Pharmacological properties
Pharmacodynamics
Dikloberl contains sodium diclofenac — substance of nonsteroid structure which has the expressed analgeziruyushchy and anti-inflammatory effect. is prostaglandinsintetaza inhibitor (tsog).
Pharmacokinetics
Absorption. Fast absorption, but more slowly, than at application of tablets with an enterosoluble covering. After application of suppositories Dikloberl in a dose of 50 mg of the C max in blood plasma is reached in 1 h, but the C max on unit of a dose makes near ⅔ the concentration reached after application of tablets with an enterosoluble covering (1.95±0.8 mkg/ml (1.9 mkg/ml = 5.9 µmol/l)).
Bioavailability. As well as in case of application of oral dosage forms of medicine, AUC makes about a half of the value received at parenteral administration of a dose. After repeated use of medicine its pharmacokinetics does not change. Accumulations of medicine do not note on condition of observance of the recommended doses.
Distribution. Linking of diclofenac with proteins of blood plasma makes 99.7%, mainly with albumine — 99.4%.
Diclofenac gets into synovial fluid where its C max is reached on 2–4 h later, than in blood plasma. The seeming T ½ makes 3–6 h of synovial fluid. In 2 h after achievement of the C max in blood plasma the concentration of diclofenac in synovial fluid remains higher, than in blood plasma; this phenomenon is observed for 12 h
Diclofenac is revealed in low concentration (100 ng/ml) in breast milk at one feeding woman. The expected amount of medicine which gets to an organism of the baby with breast milk is equivalent to a dose of 0.03 mg/kg/days
Metabolism. Diclofenac is metabolized partially by a glyukuronization of not changed molecule, but mainly — by single and repeated hydroxylation and a metoksilirovaniye that leads to formation of several phenolic metabolites most of which part forms conjugates with glucuronic acid. Two of these phenolic metabolites are biologically active, but is considerable menshe, than diclofenac.
Removal. The general system clearance of diclofenac is 263±56 ml/min. of blood plasma (average value ± an average deviation). The final period of semi-life in blood plasma is 1–2 h. The semi-life period in blood plasma of four metabolites, including two pharmacological active, is also short and is 1–3 h. About 60% of a dose of medicine are removed with urine in the form of a glyukuronidny conjugate of an intact molecule and in the form of metabolites, the majority of which also turns into glyukuronidny conjugates. In not changed look less than 1% of diclofenac are removed. The rest is removed in the form of metabolites with a stake.
Pharmacokinetics at separate groups of patients. Influence of age of the patient on absorption, metabolism and removal of medicine is noted, except the fact that at 5 patients of advanced age 15-minute in/in infusion led to increase for 50% of concentration in blood plasma, than it was expected at healthy volunteers of young age.
At the patients with a renal failure receiving therapeutic doses can not expect savings of not changed active agent, proceeding from medicine kinetics after single application. At patients with clearance of creatinine of 10 ml/min. the estimated equilibrium concentration of hydroxylated metabolites in blood plasma were about 4 times higher, than at healthy volunteers. However finally all metabolites were removed with bile.
Patients with an abnormal liver function. At patients with chronic hepatitis or the compensated cirrhosis the indicators of pharmacokinetics, metabolism of diclofenac are similar to that at patients without liver diseases.
Indication
Inflammatory and degenerative forms of rheumatism: the pseudorheumatism ankylosing a spondylitis, an osteoarthritis including a spondylarthritis; pain syndromes from a backbone; rheumatic diseases of extraarticular soft tissues; posttraumatic and postoperative pain syndromes which are followed by inflammation and hypostasis, especially after dental and orthopedic operations; gynecologic diseases which are followed by a pain syndrome and inflammation, for example primary dysmenorrhea and adnexitis; migraine attacks; bad attacks of gout; as supportive application at a serious inflammatory illness of the ENT organs which are followed by painful feeling, for example at a pharyngotonsillitis, otitis.
