Pharmacological properties

Pharmacodynamics. medicine olfen contains sodium salt of diclofenac — substance of nonsteroid structure which shows the anti-inflammatory, anesthetizing and febrifugal effects. oppression of biosynthesis of prostaglandins which play an important role in emergence of inflammation, pain and fervescence is considered the main mechanism of effect of diclofenac shown in experimental conditions. in the researches in vitro sodium diclofenac in the concentration equivalent to reached at treatment of patients, did not oppress biosynthesis of proteoglycans in cartilaginous tissue.

anti-inflammatory and anesthetizing properties of the medicine Olfen provide to

In rheumatic diseases the most expressed clinical effect which is characterized by considerable reduction of expressiveness of such symptoms as pain at rest and at the movement, morning constraint and a swelling of joints and also improvement of function of joints.

At posttraumatic or postoperative inflammation Olfen caused fast reduction of severity of spontaneous pain and pain at movements and also reduced inflammatory swellings and wound hypostases.

Significant analgetic effect of the medicine Olfen was shown to

in clinical trials at the moderate and expressed pain syndrome of not rheumatic character.

Olfen reduces severity of pain and intensity of menstrual bleeding at primary dysmenorrhea.

At simultaneous application for treatment of postoperative pain sodium diclofenac considerably reduces the need for opioids.

Olfen-75 is shown by the expressed analgesic effect at moderate and heavy pains of not rheumatic origin in 15–30 min. after introduction. Drug Olfen-75 can be used for initial therapy of inflammatory and degenerative rheumatic diseases and also for treatment at the pain caused by not rheumatic inflammation.

Pharmacokinetics. Absorption. Olfen-50 Laktab. After passing through a stomach diclofenac is quickly and completely soaked up from tablets Olfen-50 Laktab, resistant to effect of gastric juice. Though absorption takes place quickly, its beginning can be delayed because of presence at a tablet of a gastrorezistentny cover. After single dose of 1 tablet Olfen-50 Laktab C _max in blood plasma averages 1.5 mkg/ml (5 µmol/l).

in case of reception of a tablet of diclofenac in time or after a meal its passing through a stomach slows down (in comparison with reception on an empty stomach), but it has no negative impact on amount of the soaked-up active ingredient.

Olfen-75. The average volume of distribution of diclofenac of sodium is 0.12-0.17 l/kg. Linking of medicine with proteins of blood plasma happens more than for 99%. After introduction in oil the C _max in blood plasma is reached in 10–20 min. Therapeutic concentration of Olfen-75 in blood plasma makes 0.7-2 mkg/ml. Repeated introduction of medicine does not cause any changes from kidneys. At observance of the recommended intervals between administrations of medicament do not note its cumulation in an organism.

Olfen-100 of SR of Depokaps. After single dose of 1 SR Olfen-100 capsule Depokaps of the C _max diclofenac in blood plasma is reached in 4 h, and its average value is 0.5 mkg/ml (1.6 µmol/l). Meal has no clinically significant influence on absorption and system bioavailability of medicine.

Average concentration of diclofenac in blood plasma in 24 h after reception of 1 SR Olfen-100 capsule Depokaps makes 13 ng/ml (40th nmol/l). After reception of 1 SR Olfen-100 capsule Depokaps of 1 times a day the minimum concentration at the end of the period of dosing makes about 22 ng/ml (70th nmol/l).

Distribution. Linking of diclofenac with proteins of blood plasma makes 99.7%, mainly with albumine — 99.4%. The revealed volume of distribution is 0.12-0.17 l/kg of body weight.

Diclofenac gets into synovial fluid where the C _max is reached on 2–4 h later, than in blood plasma. Noted by T _½ 3–6 h make of synovial fluid. Thanks to it even in 2 h after administration of medicine of concentration of active ingredient in synovial fluid is higher, than in blood plasma, and remain at higher levels during 12 h

Metabolism. About a half of all amount of the entered active ingredient is exposed to metabolism of the first passing. Thereof the AUC levels after oral or rectal administration of medicine approximately are twice lower than AUC noted after parenteral administration of an equivalent dose of medicine.

