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Any disease of the musculoskeletal system is accompanied by pain. It becomes especially strong after sleep, when soft tissues accumulate fluid, which manifests itself in the form of puffiness and swelling. The best option elimination This kind of pain, by relieving the inflammatory process and quickly relieving pain, is taking Diclofenac. The non-steroidal anti-inflammatory drug has a fairly wide selection of release forms (gels and creams, injection solutions, tablets, suppositories), which increases its effectiveness by treating not only the source of inflammation, but also affecting it from the inside. How to use this drug correctly and what contraindications it has, we will consider further.

Pharmacological action

Diclofenac belongs to the group of NSAIDs. Active substance diclofenac sodium affects the synthesis of prostaglandins at the site of inflammation, reducing their concentration. The drug also inhibits the metabolic processes of arachidonic acid and cyclooxygenase. All this together allows you to achieve such favorable results as:

• relieving inflammation;
• relief of pain at the site of inflammation;
• elimination of hyperemia of the skin (increase in temperature).

Preparation capable of penetrating synovial fluid and linger there, being in maximum concentration. After taking Diclofenac, it is well absorbed into the blood. Maximum concentration in plasma is achieved, depending on the form of administration:

• tablets – 2-3 hours;
• injections – 15-20 minutes;
• ointment and gel – 2-4 hours.

Almost completely binds to blood albumin, where, during metabolism in the liver, it breaks down into simpler compounds that are excreted through the kidneys after 6-12 hours. Diclofenac does not accumulate, therefore can be used for long-term treatment, non-addictive and without reducing its effectiveness.

Composition and release form

Depending on the release form, the content of the main component diclofenac sodium is excellent:

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Irina Martynova. Graduated from Voronezh State Medical University named after. N.N. Burdenko. Clinical resident and neurologist of the BUZ VO \"Moscow Polyclinic\".

1. Pills, covered with a shell, white or yellowish in color. There can be two dosages: 25 and 50 mg of the active substance. There are also auxiliary components:

• cornstarch;
• dye;
• titanium dioxide.

The tablets are packaged in 10, 20, 30 pieces in blisters or dark glass jars.

1. Solution for injection– contains diclofenac sodium:

• 1 ampoule – 25 mg;
• 1 ampoule – 75 mg.

Excipients:

• purified water;
• benzyl alcohol;
• propylene glycol;
• sodium metabisulfite;
• sodium hydroxide.

The ampoules are packed in cardboard or plastic boxes, 3-5 ampoules in each.

1. Candles contain 25 mg of diclofenac sodium, as well as auxiliary components, including solid fat, glycerin and dye. Rectal suppositories are packaged in 5-10 pieces in sealed packaging.
2. Ointment 2% packaged in an iron tube, volume 30 g. The content of diclofenac sodium in 1 g of ointment is 20 mg. Used for external use.
3. Gel 5%— Diclofenac Forte, which has an increased concentration of the active component, contains in 1 g:

• diclofenac sodium – 50 mg;
• dimexide;
• propylene glycol;
• purified water;
• macrogoal

It has a homogeneous gel consistency, transparent color, sometimes with air bubbles. One tube has a volume of 40 g.

1. Gel and ointment 1%— contain diclofenac sodium 10 mg per 1 g of ointment or gel. This dosage is convenient if complex treatment is being performed, requiring not only oral administration, but also local action on the site of inflammation.
2. Eye drops 0.1%— packaged in a 5 or 10 ml bottle with a dispenser. 1 ml drops contain 1 mg of active substance. The drops are transparent in color, sometimes with a yellowish tint. Auxiliary components:

• sodium chloride;
• distilled water;
• sodium hydroxide.

Application

Diclofenac is prescribed for the treatment of diseases such as:

1. Inflammatory processes of the musculoskeletal system and joints:

• osteoarthritis;
• spondylitis;
• osteochondrosis of the spinal column;
• lumbago;
• sprains and ligament tears;
• soft tissue injuries and bruises.

1. As part of complex therapy in the treatment of ENT diseases:

• pharyngitis;
• otitis;
• tonsillitis.

1. Preparing for eye surgery, as well as eliminating negative reactions after it:

• cataract;
• swelling of the macula of the retina;
• photophobia.

1. Pain relief at:

• renal and hepatic colic;
• proctitis;
• adnexitis;
• algodismenorrhea;
• migraines.