According to the general therapeutic principles should carry out treatment concerning a basic disease by means of basic therapy. Fever in itself is not the indication to use of medicine.
Use
to minimize side effects, it is necessary to apply a minimal effective dose during the short period.
not to applyinside, only to rectal administration.
Suppositories should be entered into a rectum as it is possible more deeply, it is desirable after purgation.
Initial dose usually makes 100–150 mg/days. At not expressed symptoms and also at long therapy there is enough dose of 75-100 mg/days
Daily dose to divide into 2–3 receptions. In order to avoid night pain or morning constraint to use of medicine appoint Dikloberl in the form of rectal suppositories before going to bed in the afternoon (the daily dose should not exceed 150 mg).
At primary dysmenorrhea a daily dose is selected individually, usually it makes 50–150 mg/days. The initial dose can reach 50–100 mg/days, but in case of need it can be raised during several menstrual cycles to maximum, making 200 mg/days. Use of medicine should be begun after emergence of the first painful symptoms and to continue several days, depending on dynamics of regression of symptoms.
a course to begin withFor knocking over of an attack of migraine in a dose 100 mg at manifestation of its first signs. In case of need on the same day the second suppository (100 mg of diclofenac) can be applied. In need of the next days the treatment can be continued (the daily dose should not exceed 150 mg, to divide a dose into 2–3 applications).
daily dose can makeAt treatment of a juvenile pseudorheumatism to 3 mg/kg of body weight that is the maximum daily dose, and should not exceed 150 mg/days. Children aged from 14 years can appoint suppositories on 50 mg.
Patients of advanced age. Though at patients of advanced age the pharmacokinetics of the medicine Dikloberl does not worsen to any clinically significant degree, NPVP needs to be applied at them with care as patients of this age category, as a rule, are more inclined to development of undesirable reactions. In particular, the weakened patients of advanced age or patients with a low indicator of body weight are recommended to apply minimal effective doses, also patients need to be examined rather gastrointestinal bleedings at treatment of NPVP.
Contraindication
Hypersensitivity to active ingredient or any other component of medicine; sharp ulcer of stomach or intestines; gastrointestinal bleeding or perforation; high risk of developing postoperative bleedings, violations of fibrillation, violations of a hemostasis, hemopoietic violations or cerebrovascular bleedings; the bleeding or perforation of a GIT in the anamnesis connected with the previous treatment npvp; an active form of an ulcer stomach/bleeding or a recurrent ulcer stomach/bleeding in the anamnesis (2 or more separate episodes of the diagnosed ulcer or bleeding); inflammatory bowel diseases (for example Crohn's disease or ulcer colitis); iii pregnancy trimester; liver failure; renal failure; stagnant heart failure (nyha ii–iv); ibs at patients with stenocardia, the postponed myocardial infarction; cerebrovascular diseases at the patients who had a stroke or which have episodes of the tranzitorny ischemic attacks; diseases of peripheral arteries; stopping of perioperatsionny pain at aortocoronary shunting (or use of the cardiopulmonary bypass); as well as others npvp, diclofenac is also contraindicated to patients who have an application of an ibuprofen, of acetylsalicylic acid or others npvp provokes attacks oh, a Quincke's disease, a small tortoiseshell or sharp rhinitis; proctitis.
Side effects
side Below-mentioned effects include the phenomena about which it was reported in the conditions of short-term or prolonged use of medicine.
from the system of blood and lymphatic system: thrombocytopenia, pancytopenia, Agranulocytosis, leukopenia, anemia (hemolytic anemia, aplastic anemia). The increased temperature, pharyngitis, superficial wounds in a mouth, grippopodobny symptoms, serious apathy, bleeding from a nose, skin bleeding can be the first signs.
from the immune system: reactions of hypersensitivity, such as rash on skin and an itch, urticaria, anaphylactic and anaphylactoid reactions (including narrowing of airways, an apnoea, a cardiopalmus, arterial hypotension and shock), a Quincke's disease, including edema of face, language, internal hypostasis of a throat, an allergic vasculitis and pneumonia.
