Diclofenac, drajeuri

Prospect

Compozitie
Drajeuri enterosolubile continand 50 mg diclofenac sodic, excipienti q. s

Actiune terapeutica
Antiinflamator nesteroidian (AENS) din grupa derivatilor arilacetici cu proprietati intense antiinflamatoare, analgezice si antipiretice. Actioneaza ca un inhibitor al prostaglandinsintetazei, in plus fiind un inhibitor al agregarii plachetare.

Farmacocinetica
Bine absorbit oral, rapid si aproape total. Concentratiile plasmatice maxime (Cmax) se ating la aproximativ 2 ore dupa administrare orala si la 20-30 minute dupa administrare rectala. Dozele repetate nu duc la acumulare, concentratiile terapeutice utile fiind de 1-3 mcg/ml; realizeaza concentratii sinoviale superioare celor plasmatice si de durata mai mare, ceea ce ii confera o actiune de durata. Se leaga de proteinele plasmatice in proportie de 99%. Este extensiv metabolizat in ficat prin conjugare sau oxidare (nucleul diclorofenil), excretat in urina in proportie de 20-30% din doza administrata sub forma de metaboliti; aproximativ 90% din doza administrata este excretata in primele 96 h, 0, 7% din doza fiind excretata in urina sub forma nemodificata si 5-10% sub forma de diclofenac conjugat, 60% din doza se excreta sub forma de compusi hidroxilati conjugati. insuficienta renala nu afecteaza excretia medicamentului; in acest caz eliminarea se realizeaza pe cale biliara sub forma de conjugati ai metabolitilor. T1/2 este de 1-3 ore; biodisponibilitatea: 30-70%.

Indicatii
Reumatism inflamator cronic (in special poliartrite reumatoide, spondilartrite anchilozante, sindrom Flessinger-Leroy-Reiter, reumatismul din psoriazis) - tratament de lunga durata: unele artroze dureroase si invalidante; tratament de scurta durata al puseelor acute de reumatism abarticular (umar dureros acut, tendinite), artrite microcristaline, artroze, lombalgii, radiculite; dismenoree esentiala; tratament adjuvant in inflamatiile ORL si colica ureterala; la copii: numai in tratamentul reumatismelor inflamatorii.

Mod de administrare

Adulti- tratament de atac: 150 mg/zi, in trei prize;
        - tratament de intretinere: 75-100 mg/zi fractionat in 2-3 prize;
        - dismenoree: 100 mg/zi, in doua prize.
Administrare intrarectala: cate un supozitor seara la culcare. In crize acute doza poate fi crescuta pana la 2-3 supozitoare pe zi; in functie de starea si reactivitatea pacientului administrarea supozitoarelor poate fi asociata cu tratamentul oral.
Copii: 2-3 mg/kg corp/zi. Drajeurile se administreaza cu putin lichid, de preferat in timpul mesei sau dupa masa.

Contraindicatii

Ulcer gastric sau duodenal in evolutie, hipersensibilitate la medicament, insuficienta hepatica si renala severa, pacienti la care crizele de astm, urticarie sau rinite alergice sunt favorizate prin administrarea de acid acetilsalicilic sau alte medicamente care inhiba prostaglandinsintetaza.

Precautii
La pacientii tratati cu anticoagulante daca apare hemoragie gastrointestinala se intrerupe administrarea concomitenta de diclofenac; dicoflenacul poate reduce capacitatea naturala de aparare a organismului in caz de infectii sau poate masca semnele unor infectii. Se administreaza cu prudenta pacientilor cu colite ulceroase, boala crohn, tulburari hematologice sau de coagulare: in cazul pacientilor cu ciroza, insuficienta cardiaca sau renala se vor urmari diureza si functiile renale; in cazul tratamentelor de lunga durata se vor controla formula sanguina, functiile hepatice si renale; se va evita administrarea in primele doua trimestre de sarcina (eventual risc teratogen, risc de intarziere a nasterii). Conducatorii de vehicule vor fi avertizati de posibilitatea aparitiei unei usoare senzatii de ameteala.

Reactii adverse
La inceputul tratamentului pot sa apara tulburari digestive: greata, diaree, dureri epigastrice si foarte rar ulcer, hemoragii digestive sau perforatie ulceroasa. Rar s-a observat: astenie, insomnie, iritabilitate, ameteala sau cefalee; foarte rar: tulburari hepatice ca: icter, hepatita, cresterea transaminazelor, hipersensibilitate cutanata, eczeme. Supozitoarele pot provoca uneori iritatie locala, prurit, senzatie de arsura.

Interactiuni
Se va evita asocierea cu: anticoagulante orale siheparina (risc crescut de hemoragii), sulfamide hipoglicemiante (potentarea efectului hipoglicemiant), litiu (risc de hiperlitemie), metotrexat (potentarea efectului toxic hematologic). Poate avea efect aditiv cu: ticlopidin (cresterea activitatii antiagregante plachetare), alti AINS (risc crescut de ulcere si hemoragii). Aspirina reduce biodisponibilitatea diclofenacului.

Supradozare

Se manifesta prin: cefalee, agitatie motorie, iritabilitate crescuta, ataxie, ameteala, convulsii, dureri epigastrice, greata, voma, hematemeza, diaree, ulcer gastroduodenal, oligurie.
Tratament: evacuarea rapida amedicamentului ingerat, spitalizare; in caz de convulsii administrare de: diazepam, fenobarbital.

eficienta

89 voturi
efecte secundare

30 voturi
pret medicament

88 voturi

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AMVC Error

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File /usr/share/pear/AS/SMARTY/Smarty.class.php at 1092


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