Diclofenac-AKOS 25 mg/ml 3 ml ampoules 10 pcs. solution for intramuscular administration in Moscow

Diclofenac-AKOS 25 mg/ml 3 ml ampoules 10 pcs. solution for intramuscular administration in Moscow

• Hypersensitivity to diclofenac or to any other drug from the group of non-steroidal anti-inflammatory drugs (NSAIDs), as well as to any of the excipients of the drug; erosive and ulcerative lesions of the gastrointestinal tract (in the acute phase), bleeding from the gastrointestinal tract, inflammatory bowel diseases (nonspecific ulcerative colitis, Crohn's disease); severe liver failure, liver disease in the acute period;
• severe renal failure (creatinine clearance less than 30 ml/min), hyperkalemia;
• complete or incomplete acetylsalicylic acid intolerance syndrome (rhinosinusitis, urticaria, nasal polyps, bronchial asthma that occurs when taking acetylsalicylic acid or other NSAIDs);
• hematopoietic disorders, hemostasis disorders (including hemophilia);
• pregnancy, breastfeeding period,
• children under 18 years of age;
• period after coronary artery bypass surgery;
• with an increased risk of arterial thrombosis and thromboembolism;
• chronic heart failure, functional class II-IV according to the NYHA classification;
• clinically confirmed coronary heart disease;
• diseases of peripheral arteries and cerebral vessels; uncontrolled arterial hypertension.

With caution:
coronary heart disease, cerebrovascular diseases, congestive heart failure, arterial hypertension, significant decrease in circulating blood volume (including after major surgery), edema syndrome, peripheral arterial disease, dyslipidemia, diabetes mellitus, anemia, bronchial asthma , renal failure (creatinine clearance less than 60 ml/min), alcoholism, erosive and ulcerative diseases of the gastrointestinal tract without exacerbation, history of liver disease, diverticulitis, condition after extensive surgery, inducible porphyria, old age, smoking, severe somatic diseases , systemic connective tissue diseases, long-term use of nonsteroidal anti-inflammatory drugs, simultaneous use of glucocorticosteroids, anticoagulants, antiplatelet agents, selective serotonin reuptake inhibitors, hyperlipidemia, the presence of
Helicobacter pylori infection.

Diclofenac-acos 1% 30g ointment for external use

pharmachologic effect

Non-steroidal anti-inflammatory drug.

Composition and release form Diclofenac-akos 1% 30g ointment for external use

Ointment - 100 g:

• Active ingredient: diclofenac sodium – 1.0 g;
• Excipients: dimethyl sulfoxide (dimexide), macrogol 400 (polyethylene glycol 400), macrogol 4000 (polyethylene glycol 4000), propylene glycol, methyl parahydroxybenzoate (methylparaben, nipagin), propyl parahydroxybenzoate (propylparaben, nipazole).

30 g in aluminum tubes. Each tube with instructions for use is placed in a cardboard pack.

Description of the dosage form

The ointment is white or almost white in color, with a weak specific odor.

Directions for use and doses

Externally.

For adults and children over 12 years of age, the ointment is applied to the skin 2 times a day (every 12 hours, preferably in the morning and evening), in a dose of 2-4 g. Apply a thin layer to the skin above the inflammation and rub in lightly.

The maximum daily dose of ointment should not exceed 8 g.

The course of treatment is no more than 14 days. If there is no effect from using the drug after 7 days, you should consult a doctor.

If your hands are not the area where pain is localized, then after applying the ointment they should be washed.

Use in minimally effective doses for a minimally short course.

Pharmacodynamics

The active component of the drug diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) with pronounced analgesic and anti-inflammatory properties. Indiscriminately inhibiting cyclooxygenase types 1 and 2, it disrupts the metabolism of arachidonic acid and the synthesis of prostaglandins, which are the main link in the development of inflammation. Diclofenac is used to eliminate pain and inflammation in joints, muscles and ligaments of traumatic or rheumatic origin, helping to reduce pain and swelling associated with the inflammatory process, increasing joint mobility.

Pharmacokinetics

When applied externally, diclofenac penetrates well through the skin, mainly concentrating in the site of inflammation and synovial fluid. The amount of diclofenac that is absorbed through the skin is proportional to the time of contact of the ointment with the skin and the area of ​​its application, depending on the total dose of the drug and the degree of skin hydration. With the recommended method of applying the drug, no more than 6% of diclofenac is absorbed. The use of an occlusive dressing for 10 hours leads to a 3-fold increase in the resorption of diclofenac.