Biotransformation of diclofenac occurs partially by a glyukuronization of not changed molecule, but generally by means of one-time and repeated hydroxylation and a metoksilirovaniye that leads to emergence of several phenolic metabolites (3 hydroxies, 4 hydroxies, 5 hydroxies, 4.5 hydroxies and 3-hydroxy-4-metoksidiklofenaka) from most of which part turns into glyukuronidny conjugates. Two of the phenolic metabolites which arose at the same time pharmacological are active, but to a lesser extent, than diclofenac of sodium.

Elimination. The general system clearance of diclofenac is 263±56 ml/min. (the average level ± a standard deviation). Final T _½ — 1–2 h. T _½ 4 metabolites, including 2 pharmacological of active, it is also short and makes 1–3 h. Almost inactive metabolite, 3-hydroxy-4-metoksidiklofenak, has longer T _½ . About 60% of a dose of medicine are removed with urine in the form of metabolites and 1% of diclofenac — in not changed look. The rest of the entered dose is removed in a metabolizirovanny view with bile, and then with a stake.

Pharmacokinetics at separate groups of patients. After administration of medicament of the reliable differences in absorption, metabolism and removal of medicine connected with age patients it is noted.

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At patients with a renal failure at application of the standard or individually picked up dose of increase in amount of not changed active agent it is not revealed. At clearance of creatinine of 10 ml/min. the estimated equilibrium concentration of metabolites of diclofenac are about 4 times higher, than at healthy volunteers. Despite this, metabolites finally are removed only with bile.

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At patients with abnormal liver functions (chronic hepatitis, the compensated cirrhosis) the pharmacokinetics and metabolism of diclofenac are similar to that at patients with normal function of a liver.

Indication

Olfen-50 laktab:

• inflammatory and degenerative forms of rheumatic diseases (pseudorheumatism, the juvenile pseudorheumatism ankylosing a spondylitis, an osteoarthrosis, a spondylarthritis);
• pain syndromes from a backbone;
• rheumatic diseases of extraarticular soft tissues;
• bad attacks of gout;
• posttraumatic and postoperative pain syndromes which are followed by inflammation and hypostasis, for example after dental and orthopedic interventions;
• gynecologic diseases which are followed by a pain syndrome and inflammation, for example primary dysmenorrhea or adnexitis;
• as supportive application at a serious inflammatory illness of the ENT organs which are followed by the expressed pain syndrome, for example at a pharyngotonsillitis, otitis.

According to the general therapeutic principles, a basic disease it is necessary to treat means of basic therapy. Fever in itself is not the indication to use of medicine.

Olfen-75. Drug is used in the form of injections in oil at such states:

• inflammatory or degenerative forms of rheumatism, the pseudorheumatism ankylosing a spondylitis, an osteoarthritis, a spondylarthritis, a vertebralny pain syndrome, extraarticular rheumatism;
• bad attacks of gout;
• renal and hepatic gripes;
• pain, inflammation and hypostasis after injuries and surgical interventions;
• heavy attacks of migraine.

Olfen-100 of SR of Depokaps. Pain relief and reduction of inflammation of various degree at various states, including:

• pathology of joints: the pseudorheumatism ankylosing a spondylitis, an osteoarthritis, bad attacks of gout;
• sharp musculoskeletal diseases, such as periarthritis (for example humeroscapular periarthritis), tendinitis, tendovaginitis, bursitis;
• other morbid conditions caused by injuries including fractures, a back pain, stretchings, dislocations, orthopedic, dental and other insignificant surgeries.

According to the general therapeutic principles, a basic disease it is necessary to treat means of basic therapy. Fever in itself is not the indication to use of medicine.

