Diclofenac or dicloberl which is better. Indications for the use of various forms of the drug dikloberl

The adrenal glands, like other endocrine organs, have great value for adjustment metabolic processes. This also applies to human sexual development, maintaining the balance of water and salts, energy production for biochemical reactions and activity vegetative functions. And very important role they play for intrauterine development fetus and the formation of the body in newborns.

The structural features of the adrenal glands determine their hormonal work. They consist of a medulla and a cortical layer, each of which has its own purpose. The regulation of the production of active substances in these organs is regulated by the hypothalamic-pituitary system. The degree of their activity depends on many other factors (stressful situations, nutrition, traumatic injuries to the body or serious illnesses).

The adrenal glands begin to develop in the fetus in utero at 4-7 weeks, and begin to actively produce hormonal substances already in the second month of the mother’s pregnancy. Diseases associated with dysfunction of the adrenal glands in newborns can be congenital or acquired. All congenital variants of diseases, to one degree or another, manifest themselves clinically in the baby after birth. But sometimes he also has acquired pathological conditions. The adrenal cortex has such anatomical and physiological features that determine the prerequisites for the development of various diseases; it is often found, including in newborns. benign tumor adrenal gland

The meaning of the adrenal glands

During the fetus's stay in the womb, and during the immediate postpartum period The adrenal glands help the newborn baby develop and adapt. Special role In this regard, it belongs to the adrenal cortex, since it originates from a different germ layer, in contrast to the medulla of the organs. Pathological changes the latter are extremely rare in newborns.

Adrenal pathologies

Disruption of the adrenal glands in both adults and newborns often leads to severe conditions, which pose a direct threat to health and life. But if the problem is detected in a timely manner, there is high probability achieving compensation and restoration of all normal functions in the body.

The most common adrenal gland diseases in newborns are the following:

• acute adrenal insufficiency;

• congenital deficiency;

• hypercortisolism;

• adrenal tumors (pheochromocytoma).

Acute failure

Acute adrenal insufficiency in newborns is a very severe form of pathology. The causes of this condition are usually severe hemorrhage in these organs, which is due to:

• birth trauma;

• asphyxia;

• hemorrhagic syndrome in infectious diseases.

SCI may occur somewhat less frequently as a result of congenital hypoplasia, which is transmitted in an autosomal recessive manner, or has X-linked inheritance. Such a pathology in a newborn can be detected during genetic testing.

Signs of an acute condition

In the case when the adrenal glands practically do not work, the symptoms of the disease in children manifest themselves as follows:

1. The baby practically does not move, his blood pressure and muscle tone drop sharply.

1. The pulse is frequent, shortness of breath develops, and the volume of urine excreted decreases.

1. There is vomiting, diarrhea, and pain in the intestinal area that varies in intensity and location. As a result of fluid loss, dehydration can quickly occur, which is a very dangerous condition in a newborn baby.

1. The temperature decreases, the skin becomes pale or bluish, sometimes a marbled pattern and hemorrhages are noted.

1. IN last stage a collapsed state develops, caused by vascular insufficiency. A decrease in potassium levels in the blood causes the heart muscle to stop working.

The rate at which symptoms develop in newborns depends on the cause of the deficiency. With sudden damage to the adrenal glands as a result of hemorrhage or discontinuation of glucocorticoids, the clinical picture of the disease develops in a matter of hours. If acute failure results chronic process, then the onset of its onset may last for several days or months.

Treatment of acute adrenal insufficiency

This condition can quickly lead to the death of a newborn baby, so treatment is carried out only in an intensive care unit. When providing assistance, parenteral administration of hormones (glucocorticoids and mineralocorticoids) begins immediately. This replacement therapy, if started on time, immediately has an effect and causes an improvement in the condition of the little patient.

If necessary, anti-shock measures are taken and symptomatic treatment.

Congenital adrenal hyperplasia

All forms of this disorder, which manifests itself immediately after birth, are transmitted from parents to children. Most of them are hereditary 21-hydroxylase deficiency. A decrease in the activity of this substance leads to a decrease in the production of cortisol and progesterone. Sometimes a latent form of the disease may develop, in which ACTH secretion increases. This leads to an increase in androgen synthesis and activation of the renin-angiotensin system and loss of salts.

Clinical symptoms

There are three main types of adrenogenital syndrome:

• virile form;

• salt wasting;

• erased.

U infants The first two variants of the disease become most important. In the virile form, visual changes in the external genitalia predominate. Girls have an enlarged clitoris and labia. Sometimes the hypertrophy is so significant that it becomes difficult to determine the sex of the newborn. Boys experience hyperpigmentation and enlargement of the penis. At birth, children differ from their peers in having thicker bones, increased weight, and more developed muscles.

Salting option pathological condition adrenal glands in newborns occurs most often with adrenogenital syndrome. In this case, virilization of the genital organs also occurs, but very dangerous conditions develop in which a lack of hormones occurs. The baby often spits up, does not gain weight well, develops diarrhea and vomiting, and decreases body weight and blood pressure.

Treatment

In this case, only urgent administration of hormone replacement therapy in a newborn will help, otherwise the child will short time may die.

