Diclofenac contraindications and side effects. Diclofenac in the treatment of pain syndromes. Diclofenac: instructions for use

Excipients: propylene glycol, mannitol, benzyl alcohol, sodium metabisulfite, sodium hydroxide 1 M solution, water for injection.

Description

A clear, slightly yellowish solution with a faint odor of benzyl alcohol.

pharmachologic effect

Phenyl derivative acetic acid; has anti-inflammatory, analgesic and antipyretic effects. By indiscriminately inhibiting COX 1 and 2, it disrupts the metabolism of arachidonic acid and reduces the amount of prostaglandins (Pg) at the site of inflammation. Most effective for pain inflammatory in nature. Like all NSAIDs, the drug has antiplatelet activity.

Pharmacokinetics

Rapidly absorbed after intramuscular administration. The time to reach the maximum concentration when used at a dose of 75 mg is 15-30 minutes, the value of the maximum concentration is 1.9-4.8 (on average 2.7) μg/ml. 3 hours after administration, plasma concentrations average 10% of the maximum. Metabolized in the liver mainly by oxidation and conjugation. About 99% is bound to plasma proteins, mainly albumin. Approximately 2/3 of the administered dose is excreted in the urine, and the rest in bile. 72 hours after administration, almost 90% of the administered dose is eliminated from the body. Creates high concentrations in synovial fluid. Penetrates in small quantities into breast milk. 50% of the drug is metabolized during the “first pass” through the liver. The area under the concentration-time curve (AUC) is 2 times less after oral administration of the drug than after parenteral administration of the same dose. In patients with chronic hepatitis or compensated liver cirrhosis, pharmacokinetic parameters do not change.

In patients with renal failure with creatinine clearance less than 10 ml/min, the excretion of metabolites in bile increases, so an increase in their concentration in plasma is not observed.

Indications for use

Intramuscular administration of diclofenac sodium is indicated for acute pain, including renal colic, exacerbation of osteoarthritis and rheumatoid arthritis, acute back pain, gout attack, trauma and fracture in acute period, postoperative pain.

Contraindications

Hypersensitivity (including to other NSAIDs); erosive and ulcerative lesions of the gastrointestinal tract (in the acute phase); gastro- intestinal bleeding or perforations associated with a history of NSAID use; history of active or recurrent gastric ulcer/bleeding (two or more episodes of confirmed ulcer or bleeding); bronchial asthma(risk of exacerbation); hives or acute rhinitis caused by taking acetylsalicylic acid or other non-steroidal anti-inflammatory drugs; severe renal/liver and heart failure; hematopoietic disorders; children's age (up to 15 years); pregnancy and lactation period.

The use of diclofenac is contraindicated in patients with established coronary disease heart disease, peripheral arterial disease or cerebrovascular disease.

With caution: peptic ulcer of the stomach and duodenum, ulcerative colitis, Crohn's disease, history of liver disease, hepatic porphyria, chronic renal failure, chronic heart failure, arterial hypertension, a significant decrease in circulating blood volume (including after massive surgical intervention), elderly patients over 65 years of age (including those receiving diuretics, debilitated patients and patients with low body weight), simultaneous use of glucocorticoids, anticoagulants, antiplatelet agents, selective serotonin reuptake inhibitors.

Pregnancy and lactation

Suppression of prostaglandin synthesis may adversely affect the course of pregnancy and intrauterine development fetus Data from epidemiological studies indicate increased risk miscarriage and/or development of heart defects and gastroschisis after taking prostaglandin synthesis inhibitors in early pregnancy. The risk is believed to increase with increasing dose and duration of therapy. It has been shown that in animals, the administration of prostaglandin synthesis inhibitors leads to disruption of embryo implantation. In addition, in animals receiving a prostaglandin synthesis inhibitor during the period of organogenesis, the incidence of various developmental defects, including developmental disorders of the cardiovascular system, increased. The use of diclofenac in pregnant women has not been studied. The use of the drug during pregnancy is contraindicated. When taking prostaglandin synthesis inhibitors in the third trimester of pregnancy, the fetus may:

Premature closure ductus arteriosus and pulmonary hypertension;

Renal dysfunction, with progression of which renal failure with oligohydroamnion develops.

In the mother and in the fetus/newborn, bleeding time may be prolonged; the antiaggregation effect may occur even after taking very low doses of diclofenac. When taking diclofenac at the end of pregnancy, weakness may develop labor activity and increasing the duration of labor.

Breastfeeding period. Like other NSAIDs, diclofenac is found in mother's milk V small quantity. Diclofenac is contraindicated during breastfeeding.

Effect on fertility. Like other NSAIDs, diclofenac can affect a woman's fertility. It is not recommended for women planning pregnancy. Women who have difficulty conceiving or who have been evaluated for infertility should stop taking diclofenac.

Directions for use and doses

Intramuscularly, deep. The drug is used to treat acute conditions or stopping an exacerbation of a chronic disease.

Single dose for adults - 75 mg (one ampoule). If necessary, repeated administration is possible, but not earlier than after 12 hours. The maximum daily dose is 150 mg (2 ampoules).

The duration of intramuscular administration of the drug should not exceed 2 weeks, for patients over 65 years of age - no more than 2 days, under close medical supervision, then proceed to oral administration.

In order to reduce the risk of adverse events, it is necessary to prescribe the drug in the lowest effective dose for the shortest possible time.

Dosing in the elderly. Despite the absence of clinically significant changes in the pharmacokinetics of diclofenac in elderly patients, non-steroidal anti-inflammatory drugs should be used with caution in patients at increased risk of adverse reactions. It is recommended to use the lowest effective dose in frail elderly patients or in patients with reduced body weight; it is necessary to monitor the development of gastrointestinal bleeding in patients taking NSAIDs.

Dosing for renal failure. Diclofenac is contraindicated in patients with severe renal impairment. Not carried out special research among patients with renal failure, therefore there are no dosage recommendations. It is recommended to prescribe diclofenac with caution to patients with mild to moderate renal failure.

Dosing for liver failure. Diclofenac is contraindicated in patients with severe hepatic impairment. No specific studies have been conducted in patients with liver failure, so there are no specific dosage recommendations. Diclofenac should be used with caution in patients with mild to moderate hepatic impairment.

Side effect

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

From the outside digestive system : often- NSAID gastropathy (gastralgia, nausea, vomiting, diarrhea, abdominal pain, flatulence), anorexia; rarely- gastritis, proctitis, gastrointestinal bleeding intestinal tract(vomiting blood, melena, bloody diarrhea), gastrointestinal ulcers (with or without bleeding or perforation), nonspecific colitis with bleeding, dry mouth; very rarely- stomatitis, glossitis, esophageal damage, diaphragm-like intestinal strictures, nonspecific hemorrhagic colitis, exacerbation of ulcerative colitis or Crohn's disease, constipation, pancreatitis.

From the liver: often - increased levels of transaminases; rarely- toxic hepatitis (with or without jaundice), fulminant hepatitis, liver dysfunction; very rarely- fulminant hepatitis.

