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Dikloberl N 75
1 ampoule (3 ml) of drug Dikloberl N 75 includes 75 mg of diclofenac of sodium. Auxiliary components: benzyl alcohol, propylene glycol, attracts, Acetylcysteinum, water, sodium hydroxide.
Colourless transparent solution without visible inclusions. Ampoules contain 3 ml of solution of each, 1 or 5 ampoules in packaging from a cardboard.
Anesthetic, antiinflammatory, febrifugal action.
Pharmacodynamics and pharmacokinetics
Drug of nonsteroid structure, has strong analgeziruyushchy and anti-inflammatory action, and also is a prostaglandinsintetaza blocker.
The greatest concentration in plasma at intramuscular introduction is reached 10-20 minutes later.
Linkng with proteins of blood makes about 99,8%. Easily gets into joint liquid where its extreme concentration is registered at 3 o'clock later, than in blood. Time of semi-removal from joint liquid is equal to about 4-5 hours. Approximately 2 hours later after approach of the maximum concentration in blood the content of active agent in synovial fluid remains higher, than in blood. This phenomenon is observed within 12 hours.
It is metabolized by a glyukuronization, a hydroxylation and a metoksilirovaniye with formation of a number of phenolic derivatives which overwhelming part forms complexes with glucuronic acid. Time of semi-removal from blood makes approximately an hour and a half. About 60% of the accepted dose are removed with urine, the rest is evacuated through intestines at the same time in not changed form no more than 1% of diclofenac are removed.
Indications to use
- pseudorheumatism (including a juvenile form), the osteoarthritis ankylosing a spondylitis, a spondylarthritis;
- vertebrogenny pain syndromes;
- the rheumatic diseases affecting extraarticular soft tissues;
- the pain syndromes of a posttraumatic and postoperative origin which are followed by inflammation signs after orthopedic and stomatologic interventions;
- acute pain syndrome of moderate expressiveness of various origin.
Basic disease it is necessary to treat drugs of basic therapy. Temperature increase in itself the indication for reception of diclofenac is not.
- acute ulcer, bleeding or perforation of intestines or stomach;
- allergy to drug components;
- the increased risk of postoperative bleedings, disturbances of a hemostasis, cerebrovascular bleedings or hemopoietic disturbances;
- the bleeding or perforation of digestive organs in the past connected with reception of anti-inflammatory nonsteroid drugs;
- diseases of intestines of inflammatory character;
- aggravation of a peptic ulcer, ulcer bleeding, including in the past;
- third trimester of pregnancy;
- heart failure of congestive type;
- cerebrovascular frustration at the persons who had a stroke or cases of ischemic attacks;
- liver or renal failure;
- diseases of peripheral arteries;
- coronary heart disease at the persons who had a heart attack or having stenocardia;
- treatment of a pain syndrome before aortocoronary shunting;
- allergic reactions to the Ibuprofen, Aspirin or other antiinflammatory nonsteroid drugs.
- Reactions from a hemopoiesis: pancytopenia, thrombocytopenia, leukopenia, agranulocytosis, anemia. Pharyngitis, the increased temperature, superficial ulcerations in a mouth, bleeding from a nose, apathy, skin bleeding can be the first symptoms of these disturbances.
- Reactions from immunity: rash on skin, the small tortoiseshell, an allergic vasculitis, a Quincke's disease, an itch, pneumonia.
- Mental disorders: depression, disorientation, irritability, sleeplessness, psychotic disturbances, nightmares, other mental disorders.
- Reactions from nervous activity: dizziness, headache, excitement, dizziness, drowsiness, paresthesias, sensitivity disturbance, fatigue, spasms, memory disturbances, tremor, concern, hallucinations, disorders of taste, aseptic meningitis, confusion of consciousness, stroke, febricula.
- Reactions from touch bodies: a diplopia, sight misting, neuritis of an optic nerve, a ring in ears, vertigo, frustration of hearing.
- Reactions from blood circulation: arterial hypotension, heart failure, stethalgia, heartbeat, vasculitis, arterial hypertension, myocardial infarction.
- Reactions from breath: pneumonitis, asthma.
