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Any disease of the musculoskeletal system is accompanied by pain. It becomes especially strong after sleep, when soft tissues accumulate fluid, which manifests itself in the form of puffiness and swelling. The best option elimination This kind of pain, by relieving the inflammatory process and quickly relieving pain, is taking Diclofenac. The non-steroidal anti-inflammatory drug has a fairly wide selection of release forms (gels and creams, injection solutions, tablets, suppositories), which increases its effectiveness by treating not only the source of inflammation, but also affecting it from the inside. How to use this drug correctly and what contraindications it has, we will consider further.
pharmachologic effect
Diclofenac belongs to the group of NSAIDs. Active substance diclofenac sodium affects the synthesis of prostaglandins at the site of inflammation, reducing their concentration. The drug also inhibits the metabolic processes of arachidonic acid and cyclooxygenase. All this together allows you to achieve such favorable results as:
- relieving inflammation;
- relief of pain at the site of inflammation;
- elimination of hyperemia of the skin (increase in temperature).
A drug capable of penetrating synovial fluid and linger there, being in maximum concentration. After taking Diclofenac, it is well absorbed into the blood. Maximum concentration in plasma is achieved, depending on the form of administration:
- tablets – 2-3 hours;
- injections – 15-20 minutes;
- ointment and gel – 2-4 hours.
Almost completely binds to blood albumin, where, during metabolism in the liver, it breaks down into simpler compounds that are excreted through the kidneys after 6-12 hours. Diclofenac does not accumulate, therefore can be used for long-term treatment, non-addictive and without reducing its effectiveness.
Composition and release form
Depending on the release form, the content of the main component diclofenac sodium is excellent:
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- Pills, covered with a shell, white or yellowish in color. There can be two dosages: 25 and 50 mg of the active substance. There are also auxiliary components:
- corn starch;
- dye;
- titanium dioxide.
The tablets are packaged in 10, 20, 30 pieces in blisters or dark glass jars.
- Injection– contains diclofenac sodium:
- 1 ampoule – 25 mg;
- 1 ampoule – 75 mg.
Excipients:
- purified water;
- benzyl alcohol;
- propylene glycol;
- sodium metabisulfite;
- sodium hydroxide.
The ampoules are packed in cardboard or plastic boxes, 3-5 ampoules in each.
- Candles contain 25 mg of diclofenac sodium, as well as auxiliary components, including solid fat, glycerin and dye. Rectal suppositories are packaged in 5-10 pieces in sealed packaging.
- Ointment 2% packaged in an iron tube, volume 30 g. The content of diclofenac sodium in 1 g of ointment is 20 mg. Used for external use.
- Gel 5%— Diclofenac Forte, which has an increased concentration of the active component, contains in 1 g:
- diclofenac sodium – 50 mg;
- dimexide;
- propylene glycol;
- purified water;
- macrogoal
It has a homogeneous gel consistency, transparent color, sometimes with air bubbles. One tube has a volume of 40 g.
- Gel and ointment 1%— contain diclofenac sodium 10 mg per 1 g of ointment or gel. This dosage is convenient if complex treatment is being performed, requiring not only oral administration, but also local action on the site of inflammation.
- Eye drops 0.1%— packaged in a 5 or 10 ml bottle with a dispenser. 1 ml drops contain 1 mg of active substance. The drops are transparent in color, sometimes with a yellowish tint. Auxiliary components:
- sodium chloride;
- distilled water;
- sodium hydroxide.
Application
Diclofenac is prescribed for the treatment of diseases such as:
- Inflammatory processes of the musculoskeletal system and joints:
- osteoarthritis;
- spondylitis;
- osteochondrosis of the spinal column;
- lumbago;
- sprains and ligament tears;
- soft tissue injuries and bruises.
- As part of complex therapy in the treatment of ENT diseases:
- pharyngitis;
- otitis;
- tonsillitis.
- Preparing for eye surgery, as well as eliminating negative reactions after it:
- cataract;
- swelling of the macula of the retina;
- photophobia.
- Pain relief at:
- renal and hepatic colic;
- proctitis;
- adnexitis;
- algodismenorrhea;
- migraine.
Depending on the form of release, the drug is used as follows::
- Pills– apply between meals(the absorption process and digestibility drop sharply when consumed during meals), without chewing in the mouth, with water. The permissible daily dose is 150 mg. It is recommended to use 25-50 mg (1-2 tablets) 2-3 times a day. After achieving the effect, the dosage should be reduced to the minimum. In children (from 6 years old), the dosage is calculated from the proportion of 2 mg tablets per 1 kg of weight.
- Solution for injection - administered deeply intramuscularly, no more than 75 mg (1 ampoule). If necessary, the injection is repeated, but not earlier than after 12 hours. After 2-3 days of administration of the drug, it is recommended to switch to oral administration of the drug, maintaining the dosage.
Diclofenac injections are never administered intravenously, since this can cause not only a chemical burn of soft tissues, but also develop severe intoxication
- Rectal suppositories– enter 1-2 candles in the anus, you first need to give a cleansing enema, which will ensure maximum absorption of the active components in the rectum. Suppositories are effective for inflammatory processes in the pelvic region, as well as gynecological diseases.
- Eye drops- bury 1 drop into the conjunctival sac every 3-4 hours. After surgery, the frequency of instillation is regulated by the attending physician.
- Gels and ointments apply onto clean skin with smooth massaging movements, rubbing well into the skin until completely absorbed. The number of daily applications should not exceed 2-3 times.
Since some types of gels with diclofenac sodium have an increased concentration (5%), you need to ensure that an overdose does not occur if, in addition to ointments and creams, tablets, injections or suppositories are used.
Contraindications
- childhood up to 6 years;
- period of pregnancy and lactation;
- gastric and duodenal ulcers in the acute stage;
- hematopoietic disorder;
- poor blood clotting, as well as a tendency to bleed.
With extreme caution used in the presence of such diseases:
- renal and liver failure;
- cardiovascular diseases;
- diabetes;
- anemia;
- arrhythmia;
- bronchial asthma;
- old age.
The presence of contraindications, as well as adverse reactions, suggests that treatment with Diclofenac should be carried out only on the recommendation of a doctor, strictly following all his recommendations regarding forms and dosages.
Under no circumstances should you combine medication with alcoholic drinks, since this can lead to severe intoxication and collapse, which is extremely life-threatening.