From the nervous system: often- headache, dizziness, increased fatigue; rarely– drowsiness; very rarely- impaired sensitivity, incl. paresthesia, memory disorders, tremor, convulsions, anxiety, cerebrovascular disorders, disorientation, depression, insomnia, nightmares, irritability, mental disorders, aseptic meningitis; unknown – neuritis optic nerve, confusion, hallucinations, malaise.

From the senses: often– vertigo; very rarely- decreased visual acuity, diplopia, scotoma, decreased hearing, tinnitus.

From the outside skin: often- rash; rarely- urticaria; very rarely– hematomas, bullous rashes, eczema, incl. multiforme and Stevens-Johnson syndrome, Lyell's syndrome, exfoliative dermatitis, itching, hair loss, photosensitivity, purpura.

From the urinary system: often - nephrotic syndrome(edema); very rarely- acute renal failure, hematuria, proteinuria, oliguria, interstitial nephritis, papillary necrosis, cystitis, electrolyte imbalance in the form of a syndrome reminiscent of inadequate secretion of antidiuretic hormone, spontaneous hyponatremia.

From the hematopoietic organs: rarely- thrombocytopenia, leukopenia, hemolytic and aplastic anemia, agranulocytosis, local spontaneous bleeding and inhibition of platelet aggregation, prolongation of bleeding time.

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

From the respiratory system: rarely- bronchial asthma (including shortness of breath), very rarely– pneumonitis.

Endocrine disorders: very rarely- impotence.

Allergic reactions:very rarely - anaphylactic/anaphylactoid reactions, including a marked decrease in blood pressure and shock, angioedema(including faces).

At the site of intramuscular injection: often- burning; very rarely- infiltration, aseptic necrosis, necrosis of adipose tissue.

Overdose

Symptoms: dizziness, headache, hyperventilation, clouding of consciousness, myoclonic convulsions, nausea, vomiting, abdominal pain, bleeding, impaired liver and kidney function.

Treatment: gastric lavage, administration of activated carbon, symptomatic therapy aimed at eliminating the increase blood pressure, renal dysfunction, seizures, gastrointestinal irritation, respiratory depression. Forced diuresis and hemodialysis are ineffective (due to the significant connection with proteins and intensive metabolism).

Interaction with other drugs

Lithium. When used simultaneously with lithium, diclofenac may cause an increase in the concentration of lithium in plasma, which requires regular monitoring of the level of the latter in the blood.

Digoxin. When used simultaneously with digoxin, diclofenac may cause an increase in the concentration of digoxin in plasma, which requires regular monitoring of the level of the latter in the blood.

Diuretics and antihypertensive drugs. Concomitant use of diclofenac with diuretics or antihypertensive drugs (for example, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors) may lead to a decrease in the antihypertensive effect as a result of suppression of the synthesis of vasodilating prostaglandins. In this regard, this combination must be prescribed with caution and blood pressure control is mandatory, especially in elderly patients. Adequacy of hydration should be monitored and renal function periodically monitored after initiation of combination therapy, especially when using diuretics and ACE inhibitors, due to an increased risk of nephrotoxicity.

Medicines that can cause hyperkalemia. Concomitant treatment with potassium-sparing diuretics, cyclosporine, tacrolimus or trimethoprim may lead to increased blood potassium levels, which should be monitored frequently.

Anticoagulants and antiplatelet agents. Concomitant use may result in an increased risk of bleeding. Despite the lack of clinical trial data confirming the effect of diclofenac on the action of anticoagulants, there are isolated reports of an increased risk of bleeding in patients receiving diclofenac and anticoagulants simultaneously. When administered together, careful monitoring of hemostasis is necessary. Like other non-steroidal anti-inflammatory drugs, high dose diclofenac can reversibly inhibit platelet aggregation.

Other NSAIDs, including selective cyclooxygenase-2 inhibitors and corticosteroids. Coadministration of diclofenac with other systemic NSAIDs or corticosteroids may increase the risk of gastrointestinal bleeding or ulcers. Prescribing two or more NSAIDs at the same time should be avoided.

Selective serotonin reuptake inhibitors (SSRIs). The simultaneous administration of diclofenac and SSRIs may lead to an increased risk of gastrointestinal bleeding.

Antidiabetic drugs. Clinical studies have shown that diclofenac can be used together with oral antidiabetic agents without affecting their clinical effect. However, there are isolated cases of the development of both hypoglycemia and hyperglycemia, which require dose adjustment of antidiabetic agents during treatment with diclofenac. Such conditions require monitoring of blood glucose levels, which is preventive measure during concomitant therapy.

Methotrexate. Caution is recommended when administering NSAIDs less than 24 hours before or after treatment with methotrexate, as it may increase the concentration of methotrexate in the blood and increase its toxicity.

Cyclosporine. Diclofenac, like other NSAIDs, may increase the nephrotoxicity of cyclosporine due to its effect on the secretion of prostaglandins in the kidneys. Therefore, diclofenac when used with cyclosporine should be administered in lower doses than in patients not receiving cyclosporine.

Tacrolimus. Increased nephrotoxicity is possible when used simultaneously with diclofenac.

Antibacterial quinolones. There are isolated reports of seizures that may result from the concomitant use of quinolones and NSAIDs.

Phenytoin. At simultaneous use diclofenac and phenytoin, monitoring of phenytoin plasma levels is necessary due to increased phenytoin exposure.

Colestipol and cholestyramine. These drugs may increase or decrease the absorption of diclofenac. In this regard, it is recommended to take diclofenac no earlier than 4-6 hours after taking colestipol/cholestyramine.

Cardiac glycosides. The simultaneous administration of cardiac glycosides and NSAIDs can lead to worsening heart failure, a decrease in glomerular filtration rate and an increase in the concentration of cardiac glycoside in plasma.

Mifepristone. NSAIDs, including diclofenac, should not be used for 8-12 days after using mifepristone due to possible reduction effect of mifepristone.

Potential inhibitorsCYP2C9. Caution must be exercised when prescribing diclofenac with potential inhibitors CYP2C9(eg, voriconazole), which may lead to increased peak plasma concentrations and exposure of diclofenac due to inhibition of diclofenac metabolism.

Precautionary measures

In order to reduce the risk of adverse events, it is necessary to prescribe the drug in the lowest effective dose for the shortest possible time. The simultaneous use of diclofenac with systemic NSAIDs, including selective cyclooxygenase-2 inhibitors, should be avoided due to the lack of evidence indicating a synergistic effect, as well as due to potentiation of undesirable effects.

It is necessary to prescribe the drug with caution in old age. The lowest effective dose should be used in frail elderly patients and patients with low body weight.

As with other non-steroidal anti-inflammatory drugs, diclofenac can cause allergic reactions, including anaphylactic/anaphylactoid reactions, even in the absence of previous use of the drug.

Like other NSAIDs, diclofenac may mask signs and symptoms of infection due to its pharmacodynamic properties.

Sodium metabisulfite present in the solution can cause severe hypersensitivity reactions and bronchospasm.