Use

Dose is selected individually. medicament should be used in minimal effective doses during the smallest span, considering the treatment purpose at each specific patient.

Drug is not used at children.

Olfen-50 Laktab. Adults. The initial daily dose of diclofenac of sodium usually makes 100–150 mg, that is 2–3 tablets Olfen-50 Laktab. In less hard cases and at long therapy there is usually enough application of 75-100 mg/days (the dose of 75 mg is applied in the corresponding dosage). The daily dose is distributed, as a rule, on 2–3 receptions.

to prevent night pain and morning constraint, reception of Olfen-50 Laktab during the day can be combined with introduction of rectal capsules before going to bed, but at the same time the maximum daily dose of diclofenac should not exceed 150 mg.

At primary dysmenorrhea the daily dose is selected individually and makes, as a rule, 50–150 mg. The initial dose can make 50–100 mg and if necessary can be raised during several menstrual cycles, but it is not higher than 200 mg/days. Treatment should be begun at manifestation of the first symptoms and to continue several days, depending on dynamics of regression of symptoms.

Patients of advanced age. Though at patients of advanced age medicine Olfen-50 pharmacokinetics Laktab does not worsen to any clinically significant degree, NPVP have to be applied with extra care at such patients as they, as a rule, are more inclined to development of undesirable reactions. In particular, or with a low indicator of body weight it is recommended to apply minimal effective doses to the weakened patients of advanced age; also patients need to be examined concerning gastrointestinal bleedings at treatment of NPVP.

Olfen-75. Before use of medicine Olfen-75 conducting skin test on hypersensitivity to lidocaine to a hydrochloride is obligatory. Olfen-75 to apply in the form of injections in oil. Due to the possible emergence of anaphylactic reactions, up to development of shock, after administration of medicine Olfen-75 the patient has to be under observation not less than 1 h, at the same time on call there have to be means necessary for rendering emergency medical service.

Usual single dose of medicine are contents of 1 ampoule (that is 75 mg of diclofenac of sodium) which are entered 1 time in oil a day by a deep injection into an upper external quadrant of a gluteus. Solution has to be used right after opening of an ampoule. Any amount of unused solution needs to be utilized.

In severe pain (for example gripes) can enter medicine 2 times a day at an interval of several hours, surely changing at the same time the place of an injection. The combination of parenteral administration of medicine Olfen-75 to other dosage forms of the medicines Olfen (tablets, capsules, rectal capsules, gel or a plaster) is admissible provided that the maximum daily dose of diclofenac of sodium does not exceed 150 mg.

in the conditions of a migraine attack the clinical experience is limited to cases with initial application of one ampoule of 75 mg, to enter a dose whenever possible at once after application of suppositories on 100 mg on the same day (in case of need). The general daily dose should not exceed 175 mg in the first day. There are no available data on use of medicine Olfen-75 for treatment of attacks of migraine longer than one day.

Duration of parenteral application of Olfen-75 should not exceed

2 days. If it is necessary, treatment can be continued by medicines Olfen-50 Laktab, Olfen-100 of CP of Depokaps.

Olfen-75 is not applied for in/in injection/infusion.

Patients of advanced age. Dose adjustment is not required, but because of possible emergence of side reactions it is necessary to watch with special care patients of advanced age.

Patients with a renal failure or a liver. With a renal failure or the liver of easy and average degree of a dose decline is not required from patients.

Olfen-100 of SR of Depokaps. Adults. Olfen-100 SR of Depokaps needs to be accepted before food. To swallow of capsules without chewing, washing down with a glass of water.

Daily dose of medicine, as a rule, makes 1 Depokaps SR Olfen-100 capsule. In mild cases and at long-term treatment of purpose of 1 SR Olfen-100 capsule Depokaps in day, as a rule, happens enough. In need of application of a dose of 50 mg or 150 mg of diclofenac of sodium the treatment of Olfen-100 of SR Depokaps should be combined with reception of Olfen-50 Laktab.