Mental violations: disorientation, depression, insomnia, irritability, nightmares, psychotic violations, other mental disorders.
from nervous system: headache, dizziness, excitement or drowsiness, disturbing, incidental dizziness, drowsiness, fatigue, paresthesias, violations of memory, spasm, concern, tremor, aseptic meningitis, disorders of taste, stroke, confusion of consciousness, hallucination, violation of sensitivity, general malaise.
from an organ of sight: disorder of vision, misting of sight, diplopia, optic neuritis.
from an organ of hearing and a labyrinth: vertigo, a ring in ears, a hearing disorder.
from a cardiovascular system: heart consciousness, stethalgia, heart failure, myocardial infarction, AG, arterial hypotension, vasculitis.
from the respiratory system, bodies of a chest cavity and mediastinum: OH (including an asthma), a pneumonitis.
from digestive system: nausea, vomiting, diarrhea, dyspepsia, abdominal pain, a meteorism, anorexia, gastritis, gastrointestinal bleeding (a hematemesis, a melena, diarrhea with blood impurity), stomach ulcer or intestines with bleeding either without it or with perforation (sometimes with a lethal outcome, especially at patients of advanced age), colitis (including hemorrhagic colitis and exacerbation of ulcer colitis or Crohn's disease), a lock, stomatitis (including a stomacace), a glossitis, dysfunction of a gullet, a diafragmopodobny intestinal stenosis, pancreatitis.
from a gepatobiliarny system: increase in level of Transaminases, hepatitis, jaundice, violations from a liver, lightning hepatitis, gepatonekroz, a liver failure.
Infection and infection: reported about aggravation of the inflammations connected with infections (for example development of a necrotic fascitis), at system application of NPVP. It, perhaps, is caused by the mechanism of action of NPVP. If at use of the medicine Dikloberl the symptoms of an infection arise or worsen, to the patient recommend to see a doctor immediately. It is necessary to investigate whether such state is the basis for therapy by the antimicrobic agent / antibiotic. Very seldom at use of diclofenac symptoms of aseptic meningitis with rigidity of a neck, a headache, nausea, vomiting, fervescence or confusion of consciousness developed. Patients reckon with autoimmune diseases (system lupus erythematosus (SLE), the mixed disease of connective tissue) as inclined.
from skin and hypodermic cellulose: a hair loss, manifestations of a dieback, eczema, an erythema, a multimorfny erythema, Stephens's syndrome — Johnson, a Lyell's disease (toxic epidermal necrolysis), exfoliative dermatitis, reactions of a photosensitization, purple, including allergic, an itch.
from kidneys and an urinary system: hypostases, especially at patients with AG or a renal failure, OPN, a hamaturia, a proteinuria, interstitial nephrite, a nephrotic syndrome, papillary necrosis of a kidney.
General violations and violations in the injection site: at application of suppositories can arise: changes in the injection site, including the phenomena of local irritation, mucifying with impurity of blood or painful defecation.
from a reproductive system and mammary glands: impotence.
Given clinical trials and epidemiological data confirm the increased risk of the trombotichesky complications (for example a myocardial infarction or a stroke) connected with use of diclofenac, in particular in high therapeutic doses (150 mg/days) and at prolonged use.
Special instructions
General. to minimize side effects, treatment should be begun with the smallest effective dose during the shortest span necessary for control of symptoms.
Should avoid simultaneous use of the medicine Dikloberl with system NPVP, such as selection TsOG-2 inhibitors, due to the lack of any proofs of synergy effect and in connection with potential additive side effects.
needs to be careful concerning patients of advanced age. In particular, it is recommended to apply a minimal effective dose at the weakened patients of advanced age with small body weight.
As well as at application of other NPVP, allergic reactions, including anaphylactic/anaphylactoid reactions, even without preliminary influence of diclofenac can arise.
