Neurodiclovit Capsules, 30 pcs., for oral administration, for adults, modified release

Pharmacodynamics and pharmacokinetics

Diclofenac sodium is characterized as an anti-inflammatory, antiplatelet, analgesic and antipyretic agent. It has a non-selective inhibitory effect on COX-1 and COX-2, reduces the content of prostaglandins at the site of inflammation, and also interferes with the metabolism of arachidonic acid. For rheumatic diseases, this substance helps reduce swelling of the joints, pain, and the severity of morning stiffness. This significantly improves the functional state of the joints.

Pyridoxine hydrochloride normalizes the functioning of the nervous system. It serves as a coenzyme for important enzymes found in nerve tissues. In addition, it takes part in the biosynthesis of many neurotransmitters.

Thiamine hydrochloride, entering the human body, is converted into cocarboxylase. It is a coenzyme for many enzymes. It is an important component of metabolic processes in the body. Actively participates in the processes of nervous excitation at synapses.

Cyanocobalamin is a means for stabilizing hematopoiesis and maturation of red blood cells, which takes part in many biochemical reactions necessary for the normal functioning of the body. It also has a beneficial effect on processes occurring in the nervous system. Coenzyme forms of this substance are needed for cell renewal and growth.

The combination of B vitamins found in Neurodiclovit (pyridoxine, thiamine, cyanocobalamin) potentiates the analgesic properties of diclofenac.

Diclofenac is characterized by rapid and complete absorption upon entering the body. However, food intake slows down this process by 1-4 hours, and also reduces the maximum concentration of the active component by 40%. After taking the capsules orally, the maximum concentration of this substance is achieved in the body after 2-3 hours. It is linearly dependent on the amount of the administered dose.

The degree of bioavailability of the drug is 50%. Strong connection with blood plasma proteins. The half-life of elimination from synovial fluid is approximately 4-5 hours. The maximum concentration in synovial fluid is reached approximately 3 hours later than in plasma.

50% of the active component is broken down in the liver. Metabolic processes occur after hydroxylation and conjugation with glucuronic acid. The enzyme system P450 CYP2C9 is involved in the breakdown of Neurodiclovit. 65% of the drug is excreted through the kidneys in the form of metabolites, less than 1% - unchanged. The remaining part is excreted through bile, also in the form of metabolites.

Systemic clearance – 350 ml/min. The plasma half-life is 2 hours. Diclofenac may pass into breast milk.

The B vitamins included in the preparation are water-soluble. Absorption of pyridoxine and thiamine occurs in the upper part of the small intestine. This process largely depends on the dosage. In the body, they are broken down in the liver and excreted mainly through the kidneys. Only about 9% is excreted unchanged. At higher doses, the excretion of pyridoxine and thiamine through the intestines increases.

The absorption of cyanocobalamin largely depends on the presence of intrinsic factor in the stomach and upper small intestine. Transportation of this substance is determined by transcobalamin. After breakdown in the liver, it is excreted primarily in bile. Only about 6-30% of cyanocobalamin is excreted through the liver.

Pharmacological properties of the drug Neurodiclovit

Pharmacodynamics . Neurodiclovit is a combination drug containing diclofenac sodium and vitamins B1, B6 and B12. B vitamins function as coenzymes in metabolism, in particular in nervous tissue, which enhances the analgesic effect of diclofenac. Like other NSAIDs, dilofenac inhibits the activity of the COX enzyme, which is involved in the formation of prostaglandins from arachidonic acid. Diclofenac also inhibits the activity of the enzyme lipoxygenase. The analgesic, anti-inflammatory and antipyretic effect of diclofenac is due to inhibition of prostaglandin synthesis. Pharmacokinetics. After oral administration, dliclofenac is well and completely absorbed from the gastrointestinal tract. Bioavailability is not affected by concomitant food intake. The maximum concentration in the blood plasma is achieved 1–2 hours after administration (when taken on an empty stomach, it is achieved faster than when taking the drug with food). The therapeutic concentration of the drug in blood plasma is 0.7–2.0 mg/l. Almost 99% of diclofenac is bound to plasma proteins, mainly albumin. The half-life of diclofenac from blood plasma is about 2 hours. The total systemic clearance of diclofenac from blood plasma is about 250 ml/min. Approximately 60% of the administered dose of the drug is excreted by the kidneys in the form of active metabolites; ≤1% of diclofenac is excreted unchanged. About 30% of the drug dose is excreted in the form of metabolites in bile and feces. Impaired renal function does not cause accumulation of the active substance due to increased excretion in the bile. Absorption, metabolism and excretion of the drug do not depend on the patient's age. The vitamins included in the drug are absorbed in the intestine thanks to active and passive transport mechanisms. Distribution and excretion are similar to those for vitamins obtained from food.