Overdose
With a slight excess specified daily permissible dose , the patient may experience following symptoms:
- nausea, vomiting, dizziness up to loss of consciousness;
- convulsions;
- cardiopalmus;
- bleeding;
- pain in the epigastric region.
In case of overdose carry out symptomatic treatment, implying:
- Flushing the gastrointestinal tract, reducing the concentration of toxins;
- Introduction of a large dose of any sorbent that binds and neutralizes toxins.
- Drink plenty of boiled water at room temperature
If the symptoms appear are life-threatening, you should urgently call an ambulance.
Side effects
The most common adverse reactions that occur in patients using Diclofenac are:
- stomach ache;
- swelling of the limbs;
- noise in ears;
- anemia;
- sleep disturbance;
- chest cough.
The most dangerous side effect considered an allergic reaction, which can manifest itself in the form:
- skin rash - small blistering tubercles filled with clear liquid;
- swelling of the mucous membranes;
- itchy skin;
- anaphylactic shock and angioedema.
If taking Diclofenac causes at least one of the adverse reactions, treatment is stopped until the allergy is completely eliminated and studied.
With the rapid development of an allergic reaction, the patient is injected deeply intramuscularly with any antihistamine in a double dose. If resuscitation is necessary, the metabolic products of diclofenac sodium are eliminated using dialysis (introduction of a large amount of liquid by drip).
Drug interactions
Diclofenac may reduce the effectiveness of diuretics, increasing and retaining sodium and lithium salts in large quantities. Reduces the activity of antihypertensive drugs, and neutralizes the effects of sleeping pills drugs.
- corticotropin;
- pure ethanol;
- colchicine;
- cefoperazone;
- Plicacymin.
Their simultaneous use leads to the development of internal erosions and bleeding in the gastrointestinal tract.
There is no point in using acetylsalicylic acid, since it significantly reduces the effectiveness of Diclofenac by dissolving it into inactive particles (pacifiers) during metabolism.
Advantages
The most important advantage Diclofenac, regardless of the form of release, is its affordable price. This is one of the most affordable NSAIDs, which is affordable for absolutely any patient. Also the drug not addictive. Its continuous administration does not affect its effectiveness. The course of treatment can be selected individually, gradually reducing the dosage to a minimum.
Price
The average price for medicines containing diclofenac sodium is as follows:
- tablets - 15-20 rubles for 10 pieces;
- ointments and gels – 25-60 rubles (depending on the dosage and volume of the tube);
- rectal suppositories – 35-70 rubles for 5 pieces;
- solutions for intramuscular administration - 30-35 rubles per package;
- eye drops – 20-45 rubles (5 and 10 ml).
Conditions for dispensing from pharmacies
Tablets, eye drops and injection solution are sold strictly according to prescription. Other forms are allowed for free over-the-counter sale.
Storage conditions
Tablets, suppositories and injection ampoules are stored in a cool, dry place (best in the refrigerator). Ointments and gels can be stored in a medicine cabinet, tightly closing the tube cap after each use.
Best before date
Eye drops and rectal suppositories are stored for no more than 1 year from the date of manufacture. Other forms are stored for up to 2 years from the date of production.
Analogues
Among the drugs that have a similar effect on the body, the following analogues can be distinguished:
- Naklofen – 100 rubles;
- – 40 rubles;
- – 320 rubles;
- Diklovit candles – 150 rubles;
- – 120 rubles;
- – 15 rubles.
Thus, Diclofenac has a huge selection of forms of use, however, you need to understand that you don’t need to use them all together at the same time. This can provoke an overdose, which will lead to intoxication and a lot of negative effects on the body. Treatment should be carried out exclusively under the supervision of doctors, who will select a reasonable dosage and the most suitable form. The instructions for use may not reflect the danger that the medicine contains.
Sodium is widely prescribed and gives good results in the treatment of injuries and diseases of joints and muscles, as well as pathologies musculoskeletal apparatus. The drug belongs to the group of non-steroidal drugs that have an anti-inflammatory effect, inhibit the synthesis of prostaglandins and relieve pain. Also, injections of diclofenac can stop the destructive processes in the spine and restore part of its mobility. Read more about the article here.
Release form and composition of the drug
Medicine is released in dark ampoules of 3 ml solution in each. In the middle there is a clear liquid with a slightly noticeable odor of benzyl alcohol. The composition of the medicine includes diclofenac sodium in the amount of 75 mg in each ampoule.
Auxiliary components are:
- beckons;
- Benzyl alcohol;
- Propylene glycol;
- Sodium pyrosulfite;
- Sodium hydroxide;
- Water for injections.
Indications for use
- Inflammatory and degenerative process in rheumatic diseases;
- Pain syndrome in the spine;
- Rheumatic diseases of soft tissues that are located outside the joint;
- Attack of gout in the acute period;
- Pain in the post-traumatic and postoperative period, which is accompanied by swelling and inflammation;
- Biliary and renal colic;
- Severe migraine;
- Neuralgia;
- Increased body temperature;
- Bacterial and viral conjunctivitis.
Contraindications
- Diseases of the stomach and intestines in the acute phase;
- Inflammatory process in the intestines;
- Hypersensitivity to the components of the drug;
- Tendency to develop allergic reactions;
- When taking aspirin and other non-steroidal drugs, there is a risk of developing urticaria, acute rhinitis and an attack of bronchial asthma;
- The medicine is not prescribed until the age of 18;
- When carrying a fetus;
- Severe heart failure;
- Liver failure;
- Blood diseases and bleeding disorders;
- Bypass surgery and other heart surgeries;
- High blood pressure;
- Elderly age;
- Bronchial asthma.
pharmachologic effect
The medicine relieves pain and inflammation in a short period of time, but does not remove the cause of the disease. After administering an injection of diclofenac, the components in the drug inhibit the enzymes cyclooxygenase and arachidonic acid metabolism reactions. This effect stops the fall of platelets and inhibits the release of lysosomes, which cause the inflammatory process.
The patient already after the first injection swelling decreases, joints become more mobile, pain goes away after surgery and injury. Read about it here.
Dosage
The medication Diclofenac is prescribed to relieve pain during acute and chronic processes in the body. The drug is administered intramuscularly at a dose of 75 mg twice a day for two days. Only a doctor can prescribe medicine to a patient after a preliminary examination and diagnosis.