Depending on the form of release, the drug is used as follows::

1. Pills– apply between meals(the absorption process and digestibility drop sharply when consumed during meals), without chewing in the mouth, with water. The permissible daily dose is 150 mg. It is recommended to use 25-50 mg (1-2 tablets) 2-3 times a day. After achieving the effect, the dosage should be reduced to the minimum. In children (from 6 years old), the dosage is calculated from the proportion of 2 mg tablets per 1 kg of weight.
2. Solution for injection - administered deeply intramuscularly, no more than 75 mg (1 ampoule). If necessary, the injection is repeated, but not earlier than after 12 hours. After 2-3 days of administration of the drug, it is recommended to switch to oral administration of the drug, maintaining the dosage.

Diclofenac injections are never administered intravenously, since this can cause not only a chemical burn of soft tissues, but also develop severe intoxication

1. Rectal suppositories– enter 1-2 candles in the anus, you first need to give a cleansing enema, which will ensure maximum absorption of the active components in the rectum. Suppositories are effective for inflammatory processes in the pelvic region, as well as gynecological diseases.
2. Eye drops- bury 1 drop into the conjunctival sac every 3-4 hours. After surgery, the frequency of instillation is regulated by the attending physician.
3. Gels and ointments apply onto clean skin with smooth massaging movements, rubbing well into the skin until completely absorbed. The number of daily applications should not exceed 2-3 times.

Since some types of gels with diclofenac sodium have an increased concentration (5%), you need to ensure that an overdose does not occur if, in addition to ointments and creams, tablets, injections or suppositories are used.

Contraindications

• children under 6 years of age;
• period of pregnancy and lactation;
• gastric and duodenal ulcers in the acute stage;
• hematopoietic disorder;
• poor blood clotting, as well as a tendency to bleed.

With extreme caution used in the presence of such diseases:

• renal and liver failure;
• cardiovascular diseases;
• diabetes mellitus;
• anemia;
• arrhythmia;
• bronchial asthma;
• old age.

The presence of contraindications, as well as adverse reactions, suggests that treatment with Diclofenac should be carried out only on the recommendation of a doctor, strictly following all his recommendations regarding forms and dosages.

Under no circumstances should you combine medication with alcoholic beverages, as this can lead to severe intoxication and collapse, which is extremely life-threatening.

Overdose

With a slight excess specified daily permissible dose, the patient may experience following symptoms:

• nausea, vomiting, dizziness up to loss of consciousness;
• convulsions;
• rapid heartbeat;
• bleeding;
• pain in the epigastric region.

In case of overdose carry out symptomatic treatment, implying:

1. Flushing the gastrointestinal tract, reducing the concentration of toxins;
2. Introduction of a large dose of any sorbent that binds and neutralizes toxins.
3. Drink plenty of boiled water at room temperature

If the symptoms appear are life-threatening, you should urgently call an ambulance.

Side effects

The most common adverse reactions that occur in patients using Diclofenac are:

• stomach ache;
• swelling of the limbs;
• tinnitus;
• anemia;
• sleep disturbance;
• chest cough.

The most dangerous side effect considered an allergic reaction, which can manifest itself in the form:

• skin rash - small blistering tubercles filled with clear liquid;
• swelling of the mucous membranes;
• skin itching;
• anaphylactic shock and angioedema.

If taking Diclofenac causes at least one of the adverse reactions, treatment is stopped until the allergy is completely eliminated and studied.

With the rapid development of an allergic reaction, the patient is injected deeply intramuscularly with any antihistamine in a double dose. If resuscitation is necessary, the metabolic products of diclofenac sodium are eliminated using dialysis (introduction of a large amount of liquid by drip).

Drug interactions

Diclofenac may reduce the effectiveness of diuretics, increasing and retaining sodium and lithium salts in large quantities. Reduces the activity of antihypertensive drugs, and also neutralizes the effects of sleeping pills drugs.

• corticotropin;
• pure ethanol;
• colchicine;
• cefoperazone;
• Plicacymin.

Their simultaneous use leads to the development of internal erosions and bleeding in the gastrointestinal tract.

There is no point in using acetylsalicylic acid, since it significantly reduces the effectiveness of Diclofenac by dissolving it into inactive particles (pacifiers) during metabolism.