In the presence of latent forms of congenital hyperplasia, it should be carried out against the background of diagnostics and determination hormonal levels use required dose oral hormonal drugs which are recommended by your doctor.

Pheochromocytoma

Quite rare, but still found in a newborn is an adrenal tumor, which is called pheochromocytoma. In this case, the medulla of these organs is damaged.

Clinically, this manifests itself as increased blood pressure due to excess adrenaline and norepinephrine. The child experiences an increase in heart rate, temperature and blood sugar. The baby's hyperexcitability is striking.

Why are such deviations dangerous?

Diseases of the adrenal glands in children after their birth are fraught with serious consequences. The most dangerous condition is adrenal crisis, as it can result in the death of the baby in a matter of hours.

For violations that are associated with congenital hyperplasia, there is a loss of fluid and salt in the body, leading to dehydration. Since infant nutrition does not include the use of salty foods, in some cases the disease remains unrecognized for some time, and no measures are taken. In this case, in the urine of a newborn baby, there is a permanent loss of organs necessary for the functioning, and cardiac arrest may occur.

How to prevent adrenal diseases in newborns

In some cases, it is not possible to prevent the development of certain pathologies associated with the functioning of the adrenal glands in young children. Only timely detection of deviations gives a relatively favorable prognosis in this situation.

Adrenal crisis in a newborn can be prevented by timely stopping the increase in energy expenditure of the child’s body during serious illnesses, surgical intervention or injury.

For those babies who are forced to take hormone replacement therapy, it is imperative to draw up a schedule for taking medications. Parents should give their child medications strictly in the dosage and time sequence recommended by the pediatric endocrinologist.

For those who are planning a pregnancy and have relatives with abnormalities in the functioning of the adrenal glands, it is necessary to contact geneticists in advance in order to understand the degree of likelihood of developing a similar pathology in their unborn child, and take all necessary measures.

During the period of gestation, the expectant mother is recommended to follow a routine, eat in a timely and rational manner. Best avoided stressful situations, walk more often fresh air and move actively. For any illness, immediately seek help from a specialist and undergo timely treatment.

Hypocortisolism syndrome (chronic adrenal insufficiency) is caused by insufficient secretion of hormones from the adrenal cortex due to damage (primary hypocortisolism) or disorders of the hypothalamic-pituitary regulation (secondary and tertiary hypocortisolism).

Hormones that are synthesized in the adrenal cortex are classified as corticosteroids. The adrenal cortex itself morpho-functionally consists of three layers(zones), each of which produces certain type hormones:

• Zona glomerulosa - responsible for the production of hormones called mineralcorticoids (aldosterone, corticosterone, deoxycorticosterone).
• Zona fasciculata - responsible for the production of hormones called glucocorticoids (cortisol, cortisone)
• Zona reticularis - responsible for the production of sex hormones (androgens).

Etiology and pathogenesis

Primary hypocortisolism (Addison's disease). Predisposing factors are autoimmune diseases of various types involving the adrenal cortex, tuberculosis process, amyloidosis, HIV infection, syphilis and fungal diseases. Metastases may be the cause of hypocorticism cancerous tumors. Hereditary predisposition is realized through violations of the immune control system. There is an association with the antigens of the HLAB 8 and DW 3, DR 3, A 1 systems.

Primary hypocortisolism is based on atrophy of the adrenal cortex, most often as a consequence of an autoimmune process (autoimmune adrenalitis). In this case, immunological tolerance to the cortex tissue is disrupted, which is accompanied by the development of organ-specific reactions. Tissue specificity is determined by antigens contained in the cellular structures of the adrenal cortex. When they enter the blood, antibodies are formed to the key enzyme of steroidogenesis - 21-hydroxylase, which serve as specific markers of the disease.

At histological examination parenchymal atrophy, fibrosis, lymphoid infiltration, mainly in the glomerular or fascicular zones. In this regard, the number of cells producing glucocorticoids (cortisol) and mineralocorticoids (aldosterone) decreases.

Secondary hypocortisolism. Secondary failure adrenal cortex develops with brain tumors, after surgery, traumatic injuries brain, with autoimmune hypophysitis, cavernous sinus thrombosis, after massive bleeding. The pathogenesis is based on insufficient secretion of corticotropin. Usually combined with a deficiency of other pituitary tropic hormones (gonadotropins, thyrotropin). At long-term treatment glucocorticoid drugs for various diseases also initially develop secondary adrenal insufficiency with inhibition of corticotropin secretion according to the law feedback. Long-term therapy can lead to atrophy of the adrenal cortex.

Tertiary hypocortisolism occurs when the secretion of corticoliberin decreases due to a tumor or ischemia of the hypothalamic region, after radiation therapy, surgery, anorexia nervosa, intoxication.

Symptoms

Early signs: fatigue and weakness in the afternoon, increased sensitivity to action sun rays with a persistent tan, decreased resistance to infections and prolonged course of colds, deterioration of appetite.

Expanded clinical symptoms is very typical and is characterized by pigmentation of the skin and mucous membranes from golden to grayish shades, especially in areas of friction ( armpits, groin area, hands and elbows, lips and oral mucosa, scars). Persistent arterial hypotension, tachycardia, dyspeptic disorders, abdominal pain, weight loss, and severe muscle weakness are noted, making it difficult to move even at a slow pace.

