Diclofenac tablets what helps. Possible adverse reactions

The drug Diclofenac is potent remedy, which has a pronounced anti-inflammatory, analgesic, and antipyretic effect.

According to statistics, inflammatory processes and pain regularly bother more than 75% of adults, so the use of a drug such as Diclofenac is very popular. Moreover, thanks to the comprehensive therapeutic effects, this drug is an excellent alternative to paracetamol, since when replacing these drugs, the therapeutic effect of them practically does not change.

Compound

The main active ingredient of Diclofenac is diclofenac sodium. The auxiliary ingredients in the drug are alcohol, sodium, mannitol and water for injection (for ampoules).

It is important to know that treatment with this drug in any form of release (gel, cream, rectal suppositories, injections) must be done very carefully, since the drug can cause quite serious side effects in patients. Using the wrong dosage of the drug is considered especially dangerous. That is why, before using Diclofenac on yourself, you must first consult with your doctor.

Release form

Diclofenac has several dosage forms release, namely:

1. Enteric-coated oral tablets. Externally, such tablets have round shape and a yellow tint. The package may contain 10, 20 or 30 pieces.
2. Rectal pain-relieving suppositories, which are oblong in shape and white in color.
3. The external ointment is white in color and has a specific odor. It is packed in aluminum tubes.
4. Gel for external use with a creamy tint.
5. Solution for injection, which can be transparent or with a faint yellow tint.

It should be noted that the manufacturer of the above-described forms of release of the drug may be different companies. The quality of the drug is not much different. Pharmachologic effect. Diclofenac is a combination medicine that belongs to drug group NSAIDs.

When ingested, the drug inhibits the production of prostaglandins, which in turn have a great influence on the development of soreness, inflammation and swelling in the body. Thanks to this, Diclofenac has a pronounced anti-inflammatory, analgesic, and antipyretic therapeutic effect.

In the case of long-term use of Diclofenac, it helps to slow down the production of proteoglycan in the patient’s cartilaginous structures, due to which the drug is considered very effective for cervical osteochondrosis, low back pain and others degenerative diseases musculoskeletal system.

The antipyretic therapeutic effect of Diclofenac is based on the inhibition of the production of prostaglandins in the central nervous system, as well as its pronounced effect on the thermoregulatory structures of the body.

Diclofenac ointment and other forms of release: indications and contraindications for use

It should be immediately noted that each release form of this drug has its own indications for use.

Thus, the doctor may prescribe Diclofenac solution for treatment all kinds of diseases musculoskeletal system: arthrosis, arthritis knee joints, bursitis and osteoarthritis.

Also often this form release of the drug is used for severe back pain, radiculitis, inflammatory processes in the pelvis, specific neuralgia and severe pain syndrome that has arisen after a recent surgical intervention.

Diclofenac tablets, as well as topical ointment and cream, are commonly used to symptomatic treatment. Thus, you can use Diclofenac tablets for severe pain that provokes oncological pathologies, migraines, abdominal colic, neuralgia, toothache and post-traumatic pain. Also, the drug in enteric coatings is often prescribed for fever, high temperature, active inflammatory processes in the body and diseases of the ENT system.

Diclofenac ointment has a pronounced warming effect. This form of drug release will be most effective when used to treat pathologies of the musculoskeletal system ( chronic form arthritis, radiculitis, osteochondrosis, osteoarthritis, gout). Also Diclofenac ointment with characteristic odor can be used for ankylosing spondylitis.

Contraindications

Diclofenac ointment, as well as other forms of the drug, have quite a lot of restrictions on use, so not all willing patients will be able to use this medicine on themselves. Thus, it is contraindicated to prescribe Diclofenac during pregnancy, children under six years of age, with severe circulatory disorders and bleeding in the digestive system. It is also strictly prohibited to use such a medicine during an exacerbation of a stomach ulcer, during lactation and the patient’s individual intolerance to the active substance of the drug.

Diclofenac should be used with caution and only after permission from a doctor if the patient is elderly, has alcoholism, has asthma, serious illnesses kidney or heart disease, allergic rhinitis and diabetes mellitus. During this therapeutic therapy general state a person, as well as the work of his internal organs, must be constantly monitored. That is why such treatment is best carried out in a hospital setting.

Side effects

Diclofenac quite rarely provokes side effects in patients, however, despite being well tolerated, sometimes the drug still causes a number of unwanted deteriorations in a person’s condition. In most cases, this is caused by the incorrect dosage of using Diclofenac or treatment with it in the presence of important contraindications at the patient. The drug often causes side effects in the digestive system, which can include nausea, vomiting, bloating, diarrhea and constipation. Less common are bleeding in the gastrointestinal tract, cirrhosis of the liver, hepatitis and colic.

IN nervous system Patients after taking Diclofenac may develop side effects such as headache, dizziness, poor sleep and depressive states. In more advanced cases, patients may experience convulsions, weakness, fears, meningitis and confusion. On the part of the sensory organs, the patient may experience hearing impairment, visual impairment and problems with the sense of taste of foods.

As a rule, these complications are reversible and with timely consultation with a doctor, the person’s vision or hearing returns. Allergic reactions may cause skin itching, rashes, dermatitis of various classifications, eczema and increased sensitivity.

In more advanced cases, it occurs anaphylactic shock. In the myocardial system, patients may develop chest pain, blood pressure surges, and heart failure. Additional side effects after treatment with Diclofenac may include deterioration of kidney function, laryngeal edema, cough, nephritis and hematuria.

Diclofenac: instructions and features of use of each form of the drug

Each form of the drug has its own administration and dosage characteristics. That is why, before starting such treatment, it is important to carefully study the description of use and the effect of the medicine.

Solution

Diclofenac, the instructions for which contain Full description taking the medicine, in the form of a solution, must be injected into the muscle.

One-time permissible dose the drug is 70 mg.

To treat joint diseases, these injections should be carried out over 7-10 days. Course therapy is also allowed. Reviews about the effectiveness of Diclofenac for pathologies of the musculoskeletal system can be read on numerous patient forums.

Ointment, gel

Diclofenac, the instructions for which are included with the drug, in the form of an ointment and gel, should be applied in a thin, even layer to the affected joint two to three times a day. It is advisable to do this after a massage or physiotherapy.

On average, the course of such treatment should be from ten to fifteen days. If burning or redness of the skin occurs, treatment should be stopped, as this may be a sign allergic reaction and negatively affect human health. If cracks or wounds appear on the skin, they should be lubricated with an antiseptic and sealed with a band-aid.

Pills

Diclofenac tablets are taken orally and washed down with plain water. It is advisable to drink them an hour before meals. For adults and children over fifteen years old permissible dosage The drug is 50 mg three times a day. For the treatment of children from six to fifteen years old, 25 mg three times a day can be used. You can take these pills for no longer than seven days in a row.

Candles

The suppositories are intended for rectal use. For the treatment of adults, the daily dosage is 150 mg, which should be divided into three doses. The duration of such treatment should be no longer than ten days, after which it is recommended to take a break.

What else is it used for and how?

Diclofenac may also be used to reduce fever or pain in a person. For this purpose, adults need to take one tablet of the drug three to four times a day. To relieve inflammation in the pelvis, it is recommended to use rectal suppositories(1 candle 2-3 times a day).

Overdose

Diclofenac, the instructions for which describe all contraindications for use, in case of overdose can cause bleeding in the digestive system, loss of consciousness, headache and shortness of breath in a person.

Liver and kidney dysfunction may also occur. Treatment of overdose is symptomatic. It must be carried out in a hospital under the supervision of a doctor.

Interaction

The following features of the interaction of Diclofenac are distinguished:

1. Diclofenac can reduce the effect of sleeping pills and diuretics.
2. Reduces the effect of Digoxin.
3. Increases risk side effects when combined with other NSAIDs.
4. Reduces its concentration when combined with acetylsacylic acid.
5. When combined with drugs based on St. John's wort, Diclofenac may cause bleeding.