Procedure for working with the ampoule:
- You need to shake the ampoule a little and carefully cut the top with a special nail file. Then take a cotton swab and open the medicine and immediately withdraw the solution into a sterile syringe;
- The drug must be injected very deeply into the upper part of the buttock. It is necessary to alternate the injection into the right and left buttock;
- Before injecting the medicine, you need to hold the syringe with the medicine in a warm palm. This will help enhance the effect of the components and provide an analgesic effect faster;
- The drug Diclofenac is administered only intramuscularly. Administration of the medicine subcutaneously or intravenously is prohibited;
- For better tolerability, it is recommended to administer the medicine no more than twice a day;
- Diclofenac injections are administered only for two days. If it is necessary to continue treatment, drug injections are replaced with suppositories or tablets;
- Many doctors prescribe injections every other day, to reduce the risk of developing digestive tract pathologies
- Basically, the administration of Diclofenac alternates with injections of other analgesics.
special instructions
Are common:
- Prevent development side effects and allergic reactions are possible by using a minimum dosage of Diclofenac injections;
- It is necessary to avoid taking Diclofenac together with other non-steroidal drugs;
- It is not recommended to prescribe injections in old age in the presence of serious chronic pathologies;
- Before administering the injection, you need to test the medication for the development of allergies.
List of possible reactions
Blood system:
- Anemia;
- Thrombocytopenia;
- Leukopenia.
The immune system:
- Angioedema;
- Anaphylactic shock;
- Increased hypersensitivity.
Mental disorders:
- Depression;
- Sleep disturbance;
- Nightmarish dreams;
- Disorientation in space;
- Irritability.
Neurology:
- Migraine;
- Dizziness;
- Increased fatigue;
- Drowsiness;
- Memory impairment;
- General weakness;
- Development of stroke;
- Hallucinations.
Organs of vision:
- Decreased vision;
- Feeling foggy;
- Optic neuritis.
ENT system:
- Tinnitus;
- Hearing impairment.
Cardiac system:
- Heart attack;
- Heart failure;
- Tachycardia;
- Chest pain;
- Reduced pressure.
Digestive system:
- Nausea;
- Vomit;
- Diarrhea;
- Gastritis;
- Bleeding;
- Constipation;
- Ulcerative stomatitis;
- Pancreatitis.
From the liver:
- Jaundice;
- Hepatitis;
- Liver failure.
From the skin:
- Hives;
- Various rashes;
- Eczema;
- Allergic purpura;
- Dermatitis.
Genitourinary system:
- Impotence;
- Acute renal failure;
- Proteinuria;
- Edema.
General violations:
- Chills;
- Hyperemia at the injection site;
- General malaise.
Interaction with other drugs
- Lithium and digoxin. Coadministration may increase plasma concentrations of these drugs;
- Diuretics. Diclofenac reduces the effect of diuretics;
- Other non-steroidal drugs. The combined use of two forms of non-steroidal drugs may cause the development of undesirable reactions;
- Antidiabetic drugs. Taking Diclofenac and diabetes medications must be done under the supervision of a doctor and a blood glucose test;
- Cardiac glycosides. When these two groups of drugs are taken together, manifestations of heart failure may increase;
- Cyclosporine. Diclofenac and cyclosporine may increase the risk of developing renal failure.
Possibility of side effects
According to statistics, the development of side effects during treatment with Diclofenac injections is 10%.
Based on patient reviews, the most common are the following: side effects:
- Sleep disturbance;
- Dizziness;
- Development of severe migraine;
- Decreased hearing and vision;
- Nose bleed;
- Convulsions;
- Rashes and hemorrhages on the skin;
- Development of abscess or necrosis at the site of drug administration;
- A burning sensation at the injection site.
You can buy Diclofenac at a pharmacy without a prescription. If you administer the drug yourself at home, you must be under the supervision of a specialist during the treatment process.
Overdose
There is no reliable data on drug overdose.
Symptoms of an overdose include the following pathologies:
- Strong headache;
- Stomach ache;
- Nausea and vomiting;
- Excitation;
- Dizziness;
- Loss of consciousness;
- In more severe cases of overdose, the development of renal and liver failure is noted.
Treatment of overdose
After one hour after an overdose of Diclofenac, you must give the patient an adsorbent to drink, for example, activated carbon. Gastric lavage is also indicated, which will help reduce the absorption of toxic substances.
If you have seizures administration of diazepam is indicated. Further treatment continues symptomatic and is adjusted depending on the severity of the overdose.
Should Diclofenac injections be preferred over other drugs?
According to doctors, the medicine Diclofenac is safe for human health. This drug is well tolerated by patients and has a high anti-inflammatory and analgesic effect. Therefore, if there are no special contraindications, then you can take the medicine for a long time.
According to multiple studies, it was found that if you take Diclofenac in a dose 150 mg per day for more than 8 months, it will not have a detrimental effect on the body and will be well tolerated by patients.
It should be recalled, like all other non-steroidal drugs, Diclofenac has its contraindications and side effects, especially in patients who are at risk.
Risk factors:
- Age after 67 years;
- Stomach diseases;
- Large dose of Diclofenac;
- Combined use with other non-steroidal drugs;
- Drinking alcohol and smoking;
- The presence of Helicobacter pylari in the body.
The drug "Diclofenac" belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs). Used as an analgesic for disorders of the functioning of joints and skeletal muscles. It is produced in a variety of forms, including as a composition for intramuscular administration. In addition to liquid for injection, it is produced in the form of tablets, ointments, gels, and suppositories. The last three forms are topical medications, while diclofenac in injections and tablets is systemic.
Diclofenac is a substance derived from phenylacetic acid.
The injection solution is sold in 3 ml ampoules and packaged in packs of 5 pieces.
Diclofenac: instructions for use
Dosage form
Solution for injection in ampoules 3 ml.
Compound
- Diclofenac sodium - active ingredient (25 milligrams)
- Sodium hydroxide
- Sodium metabisulfate
- Benzyl alcohol
- Mannitol
- Propylene glycol
- Water is sterile
Action
It has an anti-inflammatory, analgesic and antipyretic effect. Blocks the release of arachidonic acid, which provokes inflammation, from damaged areas of cells. Thus, it prevents the onset of a chemical reaction leading to vasodilation and swelling, as well as damage and destruction of cells. Inhibits the action of cyclooxygenase. Inhibits the synthesis of prostaglandins. It is an antiplatelet agent. Reduces the concentration of chemicals that initiate inflammatory reactions in the damaged area. Recurrence of pain is prevented. Helps improve blood supply, reduce inflammation, protect cells from damage. Restores the functionality of joints. Joint stiffness is reduced. The severity of vascular hyperemia in the area of inflammation and the intensity of pain are reduced.