Specific signs: increased need in salt and a tendency to hypoglycemic reactions. Clinical symptoms are caused by a lack of glucocorticoids (muscle weakness, dyspeptic disorders, weight loss, hypoglycemia), mineralocorticoids (the need for salty foods, arterial hypotension) and increased secretion of melanocytotropin (proopiomelanocortin). Severe clinical signs develop when more than 80% of the adrenal cortex tissue is damaged.

Primary hypocorticism can be combined with candidiasis, type 1. With secondary and tertiary hypocortisolism, clinical symptoms are less pronounced and, as a rule, there is no pigmentation. Clear signs of the disease can only appear in stressful situations.

Diagnostics

Diagnostic criteria: pigmentation, weight loss, arterial hypotension (the peculiarity of which is an inadequate response to physical activity in the form of a decrease in blood pressure), a decrease in cortisol levels in the blood plasma (5 mmol/l), a decrease in the level of sodium in the blood serum (100 ng/ml at primary hypocortisolism and its reduction in secondary.

IN initial stages To verify the diagnosis, functional tests are used: a test with synacthen depot (a synthetic analogue of long-acting corticotropin). The test method is as follows: 1 mg of the drug is injected intramuscularly after blood sampling to study the basal level of cortisol. A repeat blood test for cortisol content is carried out after 24 hours. A sign of primary hypocortisolism is the absence of an increase in cortisol content in the blood after stimulation with synacthen. With secondary hypocortisolism, the concentration of cortisol increases markedly.

A test with long-term stimulation of the adrenal glands with synacthen depot is carried out intramuscularly daily for 5 days at a dose of 1 mg. Free cortisol in daily urine is determined both before drug administration and during the 1st, 3rd and 5th days of stimulation of the adrenal cortex. U healthy people the content of free cortisol in daily urine increases 3-5 times from the initial level. In case of secondary deficiency, on the contrary, on the 1st day of stimulation with synacthen-depot there may be no increase in the content of free cortisol in daily urine, and on the subsequent 3rd and 5th days it reaches normal values.

Differential diagnosis is carried out with conditions accompanied by hyperpigmentation, weakness, arterial hypotension, weight loss:

1. Diffuse toxic goiter
   • General signs: weakness, weight loss, pigmentation.
   • Differences between toxic diffuse goiter: arterial systolic pressure is increased and diastolic pressure is decreased (increased pulse blood pressure), increased appetite, fine tremor of the fingers, increased thyroid gland, possible atrial fibrillation.
2. Hemochromatosis
   • General signs: hyperpigmentation, muscle weakness.
   • Differences in hemochromatosis: presence, hyperglycemia, increased iron levels in the blood. However, it is necessary to study blood cortisol, since there may be a combination of hemochromatosis and hypocortisolism.
3. Chronic enterocolitis
   • General signs: weakness, weight loss, abdominal pain, hypotension, anorexia.
   • Differences chronic enterocolitis: frequent loose stool, changes in coprogram, seasonal nature of exacerbation, effect of enzyme therapy.
4. Neurotic syndromes
   • General signs: weakness, anorexia, tachycardia.
   • Differences: blood pressure is normal or unstable, there is no pigmentation or weight loss, weakness in the morning and feeling better in the evening, inconstancy of symptoms.

Treatment

Treatment is based on stimulation of the synthesis of one’s own hormones and replacement hormone therapy under the control of the following parameters: blood pressure, body weight, color skin, cortisol and corticotropin levels, potassium and sodium levels in the blood. A diet with increased content carbohydrates (at least 60%), sufficient table salt, protein and vitamins; the total calorie content of food should be 20-25% higher than usual.

If it is possible to achieve compensation for the condition (according to the criteria specified below) by prescribing ascorbic acid at a dose of 1.5 to 2.5 g/day, patients do not need constant hormonal therapy (usually with latent form). In such cases, steroid hormones (glucocorticoids) are prescribed only during stressful situations (illness, heavy physical activity, nervous tension, surgery).

If signs of the disease persist while taking ascorbic acid, hormones with predominantly glucocorticoid activity are prescribed, preferably natural ones - cortisone, cortisone acetate. The dose of cortisone acetate is selected individually until signs of compensation are achieved (from 25 to 50 mg/day).

If it is not possible to compensate for the condition with glucocorticoid hormones, mineralocorticoids - cortinef (florinef, 0.1-0.2 mg / day) are added to treatment. Overdose must be avoided to prevent fluid retention and the development of arterial hypertension syndrome.

The main thing in replacement therapy chronic failure adrenal cortex - achieving and maintaining clinical and hormonal compensation of the disease.

Clinical compensation criteria:

• stabilization of body weight;
• normalization of blood pressure;
• elimination of pigmentation of the skin and mucous membranes;
• restoration of muscle strength.

Indicators of hormonal-metabolic compensation:

• basal plasma cortisol level > 350 mmol/l;
• potassium level - 4.0-4.5 mmol/l;
• sodium level - 135-140 mmol/l;
• glycemia from 4.5 to 9.0 mmol/l during the day.

In addition to replacement therapy, etiopathogenetic treatment is prescribed, which depends on the cause of the disease.

