Symptoms:
There is no typical clinical picture resulting from diclofenac over dosage. Over dosage can cause symptoms like headache, nausea, vomiting, epigastric pain, gastrointestinal bleeding, rarely diarrhoea, dizziness, disorientation, excitation, coma, drowsiness, tinnitus, fainting, or convulsions. In rare cases of significant poisoning acute renal failure and liver damage are possible.
Therapeutic measures:
Patients should be treated symptomatically as required. Within one hour of ingestion of a potentially toxic amount, activated charcoal should be considered. Alternatively, in adults gastric lavage should be considered within one hour of ingestion of potentially toxic amounts. Frequent or prolonged convulsions should be treated with intravenous diazepam. Other measures may be indicated by the patient's clinical condition.
3 years
-
- Active, gastric or intestinal ulcers, bleeding or perforation
- History of gastrointestinal bleeding or perforation, relating to previous NSAID therapy.
- Active, or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding).
- Last trimester of pregnancy.
- Severe hepatic, renal or cardiac failure.
- Like other non-steroidal anti-inflammatory drugs (NSAIDs), diclofenac is also contraindicated in patients in whom attacks of asthma, angioedema, urticaria or acute rhinitis are precipitated by ibuprofen, acetylsalicylic acid or other nonsteroidal anti-inflammatory drugs.
- Proctitis
- Established congestive heart failure (NYHA II-IV), ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease.
Not applicable.
Hard fat
Suppositories for rectal use
Adverse reactions (Table 1) are ranked under heading of frequency, the most frequent first, using the following convention: very common: (>1/10); common (>1/100, <1/10); uncommon (>1/1,000, <1/100); rare (>1/10,000, <1/1,000); very rare (<1/10,000); Not known: cannot be estimated from the available data.
The following undesirable effects include those reported with either short-term or long-term use.
|
Blood and lymphatic system disorders | |
|
Very rare |
Thrombocytopenia, leukopenia, anaemia (including haemolytic and aplastic anaemia), Agranulocytosis. |
|
Immune system disorders | |
|
Rare
Very rare |
Hypersensitivity, anaphylactic and anaphylactoid reactions (including hypotension and shock). Angioneurotic oedema (including face oedema). |
|
Psychiatric disorders | |
|
Very rare |
Disorientation, depression, insomnia, nightmare, irritability, psychotic disorder. |
|
Nervous system disorders | |
|
Common
Rare
Very rare
Unknown |
Headache, dizziness.
Somnolence, tiredness
Paraesthesia, memory impairment, convulsion, anxiety, tremor, aseptic meningitis, taste disturbances, cerebrovascular accident.
Hallucination, confusion, malaise, disturbances of sensation |
|
Eye disorders | |
|
Very rare
Unknown |
Visual disturbance, vision blurred, diplopia.
Optic Neuritis |
|
Ear and labyrinth disorders | |
|
Common
Very rare |
Vertigo.
Tinnitus, hearing impaired. |
|
Cardiac disorders | |
|
Very rare |
Palpitations, chest pain, cardiac failure, myocardial infarction. |
|
Vascular disorders | |
|
Very rare |
Hypertension, vasculitis. Hypotension |
|
Respiratory, thoracic and mediastinal disorders | |
|
Rare
Very rare |
Asthma (including dyspnoea).
Pneumonitis. |
|
Gastrointestinal disorders | |
|
Common
Rare
Very rare
Not known |
Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, flatulence, anorexia.
Gastritis, gastrointestinal haemorrhage, haematemesis, diarrhoea haemorrhagic, melaena, gastrointestinal ulcer with or without bleeding or perforation (sometimes fatal particularly in the elderly).
Colitis (including haemorrhagic colitis and exacerbation of ulcerative colitis or Crohn's disease), constipation, Stomatitis (including ulcerative stomatitis), glossitis, oesophageal disorder, diaphragm-like intestinal strictures, pancreatitis.
Ischaemic colitis |
|
Hepatobiliary disorders | |
|
Common
Rare
Very rare |
Transaminases increased.
Hepatitis, jaundice, liver disorder.
Fulminant hepatitis, hepatic necrosis, hepatic failure. |
|
Skin and subcutaneous tissue disorders | |
|
Common
Rare
Very rare |
Rash.
Urticaria.
