Instruction for use: Diclofenac (Diclophenacum)

Pharmacological group

NSAIDs - Derivatives of acetic acid and related compounds

Ophthalmic products

Nosological classification (ICD-10)

G43 Migraine

The pain of migraine, Migraine, hemiplegic migraine, Migraine headache, A migraine attack, Continuous headache, hemicranias

G54.1 Disorders of lumbosacral plexus

Sciatica, Neurology radicular origin, spine Pathology, Sciatica lumbosacral, radiculoneuritis

H10.5 Blepharoconjunctivitis

Chronic Blepharoconjunctivitis, Blepharoconjunctivitis, Staphylococcal blepharoconjunctivitis

H10.9 Conjunctivitis, unspecified

Trahomny conjunctivitis, catarrhal conjunctivitis, Giperpapillyarny conjunctivitis, Non-infectious conjunctivitis, purulent conjunctivitis, Purulent conjunctivitis form, Year-round conjunctivitis, purulent conjunctivitis, Subacute conjunctivitis, Secondarily infected with conjunctivitis

H16.2 Keratoconjunctivitis

Chronic allergic keratoconjunctivitis, Bacterial keratoconjunctivitis, Deep forms of adenovirus keratoconjunctivitis, Infectious conjunctivitis and keratoconjunctivitis caused by Chlamydia trachomatis, Acute allergic keratoconjunctivitis, Spring keratoconjunctivitis, Phlyctenular keratoconjunctivitis

H18.3 Changes in corneal envelopes

H66 Suppurative and unspecified otitis media

Bacterial ear infections, Inflammation of the middle ear, Infections of the upper respiratory tract, Infectious-inflammatory diseases of ENT organs, Infectious-inflammatory diseases of upper respiratory tract, Infectious-inflammatory diseases of the ear, Infectious diseases of ENT organs with marked pain syndrome, ear Infection, Otitis media infection, Persistent inflammation of the middle ear in children, Ear pain of otitis

I05-I09 Chronic rheumatic heart diseases

J02.9 Acute pharyngitis, unspecified

purulent pharyngitis, Acute nasopharyngitis,Limfonodulyarny pharyngitis

J03.9 Acute tonsillitis, unspecified (angina agranulocytic)

Sore throat infections, Acute tonsillitis, Angina, Follicular tonsillitis, Angina alimentary-hemorrhagic, Secondary sore throat, Sore throat primary, Angina follicular, Angina, Inflammatory diseases of the tonsils, Catarrhal angina, Lacunar angina, Acute Sore Throat, Tonsillitis, Tonsillitis acute, Tonsillar angina, Follicular sore throat, Bacterial tonsillitis

J06 Acute upper respiratory infections of multiple and unspecified

Frequent colds viral diseases, Infections of the upper respiratory tract, Acute respiratory disease influenza character, for colds Pain, Acute colds,Cold, respiratory infection,Seasonal colds, Pain in infectious and inflammatory diseases of the upper respiratory tract, Bacterial infections of the upper respiratory tract, Bacterial respiratory infections, Viral disease of the respiratory tract, Viral respiratory tract infections, Inflammatory disease of the upper respiratory tract, Inflammation of the upper respiratory tract disease, Inflammation of the upper respiratory tract illness with difficult sputum, Inflammatory airway disease, Secondary infections with colds, Shortness of sputum in acute and chronic respiratory diseases, Upper respiratory tract infection, Infections of the upper respiratory tract, Respiratory Tract Infections, Infections of the respiratory tract and lungs, Infectious-inflammatory diseases of the upper respiratory tract, Infectious-inflammatory diseases of the upper respiratory tract and ENT-organs, Infectious-inflammatory diseases of the upper respiratory tract in children and adults, Infectious-inflammatory diseases of the upper respiratory tract, Infectious inflammation of the airways,respiratory infection, Qatar upper respiratory tract, Catarrh of the upper respiratory tract, Catarrhal disease of the upper respiratory tract, Catarrhal symptoms of the upper respiratory tract, Coughing with a cold, SARS, ARI, ARI with rhinitis phenomena, Acute respiratory infection, Acute infectious and inflammatory disease of the upper respiratory tract, Acute respiratory disease, Sore throat or nose, Respiratory viral infections, Respiratory diseases, Respiratory infections, Recurrent respiratory infections, Secondary infection with influenza, cold in the chest, Feverish condition with flu usitis, acute sinusitis, genyantritis, purulent sinusitis