Indications for use Diclofenac-akos 1% 30g ointment for external use

• back pain due to inflammatory and degenerative diseases of the spine (osteoarthrosis, radiculitis, lumbago, sciatica);
• joint pain (finger joints, knee joints, etc.) due to osteoarthritis;
• muscle pain;
• inflammation and swelling of soft tissues and joints due to injuries and rheumatic diseases;
• pain and swelling associated with diseases of muscles and joints (lumbago, sciatica, neuralgia, myalgia, tendinitis);
• degenerative diseases of the musculoskeletal system (deforming osteoarthritis, osteochondrosis).

Intended for symptomatic therapy, reducing pain and inflammation at the time of use, does not affect the progression of the disease.

Contraindications

Hypersensitivity to diclofenac.

Complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses, and intolerance to acetylsalicylic acid or other NSAIDs (including a history).

Pregnancy (III trimester), breastfeeding period, childhood (up to 12 years).

Violation of the integrity of the skin at the intended site of application.

Carefully

Hepatic porphyria (exacerbation), erosive and ulcerative lesions of the gastrointestinal tract, severe dysfunction of the liver and kidneys, chronic heart failure, bleeding disorders (including hemophilia, prolongation of bleeding time, bleeding tendency), old age, pregnancy I and II trimester.

Application of Diclofenac-akos 1% 30g ointment for external use during pregnancy and lactation

The drug should not be used in the third trimester of pregnancy.

Due to the lack of data on the penetration of the drug into breast milk, its use during breastfeeding is not recommended. If you still need to use the drug, then you should not apply it to the mammary glands or large surfaces of the skin and do not use it for a long time.

Use in the first and second trimesters is possible only after consultation with a doctor if the expected benefit to the mother outweighs the potential risk to the fetus.

special instructions

Apply externally only. The ointment can only be applied to intact areas of the skin. After applying the ointment, do not apply an occlusive dressing. Before use, patients with gastric and duodenal ulcers, impaired liver, kidney or hematopoietic function, as well as concomitant use of other NSAIDs, should consult a doctor. When using the drug together with other dosage forms of diclofenac, the maximum daily dose should be taken into account.

With long-term use and/or application to large surfaces, systemic side effects may develop due to the resorptive effect. Avoid contact of the drug with the eyes, mucous membranes or open wounds.

Impact on the ability to drive vehicles and operate machinery

The drug does not affect the ability to drive vehicles and other machinery.

Overdose

Due to the low systemic absorption when applying the ointment, an overdose is unlikely.

In case of accidental ingestion, systemic adverse reactions may develop. Symptoms: nausea and vomiting.

Treatment: gastric lavage, induction of vomiting, activated charcoal, forced diuresis, symptomatic therapy.

Hemodialysis is not effective due to the high degree of binding of diclofenac to plasma proteins (about 99%).

Side effects Diclofenac-akos 1% 30g ointment for external use

The incidence of side effects is classified according to the recommendations of the World Health Organization: very often - ≥1/10; often – from ≥1/100 to

Local reactions: infrequently - exudative erythema multiforme (including Stevens-Johnson syndrome), eczema, very rarely contact dermatitis (itching, hyperemia, swelling of the treated skin area, papular-vesicular rashes, peeling).

When applying the ointment to large surfaces of the skin over a long period of time, systemic side effects of diclofenac may develop. Systemic reactions: rarely - generalized skin rash, allergic reactions (urticaria, angioedema, bronchospastic reactions), rarely - photosensitivity, very rarely - anaphylactic reactions (including shock).

Drug interactions

The use of the drug with other NSAIDs is not recommended.

Diclofenac may enhance the effect of drugs that cause photosensitivity. Clinically significant interactions with other drugs have not been described.

Diclofenac-AKOS solution d/in 25 mg/ml 3 ml x5

Trade name: Diclofenac International name: Diclofenac

Release form: solution for intramuscular administration 75 mg (ampoules) 3 ml

Ingredients: diclofenac sodium 25 g - 1 l

Pharmacological group: NSAID (non-steroidal anti-inflammatory drug)

Pharmacological group according to ATK: M01AB05 (Diclofenac)

Pharmacological action: antiplatelet, antipyretic, NSAID, anti-inflammatory, analgesic,

Ingredients: 2 - [(2, 6 - dichlorophenyl) amino]benzoacetic acid (as sodium salt)