Contraindications

The medicine should not be taken in case of hypersensitivity to its components, bleeding from the gastrointestinal tract, bronchial asthma with polyposis of the nasal mucosa, hemostasis disorders, pregnancy , breastfeeding , hematopoiesis disorders, intracranial bleeding, erosive and ulcerative lesions of the gastrointestinal tract (especially during exacerbation). In addition, it is not recommended to give this drug to patients in childhood.

Neurodiclovit is prescribed with caution for congestive heart failure, anemia , coronary heart disease , bronchial asthma , liver or kidney failure , diabetes mellitus , inflammatory bowel diseases, inducible porphyria , alcoholism, diverticulitis , arterial hypertension , systemic connective tissue diseases, edema syndrome, old age . It is also necessary to carefully monitor the patient's condition if the drug is prescribed after extensive surgery.

Side effects

The use of capsules may be accompanied by the following side effects:

• gastrointestinal tract and liver: increased levels of liver enzymes, abdominal pain , diarrhea , constipation , bleeding in the gastrointestinal tract, feeling of bloating, nausea, flatulence , peptic ulcer (complications are possible);
• sense organs: tinnitus;
• genitourinary system: oliguria , fluid retention, interstitial nephritis , nephrotic syndrome , acute renal failure , proteinuria , papillary necrosis , hematuria , azotemia ;
• nervous system: the appearance of dizziness , headache ;
• skin: rash, itching ;
• immune system and hematopoietic organs: agranulocytosis , worsening infectious processes, leukopenia , anemia , eosinophilia , thrombocytopenia , thrombocytopenic purpura .

In addition, in rare cases, disorders such as vomiting, melena, esophageal damage, liver necrosis , dry mucous membranes, hepatorenal syndrome , colitis , jaundice , aphthous stomatitis , hepatitis , cirrhosis , changes in appetite, the gastrointestinal tract and liver .

Rarely, the central nervous system may also cause sleep disturbance , depression , aseptic meningitis , general weakness, nightmares, drowsiness , irritability, convulsions, disorientation, and increased anxiety. From the skin: alopecia , increased photosensitivity, eczema , toxic dermatitis , erythema multiforme , urticaria , Lyell's syndrome , pinpoint hemorrhages.

Very rarely, side effects such as increased blood pressure, blurred vision, taste disturbance, scotoma , diplopia , hearing impairment, laryngeal edema, cough, bronchospasm , pneumonitis , extrasystole , myocardial infarction , congestive heart failure , pain in the chest, anaphylactoid reactions are noted. , swelling of the lips and tongue, anaphylactic shock , allergic vasculitis .

Side effects of the drug Neurodiclovit

The drug is usually well tolerated, although in some cases the following side effects may develop: gastrointestinal disorders (epigastric pain, anorexia, hiccups, nausea, diarrhea, hidden bleeding), headache, dizziness, fatigue, tinnitus, eczema , skin rash, itching, sodium and water retention in the body, peripheral edema (mainly in patients with hypertension (arterial hypertension)); uncommon - gastrointestinal ulcers with severe bleeding and perforation, anemia, insomnia, anxiety, irritability, allergic reactions (bronchospasm, urticaria, anaphylactic/anaphylactoid systemic reactions), acute renal failure (isolated cases), nephrotic syndrome, hematuria, isolated cases of hepatitis (jaundice, increased level of transaminases in the blood serum), hematopoietic disorders (leukopenia, thrombocytopenia, aplastic anemia, pancytopenia, thrombocytopenic purpura, agranulocytosis, hemolytic anemia); rarely - reversible alopecia, Stevens-Johnson syndrome, Lyell's syndrome, Hebra's disease, seizures, visual impairment (blurred vision, diplopia), hearing impairment, interstitial nephritis, papillary necrosis.