M06.9 Other specified rheumatoid arthritis

Rheumatoid arthritis, Pain syndrome in rheumatic diseases, Pain in rheumatoid arthritis, Inflammation in rheumatoid arthritis, Degenerative forms of rheumatoid arthritis, Children's rheumatoid arthritis, Exacerbation of rheumatoid arthritis, Acute articular rheumatism, Rheumatic arthritis, Rheumatic polyarthritis, Rheumatoid arthritis, Rheumatic polyarthritis, Rheumatoid arthritis, Rheumatoid arthritis, Rheumatoid arthritis of active course, Rheumatoid periarthritis, Rheumatoid polyarthritis, Acute Rheumatic Arthritis, Acute rheumatism

M10 Gout

Exacerbation of gout, Acute articular attack with gout, Acute gouty attack, Gouty attack, Recurrent gout attacks, Chronic gout

M15-M19 Osteoarthritis

M16 Coxarthrosis [arthrosis of the hip joint]

Hip osteoarthritis

M25.5 Pain in the joint

Arthralgia, Pain syndrome in musculo-articular diseases, Pain syndrome in osteoarthritis, Pain syndrome in osteoarthritis, Pain syndrome in acute inflammatory diseases of the musculoskeletal system, Pain syndrome in chronic inflammatory diseases of the musculoskeletal system, Pain in the joints, Soreness of the joints, Soreness of joints in severe physical exertion, Painful inflammatory joint damage, Painful conditions of the musculoskeletal system, Painful joint conditions, Painful traumatic affection of joints, Pain in the musculoskeletal system, Pain in Shoulder Joints, Pain in the joints, Joint pain, Joint pain with injuries, Musculoskeletal pain, Pain with osteoarthritis, Pain in the pathology of the joints, Pain in rheumatoid arthritis, Pain in chronic degenerative bone diseases, Pain in chronic degenerative joint diseases, Bone-joint pain, Joint pain, Arthritic pain of rheumatic origin, Articular pain syndrome, Joint pain, Rheumatic pain, Rheumatic pains

M45 Ankylosing spondylitis

Ankylosing spondylarthrosis, Marie-Strumpel disease, Ankylosing spondylitis, Pain syndrome in acute inflammatory diseases of the musculoskeletal system, Pain syndrome in chronic inflammatory diseases of the musculoskeletal system, Bechterew's disease, Ankylosing spondylitis, Diseases of the spinal column, Rheumatic spondylitis, Bechterew-Marie-Strumpel disease

M47 Spondylosis

Spondyloarthrosis, spondylarthrosis, Diseases of the spinal column, spondylosis

M54.3 Sciatica

Ishialgia, Neuralgia of the sciatic nerve, Sciatic neuritis

M60 Myositis

Myositis, Fibrositis Fibromyositis, Inflammatory disease of soft tissues

M65 Synovitis and tendosynovitis

Acute tenosynovitis, Tendovaginitis (tenovaginitis), Tendosinovit (tenosynovitis), Tendovaginitis, Osteoarthritis in musculo-articular diseases, Inflammatory disease of soft tissues, Nonspecific tenosynovitis, Tendosinovit

M71 Other bursopathies

Bursitis, Bursopathy, Diseases of soft tissues, Osteoarthritis in musculo-articular diseases, Inflammatory disease of soft tissues, Subacute bursitis

