Diclofenac

Diclofenac: 50 mg Tablet & 75 mg IM injection.

Indications:
 Rheumatoid arthritis; Osteoarthritis; Ankylosing spondylitis
 Primary dysmenorrhoea; Pain following dental surgery; Acute attack of gout
 Inflammation in dental and other minor surgery, Post-operative pain; Low back pain and
other acute musculoskeletal disorders such as periarthritis (Frozen shoulder).
Dosage & administration
 By mouth, 75-150 mg daily in 2-3 divided doses.
 By deep intramuscular injection into acute exacerbation of pain and post-operative pain,
75 mg once daily (twice daily in severe cases) for maximum of 2 days.
 By intravenous, 75 mg repeated if necessary after 4-6 hours for maximum of 2 days.
 Prevention of post-operative pain, initially after surgery 25-50 mg over 15-60 minutes
then 5 mg/hour for maximum 2 days.
 Maximum total daily dose by any route 150 mg.
 Child 1-12 years: Juvenile arthritis, by mouth or by rectum, 1-3 mg/kg daily in divided
doses (25 mg and 12.5 mg tablet)

Side effects
Diclofenac is well tolerated, but the common side effects are epigastric pain, nausea, headache,
dizziness and diarrhoea.

Contraindications
Hypersensitivity to diclofenac, and also contraindicated in patients with hypersensitivity to
aspirin or any other NSAIDs, active or suspected peptic ulcer or gastrointestinal bleeding, in
patients who are hypersensitive to lidocaine.

Use in pregnancy & lactation

Diclofenac should not be used during pregnancy, unless there are compelling reasons for doing
so. The lowest effective dose should be used. These types of drugs are not recommended during
the last trimester of pregnancy. Very small quantities of diclofenac may be detected in breast
milk, but no undesirable effects on the infant are to be expected.

Precautions
During pregnancy and lactation, diclofenac should only be employed for compelling reasons. It
should not be used in children for other reasons than juvenile rheumatoid arthritis. In renal,
cardiac or hepatic impairment, it should be used with caution. It is better to avoid more than one
oral NSAID at a time.

Drug interactions
Concomitant ingestion with acetylsalicylic acid lowers the plasma concentration of each other.
Diclofenac increases the plasma concentrations of digoxin, methotrexate and antagonize the
activity of diuretics and the risk of nephrotoxicity of NSAID is increased. Activity of
sulfonylurea is increased by NSAIDs.
 Aceclofenac
Aceclofenac: 100 mg Tablet: Each film-coated tablet contains Aceclofenac BP 100 mg.

Indications
Aceclofenac is indicated for the relief of pain and inflammation associated with osteoarthritis,
rheumatoid arthritis, ankylosing spondylitis.

Dosage & administration

 Adults: The recommended dose is 100 mg twice daily, one tablet in the morning and
another in the evening.
 Children: There is no clinical data on the use of aceclofenac in children
 Renal impairment: There is no evidence that the dosage of aceclofenac needs to be
modified in patients with mild renal impairment.
 Hepatic impairment: The dose of aceclofenac needs to be reduced in patients with hepatic
impairment. Initial daily dose of 100 mg should be administered.

Side effects
Generally aceclofenac is well tolerated. The majority of side effects are reversible and mild
which include gastrointestinal disorders (dyspepsia, abdominal pain, nausea and diarrhoea) and
occasional occurrence of headache, dizziness or tiredness. Dermatological complaints including
rash or itching, pruritus, abnormal hepatic enzyme levels and raised serum creatinine have
occasionally been reported.

Contraindications
Aceclofenac is contraindicated in patients previously sensitive to aceclofenac or aspirin or other
NSAIDs. It should not be administered to patients with active or suspected peptic ulcer or
gastrointestinal bleeding and moderate to severe renal impairment.

Use in pregnancy & lactation

Pregnancy: There is no information on the use of aceclofenac during pregnancy. Aceclofenac
should not be administered during pregnancy, unless there are compelling reasons for doing so.
Lactation: There is no information on the secretion of aceclofenac in breast milk.

Precautions
Aceclofenac should be administered with caution to patients with symptoms indicative of
gastrointestinal disorders, with a history of peptic ulceration, ulcerative colitis.

Drug interactions
Lithium and Digoxin: Aceclofenac, like other NSAIDs, may increase plasma concentrations of
lithium and digoxin. Diuretics: Aceclofenac may inhibit the activity of diuretics. Anticoagulants:
Like other NSAIDs, aceclofenac may enhance the activity of anticoagulants.
 Naproxen

Naproxen 250 mg & 500 mg tablet.

Indications:
Rheumatoid arthritis, osteoarthritis, ankylosing spondilitis, acute gout, sports injuries, orthopedic
manipulations, dental extraction, surgical pain, prophylaxis and treatment of migraine pain,
dysmenorrhea, for uterine relaxation and analgesia in post-pertum non-nursing mother.

Dosage and administration:

Adults: Initially 250 mg twice daily after food. According to response total daily dose of 1gm
may be given.
In acute gout - initial loading dose of 750 mg followed by 250 mg 8 hourly until the attack
subsides. In acute musculo skeletal disorder or dysmenorrhoea - 500 mg followed by 250 mg
every 6-8 hours.
For children: in juvenile rheumatoid arthritis-10 mg/kg daily in 2 divided doses.

Side effects:
Nausea, vomiting, dyspepsia, bronchospasm, rashes, headache, dizziness, gastro-intestinal
discomfort.

Use in pregnancy and lactation:

Few data are available about the safety of Naproxen in pregnancy and lactation. This should be
used in pregnancy and lactation only if absolutely needed.

Precaution:
History of gastro-intestinal disease. Cardiac, hepatic and renal impairment. Allergic disorder.

Contra-indications:
Hypersensitivity to Naproxen
Peptic ulceration.
Bronchospasm
Severe renal impairment.
 Ketorolac

Ketorolac: 10 mg Tablet & 30 mg Injection

Indications
Ketorolac is very effective for the short-term management of moderate to severe pain, acute pain
and postoperative pain.

Dosage and administration:

The recommended oral dose is 10 mg every 4-6 hours for pain as required. The maximum daily
dose should not exceed 40 mg.
Bolus IV doses should be given over no less than 15 seconds.
Patients <65 years of age: The maximum daily dose should not exceed 120 mg
IM dosing: The recommended dose is 10-30 mg followed by 10-30 mg, every 4 to 6 hours up to
a maximum daily dose of 120 mg.
IV dosing: 10-30 mg initial dose, followed by 10-30 mg every 6 hours as required, up to a
maximum daily dose of 120 mg.

Patients = 65 years of age or renally impaired patients: The maximum daily dose should not
exceed 60 mg.
IM dosing: The recommended dose is 10-15 mg every 4-6 hours as required up to a maximum
daily dose of 60 mg.
IV dosing: 10-15 mg every 6 hours as required up to a maximum daily dose of 60 mg

Children between the ages of 2 to 16 yrs

Single dose of 1mg/kg IM upto max. of 30 mg. IV dose:Single dose of 0.5 mg/kg up to max. of
15 mg.

Side-effects:
GI-disorders: anorexia, nausea, diarrhoea, abdominal pain and dyspepsia.
CNS disorders - headache, dizziness, restlessness, drowsiness, insomnia, dry mouth.
Acute renal failure, bradycardia, asthma, dyspnea, hypersensitivity reactions etc .

Contraindications:
Renal impairment
In labour and delivery
In patients with active peptic ulcer disease
In patients hypersensitive to Ketorolac or other NSAIDs