With autoimmune genesis, patients receive courses of immunocorrective drugs 1-2 times a year to stimulate the T-suppressor function of the cellular immune system. In order to suppress antibody formation to the enzyme 21-hydroxylase, the dose of glucocorticoids is periodically increased (especially in intercurrent diseases, when the activity of autoaggression increases).

For tuberculosis etiology, specific anti-tuberculosis therapy is prescribed. In these cases, control over its duration and nature is carried out by a TB doctor. The use of anabolic steroids is indicated.

The adrenal glands are the glands (there are two of them) that are located above the kidneys. The functioning of the adrenal glands is very important for the functioning of the human body. If these organs do not perform their function correctly, a malfunction occurs in all organs; this malfunction can lead not only to irreparable consequences for health, but also to death.

The function of the adrenal glands is reduced to the following aspects:

• synthesis of hormones;
• regulation of metabolic processes;
• manifestation adequate reaction for stress;
• regulation of the constancy of the internal environment.

The adrenal glands consist of two layers - the cortex and the medulla. In turn, the cortical layer is divided into glomerular, fascicular and reticular, each of which performs its own specific function.

The following hormones are produced in the zona glomerulosa: corticosterone, aldosterone, and deoxycorticosterone. Corticosterone is synthesized in the zona fasciculata, and sex hormones are produced in the reticularis.

In addition to the synthesis of hormones, the cortex regulates water and electrolyte balance, stimulates the heart, is responsible for the expansion of bronchioles, normalizes blood pressure, produces adrenaline and norepinephrine, and increases sugar levels.

The function of the adrenal glands in men, in addition to the above, is as follows:

• functionality of the genital organs;
• increase in muscle strength.

The adrenal glands increase the body's resistance to various diseases, increase positive emotions, actively help fight stress and depressive situations. The hormones that these paired organs synthesize are essential for the functioning of the body; any deviation from the norm leads to serious illnesses.

How to check the functioning of the adrenal glands? There are effective diagnostic methods for checking, which will be discussed below.

Adrenal gland disorders

Adrenal diseases are accompanied by an imbalance of hormones (excess or deficiency), but can occur without hormonal imbalance. A decrease in hormone synthesis is observed in acute and chronic adrenal insufficiency. In this case, the body does not have enough adrenal hormones, as a result of which various ailments develop. The causes of primary adrenal insufficiency may be the destruction of organ tissue by various infectious diseases(for example, tuberculosis). Secondary adrenal insufficiency occurs when the functionality of the hypothalamus and pituitary gland is reduced.

Excessive synthesis of hormones is observed with tumors, enlargement of the organ cortex, and Itsenko-Cushing's disease. But some disturbances in their work can occur without changes in hormonal levels, these include cystic formations and tumors that do not exhibit hormonal activity.

Symptoms of diseases

Cushing's syndrome is an excess synthesis of hormones. Signs:

• the patient has overweight, with weight gain mainly occurring on the front of the body and face. The limbs lose weight;
• Purple stretch marks are observed on the skin;
• the skin becomes covered with acne;
• women experience increased hair growth and their cycles become disrupted;
• men develop sexual impotence;
• weakness;
• bones become brittle;
• blood pressure rises;
• Diabetes mellitus may develop;
• appetite increases;
• Insomnia, headaches, and depression appear.

Addison's disease is insufficient synthesis of hormones. Signs:

• increased pigmentation of mucous membranes and skin;
• problem with the heart and blood vessels;
• decreased appetite;
• nausea, diarrhea;
• increased thirst;
• fatigue;
• tremor of the limbs;
• anxious state.

Hyperaldosteronism is excessive production of aldosterone. Signs:

• high blood pressure;
• tachycardia, heart pain;
• headaches;
• decreased visual acuity;
• severe fatigue;
• convulsions;
• the kidneys disrupt their function;
• swelling;
• paresthesia.

Nelson's syndrome - signs:

• indigestion;
• promotion blood pressure;
• decreased blood glucose levels;
• loss of strength;
• enlargement of the sella turcica;
• skin pigmentation.

Adrenogenital syndrome - the adrenal glands synthesize androgen in excessive quantities:

• in women, the voice timbre decreases and increases muscle mass and genitals;
• in newborn children, height and weight exceed the norm, the body is disproportionate, increased hair growth;
• The body structure of girls resembles that of men.

Of course it's not full list There are a lot of diseases to which the adrenal glands are susceptible, and it is impossible to list them all at once. If you suspect a malfunction in their work, you must immediately consult a doctor, undergo examinations and begin therapy.

Diagnostic laboratory activities

The initial symptoms of incorrect adrenal gland function are not always clear. Unreasonable thinness, low blood pressure and digestive problems can appear due to various ailments. Therefore, doctors recommend tests for adrenal hormones for women who long time accept birth control pills. Suppressing reproductive function body, oral contraceptives provoke hormonal imbalance How this affects the functioning of the adrenal glands depends on what pills are taken and on the characteristics of the body’s reaction to them.

Since the balance of hormones in a problem with the adrenal glands is disturbed, tests for adrenal hormones are first necessary. Before taking the tests, the patient must prepare - the day before the test, you need to reduce physical activity and avoid taking alcoholic products, and stop smoking an hour before the test.

