Diclofenac

Pharmacological properties

Almiral is a non-steroidal drug with pronounced analgesic / anti-inflammatory properties. it is an inhibitor of prostaglandinsynthetase (cog). In vitro diclofenac sodium in concentrations equivalent to those achieved in humans does not inhibit the proteoglycan biosynthesis in cartilage. if the drug is used simultaneously with opioids for relief of postoperative pain, almiral significantly reduces the need for opioids.

Pharmacokinetics Absorption. After the administration of 75 mg of diclofenac by i / m injection, absorption begins immediately, and the average C_max in blood plasma, which is about 2.558 ± 0.968 μg / ml (2.5 μg / ml = 8 μmol / L), is reached after about 20 minutes. The absorption volume is linearly proportional to the dose.

If 75 mg of diclofenac is administered by iv infusion for 2 hours, average C_max in plasma is approximately 1.875 ± 0.436 μg / ml (1.9 μg / ml = 5.9 μmol / L). A shorter infusion time leads to a higher C_max in blood plasma, while longer infusions lead to a plateau of concentration proportional to the rate of infusion after 3-4 hours. Unlike the corresponding results of oral administration, in the case of the use of the drug in the form of suppositories or i / m administration, the plasma concentration rapidly decreases immediately after reaching maximum levels.

Bioavailability. AUC after i / m or iv injection is about twice as much as after oral or rectal administration, since this pathway avoids the metabolism of the first passage through the liver.

Distribution. 99.7% of diclofenac binds to proteins, mainly with albumin (99.4%).

Diclofenac enters the synovial fluid, where C_max established 2-4 hours after reaching a peak value in blood plasma. Expected T_½ from synovial fluid is 3–6 hours. 2 hours after reaching C_max in plasma, the concentration of diclofenac in synovial fluid exceeds this indicator in blood plasma and remains higher for up to 12 hours.

Diclofenac was detected in a low concentration (100 ng / ml) in breast milk in one woman who was breastfeeding. The estimated amount of the drug that enters the body of an infant with breast milk is equivalent to 0.03 mg / kg / day.

Metabolism. The biotransformation of diclofenac occurs in part by glucuronidation of the intact molecule, but mainly by single and multiple hydroxylation and methoxylation, which leads to the formation of several phenolic metabolites, most of which are converted to glucuronide conjugates. Two of these phenolic metabolites are biologically active, but their effect is much less pronounced than the effect of diclofenac.

The total systemic clearance of diclofenac in blood plasma is 263 ± 56 ml / min (mean ± SD). Terminal T_½ in plasma is 1-2 hours. Four metabolites, including two active ones, also have a short T_½ - 1-3 hours. About 60% of the administered dose is excreted in the urine in the form of a glucuronide conjugate of an intact molecule and in the form of metabolites, most of which also turn into glucuronide conjugates. Less than 1% is excreted as unchanged substance. The remainder of the dose is eliminated in the form of metabolites through bile with feces.

Special Patient Groups

Elderly patients. No difference depending on the age of the patient in the absorption, metabolism or excretion of the drug was noted, except that in 5 elderly patients, a 15-minute infusion resulted in a plasma concentration of 50% higher than in healthy volunteers.

Patients with impaired renal function. In patients with impaired renal function, following the usual dosage regimen, accumulation of unchanged active substance is not expected in accordance with the kinetics of the drug after a single use. Under creatinine clearance of 10 ml / min, plasma hydroxymetabolite levels are approximately 4 times higher than in healthy volunteers.

However, metabolites are finally excreted in the bile.

Patients with liver disease.In patients with chronic hepatitis or compensated cirrhosis, the kinetics and metabolism of diclofenac are the same as in patients without liver disease.

Indications

The drug with i / m administration is intended for the treatment of:

• inflammatory and degenerative forms of rheumatism, rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, spondylitis, vertebral pain, non-articular rheumatism;
• acute attacks of gout;
• renal and biliary colic;
• pain and swelling after injuries and operations;
• severe migraine attacks.

The drug, when administered as an intravenous infusion, is intended to treat or prevent postoperative pain.

Application

The drug should be used in minimum effective doses for the shortest period of time, taking into account the treatment objectives of each individual patient.

Adults The drug Almiral, injection solution, is not used for more than 2 days. If necessary, treatment can be continued with tablets or diclofenac suppositories.

