Voltaren Online Pharmacy

Interaction with other drugs

Potent inhibitors of CYP2C9: It is recommended to be careful in appointing diclofenac together with the potent CYP2C9 inhibitor (such as voriconazole), which can lead to a significant increase in the maximum concentration of diclofenac in plasma due to inhibition of diclofenac metabolism lithium preparations.

Digoxin. Voltaren can increase the concentration of lithium and digoxin in plasma. Recommended lithium monitoring and digoxin in plasma. Diuretic and antihypertensive agents. Voltaren, like other NSAIDs, when co-administered with diuretics or antihypertensive agents (eg beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors) may reduce their antihypertensive "effect. Therefore, the" combination of these drugs should be prescribed with caution, and in patients (particularly the elderly) should periodically monitor blood pressure.

Medicines that cause hyperkalemia. Simultaneous treatment with potassium-sparing diuretics, cyclosporine, tacrolimus and trimethoprim may increase the potassium level in the blood serum. In the case of this combination of drugs, the figure should be frequently monitored.

Other NSAIDs and corticosteroids. Simultaneous administration of diclofenac and other systemic NSAIDs or corticosteroids may increase the frequency of adverse events on the part of the gastrointestinal tract. Avoid the simultaneous administration of the drug Voltaren with systemic NSAIDs, including selective cyclooxygenase-2 inhibitors, in the absence of any evidence of possible benefit from the synergistic action.

Anticoagulants and antiplatelet drugs. In clinical studies, there was found to influence Voltaren drug on the action of anticoagulants, there are isolated reports of increased risk of bleeding in patients who received both Voltaren and these drugs. In the case of this combination of drugs recommended a thorough and regular monitoring of patients.

Selective serotonin reuptake inhibitors (SSRIs). Simultaneous administration of systemic NSAIDs and SSRIs may increase the risk of gastrointestinal bleeding. Antidiabetic drugs. In clinical studies have shown that simultaneous reception possible drug Voltaren and antidiabetic medications, with the latter efficacy is not changed.

However, the development of the known individual messages in cases such as hypoglycemia and hyperglycemia, necessitating dose adjustment of antidiabetic drugs while taking Voltaren drug. For this reason, during therapy recommended to control blood glucose.

Methotrexate. You should be careful when taking NSAIDs for less than 24 hours before or after taking methotrexate, as in such cases the concentration of methotrexate in the blood may increase and intensify its toxic effect.

Colestipol and cholestyramine. Simultaneous treatment with diclofenac and colestipol or cholestyramine reduces the absorption of diclofenac by about 30% and 60%, respectively. The drugs should be taken every few hours.Phenytoin. When taken together with diclofenac phenytoin, phenytoin recommended to monitor plasma levels because of its expected increase.

Cyclosporin. Effect of NSAIDs on prostaglandin synthesis in the kidneys may enhance the nephrotoxicity of cyclosporine. Therefore Voltaren be administered in smaller doses than those that would be administered to patients not receiving cyclosporine.

Antibacterials - quinolone derivatives. There are isolated reports of seizures develop in patients taking concomitant quinolone derivatives and NSAIDs.
Tacrolimus. At the same time taking NSAIDs and tacrolimus may increase the risk of nephrotoxicity of NSAIDs. This could be mediated through the renal effects of NSAIDs and antiprostaglandinovye calcineurin inhibitor.


Mifepristone. Given that NSAIDs can reduce the efficacy of mifepristone, they should be taken no earlier than 8-12 days after mifepristone.Cardiac glycosides. Simultaneous treatment with cardiac glycosides and NSAIDs may worsen heart failure and lead to increased plasma concentrations of cardiac glycosides.

Effects

Hematologic effects.Chronic administration of Voltaren is recommended, as in chronic administration of other NSAIDs, monitoring of blood analysis. Voltaren, like other NSAIDs, may temporarily inhibit platelet aggregation. Therefore, in patients with impaired hemostasis should be carefully monitored.

Respiratory effects.In patients with asthma, allergic rhinitis, swelling of the mucous membranes of the nose (nasal polyps), chronic obstructive disease of the respiratory tract (especially if they are associated with rinitopodobnymi allergic symptoms), reactions to NSAIDs, such as provocation of asthma, angioedema or urticaria occurs more often . Therefore, such patients are advised to exercise caution (readiness for emergency). This is also true for patients with allergies to other substances, eg., A skin reactions, pruritus or urticaria.

Hepatobiliary effects.Careful observation is necessary in the appointment of Voltaren to patients with impaired hepatic function, as their condition may worsen. During the administration of the drug, as well as during treatment with other NSAIDs, may increase the level of one or more liver enzymes. Therefore, long-term treatment Voltaren as a precaution shown regular liver function tests. If violations of the function of the liver persist or increase, or if the complaint or develop symptoms suggestive of liver disease, as well as if there are other side effects (eg, eosinophilia, rash, etc.), Voltaren should be discontinued .

In addition to increasing the level of liver enzymes was reported about rare cases of severe hepatic reactions, including jaundice and in very rare cases of fulminant hepatitis, liver necrosis and hepatic failure, in some cases fatal. It should be borne in mind that hepatitis in patients receiving the drug may occur without prodromal phenomena. Caution is needed in the appointment of patients Voltaren hepatic porphyria, since the drug can provoke porphyria attacks.

Skin reactions.When receiving NSAIDs, including Voltaren, very rare reports of severe, even fatal, skin reactions, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis (sm. Shobochn te areazhtsShU. Samsh-highest risk of these reactions there at the beginning of therapy and the development of these 'reactions noted in the majority of cases within the first month of treatment. Voltaren should be discontinued at the first sign of a skin rash, ulceration of the mucous membrane or any other manifestations of hypersensitivity. patients not previously treated with Voltaren, during the period of drug treatment, as well as during treatment of other NSAIDs, in rare cases may develop allergic reactions including anaphylactic and anaphylactoid reactions.