Medicine Diclofenac: storage rules, expiration date, conditions of sale of the drug in pharmacies

The medicine Diclofenac, unlike vitamins and other “light” medications, is sold only with a prescription from the attending physician, since this non-steroidal drug is toxic and potent. That is why, before going to the pharmacy, a person needs to consult a doctor for advice and a prescription.

Storage conditions

Best before date

According to the instructions for use, the drug can be used for three years from the date indicated on the package. After this period, the use of the medicine can cause side effects or significantly reduce the expected therapeutic effect.

special instructions

The medicine Diclofenac can affect the speed of a person’s reaction, therefore, during the period of treatment with it, the patient should refrain from activities that require high concentration attention. Moreover, during such therapy you need to stop drinking alcohol.

The drug Diclofenac: use for children and pregnant women, patient reviews and cost of the drug

Today, the drug Diclofenac in the pharmacological market has more than a dozen analogues that have similar composition And therapeutic effect. The most effective among them are the following drugs: Uniclofen, Ortofen, Dorsan, Diclak and Dicloran.

Also, as a good alternative to Diclofenac, you can use the drugs Voltaren, Emulgel, Paracetamol and Diclogen. Before using these medications, you should definitely consult with your doctor, since although they are analogues of Diclofenac, they may have different administration characteristics and contraindications.

For children

Diclofenac is contraindicated for the treatment of children under six years of age. Thus, if it is necessary to eliminate inflammation, pain or high temperature, the treating pediatrician should choose a safer analogue for the child. this drug.

During pregnancy and lactation

The drug Diclofenac is contraindicated for its use during pregnancy, since it active substance can have a negative impact on growth, development and general health fetus

Moreover, if it is necessary to take Diclofenac during lactation, you should stop breastfeeding, since the active substance of the drug can penetrate into breast milk.

Diclofenac acts not only as an analgesic, but also as a mild anti-inflammatory. I am not writing a gag or a call for self-medication. I personally took diclofenac for and with cystitis, reviews only positive ones. And this is very important fact. It not only relieves pain, but also slightly heals, and not many painkillers can boast of this. That's how much I notice, the simplest and cheapest medicines turn out to be very effective and are often included in expensive medicines.

The connection between pain and inflammation has been known since ancient times. And today, the most common medications for pain relief are drugs that have both anti-inflammatory and analgesic effects - non-steroidal anti-inflammatory drugs (NSAIDs).

History of the creation of diclofenac

The prototype of modern NSAIDs was acetylsalicylic acid, which was first synthesized by the young scientist Felix Hoffman at the end of the 19th century. Chemical structure and properties acetylsalicylic acid became the guidelines by which new representatives of this class of medications were created (at first they were usually designated as “aspirin-like”). It is not so much the lack of effectiveness as the toxicity of high doses of acetylsalicylic acid that served as a powerful incentive for the development of new, “non-salicylate” NSAIDs. In 1966, during the implementation of a program to develop an anti-inflammatory drug with improved biological properties in the research laboratory of the Geigy company, more than 200 analogues of 0-aminoacetic acid were synthesized to create a molecule with the necessary parameters, among which the most interesting results were shown by diclofenac sodium - sodium salt 0 -[(2,6 dichlorophenyl)-amino]-phenyl-acetic acid.

Initially, diclofenac was used mainly in the treatment of rheumatological diseases, where both components are important: a pronounced anti-inflammatory and powerful analgesic effect, but subsequently, the scope of use of diclofenac expanded significantly. Currently, diclofenac is used in surgery, traumatology and sports medicine (for damage to the musculoskeletal system, damage to soft tissues (bruises, sprains), for postoperative pain relief), in neurology (for the treatment of back pain, tunnel syndromes, migraines), in gynecology for dysmenorrhea, adnexitis, in oncology as a means of the first stage of pain relief in the WHO ladder. Intramuscular administration Diclofenac sodium is an effective method of combating renal and hepatic colic. A special dosage form of diclofenac in the form of drops has found application in ophthalmology. General practitioners also prescribe diclofenac for various pain syndromes.

Mechanism of action of diclofenac

The anti-pain effect of diclofenac is due to several mechanisms. The main mechanism of action of diclofenac is the suppression of cyclooxygenase (COX) - an enzyme that regulates the conversion of arachidonic acid into prostaglandins - mediators of inflammation, pain, fever.

Diclofenac and COX selectivity

In the early 90s of the twentieth century, two isoforms of the COX enzyme were discovered - COX-1 and COX-2. Majority positive effects NSAIDs (suppression of inflammation, pain, fever) are associated with inhibition of COX-2, and the development of adverse reactions (mainly in the form of damage to the gastrointestinal tract) is associated with suppression of COX-1 synthesis.

However, there are a number of exceptions to this rule. It has been shown that COX-1 may also play a role in the development of the inflammatory process. COX-1 is produced together with COX-2 synovial membrane patients with rheumatoid arthritis (RA). This is probably due to the lower effectiveness of selective COX-2 in some pain syndromes. Latest Research found an increased risk of cardiovascular complications with the use of highly selective COX-2 inhibitors.

Diclofenac inhibits both COX isoenzymes, mostly COX-2. Inhibition of COX-1 by diclofenac is less compared to ibuprofen and naproxen, and therefore diclofenac is less likely to cause gastrointestinal damage. At the same time, inhibition of COX-1 (albeit less pronounced than that of non-selective NSAIDs) may explain the greater effectiveness of diclofenac compared to selective COX-2 inhibitors (meloxicam, celecoxib) in a situation where COX-1 is also involved in the pathogenesis of the disease ( for example, with RA). Diclofenac has less COX-2 inhibition than etoricoxib and rofecoxib, which reduces the risk of cardiovascular complications. This balanced effect of diclofenac provides high therapeutic activity with good tolerability of treatment.

Other mechanisms analgesic effect diclofenac

In addition to inhibition of prostaglandins, other mechanisms of action of diclofenac have been identified. IN experimental study It has been shown that diclofenac sodium can significantly inhibit the migration of leukocytes to the site of inflammation. To a certain extent, diclofenac sodium can also affect the balance of cytokines, reducing the concentration of interleukin-6 and increasing the content of interleukin-10. This change in the ratio of these products helps slow down the secretion of anti-inflammatory factors. A decrease in the production of free oxygen radicals, which occurs under the influence of diclofenac sodium, can also help reduce the activity of the inflammatory process and limit its damaging effect on tissue.

In addition to pronounced anti-inflammatory activity, diclofenac sodium also has a powerful analgesic potential that is not related to its effect on inflammation. It has a complex effect on various mechanisms of perception pain, providing effective suppression pain syndrome of various etiologies. The drug has both central and peripheral antinociceptive effects.

The central analgesic activity of diclofenac sodium is mediated by opioid receptors, as evidenced by the fact that this effect is blocked by naloxone. It appears to be associated with the effect of diclofenac sodium on tryptophan metabolism. After administration of the drug in the brain, the concentration of tryptophan metabolites, which can reduce the intensity of pain, increases significantly.

The local antinociceptive effect of diclofenac sodium appears to be associated not only with the suppression of prostaglandin synthesis, since in several experimental models of pain local application inhibitors of prostaglandin synthesis such as indomethacin and celecoxib, unlike diclofenac sodium, did not achieve a significant analgesic effect. The peripheral analgesic effect of diclofenac sodium is not associated with the opioid effect, since it is not eliminated by naloxone. At the same time, the use of compounds that block the formation of NO and the activation of guanylate cyclase suppressed the analgesic effect of diclofenac sodium. Inhibitors of various types of potassium channels also had a similar effect. In cultured rat cerebellar cells, diclofenac sodium increased the activity of potassium channels, increasing the release of potassium from the cell. These results suggest that the peripheral antinociceptive effect of diclofenac sodium may be associated with activation of several types of potassium channels involving NO and guanosine cyclomonophosphate (cyclo-GMP).