V / m injection. In order to prevent damage to nerve or other tissues at the injection site, the following rules must be observed.

The dose is usually 75 mg (1 ampoule) per day, which is administered by deep injection into the upper outer quadrant of the gluteus maximus muscle. In severe cases (for example, colic), the daily dose can be increased to 2 injections of 75 mg, between which there is an interval of several hours (1 injection in each buttock). Alternatively, 75 mg of injection solution can be combined with other dosage forms of diclofenac (eg, tablets or suppositories) up to a maximum total daily dose of 150 mg of diclofenac sodium.

In conditions of a migraine attack, clinical experience is limited to cases with the initial use of 1 ampoule of 75 mg, the dose is administered, if possible, immediately after the use of suppositories of 100 mg on the same day (if necessary). The total daily dose should not exceed 175 mg on the first day.

There is no data available on the use of the drug Almiral for the treatment of migraine attacks lasting more than 1 day.

In / in infusion. Immediately before the onset of IV infusion, Almiral should be diluted in 100–500 ml of 0.9% sodium chloride solution or 5% glucose solution. Both solutions must be buffered with sodium bicarbonate solution (0.5 ml of 8.4% solution or 1 ml of 4.2%). You can use only transparent solutions.

Almiral, injection solution, should not be given as a bolus injection.

Recommended alternative dosing regimens of the drug Almiral, injection for injection:

• for the treatment of moderate and severe postoperative pain, 75 mg must be administered continuously for a period of 30 minutes to 2 hours; if necessary, treatment can be repeated after 4-6 hours, but the dose should not exceed 150 mg / day;
• for the prevention of postoperative pain, after 15 minutes - 1 hour after surgery, a loading dose of 25-50 mg must be administered, after which continuous infusion of about 5 mg / h should be used up to a maximum daily dose of 150 mg.

Elderly patients. Although in elderly patients the pharmacokinetics of the drug Almiral does not deteriorate to any clinically significant degree, NSAIDs should be used with extreme caution in such patients, who are usually more likely to develop adverse reactions. In particular, in weakened elderly patients or patients with a low body mass index, the lowest effective doses are recommended (see SPECIAL INSTRUCTIONS); patients should also be examined for gastrointestinal bleeding in the treatment of NSAIDs.

The recommended maximum daily dose of Almiral is 150 mg.

Children. Diclofenac in the dosage form of a solution for injection is contraindicated for use in children.

Contraindications

• Known hypersensitivity to the active substance, sodium metabisulfite or any other components of the drug; a history of bleeding or perforation of the gastrointestinal tract associated with previous treatment of NSAIDs; an active form of ulcer / bleeding or a recurring ulcer / bleeding history (two or more separate episodes of an established ulcer or bleeding); iii trimester of pregnancy; like other NSAIDs, diclofenac is also contraindicated in patients in whom the use of ibuprofen, acetylsalicylic acid or other NSAIDs causes attacks of asthma, angioedema, urticaria, or acute rhinitis; inflammatory bowel disease (e.g., Crohns disease or ulcerative colitis); liver failure; renal failure; congestive heart failure (ii – iv nyha functional class); high risk of developing postoperative bleeding, blood clotting, hemostatic disorders, hematopoietic disorders or cerebrovascular bleeding; treatment of perioperative pain with coronary artery bypass grafting (or using a cardiopulmonary bypass); coronary heart disease in patients with angina pectoris, myocardial infarction; cerebrovascular disease in stroke patients or with episodes of transient ischemic attack; peripheral artery disease.

In this dosage form, the drug is contraindicated in children.

Contraindications for iv use only:

• concomitant use of NSAIDs or an anticoagulant (including low-dose heparin);
• the presence of a history of hemorrhagic diathesis, confirmed or suspected cerebrovascular bleeding;
• operations associated with a high risk of bleeding;
• History of asthma;
• moderate or severe renal impairment (plasma creatinine 160 μmol / l);
• hypovolemia or dehydration for any reason.

Side effects

The following side effects include those associated with the administration of the drug almiral in the conditions of short-term and long-term use.

On the part of the blood and lymphatic system: thrombocytopenia, leukopenia, anemia (including hemolytic and aplastic), agranulocytosis.

From the side of the immune system: hypersensitivity, anaphylactic and anaphylactoid reaction (including arterial hypotension and shock), angioedema (including facial edema).

