Voltaren
Voltaren
Voltaren (Diclofenac)Pharmacological action
Voltaren contains sodium diclofenac, the material of the nonsteroid frame rendering expressed antiinflammatory, analgesic and febrifugal action.
The basic mechanism of action of the diclofenac, established in the conditions of experiment, it is considered inhibition of biosynthesis of Prostaglandinums. Prostaglandinums play the important role in a genesis of an inflammation, a pain and a fever.
In vitro sodium diclofenac in the concentrations, equivalent to what are reached at treatment of patients.
At rheumatic diseases antiinflammatory and analgesic properties of Voltaren provide the clinical effect characterised by appreciable reduction of expression of such exhibitings of diseases, as a pain in rest and at locomotion, morning constraint and a tumescence of joints, and also enriching of a functional state.
At the posttraumatic and postoperative inflammatory phenomena Voltaren quickly stops pains (arising both in rest, and at locomotion), reduces an inflammatory edema and an edema of a postoperative wound.
At Voltaren application in tablets it is noted expressed analgesic effect of a preparation at the moderate and strong pain of not rheumatic parentage. Also it has been established, that Voltaren is capable to lower pain sensations and to reduce a hemorrhage at a primary dysmenorrhea.
Besides, Voltaren facilitates migraine attacks.
Indications
- Inflammatory and degenerate diseases of a locomotorium: a pseudorheumatism, a juvenile pseudorheumatism, an ankylosing spondylitis, an osteoarthrosis, spondylarthrites, an osteoarthritis;
- The diseases of a column accompanied by a pain syndrome;
- Rheumatic diseases of extraarticular soft tissues;
- An acute attack of a gout (only for the tablets covered with an entero-solvable cover);
- The posttraumatic and postoperative pain syndromes accompanied by an inflammation and an edema;
- The gynecologic diseases accompanied by a pain syndrome and an inflammation;
- As an additional agent at serious infectious-inflammatory diseases of an ear, a throat and a nose, proceeding with the expressed pain syndrome, for example, at a pharyngitis, a tonsillitis, an otitis. The basic treatment of disease spend according to the standard principles, including with causal treatment application. The isolated fever is not the indication to preparation application;
- Migraine attacks.
Dosing regimen
Tablets should be swallowed entirely, washing down with fluid, it is desirable to meal.
For adults a recommended initial dose - 100-150 mg/days In rather easy cases of disease, and also for long therapy happen enough 75-100 mg/days the Daily dose it is necessary to part on some receptions.
At a primary dysmenorrhea a daily dose select individual; usually it compounds 50-150 mg. The initial dose should compound 50-100 mg; in need of flow of several menstrual cycles it it is possible to raise about 150 mg/days preparation Reception it is necessary to begin at appearance of the first symptoms. Depending on dynamics of clinical symptoms treatment can be continued within several days.
To children with mass of a body 25 kg and more prescribe a preparation in a dose from calculation of mass of a body/sut of 0 mg/kg (in 2-3 receptions, depending on gravity of disease). For treatment of a pseudorheumatism the daily dose can be as much as possible enlarged to 3 mg/kg (in stages).
Tablets should be swallowed entirely, it is desirable during meal.
For adults a recommended initial dose - 100 mg the Same dose is applied in rather easy cases of disease, and also to long therapy. When disease symptoms have the most expressed character at night or in the morning.
For adults a recommended initial dose - 100-150 mg/days In rather easy cases of disease, and also for long therapy happen enough 75-100 mg/days Frequency rate of application - 2-3 times.
At a migraine attack the initial dose compounds 100 mg. A preparation prescribe at the first symptoms of a coming nearer attack. In need of treatment continuation the next days the preparation daily dose should not exceed 150 mg (in some introductions).
To children with mass of a body 25 kg and more prescribe a preparation in a dose from calculation of mass of a body/sut of 0 mg/kg (a daily dose, depending on gravity of exhibitings of disease, it it is necessary to part on 2-3 single doses). For treatment of a juvenile pseudorheumatism the daily dose can be as much as possible enlarged to 3 mg/kg (in some introductions).
Side effect
From the alimentary system: sometimes - pains in epigastric range, a nausea, vomiting, a diarrhoeia, spastic strictures in a gaste, a dyspepsia, a meteorism, an anorexia; seldom - a gastrointestinal bleeding (vomiting by blood, a melena, a diarrhoeia with a blood admixing), a stomach ulcer and an intestine, accompanied or not accompanied by a bleeding or punching; on occasion - an aphthous stomatitis, a glossitis, esophagus damages, distresses from distal department of a colon, such as a nonspecific hemorrhagic colitis, an exacerbation of an ulcerative colitis or illness of the Cron, constipations, a pancreatitis; sometimes - rising of level of aminotransferases in blood serum; seldom - a hepatitis which is accompanied or not accompanied by an icterus; on occasion - a lightning hepatitis.