Thus, the analgesic effect of diclofenac may be due to its effect on various levels and links in the pathogenesis of pain. In addition to the analgesic effect associated with a decrease in inflammation in the damaged area due to inhibition of prostaglandins (COX-1 and COX-2), diclofenac can reduce pain by reducing inflammation and through other mechanisms (restraining the migration of leukocytes to the site of inflammation, influencing the balance of cytokines) by affecting on potassium channels at the peripheral level, and also reduce the perception of pain through central mechanisms(by increasing the synthesis of the precursor of serotonin (tryptophan) in brain tissue).

Indications for the use of diclofenac

Despite the wide range of currently existing NSAIDs and the creation of last years a new class of symptomatic anti-inflammatory drugs ( selective inhibitors COX-2), the most popular drug among NSAIDs remains diclofenac sodium.

The use of diclofenac in rheumatology

From the very beginning of its appearance, diclofenac found wide application in rheumatology. Important feature What allowed diclofenac to displace other drugs from the NSAID group that were used before was its high analgesic and analgesic activity, along with good tolerability.

The effect of diclofenac is manifested by a decrease in the duration of morning stiffness, a decrease in pain (at rest and during movement), a decrease in swelling, swelling of the joints, as well as an improvement in the functional ability of the joints, which helps to increase the range of movements. Diclofenac is the drug of choice for most rheumatological diseases; it is used to treat inflammatory and degenerative rheumatic diseases (arthritis, arthrosis, etc.).

The use of diclofenac in general medical practice, orthopedics, traumatology, sports medicine

The most common disorders in general medical practice are disorders of the musculoskeletal system. Pathology of the musculoskeletal system is diverse in etiology and pathogenesis. Pain in this group of lesions can be caused by trauma, degenerative processes, inflammation, dysplasia, and trophic changes (osteoporosis). The mechanisms of development of the disease can be inflammatory, mechanical, neurogenic, etc. The pronounced analgesic effect of diclofenac in moderate and severe pain, inflammatory processes that occur after operations and injuries, rapid relief of spontaneous pain and pain during movement, reduction of inflammatory swelling at the wound site have made this drug one of the most necessary for the treatment of disorders of the musculoskeletal system, which are found in general medical practice, orthopedics, traumatology, sports medicine, neurology.

In the treatment of orthopedic and traumatic injuries The form of release of the drug also matters. The possibility of combining local and general forms of diclofenac allows you to achieve maximum effectiveness while minimizing possible side effects. Local forms of diclofenac are most widely used for diseases of extra-articular tissues (tenosynovitis, bursitis, rheumatic lesion soft tissues), injuries to tendons, ligaments, muscles and joints. General forms, such as tablets, suppositories, injection solutions,? - for massive injuries (combined and combined injuries, postoperative conditions, head injuries, fractures of large bones, etc.).

The use of diclofenac in neurology

Diclofenac has found widespread use for the relief of pain syndromes in neurological practice. Diclofenac is indicated for the treatment of acute back pain, with tunnel syndromes(carpal tunnel syndrome, cubital tunnel syndrome, etc.), for migraine.

The duration of use and method of administration of the drug depend on the intensity of the pain syndrome. For moderate pain syndromes that do not limit the patient’s motor capabilities, it is possible to apply gels and ointments containing diclofenac sodium to the painful areas (spasmodic muscles) for 7–10 days. In case of intense pain that significantly limits the patient’s movement within the premises, injection routes of administration of diclofenac sodium are used for 3–7 days with a subsequent transition to oral forms. There are reports of more high efficiency phonophoresis with diclofenac compared with the use of ointment forms of the drug.

The use of diclofenac in gynecology

The ability to eliminate pain and reduce the severity of blood loss during primary dysmenorrhea allowed the use of diclofenac in gynecological practice. For primary dysmenorrhea, the daily dose is selected individually; it is usually 50–150 mg. The initial dose should be 50–100 mg; if necessary within a few menstrual cycles it can be increased to 150 mg/day. Diclofenac should be started when the first symptoms appear. Depending on the dynamics clinical symptoms Treatment can be continued for several days. Diclofenac can also be used for inflammatory diseases pelvis, including adnexitis.

Method of administration and dosage: which dosage form to choose?

The undoubted advantage of diclofenac is the variety of dosage forms, including tablets (fast and retarded action), solution for parenteral administration, suppositories, as well as forms used for local therapy: ointments, creams, gels, spray, which creates convenience in selecting an individual dose and method use of the drug in different patients. The ability to combine different routes of administration in the same patient reduces the risk of adverse reactions.

Diclofenac tablets

Tablet forms of diclofenac are available in different dosages(Table 2). The dose and route of administration of the drug for each patient are determined individually, taking into account the severity of the disease. The average recommended dose for adults is 100–150 mg/day. The maximum daily dose of diclofenac is 200 mg. In relatively mild cases of the disease, as well as for long-term therapy, a daily dose of 75–100 mg is sufficient. The daily dose should be divided into several single doses. If it is necessary to treat night pain or morning stiffness, in addition to taking the drug during the day, you can prescribe diclofenac in the form of suppositories before bedtime; however, the daily dose should not exceed 150 mg. Once the clinical effect is achieved, the dose is reduced to the minimum maintenance dose.

Children aged 6 to 15 years (inclusive) are prescribed only 25 mg tablets. The daily dose is 0.5–2 mg/kg body weight (in 2–3 doses, depending on the severity of the disease).

Adolescents aged 16 to 18 years can be prescribed 50 mg tablets. The tablets should be taken with plenty of liquid, preferably before meals. The tablets should not be split or chewed.

Diclofenac in the form of delayed-release tablets

A special form of the drug is diclofenac in the form of prolonged-release tablets. As a result of the delayed release of the active substance when taking retarded forms of diclofenac sodium, the effect occurs later, but lasts longer. These pharmacokinetic features make it possible to achieve a reduction in the number of drug doses taken by patients (1–2 times a day instead of 3–4 times a day) while maintaining a stable high concentration of the drug at the site of inflammation. This makes it preferable to use diclofenac in a retarded form when long-term use of the drug is necessary (for chronic pain syndromes, mainly in rheumatological practice).

The recommended starting dose for adults is 75 mg, that is, 1 retard tablet per day. The same dose is used in relatively mild cases of the disease, as well as for long-term therapy. In cases where the symptoms of the disease are most pronounced at night or in the morning, it is advisable to prescribe retard tablets at night.

The tablets should be swallowed whole, preferably with meals. If it is necessary to increase the dose, use an additional 1-2 tablets of diclofenac 25 mg. The maximum daily dose is 200 mg.

Currently, the Swiss pharmaceutical company Sandoz produces 75 mg bilayer tablets, which are unique in that each tablet consists of two layers and includes 12.5 mg diclofenac sodium immediate release and 62.5 mg diclofenac sodium sustained release, which provides both rapid onset of action and prolonged action of the drug.

Children and adolescents under 18 years of age should not be prescribed retard tablets.

Diclofenac in the form of rectal suppositories

The dosage form of diclofenac in the form of suppositories has a number of advantages. Suppositories do not cause the complications that are possible with parenteral administration of drugs (the development of muscle necrosis, infiltrates and suppuration at the injection site). It is advisable to prescribe suppositories if it is impossible to take drugs by mouth (in weakened patients, in the presence of esophageal strictures, etc.). When taken orally, there is a direct damaging effect of diclofenac on the cells of the gastric mucosa. With other methods of administering the drug (suppositories, ointments), the risk of damage to the gastrointestinal tract remains, but it is significantly lower. That is why, if there are signs of damage to the stomach and duodenum preference is given to suppository forms of diclofenac.