The inflammatory process is caused by compression of the damaged area and exposure to chemicals in the body that serve as mediators of inflammation. The process also prevents nutrients from reaching the tissues. Often, when the affected area swells, neighboring joints and nerve roots are also compressed, which leads to even worse consequences. Initially healthy cells are damaged and die. Diclofenac reduces the risk of such complications, neutralizes the mediators of the inflammatory reaction, blocks their release, due to which the pain goes away and the likelihood of relapse decreases.
The concentration of prostaglandins in the digestive tract decreases, which can cause unpleasant side effects in this part of the body.
Absorption begins immediately after the drug enters the muscle tissue. Twenty to thirty minutes after the injection, the concentration of the substance in the blood reaches its maximum value. Accumulation does not occur if the correct time interval between administrations is observed.
Almost the entire volume of the active substance after administration is associated with blood proteins, in particular albumin. Penetrates into the joint fluid, where high values remain for up to 12 hours after administration. 2 hours after the peak content of the substance in the blood is established, there is more of the substance in the joint fluid than in the serum.
The half-life is 2 hours, derivatives are eliminated longer. The main metabolism is carried out in liver cells. Most of the breakdown products are excreted in the urine, and some more in feces.
The initial molecules of the drug are partially glucuronidated, predominantly hydroxylated and methoxylated. Metabolic intermediates are then converted into glucuronic molecules.
Indications for use
Disease conditions in which pain is caused by an inflammatory process: gout, rheumatism, rheumatoid arthritis. Degenerative-dystrophic diseases of the joints and spine: arthrosis, osteochondrosis. Ankylosing spondylitis. Uncomfortable sensations caused by physical activity. Diseases of extra-articular areas: bursitis, tendovaginitis. Lumbago, neuralgia and muscle pain. Complications after operations, injuries.
For deforming osteoarthritis, the drug relieves pain, eliminates synovitis, and prevents the destruction of nearby cartilage and bones.
In addition to diseases of the musculoskeletal system, diclofenac injections are prescribed for pneumonia, renal and hepatic colic, migraine attacks, in gynecology - for adnexitis, salpingitis, painful menstruation, in otolaryngology - for acute inflammatory diseases of the respiratory tract - otitis, sinusitis, eustachitis.
Contraindications
Diclofenac injections are contraindicated in the following cases: children (up to 15 years), increased sensitivity to any of the components of the drug, allergic reactions to painkillers from the group of non-steroidal anti-inflammatory drugs, ulcerative lesions of the stomach or duodenum (during an exacerbation or during perforation), bleeding in the digestive system, impaired blood clotting or hematopoiesis, inflammation of the intestines, renal and liver failure, myocardial infarction and bypass surgery, heart failure, hemorrhagic stroke or the risk of its development, atherosclerosis, major blood loss, dehydration, pregnancy (last trimester) and lactation, infertility.
Relative contraindications: ulcerative lesions of the large intestine (Crohn's disease) in the past, impaired functioning of the liver, kidneys, systemic lupus erythematosus, porphyria, significant increase blood pressure, elderly age.
Before you start taking it, make sure that there are no contraindications.
Important! Should not be prescribed in combination with other NSAIDs.
If any of the contraindications exist, the doctor must select medications that are similar in action (and not in composition).
Directions for use and dosage: how to give diclofenac injections
In the first days of treatment with this drug, injections are used. Strictly intramuscular administration is indicated; under no circumstances should it be administered intravenously. How to inject diclofenac: having previously disinfected the surface, a 5 ml syringe (deep injection of the medicine is required, for which the needle of this syringe is best suited) is injected deep into the gluteal muscle or the front surface of the thigh. Recommended dose: 1 ampoule (75 mg active substance) per day. If necessary, you can re-administer the medicine at least 30 minutes after the first injection. The duration of treatment is 2-3 days. Then the doctor can extend it to 5 days if there are indications for this. It is permissible to combine intramuscular injections with forms of the same drug intended for local action - ointments, gels.
For some time after the injection, a burning sensation may remain at the injection site.
A common complication is the appearance of an infiltrate at the injection site, and it is recommended to apply ice for 1-2 minutes to avoid the appearance of an abscess.
The total dose of diclofenac per day should not exceed 150 mg.
Attention! Do not use without a doctor's prescription! There is a danger of developing NSAID-associated gastropathy, stomach ulcers, and consequences from the nervous and cardiovascular systems.
Injections can only be given in large muscle masses, for example, in the outer upper quadrant of the buttock. When selecting a syringe smaller than 5 ml, due to its short needle, there is a danger of the medicine getting into the subcutaneous tissue.
It is better to change the injection site of the medicine - for example, alternate injections into the left and right buttock.
How to check that the needle has not entered a blood vessel: after insertion, pull the syringe plunger.
Administration of the drug intravenously and subcutaneously is strictly contraindicated to avoid necrosis of blood vessels and subcutaneous tissue.
Side effects
The list of side effects of diclofenac is quite wide. Most of them are associated with the inhibition of prostaglandins, which perform a number of important functions in the body. If any of the following symptoms appear, you should stop taking the medicine:
Adverse events related to digestive system: lack of appetite, nausea, vomiting, diarrhea, bloating, abdominal and epigastric pain, development of erosion of the stomach, duodenum, gastrointestinal bleeding (the first sign is the appearance of blood in the stool, turning it black). Inflammation in the oral cavity (stomatitis). Pancreatitis. Increased transaminase activity, indicating damage to liver cells. Stomach ulcers may develop. Due to the blocking of cyclooxygenase, which protects the stomach from the aggressive effects of acids, the digestive system suffers the most.
From the nervous system: dizziness, headache, increased excitability, irritability, sleep disturbance, accompanied by nightmares. Feelings of anxiety and fear. Hand tremors, increased convulsive readiness of striated muscles. Paresthesia (impaired skin sensitivity). Tinnitus, hearing and vision impairment. The central nervous system is mainly affected when the recommended dosage is exceeded.
Blood, bone marrow: decreased hemoglobin level, development of anemia (aplastic and hemolytic anemia), decreased number of platelets and leukocytes, decreased blood clotting. Suppression of bone marrow function.
From the excretory system: impaired kidney function, inflammation, the appearance of red blood cells in the urine.