Advantages

The most important advantage Diclofenac, regardless of the form of release, is its affordable price. This is one of the most affordable NSAIDs, which is affordable for absolutely any patient. Also the drug not addictive. Its continuous administration does not affect its effectiveness. The course of treatment can be selected individually, gradually reducing the dosage to a minimum.

Price

The average price for medicines containing diclofenac sodium is as follows:

• tablets - 15-20 rubles for 10 pieces;
• ointments and gels – 25-60 rubles (depending on the dosage and volume of the tube);
• rectal suppositories – 35-70 rubles for 5 pieces;
• solutions for intramuscular administration - 30-35 rubles per package;
• eye drops – 20-45 rubles (5 and 10 ml).

Conditions for dispensing from pharmacies

Tablets, eye drops and injection solution are sold strictly according to prescription. Other forms are allowed for free over-the-counter sale.

Storage conditions

Tablets, suppositories and injection ampoules are stored in a cool, dry place (best in the refrigerator). Ointments and gels can be stored in a medicine cabinet, tightly closing the tube cap after each use.

Best before date

Eye drops and rectal suppositories are stored for no more than 1 year from the date of manufacture. Other forms are stored for up to 2 years from the date of production.

Analogs

Among the drugs that have a similar effect on the body, the following analogues can be distinguished:

• Naklofen – 100 rubles;
• – 40 rubles;
• – 320 rubles;
• Diclovit candles – 150 rubles;
• – 120 rubles;
• – 15 rubles.

Thus, Diclofenac has a huge selection of forms of use, however, you need to understand that you don’t need to use them all together at the same time. This can provoke an overdose, which will lead to intoxication and a lot of negative effects on the body. Treatment should be carried out exclusively under the supervision of doctors, who will select a reasonable dosage and the most suitable form. The instructions for use may not reflect the danger that the medicine contains.

Back pain with osteochondrosis occurs due to an inflammatory reaction in the intervertebral joints, muscles and spinal nerve roots.

Insufficient supply of nutrients to tissues leads to the destruction of their cells with the release of biologically active substances - pro-inflammatory mediators - into the surrounding space. They trigger an inflammatory response, which is manifested by swelling, pain and dysfunction of the spine.

Non-steroidal anti-inflammatory drugs (NSAIDs) are most effective in eliminating pain in such cases. One of the representatives of the group is Diclofenac, which we will dwell on in detail.

Pharmacological action of Diclofenac injections

Diclofenac is a non-hormonal anti-inflammatory drug. It combines pronounced analgesic and anti-inflammatory effects.

Diclofenac prevents the release of the main precursor of inflammatory substances, arachidonic acid, from the membranes of damaged cells. Thus, the drug stops the cascade of chemical reactions leading to the dilation of blood vessels, the release of fluid from them and tissue swelling.

Pain during inflammation is caused by compression of sensitive nerve receptors and the effect of pro-inflammatory mediators on them. Diclofenac blocks their synthesis, which quickly eliminates pain and prevents its recurrence.

Often the inflammatory reaction loses its protective function and contributes to additional damage to the intervertebral joints and nerve roots. Prolonged stagnation of blood in the vessels leads to deterioration of tissue nutrition, accumulation of metabolic products in them and acidification of the environment at the site of inflammation. Cells that were initially untouched by the degenerative process under such conditions cannot function and die.

Accordingly, a new release of arachidonic acid intensifies the inflammatory process and the pathological circle closes. Diclofenac breaks it down: it improves blood supply and protects living cells from destruction. The inflammatory reaction quickly subsides, and the pain syndrome is relieved.

Compound

Diclofenac is produced in the form of a solution for intramuscular injection, packaged in 3 ml glass ampoules. 1 ml of solution is:

• diclofenac 25 mg;
• mannitol;
• benzyl alcohol;
• sodium hydroxide;
• sodium metabisulfite;
• propylene glycol;
• sterile water up to 1 ml.

Excipients in the solution serve as preservatives and stabilizers of the active component.

Indications for use

Indicated in most situations in which pain is caused by an inflammatory process:

• , plexitis, neuritis;
• shot ( , );
• rheumatic diseases (spondyloarthritis, sacroiliitis, rheumatoid arthritis, gout, osteoarthritis);
• rheumatic damage to the eyes, heart, blood vessels;
• renal and hepatic colic;
• pain after injury or surgery;
• painful menstruation, acute inflammatory diseases of the female reproductive system (adnexitis, salpingitis);
• severe headache (including migraine);
• acute otitis media, sinusitis, eustachitis.