Very often suppositories are used in combination therapy: during the day the patient receives either injections or tablets, and at night - suppositories, which creates a better therapeutic effect due to a more uniform and long-term maintenance of the concentration of the drug in the blood. In this case, the total daily dose of diclofenac should not exceed 150 mg.

Children aged 6 to 15 years (inclusive) are prescribed only 25 mg suppositories. The daily dose is 0.5–2 mg/kg body weight (the daily dose, depending on the severity of the disease, should be divided into 2–3 single doses). For the treatment of RA, the daily dose can be increased to a maximum of 3 mg/kg (in several administrations). Adolescents aged 16 to 18 years can also be prescribed 50 mg suppositories.

The suppository is inserted into the rectum, as deep as possible, preferably after preliminary cleansing of the intestines. Suppositories should not be cut into pieces, since such a change in the storage conditions of the drug may subsequently lead to disruption of the distribution of diclofenac.

Diclofenac in the form of solution for injection

Diclofenac in injection form is preferably used when a faster analgesic effect is needed, usually with more severe acute pain (renal or hepatic colic, acute pain associated with soft tissue injuries (bruise, sprain), acute back pain, postoperative pain .Usually 1 ampoule per day is prescribed, but in severe cases, 2 injections per day can be prescribed at intervals of several hours, alternating the sides of administration.The use of injections can be combined with other dosage forms of diclofenac.The duration of parenteral use should not exceed two days; treatment if necessary continue with the same diclofenac, but in the form of tablets or rectal suppositories. intramuscular use the drug is injected deep into the upper outer quadrant of the buttock; During the day, use no more than 2 ampoules (150 mg) of the drug. For renal and hepatic colic, the administration of diclofenac is usually combined with the use of antispasmodics. With a pronounced muscular component of back pain, the administration of diclofenac is combined with the use of muscle relaxants.

Combinations of two or more NSAIDs should be avoided as their effectiveness remains unchanged and the risk of side effects increases.

Diclofenac in the form of products for external (local) use

The undesirable effect of NSAIDs on the body is sharply limited if they are used in the form of local applications. The dosage form for such therapy is a mixture of the active drug with a base that ensures absorption under the skin. This method of treatment allows you to inject the drug directly into the lesion. At the same time, the impact on other organs and tissues is minimal.

Abroad, there are dosage forms in the form of plates for gluing to the skin containing 1.3% diclofenac epolamine. Diclofenac in the form of wafers first appeared in Switzerland in 1993; currently, diclofenac in the form of wafers is registered in 43 countries around the world. Diclofenac tablets are intended primarily for those who cannot take the oral form of diclofenac due to contraindications. They are used for damage to soft tissues (bruise, sprain, compression, osteoarthritis) provided that the integrity of the skin is maintained 2 times a day. The plates are convenient for use, but are more expensive than other dosage forms.

These drugs are convenient to use and easy to dose. After applying the drug to the skin, the active compound accumulates in regional soft tissues and no more than 6% of the active substance enters the bloodstream. At the same time, the content of the drug in the muscles in the application zone is approximately three times higher than its level in the remote area. muscle tissue. This makes the use of gel forms of diclofenac preferable for a wide range of disorders of the musculoskeletal system. Gel forms of diclofenac are over-the-counter medications and are very popular.

Diclak gel is the only diclofenac preparation on the Russian market with a 5% maximum concentration of the active substance, which allows you to reduce the dose of the drug taken orally, and in some cases even replace tablets. Approved for use by children over 6 years of age.

Diclofenac as part of combination drugs for the treatment of pain

There are also dosage forms (ointments, gels) in which diclofenac is one of the main components. The combination of several drugs with different mechanisms of action can increase the effectiveness of treatment.

Safety

Diclofenac has an optimal combination of analgesic and anti-inflammatory effects and is well tolerated. Therefore, in the absence of contraindications, it can be used even for a long time. Studies have confirmed that treatment with diclofenac in fairly high doses (150 mg) with long-term use (up to 8 months or more) was well tolerated by patients. Of course, diclofenac, like any NSAID, may have side effects and contraindications. However, it should be noted that side effects, among which ulceration of the gastrointestinal mucosa (GIT) should be primarily feared, develop more often in individuals with risk factors.

Risk factors for gastrointestinal tract damage include:

• age over 65 years;
• history of peptic ulcer;
• eating food that increases gastric secretion (spicy, fatty, salty foods);
• large doses or simultaneous use of several NSAIDs;
• concomitant therapy with glucocorticoids;
• female since discovered increased sensitivity women to this group of drugs;
• smoking;
• drinking alcohol;
• Availability Helicobacter pylori.

In this regard, treatment should begin with the lowest recommended dose, especially in risk groups. In individuals at risk, the daily dose of diclofenac should not exceed 100 mg; preference should be given to short-lived dosage forms of diclofenac and prescribed either 50 mg 2 times a day or 25 mg 4 times a day. Diclofenac should be taken after meals. At long-term use taking the drug, you should refrain from drinking alcohol, since diclofenac, like alcohol, is metabolized in the liver. If complaints from the gastrointestinal tract appear, it is necessary to perform esophagogastroduodenoscopy (EGD), and if you are systematically taking diclofenac, this procedure should be prescribed every 4-6 months, since NSAID gastropathy is often asymptomatic - “silent”.

If long-term use of diclofenac is necessary, which is especially important in rheumatology, it is advisable to prescribe diclofenac together with misoprostol, which protects the gastric mucosa from damage.

In patients with hypertension, it is necessary to monitor blood pressure levels; in patients with bronchial asthma, an exacerbation may occur while taking diclofenac. In patients with chronic liver and kidney diseases, small doses of the drug should be used, monitoring the level of liver enzymes.

Before prescribing diclofenac, the doctor needs to clarify whether the patient is taking any other medications in connection with concomitant diseases, to avoid possible complications when using diclofenac in combination with other drugs. It is known that diclofenac increases the plasma concentration of digoxin, lithium, cyclosporine A, including increasing its nephrotoxicity; increases the toxicity of methotrexate. Against the background of potassium-sparing diuretics, diclofenac increases the risk of hyperkalemia, and against the background of anticoagulants - the risk of bleeding. Diclofenac reduces the effect of diuretics, antihypertensive and sleeping pills. Concomitant use of antidiabetic agents can lead to both hypo- and hyperkalemia.

More than 30 years have passed since the introduction of diclofenac into clinical practice. During this time many appeared new NSAIDs. This has significantly expanded the possibilities of providing effective assistance sick because individual reaction on treatment is highly variable. However, diclofenac occupies a special place in this therapeutic arsenal. The combination of high efficiency, good tolerability and a variety of dosage forms of the drug make it possible to select the optimal therapy for a wide range of pain syndromes.

For questions regarding literature, please contact the editor.

A. B. Danilov, Doctor of Medical Sciences

FPPOV them. I. M. Sechenova, Moscow

Table 1. Indications for the use of diclofenac

Diclofenac – medicinal product nonsteroidal origin (NSAIDs). This anti-inflammatory agent has an analgesic and anti-exudative effect, and reduces temperature.

The active substance is sodium diclofenac - 1 g.

Available in the form of rectal suppositories (suppositories), gel for external use (ointment) and solution for injection (injections).

Description

Suppositories (rectal suppositories) have white or yellowish tints and are torpedo-shaped. A homogeneous mass is indicated on the longitudinal section. It is allowed to have an air rod or a funnel-shaped recess in the candle.

Diclofenac ointment 1% is white or almost White color, with a weak specific odor.

Pharmacological properties

Diclofenac has an analgesic effect, relieves inflammation and lowers temperature. The active substance disrupts the metabolism of arachidonic acid and also reduces the level of prostaglandins in areas of inflammation.

