Diclofenac 100 mg (extended release tablets)

In order to reduce the risk of adverse events, the drug should be used at the lowest effective dose for the shortest period necessary to relieve symptoms.

Therapy with NSAIDs, including diclofenac, particularly long-term and high-dose therapy, may be associated with a small increased risk of serious cardiovascular thrombotic events (including myocardial infarction and stroke).

In patients with significant risk factors for cardiovascular events (eg hypertension, hyperlipoproteinemia, diabetes mellitus and smoking), treatment with diclofenac-containing products should only be initiated after careful evaluation and analysis.

Because of the important role of prostaglandins in maintaining renal blood flow, special caution should be exercised when prescribing the drug to patients with cardiac or renal failure, hypertension, elderly patients, patients taking diuretics or other drugs that affect renal function, and patients with For some reason, there is a decrease in circulating blood volume (for example, after extensive surgery). If diclofenac is prescribed in such cases, monitoring of renal function is recommended as a precaution. After cessation of drug therapy, normalization of renal function indicators to initial values is usually observed.

When using diclofenac, phenomena such as bleeding or ulceration/perforation of the gastrointestinal tract, in some cases fatal, were observed. These phenomena may occur at any time when using the drug in patients with or without previous symptoms and a history of serious gastrointestinal diseases. In elderly patients, such complications can have serious consequences. If patients receiving diclofenac develop bleeding or ulceration of the gastrointestinal tract, the drug should be discontinued. To reduce the risk of toxic effects on the gastrointestinal tract, the drug should be used in the minimum effective dose for the shortest possible time, especially for patients with gastrointestinal ulcers, especially complicated by a history of bleeding or perforation, as well as elderly patients.

Patients with an increased risk of developing gastrointestinal complications, as well as those 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.

Patients with a history of gastrointestinal disorders, especially the elderly, should report all symptoms of the digestive system to their doctor.

When carrying out long-term therapy, it is necessary to monitor liver function, peripheral blood patterns, and stool analysis for occult blood.

With long-term use of diclofenac, there may be an increase in the activity of one or more liver enzymes. If liver dysfunction persists or progresses or signs of liver disease or other symptoms occur (for example, eosinophilia, rash, etc.), the drug should be discontinued. It should be borne in mind that hepatitis during the use of diclofenac can develop without prodromal phenomena.

Caution must be exercised when using diclofenac in patients with hepatic porphyria, since the drug can provoke attacks of porphyria.

Diclofenac can reversibly inhibit platelet aggregation, therefore, in patients with hemostasis disorders with long-term use, careful monitoring of relevant laboratory parameters is necessary.

In patients with bronchial asthma, seasonal allergic rhinitis, swelling of the nasal mucosa (including nasal polyps), chronic obstructive pulmonary disease, chronic respiratory tract infections (especially those associated with allergic rhinitis-like symptoms), as well as in patients with allergies to other medications (rash, itching, urticaria) when prescribing diclofenac, special care should be taken (preparedness for resuscitation measures).

Severe, in some cases fatal, skin reactions, including exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, have been very rarely reported with the use of diclofenac. The highest risk and incidence of severe dermatological reactions were observed in the first month of treatment with diclofenac. If patients receiving the drug develop the first signs of skin rash, damage to the mucous membranes or other symptoms of hypersensitivity, diclofenac should be discontinued.

The anti-inflammatory effect of NSAIDs, including diclofenac, may complicate the diagnosis of infectious processes.

Due to the negative effect on fertility, the drug is not recommended for women planning pregnancy. In patients with infertility (including those undergoing examination), it is recommended to discontinue the drug.

When taking 100 mg tablets, patients with diabetes should take into account the sucrose content in the drug (1 tablet contains 94.7880 mg of sucrose).

Diclofenac and pregnancy: consequences and complications

Diclofenac may have adverse effects on the health of a pregnant woman and her unborn child.
Research by specialists has shown that the use of diclofenac in the first and second trimesters of pregnancy is permissible only in cases where the therapeutic benefit to the mother outweighs the potential danger to the child, which allows us to draw a negative conclusion whether diclofenac can be taken by pregnant women.

Taking diclofenac during the third trimester of pregnancy (especially after 30 weeks) is unacceptable, as it may be accompanied by the following consequences:

premature closure of the fetal ductus arteriosus. This process occurs as a result of an increase in oxygen content in the blood of newborns. Intrauterine closure of the ductus arteriosus can lead to right ventricular failure;
fetal renal failure;
suppression of platelet aggregation, which can lead to bleeding;
suppression of uterine contractility, which can cause a delay in labor.

Due to the inhibition of enzymes and mediators (cyclooxygenase and prostaglandins), diclofenac can negatively affect female fertility (the ability to bear children). As a result, diclofenac should be discontinued when planning pregnancy, or in patients undergoing examination for infertility.

Thus, clinical pharmacist and research initiator at Oslo University Hospital Rikshospitalet, Katerina Nezvalova-Henriksen, conducted an experiment in which she found out the effect of diclofenac on the course and outcome of pregnancy. This study, which included 6,511 pregnant women, found no effect on infant survival, birth defects, or structural heart defects. However, diclofenac use in the second trimester was significantly associated with low birth weight. Also, the use of diclofenac in the third trimester could lead to vaginal bleeding in women.

The study results suggested that the increased risk of low birth weight may have been due in part to underlying inflammatory conditions and was reassuringly similar to the expected baseline risk of low birth weight.