Contraindications

Diclofenac should not be used in the following cases:

• hypersensitivity to the drug or to other representatives of its group;
• erosive and ulcerative lesions of the stomach and duodenum during an exacerbation or with a history of perforation;
• decreased blood clotting;
• bleeding at any level of the digestive tract;
• hematopoietic disorder;
• allergic reactions to NSAIDs, including aspirin asthma;
• severe liver and kidney failure;
• decompensated heart failure;
• a history of hemorrhagic stroke or the risk of its development;
• previous myocardial infarction, coronary artery bypass surgery;
• peripheral artery disease (severe atherosclerosis);
• dehydration or acute blood loss;
• inflammatory bowel diseases;
• infertility (when trying to conceive a child);
• last trimester of pregnancy, feeding;
• childhood.

Course of treatment with injections: instructions for use

Diclofenac solution is injected intramuscularly deep into the buttock or anterior thigh. The injection is performed with a syringe with a capacity of 5 ml: its needle is long enough for intramuscular injection.

A burning sensation may be felt at the injection site, which goes away within a short time.

Diclofenac is absorbed from the muscle into the blood and creates a high concentration in the tissues within half an hour.

Side effects of the drug are directly related to its dose, so it is recommended to use the minimum effective amount of the substance.

Usually start with 75 mg per day, if necessary increasing to 150 mg of Diclofenac per day.

Injections are performed once a day, but if necessary, the drug can be re-injected no less than half an hour later. The maximum dosage of Diclofenac is 150 mg (6 ml) per day. The course of treatment with injections is 2 days, the attending physician can extend it to 5 days according to indications.

Side effects

Along with its high efficiency, Diclofenac has an extensive list of adverse reactions. They are associated with the cessation of the synthesis of prostaglandins, which, in addition to participating in the inflammatory reaction, play an important role in many organs and systems: they protect the gastric mucosa from the aggression of hydrochloric acid, for example.

The use of Diclofenac may cause:

• decreased blood clotting;
• suppression of red bone marrow function;
• allergic reactions (including dangerous skin reactions with epidermal rejection);
• irritability, depression, insomnia, headache;
• drowsiness, hallucinations, impaired sensitivity, memory, vision;
• aseptic inflammation of the meninges;
• tinnitus and hearing loss;
• decreased blood pressure;
• asthma, pneumonia;
• nausea, vomiting, abdominal pain, perforation of ulcers, bleeding (vomiting and bloody stools), stomatitis, pancreatitis;
• liver damage (hepatitis, hepatonecrosis);
• hair loss;
• photosensitivity;
• kidney damage (nephritis, necrosis of the renal papillae);
• formation of infiltrate and abscess at the injection site;
• respiratory dysfunction.

During pregnancy

The use of Diclofenac is possible in the 1st and 2nd trimesters of pregnancy strictly according to indications and after a doctor’s prescription! The drug affects the development of the embryo and increases the risk of birth defects. Diclofenac is prescribed in minimal quantities and for a short period of time.

In the 3rd trimester of pregnancy, the use of the drug can lead to severe fetal hypoxia and its death. In addition, Diclofenac reduces the contractility of the uterus, which is fraught with weakness of labor and postpartum hemorrhage.

Interaction with alcohol

The combined use of Diclofenac with ethanol increases the risk of gastrointestinal bleeding and liver damage.

Medicine price

Diclofenac is an affordable medicine, the average cost is:

• ampoules (made in Serbia) 3 ml 10 rubles per 1 piece;
• ampoules 3 ml 51 rubles for 5 pcs.;
• ampoules (made in Belarus) 3 ml 45 rubles for 10 pcs.

Analogs

Diclofenac as an active substance contains solutions:

• Voltaren;
• Diclomax;
• Diclonac;
• Diclorium;
• Diclofen;
• Naklof;
• Diclomelan;
• Naklofen;
• Ortofen;
• Orthofer;
• Diclonate P;
• Revmavec.

Reading time: 4 minutes. Views 3.5k. Published 05/01/2018

Diclofenac is a non-steroidal anti-inflammatory drug. For a long time it was used in the treatment of rheumatological diseases only. As a result of research, the range of its effects has expanded significantly.