Mental disorders: disorientation, depression, insomnia, nightmares, irritability and other mental disorders.

From the nervous system: headache, dizziness, drowsiness, fatigue, paresthesia, memory impairment, cramps, anxiety, tremor, aseptic meningitis, taste disorder, stroke, confusion, hallucinations, sensory disturbance, general malaise.

From the side of the organ of vision: blurred vision, blurred vision, diplopia, optic neuritis.

From the side of the organ of hearing and the labyrinth: vertigo, ringing in the ears, hearing impairment.

From the side of the heart: palpitations, chest pain, heart failure, myocardial infarction.

From the vascular system: hypertension, arterial hypotension, vasculitis.

Respiratory, thoracic and mediastinal disorders: AD (including dyspnea), pneumonitis.

From the digestive system: nausea, vomiting, diarrhea, dyspepsia, abdominal pain, flatulence, anorexia, gastritis, gastrointestinal bleeding, vomiting with blood, hemorrhagic diarrhea, melena, stomach or intestinal ulcer with or without bleeding or with perforation (sometimes fatal, especially in elderly patients), colitis (including hemorrhagic and peptic ulcer exacerbation or Crohns disease), constipation, stomatitis (including peptic ulcer), glossitis, disorders of the esophagus, membrane intestinal strictures, pancreatitis t

Hepatobiliary disorders: increased levels of transaminases, hepatitis, jaundice, impaired liver function, fulminant hepatitis, hepatonecrosis, liver failure.

From the skin and subcutaneous tissues: rash, urticaria, bullous rash, eczema, erythema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyells syndrome), exfoliative dermatitis, hair loss, photosensitivity reaction, purpura, allergic purpura, itching.

From the side of the kidneys and urinary tract: acute renal failure, hematuria, proteinuria, nephrotic syndrome, interstitial nephritis, renal papillary necrosis.

General disorders and disorders at the injection site: reaction at the injection site, pain, hardening, edema, necrosis at the injection site, abscess at the injection site.

From the reproductive system and mammary glands: impotence.

The increased risk of thrombotic complications (for example, myocardial infarction or stroke) associated with the use of diclofenac, in particular at high therapeutic doses (150 mg / day) and with prolonged use, has been proven.

special instructions

Are common. unwanted effects can be minimized by using the drug in the minimum effective dose for the shortest possible period necessary to control symptoms.

Avoid the use of the drug Almiral with systemic NSAIDs, including selective COX-2 inhibitors, due to the lack of any synergistic benefits and the possibility of developing additional side effects.

Caution should be exercised when prescribing the drug to elderly patients. In particular, for the elderly with poor health and for patients with insufficient body weight, it is recommended to use the drug in minimum effective doses.

As with other NSAIDs, without prior exposure to diclofenac, allergic reactions can also occur, including anaphylactic / anaphylactoid ones.

Like other NSAIDs, Almiral due to its pharmacodynamic properties can mask the signs and symptoms of infection.

Sodium metabisulfite in solution for injection can also lead to individual severe hypersensitivity reactions and bronchospasm.

The effect on the digestive system. When using all NSAIDs, including diclofenac, there have been cases of gastrointestinal bleeding (vomiting of blood, melena), ulceration or perforation, which can be fatal and occur at any time during treatment with or without symptoms, and also in the presence of a history of serious phenomena from the gastrointestinal tract. These phenomena usually have more serious consequences in the elderly. If gastrointestinal bleeding or ulceration is detected in patients receiving diclofenac, the use of the drug must be discontinued.

As with all NSAIDs, including diclofenac, careful medical supervision is required; special care should be taken when prescribing diclofenac to patients with symptoms indicating gastrointestinal disorders, or with a stomach or intestinal ulcer, a history of bleeding or perforation. The risk of gastrointestinal bleeding, ulceration or perforation increases with increasing doses of NSAIDs, including diclofenac, as well as in individuals with a history of ulcers, especially with complications such as bleeding or perforation.

In elderly patients, an increased frequency of adverse reactions is noted with the use of NSAIDs, especially such as gastrointestinal bleeding and perforation, which can be fatal.

To reduce the risk of toxic effects on the digestive system in patients with a history of ulcer, especially with complications such as bleeding or perforation, and in elderly patients, treatment is started and maintained with minimal effective doses.