Instructions for use of Neurodiclovit (Method and dosage)

For those who have been prescribed Neurodiclovit, the instructions for use recommend swallowing the capsules whole during meals, with sufficient liquid. Dosages may vary depending on the severity of the disease. On average, the dose is designed to take 1-3 capsules per day, that is, about 100 mg of diclofenac.

Instructions for use of Neurodiclovit indicate that adult patients are usually prescribed 2-3 capsules per day to begin the course. But the maximum dosage should not exceed three capsules. Maintenance dose – 1 capsule 1-2 times during the day.

Elderly patients should use this drug with caution.

Children over the age of 14 years can be prescribed Neurodiclovit, but its maximum dosage should not exceed 1 capsule 2 times a day.

The duration of the course is determined by a specialist.

Overdose

When taking the drug in increased dosages, the following symptoms may be observed: vomiting, headache , clouding of consciousness, dizziness , shortness of breath . Patients in childhood may experience myoclonic convulsions , abdominal pain , liver and kidney dysfunction, nausea, and bleeding.

Treatment includes gastric lavage, forced diuresis, and activated charcoal . Therapy is symptomatic. Hemodialysis is almost ineffective.

Special instructions for the use of the drug Neurodiclovit

The drug should not be used in the third trimester of pregnancy and during breastfeeding. During the 1st–2nd trimester of pregnancy, the drug can be used only according to strict indications in the minimum effective dose. It is not recommended for use in children under 14 years of age due to the high content of the active ingredient in the capsules. During long-term treatment with Neurodiclovit, it is recommended to monitor the peripheral blood picture, functional indicators of the liver and kidneys, and also conduct a stool test for occult blood. Patients with gastric and duodenal ulcers, a history of dyspeptic symptoms, severe liver disease, kidney disease, heart failure and hypertension (arterial hypertension) should be under strict medical supervision. The drug should be used with caution in patients with asthma, hay fever, nasal polyposis and chronic infectious diseases of the respiratory tract. Although no negative effect on the ability to drive vehicles or operate machinery was noted when taking the drug, it cannot be ruled out that the reaction rate may be reduced due to the negative effect of diclofenac on the central nervous system (dizziness, fatigue).

Interaction

Prescribing this medication may cause an increase in:

• lithium level when combined with lithium preparations;
• severity of adverse reactions when using other NSAIDs;
• the likelihood of bleeding in the gastrointestinal tract in combination with glucocorticoids;
• the effectiveness of potassium-sparing diuretics and drugs that inhibit platelet ;
• concentrations and toxicity of methotrexate .

In addition, the effectiveness of Neurodiclovit is reduced when interacting with loop diuretics and antihypertensive drugs. The concentration of its active substance (diclofenac) also decreases when combined with acetylsalicylic acid . The absorption of cyanocobalamin is reduced when taken with Colchicine , neomycin , PAS and antidiabetic drugs such as Biguanidine .

Neurodiclovit should not be used simultaneously with Levodopa , as it can dull the severity of its antiparkinsonian effect. In addition, it may reduce the antihypertensive effect of diuretics or antihypertensive drugs. So this combination is prescribed with caution. In this case, it is imperative to control blood pressure. In addition, it is necessary to consume a sufficient amount of fluid, and at the beginning and after completion of the course, monitoring of kidney function is necessary, as nephrotoxicity may occur.

serotonin reuptake inhibitors, the risk of bleeding from the gastrointestinal tract increases.

The dosage of hypoglycemic drugs while using Neurodiclovit should be carefully monitored.

Combination with colestipol or cholestyramine reduces the degree of absorption of diclofenac by approximately 30-60%. So between taking these medications it is necessary to take an interval of several hours. In addition, the concentration of diclofenac can be reduced by some drugs that stimulate enzymes ( Rifampicin , phenytoin , Carbamazepine , St. John's wort ).