Cardiovascular system: increased blood pressure, tissue swelling caused by a delay in the outflow of fluid from the body due to the presence of sodium ions in the drug.
Respiratory organs: very rarely - pneumonitis, asthmatic phenomena.
Skin and hair: redness of the skin, increased photosensitivity (up to daylight intolerance), hair loss (alopecia), itching, rash, Lyell's and Stevens-Johnson syndromes.
Complications at work immune system: increased sensitivity, angioedema, anaphylactic shock. Allergic reactions with epidermal rejection.
In rare cases, a post-injection abscess may occur. There are cases of compaction and pain at the injection site, less often - swelling and necrosis.
There is a danger of developing aseptic meningitis.
Important! Side effects and their intensity largely depend on the dose of the drug. It is advisable to use the minimum effective dose. With prolonged use and exceeding the dosage, the risk of complications increases, in particular this concerns the heart and blood vessels.
If any negative reactions of the body to the drug occur, immediately inform your doctor. A common side effect is gastrointestinal discomfort, this may just be a minor side effect but may also indicate an ulcer/bleeding.
Interaction with other chemicals and drugs
Lithium preparations, digoxin, phenytoin: diclofenac increases the concentration of drugs in the blood.
The effect of antihypertensive and diuretic drugs is weakened. Potassium-sparing diuretics, when taken with diclofenac, produce the effect of hyperkalemia.
Taking with other NSAIDs is undesirable, as the risk of side effects from the digestive system increases.
The use of quinolone derivatives increases the risk of seizures.
Cyclosporine increases nephrotoxicity.
When taking methotrexate simultaneously, its concentration increases and its toxic properties increase.
When combined with anti-diabetic drugs, sharp jumps in insulin levels may occur: both a significant decrease and an increase.
Diclofenac injections are strictly contraindicated if the patient abuses alcohol. The drug is not at all compatible with ethyl alcohol: simultaneous use is fraught with gastric bleeding and liver damage.
Use the drug with caution when simultaneously prescribing anticoagulants, antiplatelet agents, SSRI antidepressants, and glucocorticosteroids.
Captopril, enalapril - diclofenac reduces their concentration, as a result of which the dose must be increased.
special instructions
Since the active ingredient of the drug prevents platelet aggregation, laboratory monitoring of blood clotting is required during administration.
During pregnancy, diclofenac injections are prescribed only if the benefit to the mother is greater than the potential danger to the fetus. Treatment is possible only in the first and second semester; in the third, the drug is contraindicated due to the danger of intrauterine hypoxia. In general, it is best not to use this remedy at any stage of pregnancy. Diclofenac can negatively affect the fetus, increasing the likelihood of intrauterine developmental defects (it is a teratogen). The drug also affects labor; when taken, it may become weak. There is a risk of developing postpartum hemorrhage. If it becomes necessary to inject the drug during lactation, you should stop breastfeeding for the duration of treatment.
Reduce the dose when using other NSAIDs. Tell your doctor if you are using any medications at the same time as diclofenac. Consult about their interaction.
Work that requires a high speed of psychomotor reactions and increased concentration of attention is undesirable during the treatment period.
Strict medical supervision is necessary when using diclofenac in patients with the following conditions: a history of inflammatory and ulcerative lesions of the digestive system, systemic connective tissue diseases, dysfunction of the liver and excretory system organs, diabetes mellitus, hypertension, heart failure, induced porphyria, chronic infectious diseases respiratory tract, accompanied by inflammation, chronic obstructive pulmonary disease, period after surgery, lipid metabolism disorders, old age.
Avoid contact of the substance with mucous membranes and eyes, otherwise an allergic reaction may develop.
Overdose
When recommended doses are exceeded, phenomena of dysfunction of the digestive and nervous systems develop: nausea, diarrhea, vomiting, sharp pain in the abdomen, gastric and intestinal bleeding, headache, dizziness, hyperventilation, clouding of consciousness, increased muscle convulsive readiness. These conditions are treated with symptomatic therapy aimed at correcting kidney function, reducing negative side effects on the digestive system, stopping seizures, and normalizing breathing. There is no specific antidote. Methods such as forced diuresis and hemodialysis do not help.
Conditions for dispensing from pharmacies
Over the counter.
Analogues
Diclofenac sodium or potassium is the active substance in the following drugs: Diclofen, Diclomax, Diclorium, Diclonac, Voltaren, Diclomelan, Naklofen, Ortofen, Revmavec, Diclonat P.
Prices
Diclofenac is an inexpensive drug; in Moscow pharmacies its cost is 67 - 93 rubles. The cost depends on the manufacturer. For example, a Serbian-made product costs from 10 rubles for 1 ampoule. Analogs (Voltaren, Naklofen, Diclonat P) are more expensive.
Frequently asked questions from patients about diclofenac
- Which dosage form Is it better - tablets or injections?
Depending on the characteristics of the disease case and the phase of treatment. At first, injections are prescribed as a faster-acting form. Then they move on to tablets and local medications (ointments, gels). If it is necessary to treat children with this drug, suppositories are often prescribed due to the pain of injections.
- Which drug in injection form is better - Diclofenac or Voltaren?
Voltaren is an analogue of Diclofenac, since the active ingredient in them is the same.
- Is it possible to take Diclofenac and Milgamma at the same time?
Can. This is a complex of vitamins, and it is quite acceptable to prescribe them at the same time.
- If there are contraindications, which analogue is better to choose?
If you have conditions that are absolute or even relative contraindications to taking diclofenac, it would be advisable to use drugs that are similar in action but differ in composition instead: selective type 2 cyclooxygenase inhibitors, for example, Movalis. However, only your attending physician can answer which medicine is best to replace it with.
Features of the composition of the drug
There are solvents - water for injection and benzyl alcohol, almost no excipients.
If we compare diclofenac with other drugs in the NSAID group, we will notice that it has a weaker effect on the gastric mucosa and also has less cardiotoxicity.
The inflammatory reaction in the muscles, intervertebral joints and spinal nerve roots leads to back pain due to osteochondrosis.
Insufficient nutrition of tissues gradually leads to the destruction of their cells with a one-time release into environment biologically active substances - anti-inflammatory mediators.
The latter give rise to an inflammatory reaction, which occurs in the form of edema, impaired spinal function and pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are excellent for pain relief in such cases. A prominent representative of the group is Diclofenac, which we will talk about in detail today.