M77.9 Other unspecified

Capsule, Periarthritis, Tendonitis, Tendopathy, Periarthropathy

M79.0 Other unspecified rheumatism

Degenerative rheumatic disease, Degenerative and rheumatic diseases of the tendons, Degenerative rheumatic diseases, Localized forms of rheumatism of soft tissues, Rheumatism, Rheumatism with a pronounced allergic component, Rheumatism of the articular and extraarticular, Rheumatic attack, Rheumatic complaints, Rheumatic diseases, Rheumatic disease of the spine, Relapses of rheumatism, Articular and extra-articular rheumatism, Articular and muscular rheumatism, Articular rheumatism, Articular syndrome with rheumatism, Chronic rheumatic pain, Chronic articular rheumatism, Rheumatoid diseases, Rheumatic diseases of the intervertebral disc

M79.1 Myalgia

Myofascial pain syndromes ,Pain syndrome in musculo-articular diseases, Pain syndrome in chronic inflammatory diseases of the musculoskeletal system, Pain in the muscles, Tenderness of muscles, Muscular soreness in severe physical exertion, Painful conditions of the musculoskeletal system, Pain in the musculoskeletal system, Pain in the muscles, Pain at rest, Muscle aches, Muscle pain, Musculoskeletal pain, Myalgia, Muscle pain, Muscle pain at rest, Muscle pain, Muscular pain of non-rheumatic origin, Muscle pain of rheumatic origin, Acute muscle pain, Rheumatic pain, Rheumatic pains, Myofascial syndrome, Fibromyalgia

M79.2 Neurology and neuritis, unspecified

Pain syndrome with neuralgia, Brachialgia, Occipital and intercostal neuralgia, Neuralgia, Neuralgic pain, Neuralgia, Neuralgia of intercostal nerves,Neuralgia of the posterior tibial nerve, Neuritis, Neuritis traumatic, Neuritis, Neurological Pain Syndromes, Neurological contractures with spasms, Acute neuritis, Peripheral neuritis,Post-traumatic neuralgia,Severe pain of a neurogenic nature, Chronic neuritis, Essential neuralgia

N23 Renal colic unspecified

Pain in renal colic, Pain smooth muscle spasm, Pain spasm of smooth muscles (renal and biliary colic, intestinal spasms, dysmenorrhea), Pain spasm of smooth muscles of internal organs, Pain spasm of smooth muscles of internal organs (kidney and biliary colic, intestinal spasms, dysmenorrhea), renal Colic, ureteral colic, Renal colic, Renal colic with urolithiasis, Kidney disease, Spasm of smooth muscle in diseases of the urinary system, The spasm of the urinary tract, The spasm of the ureter, The spasm of the ureters, Spasms of the urinary tract, Spasms of the urinary tract

N70 Salpingitis and oophoritis

Adnexitis, Inflammatory diseases of female genitalia, Inflammatory diseases of female genital organs, Infection of the genitals, Oophoritis, Acute adnexitis, Salpingitis, Salpingo-oophoritis, Chronic inflammatory diseases of the ovaries, Inflammation of the ovaries

N71 Inflammatory diseases of the uterus, except the cervix

Intrauterine infections, Inflammatory diseases of female genitalia, Inflammatory diseases of female genital organs, Infection of the genitals, Chronic endometriometritis, Chronic inflammatory disease of the uterus, Endometritis, Endometriometry

N73.2 Parametritis and pelvic cellulitis, unspecified

Infections of pelvic fat, Pelvic cellulite, Parametritis, Pelvic cellulite

N76 Other inflammatory diseases of the vagina and vulva

Atrofic vulvovaginitis, Vulvovaginitis bacterial, Vulvovaginitis estrogen-deficient, Bacterial vaginosis, Vaginitis, Vaginitis bacterial, Inflammatory diseases of the vagina and vulva, Inflammatory diseases of female genitalia, Inflammatory diseases of female genital organs, Vulvit, Vulvovaginitis, Gardnerella, Fungal vulvovaginitis in girls and virgins, Infection of the vagina, Infection of the genitals, Colpitis, Violation of purity of the vaginal secretion, Nonspecific cervicovaginitis, Nonspecific vulvitis, Nonspecific vulvovaginitis, Nonspecific colpitis, Recurrent nonspecific bacterial vaginosis, Senylic coverings, Mixed Colpus, Chronic vaginitis, Vulvovaginal infections, Bacterial vaginitis, Mixed vaginal infections

