Dialrapid powder 900mg sachet 50mg #9

Dialrapid instruction

You can buy Dialrapid here

Composition

1 sachet contains:
active ingredient: diclofenac potassium 50.0 mg;
excipients: glyceryl dibehenate 2.0 mg, sodium saccharinate 5.0 mg, anise flavor 15.0 mg, potassium bicarbonate 22.0 mg, mint flavor 35.0 mg, aspartame 50.0 mg, mannitol 721.0 mg.

Description

Homogeneous powder from white to light yellow color with a specific smell.
The reconstituted solution is clear, slightly opalescent with a specific odor.

Release form

Powder for solution for oral administration, 50 mg.
900 mg in hermetically sealed paper / aluminum / polyethylene sachets or from paper / polyethylene terephthalate / aluminum / low density polyethylene with protection against opening by children.
On 3, 6, 9, 12, 21, 24 or 30 sachets with instructions for use in a cardboard box.

Pharmacodynamics

The preparation Dialrapid contains diclofenac potassium, a non-steroid substance that has a pronounced analgesic, anti-inflammatory and antipyretic effect.
Due to the rapid onset of action, the use of diclofenac potassium salt is preferable for the treatment of acute pain and inflammatory conditions. The main mechanism of action of diclofenac, established in studies, is the inhibition of the synthesis of prostaglandins, which play an important role in the pathogenesis of inflammation, pain and fever.
In vitro, diclofenac potassium in concentrations equivalent to those achieved when used in humans does not inhibit the biosynthesis of cartilage proteoglycans.
Diclofenac has a pronounced analgesic effect in moderate and severe pain syndrome. With post-traumatic and postoperative inflammation, diclofenac quickly relieves pain (both at rest and when moving), reduces inflammatory swelling and swelling of a postoperative wound.
In clinical studies, it was found that Diclofenac potassium can reduce pain and reduce blood loss in primary dysmenorrhea.
For migraine attacks, Dialrapid reduces the severity of headache and associated symptoms such as nausea and vomiting.

Pharmacokinetics

Suction

Diclofenac is rapidly and completely absorbed. After a single dose of the drug is taken orally at a dose of 50 mg, the maximum concentration (Сmax) of diclofenac potassium in the blood plasma is reached in 5-20 minutes and averages 5.5 µmol / l for a powder to prepare an oral solution. When taking the drug during a meal, the amount of absorbed diclofenac does not change, although the onset and rate of absorption may slow down somewhat. Absorption of diclofenac linearly depends on the dose of the drug. About half of the dose of diclofenac is metabolized during the first passage through the liver (the effect of "first passage"), the area under the concentration-time pharmacokinetic curve (AUC) after oral administration or rectally is about half of the equivalent dose used parenterally. After repeated use of the drug Dialrapid, pharmacokinetics do not change.
At observance of the recommended dosage regimen of the drug cumulation is not observed.

Distribution

Communication with serum proteins - 99.7%, mainly with albumin (99.4%). The apparent volume of distribution is 0.12-0.17 l / kg.
Diclofenac penetrates the synovial fluid, where its maximum concentration is reached 2-4 hours later than in the blood plasma. The apparent half-life of synovial fluid is 3-6 hours. 2 hours after reaching the maximum plasma concentration, the concentration of diclofenac in the synovial fluid is higher than in the blood plasma, and its values ​​remain higher over a period of time up to 12 hours.

Biotransformation / Metabolism

Diclofenac is metabolized partially by glucuronidation of the unchanged molecule, but mainly through single and multiple hydroxylation and methoxylation, which leads to the formation of several phenolic metabolites (3'-hydroxy-, 4'-hydroxy-, 5'-hydroxy-, 4 ', 5- dihydroxy- and 3'-hydroxy-4'-methoxydiclofenac), most of which are converted to glucuronide conjugates. Two phenolic metabolites are biologically active, but to a much lesser extent than diclofenac.

Removal

The total systemic plasma clearance of diclofenac is 263 ± 56 ml / min. The final half-life is 1-2 hours. The half-life of 4 metabolites, including two pharmacologically active, is also short and lasts 1-3 hours. One of the metabolites, 3’-hydroxy-4’-methoxy-diclofenac, has a longer half-life, but this metabolite is completely inactive.
About 60% of the drug dose is excreted by the kidneys in the form of glucuronic conjugates of the unchanged active substance, as well as in the form of metabolites, most of which are also glucuronic conjugates. Unchanged, less than 1% of diclofenac. The remaining dose of the drug is excreted in the form of metabolites with bile.