For rheumatism, the anti-inflammatory and analgesic effects of the drug help reduce the severity of pain, morning stiffness in movements, and swelling of the joints, which helps improve the functional state of the joints. In case of injury and after surgery, Diclofenac reduces pain and relieves inflammatory swelling.

Indications for use

Diclofenac is used for the following diseases:

• rheumatoid and psoriatic arthritis;
• juvenile chronic arthritis;
• ankylosing spondylitis;
• gouty arthritis;
• soft tissue rheumatism;
• osteoporosis of joints and spine;
• bursitis, tendovaginitis;
• myalgia;
• neuralgia;
• sciatica;
• post-traumatic syndrome with pain and inflammation;
• pain after surgery;
• adnexitis;
• migraine, headache;
• algodismenorrhea;
• proctitis;
• toothache.

As one component of the entire therapy complex, Diclofenac is used for infections and inflammations of the ear, nose and throat with pain (otitis media, tonsillitis, pharyngitis).

Contraindications

Diclofenac is contraindicated in the following cases:

• hypersensitivity to any components, including other NSAIDs;
• erosive and ulcerative disease of the stomach and intestines in the acute phase;
• bleeding in the gastrointestinal tract;
• Aspirin asthma;
• hematopoietic disorder;
• hemostasis disorders, including hemophilia;
• pregnancy;
• age (up to 15 years - suppositories 50 mg, up to 18 years - 100 mg);
• nursing;
• for hemorrhoids and rectal bleeding;
• injuries and inflammation in the rectum.

Carefully

It is recommended to use the product with extreme caution in the following cases: anemia, congestive heart failure, bronchial asthma, arterial hypertension, edema syndrome, liver failure, renal failure, alcohol addiction, inflammatory intestinal diseases, peptic ulcers intestines and stomach during remission, diabetes mellitus, after complex operations, inducible porphyria, in old age, diverticulitis, connective tissue diseases.

Instructions for use (Diclofenac suppositories)

Suppositories are used rectally (anally). Before use, it is recommended to cleanse the intestines - do an enema.

Adults are given 100 mg rectal suppositories, 1 suppository per day. Suppositories in a dosage of 50 mg are administered 1 suppository twice a day. The daily dose should not exceed 150 mg. When used simultaneously with oral forms of the drug, it is rational to use a single dose of 100 mg at night. In this case, reception in the evening oral form diclofenac should be excluded. The duration of the course of using the drug should not exceed more than 7 days.

Ointment

The gel or ointment is gently rubbed into the skin up to four times a day. After applying the drug, you must wash your hands thoroughly.

Pricks (injections)

IN initial therapy(for example, in the postoperative period or in acute conditions) used intramuscularly or intravenously. IM - the maximum dose is 75 mg per day (in severe cases, 75 mg twice a day) for one to five days. IN further treatment transferred to taking tablets or suppositories.

Side effects and overdose

The following adverse reactions are possible:

• disruption of the gastrointestinal tract;
• liver diseases;
• diseases of the intestines and gall bladder;
• headache, dizziness, irritability;
• aseptic meningitis;
• convulsions, feeling of fear, nightmare;
• tinnitus, poor hearing and vision;
• skin itching;
• increased blood pressure, extrasystole. chest pain;
• laryngeal edema, cough, bronchospasm;
• disruption of the functioning of the hematopoietic organs;
• local allergic reactions.

If unexpected reactions occur after using diclofenac, you should stop using it and consult your doctor.

Overdose

Symptoms: vomiting, headache, dizziness, shortness of breath, loss or clouding of consciousness.

Children may experience nausea myoclonic spasms, liver dysfunction, abdominal pain, bleeding, kidney dysfunction. In this case, treatment is carried out: the stomach is washed, activated charcoal is administered, symptomatic therapy and forced diuresis are used. Hemodialysis is ineffective.

Interaction with other drugs

Reduces the effect of diuretics.

Simultaneous use with paracetamol promotes the development of the nephrotoxic effect of diclofenac.

Increases the concentration of methotrexate, digoxin, lithium or cyclosporine in the blood. Reduces the effect of diuretics.

special instructions

Patients taking the drug should refrain from types of work that require high attention and quick reactions from the mental and motor functions, as well as alcohol consumption. During the course of treatment with the drug, the picture of the functions of the liver and kidneys, peripheral blood should be monitored, and stool should be examined for the presence of blood.

Transport management

Diclofenac ointment or gel does not affect the ability to drive vehicles or operate machinery.

Storage and shelf life

The drug should be stored at an air temperature of no more than 10°C.

Shelf life is 2 years; the drug cannot be used after the expiration date.

The medicine is available without a prescription.

average price

In Ukraine:

• Suppositories 50 mg - 15 UAH;
• Suppositories 100 mg - 31 UAH;
• Gel - 35 UAH;
• Table 100 mg 30 pcs - 6 UAH.

In Russia:

• Suppositories 50 mg - 50 rubles;
• Suppositories 100 mg - 116 rubles;
• Gel - 90 rub;
• Table 100 mg 30 pcs - 65 rub.

Analogs of ketoprofen gel

• Diclovit;
• Diclonac;
• Diclonate T;
• Diklof;
• Diclofenacol;
• Ketoprofen;
• Tantum;
• Otipax;
• Final gel.

Diclofenac tablets are a non-steroidal anti-inflammatory drug.

It has anti-inflammatory, analgesic, antiplatelet and antipyretic effects. Most effective for inflammatory pain. Used for the symptomatic treatment of diseases of the musculoskeletal system, reducing various types pain syndrome.

On this page you will find all the information about Diclofenac: full instructions as applied to this medicine, average prices in pharmacies, complete and incomplete analogs of the drug, as well as reviews of people who have already used Diclofenac tablets. Would you like to leave your opinion? Please write in the comments.

Clinical and pharmacological group

Conditions for dispensing from pharmacies

Available without a prescription.

Prices

How much do Diclofenac tablets cost? average price in pharmacies it is at the level of 20 rubles.

Release form and composition

Tablet forms: tablets in a s/r coating 25 mg, in a p/o coating 25 and 50 mg, retard 100 mg.

• Composition of enteric-coated tablets: 25 or 50 mg Diclofenac sodium, disubstituted calcium phosphate, starch, magnesium stearate, polyvinylpyrolidone K30, purified talc, cellulose acetate, indoresin, diethyl phthalate, carmoisin varnish, titanium dioxide, Ponceau 4R varnish, red and yellow iron oxide .

Pharmacological effect

Suppresses exudative and proliferative phase inflammation. Reduces the amount of serotonin, histamine and bradykinin, increases the threshold for the perception of pain receptors; reduces the concentration of PG in the center of thermoregulation, increases heat transfer, reduces body temperature; inhibits platelet aggregation.

Indications for use

The tablet form of Diclofenac is prescribed to relieve pain during attacks of psoriatic, gouty, juvenile, ligament and articular injuries of the knee joint.

Tablets can be used for pain in the spine. Arising as a result of degenerative changes in intervertebral discs. Applicable when tunnel syndrome wrist or elbow joint. Indispensable in case of injury, sprain or dislocation, including among athletes and people working in physically demanding jobs.

Contraindications

Contraindications to the use of tablets:

• inflammatory diseases intestines;
• exacerbation of gastrointestinal lesions (erosive-ulcerative);
• bleeding from the gastrointestinal tract;
• severe renal or liver failure;
• state after coronary artery bypass surgery;
• pregnancy and lactation;
• “aspirin triad” – intolerance to NSAID drugs in patients with bronchial asthma and nasal polyps;
• children under 6 years of age for 25 mg tablets, other dosages are contraindicated under 18 years of age;
• lactose intolerance, lactase deficiency, glucose-galactose absorption pathologies.

Prescribed with caution for the following conditions: inflammatory bowel disease, alcoholism, chronic erosive and ulcerative diseases of the gastrointestinal tract (not exacerbation), diabetes, diverticulitis, inducible porphyria, bronchial asthma, anemia, congestive heart failure, edema syndrome, arterial hypertension, liver or renal failure, condition after serious surgical interventions, elderly age, systemic pathologies of connective tissue.