Effect on the gastrointestinal tract. Diclofenac, like all NSAIDs, may cause gastrointestinal bleeding (vomiting of blood, melena), ulceration or perforation (including fatal) at any time during treatment, with or without symptoms and regardless of a history of gastrointestinal lesions. These complications may have more serious consequences in old age. If bleeding or ulceration of the gastrointestinal tract develops, the drug must be discontinued. Careful medical supervision is required when prescribing diclofenac to patients with symptoms of gastrointestinal dysfunction or a history of gastric or intestinal ulcers, bleeding or gastrointestinal perforations. The risk of gastrointestinal bleeding, ulceration or perforation is higher with increasing doses of diclofenac, as well as in patients with a history of bleeding or perforation.

An increased incidence of adverse reactions to NSAIDs has been observed in older adults, especially gastrointestinal bleeding and perforation, which can be fatal. To reduce the risk of gastrointestinal toxicity in patients, especially those with a history of bleeding and perforation, as well as in old age, treatment should be initiated and maintained at the lowest effective dose of the drug.

Combination therapy with protective agents to reduce the risk of gastrointestinal toxicity (eg, misoprostol or proton pump inhibitors) should be considered, especially in patients requiring concomitant use medicines containing low doses acetylsalicylic acid (ASA/aspirin) or drugs that increase the risk of damage to the gastrointestinal tract. Patients with a history of gastrointestinal toxicity, especially the elderly, should report any unusual abdominal symptoms.

Diclofenac should be used with caution in patients receiving concomitant medications that increase the risk of ulceration or bleeding: systemic corticosteroids, anticoagulants (warfarin), selective serotonin reuptake inhibitors (SSRIs) or antiplatelet drugs (acetylsalicylic acid). Careful medical supervision and caution are required when prescribing diclofenac to patients with nonspecific ulcerative colitis or Crohn's disease due to the possible development of an exacerbation.

Patients with impaired liver function. When prescribing the drug to patients with liver diseases, liver function may deteriorate. It is possible to develop hepatitis while taking diclofenac without prodromal symptoms. Caution must be exercised when using diclofenac in patients with hepatic porphyria, since taking the drug can trigger the development of an attack.

During therapy with diclofenac, an increase in the activity of liver enzymes may be observed. Diclofenac should be discontinued immediately if elevated liver enzyme activity persists or worsens.

Patients with impaired renal function. Cases of fluid retention and edema have been reported while taking NSAIDs, including diclofenac. Particular caution is required when prescribing diclofenac to patients with impaired cardiac and renal function, arterial hypertension, the elderly, patients receiving concomitant treatment with diuretics or drugs that affect renal function, as well as in patients with significant depletion of extracellular fluid volume, regardless of from the cause (for example, before or after major surgery). As a precautionary measure, monitoring of renal function is recommended when using diclofenac. Discontinuation of therapy usually results in restoration of function to the original level.

Effect on skin. Serious skin adverse reactions (including fatalities) have been observed very rarely with the use of NSAIDs: exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis. The greatest risk of developing these reactions was noted at the beginning of the course of therapy, during the first month of treatment. The use of diclofenac should be discontinued at the first appearance of skin rash, mucosal lesions or any other signs of hypersensitivity.

Patients with SLE and diseases connective tissue. An increased risk of aseptic meningitis has been reported in patients with systemic lupus erythematosus (SLE) and connective tissue diseases.

Influence at cardiovascular system . It is necessary to monitor the condition of patients with arterial hypertension and/or mild to moderate chronic heart failure due to possible delay fluid and the appearance of edema.

Due to the possible increased risk of cardiovascular events with long-term use or at a high dose of the drug, patients should be prescribed diclofenac at the minimum effective dose and for the shortest possible time necessary to reduce the severity of symptoms. The need for symptom relief and response to treatment should be periodically re-evaluated. Clinical trials and epidemiological data suggest a possible small increase in the risk of arterial thrombosis (eg, myocardial infarction or stroke) with the use of diclofenac, especially at high doses (150 mg per day) and during long-term treatment.

In patients with uncontrolled arterial hypertension and chronic heart failure, prescribing diclofenac is possible only after a careful assessment of the benefit/risk ratio. This assessment should also be carried out before starting treatment in patients with risk factors for developing cardiovascular diseases(eg, hypertension, hyperlipidemia, diabetes, smoking).

Effect on the blood system. During long-term treatment With diclofenac, like other NSAIDs, blood monitoring is recommended. Diclofenac can reversibly inhibit platelet aggregation. Careful monitoring of patients with hemostasis disorders is necessary. hemorrhagic diathesis or hematological disorders.

Patients with bronchial asthma. In patients with bronchial asthma, seasonal allergic rhinitis, swelling of the nasal mucosa (including nasal polyps), chronic obstructive pulmonary disease or chronic respiratory tract infections (especially with allergic rhinitis-like symptoms), reactions to NSAIDs, such as an asthma attack (so called analgesic intolerance/aspirin asthma), angioedema or urticaria are more common than in other patients. The drug should be used in these patients with extreme caution, if possible emergency assistance. This statement also applies to patients who are allergic to other substances. Like other drugs that inhibit cyclooxygenase activity, diclofenac sodium and other NSAIDs may cause bronchospasm when administered to patients with a history of asthma.

Impact on the ability to drive vehicles and potentially dangerous mechanisms. During the treatment period, you should refrain from driving vehicles and engaging in other potentially dangerous activities. dangerous species activities that require increased concentration and speed of psychomotor reactions.

Release form

In ampoules of 3 ml, 5 ampoules in a blister pack, 1 or 2 blister packs together with instructions for use are placed in a pack.

Storage conditions

Store in a place protected from light at a temperature not exceeding 25 0 C.

Keep out of the reach of children.

Best before date

Do not use after the expiration date stated on the package.

Conditions for dispensing from pharmacies

Diclofenac sodium, solution analogs, synonyms and group drugs

Self-medication can be harmful to your health.
You should consult your doctor and read the instructions before use.

Side effects may affect the digestive system in the form of nausea, vomiting, weight loss, epigastric pain, bloating, constipation, diarrhea; in some cases, erosion and bleeding of the gastrointestinal tract are likely to develop; in rare cases, liver failure may develop. When the drug was administered into the anus, there were exceptional cases when inflammatory processes colon with effusion of blood, increased symptoms of ulcerative colitis.

Damages to the central and peripheral nervous system can be observed in the form of dizziness, headache, loss of sleep, irritability, lethargy; in rare cases, a feeling of numbness of the skin, blurred vision, nervous tic, mental disorders. Damage to the hematopoietic organs in rare cases manifests itself in the form of a decrease in hemoglobin levels, a decrease in the number of platelets, leukocytes and granulocytes in the peripheral blood.

Organ damage genitourinary system may manifest as renal failure.

In rare cases, hair loss may occur. It is also possible to experience allergic reactions in the form of skin rash, itching; When using eye drops, itching and increased sensitivity of the mucous membrane of the eye to the action of ultraviolet rays may occur.