Pharmacokinetics in Special Patient Groups

After taking the drug inside, there are no differences in absorption, metabolism or elimination of the drug associated with the age of the patients.
In patients with impaired renal function, an unchanged active substance does not cumulate if the recommended dosing regimen is observed. When creatinine clearance is less than 10 ml / min, the calculated equilibrium concentrations of diclofenac hydroxymetabolites are about 4 times higher than in healthy volunteers, and the metabolites are excreted exclusively with bile.
In patients with chronic hepatitis or compensated liver cirrhosis, the pharmacokinetics indicators of diclofenac are similar to those in patients with intact liver function.

Indications for Dialrapid

For short-term treatment of the following acute conditions:
    post-traumatic pain, inflammation and swelling, for example, due to damage to the ligaments;
    postoperative pain, inflammation and swelling, for example, after dental or orthopedic surgery;
    pain and / or inflammation accompanying gynecological diseases, for example, primary dysmenorrhea or adnexitis;
    migraine attacks;
    pain syndromes of the spine;
    rheumatic diseases of extraarticular soft tissues.
Isolated temperature increase is not an indication for the use of the drug Dialrapid.

Contraindications

    Hypersensitivity to the active substance and other components of the drug, as well as to other nonsteroidal anti-inflammatory drugs (NSAIDs);
    aggravation of gastric ulcer and duodenal ulcer, ulcerative bleeding, perforation;
    inflammatory bowel disease (Crohn's disease, ulcerative colitis) in the acute phase;
    complete or incomplete combination of bronchial asthma, recurrent nasal polyposis or paranasal sinuses and intolerance to acetylsalicylic acid or other NSAIDs (including a history of);
    severe liver dysfunction, renal failure (GFR less than 15 ml / min / 1.73 m2);
    chronic heart failure, functional class II-IV according to the NYHA classification;
    clinically confirmed coronary heart disease;
    diseases of peripheral arteries and cerebral vessels;
    uncontrolled arterial hypertension;
    III trimester of pregnancy;
    breastfeeding period.
The drug should not be used in patients with phenylketonuria, as it contains a source of phenylalanine.
The drug is not recommended for use in children under the age of 14 years (due to the difficulty of dosing the drug).

Dosage and administration

The dose of the drug Dialrapid should be selected individually, with the aim of reducing the risk of side effects is recommended to use the minimum effective dose, if possible, with the shortest possible period of treatment, in accordance with the purpose of treatment and the patient's condition.
Preferably taken before meals. The contents of the sachet should be dissolved, stirring, in a glass of water (non-carbonated). The solution may remain slightly turbid, but this does not affect the effectiveness of the drug.
In the case of moderate severity of symptoms, it is usually enough to use a daily dose of 50-100 mg in powder form to prepare an oral solution (1-2 sachets).
The maximum daily dose of the drug should not exceed 150 mg / day. The daily dose should be divided into 3 doses.
In primary dysmenorrhea, the daily dose of Dialrapid should be selected individually; usually it is 50-150 mg. The initial dose is 50-100 mg (1-2 sachets); If necessary, for several menstrual cycles, the dose can be increased to 150 mg / day. The drug should be started when the first symptoms appear. Depending on the dynamics of the clinical symptoms, treatment can be continued for several days.
With a migraine attack, the initial dose for Dialrapid is 50 mg (1 sachet). The drug should be taken at the first symptoms of an approaching attack. In cases where no pain relief occurs within 2 hours after the first dose, the drug may be taken again at a dose of 50 mg. In the future, every 4-6 hours additional supplementation of the drug Dialrapid at a dose of 50 mg is possible. The total dose of the drug should not exceed 150 mg per day (for no more than 2 days). The effectiveness of the drug Dialrapid in the treatment of migraine attacks in children and adolescents has not been established.
In adolescents 14 years and older, the drug Dialrapid is used in a daily dose of 50-100 mg of the drug (at the rate of 0.5-2 mg / kg body weight per day, for the treatment of rheumatoid arthritis, the daily dose can be maximized to 3 mg / kg).
Dialrapid should not be used in children and adolescents under 14 years of age.
Patients over 65 years of age do not require dose adjustment. However, based on general medical considerations, caution should be exercised in debilitated elderly patients or patients with low body mass.
It should be used with extreme caution in patients with a high risk of developing diseases of the cardiovascular system. If necessary, long-term therapy (more than 4 weeks) in these patients should use the drug in a daily dose not exceeding 100 mg.