N94.6 Dysmenorrhea Unspecified

Pain during menstruation, Functional disorders of the menstrual cycle, Menstrual cramps, Emmeniopathy, Pain during menstruation, Painful menstrual irregularities, algomenorrhea, algomenoreya, Pain smooth muscle spasm, Pain spasm of smooth muscles (renal and biliary colic, intestinal spasms, dysmenorrhea), Pain spasm of smooth muscles of internal organs (kidney and biliary colic, intestinal spasms, dysmenorrhea), Disalgomenoreya, dysmenorrhea, Dysmenorrhea (essential) (Exfoliative), menstrual disorder, menstruation painful, metrorrhagia, Violation of the menstrual cycle, Menstrual irregularities, Prolaktinzavisimoe menstrual disorders, Prolaktinzavisimoe menstrual dysfunction, Pain spasm of smooth muscles of internal organs, Spasmodic dysmenorrhea, Primary disalgomenoreya

R52 Pain, not elsewhere classified

Pain syndrome of radicular origin, Pain syndrome of small and medium intensity of different genesis, Pain syndrome after orthopedic surgery, Pain syndrome in superficial pathological processes, Radicular pain in the background of osteochondrosis of the spine, Radicular pain syndrome, Pleural pain, Chronic pain

R52.1 Constant unrestrained pain

Pain syndrome in oncology practice, Pain syndrome pronounced, Pain syndrome in malignant neoplasms, Pain syndrome in cancer, Pain syndrome with tumors, Pain syndrome in cancer patients, Pain in malignant neoplasms, Pain in malignant tumors, Pain in tumors, Pain in cancer patients, Pain in bone metastases, Pain in cancer, Malignant pain syndrome, Intensive chronic pain, Intensive pain syndrome, Intensive non-curable pain syndrome, Intensive chronic pain syndrome, Unrestrained pain, Unrestrained pain, Tumor pain, Post-traumatic pain syndrome, Severe pain, Chronic pain, Chronic Pain Syndrome

R52.2 Other constant pain

Pain syndrome, rheumatic origin, Pain at vertebral lesions, Pain in the chamber, Pain for burns, Pain syndrome weak or moderate, Perioperative pain,Moderate to severe pain, Moderately or weakly expressed pain syndrome, Moderate to severe pain, Ear pain of otitis, Neuropathic pain, neuropathic pain

R60.0 Localized swelling

Allergic laryngeal edema, Local swelling, local edema, localized swelling, Swelling of the lower extremities, Swelling caused by inflammation of the tendon sheath, The swelling after dental surgery, Swelling of the mucosa of the nasopharynx, Swelling of traumatic origin, Traumatic edema, Swelling with injuries, Post-traumatic swelling, Post-traumatic edema, Post-traumatic soft tissue edema, Traumatic edema, Edema oral

R68.8.0 * Inflammatory syndrome

Painful syndrome of inflammatory genesis, Pain syndrome with inflammation of non-rheumatic nature, Pain syndrome with inflammatory lesions of the peripheral nervous system, Painful inflammation of the shoulder joint, Painful inflammation after trauma or surgery, Painful inflammation after surgery, Painful hemorrhoids, Inflammation of the tympanic membrane, Inflammation of the larynx, Inflammation of the gums, Inflammation of cellulose, Inflammation of lymph nodes, Tonsillitis, Inflammation of muscles, Inflammation of soft tissues, Inflammation of the mouth, Inflammation after surgery and trauma, Inflammation after orthopedic surgery, Inflammation after trauma, Inflammation in rheumatoid arthritis, Inflammation of the middle ear, Inflammatory gum disease, Inflammatory diseases of the eyelids, Inflammatory eye diseases, Inflammatory swelling of soft tissues, Inflammatory processes, Inflammatory processes after surgical interventions, Inflammatory process, Inflammatory Syndrome, Inflammatory syndrome of non-rheumatic origin, Inflammatory syndrome after surgery, Purulent infections, Infringements of function of a liver of an inflammatory etiology, Acute inflammation of the musculoskeletal tissue, Pre-inflammatory soft tissue inflammation