Bullous eruptions, eczema, erythema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), dermatitis exfoliative, loss of hair, photosensitivity reaction, purpura, allergic purpura, pruritus. |
|
Renal and urinary disorders | |
|
Very rare |
Acute renal failure, haematuria, proteinuria, nephrotic syndrome, interstitial nephritis, renal papillary necrosis. |
|
Reproductive system and breast disorders
| |
|
Very rare |
Impotence. |
|
General disorders and administration site conditions | |
|
Rare |
Application site irritation, Oedema Reporting of side effects: If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine. |
Acute Toxicity
The study of acute toxicity in various animal models did not reveal any special sensitivity.
Chronic Toxicity
The chronic toxicity was examined in rats, dogs and monkeys. Ulceration in the gastrointestinal tract was observed and produced complications, i.e. peritonitis, anemia and leucocytosis.
Mutagenic and Carcinogenic Potential
A mutagenic effect of diclofenac seems to be excluded by the results of in-vitro and in-vivo tests. Studies on carcinogenicity in rats did not show any evidence of tumour-developing activities.
Reproduction Toxicology
The embryotoxic potential of diclofenac was studied in 3 animal models (rat, mouse and rabbit). Fetal death and retardation of growth resulted in doses in the toxic range. Malformations have not been observed. The gestation period and duration of parturition were prolonged by diclofenac. The effect on fertility was not examined. Doses below the maternal-toxic range did not reveal any influence on the postnatal development of the descendants.
Relief of all grades of pain and inflammation in a wide range of conditions, including:
- arthritic conditions: rheumatoid arthritis, osteo-arthritis, ankylosing spondylitis, acute gout,
- acute musculo-skeletal disorders such as periarthritis (for example frozen shoulder), tendinitis, tenosynovitis, bursitis,
- other painful conditions resulting from trauma, including fracture, low back pain, sprains, strains, dislocations, orthopaedic, dental and other minor surgery.
Pharmacotherapeutic group
Nonsteroidal anti-inflammatory drugs (NSAIDs).
Mechanism of Action:
Econac 100 mg suppositories are a non-steroidal agent with marked analgesic/anti-inflammatory properties. It is an inhibitor of prostaglandin synthetase, (cyclo-oxygenase). Diclofenac sodium in vitro does not suppress proteoglycan biosynthesis in cartilage at concentrations equivalent to the concentrations reached in human beings.
Absorption
Diclofenac is rapidly and efficiently absorbed after conventional oral, rectal or intramuscular administration.
Maximal plasma concentrations after rectal administration are attained after approximately thirty minutes. Peak plasma concentrations and area under the plasma concentration-time curve (AUC) are linearly related to a dose over the range of 25 - 150 mg, regardless of administration route; after oral, rectal or intramuscular doses no accumulation occurred after repeated doses.
In elderly patients of more than 62 years of age and patients aged 2 - 7 years with juvenile rheumatoid arthritis peak plasma concentrations, time to peak plasma concentrations (tmax) and AUC values are similar to those produced in adult patients without arthritic conditions.
Distribution
Highest concentrations of Diclofenac are found in descending order in the liver, bile, kidneys, blood, heart and lungs.
Diclofenac passes into the synovial fluid of patients with osteoarthritis and rheumatoid arthritis, where higher concentrations are maintained compared with plasma concentrations.
Even though Diclofenac has a relatively short elimination half-life in plasma (1.5 hours), the drug persists in synovial fluid.
Diclofenac, like all NSAIDs, is > 99.5 % bound to human serum proteins, specifically to albumin. The volume of distribution of diclofenac in healthy subjects is 0.12 to 0.17 L/kg and that of the central compartment 0.04 L/kg.
Metabolism
Diclofenac is metabolized in the liver by conjugation. The principal metabolite in humans, 4'-hydroxydiclofenac, which has about 1/40 of the activity of the parent compound against adjuvant-induced arthritis.
5'-hydroxydiclofenac and 4', 5'-dihydroxydiclofenac do not have any pharmacologic activity. Drug disposition in patients with hepatic impairment is comparable to that in normal subjects.
Elimination
Diclofenac is eliminated by urinary and biliary excretion of glucuronide and sulfate conjugates of the metabolites.
Urinary excretion of 4'-hydroxydiclofenac accounts for 20 % to 30 % of the dose. Biliary excretion of this metabolite accounts for 10 % to 20 %. The other metabolites excreted in urine each account for 10 % to 20 % of the dose; smaller amounts are excreted in the bile.
Approximately 90 % of an oral dose of diclofenac is excreted within 96 hours. The mean elimination half-life of the unchanged drug is 1.2 to 1.8 hours. Elimination rates in renally impaired patients are comparable to those in other patients. The steady state concentrations of the total metabolites in patients with severe renal impairment are four times higher than in subjects with normal renal function, but exert no additional pharmacological effects.