Thanks to the pharmakodinamichesky Dikloberl properties, as well as other NPVP, can mask signs and symptoms of an infection.
Influence on a digestive tract. At application of all NPVP, including diclofenac, cases of gastrointestinal bleedings (vomiting blood, a melena), ulceration or perforation which can be lethal are registered and occur at any time in the course of treatment at existence or lack of precautionary symptoms or the previous anamnesis of the serious phenomena from a GIT. These phenomena usually have serious consequences at patients of advanced age. If at the patients receiving diclofenac the phenomena of gastrointestinal bleeding or ulceration are noted, use of medicine needs to be stopped.
As well as at application of other NPVP, including diclofenac, for patients with the symptoms demonstrating violations from a digestive tract the medical observation and extra care is obligatory for. The risk of developing of bleeding, ulcer or perforation in a GIT increases with increase in a dose of NPVP, including diclofenac, and at patients with an ulcer in the anamnesis, especially with a complication in the form of bleeding or perforation, and at patients of advanced age.
Patients of advanced age have the increased frequency of undesirable reactions to application of NPVP, especially concerning gastrointestinal bleeding and perforation which can be lethal.
to reduce risk of such toxic impact on a digestive tract, treatment is begun and supported by low effective doses.
For such patients and also those which need the accompanying use of the medicines containing acetylsalicylic acid or other medicines in low doses which probably increase risk of undesirable impact on a digestive tract it is necessary to consider a question of application of combination therapy using protective equipment (for example inhibitors of a proton pomp or mizoprostol). To patients with gastrointestinal toxicity in the anamnesis, especially advanced age, it is necessary to report about any unusual abdominal symptoms (especially bleeding in a digestive tract). Cautions are also necessary for the patients receiving at the same time medicines which can increase risk of an ulcer or bleeding, such as system corticosteroids, anticoagulants (for example warfarin), antitrombotichesky means (for example acetylsalicylic acid) or selective serotonin reuptake inhibitors.
Influence on a liver. Careful medical observation is necessary in case Dikloberl appoint to patients with an abnormal liver function as their state can worsen.
As well as at application of other NPVP, including diclofenac, the level of one or several enzymes of a liver can increase.
byduring long-term treatment by the medicine Dikloberl appoint regular observation of function of a liver and levels of liver enzymes as a precautionary measure. If abnormal liver functions remain or aggravated and if clinical signs or symptoms can be connected with the progressing diseases of a liver or if other manifestations are observed (for example an eosinophilia, rash), use of the medicine Dikloberl should be stopped. The course of diseases, such as hepatitis, can pass without prodromal symptoms. Cautions are necessary if Dikloberl apply at patients with a hepatic porphyria, because of the probability of provoking of an attack.
Influence on kidneys. As at treatment of NPVP, including diclofenac, cases of a delay of liquid and hypostases are registered, special attention should be paid to patients with dysfunctions of heart or kidneys, AG in the anamnesis, to the patients of advanced age, patients receiving therapy by diuretics or medicines which significantly influence functions of kidneys and also to patients with considerable reduction of extracellular volume of liquid for any reason, for example, to or after serious surgical intervention. In such cases as a precautionary measure the monitoring of kidney function is recommended. The therapy termination usually leads to return to a state which preceded treatment.
Impact on skin. Due to the application of NPVP, including the medicine Dikloberl, serious reactions from skin (some of them were lethal) are seldom or never registered, including exfoliative dermatitis, Stephens's syndrome — Johnson and a toxic epidermal necrolysis. At patients the highest risk of development of these reactions is noted at the beginning of a therapy course: reactions arise in most cases within the first month of treatment. Use of the medicine Dikloberl should be stopped at the first appearance of skin rashes, damages of a mucous membrane or at emergence of any other signs of hypersensitivity.
System lupus erythematosus and the mixed diseases of connective tissue. At patients with a system lupus erythematosus and the mixed diseases of connective tissue the increased risk of developing aseptic meningitis can be noted.