S05 Injury of the eye and orbit

Wounds of the eye penetrating, Non-penetrating wound of the eyeball, Superficial injury of the cornea, Post-traumatic keratopathy, Post-traumatic central retinal dystrophy, Penetrating wound of the cornea, Condition after eye injuries, Condition after eyeball injuries, Penetrating corneal wounds, Injuries to eye tissues, Injuries to the cornea, Injury of anterior part of eye

T14.3 Dislocation, sprain and damage to the capsular-ligamentous apparatus of the joint of the unspecified area of the body

Painful stretching of muscles, Pain and inflammation in tension, Dislocation of dislocation, Degenerative changes in the ligamentous apparatus, Edema due to sprains and bruises, Edema after interventions for sprains, Damage and rupture of ligaments, The musculoskeletal system is damaged, Damage to ligaments, Damage to the joints, Ligament ruptures, Tendon tendons,Ruptures of the tendons of muscles,Stretching, Crick, Stretching of the muscle, Sprain, Tension of the tendons, Extensions,Stretch muscles, Sprains, Tension of the tendons, Injury of the musculoskeletal system, Injuries to the joints, Injuries of capsule-articular tissues, Injuries of the osteoarticular system, Injuries to ligamentsInjuries to the joints, Joint wounds, Stretching of the ligamentous apparatus, Habitual stretching and tearing

T14.9 Injury unspecified

Pain syndrome after trauma, Pain syndrome with injuries, Pain syndrome with trauma and after surgery, Pain in case of injury, Pain of a traumatic nature, Joint pain with injuries, Postoperative and post-traumatic pain, Pain in case of injury, Pain of a traumatic origin, Severe pain syndrome of traumatic origin, Deep tissue damage, Deep scratches on the trunk, Closed injury, Minor Household Injuries, Minor skin damage, Violations of the integrity of soft tissues, Uncomplicated trauma, Extensive traumatic injury, Acute pain syndrome of traumatic origin, Edema with trauma, Postponed sports injuries, Post-traumatic pain, Soft tissue injuries, Joint wounds, Sports injuries, Injury, Traumatic pain, Traumatic pains, Traumatic infiltrate,Injuries to sports