Pharmacological action of Diclofenac injections
Diclofenac is a non-hormonal drug with an anti-inflammatory effect. It includes both anti-inflammatory and analgesic effects.
Diclofenac impedes the release of the main precursor of inflammatory components - arachidonic acid, consisting of membranes of damaged cells. Therefore, the product tends to stop the flow chemical reactions, leading to the release of fluid from the vessels, their expansion and tissue swelling.
The pain that occurs during inflammation is the result of the action of anti-inflammatory mediators and compression of sensitive nerve receptors. Diclofenac stops their synthesis, which easily removes the pain syndrome and prevents its recurrence.
Very often, the inflammatory reaction fades, losing its main function (protective) and activates additional damage to the nerve roots and intervertebral joints. Long-term stagnation of blood in the vessels provokes changes in tissue nutrition, acidification of the environment directly at the site of inflammation and the accumulation of metabolic products in tissues.
From this it is clear that a new flow of arachidonic acid can intensify the entire inflammatory process and this completes the circle of disorders. Diclofenac destroys it: helping to protect living cells from destruction and improve blood supply.
Release form and composition of Diclofenac
Solution for injection and inhalation Diclofenac is a light yellow or transparent colorless liquid. 1 ml of solution contains 25 mg of the main active ingredient - diclofenac sodium. It also contains additional components, which include:
Diclofenac in solution for parenteral administration is a clear, colorless or light yellow liquid. 1 ml of solution contains 25 mg of the main active ingredient - diclofenac sodium. In addition, it contains auxiliary substances, which include:
- Macrogol 400.
- Disodium edetate.
- Propylene glycol.
- N-acetylcysteine.
- Water for injections.
- Sodium hydroxide.
Diclofenac in solution form is available in 3 ml glass ampoules (75 mg of active substance). The ampoules are placed in contour packaging with cells of 5 pieces. The cardboard packaging contains instructions for using the product and one blister pack.
| Form | Compound |
|---|---|
| Diclofenac solution for intramuscular injection is transparent, slightly colored, with a faint aroma of benzyl alcohol | - 1 ml of solution includes diclofenac sodium 25 mg, in 1 ampoule (3 ml) - 75 mg. - additional components: benzyl alcohol, purified water for injection. - ampoules of 3 ml, cardboard packaging of 5 or 10 ampoules. |
| Diclofenac tablets, fully coated | - 1 tablet contains diclofenac sodium 25 or 50 mg. - 10, 20, 30, 50 or 100 pieces in cardboard packaging. |
| Diclofenac retard tablets | - 1 tablet contains diclofenac sodium 75 or 150 mg. - 20, 30, 50, 100 pieces in cardboard packaging. |
| Diclofenac in rectal suppositories | - 1 suppository contains diclofenac - 25, 50 or 100 mg - additional components: 1,2 - aerosil, propylene glycol, vitepsol, - 10 pieces in a cardboard package. |
| Diclofenac in the form of ointment 1%, light in color, with a subtle specific aroma | - 1 g of ointment contains 10 mg of diclofenac sodium. - additional components - polyethylene oxide-4000, polyethylene oxide-400, nipagin, 1,2-propylene glycol, nipazole. - 30 or 40 in aluminum tubes, 1 tube in a paper pack. |
| Diclofenac in gel form 1% | - 1 g of gel contains diclofenac sodium 10 mg. - in tubes of 40, 60 g, in a paper pack 1 tube. |
| Diclofenac in gel form 5% | - 1 g of gel contains diclofenac sodium 50 mg. - in tubes of 50 and 100 g. |
Indications for use of Diclofenac
The use of Diclofenac injection solution is prescribed for pathological disorders in the body accompanied by inflammation and pain, these include:
Diclofenac solution for parenteral administration is also used in the combined symptomatic treatment of hepatic or renal colic.
Contraindications to the use of Diclofenac
There are several real prohibitions for the use of Diclofenac in solution for parenteral administration, these include:
- Individual intolerance to the excipients of the drug or diclofenac sodium itself.
- Peptic ulcer, with a defect in the duodenum or gastric mucosa.
- Shift in the process of hematopoiesis of unknown origin in the red bone marrow.
- Gastrointestinal bleeding at the time of use of the drug or in the recent past.
- The “Aspirin triad” is a pathological complex of symptoms that results in polypous rhinosinusitis, bronchial asthma and high sensitivity to aspirin (a drug from the group of non-steroidal anti-inflammatory drugs).
- Hemophilia is a blood clotting disorder.
- Breastfeeding and pregnancy in the third trimester of its development.
- Age up to 15 years.
The drug should be used very carefully in case of such significant contraindications as: peptic ulcer of the large intestine (Crohn's disease), disturbance of processes in the digestive tract, porphyria, disturbance of the functional activity of the kidneys and liver, permanent disorder of connective tissue (lupus erythematosus), a noticeable increase in blood pressure, old age, heart failure.
Before using Diclofenac in solution for injection, you need to know that there are no contraindications.
How to give Diclofenac injections (dosage)
If the patient has started a course of treatment with Diclofenac, specialists prescribe this drug intramuscularly in the first week. Before performing an injection, it is very important to choose the correct injection site medicinal product– injections are given only into massive muscle tissue.
Very often the injection is made into the upper outer square of the buttock - for the injection you can use a syringe with a volume of 5 ml and a long needle.
When performing an injection, you should try to insert the syringe needle into the muscle and pull the plunger towards you - this will show that the needle has not entered the blood vessel.
Injecting Diclofenac into blood vessels (veins) and subcutaneously is strictly contraindicated - this can provoke necrosis of the subcutaneous fatty tissue or blood vessel.
It is recommended to change the side of administration of the drug daily - make injections in shifts in the left and right buttocks.
As a rule, one injection of the drug intramuscularly is sufficient, but if necessary, it is possible to combine internal administration of Diclofenac in tablets and injections of the drug, zonal application of Diclofenac gel or ointment to the site of the affected joint.
For children, use Diclofenac in rectal suppositories, topical application of ointment or oral tablets, since injections for children are quite painful.
It is very important, in the treatment of adults, not to exceed the daily dose of Diclofenac of 150 mg. You need to focus on this figure when calculating the number of daily injections.
In the treatment of children, the dosage is calculated depending on the weight and age of the patient (taking into account the general condition of the child, experts prescribe the drug at a dose of 2 mg/kg of weight), the daily dose in this case is usually divided into several equal doses.