In cases when symptoms of a disease are most expressed at night or in the morning, Olfen-100 of SR of Depokaps it is desirable to accept for the night.

Contraindication

Olfen-50 laktab, olfen-100 sr depokaps:

• hypersensitivity to acting or to excipients of medicine;
• bleeding or perforation in a GIT in the anamnesis connected with the previous treatment of NPVP;
• an active form of a peptic ulcer / bleeding or a recurrent peptic ulcer / bleeding in the anamnesis (2 or more separate episodes of the established ulcer or bleeding);
• as well as other NPVP, diclofenac it is also contraindicated to patients who have an application of an ibuprofen, acetylsalicylic acid or other NPVP provokes attacks OH, a Quincke's disease, a small tortoiseshell or sharp rhinitis;
• inflammatory bowel diseases (for example Crohn's disease or ulcer colitis);
• liver failure;
• renal failure;
• stagnant heart failure (NYHA II–IV);
• an ischemic heart disease at the patients having stenocardia, the postponed myocardial infarction;
• cerebrovascular diseases at the patients who had a stroke or having episodes of the tranzitorny ischemic attacks;
• a disease of peripheral arteries;
• treatment of perioperatsionny pain at aortocoronary shunting (or use of the cardiopulmonary bypass).

Olfen-75:

• hypersensitivity to active ingredients or any components of medicine;
• hypersensitivity to lidocaine or other amide mestnoanesteziruyushchy means;
• convulsive attacks in the anamnesis caused by use of lidocaine;
• WPW cm;
• porphyria;
• myasthenia;
• anticoagulating therapy;
• bleeding or perforation in a GIT in the anamnesis connected with the previous treatment of NPVP;
• an active form of a peptic ulcer / bleeding or a recurrent peptic ulcer / bleeding in the anamnesis (2 or more separate episodes of the established ulcer or bleeding);
• as well as other NPVP, diclofenac it is also contraindicated to patients who have an application of an ibuprofen, acetylsalicylic acid or other NPVP provokes attacks OH, a Quincke's disease, a small tortoiseshell or sharp rhinitis;
• inflammatory bowel diseases (for example Crohn's disease or ulcer colitis);
• liver failure;
• renal failure;
• stagnant heart failure (NYHA II–IV);
• an ischemic heart disease at the patients having stenocardia, the postponed myocardial infarction;
• cerebrovascular diseases at the patients who had a stroke or having episodes of the passing ischemic attacks;
• a disease of peripheral arteries;
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• it is contraindicated for treatment of perioperatsionny pain at aortocoronary shunting (or when using the cardiopulmonary bypass);
• AV blockade of II and III degree, a sick sinus syndrome, Adams's syndrome — Stokes, the expressed arterial hypotension, bradycardia, cardiogenic or hypovolemic shock, full cross heart block;
• high risk of postoperative bleeding, violations of fibrillation, incomplete hemostasis, violations of a hematopoiesis or cerebrovascular bleedings.

Side effects

in case of side reactions needs to see a doctor.

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Both at long, and at short-term administration of medicament the following side reactions can be observed.

from blood and lymphatic system: thrombocytopenia, leukopenia, anemia (including hemolytic and aplastic), Agranulocytosis.

from the immune system: reactions of hypersensitivity (anaphylactic and anaphylactoid reactions, including arterial hypotension and shock), Quincke's disease (including face edema), feeling of heat, cold or numbness of extremities.

from mentality: disorientation, depression, insomnia, nightmares, irritability, psychotic frustration.

from nervous system: headache, dizziness, drowsiness, paresthesias, violations of memory, spasm, concern, tremor, aseptic meningitis, violation of taste, stroke, violation of sensitivity, increased fatigue, confusion of consciousness, hallucination, general malaise.