Patients with impaired renal function

There is no evidence of the need for dose adjustment when using the drug in patients with impaired renal function due to the lack of studies on the safety of the drug in patients in this category.
Caution must be exercised when using the drug in patients with impaired renal function.
The use of the drug in patients with renal insufficiency (GFR less than 15 ml / min / 1.73 m2) is contraindicated (see section “Contraindications”).

Patients with impaired liver function mild to moderate severity

There is no evidence of the need for dose adjustment when using the drug in patients with mild or moderately impaired liver function due to the lack of studies on the safety of the drug in this category of patients.

Cautions, therapy control

Carefully

When using the drug Dialrapid and other NSAIDs, care must be taken to carefully monitor patients with symptoms / signs indicating lesions / diseases of the gastrointestinal tract (GIT) or with anamnestic data to suspect ulcerative lesions of the stomach or intestines, bleeding or perforation; in patients with a history of Helicobacter pylori infection, ulcerative colitis, Crohn's disease, a history of abnormal liver function, and in patients with complaints that they suspect a gastrointestinal tract disease. The risk of gastrointestinal bleeding increases with increasing doses of NSAIDs or with a history of gastrointestinal ulcers, especially bleeding and ulcer perforation, and in elderly patients.
Special care should be taken when using the drug Dialrapid in patients receiving drugs that increase the risk of gastrointestinal bleeding: systemic corticosteroids (including prednisone), anticoagulants (including warfarin), antiplatelet agents (including clopidogrel , acetylsalicylic acid) or selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline).
Caution is necessary when using the drug Dialrapid in patients with impaired liver function of mild and moderate degrees of severity, as well as in patients with hepatic porphyria, since the drug can provoke attacks of porphyria. Special care is required in the treatment of patients with impaired renal function, including chronic renal failure (GFR 15-60 ml / min / 1.73 m2), dyslipidemia / hyperlipidemia, diabetes mellitus, arterial hypertension, in the treatment of smoking patients or patients who abuse alcohol, with the treatment of elderly patients, patients receiving diuretics or other drugs affecting the kidney function, as well as patients with a significant decrease in circulating blood volume (BCC) of any etiology, for example, before and after mas surgical interventions.
The drug Dialrapid should be used with caution in patients with defects in the hemostatic system.
Care should be taken when using the drug in patients at risk of developing cardiovascular thrombosis (including myocardial infarction and stroke).
Caution must be exercised when using the drug Dialrapid in elderly patients. This is especially true for weak or low-weight older people.

Use during pregnancy and during breastfeeding

There are not enough data on the safety of diclofenac in pregnant women, so the use of Dialrapid in the first and second trimesters of pregnancy should be used only when the expected benefit to the mother outweighs the potential risk to the fetus. The drug Dialrapid, like other NSAIDs (prostaglandin synthesis inhibitors), is contraindicated in the last 3 months of pregnancy (possibly suppression of uterine contractility, impaired renal function in the fetus, followed by oligohydroamnion) and / or premature closure of the arterial duct in the fetus).
Despite the fact that the drug Dialrapid, like other NSAIDs, penetrates into breast milk in small quantities, it should not be used during breastfeeding in order to avoid unwanted effects on the baby. Diclofenac was detected in low concentrations (100 ng / ml) in breast milk of one of the nursing mothers. The estimated amount of the drug that passes through breast milk into the baby’s body is equivalent to 0.03 mg / kg / day.
If necessary, the use of the drug by a nursing woman stops breastfeeding.
Since Dialrapid, like other NSAIDs, may have a negative effect on fertility, it is not recommended to use the drug in patients planning a pregnancy.
In patients undergoing examination and treatment for infertility, the drug should be discontinued.

