Diclofenac, 100 mg suppositories, 6 pcs.

Pharmgroup:

NSAIDs.

Pharmic action:

Penylacetic acid derivative NSAID; has anti-inflammatory, analgesic and antipyretic effects. By indiscriminately inhibiting COX1 and COX2, it disrupts arachidonic acid metabolism, decreases amount of Pg in inflamed area.
It is most effective for pain of inflammatory nature. Like all NSAIDs, the drug has antiaggregant activity.

Pharmacokinetics:

Absorption is rapid and complete, food slows the rate of absorption. After oral administration of 50 mg, Cmax is 1.5 mcg/ml, TCmax is 2-3 h.

Diclofenac prolonged action: as a result of the delayed release of the drug the Cmax in plasma is lower than that of short-acting drugs; however, it remains high for a long time after administration. Cmax is 0.5-1 mcg/ml, TCmax is 5 h after administration of 100 mg long-acting tablets.

After an IV infusion of 75 mg, Cmax is 1.9 µg/mL (5.9 µmol/L). After intravenous administration, Cmax is 2.5 µg/mL (8 µmol/L), TCmax is 20 min.

In rectal administration TCmax – 30 min.

The plasma concentration is in a linear relationship to the amount of dose administered.

There is no change in the pharmacokinetics of diclofenac on repeated administration. It does not cumulate if the recommended interval between meals is observed.

The bioavailability is 50%. Binding to plasma proteins is more than 99% (most of it binds to albumin). It penetrates into breast milk and synovial fluid; Cmax in synovial fluid is observed 2-4 hours later than in plasma. T1/2 from synovial fluid is 3-6 h (the drug concentrations in synovial fluid are higher 4-6 h after administration than in plasma and remain higher during 12 h).

50% of the drug is metabolized during the “first passage” through the liver; AUC is half as much after oral administration than after parenteral administration of the same dose. Metabolism occurs as a result of multiple or single hydroxylation and conjugation to glucuronic acid. The CYP2C9 isoenzyme is also involved in the metabolism of the drug. The pharmacological activity of the metabolites is less than that of diclofenac.

The systemic clearance is 260 ml/min. T1/2 from plasma is 1-2 hours. 60% of the administered dose is excreted as metabolites through the kidneys; less than 1% is excreted unchanged, the rest of the dose is excreted as metabolites in the bile.

In patients with significant renal insufficiency (CKD less than 10 ml/min) excretion of metabolites in bile is increased, while there is no increase of their concentrations in blood.

In patients with chronic hepatitis or compensated liver cirrhosis pharmacokinetic parameters do not change.

Indications

Inflammatory and inflammation-activated degenerative forms of rheumatism:

Active ingredient

Composition

Active ingredient:

diclofenac 100 mg;

Associates:

1,2-propylene glycol,

aerosil,

vitepsol

How to take, the dosage

Rectally. Adults: 100 mg once daily, 50 mg twice daily or 25 mg 3-4 times daily.

The maximum daily dose is 150 mg.

Children over 12 years of age: 50 mg 1-2 times a day or 25 mg 2-3 times a day.

Interaction

In concomitant use of the drug Diclofenac with digoxin, phenytoin or lithium drugs may increase plasma concentrations of these drugs; with diuretics and hypotensive agents – possible decrease in the effect of these drugs; with potassium-saving diuretics – possible development of hyperkalemia; with acetylsalicylic acid – decrease of diclofenac concentration in blood plasma and increased risk of side effects.

Diclofenac may increase the toxic effects of cyclosporine on the kidneys.

Diclofenac may cause hypo- or hyperglycemia, therefore concomitant use with hypoglycemic agents requires control of blood glucose concentration.

When using methotrexate for 24 hours before or after taking Diclofenac it is possible to increase the concentration of methotrexate and increase its toxic effect.

When concomitant use with anticoagulants regular monitoring of blood clotting is required.

Special Instructions

Cautiously use the drug together with other NSAIDs.

Pediatric use

In children under 6 years of age, if it is necessary to use the drug in the form of an ointment, a physician’s supervision is required.

Impact on driving and operating machinery

Because of the possible side effects of high doses of the drug, such as dizziness and fatigue, in some cases the ability to drive or operate a vehicle or other moving objects is impaired. These phenomena are intensified with simultaneous use of alcohol.

Contraindications

Hypersensitivity (including to other NSAIDs), complete or incomplete combination of bronchial asthma, recurrent nasal and paranasal sinus polyposis and intolerance to ASA or other NSAIDs. NSAIDs (including history), erosive-ulcerative lesions of the gastrointestinal tract and 12 duodenum, active gastrointestinal bleeding, inflammatory bowel disease, severe liver and heart failure; period after coronary artery bypass grafting; Severe renal insufficiency (CKR less than 30 ml/min), progressive renal disease, active liver disease, confirmed hyperkalemia, pregnancy (III trimester), lactation, children (under 14 years of age – for enteric coated tablets 50 mg and rectal suppositories 50 mg, under 18 years – for sustained release tablets and suppositories 100 mg).
With rectal administration (additionally): proctitis.

For FP containing lactose (additionally): hereditary lactose intolerance, glucose-galactose malabsorption, lactase deficiency.

With caution. Gastric and 12-duodenal ulcer, ulcerative colitis, Crohn’s disease, liver diseases in anamnesis, hepatic porphyria, CHF, arterial hypertension, significant reduction of the blood circulation (including

Elderly patients (including those treated with diuretics, debilitated, and underweight),

Bronchial asthma, concomitant use of GCS (including prednisolone), anticoagulants (including warfarin), anticoagulants (including warfarin), and antiplatelet agents.anticoagulants (including warfarin), antiplatelet agents (including ASA, clopidogrel), selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline),
CHD, cerebrovascular disease, dyslipidemia/hyperlipidemia,

Diabetes mellitus, peripheral arterial disease, smoking, CKD (IQ 30-60 ml/min), presence of Helicobacter pylori infection, long-term use of NSAIDs, alcoholism, severe medical conditions.

Side effects

Digestive system disorders: nausea, vomiting, epigastric pain, anorexia, flatulence, constipation, gastritis up to erosive with bleeding, increased transaminase activity, drug-induced hepatitis, pancreatitis.

Urinary system disorders: interstitial nephritis.

CNS disorders: headache, dizziness, disorientation, agitation, insomnia, irritability, fatigue, aseptic meningitis.

Respiratory system: bronchospasm.

Hematopoietic system: anemia, thrombocytopenia, leukopenia, agranulocytosis.

Dermatological reactions: exanthema, erythema, eczema, hyperemia, erythrodermia, photosensitization.

Allergic reactions: erythema multiforme, Lyell’s syndrome, Stevens-Johnson syndrome, anaphylactic reactions, including shock.

Local reactions: burning, infiltrate formation, necrosis of adipose tissue possible at the injection site.

Others: fluid retention in the body, edema, increased BP.

Similarities