Use during pregnancy and lactation

Contraindicated in the third trimester of pregnancy. In the 1st and 2nd trimester of pregnancy should be used according to strict indications and in the smallest dosage.

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

Instructions for use

The instructions for use indicate that Diclofenac in tablet form should be taken orally, without chewing and with a sufficient amount of water, preferably 30 minutes before meals (to achieve a quick therapeutic effect). It is also possible to take the drug before, during or after meals.

• For children over 15 years of age and adults, Diclofenac is prescribed 2-3 times a day, 25-50 mg (maximum 150 mg per day). After improvement, the dose is gradually reduced and switched to maintenance therapy - 50 mg per day.

When treating juvenile rheumatoid arthritis the daily dose can be increased to 3 mg/kg body weight.

For children, the drug is usually prescribed in the following doses (single/daily):

• 6-7 years (20-24 kg) – 25/25 mg;
• 8-11 years (25-37 kg) – 25/50-75 mg;
• 12-14 years (38-50 kg) – 25-50/75-100 mg.

How long can it be used?

Most pathologies and complications associated with the use of this drug occur during the duration of treatment. How to take Diclofenac tablets to prevent unpleasant symptoms? First of all, the process must be supervised by a doctor. Adult patients are prescribed 2-3 tablets per day. The dose is reduced as improvements occur.

The duration of treatment should not exceed 2 weeks, with the exception of complex cases.

Side effects

At orally the following side effects are possible: dyspeptic symptoms, erosive and ulcerative lesions digestive canal, perforation of its walls, gastric and intestinal bleeding, increased drowsiness, dizziness, hypersensitivity reactions, irritability.

Overdose

Symptoms: Hypotension, renal failure, seizures, gastrointestinal irritation or respiratory depression may occur.

Treatment: There is no specific antidote. In case of acute poisoning, it is necessary to stop the absorption of the drug from the gastrointestinal tract as soon as possible. Gastric lavage, administration of activated charcoal and other symptomatic and supportive therapy are indicated. The use of forced diuresis, dialysis or blood transfusion is poorly justified, due to the fact that NSAIDs in to a large extent bind to serum proteins and have extensive metabolism.

special instructions

During treatment with the drug, systematic monitoring of peripheral blood, liver and kidney function, and stool examination for the presence of blood should be carried out.

Patients taking the drug should avoid activities that require increased attention and rapid mental and motor reactions, alcohol consumption.

Drug interactions

1. Reduces the effect of hypoglycemic drugs.
2. Reduces the effects of antihypertensive and hypnotic drugs.
3. Acetylsalicylic acid reduces the concentration of diclofenac in the blood.
4. Increases plasma concentrations of digoxin and methotrexate. lithium and cyclosporine drugs.
5. Concomitant use with paracetamol increases the risk of developing nephrotoxic effects of diclofenac.
6. Cefamandole, cefoperazone, cefotetan, valproic acid and plicamycin increase the incidence of hypoprothrombinemia.
7. Cyclosporine and gold preparations increase the effect of diclofenac on the synthesis of prostaglandins in the kidneys, which increases nephrotoxicity.
8. Simultaneous administration with ethanol, colchicine, corticotropin and St. John's wort preparations increases the risk of bleeding in the gastrointestinal tract.
9. Reduces the effect of diuretics; against the background of potassium-sparing diuretics, the risk of hyperkalemia increases; against the background of anticoagulants, thrombolytic agents (alteplase, streptokinase, urokinase) - the risk of bleeding (usually from the gastrointestinal tract).
10. Diclofenac enhances the effect of drugs that cause photosensitivity. Drugs that block tubular secretion increase the plasma concentration of diclofenac, thereby increasing its toxicity.
11. Increases the likelihood of side effects of other NSAIDs and glucocorticosteroids (bleeding in the gastrointestinal tract), the toxicity of methotrexate and the nephrotoxicity of cyclosporine.

IN Diclofenac gel 5 percent active substance - diclofenac sodium (Diclofenac sodium) - included in a concentration of 50 mg/g, in 1 percent— at a concentration of 10 mg/g. Excipients: isopropyl alcohol, benzyl alcohol, carbomer 940, sodium metabisulfite, polysorbate 80, triethanolamine, purified water.

Compound Diclofenac ointment: Diclofenac sodium (10 or 20 mg/g), propylene glycol, dimethyl sulfoxide, macrogol 400 and 1500.

Compound Diclofenac injections: Diclofenac sodium (25 mg/ml), sodium metabisulfite, mannitol (E421), benzyl alcohol, sodium hydroxide, propylene glycol, water for injection.

IN Diclofenac rectal suppositories includes 50 or 100 mg Diclofenac sodium and solid fat.

Compound enteric-coated tablets: 25 or 50 mg Diclofenac sodium, disubstituted calcium phosphate, starch, magnesium stearate, polyvinylpyrrolidone K30, purified talc, cellulose acetate, indoresin, diethyl phthalate, carmoisin varnish, titanium dioxide, Ponceau 4R varnish, iron oxide red and yellow.

Compound tablets po.: 25 mg Diclofenac sodium, milk sugar, sucrose, povidone, stearic acid, potato starch. Shell: castor oil, cellacephate, titanium dioxide, tropeo-lin O dyes and azorubin.

Compound retard tablets: 100 mg Diclofenac sodium, hypromellose, hyaetellose, Kollidon SR, sodium alginate, MCC, magnesium stearate. Shell: collicut MAE 100 R, povidone, talc, propylene glycol, titanium dioxide, iron oxide yellow and red.

Compound eye drops: Diclofenac sodium (1 mg/ml), sodium chloride and dihydrogen phosphate dihydrate, propylene glycol, sodium hydroxide, hydrogen phosphate dodecahydrate and disodium edetate, water d/i.

Release form

For external use: gel 1 and 5%; ointment 1 and 2%.

Parenteral administration: solution 25 mg/ml, rectal suppositories 50 and 100 mg, eye drops 0.1% (ATC code - S01BC03).

Tablet forms: tablets in a s/r coating 25 mg, in a p/o coating 25 and 50 mg, retard 100 mg.

pharmachologic effect

Anti-inflammatory, analgesic, antipyretic.

Pharmacodynamics and pharmacokinetics

The NSAID Diclofenac is a derivative phenylacetic acid . Its mechanism of action is based on the ability to suppress the biosynthesis of Pg (prostaglandins) - biologically active lipids that are mediators of fever, pain and inflammation.

Like other NSAIDs, it prevents aggregation .

The drug is quickly and completely absorbed; food slows down absorption for 1-4 hours (reducing Cmax by 40%). Cmax when taken orally is observed after 2-3 hours. Changes in this indicator are dose-dependent.

Pharmacokinetic profile on background repeated administration does not change. If the recommendations for use are followed, it does not accumulate in the body.

Bioavailability – 50%. More than 99% bound to plasma proteins (mainly bound to albumins ). Penetrates into the synovium and breast milk.

Half dose taken metabolized during the “first passage” through the liver. The process is based on single or multiple hydroxylation and conjugation with glucuronic acid. Plasma T1/2 - 1-2 hours.

60% of the dose is excreted by the kidneys in the form of metabolic products, less than 1% in its pure form, the rest of the administered drug is excreted in bile.

Indications for the use of Diclofenac in injections and suppositories. What does Diclofenac tablets help with?

Diclofenac tablets, ointment, gel, suppositories and injections are used for short-term treatment of moderately intense pain, including pain that develops against the background of:

• degenerative and inflammatory diseases musculoskeletal system (the drug is prescribed for , ,spondyloarthritis , rheumatic diseases soft tissues, etc.);
• peripheral nerve damage, sciatica, lumbago ;
• seizures And ;
• inflammatory processes in the pelvic organs, algodismenorrhea ;
• injuries and operations.

