a) Symptoms
Symptoms include headache, nausea, vomiting, epigastric pain, gastrointestinal bleeding, rarely diarrhoea, disorientation, excitation, coma, drowsiness, dizziness, tinnitus, fainting, occasionally convulsions. In cases of significant poisoning acute renal failure and liver damage are possible. Other complications that might be encountered include hypotension, respiratory depression, and gastro-intestinal irritation.
b) 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 a potentially life-threatening overdose.
Good urine output should be ensured.
Renal and liver function should be closely monitored.
Patients should be observed for at least four hours after 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.
36 months.
Hypersensitivity to diclofenac sodium or any of the other constituents.
NSAIDs are contraindicated in patients who have previously shown hypersensitivity reactions (e.g. asthma, rhinitis, angioedema or urticaria) in response to ibuprofen, aspirin, or other non-steroidal anti-inflammatory drugs.
Severe hepatic failure, renal failure and heart failure.
During the last trimester of pregnancy.
Active, or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding).
History of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy.
Not applicable.
| Purified talc | EP |
| Ethylcellulose | EP |
| Magnesium Stearate | EP |
| Povidine | EP |
| Stearic acid | USP |
| Hydroxypropylmethlcellulose | EP |
| Ethylcellulose | EP |
| Diethyl phthalate | USP |
| Titanium dioxide E171 | EP |
| Polyethylene glycol 4000 | BP |
Modified Release Tablets
Gastrointestinal: The most commonly-observed adverse events are gastrointestinal in nature. Peptic ulcers, perforation or GI bleeding, sometimes fatal, particularly in the elderly, may occur. Nausea, vomiting, diarrhoea, flatulence, constipation, dyspepsia, anorexia, abdominal pain, melaena, haematemesis, ulcerative stomatitis, exacerbation of colitis and Crohn's disease have been reported following administration. Less frequently, gastritis, glossitis and oesophageal lesions have been observed. Pancreatitis has been reported very rarely.
Hypersensitivity: Hypersensitivity reactions have been reported following treatment with NSAIDs. These may consist of (a) non-specific allergic reactions and anaphylaxis (b) respiratory tract reactivity comprising asthma, aggravated asthma, bronchospasm or dyspnoea, or (c) assorted skin disorders, including rashes of various types, pruritus, urticaria, purpura, angiodema and more rarely, exfoliative and bullous dermatoses (including epidermal necrolysis and erythema multiforme).
Cardiovascular and cerebrovascular: Oedema, hypertension and cardiac failure have been reported in association with NSAID treatment. Hypotension, chest pains and palpitations have been rarely reported.
Clinical trial and epidemiological data suggest that use of diclofenac, particularly at a high dose (150mg daily) and in long-term treatment may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke).
Other adverse events reported less commonly include:
Renal: Nephrotoxicity in various forms, including interstitial nephritis, nephrotic syndrome and renal failure. Other occasional effects on the kidney include acute renal insufficiency, urinary abnormalities (e.g. haematuria, proteinuria), nephritic syndrome and papillary necrosis.
Hepatic: Abnormal liver function for example occasional reports of elevation of serum aminotransferase enzymes (ALT, AST), hepatitis and jaundice.
Neurological and special senses: Visual disturbances, optic nephritis, headaches, paraesthesia, reports of aseptic meningitis (especially in patients with existing auto-immune disorders, such as systemic lupus erythematosus, mixed connective tissue disease), with symptoms such as stiff neck, headache, nausea, vomiting, fever or disorientation , depression, confusion, hallucinations, tinnitus, vertigo, dizziness, malaise, fatigue and drowsiness.
Other isolated effects on the central nervous system include tiredness, impaired hearing, insomnia, convulsions, irritability, anxiety, psychotic reactions, tremor, memory disturbance, disturbance of sensation, nightmares and taste alterations.
Haematological: Thrombocytopenia, neutropenia, agranulocytosis, aplastic anaemia and haemolytic anaemia. Leucopoenia has been rarely reported.
Dermatological: Bullous reactions including Stevens Johnson Syndrome, Lyells syndrome and Toxic Epidermal Necrolysis (including erythroderma) (very rare). Photosensitivity, eczema, hair loss.
Other: Impotence has been reported rarely.
No relevant information additional to that already included elsewhere in the SPC.
Rheumatoid arthritis, osteoartbritis, acute gout, low back pain, relief of pain in fractures, acute musculo-skeletal disorders and trauma including periarthritis (particularly frozen shoulder), bursitis, tendinitis, tenosynovitis, dislocations, sprains and strains, ankylosing spondylitis, and the control of pain and inflammation in orthopaedic, dental and other minor surgery.
Diclofenac sodium is a non-steroidal, anti-inflammatory drug (NSAID) with analgesic and antipyretic properties. It is an inhibitor of prostaglandin synthetase.
Diclofenac 75 Retard Tablets are extended release preparations designed to release diclofenac over a period of time. Following a pharmacokinetic study with the 100 mg tablet in volunteers it was found that the average time to reach maximum plasma concentration was 6.05 hours.
The average elimination half life was found to be 6.75 hours. The average maximum plasma concentrations were found to be 262ng/ml.
General characteristics of the active substance
Diclofenac sodium is almost totally absorbed after oral administration and it is subject to significant first-pass metabolism with only approximately 60% of an oral dose reaching the systemic circulation.
Diclofenac sodium is highly protein bound (>99%). It is mainly excreted in the form of metabolites via the urine but also in the bile.
The main metabolite has minimal anti-inflammatory activity compared with the parent drug.
