor.
Influence on hematological parameters. With long-term use of this preparation, like other NSAIDs, monitoring of a complete blood count is recommended.
Dicloberl can temporarily suppress platelet aggregation. Patients with impaired hemostasis, hemorrhagic diathesis or hematological disorders should be carefully monitored.
History of asthma. Patients with AD, seasonal allergic rhinitis, nasal swelling (i.e. nasal polyps), COPD, or chronic respiratory tract infections (especially those associated with allergic, rhinitis-like symptoms) are more likely to have NSAID reactions such as exacerbation of AD (so-called intolerance to analgesics / analgesic asthma), Quincke's edema or urticaria. In this regard, in relation to such patients, special measures are recommended (readiness to provide emergency medical care). This also applies to patients with allergic reactions to other substances, such as rash, itching, hives.
Like other preparations that suppress the activity of prostaglandin synthetase, diclofenac sodium and other NSAIDs can provoke the development of bronchospasm when used in patients with asthma, or in patients with a history of asthma.
Fertility in women. For fertility in women, see section "Use during pregnancy and lactation."
General. Acute hypersensitivity reactions (eg, anaphylactic shock) are rare. At the first signs of a hypersensitivity reaction after using the preparation Dicloberl, therapy should be stopped.
With prolonged use of painkillers, a headache may occur, which cannot be stopped by increasing the dose of the preparation.
With the simultaneous use of alcohol, adverse reactions associated with the action of the active substance, especially those that affect the gastrointestinal tract or the central nervous system, may be exacerbated by the use of NSAIDs.
Use during pregnancy and lactation. Pregnancy. In the I and II trimester of pregnancy, the preparation Dicloberl can be prescribed only when the expected benefit to the mother outweighs the potential risk to the fetus and only in the minimum effective dose, and the duration of treatment should be as short as possible. As in the case of the use of other NSAIDs, the preparation is contraindicated in the last 3 months of pregnancy (suppression of the contractility of the uterus and premature closure of the ductus arteriosus in the fetus are possible).
Inhibition of prostaglandin synthesis can adversely affect the course of pregnancy and / or the development of the embryo / fetus. Epidemiological data indicate an increased risk of miscarriages and / or the risk of developing heart defects and gastroschisis after using an inhibitor of prostaglandin synthesis in early pregnancy. The absolute risk of cardiovascular disease was increased from 1% to ≈1.5%.
It is possible that the risk increases with the dose and duration of treatment. It has been shown that in animals the administration of an inhibitor of prostaglandin synthesis leads to an increase in pre- and post-implantation loss and mortality of the embryo / fetus.
In addition, in animals that received an inhibitor of prostaglandin synthesis during the period of organogenesis, an increased frequency of various malformations, including those of the cardiovascular system, was recorded. If Dicloberl is used by a woman who seeks to become pregnant, or in the first trimester of pregnancy, the dose should be as low as possible, and the duration of treatment should be as short as possible.
In the third trimester of pregnancy, all inhibitors of prostaglandin synthesis can affect the fetus as follows: cardiopulmonary toxicity (with premature closure of the ductus arteriosus and pulmonary hypertension); impaired renal function, which can progress to renal failure with oligohydramnios.
Effects on the mother and newborn, as well as at the end of pregnancy: possible prolongation of bleeding time, antiplatelet effect, which can develop even at very low doses; inhibition of uterine contractions, which leads to a delay or lengthening of labor.
So, Dikloberl is contraindicated in the third trimester of pregnancy.
Lactation. Like other NSAIDs, diclofenac passes into breast milk in small amounts. In this regard, Dicloberl should not be used by women during breastfeeding in order to avoid unwanted effects on the baby.
Fertility in women. Like other NSAIDs, Dicloberl can negatively affect female fertility, so it is not recommended to prescribe the preparation to women who are planning a pregnancy. For women who have problems with conception or are undergoing studies for infertility, the advisability of discontinuing the preparation Dicloberl should be considered.
Children. Dicloberl is not used in children due to the high content of the active substance.