Cardiovascular and cerebrovascular effects. Patients with existence in the anamnesis of AG and/or stagnant heart failure of light or moderate severity require carrying out the corresponding monitoring and observance of recommendations as in connection with application of NPVP, including diclofenac, cases of a delay of liquid and hypostases are registered.
Given clinical trials and epidemiological data demonstrate that use of diclofenac, especially in high doses (150 mg/days) and at long-term treatment, can be connected with slight increase of risk of development of arterial trombotichesky events (for example a myocardial infarction or a stroke).
to Patients with uncontrollable AG, stagnant heart failure, a steady ischemic heart disease, diseases of peripheral arteries and/or a cerebrovascular disease is not recommended to appoint diclofenac, in case of need application is possible only after careful assessment of a ratio risk/advantage only in a dosage no more than 100 mg/days. The similar assessment should be carried out before long-term treatment of patients with risk factors of development of the cardiovascular phenomena (for example with AG, a lipidemia, diabetes and the smoking patients).
should informPatients on possibility of the serious trombotichesky phenomena (stethalgia, short wind, weakness, violation of the speech) at any time. In this case it is necessary to see a doctor immediately.
Influence on hematologic indicators. At prolonged use of this medicine, as well as other NPVP, monitoring of complete analysis of blood is recommended.
Dikloberl can temporarily suppress aggregation of platelets. It is necessary to observe carefully patients with violation of a hemostasis, hemorrhagic diathesis or hematologic violations.
OH in the anamnesis. Patients with OH, seasonal allergic rhinitis, a rhinedema (that is nasal polyps), HOBL or persistent infections of airways (especially such which are connected with allergic similar to rhinitis symptoms) have reactions to NPVP, such as aggravation OH more often (so-called intolerance of analgetics / analgetic asthma), a Quincke's edema, urticaria. In this regard concerning such patients special measures (readiness for rendering emergency medical service) are recommended. It also concerns patients with allergic reactions to other substances, such as rash, itch, urticaria.
As well as other medicines suppressing activity of a prostaglandinsintetaza, diclofenac of sodium and other NPVP can provoke development of a bronchospasm at application for patients with OH or patients with OH in the anamnesis.
Fertility at women. Rather female fertility (see Use during pregnancy and feeding by a breast).
General. Acute reactions of hypersensitivity (for example an acute anaphylaxis) arise seldom. At the first signs of reaction of hypersensitivity after use of the medicine Dikloberl the therapy has to be stopped.
At prolonged use of the anesthetizing medicines the headache which you should not stop increase in a medicament dose can arise.
At simultaneous alcohol intake the side reactions connected with effect of active agent especially those which influence a GIT or central nervous system can amplify at application of NPVP.
Children. Suppositories Dikloberl 100 do not apply at children because of high content in them active ingredient. Dikloberl 50 not to appoint to children aged up to 14 years because of high content in it active ingredient; medicament can be used at children aged from 14 years.
Use during pregnancy and feeding by a breast
Pregnancy. In I and II trimester of pregnancy it is only possible to appoint the medicine Dikloberl when the expected advantage for mother exceeds potential risk for a fruit, and only in a minimal effective dose, and duration of treatment has to be so small as far as it is possible. As well as in case of application of other NPVP, medicine is contraindicated in the last 3 months of pregnancy (possibly oppression of sokratitelny ability of a uterus and premature closing of an arterial channel at a fruit).
Inhibition of synthesis of prostaglandins can negatively affect a course of pregnancy and/or development of an embryo/fruit. Data of epidemiological researches confirm the increased risk of abortions and/or risk of development of warm defects and a gastroshizisa after use of inhibitor of synthesis of prostaglandins in the early stages of pregnancy. The absolute risk of cardiovascular defects was increased from 1 to about 1.5%.
