Lesion of the gastrointestinal tract.
When using diclofenac, such phenomena as bleeding or ulceration / perforation of the gastrointestinal tract, in some cases with a fatal outcome, were noted. These phenomena can occur at any time with the use of drugs in patients with the presence or absence of previous symptoms and serious gastrointestinal diseases in or without anamnesis. In elderly patients, such complications can have serious consequences. When developing in patients receiving the drug
diclofenac, bleeding or ulceration of the gastrointestinal tract, the drug should be discarded.To reduce the risk of toxic effects on the gastrointestinal tract to patients with gastrointestinal ulcer, especially complicated bleeding or perforation in the anamnesis, as well as
In elderly patients, the drug should be administered at the lowest effective dose at the lowest possible short course.
Patients with an increased risk of developing gastrointestinal complications, as well as patients receiving low-dose acetylsalicylic acid (aspirin), or other drugs that can increase the risk of GI loss, should take gastroprotectors (for example, proton pump inhibitors or
misoprostol). Patients with a history of gastrointestinal disease, especially the elderly, should be informed of all symptoms
from the digestive system.
Skin Reactions
Serious dermatological reactions such as exfoliative dermatitis, Stevens-Jones syndrome, toxic epidermal necrolysis, in some cases fatal, against diclofenac were noted
rarely. When developing in patients receiving the drug
diclofenac, the first signs of skin rash, lesions of mucous membranes or other symptoms of hypersensitivity, the drug should be canceled.
Masking the signs of the infectious process
Anti-inflammatory effect of the drug
diclofenac can make it difficult to diagnose infectious processes.
Use with other NSAIDs
Do not prescribe a drug
diclofenac together with other NSAIDs, including selective inhibitors of COX-2 because of the risk of increased adverse events.
Effects on the liver
Since during the period of drug use
diclofenac there may be an increase in activity of one or more
"hepatic" enzymes, with prolonged therapy with the drug, as a precautionary measure, shows control of liver function.
With the preservation and progression of violations of the hepatic function or the appearance of signs of liver disease, or other symptoms (eg, eosinophilia, rash, etc.), the drug should be discontinued. It should be borne in mind that hepatitis against the background of the drug
diclofenac can develop without prodromal phenomena.
Effects on the kidneys
Against the background of drug therapy
diclofenac it is recommended to monitor renal function in patients with hypertensive
heart disease, kidney disease, elderly patients, patients receiving diuretics or other drugs that affect renal function, as well as in patients with a significant decrease in the volume of circulating blood of any etiology, for example, before and after massive surgical interventions.
After discontinuation of therapy with the drug, normalization of renal function to normal values is usually noted.
Effects on the hematopoietic system
A drug
diclofenac may temporarily inhibit platelet aggregation. Therefore, patients with hemostasis disorders should carefully monitor the relevant laboratory indicators.
Patients with bronchial asthma
Exacerbation of bronchial asthma (NSAID intolerance / bronchial asthma induced by NSAID intake), Quincke's edema and urticaria are most often noted in patients with bronchial asthma, seasonal allergic rhinitis, nasal
polyps, chronic obstructive pulmonary disease or chronic infectious respiratory diseases (especially associated with allergic rhinitis-like symptoms).In this group of patients, as well as in patients with allergies to other drugs (rash, itching or urticaria) with the appointment of diclofenac
special care must be taken (readiness for resuscitation).
Impact on fertility
Because the
diclofenac, like other NSAIDs, can have a negative effect on fertility, women,
planning pregnancy, it is not recommended to take the drug.
Patients, undergoing examination and treatment for infertility, the drug should be discarded.