It should also be taken into account that thiamine is inactivated by 5-fluorouracil, and antacids, in turn, reduce the degree of its absorption. Loop diuretics can inhibit tubular reabsorption of thiamine and, with a long course of treatment, reduce its concentration.

Neurodiclovit capsules No. 30 (30 pieces) - Instructions

Dosage form

Capsules, 30 pieces per pack.

Compound

Active ingredient: 1 capsule contains diclofenac sodium 50 mg, thiamine hydrochloride (vitamin 1) 50 mg, pyridoxine hydrochloride (vitamin 6) 50 mg, cyanocobalamin (vitamin 12) 0.25 mg.

Excipients: povidone, methacrylate copolymer (type A) 30% dispersion, triethyl citrate, talc, red iron oxide (E172), yellow iron oxide (E172), titanium dioxide, gelatin.

Pharmacological group

Diclofenac, combinations.

Pharmacological properties

Pharmacodynamics. Neurodiclovit is a combination of diclofenac and neurotropic vitamins B1, B6 and B12. Like other non-steroidal anti-inflammatory drugs, diclofenac inhibits the enzyme cyclooxygenase, which converts arachidonic acid into prostaglandins. Diclofenac also inhibits the enzyme lipoxygenase. The analgesic, anti-inflammatory and antipyretic effects of diclofenac are due to inhibition of prostaglandin synthesis.

B vitamins function as coenzymes in metabolism and in particular in neurology, which has a positive effect on the analgesic effect of diclofenac sodium.

Pharmacokinetics. After oral administration, diclofenac is well and completely absorbed from the gastrointestinal tract. Bioavailability is independent of food intake. The maximum concentration in blood plasma is achieved 1-2 hours after administration (faster on an empty stomach than after a meal). The vitamins contained in the drug are absorbed in the intestines through active and passive mechanisms. Distribution and excretion are similar to vitamins taken with food. After oral administration of diclofenac, half the concentration of the drug was found in plasma that was found after parenteral administration of the same dose. Therapeutic plasma concentration is approximately 0.7-2.0 mg/L. Almost 99% of diclofenac is bound to plasma proteins, mainly albumin.

About 60% of the dose taken is excreted by the kidneys in the form of active metabolites; less than 1% of diclofenac is excreted unchanged. About 30% of the drug dose is excreted in the form of metabolites through bile and feces. The half-life of diclofenac from plasma is approximately 2:00. The total systemic clearance of diclofenac from plasma is approximately 250 ml/min.

Impaired renal function does not cause accumulation of the active substance due to increased bile excretion. Absorption, metabolism and excretion of the drug do not depend on age.

Indications for use

Inflammatory and degenerative forms of rheumatic diseases:

• chronic polyarthritis;
• ankylosing spondylitis (ankylosing spondylitis)
• arthrosis
• spondyloarthritis,
• acute gouty arthritis
• extra-articular rheumatism of soft tissues
• neuritis and neuralgia, such as cervical syndrome, lumbago, sciatica.

Directions for use and doses

Capsules should be swallowed whole with sufficient liquid during meals.

Depending on the severity of the disease, the recommended dose is 1-3 capsules per day, which is equivalent to 50-150 mg of diclofenac, respectively.

Adults. For initial therapy, the dose of the drug is 2-3 capsules per day. Maintenance dose - 1 capsule 1-2 times a day. The maximum daily dose should not exceed 3 capsules.

Children over 14 years old. The maximum daily dose is 1 capsule 2 times a day.

The duration of treatment is determined by the doctor.

Elderly patients. Although the pharmacokinetics of diclofenac do not depend on age, the dose should be adjusted with caution in elderly patients.

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

Children. It is not recommended for the treatment of children under 14 years of age due to the high content of the active substance in the capsule.