The time of treatment with the drug in each individual case is calculated individually.
Side effects of Diclofenac
When starting to use Diclofenac in injections from the side different systems and organs, side effects may be observed, which experts include:
Digestive system- vomiting, nausea, diarrhea, abdominal pain, loss of appetite, bloating (flatulence), the appearance of erosions in the duodenum or stomach, gastrointestinal bleeding, which is manifested by black stools or the appearance of blood in it.
The activity of transminases (liver enzymes ALT, AST) may also increase, which indicates a violation of the condition of hepatocytes. Oral cavity, a good place for the occurrence of inflammation - stomatitis. An inflammatory process forms in the oral cavity, which is called stomatitis.
Nervous system– diffuse headache, dizziness, sleep disturbance, increased irritability and excitability, the appearance of nightmares, anxiety and feelings of fear. On the part of the sensory organs, manifestation of tinnitus, hearing and vision impairment.
Increased twitching of striated skeletal muscles, hand tremors, and paresthesia (changes in the sensitivity of the skin) may also occur.
Red bone marrow and blood– decreased blood clotting, decreased number of leukocytes (leukopenia) and platelets (thrombocytopenia), the formation of anemia (anemia).
urinary system– decreased active manifestation of the kidneys, the appearance of blood in the urine (hematuria), inflammatory process in the kidney tissues (interstitial nephritis).
Subcutaneous tissue and skin– increased sensitivity of the skin to light (especially to sunlight), development of erythema (redness of the skin), rash and itching of the skin, alopecia (hair loss process).
Respiratory system– in rare cases, pneumonitis may occur.
The cardiovascular system– the occurrence of tissue edema due to a delay in human body water and sodium, a gradual increase in blood pressure.
Possible development of a local inflammatory reaction with subsequent redness of the skin, development of infiltration and pain. If side effects are observed, the use of Diclofenac in solution for parenteral administration is discontinued.
Use of Diclofenac during pregnancy
During pregnancy, the use of Diclofenac is allowed in the 1st and 2nd trimesters, strictly according to the recommendations of the attending physician! The drug can affect the formation of the embryo and significantly increases the risk of developing congenital pathologies. Diclofenac is prescribed in minimal doses for a short period of time.
In the 3rd trimester, the use of the drug can provoke severe fetal hypoxia and its death. In addition, Diclofenac blocks the contractile function of the uterus, which can lead to postpartum hemorrhage and weakness of labor.
Interaction of Diclofenac with alcohol
The combined use of ethanol with Diclofenac significantly increases the risk of kidney damage and gastrointestinal bleeding.
Special instructions for the use of Diclofenac
Before using Diclofenac solution, you should read its instructions. You need to pay attention to several special conditions, which include:
The main active component of the drug blocks the adhesion of platelets, therefore, when the use of Diclofenac in a solution for parenteral administration is prescribed, the position of the hemostasis system (blood coagulation system) must be monitored in the laboratory.
You can use the product in the 1st and 2nd trimester of pregnancy, but only after examination and appointment by a specialist. Use is recommended if the desired benefit for the pregnant woman outweighs the possible risks for the fetus.
When using other non-steroidal anti-inflammatory drugs simultaneously, the dose of Diclofenac in solution for injection will need to be reduced.
When pharmacological agents of other groups are used, your doctor should be aware of this, since their general use of Diclofenac in solution may provoke unwanted drug interactions.
During the course of treatment, you should not do work that requires an increased speed of psychomotor reactions and concentration.
Diclofenac solution for parenteral administration can be purchased at the pharmacy only with a prescription from a specialist. It is prohibited to use the product independently or on the advice of friends.
Video. Diclofenac for sports injuries: ointment, gel, injections, injections
Diclofenac in active form contains the following solutions:
- Diclofen.
- Naklof.
- Diclomelan.
- Naklofen.
- Voltaren.
- Diclonak.
- Diclorium.
- Ortofen.
- Orthofer.
- Diclonate P.
- Revmavec.
- Diclomax.
Terms and conditions of storage
Diclofenac solution for parenteral administration can be stored for 5 years. The product must be stored at a constant temperature no higher than +25° C, away from children.
Price for Diclofenac
Diclofenate is classified as a budget pharmacological agent, the average price is:
- ampoules (made in Serbia) 10 rubles per 1 piece with a volume of 3 ml.
- ampoules 51 rubles for 5 pieces of 3 ml.
- ampoules (made in Belarus) 45 rubles for 10 pieces of 3 ml.
Instructions for use of the drug for specialists
DICLOFENAC
Tradename
Diclofenac
International nonproprietary name
Diclofenac
Dosage form
Solution for intramuscular administration, 25 mg/ml, 3 ml
1 ml of solution contains
active substance - diclofenac sodium 25 mg/ml,
excipients: benzyl alcohol, sodium metabisulfite, mannitol, sodium hydroxide, propylene glycol, water for injection.
Description
A transparent, colorless to slightly yellow solution with a faint characteristic odor of benzyl alcohol.
Pharmacotherapeutic group
Non-steroidal anti-inflammatory drugs (NSAIDs).
Acetic acid derivatives
ATS code М01АВ05
Pharmacological properties
Pharmacokinetics
The time to reach the maximum concentration when administered intramuscularly at a dose of 75 mg is 15-30 minutes, the value of the maximum concentration is 1.9-4.8 (on average 2.7) mcg/ml. 3 hours after administration, plasma concentrations average 10% of the maximum.
Communication with plasma proteins is more than 99% (most of it is bound with albumin).
Metabolism occurs as a result of multiple or single hydroxylation and conjugation with glucuronic acid. The enzyme system P450 CYP2C9 takes part in the metabolism of the drug. The pharmacological activity of the metabolites is lower than that of diclofenac.
Systemic clearance is 350 ml/min, volume of distribution is 550 ml/kg. The half-life of plasma is 2 hours. 65% of the administered dose is excreted in the form of metabolites by the kidneys; less than 1% is excreted unchanged, the rest of the dose is excreted as metabolites in the bile.
In patients with severe renal failure (creatinine clearance less than 10 ml/min), the excretion of metabolites in bile increases, but no increase in their concentration in the blood is observed.
In patients with chronic hepatitis or compensated liver cirrhosis, the pharmacokinetic parameters of diclofenac do not change.
Diclofenac passes into breast milk.