Indications: Inflammatory and degenerative diseases of the musculoskeletal system: rheumatoid, psoriatic, juvenile chronic arthritis, ankylosing spondylitis (ankylosing spondylitis), neuralgic amyotrophy (Personage-Turner disease), osteoarthritis, rheumatism, gouty arthritis (in case of an acute attack of gout, fast-acting dosage forms are preferred ), arthritis due to Reiter's disease. Pain syndrome: headache (including migraine) and toothache, bursitis, tendinitis, lumbago, sciatica, ossalgia, neuralgia, myalgia, arthralgia, radiculitis, in cancer, post-traumatic and postoperative pain syndrome accompanied by inflammation. Algodismenorrhea, inflammatory processes in the pelvis, incl. adnexitis, childbirth (as an analgesic and tocolytic agent). Infectious and inflammatory diseases of the ENT organs with severe pain syndrome (as part of complex therapy): pharyngitis, tonsillitis, otitis media. Feverish syndrome with “colds” and infectious diseases.

Dosage regimen: IV drip. The maximum daily dose is 150 mg. Immediately before intravenous administration, diclofenac (contents of 1 ampoule - 75 mg) should be diluted in 100-500 ml of 0.9% NaCl solution or 5% dextrose solution (after adding sodium bicarbonate solution to the infusion solutions - 0.5 ml 8.4% or 1 ml 4.2% solution). Depending on the severity of the pain syndrome, the infusion is carried out for 30-180 minutes. In order to prevent postoperative pain, an infusion is carried out with a “shock” dose of the drug (25-50 mg over 15-60 minutes). Subsequently, the infusion is continued at a rate of 5 mg/hour (until the maximum daily dose of 150 mg is reached). For the treatment of acute conditions or relief of exacerbation of a chronic disease, intramuscular (single) administration is also possible; further treatment is continued with oral diclofenac, taking into account the maximum daily dose of 150 mg (including on the day of injection). The injection solution is injected deep intramuscularly for no more than 2 weeks.

Contraindications: Hypersensitivity (including to other NSAIDs), bronchial asthma, urticaria or acute rhinitis, provoked by taking ASA or other NSAIDs, erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, severe renal/liver and heart failure, for LF containing lactose - hereditary galactose intolerance, impaired absorption of glucose-galactose, severe lactose deficiency, pregnancy (III trimester), lactation period, children's age (up to 14 years - for enteric-coated tablets 50 mg and rectal suppositories 50 mg and up to 18 years - for extended-release tablets and suppositories 100 mg). For rectal use: proctitis. With caution. Peptic ulcer of the stomach and duodenum, ulcerative colitis, Crohn's disease, history of liver disease, hepatic porphyria, chronic renal failure, heart failure, arterial hypertension, significant decrease in blood volume (including after massive surgery), elderly patients (including including those receiving diuretics, weakened patients and those with low body weight), bronchial asthma (for parenteral administration - risk of exacerbation), simultaneous use of corticosteroids, anticoagulants, antiplatelet agents, selective serotonin reuptake inhibitors.

Side effects: Often - 1-10%, sometimes - 0.1-1%, rarely - 0.01-0.1%, very rarely - less than 0.001%, including isolated cases. From the digestive system: often - epigastric pain, nausea, vomiting, diarrhea, dyspepsia, flatulence, anorexia, increased aminotransferase activity, rarely - gastritis, proctitis, bleeding from the gastrointestinal tract (vomiting of blood, melena, diarrhea mixed with blood), gastrointestinal ulcers (with or without bleeding or perforation), hepatitis, jaundice, liver dysfunction, very rarely - stomatitis, glossitis, esophageal damage, diaphragm-like intestinal strictures (nonspecific hemorrhagic colitis, exacerbation of ulcerative colitis or Crohn's disease), constipation, pancreatitis, fulminant hepatitis, exacerbation of hemorrhoids (for rectal suppositories). From the nervous system: often - headache, dizziness, rarely - drowsiness, very rarely - sensory disturbances, incl. paresthesia, memory disorders, tremor, convulsions, anxiety, cerebrovascular disorders, aseptic meningitis, disorientation, depression, insomnia, nightmares, irritability, mental disorders. From the senses: often - vertigo, very rarely - visual impairment (blurred vision, diplopia), hearing impairment, tinnitus, impaired taste. From the urinary system: very rarely - acute renal failure, hematuria, proteinuria, interstitial nephritis, nephrotic syndrome, papillary necrosis. From the hematopoietic organs: very rarely - thrombocytopenia, leukopenia, hemolytic and aplastic anemia, agranulocytosis. Allergic reactions: anaphylactic/anaphylactoid reactions, including a marked decrease in blood pressure and shock, very rarely - angioedema (including facial edema). From the cardiovascular system: very rarely - palpitations, chest pain, increased blood pressure, vasculitis, heart failure, myocardial infarction. From the respiratory system: rarely - bronchial asthma (including shortness of breath), very rarely - pneumonitis. From the skin: often - skin rash, rarely - urticaria, very rarely - bullous rashes, eczema, incl. multiforme and Stevens-Johnson syndrome, Lyell's syndrome, exfoliative dermatitis, itching, hair loss, photosensitivity, purpura, incl. allergic. Other: often - irritation at the injection site (for injection forms), very rarely - abscess at the injection site (for injection forms), rarely - swelling. Overdose. Symptoms: vomiting, bleeding from the gastrointestinal tract, diarrhea, dizziness, tinnitus, convulsions, in case of significant overdose - acute renal failure, hepatotoxic effect. Treatment: gastric lavage, activated charcoal, symptomatic therapy aimed at eliminating increased blood pressure, renal dysfunction, convulsions, gastrointestinal irritation, respiratory depression. Forced diuresis and hemodialysis are ineffective (due to the significant connection with proteins and intensive metabolism).