Z100 * CLASS XXII Surgical practice

Abdominal surgery, adenomectomy, Amputation, Coronary angioplasty, Angioplasty of the carotid arteries, Antiseptic skin treatment for wounds, Antiseptic Hand, Appendectomy, atherectomy, Balloon coronary angioplasty, Vaginal hysterectomy, The coronary bypass, Interventions in the vagina and cervix, Interventions on the bladder, Intervention in the mouth, Restoration and reconstructive surgery, Hand hygiene of medical personnel, Gynecologic surgery, Gynecological intervention, Gynecological surgery, Hypovolemic shock during operations, Disinfection of purulent wounds, Disinfection of wounds edges, Diagnostic intervention, Diagnostic procedures, Cervical Diathermocoagulation, Long-surgery, Replacing the fistula catheters, Infection in orthopedic surgery, Artificial heart valve, cystectomy, Short-term outpatient surgery, Short-term operation, Short surgical procedures, Krikotireotomiya, Blood loss during surgery, Bleeding during surgery and in the postoperative period, Kuldotsentez, laser photocoagulation, laser coagulation, retinal laser coagulation, Laparoscopy, Laparoscopy in Gynecology, CSF fistula, Small gynecological operations, Small surgical procedures, Mastectomy and subsequent plastic, mediastinotomy, Microsurgical operations on the ear, Mukogingivalnye operation, suturing, Minor surgery, neurosurgical operation, Immobilization of the eyeball in ophthalmic surgery, testectomy, pancreatectomy, Perikardektomiya, The period of rehabilitation after surgery, The period of, convalescence after surgery, Percutaneous transluminal coronary angioplasty, Pleural thoracentesis, Pneumonia postoperative and posttraumatic, Preparation for surgical procedures, Preparation for surgery, Preparation of the surgeon's hands before surgery, Preparation of the colon for surgical procedures, Postoperative aspiration pneumonia in neurosurgical and thoracic surgery, Postoperative nausea, Postoperative bleeding, postoperative granuloma, postoperative shock, The early postoperative period, myocardial revascularization, Radiectomy, gastric Resection, bowel resection, uterine Resection, liver Resection, enterectomy, Resection of part of the stomach, Reocclusion of the operated vessel, Bonding tissues during surgical procedures, Removal of sutures, Condition after eye surgery, Condition after surgery, Condition after surgery in the nasal cavity, Condition after gastrectomy, Status after resection of the small intestine, Condition after tonsillectomy, Condition after removal of the duodenum, Condition after phlebectomy, Vascular surgery, Splenectomy, Sterilization of surgical instruments, Sterilization of surgical instruments, sternotomy, Dental surgery, Dental intervention in periodontal tissues, strumectomy, Tonsillectomy, Thoracic surgery, total gastrectomy, Transdermal intravascular coronary angioplasty, Transurethral resection, Turbinektomiya, Removal of a tooth, cataract surgery, Removal of cysts, tonsillectomy, Removal of fibroids, Removing the mobile primary teeth, Removing polyps, Removing broken tooth, Removal of the uterus body, Removal of sutures, Urethrotomy, Fistula likvoroprovodyaschih ways, Frontoetmoidogaymorotomiya, Surgical infection, Surgical treatment of chronic limb ulcersm, Surgery, The surgery in the anal area, The surgery on the colon, Surgical practice, The surgical procedure, Surgical interventions, Surgery on the gastrointestinal tract, Surgical procedures on the urinary tract, Surgical procedures on the urinary system, Surgical intervention of the genitourinary system, Surgical procedures on the heart, Surgical manipulation, surgery, Surgery on the veins, Surgical intervention, Vascular surgery, Surgical treatment of thrombosis, cholecystectomy, Partial gastric resection, transabdominal hysterectomy, Percutaneous transluminal coronary angioplasty, Percutaneous transluminal angioplasty, Coronary artery bypass, tooth Extirpation, Extirpation of milk teeth, pulpectomy, pulsative cardiopulmonary bypass, tooth Extraction, teeth Extraction, cataract extraction, Electrocoagulation, endourological intervention, episiotomy, Etmoidotomiya, Complications after tooth extraction

CAS 15307-86-5

Pharmacology

Pharmacological action - anti-inflammatory, antipyretic, antiaggregational, analgesic, antirheumatic.

It inhibits cyclooxygenase, as a result of which the reactions of the arachidonic cascade are blocked and the synthesis of PGE2, PGF2alpha, thromboxane A2, prostacyclin, leukotrienes and release of lysosomal enzymes is disrupted; suppresses platelet aggregation; with long-term use has a desensitizing effect; in vitro causes a slowdown in the biosynthesis of proteoglycan in the cartilage in concentrations corresponding to those observed in humans.