A blood test for adrenal hormones can be taken from a child, as well as from men, on any day; women take this test on the 7th day of the menstrual cycle.

How to check the functioning of the adrenal glands in women? You need to donate blood for androgen testing. It is this analysis that will help distinguish adrenal diseases from others. women's problems. Normally, the adrenal glands in women should produce 80-560 mcg/dl. You also need to test the hormone cortisol. The norm of this hormone for an adult (both men and women) is 150-600 nmol/l.

To get a complete picture, you need to donate blood for the hormone aldosterone, which is important element in the production of both female and male sex hormones. It is taken in a lying position (norm 13-145) and in a standing position (norm 27-270). The stress resistance hormone (ACTH) changes its level throughout the day. The morning norm of this hormone should not exceed 25, and in the evening 19 units.

How else can you test your adrenal hormones? Saliva tests for the hormone cortisol are considered more accurate than blood tests for the hormones being tested. This analysis is called the 24-saliva test. With its help, you can determine the functioning of the adrenal glands in dynamics, since it must be taken 4 times during the day. To check the condition of the adrenal glands, a saliva test is done in the morning - high rate, at noon – the level decreases slightly, in the afternoon – the level decreases more noticeably, in the evening – the lowest level. In some cases, a urine test is prescribed.

Instrumental methods

How to check the adrenal glands using instrumental diagnostics? For staging correct diagnosis alone laboratory research not enough. Once the blood, urine, and saliva tests reveal certain problems, the doctor may refer the patient for further testing of the adrenal glands. Diagnostics includes:

Compared to ultrasound, which shows only the size of organs and foreign inclusions that may be present in them, CT and MRI are much more informative methods. In this case, a more detailed diagnosis of the kidney and adrenal glands is carried out. The procedure can be carried out with contrast agent and without it. No preparation is needed for the procedure; the only condition is to remove all metal objects, including watches and belts.

Is it possible to test your adrenal glands yourself?

It is of course difficult to check their work at home. However, if you have sleep disturbances, nervousness, emotional lability If you have a hard time with PMS or have a complex course of menopausal syndrome, you can perform the following tests:

1. Measuring pressure, this test is called the “Pressure Test”. Lie still for a while and then measure your blood pressure. Then stand up and immediately take your blood pressure again. If the pressure has increased after getting up, this is normal, but if it is lower, then you can begin to suspect reduced functionality of the adrenal glands.
2. Measuring body temperature. After 3 hours have passed since you woke up, take your temperature and write down the reading. Then, every 3 hours throughout the day (before you go to bed), take your temperature and record your readings. Next, you need to determine the average. This test is continued for 5-7 days, after which the results are drawn. If your average temperature fluctuates by no more than two-tenths from day to day, your cortisol levels may be low. If the temperature fluctuations are significant, but it is below normal, then probably, in addition to the adrenal glands, you should also check the condition of the thyroid gland. If the temperature is consistently low, then most likely everything is fine with the adrenal glands, but there may be problems with the thyroid gland. Ideally, the average temperature should be 36.5-36.6 C, there should be no fluctuations from day to day.

Photo of the drug

Latin name: Dicloberl

ATX code: M01AB05

Active ingredient: Diclofenac

Analogues: Diclovit, Voltaren, Diclofenac, Rapten Rapid, Rapten Duo

Manufacturer: Berlin-Chemie AG/Menarini Group (Germany)

Manufacturer's website: berlin-chemie.ru

Description is valid on: 27.09.17

Dicloberl and Dicloberl retard are non-steroidal anti-inflammatory drugs that are developed for the treatment of rheumatic diseases.

Active ingredient

Diclofenac.

Release form and composition

Diclofenac 50 is an enteric-coated tablet that contains 50 milligrams of diclofenac sodium. Tablets are sold in blisters in cardboard packages (50 or 100 tablets).

Dicloberl 75 is an injection solution containing 75 milligrams of diclofenac sodium. Available in a cardboard box of five ampoules (each three milliliters).

Dicloberl 50 and 100 suppositories are rectal suppositories, active substance of which is also diclofenac sodium (50 or 100 milligrams). Suppositories are sold in blisters of 5 or 10 suppositories.

Diclofenac retard is a long-acting capsule containing 100 milligrams of diclofenac sodium. Inactive ingredients: oydragit RL 12.5, sucrose, talc, white gelatin, shellac, corn starch, titanium dioxide. Dicloberl retard is sold in blisters of 10, 20 or 50 capsules.

Indications for use

Indications for use of Dicloberl:

• Degenerative and inflammatory diseases musculoskeletal system: juvenile chronic, psoriatic, rheumatoid arthritis, neuralgic amyotrophy, ankylosing spondylitis (ankylosing spondylitis), rheumatism, osteoarthritis, arthritis in Reiter's disease, gouty arthritis(at the moment acute attack for gout, it is advisable to use fast-acting dosage forms).
• As a tocolytic and analgesic– algodismenorrhea, childbirth, pelvic inflammation, etc.
• Pain syndrome – toothache, migraine, tendonitis, bursitis, sciatica, lumbago, neuralgia, ossalgia, arthralgia, myalgia, radiculitis, postoperative and post-traumatic syndrome (which is accompanied by an inflammatory process), in cancer.
• Feverish syndrome in infectious and colds.
• Infectious and inflammatory diseases of the ENT organs with pain syndrome - otitis media, tonsillitis, pharyngitis, etc.