- Reactions from digestion: an abdominal pain, vomiting, a meteorism, nausea, anorexia, gastritis, dyspepsia, diarrhea, bleeding from digestive organs, stomach ulcer (with possible perforation or bleeding), a lock, disturbance of work of a gullet, colitis, a glossitis, stomatitis, pancreatitis, an intestinal stenosis, hepatitis, increase of content of transaminases, disorders of a liver, jaundice, gepatonekroz, fulminant hepatitis, a liver failure.
- Reactions from skin: displays of eczema and erythema, hair loss, Lyell's disease, Stephens-Johnson's syndrome, exfoliative dermatitis, purpura, photosensitization, itch.
- Reactions from the urinogenital sphere: acute renal failure, hypostases, proteinuria, hamaturia, nephrotic syndrome, intersticial nephrite, impotence, papillary necrosis of tissue of kidney.
The instruction on pricks Dikloberl N 75 (A way and a dosage)
To reduce risk of emergence of side reactions, it is necessary to use minimum possible effective dose throughout the least short period.
Dikloberl's pricks, application instruction
Treatment by drug is recommended to be carried out by method of a single injection. Solution is entered deeply into a buttock muscle. If long therapy is necessary, then it is continued by peroral or rectal forms of diclofenac. In day when the drug injection was made the general daily dose should not be more than 150 mg.
Pricks Dikloberl should be applied with care at this group of persons as they are in the bulk more inclined to undesirable reactions. The weakened elderly patients or patients with a low weight need to appoint the smallest effective doses of drug.
Overdose signs: nausea, a headache, pain in epigastriums, vomiting, bleeding from digestive organs, drowsiness, spasms, dizziness, diarrhea, a disorientation, a coma, excitement, a sonitus, damage of a liver, an acute renal failure.
Overdose treatment: symptomatic. At frequent or long spasms it is necessary to enter Diazepam.
At simultaneous use Dikloberl is capable to increase the content of lithium in blood. In such cases monitoring of concentration of lithium in blood is recommended.
When sharing with Digoxin increase of concentration of the last in blood is not excluded. In such cases monitoring of concentration of Digoxin in blood is recommended.
Combined use of diclofenac with anti-hypertensive means and diuretics can lead to weakening of their anti-hypertensive effect because of suppression of synthesis of angiodilyatiruyushchy prostaglandins. Patients need to receive appropriate amount of liquid, also regular control of work of kidneys after the beginning of similar treatment is recommended.
The concomitant use with Cyclosporine, kaliysberegayushchy diuretics, Trimethoprimum or Takrolimus can increase the content of potassium in blood therefore control of a condition of such patients needs to be carried out more often.
Simultaneous use with anticoagulants can increase risk of bleeding as diclofenac in high doses can suppress reversibly pasting of thrombocytes therefore follows conducts regular careful examination of such patients.
Sharing of diclofenac and other anti-inflammatory nonsteroid drugs or glucocorticosteroids is capable to increase probability of developing of an ulcer or gastrointestinal bleeding. Therefore the concomitant use of two or more anti-inflammatory nonsteroid drugs should be avoided.
The concomitant use of anti-inflammatory nonsteroid drugs and blockers of the return serotonin reuptake increases risk of development of bleedings from digestive organs.
It is possible to appoint diclofenac together with peroral forms of hypoglycemic means and it influences their therapeutic effect. But there are some messages on emergence in the specified cases of a hyperglycemia and a hypoglycemia that caused the necessity of correction of a dosage of antidiabetic means during diclofenac reception. Therefore it is recommended to control the content of glucose in blood during the combined treatment.
Diclofenac is capable to reduce the speed of removal of the Methotrexate that leads to increase in level of the last in blood. Diclofenac needs to be used not earlier than in 24 hours prior to reception of the Methotrexate in order to avoid cases of increase in concentration of the last and strengthening of its toxic effects.
Joint reception with cyclosporines is capable to increase their nephrotoxicity, because of it it is necessary to appoint diclofenac in reduced doses.
At use of anti-inflammatory nonsteroid drugs with Takrolimus increase in risk of emergence of nephrotoxicity is possible.
Development of spasms in the persons who are at the same time using derivatives of a hinolon and Dikloberl is not excluded. This phenomenon can be observed at patients, both with existence of spasms in the past, and without them. It is necessary to be to the patients, careful at the solution of a question of purpose of hinolon, who are already receiving anti-inflammatory nonsteroid drugs.
