EPIFENAC 50MG TAB; diclofenac sodium, anti inflammatory agents .
EPIFENAC 50MG TAB
Medicines for the musculoskeletal system (locomotor system) – anti-rheumatic and analgesic drugs.
- Rheumatoid arthritis (rheumatism – rheumatoid arthritis).
- Gouty arthritis.
- Juvenile rheumatoid arthritis.
- Moderately severe pain reliever and anti-inflammatory: myositis, ligamentitis, bursitis, pain and swelling after injuries and surgeries, inflammatory pain in general, menstrual pain, and also fever reducer.
– Medical effect (how the medicine work):
- Diclofenac Sodium : It is a non-steroidal anti-inflammatory drug NSAID. The mechanism of action of the drug has not been fully determined, but the main mechanism of its action as an anti-inflammatory, anti-inflammatory, and antipyretic is by inhibiting the formation of prostaglandin by inhibiting the cyclooxygenase. Prostaglandins play a major role in the symptoms of pain, inflammation and fever.
- Diclofenac potassium is more water-soluble than diclofenac sodium, and therefore it is absorbed faster and its effect begins faster. It is used in acute pain, but diclofenac sodium is absorbed more slowly and is used in chronic pain.
– Pharmaceutical kinematics:
It is metabolized in the liver and is excreted in the urine 60% and the bile juice (then into the stool) 40%, it adheres to plasma proteins by 99%, and when given as an injection the highest level in the blood is equal to twice the highest level when taking the same dose orally and reaches a period of The half-life of the drug is 1-2 hours.
– Side effects:
one of the importants
- Cardiovascular: It increases the likelihood of heart or cerebral strokes by the same amount of celisoxib (37%). Therefore, alternatives should be used in patients with cardiovascular disease, it may cause an increase or increase in high blood pressure, fluid retention, and vasculitis.
- Digestive system: stomach pain, nausea, stomach ulcers, diarrhea or flatulence, and rarely, intestinal bleeding, glossitis and mouth.
- Nervous system: it can cause headache, dizziness, and rarely depression, anxiety, discomfort, and bad dreams.
- Immune system: skin rash and, rarely, hypersensitivity (anaphylaxis) to the drug.
- Hepatitis: increases liver enzymes, and rarely hepatitis.
- Kidney: it causes edema and very rarely, renal failure, nephrotic syndrome, nephritis.
- The senses: blurry vision is rare and hearing impaired.
- Blood: very rare, it causes oligohydramnios, leukopenia, anemia, hemolysis.
- Respiratory system: asthma rarely, very rare pneumonia.
- Hypersensitivity to Diclofenac Sodium or to aspirin or other non-steroidal drugs.
- Patients for whom aspirin or other non-steroidal agents cause asthma, urticaria, acute rhinitis.
- Active peptic ulcer or intestinal bleeding.
- Use the drug with caution in asthma patients. NSAIDs cause asthma attacks in 8-20% of asthma patients, and the safest drug in these patients is nimesulide.
- Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.
- Violent heart failure.
- Coronary artery disease or pain resulting from surgery to treat it
- Severe hepatic impairment (Child-Pugh Grade C)
- Severe renal impairment (creatinine clearance <30 mL / min).
- Headache caused by overuse of painkillers: Short-acting medications are stopped and replaced with a long-acting drug such as methadone, and stimuli and exercise are stopped.
- Patients being treated with anticoagulants.
- Heart disease and vascular disease.
- It should be used with caution in patients with hepatic porphyria, as it may worsen the condition.
- It should be used with caution in cases of active or violent bleeding.
- NSAIDs generally should be avoided in patients with dengue hemorrhagic fever.
- Children less than one year old.
- Pregnant women from 5 months and older.
– Drug interactions:
- Other non-steroidal anti-inflammatory drugs: the occurrence of ulcers or bleeding, or an increased incidence of other side effects.
- Anti-hypertensive drugs (beta-blockers, ACE inhibitors, diuretics): like other non-steroidal anti-inflammatory drugs, the drug leads to a decrease in their effect. In their use with diuretics and ACE inhibitors, adequate fluids should be given as the risk of failure increases Renal, and with drugs that provide urine potassium, an excess of potassium in the blood may occur.
- Anticoagulant and anti-platelet drugs: Like other non-steroidal anti-inflammatory drugs, using them together can increase the risk of bleeding.
- Lithium: Like other NSAIDs, it may increase the lithium concentrations in the blood.
- Digoxin: Like other NSAIDs, it may increase the concentrations of digoxin in the blood.
- Anti-diabetic drugs: NSAIDs, when used in high doses, can lead to a decrease in the blood sugar level, so it is recommended to monitor the blood sugar level as a precaution.
- Methotrexate: Like other non-steroidal anti-inflammatory drugs, it may cause increased blood concentrations of methotrexate.
- Cyclosporine: Like other non-steroidal anti-inflammatory drugs, it increases the risk of cyclosporine in the kidneys, so it should be used in lower doses than those given to those not receiving cyclosporine.
- Quinolones: There have been reports of convulsions, possibly due to use with NSAIDs.
- Phenytoin: The drug increases the effect of Phenytoin.
- Selective serotonin reuptake inhibitor and corticosteroid: Concomitant use with non-steroidal anti-inflammatory drugs increases the risk of gastrointestinal bleeding and in this case it is recommended to use protective anti-ulcer medications.
- Cholestyramine and Colestipol: reduce the effect of the drug (and other NSAIDs) by reducing its absorption from the intestine. Therefore, it should be taken an hour before or 4 hours after cholestyramine.
- Acidity drugs containing aluminum or magnesium (high dose): They reduce the absorption of the drug into the blood and thus its effect, so it should be taken away from the drug for a period of not less than an hour.
- Strong CYP2C9 inhibitors such as fluconazole and Sulfinpyrazone: These may increase the concentration of the drug in the blood and thus need to reduce the dose.