Suppositories are also prescribed in addition to the main treatment for severe inflammatory ENT diseases (For example, otitis , or ).

When is it advisable to use Diclofenac in injections?

As a rule, indications for the use of injections are situations in which it is necessary to achieve an analgesic effect as quickly as possible. The injection solution is administered for liver or acute pain in the back or muscles if they are damaged, after surgery.

For the treatment and prevention of postoperative pain syndrome, intravenous administration of Diclofenac is indicated.

What is Diclofenac tablets for?

Indications for the use of tablet forms of the drug are the same as for injection solution. Sometimes Diclofenac tablets are also used to relieve toothache.

A special form of the drug is Diclofenac retard- tablets with delayed release of the active substance. If the use of injections allows you to quickly relieve pain, then the use of retard tablets allows you to maintain the effect for a longer time (and reduce the frequency of use of the drug).

Retard tablets are preferred when long-term treatment is required. They are mainly used in rheumatological practice for chronic pain syndromes .

What does Diclofenac ointment and gel form help with?

Gel and ointment with Diclofenac are easy to dose and convenient to use. After applying them to the skin, the active substance accumulates in soft tissues, practically not entering the bloodstream (no more than 6% of the substance enters the blood). These dosage forms are used for various kinds violations locomotor system .

Application of gel with five percent content diclofenac allows you to significantly reduce the dose taken orally and sometimes completely replace tablets.

For what diseases are rectal suppositories prescribed?

The drug is prescribed when it is impossible to take the medicine by mouth: in the presence of esophageal strictures, in weakened patients, etc.

When taken orally, the medicine damages the cells of the gastric mucosa; when using suppositories, the risk of damage is significantly lower. In addition, suppositories do not cause the complications that can develop with parenteral administration: muscle necrosis , formation of infiltrates and suppurations at the injection site.

Very often, suppositories are used in combination therapy: during the day the patient receives tablets or injections, and at night - Diclofenac in the form of suppositories. This treatment regimen allows you to achieve best results due to a more uniform and prolonged maintenance of a certain plasma concentration of the drug.

Suppositories with Diclofenac are considered one of the best suppositories from . At rectal use the drug does not pass through the liver and almost completely enters the prostate .

In gynecology, suppositories with Diclofenac are used for sudden acute pain (for example, with inflammation of the ovaries or algomenorrhea ).

The choice in favor of suppositories is explained by the fact that their use allows you to achieve the desired effect in the shortest possible time: in the vagina, the medicine quickly dissolves under the influence of temperature and is just as quickly (and in the maximum volume) delivered to the diseased organ.

Indications for use of the drug in the form of eye drops

Eye drops, according to the annotation, are prescribed for:

• inhibition of miosis during surgical treatment ;
• relief of inflammation in postoperative period, as well as inflammation after injury to the eyeball (both penetrating and non-penetrating);
• prevention of non-infectious inflammation affecting the anterior parts of the eye;
• prevention of edema before and after surgery for lens removal and implantation;
• pain relief during vision correction surgery using an excimer laser.

Additionally

In some cases, to increase the effectiveness of conservative therapy neuralgic syndrome it is recommended to prescribe a combination of drugs “ And Diclofenac ”.

What's happened Milgamma ? This is a combination drug based on Vgroup B itamins . The latter potentiate the effects analgesics , allowing at the same time to reduce the dose of NSAIDs, and reliably have a pronounced anti-inflammatory And antinociceptive effects .

Contraindications for use

The description of the drug Diclofenac indicates that the drug is contraindicated in:

• hypersensitivity to its components;
• active ulcer, perforation of the walls of the digestive canal, gastric and intestinal bleeding;
• inflammatory diseases of the digestive tract;
• “aspirin asthma ”;
• pronounced functional impairment heart, kidneys, liver.

General contraindications for Diclofenac include recent surgery. coronary artery bypass surgery , pregnancy (contraindication for suppositories - the last 3 months of pregnancy), lactation and age up to 6 years.

Rectal use of the drug is also contraindicated in proctitis .

Ointment and gel should not be used on areas of the body with damaged skin integrity.

IN pediatric practice suppositories 50 mg and tablets in a red coating are prescribed from 14 years of age. Retard tablets and 100 mg suppositories are intended exclusively for the treatment of patients over 18 years of age.

An absolute contraindication to the use of eye drops is hypersensitivity to their components.

Drops should be prescribed with caution when “ aspirin asthma ”, superficial herpetic keratitis , diseases that are accompanied by disorders of plasma hemostasis; children, people old age, pregnant and lactating women.

Side effects of Diclofenac

When taken orally, the following side effects are possible: dyspepsia, erosive and ulcerative lesions of the digestive canal, perforation of its walls, gastric and intestinal bleeding, increased drowsiness, dizziness, hypersensitivity reactions, irritability.

After using the drops the following are noted:

• burning sensation;
• corneal clouding;
• impaired clarity of perception (immediately after instillation);
• iritis;
• hypersensitivity reactions.

Side effects of injections

Intramuscular injections of Diclofenac may be accompanied by a burning sensation at the injection site, abscess, and necrosis of adipose tissue.

Instructions for use of Diclofenac

Diclofenac injections: instructions for use

For relax acute conditions or relief of aggravated chronic disease Diclofenac in ampoules is administered 1 time intramuscularly (deeply). IN further patient transferred to taking the tablet form of the drug.

The dosage of injections is 25-50 mg 2 or 3 times a day.

Diclofenac is administered intravenously by drip. The highest dose is 150 mg/day. Before administration, the contents of the ampoule should be diluted in 0.1-0.5 l NaCl solution 0.9% or dextrose solution 5%. IN infusion solutions pre-add sodium bicarbonate solution (0.5 ml if the solution concentration is 8.4%, and 1 ml if the concentration is 4.2%).

The duration of the infusion, depending on the intensity of the pain, is from half an hour to an hour and a half.

To prevent postoperative pain, the infusion is recommended to be carried out with a “shock” dose - 25-50 mg of Diclofenac over 15-60 minutes. Subsequently, the drug is administered at a rate of 5 mg/hour (until the highest daily dose is reached - 150 mg).

How many days can you inject Diclofenac?

IM injections of Diclofenac are allowed for no more than 2 days in a row. In some cases, the course of treatment with injections can last up to 5 days.

How often can you inject the drug?

NSAIDs cause quite serious side effects, so it is optimal to use Diclofenac no more than once every three months, 3-5 injections per course.

Diclofenac gel: instructions for use

A single dose of the gel depends on the size of the painful area. As a rule, from 2 to 4 grams of the product are used. The cream should be applied to the skin at the site of pain projection and rubbed gently. During the day, the procedure is repeated 3-4 times.

To enhance the effect, the gel can be used with tablets, suppositories or injections of medication.

Diclofenac ointment: instructions for use

The ointment is taken in the same quantity as the gel and rubbed into the skin over the inflammation in the same way. Maximum dose- 8 g/day. Frequency of use: 2-3 times/day.

Diclofenac tablets: instructions for use

Diclofenac tablets (Acri, UBF, Stada, Sandoz, etc.) are taken orally with food or after meals (without chewing or crushing). Adults should take 50 to 150 mg/day. in 2-3 doses.

Diclofenac: how to take retard tablets?

Diclofenac retard is taken 100 mg once a day.

If after taking 100 mg Diclofenac desired effect not achieved, you can additionally take 1 tablet of 50 mg (usual duration of action).

Diclofenac suppositories: instructions for use

The starting dose for an adult is 50-150 mg/day, depending on the indications. In this case, the patient should receive no more than 150 mg of diclofenac sodium in total during the day. The daily dose should be divided into 2-3 doses.