Characteristics in patients
Plasma concentration of unchanged diclofenac are not reported to be significantly affected by age, renal or hepatic impairment. The metabolite concentrations may be increased by severe renal impairment.
08/04/2014
Rheumatac Retard 75
Amdipharm UK Limited
Capital House, 85 King William Street,
London EC4N 7BL, UK
Store in a dry place below 25°C. Protect from light.
PVdC/PVC/aluminiumlPVdC blister strip.
Number of tablets per carton 28, 30, 50, 56, 60, 84, 100, 250, 500, 1000
PL 20072/0219
Pregnancy:
Congenital abnormalities have been reported in association with NSAID administration in man; however, these are low in frequency and do not appear to follow any discernable pattern.- Special Warnings and Precautions for Use, regarding female fertility.
Rheumatac 75 Retard. Each tablets contains 75mg diclofenac sodium BP.
In all patients:
).
Monitoring of renal function, hepatic function (elevation of liver enzymes may occur) and blood counts should be performed on long-term NSAID patients, as a precautionary measure.
The use of diclofenac with concomitant NSAIDs including cycloxygenase-2 selective inhibitors should be avoided.
Elderly:
The elderly have an increased frequency of adverse reactions to NSAIDs especially gastrointestinal bleeding and perforation, which may be fatal.
Respiratory disorders:
Caution is required if administered to patients suffering from, or with a previous history of, bronchial asthma since NSAIDs have been reported to precipitate bronchospasm in such patients.
Cardiovascular, Renal and Hepatic Impairment:
The administration of an NSAID may cause a dose dependent reduction in prostaglandin formation and precipitate renal failure.).
Patients with a history of GI toxicity, particularly when elderly, should report any unusual abdominal symptoms (especially GI bleeding) particularly in the initial stages of treatment.
Caution should be advised in patients receiving concomitant medications which could increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin reuptake inhibitors or anti-platelet agents such as aspirin.
When GI bleeding or ulceration occurs in patients receiving diclofenac, the treatment should be withdrawn.
NSAIDs should be given with care to patients with a history of gastrointestinal disease (ulcerative colitis, Crohn's disease) as these conditions may be exacerbated.
Patients with a history of haematemesis, or melaena, should be carefully observed.
Haematological disorders:
Care should be taken when treating patients with haematological abnormalities, or bleeding diathesis.
Hepatic Disorders:
Diclofenac must be stopped if liver function tests show abnormalities, which persist or worsen, or if liver disease develops or if other symptoms such as eosinophilia or rash occur.
Diclofenac may trigger an attack in patients with hepatic porphyria.
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.
Dermatological:
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 highest risk for 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. Diclofenac should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.
Impaired Female fertility:
The use of diclofenac may impair female fertility and is not recommended in women attempting to conceive. In women who have difficulties conceiving or who are undergoing investigation of infertility, withdrawal of diclofenac should be considered.
Undesirable effects such as dizziness, drowsiness, fatigue and visual disturbances are possible after taking NSAIDs. If affected, patients should not drive or operate machinery.
Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms.
For oral administration. Tablets should be swallowed whole preferably with or after food.
Adults: One 75 mg tablet once or twice a day.
Children: Not suitable for use in children.
Elderly: Care should be used when treating patients who are frail or have a low body weight, as they will in general be more susceptible to adverse reactions. The elderly are at an increased risk of the serious consequences of adverse reactions. If an NSAID is considered necessary, the lowest effective dose should be used and for the shortest possible duration. The patient should be monitored regularly for GI bleeding during NSAID therapy.
None stated.
27 March 1998
Other analgesics (including cycloxygenase-2 selective inhibitors): Avoid concomitant use of two or more NSAIDs (including aspirin) as this may increase the risk of adverse effects.
Anti-hypertensives: Reduced anti-hypertensive effect.
Diuretics: Reduced diuretic effect. Diuretics can increase the risk of nephrotoxicity of NSAIDs. The activity of diuretics may be inhibited by some NSAIDs. Increased serum potassium levels may result when diclofenac is given concomitantly with potassium-sparing diuretics. Serum potassium levels should therefore be monitored.
Cardiac glycosides: NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma glycoside levels.
Lithium: Decreased elimination of lithium.
Methotrexate: Decreased elimination of methotrexate.
Ciclosporin: Increased risk of nephrotoxicity as a result of the effect of NSAIDs on renal prostaglandins.
Mifepristone: NSAIDs should not be used for 8-12 days after mifepristone administration as NSAIDs can reduce the effect of mifepristone.
Corticosteroids: Increased risk of GI ulceration or bleeding.
Anti-coagulants: NSAIDs may enhance the effects of anti-coagulants, such as warfarin. Monitoring is recommended to ensure the desired response to the anticoagulant is maintained, as there are rare reports of increased risk of haemorrhage with combined diclofenac and anticoagulant therapy.
Quinolone antibiotics: Animal data indicate that NSAIDs can increase the risk of convulsions associated with quinolone antibiotics. Patients taking NSAIDs and quinolones may have an increased risk of developing convulsions.
Antiplatelet agents and selective serotonin reuptake inhibitors (SSRIs): Increased risk of gastrointestinal bleeding.
Tacrolimus: Possible increased risk of nephrotoxicity when NSAIDs are given with tacrolimus.
Anti-diabetics: It has been reported that hypo- and hyperglycaemic effects have occurred rarely when diclofenac and oral antidiabetic agents have been given together and adjustment of the hypoglycaemic may be required.
Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with zidovudine. There is evidence of an increased risk of haemarthroses and haematoma in HIV(+) haemophiliacs receiving concurrent treatment with zidovudine and ibuprofen.