For such patients, as well as patients requiring the concomitant use of drugs containing low doses of acetylsalicylic acid, or other drugs that are likely to increase the risk of undesirable effects on the digestive system, consideration should be given to combination therapy using protective drugs (e.g. proton pump inhibitors or misoprostol).

Patients with a history of gastrointestinal toxicity, especially the elderly, should report any unusual abdominal symptoms (especially gastrointestinal bleeding). Cautions are also needed for patients receiving concomitant medications that may increase the risk of ulcers or bleeding, such as systemic corticosteroids, anticoagulants (e.g. warfarin), antithrombotic drugs (e.g. acetylsalicylic acid), or selective serotonin reuptake inhibitors.

Effect on the liver. Careful medical supervision is necessary if Almiral is prescribed to patients with impaired liver function, since their health condition may worsen.

As with other NSAIDs, including diclofenac, the level of one or more liver enzymes can increase. With long-term treatment with Almiral, regular monitoring of liver function is prescribed as a precaution.

If impaired liver function persists or worsens, if clinical signs or symptoms may be associated with progressive liver disease, or if other manifestations are noted (e.g. eosinophilia, rash), the use of the drug Almiral must be discontinued.

Diseases such as hepatitis can go away without prodromal symptoms.

Cautions are necessary if Almiral is used in patients with hepatic porphyria, because of the likelihood of provoking an attack.

Effect on the kidneys. Since fluid retention and edema have been reported in the treatment of NSAIDs, including diclofenac, special attention should be given to patients with impaired heart or kidney function, a history of hypertension, elderly people, patients receiving concomitant therapy with diuretics, or drugs that significantly affect kidney function , and patients with a significant decrease in extracellular fluid volume for any reason, for example, before or after major surgery. In such cases, monitoring of kidney function is recommended as a precaution. Discontinuation of therapy usually leads to a return to the condition prior to treatment.

Effect on the skin. In connection with the use of NSAIDs, including diclofenac, very rarely serious skin reactions were recorded (some of them were fatal), including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis. Obviously, a high risk of developing these reactions was identified at the beginning of the course of therapy, in most cases - during the 1st month of treatment. The use of the drug Almiral should be discontinued at the first appearance of skin rashes, damage to the mucous membrane, or any other signs of hypersensitivity.

Systemic lupus erythematosus and mixed connective tissue diseases. In patients with systemic lupus erythematosus and mixed connective tissue diseases, an increased risk of developing aseptic meningitis is possible.

Cardiovascular and cerebrovascular effects. Diclofenac can be prescribed to patients with significant risk factors for cardiovascular events (e.g. AH, hyperlipidemia, diabetes mellitus, smoking) only after a thorough clinical evaluation. Since the cardiovascular risks of diclofenac may increase with increasing doses and increasing the duration of therapy, it must be used for the shortest possible period and at the minimum effective dose.The patients need for diclofenac should be periodically reviewed to reduce the severity of symptoms and response to therapy. Use with caution in patients over the age of 65.

For persons with a history of hypertension and / or congestive heart failure of mild or moderate severity, appropriate monitoring and recommendations should be made, since cases of fluid retention and edema have been reported in connection with the use of NSAIDs, including diclofenac.

The use of diclofenac, especially in high doses (150 mg / day) for a long time, may be associated with a slight increase in the risk of developing arterial thrombotic events (for example, myocardial infarction or stroke).

It is not recommended to prescribe diclofenac in patients with uncontrolled hypertension, congestive heart failure, persistent coronary artery disease, peripheral artery disease and / or cerebrovascular disease, if necessary, it is possible only after a thorough assessment of the risk / benefit ratio only at a dose of no more than 100 mg / day. A similar assessment should be carried out before starting long-term treatment of patients with risk factors for the development of cardiovascular events (eg, hypertension, hyperlipidemia, diabetes mellitus and smoking).

Patients should be informed of the possibility of serious thrombotic events (chest pain, shortness of breath, weakness, speech impairment) at any time. In this case, consult a doctor immediately.

Effect on hematological parameters. With prolonged use of the drug, like other NSAIDs, monitoring of blood counts is recommended.

Like other NSAIDs, Almiral can temporarily inhibit platelet aggregation. Patients with hemostatic disorders, hemorrhagic diathesis, or hematological disorders should be carefully monitored.