Contraindications

• Hypersensitivity to the components of the drug.
• Stomach or duodenal ulcer.
• Porphyria, hemorrhagic diathesis, hematopoiesis disorder.
• Crohn's disease, ulcerative colitis.
• Severe heart failure.
• The drug is contraindicated in patients whose asthma attacks, skin reactions or acute rhinitis are provoked by taking acetylsalicylic acid or other drugs that inhibit prostaglandin synthesis.
• Severe renal and liver failure.
• Gastrointestinal bleeding or perforation.
• Erythremia, erythrocytosis, thromboembolism.
• Allergic diseases.
• Congestive heart failure (NYHA II-IV).
• Coronary heart disease in patients with angina pectoris and postmyocardial infarction.
• Cerebrovascular diseases in patients who have had a stroke or have episodes of transient ischemic attacks.
• Peripheral arterial diseases.
• Treatment of PERIOPERATIVE pain during coronary artery bypass grafting (or use of a heart-lung machine).

Interaction with other drugs and other types of interactions

Co-administration of Neurodiclovit and other drugs may cause an increase or decrease in effectiveness.

Increase:

• plasma levels of lithium and digoxin,
• risk of gastrointestinal bleeding with concomitant therapy with GCS,
• side effects of other non-steroidal anti-inflammatory drugs,
• effectiveness of potassium-sparing diuretics (control of potassium levels),
• the effectiveness of drugs that inhibit platelet aggregation,
• level and toxicity of methotrexate. Prescription of non-steroidal anti-inflammatory drugs less than 24 hours before or after treatment with methotrexate should be avoided.

Decrease:

• effectiveness of diclofenac with furosemide and other loop diuretics,
• effectiveness of diclofenac as an antihypertensive agent,
• mutual decrease in the concentrations of diclofenac and acetylsalicylic acid in the blood serum,
• absorption of vitamin B 12 when used together with colchicine, PAS, neomycin and antidiabetic agents such as biguanidine.

Concomitant use with levodopa is contraindicated, since vitamin B6 may reduce the antiparkinsonian effect of levodopa.

Like other NSAIDs, concomitant use with diuretics or antihypertensive drugs (for example, beta-calcium channel blockers, angiotensin-converting enzyme inhibitors) may reduce their antihypertensive effect. Therefore, a combination of such drugs should be prescribed with caution, and patients (especially elderly) should periodically monitor blood pressure. Patients should drink sufficient amounts of water, and renal function should be periodically monitored after initiation and completion of concomitant therapy, particularly when using diuretics and ACE inhibitors due to the increased risk of nephrotoxicity. Concomitant use of systemic NSAIDs and selective serotonin reuptake inhibitors may increase the risk of gastrointestinal bleeding.

The simultaneous use of diclofenac and antidiabetic drugs is possible, but the effectiveness of the latter does not change. However, there are isolated reports of the development in such cases of both hypoglycemia and hyperglycemia, which necessitated the need to change the dose of glucose-lowering drugs during the use of diclofenac. For this reason, it is recommended to monitor blood glucose levels during therapy. The simultaneous use of diclofenac and colestipol or cholestyramine reduces the absorption of diclofenac by approximately 30% and 60%, respectively. The drugs should be taken at intervals of several hours. Enzyme-stimulating drugs, such as rifampicin, carbamazepine, phenytoin, St. John's wort (Hypericum perforatum) and others, can theoretically reduce diclofenac plasma concentrations. The effect of NSAIDs on the synthesis of prostaglandins in the kidneys may enhance the nephrotoxicity of cyclosporine. There are isolated reports of the development of seizures in patients receiving concomitant quinolone derivatives and NSAIDs.

The action of thiamine is inactivated by 5-fluorouracil, since the latter competitively inhibits the phosphorylation of thiamine to thiamine pyrophosphate.

Antacids reduce the absorption of thiamine. Loop diuretics, such as furosemide, which inhibit tubular reabsorption, may increase thiamine excretion and thus decrease thiamine levels with long-term therapy.

Concomitant use with pyridoxine antagonists (for example, isoniazid, hydralazine, penicillamine or cycloserine), oral contraceptives may increase the need for vitamin B6.

Features of application

The occurrence of side effects can be reduced by using the minimum effective dose for the shortest time necessary to control the symptom.