After the introduction of the interior is completely resorbed, food can slow down the rate of absorption, without affecting its completeness. Cmax in plasma is achieved after 1-2 hours. As a result of sustained release of active substance Cmax, diclofenac prolonged action in blood plasma is lower than that produced when a short-acting preparation is administered; the concentration remains high for a long time after the administration of the prolonged form, Cmax 0.5-1 μg / ml, the time of Cmax occurrence is 5 hours after the administration of 100 mg of diclofenac of prolonged action. The concentration in the plasma is linear depending on the amount of the administered dose. With the / m introduction of Cmax in the plasma is achieved after 10-20 minutes, with rectal - after 30 minutes. Bioavailability - 50%; intensively subjected to presystemic elimination. Binding to plasma proteins is over 99%. It penetrates well into the tissues and synovial fluid, where its concentration increases more slowly, reaches higher values in 4 hours than in plasma. Approximately 35% is excreted as metabolites with feces; about 65% is metabolized in the liver and is excreted through the kidneys as inactive derivatives (unchanged, less than 1% is excreted). T1 / 2 from the plasma - about 2 hours, synovial fluid - 3-6 hours; at observance of the recommended interval between receptions does not cumulate.

When applied locally, it penetrates through the skin. When instilled into the eye, the onset time of Cmax in the cornea and conjunctiva is 30 min after instillation, it penetrates into the anterior chamber of the eye, and does not enter the systemic circulation in therapeutically significant quantities.

Relieves pain at rest and during movement, morning stiffness, swelling of the joints, improves their functional capacity. In inflammatory processes that occur after surgery and trauma, quickly alleviates both spontaneous pain and pain while moving, reduces inflammatory edema at the wound site. In patients with polyarthritis who received course treatment, the concentration in synovial fluid and synovial tissue is higher than in blood plasma. For anti-inflammatory activity excels acetylsalicylic acid, butadione, ibuprofen; there is evidence of greater clinical response and better tolerability than indomethacin; with rheumatism and Bechterew's disease is equivalent to prednisolone and indomethacin.

Application of Diclofenac

Inflammatory joint diseases (rheumatoid arthritis, rheumatism, ankylosing spondylitis, chronic gouty arthritis), degenerative diseases (deforming osteoarthritis, osteochondrosis), lumbago, sciatica, neuralgia, myalgia, diseases of extraarticular tissues (tendovaginitis, bursitis, rheumatic soft tissue damage), posttraumatic pain syndromes accompanied by inflammation, postoperative pain, acute gout attack, primary dysregorenorea, adnexitis, migraine attacks, renal and hepatic colic, infectious diseases and otolaryngology, residual effects of pneumonia. Locally - injuries to the tendons, ligaments, muscles and joints (for pain and inflammation removal during stretching, dislocations, bruises), localized forms of soft tissue rheumatism (pain and inflammation elimination). In ophthalmology - non-infectious conjunctivitis, post-traumatic inflammation after penetrating and non-penetrating injuries of the eyeball, pain syndrome with excimer laser, during the operation of removal and implantation of the lens (pre- and postoperative prophylaxis of miosis, cystoid edema of the optic nerve).

Contraindications

Hypersensitivity (including to other NSAIDs), violation of hematopoiesis of unspecified etiology, peptic ulcer of stomach and duodenum, destructive and inflammatory bowel disease in the phase of exacerbation, aspirin bronchial asthma, children's age (up to 6 years), the last trimester of pregnancy .

Restrictions for use

Violation of the liver and kidney function, heart failure, porphyria, work that requires increased attention, pregnancy, breast-feeding.

pregnancy and lactation

The action category for the fetus is FDA-C (up to 30 weeks gestation).

The action category for the fetus is FDA-D (after 30 weeks gestation).

Side effects of Diclofenac

Gastrointestinal disorders (nausea, vomiting, anorexia, flatulence, constipation, diarrhea), NSAID-gastropathy (lesion of the antral part of the stomach in the form of erythema mucosa, hemorrhages, erosions and ulcers), acute medical erosion and ulcers of other parts of the gastrointestinal tract, intestinal hemorrhage, impaired liver function, increased serum transaminase levels, drug hepatitis, pancreatitis, interstitial nephritis (rarely - nephrotic syndrome, papillary necrosis, acute renal failure), headache, staggering while walking, g irritability, fatigue, swelling, aseptic meningitis, eosinophilic pneumonia, local allergic reactions (exanthema, erosion, erythema, eczema, ulceration), erythema multiforme, Stevens-Johnson syndrome, Lyell syndrome, erythroderma, bronchospasm, systemic anaphylactic reactions (including shock), hair loss, photosensitivity, purpura, hemopoiesis disorders (anemia-hemolytic and aplastic, leukopenia up to agranulocytosis, thrombocytopenia), cardiovascular disorders (increased blood pressure), violations of sensitivity and vision, convulsions.