Pharmacodynamics: NSAIDs, a derivative of phenylacetic acid, have anti-inflammatory, analgesic and antipyretic effects. By indiscriminately inhibiting COX1 and COX2, it disrupts the metabolism of arachidonic acid and reduces the amount of Pg at the site of inflammation. Most effective for inflammatory pain. Like all NSAIDs, the drug has antiplatelet activity.

Pharmacokinetics: Absorption is rapid and complete, food slows the rate of absorption. After oral administration of 50 mg, Cmax is 1.5 mcg/ml, TCmax is 2-3 hours. Long-acting diclofenac: as a result of the slow release of the drug, Cmax in plasma is lower than that created with the administration of short-acting drugs, but it remains high for a long time after reception. Cmax - 0.5-1 mcg/ml, TCmax - 5 hours after taking 100 mg extended-release tablets. After intravenous drip administration of 75 mg, Cmax is 1.9 μg/ml (5.9 μmol/l). After intramuscular administration, Cmax is 2.5 mcg/ml (8 μmol/l), TCmax is 20 minutes. For rectal administration, TCmax is 30 minutes. Plasma concentration is linearly dependent on the administered dose. There are no changes in the pharmacokinetics of diclofenac following repeated administration. Does not accumulate if the recommended interval between meals is observed. Bioavailability - 50%. Communication with plasma proteins is more than 99% (most of it is associated with albumin). Penetrates into breast milk and synovial fluid, Cmax in synovial fluid is observed 2-4 hours later than in plasma. T1/2 from synovial fluid - 3-6 hours (concentrations of the drug in synovial fluid 4-6 hours after its administration are higher than in plasma, and remain higher for another 12 hours). 50% of the drug is metabolized during the “first pass” through the liver, AUC is 2 times less after oral administration of the drug than after parenteral administration of the same dose. Metabolism occurs as a result of multiple or single hydroxylation and conjugation with glucuronic acid. The CYP2C9 isoenzyme is also involved in the metabolism of the drug. The pharmacological activity of the metabolites is less than that of diclofenac. Systemic clearance is 260 ml/min. T1/2 from plasma - 1-2 hours. 60% of the administered dose is excreted in the form of metabolites through the kidneys, less than 1% is excreted unchanged, the rest of the dose is excreted in the form of metabolites in the bile. In patients with severe renal failure (creatinine clearance less than 10 ml/min), the excretion of metabolites in bile increases, but no increase in their concentration in the blood is observed. In patients with chronic hepatitis or compensated liver cirrhosis, pharmacokinetic parameters do not change.