For children 6-15 years old, the dose is selected at the rate of 0.5-2 mg/kg/day. At rheumatoid arthritis the highest daily dose may be 3 mg/kg.

Instructions for eye drops

Before surgery, the patient is administered 1 drop of solution 5 times every 30-35 minutes. After surgery - 3 times, 1 drop. In the future, treatment is continued, instilling 3-5 rubles/day. 1 drop each. The duration of treatment depends on the characteristics of the clinical situation.

Additionally

The regimen for using drugs from different manufacturers is the same: that is, there is no difference in how to use Diclofenac-Acree and, for example, Diclofenac Stada .

Overdose

An overdose can cause central nervous system disorders and digestive disorders. The first ones most often manifest themselves:

• dizziness and headaches;
• increased excitability;
• clouding of consciousness;
• phenomena of hyperventilation with increased convulsive readiness.

Disorders of the digestive system are manifested by: nausea, abdominal pain, vomiting, gastrointestinal bleeding.

At severe poisoning Possible liver damage, acute renal failure, respiratory depression, hypotension.

The drug does not have an antidote. Special measures such as hemoperfusion , dialysis or forced diuresis , do not guarantee the removal of the drug due to its almost complete binding to plasma proteins and intensive metabolism.

Due to the low systemic absorption of the gel/ointment, overdose is considered unlikely. Accidental ingestion of the gel or ointment may cause systemic adverse reactions.

The patient is prescribed gastric lavage, induced vomiting, and given a drink. enterosorbent . Therapy is symptomatic.

Interaction

Simultaneous use with:

• lithium preparations , or — helps to increase the plasma concentration of these drugs;
• antihypertensive drugs and diuretics - reduces the effectiveness of these funds;
• potassium-sparing diuretics - leads to hyperkalemia ;
• GCS or other NSAIDs - causes adverse reactions from the gastrointestinal tract;
• acetylsalicylic acid - helps to reduce the serum concentration of diclofenac;
• - increases the nephrotoxic effect of the latter;
• antidiabetic drugs - may provoke hyper- or hypoglycemia ;
• - can lead to increased concentration and increased toxicity of the latter;
• anticoagulants - requires regular monitoring hemocoagulation .

If indicated eye drops can be combined with other ophthalmic agents that contain corticosteroids (at least a 5-minute break must be maintained between instillations).

Terms of sale

External therapy products are classified as over-the-counter products. All other dosage forms are available by prescription.

Storage conditions

List B. Optimal temperature regime— 10-25°C.

Best before date

Diclofenac (eye drops) has the following analogues: synonyms - Voltaren Ofta , Diklo-F , Diclofenaclong , Uniclofen ; drugs similar in their mechanism of action - , Acular LS, ,Ketadrop , Broxinac .

What is better - ointment or gel? Why is the gel prescribed and what is the ointment for?

The basic basis of the ointment is fat, the gel is water, so the ointment is a more viscous substance compared to the gel. It absorbs more slowly and in some cases can cause clogged pores.

The gel quickly spreads and dries on the skin, forming a thin protective film and leaving no stains on clothes. It simultaneously supplies moisture and dries.

Due to the presence of fat in its composition, the ointment has a predominantly softening and moisturizing effect. Because of this, ointments are used mainly to treat irritated and flaky skin. The gel is more effective for the deeper layers of the skin and joints.

Voltaren or Diclofenac - which is better?

is an imported (and, accordingly, more expensive) generic version of the drug. That is, there is no significant difference in the action of these funds.

Voltaren is distinguished only by the fact that when applied externally, it is more quickly absorbed into tissues and penetrates into the site of inflammation, and when taken orally, it retains the concentration necessary to relieve pain and inflammation longer.

Which is better: Movalis or Diclofenac?

Active substance — meloxicam (a derivative of ethanol acid), like diclofenac sodium, belongs to the group of NSAIDs. Diclofenac non-selectively inhibits the activity of the COX-1 and COX-2 enzymes, while meloxicam exhibits selectivity for COX-2.

Suppression of COX-2 ensures the therapeutic effectiveness of NSAIDs, suppression of COX-1 can provoke adverse reactions from the kidneys and gastrointestinal tract.

Thus, if we talk about the effectiveness of the drugs, they have proven themselves to be approximately the same. Comparing which is better - diclofenac or meloxicam , - based on the frequency of side effects, we can conclude that Movalis (meloxicam ) is better tolerated by patients.

In addition, unlike the analogue, meloxicam has a stimulating effect on the metabolism of cartilage tissue.

Which is better: Diclofenac or Ibuprofen?

Preparations based on ibuprofen indiscriminately inhibit COX. That is, having the same indications for use and contraindications, they also provoke the same side effects.

However, unlike its counterpart, It is somewhat better tolerated by children and pregnant women, which makes it possible to use it (albeit with caution) in pediatrics and obstetrics and gynecology practice.

Ketonal or Diclofenac - which is better?

Ketonal belongs to the group of drugs ketoprofen - a substance with a strong analgesic and anti-inflammatory effect. Ketonal tens of times more effective than drugs ibuprofen , which makes it advisable to use it for the treatment of spinal injuries and osteochondrosis .

Non-selectively suppressing COX, it quickly causes adverse reactions from the gastrointestinal tract, even when used externally.

What is better - Diclofenac or Ketorol?

is a non-selective COX inhibitor. According to doctors, the effectiveness of the tablets Ketorola higher than the effectiveness of Diclofenac tablets, and the effectiveness of the injection solution is comparable. Moreover, with comparable analgesic efficacy, the duration of action Ketorola twice that of its counterpart.

Diclofenac (more often in injections than tablets) more often than Ketorol , caused adverse reactions - mainly from the gastrointestinal tract. They were regarded by the physician as minor and doubtfully related to therapy, and did not require discontinuation of treatment.

Which is better: Diclofenac or Ortofen?

Drugs Diclofenac and have no fundamental differences, since they are based on the same active substance.

Which is better: Diclofenac or Diclofenac Retard?

Pills Retard used for treatment chronic rheumatic pain . Regular tablets used to relieve acute pain. Thus, the choice of dosage form is completely determined by the indications for use.

Aceclofenac and Diclofenac - the difference

Aceclofenac is a derivative of phenylacetylic acid.

It is distinguished by its high bioavailability and high speed achieving peak concentration in the blood (1-3 hours), the ability to be completely metabolized into pharmacologically active products (one of which, by the way, is diclofenac).

In addition to the main action, Aceclofenac suppresses the synthesis of interleukin-1 and tumor necrosis factor, which are the most important pro-inflammatory cytokines.

Today this drug is considered one of the best. Its advantages:

• availability;
• high quality;
• a balanced combination of anti-inflammatory and analgesic effectiveness with
• well tolerated.

Diclofenac with alcohol - compatible or not?

Diclofenac and alcohol are incompatible.

Consequences of alcohol with NSAIDs

Drinking alcohol during treatment with NSAIDs can cause:

• deterioration of liver function;
• reducing the effectiveness of the drug;
• development of unpredictable complications and adverse reactions;
• and, as a consequence, strengthening stagnation in the circulatory system and intoxication of the body.

Injections and alcohol are not compatible, since the injection form of the drug stimulates the activity of the central nervous system, and alcohol, on the contrary, inhibits it. As a result, quite serious neurological disorders are possible.

Diclofenac during pregnancy and breastfeeding

All dosage forms during pregnancy are used in exceptional cases, taking into account the benefit/risk ratio.

Like other NSAIDs, in the 3rd trimester the drug can cause a lack of uterine contraction in a woman in labor and/or premature closure of the ductus arteriosus in a newborn.

The medicine can penetrate not only into milk, but also through the placental barrier, even when using dosage forms for external therapy. Thus, even the use of gel and ointment during pregnancy can disrupt the development of the fetus.

The drug affects fertility, so it is not recommended for women who are planning a pregnancy, as well as for women who have problems with fertilization.