Special instructions

Gastrointestinal lesions

When using all NSAIDs, including diclofenac, there have been bleeding or ulceration / perforation of the gastrointestinal tract, in some cases fatal. These phenomena can occur during any period of treatment in patients with or without the preceding symptoms or gastrointestinal disease in history. In elderly patients, such complications can have serious consequences. With the development in patients with the use of the drug Dialrapid bleeding or ulceration of the gastrointestinal tract, the drug should be discontinued.
To reduce the risk of toxic effects on the gastrointestinal tract in patients with ulcerative lesions of the gastrointestinal tract, especially complicated by bleeding or perforation in history, as well as in elderly patients, the drug should be used in the minimum effective dose.
Patients with an increased risk of developing gastrointestinal complications, as well as patients receiving therapy with low doses of acetylsalicylic acid or other drugs that can increase the risk of damage to the gastrointestinal tract, should take gastroprotectors (for example, proton pump inhibitors or misoprostol).
Patients with a gastrointestinal lesion in history, especially the elderly, must inform the doctor about all the unusual abdominal symptoms.

Patients with bronchial asthma

Exacerbation of bronchial asthma (NSAID intolerance / asthma provoked by NSAIDs), angioedema and urticaria are most often observed in patients with bronchial asthma, seasonal allergic rhinitis, polyps of the nasal mucosa, chronic obstructive pulmonary disease or chronic infectious diseases of the respiratory tract 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), when using the drug Dialrapid, special care should be taken (readiness for resuscitation).

Skin reactions

Such serious dermatological reactions as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, in some cases with a fatal outcome, against the background of the use of NSAIDs, including diclofenac, were very rare. The greatest risk and frequency of severe dermatological reactions were observed in the first month of diclofenac treatment. With the development in patients receiving the drug Dialrapid, the first signs of a skin rash, mucosal lesions or other symptoms of hypersensitivity, the drug should be canceled. In rare cases, patients who are not allergic to diclofenac may experience anaphylactic / anaphylactoid reactions when they use Dialrapid.

Impact on the liver and biliary tract

Since during the use of the drug Dialrapid, as well as in other NSAIDs, there may be an increase in the activity of one or several liver enzymes, with prolonged therapy with the drug, monitoring of liver function is shown as a precautionary measure. While maintaining and progression of hepatic impairment or the appearance of signs of liver disease, or other symptoms (eg, eosinophilia, rash, etc.), the use of the drug Dialrapid should be canceled. It should be borne in mind that against the background of the use of the drug Dialrapid hepatitis can develop without prodromal events.

Impact on the kidneys

During treatment with NSAIDs, including diclofenac, fluid retention and edema were noted, therefore, special caution should be taken and it is recommended to monitor kidney function in patients with essential hypertension, impaired heart or kidney function, elderly patients, patients receiving diuretics or other drugs affecting renal function, as well as in patients with a significant decrease in the volume of circulating blood plasma of any etiology, for example, in the period before and after massive surgical interventions. After discontinuation of drug therapy, normalization of indicators of renal function to the initial values ​​is usually noted.

Impact on the cardiovascular system

NSAID therapy, including diclofenac, especially long-term therapy and high-dose therapy, may be associated with a slight increase in the risk of developing serious cardiovascular thrombotic complications (including myocardial infarction and stroke).
In patients with diseases of the cardiovascular system and a high risk of developing diseases of the cardiovascular system (for example, with arterial hypertension, hyperlipidemia, diabetes mellitus, smokers), the drug should be used with extreme caution at the lowest effective dose for the shortest possible duration of treatment, since the risk of thrombotic complications increases with increasing dose and duration of treatment. With prolonged therapy (more than 4 weeks), the daily dose of diclofenac in such patients should not exceed 100 mg. It should periodically assess the effectiveness of treatment and the patient's need for symptomatic therapy, especially in cases where its duration is more than 4 weeks. The patient should be instructed to immediately seek medical help when the first symptoms of thrombotic disorders appear (for example, chest pain, feeling short of air, weakness, speech disorders).

Impact on the blood system

The preparation Dialrapid, as well as other NSAIDs, can temporarily inhibit platelet aggregation. Therefore, in patients with impaired hemostasis, careful monitoring of relevant laboratory parameters is necessary. The drug Dialrapid is recommended only for short-term treatment, but with prolonged use of the drug Dialrapid, like other NSAIDs, shows a systematic control of the pattern of peripheral blood.

Masking signs of an infectious process

The drug Dialrapid, like other NSAIDs due to its pharmacodynamic properties, can mask the manifestations of infectious diseases.

Use simultaneously with other NSAIDs

You should not use the drug Dialrapid simultaneously with other NSAIDs, including selective inhibitors of COX-2 due to the risk of increasing the frequency of adverse events.