BA in history. Patients with AD, seasonal allergic rhinitis, patients with swelling of the nasal mucosa (nasal polyps), COPD or chronic respiratory infections (especially those associated with allergic, rhinitis-like symptoms) are more likely than others to experience NSAIDs similar to exacerbation AD (so-called intolerance to analgesics / analginic asthma), Quinckes edema, urticaria. In this regard, special measures are recommended for such patients (readiness to provide emergency care). This also applies to patients with an allergy to other substances, which is manifested by skin reactions, itching or urticaria.

Like other drugs that suppress the activity of prostaglandinsynthetase, diclofenac sodium and other NSAIDs can provoke the development of bronchospasm in patients with BA or with a history of BA.

Fertility in women. The use of the drug Almiral can lead to impaired fertility in women and is not recommended when planning pregnancy. For women who may have difficulty conceiving or are being examined for infertility, consideration should be given to discontinuing the drug Almiral.

Use during pregnancy and lactation

Pregnancy. In the I and II trimester of pregnancy, Almiral can be prescribed only if the expected benefit to the mother outweighs the potential risk to the fetus, only in the minimum effective dose, the duration of treatment should be as short as possible. Like other NSAIDs, the drug is contraindicated in the last trimester of pregnancy (inhibition of uterine contractility and premature closure of the ductus arteriosus in the fetus is possible).

Inhibition of prostaglandin synthesis may adversely affect pregnancy and / or embryo / fetal development. Epidemiological studies indicate an increased risk of miscarriage and / or development of heart defects and gastroschisis after the use of an inhibitor of prostaglandin synthesis in early pregnancy. The absolute risk of cardiovascular disease has increased from less than 1% to about 1.5%.

It is possible that the risk increases with increasing doses and increasing treatment duration. It has been shown that in animals the administration of an inhibitor of prostaglandin synthesis leads to an increase in pre- and post-implantation losses and mortality of the embryo / fetus.

In addition, in animals treated with an inhibitor of prostaglandin synthesis during organogenesis, an increased frequency of various malformations, including from the cardiovascular system, was recorded. If the drug is used in women who are planning a pregnancy, or in the first trimester of pregnancy, the dose should be as low as possible, and the duration of treatment should be as short as possible.

In the III trimester of pregnancy, all prostaglandin synthesis inhibitors can affect the fetus as follows:

• cardiopulmonary toxicity (with premature closure of the ductus arteriosus and pulmonary hypertension);
• impaired renal function, which can progress to renal failure with oligohydramnios.

On mother and newborn, as well as at the end of pregnancy:

• prolongation of bleeding time is possible, antiplatelet effect, which can develop even at very low doses;
• inhibition of uterine contractions, which leads to a delay or prolongation of labor.

Therefore, Almiral is contraindicated during the third trimester of pregnancy.

The period of breastfeeding. Like other NSAIDs, diclofenac passes into breast milk in a small amount. Thus, in order to avoid undesirable effects on the baby, the drug should not be used during lactation.

Fertility. Like other NSAIDs, diclofenac can affect a woman’s fertility. The drug is not recommended for women planning a pregnancy. Women who have difficulty with fertilization, or those who have been tested for infertility, should stop using the drug.

The ability to influence the reaction rate when driving vehicles or working with other mechanisms. Patients who have experienced visual impairment, dizziness, drowsiness, or other disorders of the central nervous system during treatment with Almiral should refrain from driving vehicles and working with other mechanisms.

Interactions

The following are the interactions that have been reported with the use of r-ra for injection and / or other dosage forms of diclofenac.

Lithium. With the simultaneous use of diclofenac can increase the concentration of lithium in blood plasma. Monitoring of plasma lithium levels is recommended.

Digoxin. With the simultaneous use of diclofenac may increase the concentration of digoxin in blood plasma. Monitoring plasma digoxin levels is recommended.

Diuretics and antihypertensive agents. Like other NSAIDs, the simultaneous use of diclofenac with diuretics and antihypertensive agents (e.g. β-adrenergic blockers, ACE inhibitors) can lead to a decrease in their antihypertensive effect due to inhibition of the synthesis of vasodilating prostaglandins. Thus, this combination is used with caution, and patients, especially the elderly, should be closely monitored for blood pressure. Patients should receive proper hydration; it is also recommended that renal function be monitored after concomitant therapy is started and regularly after it, especially with respect to diuretics and ACE inhibitors, due to an increased risk of nephrotoxicity.