A burning sensation may occur in the area of ​​intramuscular injection; when used externally, rarely - skin rashes, itching, and irritation.

Before use, you should consult a specialist.

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ATTENTION! The information posted on our website is for reference or popular information only and is provided by to a wide circle readers for discussion. Prescription of medications should only be carried out qualified specialist, based on medical history and diagnostic results.

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Diclofenac is anti-inflammatory non-steroidal drug. It has a pronounced analgesic, anti-inflammatory and antipyretic effect. It looks like ampoules with liquid from pale yellow to amber. The composition of the drug includes:

1. The active ingredient is sodium or potassium salt Diclofenac - it does not play a special role which salt was used in the production of the drug. 2. Propylene glycol

3. Sodium pyrosulfate

4. Sodium hydroxide 5. Benzyl alcohol

6. Water for injections

Many doctors and pharmacists prefer the drug Diclofenac, since it is the golden mean among drugs of this type. Its effect is noticeable within the first hour after administration. It also does not cause strong and frequent side effects, such as the opening of stomach or intestinal ulcers, unlike other medications.

Diclofenac reduces the concentration of prostaglandins in the oral mucosa and gastrointestinal tract, which reduces the resistance of the walls of the vessels of the stomach and intestines to various factors that damage them.

Intramuscular injections Diclofenac is given as a course of injections for no more than ten days. There is a dosage of 25 mg/ml and 75 mg/ml. The drug is injected into the femoral muscle - the middle of the thigh, if a person injects it himself, or into the gluteal muscle in the upper outer square with a long needle with a five-pack injection syringe. This method of administration will avoid swelling at the injection site, swelling and unpleasant conditions. It is contraindicated to administer Diclofenac intravenously or subcutaneously - this can lead to tissue necrosis and subcutaneous tissue.

The drug is used for: 1. Arthritis, Arthrosis, Rheumatism and other diseases of the joints and musculoskeletal system - musculoskeletal system. The analgesic effect is achieved after just twenty minutes. After two hours, the peak concentration of the active component in human blood occurs. A course of Diclofenac will reduce discomfort in bones and joints in the early morning hours; 2. Degenerative-dystrophic diseases; 3. Ankylosing spondylitis; 4. Leg injuries, kneecaps, joints, ankle; 5. Inflammatory processes in muscles and joints; 6. Postoperative period, during which patients often suffer from severe pain; 7. Neuralgia; 8. Gout; 9. Spondylopathy – damage to the joints of the spine; 10. Polymyalgia; 11. Deforming osteoarthritis. In the case of this disease, Diclofenac anesthetizes and eliminates synovitis, prevents further destruction of cartilage and bone; 12. To relieve pain during migraines. 13. Pain during menstruation in women; 14. The drug is used in case of hepatic or renal colic; 15. Herniated intervertebral discs with severe pain;

16. Rarely, the drug is prescribed for influenza and other colds as an antipyretic with an analgesic effect.

Diclofenac is contraindicated in pregnant and lactating women, since the active components penetrate the placenta - distort the formation of the fetus, and can cause serious damage to the newborn, penetrating into mother's milk with blood plasma. Children under six years old. Children 6–12 years old must be supervised by a local pediatrician or a specialist doctor in a hospital and on the recommendation of a specialist.

The drug is not recommended for use by patients with diseases of the gastrointestinal tract, stomach ulcers and intestinal problems, colitis. Patients with bronchial asthma and severe allergic symptoms for non-steroidal drugs. People with severe chronic liver and kidney diseases or damage to them.

It is undesirable to prescribe the drug in parallel with other non-steroidal anti-inflammatory drugs, as this can lead to accumulation of the active substance and further overdose of the drug.

Only on the recommendation of a doctor after all tests, the drug is prescribed to people with heart disease and high blood pressure. It is also worth remembering that it is strictly forbidden to combine Diclofenac injections with drinking alcohol - this has an extremely negative effect on the mucous membrane of the digestive system.

Overdose symptoms: 1. Abdominal pain; 2. From the central nervous system: migraines, headaches, lethargy, decreased visual acuity, blurred vision, dizziness. After administration of the drug, it is not recommended to start administering vehicles, since the body’s reactions from the nervous system are reduced; 3. Mild tremor and possible slight increase in temperature; 4. Rapid breathing; 5. Allergic reactions; 7. Convulsions; 8. Decreased appetite; 9. Nausea, vomiting; 10. Bloating; 11. Meningitis; 12. Increased pulse and blood pressure;

13. Diarrhea.

If side effects are detected due to an overdose of the drug, therapy is immediately suspended, gastric lavage, enemas are prescribed, it is recommended to consume more fluids, drips with saline are possible and additional therapy to support kidney and liver function.

From phenylacetic acid by chemical reactions get basic active ingredient Diclofenac. It stops the production of arachidonic acid from soft tissue cells and joints, reducing pain and reducing inflammation. The drug reduces swelling of the joints, normalizing the balance of intra-articular fluid. The drug affects blood circulation in tissue cells, normalizing it.

For pain medium degree severity, one injection per day is prescribed. For more pronounced pain syndrome, the dose is increased to two to three injections. The daily dose for an adult should not exceed 250 mg/ml, which is no more than three ampoules of 75 mg/ml dosage.

Before prescribing a course of Diclofenac, it is necessary to conduct a blood screening to identify a hypothetical discrepancy with the body’s capabilities of this patient.

Interaction with other medications: 1. When taken together with acetylsalicylic acid, a decrease in Diclofenac in the blood plasma is observed; 2. Reduces the impact of antihypertensive drugs; 3. Simultaneous use with other non-steroidal drugs has a high risk of immediate overdose; 4. When combining Diclofenac with Warfarin, bleeding appears in the internal organs;

5. When taking antidepressants, their dose must be reduced when diclofenac injections are prescribed.

Most patients who received a Diclofenac injection note a rapid effect and a decrease in pain. After only half an hour, relief occurs, whereas when taking the tablet form, the effect is not so pronounced and occurs much later. The pain subsides for up to eight hours. When administered intramuscularly, Diclofenac is gradually absorbed into the blood plasma and distributed throughout the body, prolonging the analgesic effect. Whereas when taking a pill, you have to wait quite a long time for the effect - about two hours, and it soon goes away - after another two or three hours.

The most common side effects patients noted were dizziness, diarrhea, drowsiness, increased irritability and aggressiveness. Pain and a burning sensation at the site of puncture of muscle tissue are also common. Possible abscess and necrosis of the subcutaneous tissue is not so common and occurs either due to the characteristics of the patient’s body or due to inept administration of the drug. In this case, a cold compress must be applied to the damaged injection site; heating is prohibited.

Diclofenac often does not help patients with advanced diseases of bones and joints pronounced effect, since it is a drug with an average gap between effectiveness and the least side effects. However, many people suffering from constant pain Diclofenac is used for diseases of bones and joints due to its low cost and availability.