Special instructions: In order to quickly achieve the desired therapeutic effect, take 30 minutes before meals. In other cases, take before, during or after meals, unchewed, with a sufficient amount of water. Because of the important role of Pg in maintaining renal blood flow, special caution should be exercised when prescribing to patients with heart or renal failure, as well as when treating elderly patients taking diuretics, and patients who, for any reason, have a decrease in blood volume (for example, after a major surgical intervention). If diclofenac is prescribed in such cases, monitoring of renal function is recommended as a precaution. In patients with renal failure with CC less than 10 ml/min, the Css of metabolites in plasma should theoretically be significantly higher than in patients with normal renal function, but this is not actually observed, since in this situation the excretion of metabolites in the bile is enhanced. In patients with liver failure (chronic hepatitis, compensated cirrhosis of the liver), the kinetics and metabolism do not differ from similar processes in patients with normal liver function. When carrying out long-term therapy, it is necessary to monitor liver function, peripheral blood patterns, and stool analysis for occult blood. Due to the negative effect on fertility, the drug is not recommended for women wishing to become pregnant. In patients with infertility (including those undergoing examination), it is recommended to discontinue the drug. During the treatment period, the speed of mental and motor reactions may decrease, so it is necessary to refrain from driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Interaction: Increases plasma concentrations of digoxin, methotrexate, Li+ drugs and cyclosporine. Reduces the effect of diuretics; against the background of potassium-sparing diuretics, the risk of developing hyperkalemia increases; against the background of anticoagulants, antiplatelet and thrombolytic drugs (alteplase, streptokinase, urokinase), the risk of bleeding increases (usually the gastrointestinal tract). Reduces the effect of antihypertensive and hypnotic drugs. Increases the likelihood of side effects of other NSAIDs and corticosteroids (bleeding in the gastrointestinal tract), the toxicity of methotrexate and the nephrotoxicity of cyclosporine. ASA reduces the concentration of diclofenac in the blood. Concomitant use with paracetamol increases the risk of developing nephrotoxic effects of diclofenac. Reduces the effect of hypoglycemic drugs. Cefamandole, cefoperazone, cefotetan, valproic acid and plicamycin increase the incidence of hypoprothrombinemia. Cyclosporine and Au preparations increase the effect of diclofenac on Pg synthesis in the kidneys, which is manifested by increased nephrotoxicity. Selective serotonin reuptake inhibitors increase the risk of gastrointestinal bleeding. Simultaneous administration with ethanol, colchicine, corticotropin and St. John's wort preparations increases the risk of bleeding in the gastrointestinal tract. Drugs that cause photosensitivity increase the sensitizing effect of diclofenac to UV irradiation. Drugs that block tubular secretion increase the plasma concentration of diclofenac, thereby increasing its effectiveness and toxicity. Antibacterial drugs from the quinolone group - the risk of developing seizures.

Dispensed from pharmacies: available with prescription.

Drug registration number: P No. 003074/01

Date of registration (re-registration) of the drug: 08.12.2003

Diclofenac-akos 25 mg/ml 3 ml 5 pcs. solution for intramuscular administration

Composition and release form Diclofenac-akos 25 mg/ml 3 ml 5 pcs. solution for intramuscular administration

Solution - 1 ml.:
Active substances: diclofenac sodium - 25 mg/1 amp.

Excipients: benzyl alcohol, propylene glycol, water for injection.

Solution. 25 mg/3 ml: amp. 5 pieces.

Description of the dosage form

The solution for intramuscular administration is clear, slightly colored, with a faint odor of benzyl alcohol.

Directions for use and doses

Single dose for adults - 75 mg (1 ampoule). If necessary, repeated administration is possible, but not earlier than after 12 hours. When using other dosage forms of diclofenac, the maximum daily dose should not exceed 150 mg.

Indications for use Diclofenac-akos 25 mg/ml 3 ml 5 pcs. solution for intramuscular administration

For short-term treatment of pain of various origins, moderate intensity:

• Diseases of the musculoskeletal system (rheumatoid arthritis, psoriatic, juvenile chronic arthritis, ankylosing spondylitis; gouty arthritis, rheumatic soft tissue lesions, osteoarthritis of peripheral joints and spine (including with radicular syndrome). The drug is intended for symptomatic therapy, pain reduction and inflammation at the time of use does not affect the progression of the disease;
• lumbago, sciatica, neuralgia;
• algodismenorrhea, inflammatory processes of the pelvic organs, incl. adnexitis;
• post-traumatic pain syndrome accompanied by inflammation;
• postoperative pain.

Contraindications

• Hypersensitivity (including to other NSAIDs or auxiliary components);
• erosive and ulcerative lesions of the gastrointestinal tract (in the acute phase);
• bleeding from the gastrointestinal tract;
• inflammatory bowel diseases (ulcerative colitis, Crohn's disease);
• severe liver failure;
• liver diseases in the acute period;
• severe renal failure (creatinine clearance less than 30 ml/min);
• heart failure;
• hyperkalemia;
• complete or incomplete acetylsalicylic acid intolerance syndrome (rhinosinusitis, urticaria, nasal polyps, bronchial asthma that occurs when taking acetylsalicylic acid or other NSAIDs);
• hematopoietic disorders, hemostasis disorders (including hemophilia);
• period after coronary artery bypass surgery.