Drugs that are known to cause hyperkalemia. Concomitant treatment with potassium-sparing diuretics, cyclosporine, tacrolimus, or trimethoprim may be associated with an increase in the level of potassium in the blood plasma, therefore, monitoring the condition of patients should be carried out more often.

Anticoagulants and antithrombotic agents. Precautions are recommended, as concomitant administration may increase the risk of bleeding.Although clinical studies do not indicate the effect of diclofenac on anticoagulant activity, there is some evidence of an increased risk of bleeding in patients receiving diclofenac and anticoagulants simultaneously. Therefore, to ensure that changes in the dose of anticoagulants are not required, careful monitoring of the health status of such patients is recommended. Like other NSAIDs, diclofenac in high doses can temporarily inhibit platelet aggregation.

Other NSAIDs, including selective COX-2 and GCS inhibitors. The simultaneous administration of diclofenac and other systemic NSAIDs or GCS may increase the risk of gastrointestinal bleeding or ulcers. The simultaneous use of two or more NSAIDs should be avoided.

Selective serotonin reuptake inhibitors. The simultaneous use of systemic NSAIDs and selective serotonin reuptake inhibitors can increase the risk of bleeding in the digestive tract.

Antidiabetic drugs. Diclofenac can be used with oral antidiabetic agents without affecting their clinical effect. However, isolated cases are known with both hypo- and hyperglycemic effects, requiring changes in the dose of antidiabetic drugs during treatment with diclofenac. Such conditions require monitoring of blood glucose levels, which is a precaution with concomitant therapy.

Methotrexate. Diclofenac can suppress the clearance of methotrexate in the renal tubules, which leads to an increase in the level of methotrexate. With the introduction of NSAIDs, including diclofenac, less than 24 hours before treatment with methotrexate, caution is recommended, since blood concentration and toxicity of methotrexate may increase. Serious toxicity cases have been reported when methotrexate and NSAIDs, including diclofenac, were used at intervals of 24 hours. This interaction is mediated through the accumulation of methotrexate as a result of impaired renal excretion in the presence of NSAIDs.

Cyclosporin. Diclofenac, like other NSAIDs, can increase cyclosporin nephrotoxicity due to the effect on kidney prostaglandins. In this regard, it should be used at lower doses than in patients who do not use cyclosporine.

Tacrolimus. When using NSAIDs with tacrolimus, an increased risk of nephrotoxicity is possible, which can be mediated through the renal antiprostaglandin effects of NSAIDs and a calcineurin inhibitor.

Antibacterial quinolones. There is some evidence regarding seizures that may result from the combined use of quinolones and NSAIDs. This can be noted in patients with both the presence and absence of a history of epilepsy or seizures. Therefore, caution should be exercised when considering quinolone use in patients already receiving NSAIDs.

Phenytoin. When using phenytoin simultaneously with diclofenac, it is recommended to monitor the concentration of phenytoin in blood plasma in connection with the expected increase in phenytoin exposure.

Colestipol and colestyramine. These drugs may cause a delay or decrease in absorption of diclofenac. Thus, it is recommended to use diclofenac at least 1 hour before or 4-6 hours after the use of colestipol / colestyramine.

Cardiac glycosides. The simultaneous use of cardiac glycosides and NSAIDs can increase heart failure, reduce glomerular filtration rate and increase blood plasma glycosides.

Mifepristone NSAIDs should not be used within 8-12 days after the use of mifepristone, since NSAIDs can reduce the effect of the latter.

Powerful CYP 2C9 inhibitors. Caution is advised when concomitantly administering diclofenac with potent CYP 2C9 inhibitors (e.g. voriconazole), which can lead to a significant increase in C_max in blood plasma and exposure to diclofenac due to inhibition of its metabolism.

Incompatibility. Almiral, injection solution, must not be mixed with other injection solutions.

Overdose

Symptoms there is no typical clinical picture of the effects of an overdose of diclofenac. an overdose can cause symptoms such as headache, nausea, vomiting, epigastric pain, gastrointestinal bleeding, diarrhea, dizziness, disorientation, agitation, coma, drowsiness, tinnitus, loss of consciousness or cramps. in case of severe poisoning, hep and liver damage are possible.

Treatment. Within 1 hour after applying a potentially toxic amount of the drug inside, you should consider using activated carbon. In addition, in adults, the possibility of gastric lavage within 1 h after the application of potentially toxic