Often patients inject Diclofenac on their own, without seeking help from a doctor. This leads to a host of undesirable consequences: overdose, side effects, the opening of new ulcers in the stomach and intestines, and a decrease in the analgesic effect. In case of any disease, you must seek help from a specialist who will select the duration of the course, dosage, and method of application. Then the treatment will become effective.

medn.ru

Side effects of diclofenac

Informational portal No. 1 About the fight against pain and inflammation

Despite its worldwide recognized effectiveness, the anti-inflammatory drug diclofenac still has side effects. Moreover, they do not develop in the same way; the risk group includes, first of all, elderly people who are over sixty-five years old and women who are particularly sensitive to drugs in this group.

Those who have peptic ulcers, smoke or abuse alcohol should also be careful. Great opportunity to feel side effects for those who prefer spicy, salty, fatty foods, takes several NSAIDs at the same time or undergoes parallel treatment with glucocorticoids.

When taking diclofenac, side effects may vary depending on the route of administration. Most often, the medicine is administered intramuscularly. At the same time, the central nervous system may react with headache, insomnia and irritability. Fatigue sets in quickly.

The digestive system responds with constipation, flatulence, gastritis, pancreatitis, nausea and vomiting. In severe cases, possible internal bleeding. Problems with the urinary system can cause acute renal failure. Problems in the respiratory system can cause bronchospasms. By affecting hematopoiesis, diclofenac causes anemia, leukopenia, thrombocytopenia. After an injection, sealing pads often form on the skin.

If you use diclofenac topically, side effects appear primarily on the skin. It could be a burning sensation allergic rashes, redness of the skin.

In addition, diclofenac promotes fluid retention in the body and can cause swelling and increased blood pressure.

Based on the above, we can conclude that, compared with the high effectiveness of the drug diclofenac, side effects are not common and do not pose a threat to life.

This means that the drug can be considered one of the main ones, capable of relieving pain and fighting inflammatory processes in the body. The risk is minimal and is fully compensated by high efficiency.

diklofenak.ru

Diclofenac

Diclofenac is medicinal substance from the group of NSAIDs (non-steroidal anti-inflammatory drugs), a derivative of acetic acid. The active ingredient of the drug is of the same name – diclofenac. Release forms:

• Tablets – 100 mg of active substance each
• Tablets – 50 mg of active substance each
• Tablets – 25 mg of active substance each
• Gel for external use – 1%, 40, 50 and 60 g
• Ointment for external use – 1%, 30 g
• Solution for injection – 25 mg in 1 ml, ampoules of 3 ml

Indications for use of Diclofenac

Diclofenac is indicated for all diseases spinal column, because they are all accompanied by pain, and most of them are accompanied by inflammatory processes of varying severity.

Contraindications

There are many contraindications to the use of Diclofenac concomitant diseases patient:

• Lactation period
• Pregnancy for the first 12 weeks of gestation and from 28 weeks until birth
• Children under 6 years old
• Ulcers in the stomach and intestines
• Previous history of gastrointestinal bleeding
• Kidney failure
• Liver failure
• Urticaria to any NSAIDs
• Allergy to the drug and its components
• Bronchial asthma
• Porphyria (take in extreme cases and with caution)

Operating principle

The action of Diclofenac is based on blocking the enzyme cyclooxygenase (COX-1 and COX-2). This leads to inhibition of the development of inflammation processes in tissues. The drug also affects pain centers in the brain, being a fairly strong analgesic.

As a result, the patient feels a noticeable reduction in pain, inflammation decreases, the range of motion in the spine increases, stiffness in the vertebrae noticeably decreases, and swelling in the joints of the spinal column decreases slightly.

Mode of application

Diclofenac in tablet form

The tablets should be taken orally with a sufficient amount of water or other liquid, if possible during meals or within 30 minutes after meals. The daily dosage ranges from 75 to 200 mg, divided into 2-3 doses. The maximum single dose is 100 mg. Children from 6 to 16 years old - 2 mg per kg of child weight. The course of treatment is selected individually. It can be one-time appointments if pain occurs, or course - from 5 to 15 days. If necessary, it can be extended.

Diclofenac in the form of solution for injection

Diclofenac solution can be administered either intramuscularly or intravenously, 75 mg (1 ampoule) 1-2 times a day. The course of treatment is a maximum of 5 days. After this, if necessary, the patient is transferred to the tablet form of the drug. For children, the drug is calculated according to the scheme of 2 mg per kg of weight, but not exceeding 75 mg per day.

Diclofenac in gel and ointment form

External forms of Diclofenac are used in combination with tablets. The ointment or gel should be applied to the affected area of ​​the back, approximately 2-3 g, 2 to 4 times a day. The course of treatment corresponds to that when taking tablets.

Side effects

Diclofenac has a lot of side effects, but they are extremely rare:

• Bleeding from the stomach or intestines
• Exacerbation of gastritis or peptic ulcer
• Bloating (flatulence)
• Rash and itching on the skin
• Increased sleepiness during the day
• Dizziness
• Headache
• Increased excitability of the nervous system
• Vomit
• Nausea
• Constipation, diarrhea, or alternation of both
• Pancreatitis
• Kidney failure
• Edema
• Bronchospasm
• Anaphylactic shock
• Increased blood pressure numbers
• Convulsions
• Burning at the injection site

If any of the symptoms of side effects occur, you must stop the drug, consult your doctor and take symptomatic remedies.

If the dosage of the drug is exceeded, a number of symptoms may occur:

• Headache
• Dizziness
• Impaired consciousness
• Convulsions
• Breathing disorders
• Nausea
• Vomit
• Gastrointestinal bleeding
• Kidney failure
• Liver failure

As therapeutic measures it is necessary to cancel Diclofenac, rinse the stomach and take activated carbon or other intestinal sorbents. If necessary, symptomatic treatment.

special instructions

During pregnancy up to 12 weeks and from 28 weeks until birth, taking Diclofenac is contraindicated because it can adversely affect the development of the child. During breastfeeding, breastfeeding should be avoided if this medication is necessary.

Diclofenac is contraindicated for children under 6 years of age. After 16 years - take adult dosages.

Alcoholic drinks do not affect the work of Diclofenac.

Analogues of Diclofenac

Voltaren, Diklak, Dikloberl, Ortofen, Naklofen, etc.

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 at orally noted after 2-3 hours. Changes in this indicator are dose-dependent.

The pharmacokinetic profile does not change with repeated administration. 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 of the dose taken is 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 moderately intense pain, including pain that develops against the background of:

• degenerative and inflammatory diseases of the musculoskeletal system (the drug is prescribed for , ,spondyloarthritis , rheumatic diseases soft tissues, etc.);
• lesions peripheral nerves, 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 the injection solution. Sometimes Diclofenac tablets are also used to relieve toothache.

A special form of the drug is Diclofenac retard- active slow-release tablets 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 types of disorders 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 the best candles 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 improve efficiency conservative therapy neuralgic syndrome it is recommended to prescribe a combination of drugs “ And Diclofenac ”.