Contraindications

Dicloberl suppositories, as well as capsules, tablets and injections are contraindicated for:

• bronchial asthma;
• hematopoietic disorders;
• gastrointestinal bleeding;
• allergic reactions to diclofenac sodium;
• peptic ulcer;
• stomach ulcer or duodenum;
• pregnancy and lactation;

Also, the above-mentioned medicine should not be taken by children under 15 years of age.

Instructions for use of Dicloberl (method and dosage)

Dicloberl injections are administered intramuscularly. The average daily dosage is 75 milligrams (one ampoule). The maximum permissible daily dose in injections should not exceed 150 milligrams.

Dicloberl 50 suppositories are inserted deep into the rectum (only after defecation). The dosage is determined individually by the attending physician (it all depends on the severity of the disease). Daily dose, typically varies from 50 to 150 milligrams. It is divided into two or three doses.

Dicloberl retard capsules are taken 100 milligrams (one capsule) once a day. If necessary, tablets can also be used.

Dicloberl 50 tablets are taken orally while eating food, with a small amount of liquid. The daily dose averages 50-150 mg (in two to three doses). The duration of treatment is determined solely by the treating doctor.

Side effects

The use of the drug Dicloberl may cause the following side effects:

• From the central side nervous system – headache, dizziness, increased fatigue, insomnia, agitation, sensory disturbances, changes in taste, impaired vision and sound perception, feelings of fear, disorientation, convulsions, depression, nightmares, confusion, stiff neck.
• From the digestive system - glossitis, dyspepsia, esophagitis, pancreatitis, liver damage, exacerbation of diseases of the gastrointestinal tract, abdominal pain, constipation, diarrhea, nausea, vomiting, minor gastrointestinal bleeding, loss of appetite. Sometimes bloody diarrhea, hematemesis, and melena may occur.
• From the outside cardiovascular system– palpitations, chest pain, arterial hypertension, decreased blood pressure, palpitations, chest pain.
• From the hematopoietic system - agranulocytosis, anemia, leukopenia, thrombocytopenia.
• Allergic reactions - bullous rash, skin rash, burning sensation at the sites of Dicloberl injections, Lyell's syndrome, swelling of the face, larynx and tongue, Stevens-Johnson syndrome, bronchospasm, anaphylactic shock.
• Dicloberl suppositories often cause a burning sensation in the anus after administration.

Overdose

In case of overdose, the following symptoms occur: dizziness, headaches, hyperventilation, clouding of consciousness, in children - myoclonic spasms, nausea, vomiting, abdominal pain, bleeding, liver and kidney dysfunction. Symptomatic treatment is used to eliminate symptoms.

Analogues

Diclovit, Voltaren, Diclofenac, Rapten Rapid, Rapten Duo.

Pharmacological action

This drug is considered a non-steroidal anti-inflammatory drug, a derivative of phenylacetic acid. The main active ingredient is diclofenac sodium. Due to the inhibition of prostaglandin synthesis, the drug has a pronounced anti-inflammatory effect. Dicloberl has analgesic, antipyretic and anti-edematous (at the time of tissue swelling during the inflammatory process) effect. Under the influence of ADP and collagen, it reduces the adhesive properties of platelets.

Special instructions

Treatment should be started with small doses to ensure there are no adverse reactions. Combining Dicloberl with other NPS increases the risk of side effects.

Dicloberl is able to mask signs of infection.

Elderly patients have increased risk the occurrence of undesirable reactions to NPS, especially with regard to bleeding and perforation. For these patients, the question of prescribing should be decided. combination therapy using gastroprotective agents.

Attentive medical supervision necessary when prescribing Dicloberl to patients with liver diseases, due to the possible deterioration of their condition.

During long-term treatment it is prescribed constant surveillance liver function and liver enzyme levels. If the functioning of the organ is disrupted or the problems worsen, the use of Dicloberl should be stopped immediately.

The use of diclofenac may be associated with an increased likelihood of thrombotic events (heart attack or stroke).

With long-term use of Dicloberl, regular monitoring of blood tests should be carried out.

Patients who experience vertigo, blurred vision, or disturbances during treatment with the drug nervous activity, drowsiness, fatigue, lethargy, you should not drive a car.

During pregnancy and breastfeeding

Contraindicated during pregnancy and breastfeeding.

In childhood

Contraindicated for children under 15 years of age.

In old age

It is prescribed with extreme caution, since older people are more prone to developing adverse reactions.

Drug interactions

The drug increases the level of lithium and digoxin in the blood plasma, increases the toxicity of cyclosporine to the kidneys, and reduces the effectiveness antihypertensive drugs and diuretics.

Acetylsalicylic acid reduces the concentration of diclofenac in the blood serum.

At simultaneous use with potassium-sparing diuretics, Dicloberl increases the risk of developing hyperkalemia. Simultaneous use with glucocorticoids increases the likelihood of bleeding in the gastrointestinal tract.