For Olfen-75 also: a loss of consciousness up to a coma, muscular spasms, the motor block, a dysarthtia, a dysphagy, a nystagmus.

from an organ of sight: disorder of vision, illegibility of sight, diplopia, optic neuritis.

For Olfen-75 also: flashing of "front sights", photophobia, conjunctivitis.

from organs of hearing and a vestibular mechanism: vertigo, sonitus, hearing disorder.

For Olfen-75 also: hyperacusia.

from a cardiovascular system: the strengthened heartbeat, a stethalgia, a myocardial infarction, heart failure, AG, arterial hypotension, a vasculitis, arrhythmia, bradycardia.

For Olfen-75 also: delay of conductivity of heart, cross heart block, stop of warm activity, collapse, tachycardia, inflows.

from respiratory organs: OH (including short wind), bronchospasm, pneumonitis, oppression or apnoea.

For Olfen-75 also: rhinitis.

from digestive system: an abdominal pain, nausea, vomiting, diarrhea, abdominal spasms, dyspepsia, a meteorism, anorexia, gastritis, gastrointestinal bleedings, vomiting with blood, hemorrhagic diarrhea, a melena, stomach ulcers and intestines with or without bleeding and 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, damages of a gullet, diafragmopodobny intestinal strictures, pancreatitis.

Gepatobiliarny violations: the increased level of Transaminases, hepatitis, jaundice, liver dysfunction, lightning hepatitis, liver necrosis, a liver failure.

from skin and hypodermic cellulose: rash, urticaria, bullous rashes, eczema, an erythema, a multiformny erythema, Stephens's syndrome — Johnson, a Lyell's disease (toxic epidermal necrolysis), exfoliative dermatitis, an alopecia, a photosensitization, purple, allergic purple, naggers.

from kidneys and urinary tract: a liquid delay in an organism, hypostases, OPN, a hamaturia, a proteinuria, interstitial nephrite, a nephrotic syndrome, renal papillary necrosis.

from a reproductive system: impotence.

General frustration: hypostasis.

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It was reported about the increased risk of 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 prolonged use.

For Olfen-75 also: the general violations and reactions in the injection site: a general malaise, a malignant hyperthermia, weakness, reactions in the place in oil of an injection, for example pain, feeling of easy burning or consolidation of fabrics, hypostasis, necrosis in the place of an injection, abscess in the place of an injection.

Special instructions

General. to minimize side effects, treatment should be begun with the lowest effective dose during the shortest span necessary for control of symptoms.

Should avoid use of the medicine Olfen 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.

care at patients of advanced age Is necessary for

. In particular, are recommended to apply the lowest effective dose the weakened patients of advanced age with low body mass index.

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As well as at application of other NPVP, allergic reactions, including anaphylactic/anaphylactoid reactions, even without preliminary influence of diclofenac can be observed.

Thanks to the pharmakodinamichesky properties, sodium diclofenac, 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 cases blood, melenas), ulceration or perforation which can be lethal were 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 more serious consequences at patients of advanced age. If at the patients receiving diclofenac the phenomena of gastrointestinal bleeding or ulceration are observed, use of medicine needs to be stopped.

As well as at application of other NPVP, including diclofenac, for patients with the symptoms demonstrating violation from a digestive tract the medical observation and extra care is obligatory for

. The risk of developing of bleeding, ulcer or perforation in a digestive tract increases with increase in a dose of NPVP, including diclofenac.

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 minimal effective doses. For such patients and also those who need the accompanying use of the medicines containing low doses of acetylsalicylic acid or other medicines which probably increase risk of undesirable impact on a digestive tract it is necessary to consider a question of additional use of protective equipment (for example inhibitors of a proton pomp or mizoprostol). Patients with gastrointestinal toxicity in the anamnesis, especially advanced age, have to report about any unusual abdominal symptoms (especially bleedings in digestive trakt). Precautionary measures are also necessary for the patients receiving at the same time medicines which can increase risk of an ulcer or bleeding, such as system GKS, 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 Olfen patients need to appoint 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.

