Diclofenac in different forms of release: indications for use
Medicine in tablets, injections, ointments, gels, suppositories can be used for short-term suppression of painful sensations that arise as a consequence of:
- osteochondrosis, rheumatic tissue lesions, osteoarthrosis, arthritis;
- sciatica, peripheral nerve damage, lumbago;
- gout, migraines;
- inflammation in the pelvic area, injuries and surgical interventions.
Suppositories are prescribed as an addition to the main therapy for complex inflammatory processes such as otitis, laryngitis, and pharyngitis.
Injection administration of Diclofenac according to the instructions is recommended to obtain a quick analgesic effect. The drug is administered for renal and hepatic colic, acute pain syndrome in damaged muscles, after surgery. Prevention and treatment of postoperative discomfort is carried out by intravenous infusion of Diclofenac.
Eye drops are prescribed to patients:
- to prevent inflammation and swelling during surgical interventions;
- with penetrating and non-penetrating injuries of the eyeballs;
- to suppress discomfort during laser vision correction.
What does Disclofenac tablets help with: the indications are similar to the injectable forms of the medication. It is sometimes used to relieve toothache. Gel and ointment are used to treat disorders of the locomotor system, rectal suppositories are used when it is impossible to take the medication orally.
Suppositories are safer and are not capable of causing complications from parenteral administration of Diclofenac: necrosis, infiltrates, suppuration at the needle entry site. Suppositories are used in combined regimens: tablets or injections are prescribed during the day, and rectal medications are prescribed at night. In gynecological practice, suppositories are prescribed for acute pain syndrome that occurs against the background of an inflammatory process in the ovaries or painful menstruation.
Composition and features
Diclofenac is available in several dosage forms. Apply ointment or gel externally.
The substance is diclofenac sodium, its concentration in the ointment is 10 or 20 mg per 1 g, in the gel - 10 or 50 mg per 1 g. Accordingly, the gel can be 1 or 5 percent, and the ointment 1 or 2 percent.
The auxiliary components in the gel are alcohol, propylene glycol, lavender oil, purified water and hyaetellose. The ointment additionally contains propylene glycol, dimethyl sulfoxide and macrogol.
The gel is a homogeneous transparent substance with a slight yellow tint or no color, there is a specific odor, the base is water.
The basic component of the ointment is fat; it has a thicker consistency. Therefore, it is better to use a gel for joints and deep layers of the epidermis. It spreads more easily and dries faster, does not leave stains on clothes and creates a protective film on the skin.
If the skin at the site of application is irritated and prone to peeling, then it is better to use ointment, as it additionally softens and moisturizes the skin at the site of application.
Contraindications and non-standard reactions from Diclofenac
The instructions indicate that the medication is not prescribed:
- in case of individual intolerance to the component composition;
- bleeding from the gastrointestinal tract, ulcers, perforation and inflammation of the digestive canal;
- bronchial asthma arising under the influence of NSAIDs;
- liver, kidney, heart failure.
Diclofenac is contraindicated for proctitis (in suppositories), after coronary artery bypass surgery, during pregnancy and for children under 6 years of age. Ointments and gels are not used for skin damage. Suppositories and tablets are prescribed to patients over 14 years of age. Increased caution is needed when treating patients with herpetic keratitis, children, the elderly, and nursing women.
The following side effects may occur when taking tablets:
- dyspeptic disorders;
- erosions and ulcers of the gastrointestinal tract;
- bleeding in the digestive tract;
- drowsiness, unreasonable irritability;
- attacks of dizziness, allergies.
Diclofenac drops can provoke:
- burning, cloudiness of the cornea;
- decreased visual acuity (temporary);
- allergies, iritis.
Intramuscular administration of the drug is sometimes accompanied by unpleasant sensations, and in difficult cases leads to tissue necrosis and abscess.
Diclofenac 25 mg/ml (solution)
The risk of adverse reactions when using diclofenac increases with increasing dose and duration of treatment. In order to reduce the risk of adverse events, the drug should be used at the minimum effective dose for the shortest period necessary to relieve symptoms. With regular use of the drug, the need for symptom relief, response to treatment should be periodically assessed and the dose adjusted in a timely manner.
Damage to the gastrointestinal tract
When using diclofenac, phenomena such as bleeding or ulceration/perforation of the gastrointestinal tract, in some cases with fatal outcome, were observed. These events may occur at any time when using drugs in patients with or without previous symptoms and a history of serious gastrointestinal diseases. In older patients, such complications can have serious consequences. If bleeding or gastrointestinal ulceration develops in patients receiving diclofenac, the drug should be discontinued.
To reduce the risk of toxic effects on the gastrointestinal tract in patients with gastrointestinal ulcers. especially with a history of complicated bleeding or perforation, as well as in elderly patients, the drug should be used in the minimum effective dose. Patients at increased risk of developing gastrointestinal complications, as well as patients receiving therapy with low doses of acetylsalicylic acid (Aspirin), should take gastroprotectors (proton pump inhibitors or misoprostol) or other medications to reduce the risk of unwanted effects on the gastrointestinal tract.
Patients with a history of gastrointestinal lesions, especially the elderly, should report all abdominal symptoms to the doctor.
Patients with bronchial asthma
Exacerbation of asthma (NSAID intolerance/NSAID-induced asthma), angioedema and urticaria are most often observed in patients with bronchial asthma, seasonal allergic rhinitis, nasal polyps, chronic obstructive pulmonary disease or chronic infectious diseases of the respiratory tract (especially those associated with allergic rhinitis). rhinitis-like symptoms). In this group of patients, as well as in patients with allergies to other drugs (rash, itching or urticaria), special caution should be observed when using diclofenac (preparedness for resuscitation measures).