The ability to influence the reaction rate when driving or working with other mechanisms. Patients who experience visual impairment, dizziness, vertigo, drowsiness, central nervous system disorders, lethargy or fatigue during therapy with Dicloberl should not drive vehicles or operate machinery.
Interactions
Below are the interactions noted with the use of diclofenac in the form of enteric tablets and / or in other dosage forms.
Lithium. Provided the simultaneous use of diclofenac can increase the concentration of lithium in the blood plasma. Monitoring of serum lithium levels is recommended.
Digoxin. If used simultaneously, diclofenac can increase the concentration of digoxin in the blood plasma. Monitoring of serum digoxin levels is recommended.
Diuretics and antihypertensive preparations. Like other NSAIDs, the simultaneous use of diclofenac with diuretics and antihypertensive agents (for example, β-adrenergic receptor blockers, ACE inhibitors) can lead to a decrease in their antihypertensive effect by inhibiting the synthesis of vasodilating prostaglandins. Thus, such a combination is used with a reservation, and patients, especially the elderly, should be closely monitored for blood pressure. Patients should receive adequate hydration, it is also recommended to monitor renal function after the initiation of concomitant therapy and on a regular basis after it, especially with regard to diuretics and ACE inhibitors, due to the increased risk of nephrotoxicity.
Preparations known to cause hyperkalemia. Concomitant treatment with potassium-sparing diuretics, cyclosporine, tacrolimus or trimethoprim may be associated with an increase in serum potassium levels, so patients should be monitored more frequently.
Anticoagulants and antithrombotic agents. Concomitant use can increase the risk of bleeding, so it is recommended to take precautions. Although clinical studies do not indicate the effect of diclofenac on the activity of anticoagulants, there are some data on an increased risk of bleeding in patients using simultaneously diclofenac and anticoagulants. Therefore, to ensure that no changes in the dosage of anticoagulants are required, careful monitoring of such patients is recommended. Like other NSAIDs, high doses of diclofenac can temporarily suppress platelet aggregation.
Other NSAIDs, including selective COX-2 inhibitors, and corticosteroids. Concomitant use of diclofenac and other NSAIDs or corticosteroids may increase the risk of gastrointestinal bleeding or ulcers. The simultaneous use of two or more NSAIDs should be avoided.
Selective serotonin reuptake inhibitors. The simultaneous use of NSAIDs and selective serotonin reuptake inhibitors may increase the risk of gastrointestinal bleeding.
Antidiabetic preparations. Clinical studies have shown that diclofenac can be used in combination with oral hypoglycemic agents, which does not affect their therapeutic effect. However, there are some reports of the development in such cases of both hypoglycemia and hyperglycemia, which necessitated a change in the dose of antidiabetic agents during the use of diclofenac. For this reason, it is recommended to monitor blood glucose levels during combination therapy as a precautionary measure.
Methotrexate. Diclofenac can suppress the renal tubular clearance of methotrexate, resulting in increased methotrexate levels. Care should be taken when prescribing NSAIDs, including diclofenac, less than 24 hours before using methotrexate, since in such cases the concentration of methotrexate in the blood may increase and its toxic effect may increase. Cases of serious toxicity have been reported when the interval between the use of methotrexate and NSAIDs, including diclofenac, was within 24 hours. This interaction is mediated through the accumulation of methotrexate as a result of impaired renal excretion in the presence of NSAIDs.
Cyclosporine. The effect of diclofenac, like other NSAIDs, on the synthesis of prostaglandins in the kidneys may increase the nephrotoxicity of cyclosporin, therefore, diclofenac should be used in lower doses than in patients not using cyclosporin.
Tacrolimus. When using NSAIDs with tacrolimus, an increased risk of nephrotoxicity is possible, which may be mediated through the renal antiprostaglandin effects of NSAIDs and a calcineurin inhibitor.
Antibacterial quinolones. It is possible that seizures develop in patients taking quinolone derivatives and NSAIDs at the same time. This can occur in patients with or without a history of epilepsy and seizures. Thus, caution should be exercised when deciding whether to use quinolones in patients who are already receiving NSAIDs.