The drug should be used with caution in patients with asthma, hay fever, swelling of the nasal mucosa (nasal polyps) or chronic infectious diseases of the respiratory tract.

Patients with a history of high blood pressure and/or heart failure require appropriate monitoring and consultation, as fluid retention and edema have been reported with NSAID treatment.

In patients with inadequately controlled hypertension, decompensated heart failure, pre-existing ischemic heart disease, peripheral arterial vascular disease and/or cerebrovascular disease, diclofenac should be prescribed after careful consideration. Similar factors should also be taken into account before starting the drug if the patient is prone to cardiovascular diseases (eg hypertension, hyperlipidemia, diabetes mellitus, smoking).

Clinical studies and epidemiological data show that the use of diclofenac, especially in high doses (150 mg per day) and for a long period, may be accompanied by a slight increase in the risk of arterial thrombotic complications (myocardial infarction or attack).

During long-term treatment with Neurodiclovit, it is recommended to monitor peripheral blood counts, liver and kidney function.

Patients with gastric and duodenal ulcers, a history of dyspeptic symptoms and patients with severe liver disease, kidney disease, heart failure or arterial hypertension require careful medical monitoring.

All NSAIDs are characterized by the following adverse reactions, such as gastrointestinal bleeding, ulcers and perforations, which can be fatal and occur during treatment, against the background of warning symptoms or in the absence of them, as well as in patients with a history of serious gastrointestinal events. In general, such phenomena are most dangerous for elderly patients. In some cases, when these complications develop in patients taking diclofenac, the drug should be discontinued.

Severe, even fatal, skin reactions, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been very rarely reported in association with the use of NSAIDs, including diclofenac. The highest risk of these reactions exists at the beginning of therapy, and the development of these reactions is observed in most cases in the first month of treatment. The drug should be discontinued at the first appearance of skin rash, mucosal ulcers or any other manifestations of hypersensitivity.

Diclofenac, due to its pharmacodynamic properties, can mask symptoms characteristic of infectious and inflammatory diseases.

With the introduction of vitamin 12, the clinical picture, as well as laboratory tests for funicular myelosis or pernicious anemia, may lose their specificity.

Drinking alcohol and black tea reduces the absorption of thiamine. Drinking drinks containing sulfites (such as wine) increases the degradation of thiamine.

Patients with neoplasms, with the exception of cases accompanied by megaloblastic anemia and vitamin B12 deficiency, should not use the drug.

The drug is used for angina pectoris.

Diclofenac should only be prescribed to patients with significant risk factors for cardiovascular events (eg hypertension, hyperlipidemia, diabetes mellitus, smoking) after careful clinical assessment. Since the cardiovascular risks of diclofenac may increase with increasing dose and duration of treatment, it should be administered for the shortest possible period and at the most effective dose. Patients' needs for diclofenac for symptom relief and response to therapy should be periodically reviewed. Use with caution in patients over 65 years of age.

The ability to influence the reaction rate when driving vehicles or other mechanisms

Although no negative effects on the ability to drive vehicles or operate machinery were observed, it cannot be ruled out that reactivity may worsen due to the negative effect of diclofenac on the central nervous system (dizziness, fatigue).

Use during pregnancy or breastfeeding

Due to the lack of clinical data, the simultaneous use of vitamins B1, B6 and B12 is not recommended during pregnancy and lactation.

Overdose

Symptoms of diclofenac overdose and intoxication are an increase in the frequency of side effects from the gastrointestinal tract and central nervous system. Features of application.

In case of severe diclofenac poisoning, the development of acute renal failure and liver damage is possible.

Vitamin B1: has a wide therapeutic range. After oral administration, no symptoms were detected. Very high doses (more than 10 g) exhibit a curare-like effect, suppressing the conduction of nerve impulses.

Vitamin B 6: shows very low toxicity. Long-term intake (more than 6-12 months) in doses of more than 50 mg of vitamin B 6 daily can lead to peripheral sensory neuropathy. Excessive use of vitamin 6 in doses of more than 1 g per day for several months can lead to neurotoxic effects. Neuropathies with ataxia and sensory disorders, cerebral spasms with EEG changes, as well as in some cases hypsochromic anemia and seborrheic dermatitis have been described after administration of more than 2 g per day.