At reception of Phenytoinum together with diclofenac it is necessary to carry out monitoring of content of the first in blood in connection with possible increase in its contents.
The drugs containing probenetsid slow down removal of diclofenac from an organism.
Co-administration of cardiac glycosides and anti-inflammatory nonsteroid drugs can aggravate heart failure, slow down process of glomerular filtering and increase the maintenance of glycosides in blood.
Dikloberl it is not necessary to use within 9-12 days after the last reception of Mifepristone as diclofenac is capable to weaken effect of the last.
Care at combined use of diclofenac with strong CYP2C9 inhibitors as it can lead to increase of concentration of diclofenac in blood owing to braking of its metabolism is recommended.
Terms of sale
To protect from children. To store in an original packing at the room temperature.
Period of validity
To lower risk of emergence of side reactions, treatment needs to be begun with a minimal effective dose which should be accepted the most short course necessary for stopping of symptoms.
It is necessary to avoid joint reception of Dikloberl with system anti-inflammatory nonsteroid drugs because of possible strengthening of side effects.
Thanks to the pharmacological properties drug Dikloberl is capable to mask symptoms of an infection.
When using all anti-inflammatory nonsteroid drugs cases of bleedings from digestive organs, perforation and formation of ulcers which can be deadly were revealed. If similar frustration are diagnosed for the patients receiving diclofenac, then its use should be stopped immediately.
Elderly patients have the increased risk of emergence of undesirable reactions to anti-inflammatory nonsteroid drugs, especially concerning bleeding and perforation. For the specified group of patients, and also for persons in need in simultaneous use of acetylsalicylic acid, it is necessary to resolve an issue of purpose of a combination therapy with use of gastroprotektorny means (inhibitors of a pomp of protons or Mizoprostol).
Attentive medical supervision is necessary at Dikloberl's appointment for patients with liver diseases, because of possible deterioration in their state.
During long treatment supervision over work of a liver and content of liver enzymes is appointed the described means constant. If disturbance of work of a liver remain or aggravated, or there are clinical signs which are allegedly connected with progressing of an illness, Dikloberl's use needs to be stopped immediately.
As at therapy by anti-inflammatory nonsteroid drugs increase in frequency and expressiveness of hypostases were registered, the special attention needs to be paid to persons with arterial hypertension, disturbances of cardiac performance or kidneys, at advanced age, receiving diuretics or nefrotoksichny means, and also to or after serious operations.
At patients with a system lupus erythematosus or other diseases of connecting fabric increase of risk of aseptic meningitis is not excluded.
Patients with diseases of peripheral arteries, coronary heart disease, heart failure of congestive type, heavy arterial hypertension, a cerebrovascular illness are not recommended to appoint drug, in extreme cases its use in a dosage to 100 mg a day is possible.
At long reception of this drug it is necessary to carry out regular monitoring of blood test.
It is necessary to watch attentively patients with hemorrhagic diathesis the disturbance of a hemostasis or hematologic disturbances accepting Dikloberl.
Patients with a chronic obstructive pulmonary disease, asthma, allergic rhinitis, polyps of a nasal cavity or persistent infections of respiratory ways have side effects (asthma attacks, a Quincke's edema, the small tortoiseshell) because of reception of anti-inflammatory nonsteroid drugs more often. It touches as well faces with allergic reactions to other substances, such as an itch, rash, urticaria.
At long reception of anesthetics there can be a headache which you should not treat increase of a dosage of drugs.
To patients at whom during treatment by drug arises vertigo deterioration in sight, disturbance of nervous activity, drowsiness, fatigue, slackness, it is not necessary to be engaged in driving of motor transport.
Coincidence on the ATH code of the 4th level:
- Dikloberl Retard
- Naklofen Duo
- img class="drug-slider-img" src="//medicalmed.us/img/1389490547_nayzilat.png" tppabs="medicalmed.us/wp-content/uploads/2014/08/1389490547_nayzilat.png">Nayzilat
The most widespread analogs of Dikloberl are listed below: Almiral, Argett Rapid, Bioran, Voltarenum, Diclofenac, Diklak, to Diklobr, Ketarolak, Naklofen, Olfen, Ortophenum, Ibuprofen, Rapten, Feloran.
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