With the / m introduction - burning, the formation of infiltrate, abscess, necrosis of adipose tissue.

When applying suppositories - local irritation, mucous discharge with an admixture of blood, pain during defecation.

With topical application - itching, erythema, rashes, burning, it is also possible the development of systemic side effects.

Interaction

Increases the concentration in the blood of lithium, digoxin, indirect anticoagulants, oral antidiabetic drugs (possible both hypo- and hyperglycemia), quinolone derivatives. Increases the toxicity of methotrexate, cyclosporine, the likelihood of developing side effects of glucocorticoids (gastrointestinal bleeding), the risk of hyperkalemia against a background of potassium-sparing diuretics, reduces the effect of diuretics. The concentration in the plasma decreases with the use of acetylsalicylic acid.

Overdose

Symptoms: dizziness, headache, hyperventilation, confusion, in children - myoclonic cramps, gastrointestinal disorders (nausea, vomiting, abdominal pain, bleeding), disorders of liver and kidney function.

Treatment: gastric lavage, the introduction of activated charcoal, symptomatic therapy aimed at eliminating the increase in blood pressure, impaired renal function, seizures, gastrointestinal irritation, respiratory depression. Forced diuresis, hemodialysis are ineffective.

Routes of administration

Inside, in / m, in / in, rectally, topically (skin, instillation in the conjunctival sac).

Precautions for Diclofenac

With long-term treatment, it is necessary to periodically study the formula of blood and liver function, the analysis of feces for latent blood. In the first 6 months of pregnancy should be used according to strict indications and in the lowest dosage. Because of the possible reduction in reaction speed, it is not recommended to drive vehicles and work with mechanisms. Do not apply to damaged or exposed areas of the skin, in combination with an occlusive dressing; Do not get into eyes and mucous membranes.

Update of information

Risk of gastrointestinal complications

Risk of gastrointestinal complications. Diclofenac sodium, like other NSAIDs, can cause serious side effects from the gastrointestinal tract, incl. bleeding, ulceration and perforation of the stomach or intestines, which can be fatal. These complications can occur at any time with or without prognostic symptoms in patients using NSAIDs. Only in 1 out of 5 patients, serious side effects from the gastrointestinal tract on the background of therapy with NSAIDs were symptomatic. Ulcerous lesions of the upper gastrointestinal tract, large bleeding or perforation caused by NSAIDs were observed in approximately 1% of patients treated for 3-6 months and approximately 2-4% of patients treated for 1 year. The risk of complications from the gastrointestinal tract is higher with prolonged intake of drugs, but it also exists with short-term therapy. Elderly patients have a higher risk of developing serious complications from the gastrointestinal tract.

Information sources

Risk of thromboembolic complications

The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) concluded that the effects of diclofenac-containing drugs on the cardiovascular system in their systemic application (capsules, tablets, injection forms) are similar to those for selective COX-2 inhibitors, especially when diclofenac is used in high doses (150 mg daily) and with long-term treatment.

PRAC concludes that the use of diclofenac is greater than the risks, but recommends the same precautions as using COX-2 inhibitors to minimize the risk of thromboembolic complications.

Patients with previous severe cardiovascular diseases, incl. in chronic heart failure, IHD, cerebrovascular disorders, peripheral arterial disease, diclofenac should not be used. Patients with risk factors (eg, high blood pressure, elevated cholesterol, diabetes, smoking) should use diclofenac with great caution.