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Diclofenac Sodium NSAIDs

(BRITISH) UK Trade name products: (Diclomax Retard) (Voltarol) (Voltarol 75mgSR) (Voltarol Retard) (Arthrotec: contains diclofenac sodium 50mg and misoprostal 200mg)

(AMERICAN) US Trade name products which contain diclofenac include the immediate-release preparation: (Cataflam), and the delayed-release preparation (Voltaren).

INDICATION

A nonsteroidal anti-inflammatory medication used to reduce fever, pain, and inflammation.

SIDE EFFECTS

Allergic reactions, rash, bruising, itching, hair loss, photosensitivity, blisters, asthma, liver dysfunction, jaundice, kidney failure, decreased urine output, abdominal pain and cramps, constipation, diarrhoea, indigestion, nausea, vomiting, gas, abdominal swelling, ulcers, GI bleeding, bloody or black stools, altered appetite, colitis, swelling of the lips, tongue, or throat, ringing in the ears, congestive heart failure, high blood pressure, irritability, insomnia,
depression, anxiety, and drowsiness.

INTERACTIONS and PRECAUTIONS

  1. Anticoagulants, warfarin, and aspirin can INCREASE the risk of bleeding.
  2. Digoxin, lithium, methotrexate, and cyclosporin may have increased levels that could lead to drug toxicity.
  3. Diuretics may have decreased effects with increased potassium levels.
  4. Insulin and oral hypoglycaemic agents may need altered doses.
  5. Use with ACE inhibitors (captopril, lisinopril, enalapril) can result in their decreased ACE inhibitor effect.
  6. Use with beta-blockers (propranolol, metoprolol, carteolol, nadolol) can result in their decreased antihypertensive effects.

USUAL DOSE

Adults:

oral, 150-200 mg a day in two to four divided doses; or (Voltaren SR), oral, 100 mg a day in the morning or evening.

Overdose of Nonsteroidal Anti-inflammatory Drugs (NSAID)

This represents a wide variety of medications. The most common is ibuprofen (Advil, Nuprin) and is available without a prescription.

FIRST AID: Administer ipecac: 2 tablespoons for adults and 1 tablespoon for children ages 1 to 12. Dosage should be followed by several cups of water to induce vomiting. Use ipecac only within 30 minutes of ingestion, and only if the patient is NOT sleepy. Less than 6 tablets of Advil (200mg) in a 25 Lb child would usually require ipecac treatment. Notify your poison control centre or emergency room for confirmation.

RELATIVE TOXICITY: Although acute NSAID overdoses often appear mild, there is insufficient data in the current literature to accurately assess the range of toxicity. Data on ibuprofen suggest ingestion of less than 100 mg/kilogram of body weight are relatively well tolerated. Ingestion of other NSAID's (other than ibuprofen) should be considered potentially toxic, as they are not recommended for use in children. NSAID's primarily affect the nervous system and the GI tract.

TOXIC EFFECTS: Nausea, vomiting, drowsiness, and abdominal pain are the most common symptoms. Gastrointestinal bleeding may also occur. Seizures and coma have been reported.

RECOMMENDATIONS: Administer ipecac following the above guidelines, and contact your local emergency room or poison control centre IMMEDIATELY.

REMEMBER: Bring the remaining pills and the original container to the hospital.

 

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