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during long-term treatment by the medicine Olfen appoints regular observation of functions of a liver and levels of liver enzymes as a precautionary measure. If abnormal liver functions remain or worsen 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 Olfen should be stopped. The course of diseases, such as hepatitis, can pass without prodromal symptoms. Precautionary measures are necessary if Olfen patients need to apply 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 were 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 function of kidneys and also to persons with significant 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 function of kidneys 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 sodium diclofenac, serious reactions from skin (some of them were lethal) were 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 observed at the beginning of a therapy course: emergence of reaction is noted in most cases within the first month of treatment. Use of the medicine Olfen needs to 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 observed.

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 providing recommendations as in connection with application of NPVP, including diclofenac, cases of a delay of liquid and hypostases were 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 to patients who smoke).

Patients have to be informed by

on possibility of serious trombotichesky cases (stethalgia, short wind, weakness, violation of the speech) which can happen 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.

Olfen can temporarily suppress aggregation of platelets. It is necessary to watch 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), chronic obstructive diseases of lungs or persistent infections of airways (especially such which are connected with allergic similar to rhinitises, 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 it is recommended to take special measures (readiness for rendering emergency aid) in respect of such patients. 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 with OH in the anamnesis.

Olfen-75. As Olfen-75 contains lidocaine a hydrochloride, before application it is necessary to carry out skin test on individual sensitivity. Only health workers can carry out administration of lidocaine.

As well as should appoint other lidokainsoderzhashchy medicines, medicine by

with care the patient with epilepsy, at cardiac conduction abnormality, respiratory insufficiency.

Also should consider

that when processing the place of an injection the disinfecting solutions containing heavy metals risk of development of local reaction in the form of morbidity and hypostasis increases.

As lidocaine has the expressed aritmogenny effect, it is necessary to use with care medicament at persons with complaints to arrhythmia in the past.

to apply

With care at patients with heart failure of moderate degree, arterial hypotonia of moderate degree, incomplete AV blockade, violation of intra ventricular conductivity, abnormal liver functions and kidneys of average degree (clearance of creatinine of 10 ml/min.), breath dysfunction, the epilepsy raised by convulsive readiness, a heavy myasthenia after heart surgeries, at genetic predisposition to a hyperthermia, the weakened patients and patients of advanced age; at implementation of an injection in the inflamed (infected) site.

At use of lidocaine obligatory is control of the ECG. In case of violations of activity of sinus node, lengthening of an interval of P-Q, the QRS expansion or at development of new arrhythmia it is necessary to reduce a dose or to cancel medicine.

Before use of lidocaine at heart diseases (the hypopotassemia reduces efficiency of lidocaine) needs to normalize potassium level in blood.

1 mmol (23 mg) on a sodium dose contains

Olfen-75, that is it is almost free from sodium.

Can cause the symptoms similar to that, arising at alcohol intake owing to existence in composition of propylene glycol.

Olfen-100 of SR of Depokaps. Drug contains lactose. Patients with rare hereditary forms of intolerance of a galactose, deficiency of Lappa lactases or malabsorption of glucose galactose should not use this drug.

Use during pregnancy or feeding by a breast. Pregnancy. Oppression of synthesis of prostaglandins can have negative effect on pregnancy and/or embriofetalny fetation. Data of epidemiological researches indicate the increased risk of termination of pregnancy, malformations of heart and gastroshizis after use of inhibitors of synthesis of prostaglandins in the early stages of pregnancy. It is considered that this risk increases at increase in a dose of medicines and increase in duration of therapy.

Diclofenac of sodium should not be applied in I and II trimester of pregnancy if in it there is no emergency. If diclofenac of sodium is applied by the woman who tries to become pregnant, or in I or II trimester of pregnancy, the dose has to be minimum, and will continue