Bioavailability
The relative bioavailability of the suppositories compared to the reference product is 96.4 %.
The 90 % confidence intervals are for:
| - AUC o-∞: | 90.5 - 102.7 |
| - Cmax: | 77.0 - 93.4 |
29/09/2016
Econac 100 mg suppositories
Mercury Pharma Group Ltd
Capital House, 85 King William Street,
London EC4N 7BL, UK
Do not store above 25°C.
PVC strips with 10 suppositories
PL 10972/0069
One suppository contains 100 mg diclofenac sodium
General
The concomitant use of diclofenac with systemic NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided due to the absence of any evidence demonstrating synergistic benefits and the potential for additive undesirable effects.
Caution is indicated in the elderly on basic medical grounds. In particular, it is recommended that the lowest effective dose be used in frail elderly patients or those with a low body weight.
As with other NSAIDs, allergic reactions, including anaphylactic/anaphylactoid reactions, can also occur in rare cases with diclofenac without earlier exposure to the drug.
Like other NSAIDs, Econac suppositories may mask the signs and symptoms of infection due to its pharmacodynamic properties.
Gastrointestinal effects:
Gastrointestinal bleeding, haematemesis, melaena, ulceration or perforation which can be fatal has been reported with all NSAIDs including diclofenac and may occur at any time during treatment, with or without warning symptoms or a previous history of serious gastrointestinal events. They generally have more serious consequences in the elderly. If gastrointestinal bleeding or ulceration occurs in patients receiving Econac suppositories, the medicinal product should be withdrawn.
As with all NSAIDs, including diclofenac, close medical surveillance is imperative and particular caution should be exercised when prescribing Diclofenac in patients with symptoms indicative of gastrointestinal (GI) disorders or with a history suggestive of gastric or intestinal ulceration, bleeding or perforation.
The risk of GI bleeding, is higher with increasing NSAID doses, and in patients with a history of ulcer, particularly if complicated with haemorrhage or perforation.
The elderly have an increased frequency of adverse reactions to NSAIDs especially gastrointestinal bleeding and perforation which may be fatal.
To reduce the risk of GI toxicity in patients with a history of ulcer, particularly if complicated with haemorrhage or perforation and in the elderly, the treatment should be initiated and maintain at the lowest effective dose.
Combination therapy with protective agents (e.g. misoprostol or proton pump inhibitors) should be considered for these patients, and also for patients requiring concomitant use of medicinal products containing low dose acetylsalicylic acid (ASA)/ aspirin, or other medicinal products likely to increase gastrointestinal risk.
Patients with a history of GI toxicity, particularly the elderly, should report any unusual abdominal symptoms (especially GI bleeding).
Caution is recommended in patients receiving concomitant medications which could increase the risk of ulceration or bleeding, such as systemic corticosteroids, anticoagulants, such as warfarin, anti-platelet agents such as acetylsalicylic acid or selective serotonin-reuptake inhibitors.
Close medical surveillance and caution should also be exercised in patients with ulcerative colitis or Crohn's disease, as their condition may be exacerbated.
Hepatic effects:
Close medical surveillance is required when prescribing Diclofenac to patients with impaired hepatic function, as their condition may be exacerbated.
As with other NSAIDs, including diclofenac, values of one or more liver enzymes may increase. During prolonged treatment with Diclofenac, regular monitoring of hepatic function is indicated as a precautionary measure. If abnormal liver function tests persist or worsen, if clinical signs or symptoms consistent with liver disease develop, or if other manifestations occur (e.g. eosinophilia, rash), Diclofenac should be discontinued. Hepatitis may occur with use of diclofenac without prodromal symptoms.
Caution is called for when using Diclofenac in patients with hepatic porphyria, since it may trigger an attack.
Renal effects
As fluid retention and oedema have been reported in association with NSAID therapy, including diclofenac, particular caution is called for in patients with impaired cardiac or renal function, history of hypertension, the elderly, patients receiving concomitant treatment with diuretics or medicinal products that can significantly impact renal function, and in those patients with substantial extracellular volume depletion from any cause, e.g. before or after major surgery. Monitoring of renal function is recommended as a precautionary measure when using Diclofenac in such cases. Discontinuation of therapy is usually followed by recovery to the pre-treatment state.
The importance of prostaglandins in maintaining renal blood flow should be taken into account in patients with impaired cardiac or renal function, those being treated with diuretics or recovering from major surgery.