Pharmacodynamics
Diclofenac is a non-steroidal anti-inflammatory drug, a derivative of phenylacetic acid. It has a pronounced anti-inflammatory, analgesic and moderate antipyretic effect. Indiscriminately inhibits cyclooxygenase 1 and 2, disrupts the metabolism of arachidonic acid, and reduces the amount of prostaglandins at the site of inflammation. In rheumatic diseases, the anti-inflammatory and analgesic effect of diclofenac helps to significantly reduce the severity of pain, morning stiffness, and swelling of the joints, which improves the functional state of the joint. In case of injuries, in the postoperative period, diclofenac reduces painful sensations and inflammatory edema.
Indications for use
For short-term treatment of diseases of various origins of moderate intensity:
Diseases of the musculoskeletal system (rheumatoid arthritis,
psoriatic, juvenile arthritis, ankylosing spondylitis;
gouty arthritis, rheumatic soft tissue lesions,
osteoarthritis)
Lumboischialgia, neuralgia
Algodismenorrhea, inflammatory processes pelvic organs, including
including adnexitis
Post-traumatic pain syndrome accompanied by inflammation
Postoperative pain
Directions for use and doses
It is administered deeply intramuscularly. Single dose for adults - 75 mg (1 ampoule). If necessary, repeated administration is possible, but not earlier than after 12 hours.
Duration of use is no more than 2 days, if necessary, then switch to oral or rectal use of diclofenac.
Side effects
When administering the drug, there may be a burning sensation, pain at the injection site, the formation of infiltrate, and in extremely rare cases - an abscess, necrotic tissue
Abdominal pain, nausea, diarrhea, constipation, flatulence, increased
activity of hepatic transaminases, peptic ulcer with possible
complications (bleeding, perforation)
Headache, dizziness, tinnitus
Skin itching, skin rash
Vomiting, jaundice, melena, blood in the stool, damage to the esophagus,
aphthous stomatitis, dry oral mucosa, hepatitis
(possibly fulminant course), liver necrosis, cirrhosis,
hepatorenal syndrome, pancreatitis, cholecystitis, colitis
Sleep disturbance, drowsiness, depression, irritability, aseptic
meningitis (more often in patients with systemic lupus erythematosus and other
systemic connective tissue diseases), convulsions, weakness,
disorientation, nightmares, feeling of fear
Blurred vision, diplopia, taste disturbance, reversible or irreversible
hearing loss, scotoma
Alopecia, urticaria, eczema, toxic dermatitis, multiforme
exudative erythema, incl. Stevens-Johnson syndrome, toxic
epidermal necrolysis (Lyell's syndrome), increased
photosensitivity, pinpoint hemorrhages
Proteinuria, oliguria, hematuria
Nephrotic syndrome, interstitial nephritis, papillary necrosis,
acute renal failure
Anemia (including hemolytic and aplastic), leukopenia,
thrombocytopenia, eosinophilia, agranulocytosis
Thrombocytopenic purpura, vasculitis
Worsening of infectious processes
Cough, bronchospasm, laryngeal edema, pneumonitis
Increased blood pressure, chronic cardiac
insufficiency, extrasystole, chest pain
Anaphylactic shock
Contraindications
Hypersensitivity, including to other non-steroidal
anti-inflammatory drugs (NSAIDs)
Erosive and ulcerative lesions of the gastrointestinal tract (in the phase
exacerbation), bleeding from the gastrointestinal tract
- “aspirin” triad
Hematopoietic disorders
Hemostasis disorders (including hemophilia)
Pregnancy and lactation
Children under 18 years of age
Carefully
Anemia, bronchial asthma, congestive heart failure, arterial hypertension, edema syndrome, liver or kidney failure, alcoholism, inflammatory diseases intestines, erosive and ulcerative diseases of the gastrointestinal tract without exacerbation, diabetes mellitus, condition after extensive surgery, inducible porphyria, old age, diverticulitis, systemic connective tissue diseases.
Drug interactions
Increases plasma concentrations of digoxin, methotrexate, lithium and cyclosporine.
Reduces the effect of diuretics; against the background of potassium-sparing diuretics, the risk of hyperkalemia increases; against the background of anticoagulants, thrombolytic agents (alteplase, streptokinase, urokinase) - the risk of bleeding (usually from the gastrointestinal tract).
Reduces the effects of antihypertensive and hypnotic drugs.
Increases the likelihood of side effects of other non-steroidal anti-inflammatory drugs and glucocorticosteroids (bleeding in the gastrointestinal tract), methotrexate toxicity and cyclosporine nephrotoxicity.
Acetylsalicylic acid reduces the concentration of diclofenac in the blood.
Concomitant use with paracetamol increases the risk of developing nephrotoxic effects of diclofenac.
Reduces the effect of hypoglycemic drugs.
Cefamandole, cefoperazone, cefotetan, valproic acid and iplicamicin increase the incidence of hypoprothrombinemia.
Cyclosporine and gold preparations increase the effect of diclofenacan on the synthesis of prostaglandins in the kidneys, which increases nephrotoxicity.
Simultaneous administration with ethanol, colchicine, corticotropin and St. John's wort preparations increases the risk of bleeding in the gastrointestinal tract.
Diclofenac enhances the effect of drugs that cause photosensitivity.
Drugs that block tubular secretion increase the plasma concentration of diclofenac, thereby increasing its toxicity.
special instructions
Particular attention should be paid to patients with known disorders of the gastrointestinal tract, as well as with fairly serious disorders of the liver and kidneys. Periodic examination of the blood count is recommended during long-term treatment.
Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms
Patients using the drug must refrain from activities that require increased concentration and rapid mental and motor reactions, and alcohol consumption.
Overdose
Symptoms: vomiting, dizziness, headache, shortness of breath, clouding of consciousness.
Treatment: symptomatic therapy, forced diuresis.
Hemodialysis is ineffective.
Release form and packaging
3 ml of the drug vampulu colorless glass I hydrolytic class. A dot and a ring are applied to the ampoule with brown paint. 5 ampoules in blister PVC packaging with aluminum coating. Outline packaging along with instructions for use in a cardboard box.
Storage conditions
Store at temperatures between 15o and 25oC.
Keep out of the reach of children!
Best before date
Do not use after the expiration date indicated on the packaging
Conditions for dispensing from pharmacies
On prescription
Manufacturer
Hemofarm concern A.D., Serbia and Montenegro
26300 Vršac, Beogradski put bb, Serbia and Montenegro