What's happened Milgamma ? This combination drug, which is 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 ”;
• severe functional failure of the heart, kidneys, and liver.

General contraindications for Diclofenac are also recently previous 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, 50 mg suppositories and O-coated tablets are prescribed from the age of 14. 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, elderly people, 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

To alleviate acute conditions or relieve an 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%. Sodium bicarbonate solution is first added to the infusion solutions (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 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 of Diclofenac the desired effect is 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 further treatment continue, 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.

In severe poisoning, liver damage, acute renal failure, respiratory depression, and hypotension are possible.

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

Means for external therapy belong to the category of 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 are 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 rate of reaching 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 inhibits 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 NSAID treatment may cause:

• deterioration of liver function;
• reducing the effectiveness of the drug;
• development of unpredictable complications and adverse reactions;
• and, as a consequence, increased stagnation in 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.

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 of pain.

On this page you will find all the information about Diclofenac: complete instructions for use for this drug, average prices in pharmacies, complete and incomplete analogues 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 the exudative and proliferative phases of 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 joint injuries knee joint.

Tablets can be used for pain in the spine. Arising due to and degenerative changes intervertebral discs. Used for carpal tunnel syndrome 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;
• condition after coronary artery bypass surgery;
• pregnancy and lactation;
• “aspirin triad” – intolerance 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, erosive and ulcerative diseases Gastrointestinal tract chronic (beyond exacerbation), diabetes, diverticulitis, inducible porphyria, bronchial asthma, anemia, congestive heart failure, edema syndrome, arterial hypertension, liver or kidney failure, condition after major surgical interventions, old age, systemic connective tissue pathologies.

Use during pregnancy and lactation

Contraindicated in III trimester pregnancy. In the first and second trimesters of pregnancy it should be used according to strict indications and in the lowest 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

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.

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 are highly bound 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.

One of the most common locations of arthrosis is the knee joints. It is characterized by a gradual change in the properties of cartilage tissue and its destruction. Pain with arthrosis of the knees is the main symptom by which the presence of the disease can be determined.

Distinctive features of the pain syndrome.

Knee pain does not occur immediately and is practically unnoticeable in the initial stages. Some time passes, it could be a month, six months, a year, and noticeable pain appears when physical activity, but they go away after rest and only become noticeable with repeated exercise. Sudden Appearance pain not typical for arthrosis. Most likely this may be due to a knee injury or something else.

Gradually, the pain intensifies and occurs not only with increased physical activity, but even at rest. In the last stages of the disease, the pain becomes unbearable, it does not allow you to take a step, movement is only possible with the help of crutches or in a wheelchair.

What causes pain:

• destruction of the cartilage structure, loss of its shock-absorbing properties → exposure of bone structures;
• inflammation of the synovial membrane (as a secondary process) against the background of arthrosis, which initially arose in the diseased knee joint;
• the formation of osteophytes (bone growths) that cut into soft tissue;
• damage to the tissues surrounding the knee joint (spasm of the periarticular muscles, fibrosis of the joint capsule).

What painkillers are best to use.

In search of something to relieve knee pain due to arthrosis, you can try many drugs, but it is better to choose those that will really help.

Analgesics and non-steroidal anti-inflammatory drugs.

Indomethocin (in rectal suppositories) in addition to anti-inflammatory, analgesic and antipyretic, it also has an antiaggregation effect. Very suitable for the treatment of arthrosis, as it promotes the restoration of cartilage.

Meloxicam (orally, intramuscularly, rectally) is most wide application just for arthralgia. It is a selective COX-2 inhibitor, reduces the production of prostaglandins, relieves inflammation and pain.

Diclofenac (Ortofen) is the drug of choice in the presence of inflammation; in the acute period there is a dosage form in intramuscular injections, in tablets.

Ibuprofen (Nurofen) is the most popular drug from the group of non-steroidal anti-inflammatory drugs. Relieves inflammation by suppressing the production of prostaglandins. The effect occurs within 15 minutes. Available in tablets and suspensions.

Analgin (metamizole sodium) is primarily used as an analgesic, with anti-inflammatory and antipyretic effects in the background. Quickly relieves pain from arthrosis, but not for long. Side effect is the development of agranulocytosis (replacement of leukocytes with granulocytes and monocytes, a sharp decline immunity). Available in tablets and ampoules for injection.

Nise tablets block COX-2, are used in inflammatory, degenerative processes, and reduce the risk of tissue necrosis.

Paracetamol reduces the synthesis of prostaglandins, affects the neurons of the central nervous system, and relieves pain.

Aspirin (acetylsalicylic acid), in addition to its anti-inflammatory and analgesic effect, relieves fever and prevents thrombosis. Side effects: gastrointestinal bleeding, Reye's syndrome.

Ketanov has a pronounced pain reliever. Relieves pain quickly, but not for long. Available in tablets and injectable forms. Side effects such as hyperesthesia, nightmares, palpitations, stomach pain.

All of the drugs listed above have side effects on the gastrointestinal tract. Associated with a decrease in the production of prostaglandin, which is known to protect the gastric mucosa. Manifests Negative influence: vomiting, diarrhea, stomach pain, the formation of ulcers and gastrointestinal bleeding.

Corticosteroids.

This group of drugs copes well with swelling and inflammation, restores mobility in the knees, and relieves pain. Prescribed by a doctor for severe swelling, which complicates the course of arthrosis. They are used in the form of intra-articular injections introduced into the cavity of the knee joint. These include: Kenalog, Diprospan, Hydrocortisone, Celeston, Flosteron. The main goal is to relieve knee pain. These drugs do not improve blood flow and are not able to restore cartilage tissue. Side effect: when administered, skin hyperemia occurs. Which is treated by taking antihistamines.

Should you avoid exercise if you have joint pain?

Physical therapy for a patient with knee arthrosis is, of course, necessary. Regular exercise improves knee mobility, strengthens muscles, and gradually relieves
t pain. Classes are held under the strict supervision of a specially trained trainer who controls the load and technique. If you have severe pain, you should not perform exercises with force. To facilitate movements and relieve knee pain, exercises are best done in water, in a lying or sitting position. You need to perform the exercises slowly, avoid sudden movements, gradually increasing the load. Be sure to include stretching exercises in the complex.

To strengthen muscles, it is better to perform static strength exercises than dynamic ones. Before class, a little knee massage will help. Avoid active species sports (basketball, tennis, jogging), it is better to walk at your usual pace, swimming in the pool.

Pain-relieving ointments and rubs.

Another option for relieving knee pain due to arthrosis is the use of traditional medicine. Here are some recipes:

1. Rubbing: Brew 1 tablespoon of wormwood flowers in a mug of boiling water. The resulting decoction is rubbed onto the joint 2-3 times a day.
2. Rubbing: Take 3-4 tablespoons of lilac flowers, pour 1 liter of vodka and leave for a week. Rub into the knee 2 times a day.
3. Ointment: Kerosene 50 grams, a quarter cup vegetable oil, fourth part laundry soap, level teaspoon of soda. Mix everything and grind until an ointment is formed. The resulting mass must be thoroughly rubbed until completely dry.
4. Ointment: 1 tablespoon of hop cones mixed with 1 tablespoon of lard. Lubricate the knee for severe pain

Conclusion.