Vitamin B 12: after parenteral administration (in rare cases, after oral administration) above recommended doses of the drug, allergic reactions, eczematous skin disorders and a benign form of acne were observed. With long-term use in high doses, disturbances in the activity of liver enzymes, pain in the heart, and hypercoagulation are possible.

Adverse reactions

From the cardiovascular system: heart failure, arterial hypertension, edema, tachycardia, palpitations, chest pain, myocardial infarction, vasculitis.

Blood disorders: hematopoietic disorders (leukopenia, thrombocytopenia, aplastic anemia, panmyelopathy, purpura, agranulocytosis, hemolytic anemia).

From the nervous system: headache, nausea, drowsiness, convulsions, dizziness, paresthesia, memory impairment, anxiety, tremor, aseptic meningitis, taste disorder (distortion), cerebral circulation disorders, touch disorders.

Visual impairment: visual impairment (blurred image, double vision).

Hearing impairment: tinnitus, hearing loss.

From the gastrointestinal tract: pain in the epigastric region; anorexia; hiccups; nausea; stomach upset; gastrointestinal bleeding gastrointestinal ulcers accompanied by severe bleeding; perforation and anemia; vomiting diarrhea dyspepsia flatulence gastritis; colitis (including hemorrhagic colitis and exacerbation of ulcerative colitis or Crohn's disease), constipation, stomatitis; glossitis; esophageal disorders, increased acidity of gastric juice, diaphragm-like intestinal strictures; pancreatitis.

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

From the skin and subcutaneous tissues: rash, redness, itching, alopecia, erythema of various types, exfoliative dermatitis, photosensitivity.

From the immune system: allergic reactions such as bronchospasm, urticaria, anaphylactic/anaphylactoid reactions, Stevens-Johnson syndrome, Lyell's syndrome, angioedema.

From the digestive system: hepatitis, including fulminant hepatitis, jaundice, increased levels of transaminases, in isolated cases acute.

Mental disorders: insomnia, hyperarousal, irritability, disorientation, depression, nightmares, psychotic disorders, malaise.

General disorders: sodium and water retention in the body, peripheral edema, increased sweating, asthma, pneumonitis.

Clinical trial and epidemiological data indicate an increased risk of thrombotic complications (eg myocardial infarction or stroke) associated with the use of diclofenac, particularly at high therapeutic doses (150 mg per day) and for long periods of time.

Best before date

2 years.

Storage conditions

Store in a dry place, protected from light and out of reach of children, at a temperature not exceeding 25 ° C.

Vacation category

On prescription.

Analogues of Neurodiclovit

Level 4 ATC code matches:
Voltaren

Rapten

Zerodol

Dickloberl Retard

Dikloberl N 75

Dicloberl

Ketanov

Dolak

Panoxen

Ketorolac

Naklofen Duo

Naklofen

Olfen-100

Olfen-75

Nizilat

Fanigan

Aertal

Methindol retard

Ortofen

In pharmacies you can find the following analogues of Neurodiclovit:

• Blokium B12
• Bol-Ran
• Dilocaine
• Diclofenac
• Dolex
• Maxigesik
• Olfen-75
• Fanigan
• Flamidez
• Tsinepar

Why tablets offered as analogues of this remedy help in each specific case is best checked with your doctor.

Neurodiclovit price, where to buy

The price of Neurodiclovit, on average, is about 380 rubles for a package containing 30 capsules. In Ukraine, the cost of this product is about 160 hryvnia. It is worth noting that the price of Neurodiclovit is lower than many of its analogues.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine

LuxPharma* special offer

• Neurodiclovit caps.
  30pcs 1280 rub. order

ZdravCity

• Neurodiclovit capsules 30 pcs. Lannacher Heilmittel

  RUB 369 order

Pharmacy Dialogue

• Neurodiclovit capsules No. 30 Lannacher

  408 rub. order

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Pharmacy24

• Neurodiclovit No. 30 capsules G.L Pharma GmbH, Austria
  159 UAH.order