Modern analogues of novocaine in dentistry -

Lidocaine replaced novocaine around the 90s. Lidocaine is 2.5 times stronger than novocaine in terms of depth of anesthesia and duration of effect, and it does not lose effectiveness when administered in the area of inflammation (for example, with purulent abscesses). Lidocaine also has a much lower incidence of side effects. But as we said above, in dentistry lidocaine is now used only in provincial medical institutions, because In terms of depth and duration of anesthesia, lidocaine is 2-3 times inferior to articaine preparations (for example, ultracaine).

Lidocaine 2% solution in ampoules of 2 ml –

And although lidocaine is now practically not used in dentistry, in general surgery it is still one of the most widely used local anesthetics (24stoma.ru). The most popular anesthetics in dentistry today are drugs based on articaine (for example, ultracaine, ubistezin, septanest and others). For dentists, these drugs are no longer produced in glass or plastic ampoules, but in special glass carpules.

Carpule syringe and anesthetic carpules –

Each capsule contains 1.7 ml of anesthetic and is ready for use (i.e. it does not need to be opened). It is completely inserted into a special carpule syringe, into which a special double-sided needle is then screwed in from the side of the syringe nose. When you press the syringe plunger, the latter presses on the movable rubber tab located in the lower part of the carpule, which causes an increase in pressure inside the carpule and leads to the release of the anesthetic solution through the needle into the tissue.

How is anesthesia performed in dentistry?

For more information about modern anesthesia in dentistry, read the article: → Pain relief in dentistry

Use of novocaine for electrophoresis, compresses and antibiotic dilution

Electrophoresis with novocaine is not very effective. It is best to use the anesthetic Lidocaine 2% for electrophoresis (sold in ampoules of 2 ml).

Compress with dimexide and novocaine -

Compresses with dimexide are very often prescribed by maxillofacial surgeons, especially for traumatic injuries to the face (for example, fractures of the facial bones). A prerequisite is that there should be no violation of the integrity of the skin in the area where the compress is applied. Compresses with dimexide can reduce swelling and inflammation of soft tissues much faster; for example, in case of a broken jaw, just a few procedures are enough.

Dimexide concentrate (in 100 ml bottles) –

Dimexide with novocaine compress: the proportions of the compress with dimexide and novocaine are used only externally. When applying a compress on the face, you need to use a 20-25% concentration of dimexide. To do this, dilute dimexide in the following proportion: 1 part dimexide - three parts warm boiled water. When used on less sensitive areas of the body, you can use more concentrated solutions (30, 35, 40%).

Moisten gauze pads with a solution diluted with water. Apply the contents of 1 ampoule of novocaine (5 ml of solution) directly onto moistened wipes. Apply the wipes to the desired area. Place a plastic film over the napkin, completely covering the area of the applied gauze napkin with the solution. Place a layer of fabric on top of the polyethylene (the thicker the fabric, the stronger the thermal effect will be - keep this in mind!) and bandage it.

The time of one compress is 20-30 minutes. The course of treatment is 10-12 procedures (1 procedure per day). From experience, we can say that to enhance the analgesic effect, it is better to use lidocaine rather than novocaine (2-4 ml of lidocaine per 1 compress). Lidocaine penetrates the skin better, is less allergic, and its analgesic effect is 2 times stronger.

Dimexide: how to apply a compress (example)

→ DIMEXIDE instructions for use (official, PDF)

How to dilute ceftriaxone with novocaine -

It is not advisable to dilute the antibiotic Ceftriaxone with novocaine, because the antibiotic itself is quite allergenic, and novocaine increases the risk of developing anaphylactic shock many times (compared to lidocaine). It is optimal to dilute ceftriaxone with a lidocaine solution (this is also recommended by WHO). This anesthetic is much less allergic and has a stronger analgesic effect.

500 mg of ceftriaxone must be diluted in 2-2.5 ml of solvent. To dilute 1000 mg of ceftriaxone - 3.5-4 ml of solvent. The latter can be used either water for injection or a 0.5-1% solution of novocaine, but best of all is a 1% solution of lidocaine. But in order to dissolve ceftriaxone in lidocaine, you will still have to use water for injection, because. the concentration of lidocaine in ampoules is 2%.

For example, to obtain a 1% lidocaine solution for diluting 500 mg of ceftriaxone, you will need to first draw 1.0 ml of lidocaine into a syringe, and then another 1.0 ml of water for injection into the same syringe. Then add the resulting solution to the vial with ceftriaxone and shake.

Cefazolin: how to dilute with novocaine

Let us say right away that it is undesirable to dilute cefazolin with novocaine, as well as ceftriaxone (for the same reasons). It is also best to use a 1% lidocaine solution. To dissolve 1000 mg of cefazolin, 4 ml of a 1% lidocaine solution is needed. To obtain a 1% solution of lidocaine, you need to mix 2 ml of lidocaine and 2 ml of water for injection in a syringe, drawing both solutions in turn into one syringe. The resulting solution is injected into a cefazolin ampoule. We hope that our article on the topic “Novocain - instructions for use” was useful to you!

Sources:

1. Dental education of the author of the article, 2. Personal experience as a dental surgeon, maxillofacial surgeon, 3. National Library of Medicine (USA), 4. “Local anesthesia in dentistry” (Baart J.), 5. “Propaedeutics of surgical dentistry" (Soloviev M.).