The most unpleasant thing about arthrosis of the knee joint is the pain that limits movement and interferes with sleep. It is important to see a doctor in time. He will tell you how to relieve knee pain due to arthrosis. Don't let knee pain ruin your life.

Diclofenac tablets for the treatment of joint pain: benefits and harms

Diclofenac belongs to NSAIDs, acetic acid derivatives and related drugs, ATC code – M01AB05.

Studies have demonstrated the drug's anti-inflammatory effects by inhibiting prostaglandin production.

The drug relieves pain, swelling and fever due to its anti-inflammatory effect. In addition, Diclofenac inhibits ADP and produces collagen-induced platelet pooling.

Pharmaceutical properties of the product

After oral administration of Diclofenac tablets, the medicine is completely absorbed from the gastrointestinal tract distally to the stomach. Peak plasma concentrations are achieved within 1-16 hours.

Oral administration of Diclofenac is subject to a significant “first pass” effect, with only 35-70% of the administered dose reaching post-hepatic circulation unchanged. Approximately 30% of the dose is excreted in metabolized form in the feces.

About 70% of substances are excreted by the kidneys as inactive metabolites after undergoing hepatic metabolism. The half-life is approximately 2 hours and depends primarily on hepatic and renal function.

List of active and excipients

Composition of Diclofenac tablets:

Extended-release, film-coated tablets, completely or almost odorless. PVC/PVDC/Al box (opaque, white). Packaging: 20, 30, 50 and 100 extended-release tablets.

Other forms of release: suppositories, solution and preparations for local treatment(gel and ointment).

Therapeutic indications

Diclofenac in tablet form is used for the symptomatic treatment of inflammation and pain in:

In case of postoperative or post-traumatic swelling and inflammation, the patient can take Diclofenac without consulting a doctor; other cases require taking the medication only with the consent or recommendation of a doctor.

The release of the drug and the onset of action of Diclofenac may be slower. Therefore, the drug should not be used in cases where a rapid onset of action is required.

Contraindications for use

Diclofenac tablets should not be taken if:

• sensitivity to any of the components;
• if previously, when taking aspirin or other NSAIDs, reactions such as bronchospasm, asthma, rhinitis or urticaria were present;
• if there is a history gastrointestinal bleeding or perforation associated with previous NSAID therapy;
• active or anamnestic recurrent peptic ulcer (2 or more episodes);
• severe heart failure;
• disorders of blood clotting or hematopoiesis;
• any active bleeding;
• serious deterioration in liver or kidney function;
• in the 3rd trimester of pregnancy.

Dosage and method of administration

The dosage of Diclofenac depends on the severity of the disease. The optimal dose for children over 15 years of age and adults: 50-150 mg of the drug per day, divided into 2-3 single doses.

There is no need for dosage adjustment for elderly patients. However, given the profile of possible side effects, it is necessary to carefully monitor the drug intake, especially in elderly patients.

For mild to moderate hepatic and renal failure, dose reduction is not required.

Diclofenac tablets are taken whole, without chewing, with liquid (1 glass still water) on an empty stomach 1-2 hours before meals.

The duration of treatment for a particular patient is determined only by the attending physician! For rheumatic diseases, it is possible to use tablets for a longer period.

Cases of overdose

There is no specific clinical picture. Symptoms such as dizziness, headache, changes in consciousness (also myoclonus in children), nausea and vomiting, gastrointestinal bleeding, diarrhea, ringing in the ears or convulsions may occur.

Hypotension and cyanosis may also occur.

In cases of poisoning, acute liver failure and/or kidney problems may occur.

Therapeutic actions in case of overdose

Treatment of NSAID poisoning, including Diclofenac, consists of supportive measures and symptomatic treatment aimed at suppressing complications:

• hypotension;
• renal failure;
• seizures;
• gastrointestinal disorders.

After ingestion of potentially toxic high doses, gastric lavage (lavage) is considered.

Side effects

Possible side effects are generally dose dependent and vary among individual patients. The risk of their occurrence often depends on the dose and duration of use of the drug.

So the following undesirable effects are possible:

Special warnings and precautions

Minimize negative effects possible by taking the minimum dose for the most short term necessary to inhibit symptoms.

Diclofenac is not prescribed together with other systemic NSAIDs due to the lack of evidence demonstrating synergistic activity and the potential for additive adverse reactions.

Like other NSAIDs, Diclofenac, due to its pharmacodynamic properties, is able to mask the signs of infectious diseases.

Compatibility of the drug with alcohol

Alcohol and Diclofenac are incompatible!

Their combination interferes with liver function.

The aggressive action of these 2 incompatible substances can lead to a decrease in the effect of the drug and unpredictable complications.

The combination of alcohol and medication can cause high blood pressure(hypertension) and increase stagnation of blood circulation. This causes intoxication.

The combination of Diclofenac with alcohol has an effect on the central nervous system. If alcohol stimulates activity nerve cells, the drug slows it down. This combination can cause damage to the central nervous system and cause symptoms such as pathological fatigue, decreased response to stimuli, and memory impairment.

Liver dysfunction

Like other NSAIDs, Diclofenac may increase liver enzyme values. For safety reasons, it is necessary to monitor liver function throughout the entire treatment period.

Discontinuation of the drug is necessary if abnormal liver function tests persist or worsen, signs of liver disease, or other symptoms occur.

Hepatitis can occur without prior symptoms. Particular caution should be exercised in patients with hepatic porphyria.

Renal dysfunction

Very rarely, damage to kidney tissue may occur, some of which may be accompanied by acute kidney failure, proteinuria (protein in the urine) and/or hematuria (blood in the urine).

In very rare cases, nephrotic syndrome (accumulation of water in the body (edema) and severe proteinuria) may develop.

Decreased urine output, fluid buildup in the body, and a general feeling of malaise can be symptoms of kidney damage that can lead to kidney failure.

Interaction with other drugs

Taking Diclofenac tablets with other medications:

Pregnancy, breastfeeding and children

Inhibition of prostaglandin production can negatively affect pregnancy. Research results indicate an increased risk of miscarriage and the development of heart defects after taking the drug in the 1st-2nd trimester. It is indicated that the risk is directly proportional to the dose and duration of therapy.

You should not take Diclofenac tablets during the 1st or 2nd trimester of pregnancy unless absolutely necessary.

If the drug is prescribed to women who are in the 1st or 2nd trimester of pregnancy, the dose and duration of therapy should be minimal. The drug should not be taken during the 3rd trimester of pregnancy.

Like other NSAIDs, Diclofenac passes into breast milk, which is why it should not be administered during breastfeeding in order to avoid negative effects on the baby.

The use of Diclofenac in children and adolescents under 15 years of age is not recommended, since there is insufficient experience with the use of the drug in this age group.