3.60 out of 5 (47 Votes)

Efficiency

Easy to find in pharmacies

Side effects

Average rating

Based on 3 reviews

The inflammatory process caused active work pathogenic microorganisms, can provoke many diseases. Medicines help eliminate pain and relieve swelling of soft tissues NSAID groups(non-steroidal anti-inflammatory drugs), one of which is Dicloberl. The main component diclofenac sodium helps in the treatment of many diseases accompanied by inflammation. What are its features and advantages, as well as in what cases it is best to use it, we will analyze further.

Pharmacological action

Dicloberl is a non-steroidal anti-inflammatory drug based on phenylacetic acid. Capable of exerting the following factors on the body:

• relieves inflammation in soft tissues;
• has an antipyretic effect;
• helps reduce swelling;
• reduces sensitivity nerve fibers affected area.

All this is achieved by inhibiting the synthesis of proglandins, which signal the presence of foreign bodies in the body.

At orally his drug maximum concentration observed in plasma in 1-15 hours. In this case, diclofenac is completely absorbed in the intestine and excreted in the urine 15-20 hours after administration. Parenteral (intramuscular) introduction allows speed up the absorption process, however efficiency is much lower than when taken orally. Usage rectal suppositories increases the percentage of absorption, allowing you to achieve maximum concentration in blood plasma at maximum short terms.

Dicloberl undergoes a partial course of metabolism, binding well to blood proteins. Inactive metabolites formed as a result of conjugation by hepatocytes are excreted by the kidneys. The rest of the metabolites are excreted by the intestines within 12-15 hours.

Ask your question to a neurologist for free

Irina Martynova. Graduated from Voronezh State University medical university them. N.N. Burdenko. Clinical resident and neurologist of the Moscow Polyclinic.

Indications for use

The drug is effective in the treatment of diseases such as:

• rheumatic diseases: rheumatoid arthritis, osteoarthritis, osteomyelitis;
• and cartilage;
• myalgia;
• spicy pain syndromes spine;
• gynecological diseases accompanied by extensive inflammatory process;
• spicy migraine attacks, especially in the chronic stage of the disease;

In addition to narrow specialization and treatment of specific groups of diseases, Dicloberl is widely used in complex therapy when the following diseases occur:

• acute tonsillitis of advanced form;
• chronic otitis in the acute stage;
• pharyngotonsillitis.

As a prophylactic agent, Dicloberl widely used before surgery on ENT organs (removal of polyps, tonsils, adenoids), as well as in gynecology.

Reception of Dicloberl as the main one medicinal product is possible only after consultation and prescription of a doctor. Fever or joint pain is not a key factor affecting the cost-effectiveness of using this medication. Only after comprehensive examination, based on the data obtained on the state of health and diagnosis, the drug is able to have a beneficial effect on the body.

Composition and release form

Basic active ingredient drug - sodium. Its concentration varies depending on the form of release, of which there are several:

1. Rectal suppositories– may contain 100 and 50 mg of diclofenac in one suppository. In addition, there are also auxiliary components:

• cornstarch;
• ethyl alcohol;
• hard fat;
• propyl galate

1. Ampoules for intramuscular injections – contain diclofenac sodium 75 mg in each ampoule. Auxiliary components:

• propylene glycol;
• solution for injection;
• acetylcysteine;
• benzyl alcohol;
• sodium hydroxide.

1. Pills contain 50 mg diclofenac sodium in each capsule. Related ingredients that improve the transportation of the tablet, as well as its absorption in the gastrointestinal tract:

• magnesium stearate;
• cornstarch;
• yellow pigment (dye E211);
• simethicone emulsion;
• talc;
• glucose monohydrate;
• titanium dioxide;
• methacrylic acid.

1. Dikloberl-Retard- these are tablets, the action of which allows the accumulation of the active element in the body, which explains its prolonged effect on the source of inflammation. It is used for protracted inflammatory processes that have a chronic course. One tablet contains an increased concentration of diclofenac - 100 mg. Inactive components are also present:

• sucrose;
• maltose monohydrate;
• cornstarch;
• gelatin;
• white dye;
• talc.

The feasibility of using one or another form of release directly depends on indicators such as:

• type of disease;
• duration and characteristics of the course of the disease;
• individual sensitivity to components;
• presence of chronic diseases.

Only a doctor is able to choose the correct form of Dicloberl and its dosage, knowing all the details and nuances about the course of the disease and its characteristics.

Method of administration and duration of treatment

For parenteral use Dicloberl is injected deep into the gluteal muscle. Daily dosage amounts to 75 mg of substance– this is 1 ampoule. IN in rare cases daily allowance permissible norm can be doubled (150 mg). Duration the course of treatment should not exceed 10 days. If it is necessary to continue treatment, it is carried out using tablets and rectal suppositories.

Daily dose Dicloberla in tablets amounts to 50 mg. Sometimes it is increased to 150 mg, dividing the dose into 2-3 doses. Tablets are taken directly with meals(this helps reduce the risk of irritation of the stomach walls), drinking a small amount warm water. The duration of the course depends on the indications and doctor's prescription.