Effects on renal function are usually reversible on withdrawal of Econac 100 mg suppositories.
Skin effects:
Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs,. Patients appear to be at the highest risk of these reactions early in the course of therapy: the onset of the reaction occurring in the majority of cases within the first month of treatment. Econac Suppositories should be discontinued at the first appearance of skin rash, mucosal lesions or any other signs of hypersensitivity.
SLE and mixed connective tissue disease:
In patients with systemic lupus erythematosus (SLE) and mixed connective tissue disorders there may be an increased risk of aseptic meningitis.
Cardiovascular and cerebrovascular effects
Patients with significant risk factors for cardiovascular events (e.g. hypertension, hyperlipidaemia, diabetes mellitus, smoking) should only be treated with diclofenac after careful consideration. As the cardiovascular risks of diclofenac may increase with dose and duration of exposure, the shortest duration possible and the lowest effective daily dose should be used. The patient's need for symptomatic relief and response to therapy should be re-evaluated periodically.
Appropriate monitoring and advice are required for patients with a history of hypertension and/or mild to moderate congestive heart failure as fluid retention and oedema have been reported in association with NSAID therapy, including diclofenac.
Clinical trial and epidemiological data consistently point towards increased risk of arterial thrombotic events (for example myocardial infarction or stroke) associated with the use of diclofenac, particularly at high dose (150mg daily) and in long term treatment.
Patients with uncontrolled hypertension, congestive heart failure, established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease should only be treated with diclofenac after careful consideration.
Haematological effects:
Use of Econac 100 mg suppositories is recommended only for short term treatment. During prolonged treatment with Diclofenac, as with other NSAIDs, monitoring of the blood count is recommended. Diclofenac may reversibly inhibit platelet aggregation. Patients with defects of haemostasis, bleeding diathesis or haematological abnormalities should be carefully monitored.
Pre-existing asthma
In patients with asthma, seasonal allergic rhinitis, swelling of the nasal mucosa (i.e. nasal polyps), chronic obstructive pulmonary diseases or chronic infections of the respiratory tract (especially if linked to allergic rhinitis-like symptoms), reactions on NSAIDs like asthma exacerbations (so-called intolerance to analgesics / analgesics-asthma), Quincke's oedema or urticaria are more frequent than in other patients. Therefore, special precaution is recommended in such patients (readiness for emergency). This is applicable as well for patients who are allergic to other substances, e.g. with skin reactions, pruritus or urticaria.
Like other drugs that inhibit prostaglandin synthetase activity, diclofenac sodium and other NSAIDs can precipitate bronchospasm if administered to patients suffering from, or with a previous history of bronchial asthma.
Female fertility:
The use of Econac suppositories may impair female fertility and is not recommended in women attempting to conceive. In women who may have difficulties conceiving or who are undergoing investigation of infertility, withdrawal of Econac suppositories should be considered.
Patients who experience visual disturbances, dizziness, vertigo, somnolence central nervous system disturbances, drowsiness or fatigue while taking NSAIDS should refrain from driving or operating machinery.
Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms.
Posology:
Adults:
One 100mg suppository may be given as a once daily treatment usually at night.
Where necessary therapy may be combined with tablets up to a total maximum dose of 150 mg diclofenac per day.
Special population:
Elderly patients
Although the pharmacokinetics of Econac are not impaired to any clinically relevant extent in elderly patients, non-steroidal anti-inflammatory drugs should be used with particular caution in such patients who, generally, are more prone to adverse reactions. In particular, it is recommended that the lowest effective dosage be used in frail, elderly patients or those with a low body weight (see also Precautions) and the patient should be monitored for GI bleeding during NSAID therapy.
Renal impairment
Diclofenac is contraindicated in patients with severe renal impairment. No specific studies have been carried out in patients with renal impairment, therefore, no specific dose adjustment recommendations can be made. Caution is advised when administering diclofenac to patients with mild to moderate renal impairment.
Hepatic impairment
Diclofenac is contraindicated in patients with severe hepatic impairment. No specific studies have been carried out in patients with hepatic impairment, therefore, no specific dose adjustment recommendations can be made. Caution is advised when administering diclofenac to patients with mild to moderate hepatic impairment.
Paediatric population
Children (aged 1 - 12 years):
Econac 100 mg suppositories are not suitable for children.
Method of administration:
Not to be taken by mouth, as per rectal administration only.
The suppositories should be inserted well into the rectum. It is recommended to insert the suppositories after passing stools.
04/11/2010