It is possible that the risk increases with a dose and duration of treatment. It is shown that at animals the introduction of inhibitor of synthesis of prostaglandins leads to increase pre- and post-implantation loss and lethality of an embryo/fruit.
byBesides, at the animals receiving inhibitor of synthesis of prostaglandins in the period of an organogenesis registered the increased frequency of various malformations, including from a cardiovascular system. If Dikloberl applies the woman who aims to become pregnant, or in the I trimester of pregnancy, the dose has to be as low as possible, and treatment duration — is as little as possible.
In the III trimester of pregnancy all inhibitors of synthesis of prostaglandins can influence a fruit as follows:
- cardiopulmonary toxicity (with premature closing of an arterial channel and pulmonary hypertensia);
- a renal failure which can progress to a renal failure with oligogidramniony.
Impact on mother and the newborn and also at the end of pregnancy:
lengthening of a bleeding time, antiagregantny effect which can develop even at very low doses is possible- ;
- slowing down of reductions of a uterus that leads to a delay or lengthening of childbirth.
So, Dikloberl is contraindicated in the III trimester of pregnancy.
Feeding by a breast. As well as other NPVP, diclofenac in insignificant quantity gets into breast milk. In this regard Dikloberl it is not necessary to apply at women during feeding by a breast to avoid undesirable influence on the baby.
Fertility at women. As well as other NPVP, Dikloberl can have negative effect on female fertility therefore women who plan pregnancy are not recommended to appoint medicine. For women who have problems with conception or there take place researches on infertility, it is necessary to consider expediency of medicament withdrawal Dikloberl.
Ability to influence speed of response at control of vehicles or work with other mechanisms
to Patients who during therapy by the medicine Dikloberl have disorders of vision vertigo, drowsiness, violations from central nervous system, slackness or fatigue, it is not necessary to steer vehicles or to work with mechanisms.
byInteraction
gave the interactions noted at use of diclofenac in the form of enterosoluble tablets and/or in other dosage forms Below.
Lities. On condition of simultaneous application, diclofenac can increase concentration of lithium in blood plasma. Monitoring of level of lithium in blood serum is recommended.
Digoksin. On condition of simultaneous application, diclofenac can increase concentration of digoxin in blood plasma. Monitoring of level of digoxin in blood serum is recommended.
Diuretics and antihypertensive drugs. As well as can lead other NPVP, simultaneous use of diclofenac with diuretics and antihypertensive medicaments (for example blockers of β-adrenoceptors, APF inhibitors) to decrease in their antihypertensive effect by inhibition of synthesis of vasodilating prostaglandins. Thus, the similar combination is applied with the reservation, and to patients, especially advanced age, it is necessary to be under careful observation concerning the ABP. Patients should receive appropriate hydration, also monitoring of kidney function after the beginning of the accompanying therapy and on a regular basis after it, mainly concerning diuretics and APF inhibitors, in connection with increase in risk of nephrotoxicity is recommended.
Drugs which, as we know, cause a hyperpotassemia. The accompanying treatment by kaliysberegayushchy diuretics, cyclosporine, takrolimusy or Trimethoprimum can be connected with increase in level of potassium in blood serum therefore monitoring of a condition of patients should be carried out more often.
Anticoagulants and antitrombotichesky means. Simultaneous application can increase risk of bleeding therefore it is recommended to take precautionary measures. Though clinical trials do not demonstrate influence of diclofenac on activity of anticoagulants, there are separate data on increase in risk of bleeding at the patients applying at the same time diclofenac and anticoagulants. Therefore for confidence that no changes in a dosage of anticoagulants are required, careful monitoring of such patients is recommended. As well as other NPVP, diclofenac in high doses can temporarily suppress aggregation of platelets.
Other NPVP, including selection TsOG-2 inhibitors, and corticosteroids. Simultaneous use of diclofenac and other NPVP or corticosteroids can increase risk of gastrointestinal bleeding or ulcer. It is necessary to avoid simultaneous application of two or more NPVP.
Selective serotonin reuptake inhibitors. Simultaneous application of NPVP and selection inhibitors of the return capture can increase risk of gastrointestinal bleedings.