Phenytoin. When using phenytoin simultaneously with diclofenac, it is recommended to monitor the concentration of phenytoin in the blood plasma in connection with the expected increase in the effect of phenytoin.
Probenecid. Medicines containing probenecid can inhibit the elimination of diclofenac sodium from the body.
Colestipol and cholestyramine. These preparations may delay or decrease the absorption of diclofenac. Therefore, it is recommended to prescribe diclofenac at least 1 hour before or 4–6 hours after the use of colestipol / cholestyramine.
Cardiac glycosides. The simultaneous use of cardiac glycosides and NSAIDs can increase heart failure, reduce the glomerular filtration rate and increase the level of glycosides in the blood plasma.
Mifepristone. NSAIDs should not be used within 8–12 days after taking mifepristone, as NSAIDs can reduce the effect of mifepristone.
Potent inhibitors of CYP 2C9. It is recommended to be careful when prescribing diclofenac with potent inhibitors of CYP 2C9 (for example voriconazole), which can lead to a significant increase in plasma Cmax and exposure to diclofenac due to inhibition of the metabolism of diclofenac.
Overdose
Symptoms there is no typical clinical picture characteristic of diclofenac overdose. overdose can cause symptoms such as headache, nausea, vomiting, epigastric pain, gastrointestinal bleeding, diarrhea, dizziness, disorientation, agitation, coma, drowsiness, tinnitus, or seizures. opn and liver damage are possible in case of severe intoxication.
Treatment. Treatment of acute poisoning with NSAIDs, including diclofenac, is supportive and symptomatic therapy. This applies to the treatment of manifestations such as arterial hypotension, renal failure, convulsions, gastrointestinal disorders, respiratory depression. It is unlikely that specific therapeutic measures such as forced diuresis, dialysis or hemoperfusion will be effective in removing NSAIDs, including diclofenac, since the active substances of these preparations to a large extent bind to blood proteins and undergo intensive metabolism. After the application of potentially toxic doses, activated charcoal may be prescribed, and after the application of potentially life-threatening doses, evacuation of the stomach contents (for example, induce vomiting, flush the stomach).
Storage conditions
Tablets - at a temperature not exceeding 30 ° C. capsules - at a temperature not exceeding 25 ° C.
Tags: Dicloberl
Products viewed
Turbiotic Skin 10 capsules — Made in Poland — Free Delivery
Product descriptionThe most studied lactobacillus is Lactobacillus rhamnosus GG for turbo treatment of skin problems.How does it work?TURBIOTIC skin helps to restore the intestinal microflora and intestinal barrier, which protects against the penetration of allergens and toxins into the blood; Serve..
$21.88
Buyers Online
- Customer from Port Charlotte registered for an account
- Customer from London registered for an account
- Customer from DUBLIN 7 registered for an account
- Customer from Kennesaw registered for an account
- Customer from Riga registered for an account
- Customer placed a new order for Galstena oral drops 50 ml — Made in Austria — Free Delivery
- Customer placed a new order for CEREBROLYSIN 10ML 5 VILAS - MADE IN AUSTRIA - FREE SHIPPING
- Customer placed a new order for Duxet 60mg 28 capsules — Made in Turkey — Free Delivery
- Customer placed a new order for 2 x MAXIGRA GO 25MG 4 TABS — MADE IN POLAND — FREE SHIPPING
- Customer placed a new order for 2 x FOTIL EYE DROPS 5ML — MADE IN FINLAND — FREE SHIPPING
- Customer from Maple Ridge updated their account details
- Customer from Maple Ridge logged in
- Customer from Gilmanton logged in
- Customer from Lake Stevens logged in
- Customer placed a new order for Lidocain spray 10% 38g — Made in Hungary — Free Delivery
- Customer placed a new order for Soleron 100mg 30 tablets — Made in Ukraine — Free Delivery
- Customer from Gilmanton logged in
- Customer from Founex logged in
- Customer from Miami Beach placed a new order for Essentiale N solution for injection 250mg/5ml, 5 ml x 5 ampoules — Made in Spain — Free Delivery
- Customer from Miami Beach registered for an account