Skin reactions
Serious dermatological reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, in some cases fatal, have been reported very rarely with the use of diclofenac. The highest risk and incidence of severe dermatological reactions were observed in the first month of treatment with diclofenac. If patients receiving diclofenac develop the first signs of skin rash, damage to the mucous membranes or other symptoms of hypersensitivity, the drug should be discontinued.
In rare cases, anaphylactic/anaphylactoid reactions may develop in patients who are not allergic to diclofenac.
Effects on the liver
Since during the period of use of diclofenac there may be an increase in the activity of one or more liver enzymes, monitoring of liver function is indicated as a precautionary measure during long-term therapy with the drug. If liver dysfunction persists or progresses or signs of liver disease or other symptoms occur (for example, eosinophilia, rash, etc.), the drug should be discontinued. It should be borne in mind that hepatitis during the use of diclofenac can develop without prodromal phenomena.
Effects on the kidneys
During therapy with diclofenac, it is recommended to monitor renal function in patients with hypertension, impaired cardiac or renal function, the elderly, patients receiving diuretics or other drugs that affect renal function, as well as in patients with a significant decrease in the volume of circulating blood plasma of any etiology, for example, in the period before and after major surgical interventions. After cessation of drug therapy, normalization of renal function indicators to initial values is usually observed.
Effects on the cardiovascular system
Therapy with NSAIDs, including diclofenac, particularly long-term therapy and high-dose therapy, may be associated with a small increase in the risk of serious cardiovascular thrombotic complications (including myocardial infarction and stroke).
Patients with cardiovascular disease and a high risk of developing cardiovascular disease (eg, hypertension, hyperlipidemia, diabetes mellitus, smokers) should be prescribed the drug only after careful consideration and used with extreme caution, at the lowest effective dose when the minimum possible duration of treatment, since the risk of thrombotic complications increases with increasing dose and duration of treatment. With long-term therapy (more than 4 weeks), the daily dose of diclofenac in such patients should not exceed 100 mg. The effectiveness of treatment and the patient's need for symptomatic therapy should be periodically assessed, especially in cases where its duration is more than 4 weeks.
The patient should be instructed to immediately seek medical attention if the first symptoms of thrombotic disorders (eg, chest pain, shortness of breath, weakness, speech disturbances) appear. Impact on the hematopoietic system
Diclofenac may temporarily inhibit platelet aggregation. Therefore, in patients with hemostasis disorders, it is necessary to carefully monitor relevant laboratory parameters. With long-term use of diclofenac, it is recommended to conduct regular clinical tests of peripheral blood.
Masking signs of an infectious process
The anti-inflammatory effect of diclofenac may complicate the diagnosis of infectious processes.
Use simultaneously with other NSAIDs
Diclofenac should not be used concomitantly with other NSAIDs, including selective COX-2 inhibitors, due to the risk of increased adverse events.
Impact on women's fertility
Diclofenac may have a negative effect on women's fertility, so diclofenac is not recommended for women wishing to become pregnant. In women experiencing difficulty conceiving (including those undergoing testing), the possibility of discontinuing the use of diclofenac should be considered.
The sodium metabisulfite contained in the drug can rarely cause severe hypersensitivity reactions and bronchospasm.
Information for Patients on a Sodium Controlled Diet
The sodium content in one ampoule (3 ml) of Diclofenac solution for injection does not exceed 1 mmol (23 mg), i.e. practically “sodium-free”.
How to use Diclofenac ointment
According to the instructions for use of Diclofenac ointment, the product in a volume of 2-4 g is distributed over the skin at the site of pain, using a slight rubbing motion. It is allowed to use the ointment 2-3 times a day, but the maximum dose should not exceed 8 g.
Children 6-12 years old are allowed to use the ointment no more than twice a day. When determining it, take into account the fact of simultaneous use of diclofenac drugs in other dosage forms (for example, tablets or suppositories).
Duration of therapy is up to 14 days.
How to use Diclofenac gel
Instructions for use of Diclofenac gel contain detailed information on doses and methods of use of the medicine.
The gel is used only externally in adults and children over 12 years of age according to indications. Apply to the site of inflammation with light rubbing movements 2 or 3 times a day. For one application, 2 g of the drug is enough, which corresponds to a strip of 4 cm.
The maximum permissible dose per day is no more than 6 g. Duration of therapy is no more than two weeks, longer periods are possible in agreement with the attending physician. Be sure to wash your hands after using Diclofenac.
pharmachologic effect
Diclofenac is a representative of the group of non-steroidal anti-inflammatory drugs.
Reduces the production of arachidonic acid and disrupts the synthesis of prostaglandins, therefore it has a triple effect:
- relieves inflammation;
- relieves pain;
- reduces high temperature.
When used externally, it reduces pain in joints both at rest and during movement, relieves swelling and stiffness in the morning, and allows you to increase physical activity.
Can the product be used by pregnant women and children?
Pregnancy, especially the third trimester, is a contraindication to the use of Diclofenac. If treatment with the drug is necessary in the first half of pregnancy, the doctor is obliged to evaluate all the negative consequences for the fetus and the expected benefits for the woman.
The ability of the drug to pass into breast milk has not been studied, so treatment is not advisable during breastfeeding. If there are serious reasons to use a gel or ointment during lactation, do not apply the substance to large areas of the skin and do not treat it for a long time.
In pediatric practice, it is used in the treatment of children only from 12 years of age.