Impact on ability to drive vehicles and / or mechanisms

Patients who have visual impairments, dizziness, drowsiness, vertigo or other disorders of the central nervous system against the background of the use of the drug Dialrapid, should not drive vehicles and work with mechanisms.

Side effects of Dialrapid

The following are undesirable effects (AEs) that were identified during clinical trials, as well as when diclofenac was used in clinical practice.
The following criteria were used to assess the frequency of AE: “often” -> 1/100, 1/10, “infrequently” -> 1/1000, “rarely” -> 1/10000, “very rarely” - the types of AE are grouped according to -organized medical dictionary for regulatory activities MedDRA, within each class of AE are listed in decreasing order of frequency of occurrence, within each group allocated for frequency of occurrence, AEs are distributed in order of decreasing importance.
Blood and lymphatic system disorders: very rarely - thrombocytopenia, leukopenia, hemolytic anemia, aplastic anemia, agranulocytosis.
Immune system disorders: rarely - hypersensitivity, anaphylactic / anaphylactoid reactions, including lowering blood pressure (BP) and shock; very rarely - angioedema (including swelling of the face).
Mental disorders: very rarely - disorientation, depression, insomnia, nightmares, irritability, mental disorders.
Nervous system disorders: often - headache, dizziness; rarely - drowsiness; very rarely - sensitivity disorders, including paresthesias, memory disorders, tremor, convulsions, anxiety, acute cerebral circulation disorders, aseptic meningitis.
Violations on the part of the organ of vision: very rarely - visual disturbances (blurred vision), diplopia.
Disturbances from an organ of hearing and labyrinth disturbances: often - vertigo; very rarely - hearing loss, tinnitus.
Heart disturbances: infrequently - myocardial infarction, heart failure, palpitations, chest pain.
Vascular disorders: very rarely - increased blood pressure, vasculitis.
Disturbances of the respiratory system, chest mediastinal organs: rarely - bronchial asthma (including shortness of breath); very rarely - pneumonitis.
Disorders of the gastrointestinal tract: often - abdominal pain, nausea, vomiting, diarrhea, dyspepsia, flatulence, loss of appetite; rarely - gastritis, gastrointestinal bleeding, vomiting of blood, melena, diarrhea mixed with blood, stomach and intestinal ulcers (with or without bleeding, stenosis or perforation, with the possible development of peritonitis); very rarely - stomatitis, glossitis, esophageal damage, diaphragm-like strictures in the intestines, colitis (non-specific hemorrhagic colitis, ischemic colitis, exacerbation of ulcerative colitis or Crohn's disease), constipation, pancreatitis, dysgeusia.
Disorders of the liver and biliary tract: often - increased activity of aminotransferases in the blood plasma; rarely - hepatitis, jaundice, abnormal liver function; very rarely - fulminant hepatitis, liver necrosis, liver failure.
Violations of the skin and subcutaneous tissues: often - skin rash; rarely - urticaria; very rarely - bullous dermatitis, eczema, erythema, erythema multiforme, Stevens-Johnson syndrome, Lyell's syndrome (toxic epidermal necrolysis), exfoliative dermatitis, pruritus, alopecia, photosensitivity reactions, purpura, Shenlein-Genoha purpura.
Kidney and urinary tract disorders: very rarely - acute kidney damage (acute renal failure), hematuria, proteinuria, tubulo-interstitial nephritis, nephrotic syndrome, papillary necrosis.
General disorders and disorders at the injection site: rarely - edema.

Violations of the cardiovascular system

Data from clinical studies indicate a slight increase in the risk of cardiovascular thrombotic complications (for example, myocardial infarction), especially with long-term use of diclofenac in high doses (daily dose of more than 150 mg).

Visual impairment

Visual disorders, such as visual impairment, blurred vision or diplopia, appear to be class-based effects of NSAIDs and are reversible upon discontinuation. A possible mechanism for the development of such disorders is the inhibition of the synthesis of prostaglandins and other related substances, which changes the regulation of blood flow in the retina, which is manifested by potential visual disorders. If such symptoms develop during therapy with diclofenac, the possibility of an ophthalmologic examination should be considered to rule out any other reasons.
If any of the side effects indicated in the instruction are aggravated, or you have noticed any other side effects that are not indicated in the instruction, inform your doctor.