From party TSNS and peripheric excitatory system: sometimes - a headache, giddiness; seldom - drowsiness; on occasion - sensitivity disturbances, including paresthesias, dysmnesias, a disorientation, a sleeplessness, irritability, cramps, depression, sensation of alarm, night nightmares, a tremor, psychotic reactions, an aseptic meningitis.
From sense bodys: on occasion - sight disturbances (sight misting, a diplopia), a hearing disorder, a sonitus, disturbances of gustatory sensations.
From cardiovascular system: on occasion - a heart consciousness, stethalgias, BP rising, aggravation of a congestive heart failure.
Dermatological reactions: sometimes - dermal eruptions; seldom - an urticaria; on occasion - violent rashes, an eczema, Stevens-Johnson's syndrome, a Lyell's disease (an acute toxic epidermal necrolysis), an erythrosis (an exfoliative dermatitis), abaissement of a hair, photosensitivity reactions; purpura, including allergic.
From hemopoiesis system: on occasion - a thrombocytopenia, a leukopenia, a hemolitic anaemia, an aplastic anaemia, an agranulocytosis.
Hypersensitivity reactions: seldom - a bronchospasm, system anaphylactic/anaphylactoid reactions, including a hypotension; on occasion - a vasculitis, a pneumonitis.
Contraindications
- A stomach ulcer or an intestine;
- Anamnestic data on attacks of a bronchial asthma, an urticaria, the acute rhinitis, bound to application of Acidum acetylsalicylicum, and also any preparations depressing development of Prostaglandinums;
- A proctitis;
- Hypersensitivity to diclofenac and any other ingredients of a preparation.
Pregnancy and lactemia
Voltaren application at pregnancy is possible only when the expected advantage for mother exceeds potential risk for a foetus. A preparation prescribe in the minimum effective dose. The same as and in case of application of other inhibitors of a Prostaglandinum-synthetase, these references are especially important in III trimester of pregnancy.
At Voltaren reception inside in a dose everyone 8 h diclofenac inpours of 50 mg into thoracal milk, however in so small quantity that there are no establishments to expect any undesirable phenomena at the child who is on thoracal feeding.
In need of appointment of Voltaren in a lactemia it is necessary to solve a question on the termination of thoracal feeding.
The special indicatings
During Voltaren application careful medical observation over those patients which have the complaints specifying in diseases GASTROINTESTINAL TRACT is necessary; having data in the anamnesis about a stomach or intestine canker; suffering an ulcerative colitis or illness of the Cron, and also having disturbances of function of a liver.
During Voltaren application, level of one or several hepatic enzymes can raise. Therefore at long therapy by Voltaren as a safety measure the control of function of a liver is shown. If disturbances from functional indicators of a liver remain or strengthen, or if there are clinical exhibitings of diseases of a liver or other symptoms (for example, an eosinophilia, an eruption, etc.), Voltaren should be cancelled. It is necessary to mean, that the hepatitis against Voltaren application can arise without the prodromal phenomena.
Guard is necessary at Voltaren appointment sick of a hepatic porphyria since the preparation can provoke porphyria attacks.
As Prostaglandinums play the important role in maintenance of a renal blood flow, extra care is required at treatment of patients with disturbances of function of heart or the nephroses sick, receiving diuretic agents, and also patients which have an appreciable reduction of volume of a circulating blood plasma of any aetiology, for example, in the season before and after massive surgical interventions. In these cases during Voltaren application the control of function of nephroses is recommended as a safety measure. Preparation phase-out usually leads to restoration of function of nephroses to initial level.
It is necessary to be careful at application of Voltaren at patients of advanced age. It is especially actual at relaxed or having low mass of a body of older persons; they are recommended to prescribe a preparation in the minimum effective dose.
Against Voltaren application at any time can arise (for the first time or repeatedly) a gastrointestinal bleeding or to educe an ulceration/punching GASTROINTESTINAL TRACT, accompanied or not accompanied by symptoms-predecessors. More serious consequences of these complications can become perceptible at patients of advanced age. In those rare cases when at the patients receiving Voltaren, these complications educe, the preparation should be excellent.
Influence on ability to driving of motor transport and to control of mechanisms
To patients who against Voltaren application have giddiness or other disturbances from party TSNS, including sight disturbances, it is not necessary to drive a motor vehicle or to control mechanisms in preparation application.
Overdosage
The typical clinical picture inherent to an overdosage of Voltaren, does not exist.
In case of an overdosage at preparation reception inside, with a view of the prompt prevention of an adsorption of diclofenac it is necessary to spend a gastric lavage and to prescribe the activated coal.
Medicinal interaction
Voltaren can raise concentration of lithium and digoxin in plasma at simultaneous application with these preparations.
Though in clinical researches it is not established influences of Voltaren on action of anticoagulants, there are separate reports on augmentation of risk of bleedings in cases of their joint application. Careful observation over the patients receiving these preparations simultaneously Is recommended.
Voltaren can be prescribed together with peroral hypoglycemic preparations and thus efficacyy of the last does not variate. However, separate reports on development in such cases as hypoglycemias, and hyperglycemias that caused necessity of change of a dose of hypoglycemic preparations against Voltaren application are known.
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