In situations where use by children is necessary, the drug is prescribed to children over 6 years of age, at a dose of 2 mg/kg/day.

Analysis of reviews, pros and cons

After studying the reviews of patients and doctors, analyzing the pros and cons, we can draw conclusions about how effective and safe Diclofenac tablets are.

Pros and cons following from practical application

The positive aspects of using Diclofenac tablets are that it relatively quickly relieves painful sensations in the joints.

Side effects of the drug can be classified as both pros and cons.

On the one hand, they rarely appear, on the other hand, if it comes to this, the complications appear quite clearly.

In addition, the negative side of the drug is its low “compatibility” with renal and liver failure; in addition to this, cases of adverse effects of Diclofenac on the body of older people have been observed.

Purchase and storage

Average price of Diclofenac:

• tablets (50 mg, 20 pcs.): 45 rubles;
• gel (5%, 50 g): 95 RUR;
• eye drops (0.1%, 5 ml.): 30 rubles;
• ampoules (25 mg/ml, 10 pcs.): 43-50 rubles;
• ointment (1%, 30 g): 30 rub.

Shelf life of the drug: 4 years. This medicine does not require any special storage conditions; it is kept at a temperature of 15-25ºС.

Dispensed in pharmacies with a prescription.

Selection of available analogues

The following analogues of Diclofenac tablets are available, some of them are cheaper and some are safe:

1. Ortofen. Due to the similar active component, the effect is similar to Diclofenac.
2. Naproxen. More typical wide range action and fewer side effects.
3. Diclak-gel. A drug local action. The active ingredient is diclofenac sodium.
4. Neurodiclovit (gel, suppositories). Maximum therapeutic effect, minimum side effects.

In Russia, such drugs are produced containing the active ingredient diclofenac sodium, such as: Diclofenac retard, Diclofenac Bufus, Diclovit.

The main symptom of sciatica (inflammation of the sciatic nerve) is pain. The pain is localized in the lower back and also spreads to lower limb. For mild forms of the disease, physiotherapeutic treatment methods are effective. However, in some cases, such procedures do not provide sufficient relief, and it is necessary to resort to therapeutic blockades. A blockade for inflammation of the sciatic nerve is carried out only as a last resort.

To reduce pain with sciatica with medication, patients are usually prescribed:

• novocaine;
• lidocaine;
• diclofenac;
• movalis.

Novocaine and lidocaine blockades are carried out by injecting an anesthetic at a certain point in order to reduce pain when the sciatic nerve is damaged. The use of lidocaine is more effective than novocaine blockade. In addition, lidocaine has a lower toxicity rate.

Diclofenac is a drug that achieves a pronounced anti-inflammatory and lasting analgesic effect. It is recommended to reduce pain from sciatica. In cases of severe sciatica, only injections of diclofenac are effective; the drug is administered intramuscularly. Diclofenac in the form of tablets, ointments, and patches is effective for mild forms. The dosage depends on body weight and age.

Movalis also has analgesic and anti-inflammatory effects. Like diclofenac, it is administered intramuscularly. These medications are effective in treating sciatica. Diclofenac and movalis belong to the group of the most powerful anti-inflammatory drugs.

Benefits of the blockade

1. Therapeutic blockade gives a more effective and faster result in cases of damage to the sciatic nerve. The blockade can stop very intense pain for sciatica, since the drug directly affects the nerve fibers.
2. The risk of side effects of drugs with this method of administration is minimal. This is explained by the fact that the medicine enters first directly into the lesion, and then into the general bloodstream.
3. The blockade not only relieves pain, but also reduces muscle tension and inflammatory response.

Indications and contraindications

Injections are prescribed to treat sciatica. Therapeutic blockades are used only in severe cases of neuralgia, when other methods are ineffective. The indication for this procedure is intense pain that cannot be relieved by other means. Drug treatment gives good results.

Carrying out lidocaine or novocaine blockade has a number of contraindications. Among them are:

• arterial hypotension;
• bradycardia;
• sick sinus syndrome;
• cardiogenic shock;
• atrioventricular block of the second and third degree;
• allergic reaction;
• severe liver failure;
• myasthenia gravis;
• history of epileptiform convulsions after administration of novocaine or lidocaine;
• pregnancy.

The administration of diclofenac and movalis for sciatica also has contraindications:

• allergic reaction;
• hematopoietic pathologies;
• peptic ulcer;
• inflammation of the intestines during an exacerbation;
• severe renal and liver failure;
• last trimester of pregnancy;
• breast-feeding.

Injections of diclofenac or movalis are prescribed with caution to patients with coronary heart disease.

The patient's position is on his stomach. The blockade is performed only at the Voino-Yasenetsky point, which is located directly above the nerve. To find this point, two lines should be drawn: the horizontal line is drawn along the top of the greater trochanter, and the vertical line is drawn through the outer edge of the ischial tuberosity. The point is located at the place where they intersect; it is more convenient to mark it with an iodine solution before administering the drug.

The dosage of the drug for the treatment of sciatic neuralgia is determined only by the doctor. The needle is inserted into the indicated place, then infiltration is carried out layer by layer, gradually directing it deeper into the sciatic nerve. The drug should not be administered intraneurally, as this will lead to nerve injury. When carrying out novocaine blockade using this method, it is recommended to add hydrocortisone to novocaine. Adding corticosteroids to the anesthetic gives a longer therapeutic effect.

Possible complications in the treatment of sciatica

Among the complications of blockade for the treatment of sciatic nerve neuralgia are:

• nerve damage;
• broken off injection needle;
• vessel damage.

Nerve damage

If the technique of administering the drug is violated, nerve damage may occur. The consequences of this phenomenon are intense pain and impaired sensitivity. The risk of such a complication if the injection is performed correctly is minimal. If damage to the sciatic nerve does occur, treatment should be started immediately. Therapy consists of the administration of B vitamins, proserin, pyrogenal. The dosage is determined by a specialist. In addition to drug treatment, physiotherapy is carried out. The patient is prescribed galantamine electrophoresis and electrical muscle stimulation. Also recommended physiotherapy and massage.

Broken injection needle

The cause of needle breakage is usually an inadequate motor response of the patient in response to the injection. Most often, a breakage occurs near the cannula. In this case, removal is not difficult, since the end of the needle protrudes. In rare cases, removing the needle without surgery becomes impossible. If the needle is sterile, then it is usually encapsulated in soft tissues and does not cause discomfort to the patient. However, infection is possible, which requires surgical removal in a hospital.

Vessel damage

Injury to a vessel by a needle manifests itself in the form of a hematoma. If a vessel is injured, it is necessary to compress the needle injection site with a cotton swab for several minutes. If the rules of administration are followed, such a complication usually does not arise. To prevent injury to the vessel, the injection should be performed in strict accordance with the anatomical landmarks of the sciatic nerve.

When the drug is administered by a specialist, the listed complications occur very rarely. To avoid side effects of sciatica treatment associated with overdose, only the correct amount of the drug should be administered. For diclofenac maximum daily dose is 150 mg, for movalis – 15 mg.