Overdose

Symptoms: vomiting, gastrointestinal bleeding, diarrhea, dizziness, tinnitus, convulsions. In case of significant poisoning, the development of acute renal failure and liver damage is possible.
Treatment: supportive and symptomatic treatment is indicated for such complications as a decrease in blood pressure, renal failure, convulsions, gastrointestinal disorders and respiratory depression. Forced diuresis, hemodialysis, or hemoperfusion are not effective for diclofenac, since NSAIDs are largely bound to plasma proteins and are extensively metabolized.
In the case of life-threatening overdose when taking the drug inside, in order to quickly prevent the absorption of diclofenac should be a gastric lavage followed by the use of activated charcoal.

Interaction

The following types of drug interactions were observed when using the drug Dialrapid and / or other dosage forms of diclofenac.

Revealed interactions

Inhibitors of the isoenzyme CYP2C9. Caution should be exercised with the simultaneous use of diclofenac and CYP2C9 isoenzyme inhibitors (such as voriconazole) due to the possible increase in plasma concentration of diclofenac and its exposure.
Lithium, digoxin. Since diclofenac may increase plasma concentrations of lithium and digoxin, it is recommended that lithium and digoxin concentrations in the blood be measured while being used with diclofenac.
Diuretic and antihypertensive drugs. With simultaneous use with diuretics and antihypertensive drugs (for example, beta-blockers, ACE inhibitors), diclofenac, like other NSAIDs, can reduce their hypotensive effect, therefore, in patients, especially elderly, while using diclofenac and diuretics or hypotensive drugs should be regularly measure blood pressure, control kidney function and degree of hydration (especially when combined with diuretics and ACE inhibitors due to increased risk of nephrotoxicity).
Cyclosporine and tacrolimus. The effect of diclofenac on kidney prostaglandin activity may increase the nephrotoxicity of cyclosporin and tacrolimus. In connection with the foregoing, the dose of diclofenac in patients receiving cyclosporine or tacrolimus should be lower than in patients not receiving these drugs.
Drugs that can cause hyperkalemia. Simultaneous use of diclofenac with potassium-sparing diuretics, cyclosporine, tacrolimus and trimethoprim can lead to an increase in plasma potassium (in the case of such simultaneous use, this indicator should often be monitored).
Antibacterial agents - derivatives of quinolone. There are separate reports of the development of seizures in patients who received both quinolone and diclofenac derivatives.

The alleged interaction of NSAIDs and glucocorticosteroids

Simultaneous systemic use of diclofenac and other systemic NSAIDs or glucocorticosteroids may increase the incidence of AE from the gastrointestinal tract.
Anticoagupanty and antiagreganty. Although clinical studies have not established the effect of diclofenac on the effect of anticoagulants, there are separate reports of an increased risk of bleeding in patients taking this combination of drugs. Patients receiving simultaneous treatment with these drugs should be carefully observed.
Selective serotonin reuptake inhibitors. The simultaneous use of diclofenac with selective serotonin reuptake inhibitors increases the risk of gastrointestinal bleeding.
Hypoglycemic drugs. In clinical studies it has been found that with simultaneous use, diclofenac does not affect the effectiveness of oral hypoglycemic drugs. However, there are individual reports of the development of both hypoglycemic and hyperglycemic conditions during the use of diclofenac, requiring changes in the dose of hypoglycemic drugs. In patients receiving simultaneous treatment with hypoglycemic drugs and diclofenac, blood glucose concentrations should be measured regularly.
There have been isolated reports on the development of metabolic acidosis with simultaneous use of diclofenac with metformin, especially in patients with impaired renal function.
Methotrexate. Caution should be exercised when using NSAIDs, including diclofenac, less than 24 hours before or after taking methotrexate, since in such cases the concentration of methotrexate in the blood may increase and its toxic effect may increase.
Phenytoin. With simultaneous use of phenytoin and diclofenac, it is necessary to control the concentration of phenytoin in the blood plasma due to the possible enhancement of its systemic effects.
Inductors of an isoenzyme CYP2C9. Care should be taken when using diclofenac simultaneously with inducers of the isoenzyme CYP2C9 (such as rifampicin), since this can lead to a significant decrease in the concentration of diclofenac in plasma and a decrease in its exposure.

Terms and conditions of storage

In a dry place at a temperature not higher than 25 ° C.
The drug should be kept out of the reach of children.
Shelf life - 3 years. The drug should not be used after the expiration date.

Terms of sell

You don't need a prescription to buy Dialrapid.