With caution: coronary heart disease, cerebrovascular diseases, congestive heart failure, arterial hypertension, significant decrease in circulating blood volume (including after major surgery), edema syndrome, peripheral arterial disease, dyslipidemia, diabetes mellitus, anemia, bronchial asthma , renal failure (creatinine clearance less than 60 ml/min), alcoholism, erosive and ulcerative diseases of the gastrointestinal tract without exacerbation, history of liver disease, diverticulitis, condition after extensive surgery, inducible porphyria, old age, smoking, severe somatic diseases , systemic connective tissue diseases, long-term use of nonsteroidal anti-inflammatory drugs, simultaneous use of glucocorticosteroids, anticoagulants, antiplatelet agents, selective serotonin reuptake inhibitors, hyperlipidemia, the presence of Helicobacter pylori infection.

Application of Diclofenac-akos 25 mg/ml 3 ml 5 pcs. solution for intramuscular administration during pregnancy and lactation

Contraindicated: pregnancy and breastfeeding, age under 18 years.

Side effects Diclofenac-akos 25mg/ml 3ml 5 pcs. solution for intramuscular administration

To reduce the risk of adverse events, the minimum effective dose should be used in a short course.

Often - 1-10%; sometimes - 0.1-1%; rarely - 0.01-0.1%; very rarely - less than 0.001%, including isolated cases.

From the digestive system:

• Often - epigastric pain, nausea, vomiting, diarrhea, dyspepsia, flatulence, anorexia, increased aminotrapsferase activity;
• rarely - gastritis, proctitis, bleeding from the gastrointestinal tract (vomiting with blood, melena, diarrhea mixed with blood), ulcers of the gastrointestinal tract (with or without bleeding or perforation), hepatitis, jaundice, impaired liver function;
• very rarely - stomatitis, glossitis, damage to the esophagus, diaphragm-like intestinal strictures (nonspecific hemorrhagic colitis, exacerbation of ulcerative colitis or Crohn's disease), constipation, pancreatitis, fulminant hepatitis.

From the nervous system:

• Often - headache, dizziness;
• rarely - drowsiness;
• very rarely - sensory disturbance, incl. paresthesia, memory disorders, tremor, convulsions, anxiety, cerebrovascular disorders, aseptic meningitis, disorientation, depression, insomnia, nightmares, irritability, mental disorders.

From the senses:

• Often - vertigo;
• very rarely - visual impairment (blurred vision, diplopia), hearing impairment, tinnitus, impaired sense of taste.

From the urinary system: very rarely - acute renal failure, hematuria, proteinuria, interstitial nephritis, nephrotic syndrome, papillary necrosis.

From the hematopoietic organs: very rarely - thrombocytopenia, leukopenia, hemolytic and aplastic anemia, agranulocytosis.

Allergic reactions:

• Anaphylactic/anaphylactoid reactions, including a pronounced decrease in blood pressure and shock;
• very rarely - angioedema (including the face).

From the cardiovascular system: very rarely - palpitations, chest pain, increased blood pressure, vasculitis, heart failure, myocardial infarction.

From the respiratory system:

• Rarely - bronchial asthma (including shortness of breath);
• very rarely - pneumonitis.

From the skin:

• Often - skin rash;
• rarely - urticaria;
• very rarely - bullous rashes, eczema, incl. multiforme and Stevens-Johnson syndrome, Lyell's syndrome, exfoliative dermatitis, itching, hair loss, photosensitivity, purpura, incl. allergic.

Local reactions with intramuscular injection: burning, infiltration, aseptic necrosis, necrosis of adipose tissue.

Drug interactions

With the simultaneous use of Diclofenac with digoxin, phenytoin or lithium preparations, it is possible to increase the plasma concentrations of these drugs; with diuretics and antihypertensive drugs - the effect of these drugs may be reduced; with potassium-sparing diuretics - hyperkalemia may develop; with acetisalicylic acid - a decrease in the concentration of diclofenac in the blood plasma and an increased risk of side effects.

Diclofenac may enhance the toxic effect of cyclosporine on the kidneys.

Diclofenc can cause hypo- or hyperglycemia, therefore, when used simultaneously with hypoglycemic agents, monitoring of blood glucose concentrations is required.

When using methotrexate within 24 hours before or after taking Diclofenac, the concentration of methotrexate may increase and its toxic effect may increase.

When used simultaneously with anticoagulants, regular monitoring of blood clotting parameters is necessary.