Antidiabetic medicines. Clinical trials showed that diclofenac can be applied combined with oral hypoglycemic means that does not affect their therapeutic effect. However there are some messages about development in such cases both a hypoglycemia, and a hyperglycemia that caused need of change of a dose of antidiabetic means during use of diclofenac. For this reason as a precautionary measure it is recommended to control during combination therapy glucose level in blood.
Methotrexate. Diclofenac can suppress clearance of a methotrexate in renal tubules that leads to increase in levels of a methotrexate. It is necessary to be careful when assigning NPVP, including diclofenac, less than for 24 h before application of a methotrexate as in such cases the concentration of a methotrexate in blood can increase and amplifies its toxic action. Cases of serious toxicity when the interval between application of a methotrexate and NPVP, including diclofenac, was within 24 h are registered. This interaction is mediated through accumulation of a methotrexate as a result of violation of kidney excretion in the presence of NPVP.
Cyclosporine. Diclofenac influence, as well as other NPVP, on synthesis of prostaglandins in kidneys can increase nephrotoxicity of cyclosporine, in this regard diclofenac should be applied in lower doses, than at the patients who are not applying cyclosporine.
Takrolimus. At application of NPVP with takrolimusy increase in risk of nephrotoxicity is possible that can be mediated through renal antiprostaglandinovy effects of NPVP and inhibitor of a kaltsinevrin.
Antibacterial hinolona. Development of spasms in the patients who are at the same time accepting derivatives of a hinolon and NPVP is possible. It can be observed at patients as with epilepsy and spasms in the anamnesis, and without them. Thus, patients who already receive NPVP should show care at the solution of a question of purpose of hinolon.
Phenytoinum. At use of Phenytoinum along with diclofenac it is recommended to carry out monitoring of concentration of Phenytoinum in blood plasma in connection with the expected increase in influence of Phenytoinum.
Probenetsid. The medicines containing probenetsid can slow down sodium diclofenac removal.
Kolestipol and holestiramin. These medicines can cause a delay or reduction of absorption of diclofenac. Thus, it is recommended to appoint diclofenac at least for 1 h to or in 4–6 h after application of a kolestipola/holestiramin.
Cardiac glycosides. Simultaneous use of cardiac glycosides and NPVP can strengthen heart failure, reduce glomerular filtration rate and increase the level of glycosides in blood plasma.
Mifepristone. NPVP should not be applied within 8–12 days after intake of mifepristone as NPVP can reduce effect of mifepristone.
Powerful CYP inhibitors 2C9. It is recommended to be careful at the combined prescribing of diclofenac with powerful CYP inhibitors 2C9 (for example with vorikonazoly) that can lead to substantial increase of the C max in blood plasma and exposure of diclofenac owing to diclofenac metabolism oppression.
Overdose
Symptoms. the typical clinical picture characteristic of diclofenac overdose, does not exist. the overdose can cause such symptoms as a headache, nausea, vomiting, pain in epigastriums, gastrointestinal bleeding, diarrhea, dizziness, a disorientation, excitement, a coma, drowsiness, sonitus or spasms. opn and damage of a liver vozmo
Characteristics | |
Active ingredients | Diclofenac |
Amount of active ingredient | 50 mg |
Applicant | Berlin-Chemie Menarini |
Code of automatic telephone exchange | M01AB05 Diclofenac |
Interaction with food | It doesn't matter |
Light sensitivity | Not sensitive |
Market status | The branded generic |
Origin | Chemical |
Prescription status | According to the prescription |
Primary packing | blister |
Producer | BERLIN-HEMI AG |
Quantity in packing | 10 suppositories |
Release form | rectal suppositories |
Route of administration | Rectal |
Sign | Import |
Storage temperature | from 5 °C to 25 °C |
Trade name | Dikloberl |
Dikloberl the 50th soup. 50 mg No. 10
- Product Code: 179129
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$20.20