Rectal suppositories Dicloberl is injected directly into the rectum after it has been cleared of feces. If you have constipation, you can give a cleansing enema, which will help to gently remove feces and facilitate the absorption of diclofenac. The daily dose should not exceed 150 mg. For better absorption and digestibility by the body, it is divided into 2 doses: morning and evening. The duration of treatment should not be more than 5 days. When a suppository is inserted into a full intestine, the effectiveness of treatment decreases sharply.

Dicloberl-Retard capsules are used once a day, since the initially increased concentration of diclofenac (100 mg) has more successful treatment, however, it can provoke adverse reactions in case of overdose.

Contraindications

Diclober is not used in treatment inflammatory processes when the following contraindications exist:

• • peptic ulcer of the stomach and duodenum (especially with chronic course during the period of exacerbation);
  • gastritis and minor gastric bleeding;
  • disorders of hematopoietic functions;
  • bronchial asthma and other chronic lung diseases;
  • chronic liver and kidney diseases;
  • children under 15 years of age;
  • hypersensitivity to one of the components of the drug;
  • spicy inflammatory diseases intestines;
  • ischemia developed against the background of angina pectoris, as well as in the presence of myocardial infarction;
  • oncological neoplasms of the intestine and rectum;
  • cerebrovascular diseases, including stroke.

In some cases, the drug is contraindicated when the patient has an acute allergic reaction to any medical supplies, including NSAIDs. Use with caution during pregnancy, but only in the early stages.

Overdose

Intentional or accidental overdose occurs when one-time the dose of Dicloberl exceeds 400 mg. The patient may experience symptoms such as:

• dizziness, clouding of consciousness, fainting;
• fever, tachycardia, sharp increase pressure;
• nausea and vomiting associated with diarrhea;
• angioedema, urticaria, Quincke's edema;
• convulsions;
• attacks of acute spasmodic pain in the stomach, which can provoke bleeding;
• pain in the kidneys and liver.

When diagnosing symptoms of overdose, symptomatic treatment is carried out, flushing the gastrointestinal tract. In cases where acute allergic reaction, necessary immediately call ambulance , give the person plenty of water, and take a double dose of anything antihistamine (Zodak, Diazolin, Finistil, Suprastin). If such a reaction is caused by a tablet or suppository, you need to eliminate their remains from the gastrointestinal tract as quickly as possible.

Side effects

If available individual intolerance components of the drug, as well as the presence of health problems, the following adverse reactions may occur:

• • From the gastrointestinal tract: spastic pain, nausea, vomiting, diarrhea, loss of appetite, esophagitis, development of peptic ulcer.
  • From the outside circulatory system : anemia, agranulocytosis, leukopenia.

• From the central nervous system: anxiety, hyperexcitability, dizziness, convulsions and confusion.
• From the cardiovascular system: arterial hypertension, chest and chest pain, tachycardia.

A complete examination, as well as a gradual increase in the dosage of Dicloberl, can reduce the risk of adverse reactions. Subject to availability acute manifestations, life-threatening person, the drug is replaced with an analogue.

Drug interactions

With the simultaneous use of Dicloberl and potassium-sparing diuretics, the concentration of salts in the blood increases sharply. Concomitant use with such substances is not recommended, How:

• phenytoin;
• angiotensive inhibitors;
• cyclosporine.

Use Dicloberl with caution if available diabetes mellitus requiring constant administration of insulin. The components of the drug can affect glucose concentrations, increasing the risk of diabetic coma.

Benefits of use

Dicloberl not only has a whole range of effects, but also allows you to treat a variety of diseases. Combines well in complex therapy, quite rarely provokes the occurrence of acute allergic reactions. But the most important advantage is its availability. Low price allows it to be used by all segments of the population.

Price

Rectal suppositories cost from 120 to 200 rubles, depending on the number of candles and manufacturer. Dikloberl-Retard (20 pieces per package) cost 235 rubles, and the drug in ampoules will cost 190 rubles for a pack of 5 ampoules. For 50 tablets of Dicloberl (50 mg) you will have to pay 145 rubles, which is quite a bit if you take into account analogs.

Vacation conditions

The drug, regardless of its release form, is available without a prescription.

Storage conditions and shelf life

Rectal suppositories and ampoules for intramuscular injections are stored in the refrigerator at a temperature not exceeding 6°C. Shelf life from the date of manufacture is 3 years. Tablets are stored in a cool, dry place out of reach of children. Shelf life – 3 years.

After its expiration, it is better to abandon the use of Dicloberl, since its effectiveness will be noticeably reduced.

Analogues

If it is impossible to carry out treatment with Dicloberl, Despite the fact that the drug is available for free sale, its uncontrolled use can lead to undesirable adverse reactions, even death. You cannot self-medicate, which can be not only ineffective, but also life-threatening. Only a doctor can prescribe Dicloberl, determining its dosage and duration of treatment.

Thus, Dicloberl, belonging to the group, allows you to fight more than 30 diseases, providing decongestant, analgesic and anti-inflammatory effects. Injections and suppositories have the greatest efficiency during treatment gynecological diseases, while tablets are appropriate for a long course of treatment of various diseases. Before starting to use Dicloberl, you must study the instructions, which indicate contraindications and precautions for using the drug in complex therapy.