Possessing antipyretic, antirheumatic, powerful anti-inflammatory and analgesic effects, it is successfully used in:

• neurology;
• surgery;
• oncology;
• traumatology;
• urology;
• gynecology;
• other areas of medicine.

Diclofenac ampoules - prices

The active substance of the drug belongs in its chemical structure to derivatives of acetic acid; it contains the sodium salt of this acid - diclofenac sodium.

This substance, inhibiting COX1 and COX2, changes the metabolic processes of arachidonic acid.

At the site of inflammation, it reduces the amount of Pg, disrupting the biosynthesis of prostaglandins, which play a decisive role in the development of the genesis of inflammation, fever, and pain.

The main forms of release of Diclofenac are tablets, gels, ointments, injection solutions, eye drops, suppositories.

The injection solution is available in 3mm ampoules and contains 25 mg/ml of the active substance.

The medicine contains: sodium disulfite, propylene glycol, mannitol, benzyl alcohol, sodium hydroxide solution.

Prices for Diclofenac injection solutions depend on the manufacturer, the dosage of the active substance of the drug, and the volume of the package.

In particular, in pharmacies you can buy:

• ampoules 25 mg/ml, 3ml, 10 pieces – up to 50 rubles;
• ampoules 75 mg/ml, 3ml, 5 pieces – up to 80 rub.

What do Diclofenac injections help with?

Intramuscular injections of the drug can quickly provide an antipyretic effect, relieve painful spasms, and improve the overall functional state.

Diclofenac injections are indicated for:

• diseases of the spine with severe pain;
• rheumatoid arthritis, osteoarthritis;
• pinched sciatic nerve, lumbago;
• exacerbations of osteochondrosis;
• post-traumatic and postoperative pain;
• acute attacks of gout;
• neuralgia, neuritis;
• spondyloarthrosis;
• arthrosis;
• gynecological diseases with acute pain;
• severe migraine attacks.

Note! The use of an injection solution is indicated only when other forms of this drug do not contribute to the rapid relief of inflammatory processes.

Instructions for use of the drug

The approach to prescribing treatment is strictly individual; the patient’s condition should be taken into account.

The first dose of the drug is usually 75 mg/ml, the positive effect is achieved within 30 minutes. The maximum daily dose should not exceed 150 mg/ml. In case of acute pain, after a few hours you can repeat the injection or replace it with other forms of the drug.

Elderly patients (over 50 years old) should adhere to the lowest therapeutic dose of the medication. The same applies to people with critically low body weight (below 30 kg).

For diseases of the cardiovascular system, injections should be prescribed with extreme caution, not exceeding the daily dose of the drug over 100 mg/ml.

Contraindications for use

This medicine is contraindicated in children under 14 years of age. Injections should be prescribed with caution to patients with hypersensitivity to the components of the drug.

Diclofenac injections are contraindicated for:

• active form of peptic ulcer;
• peripheral arterial diseases;
• coronary heart disease;
• severe forms of renal and liver failure;
• pregnancy, breastfeeding;
• inflammation of the rectum;
• surgical interventions with a high risk of bleeding;
• bronchial asthma;
• hypovolemia or degradation of various origins;
• simultaneous use of the drug with anticoagulants.

Overdose with a short course of treatment is unlikely, given the insignificant systemic absorption. Long-term use increases the risk of heart attacks and heart disease (up to 40%).

Manifestation of side effects:

1. Nausea, vomiting, flatulence, constipation, gastritis.
2. Allergic reactions may develop.
3. Anemia, agronulocytosis, aikopenia.
4. Disorders of the urinary system.
5. Headache, agitation, insomnia, aseptic meningitis.
6. The appearance of edema, increased blood pressure.
7. Difficulty breathing.

Good to know! An overdose of the drug can cause dizziness with clouding of consciousness, internal bleeding, drowsiness, fainting, and coma.

Analogues and their cost

Similar non-steroidal drugs differ in the amount of active substance.

The most common analogues of Diclofenac are:

1. Voltaren- a drug from a Swiss manufacturer, it is absorbed better than Diclofenac, the therapeutic effect lasts longer. Price - about 290 rub.
2. Movalis– used for long-term treatment, as it has a gentle effect on the body. Price – 700-800 rub.
3. Dicklawburn– a complete analogue of Diclofenac, produced in Germany. Price – 250-500 rub.
4. Ortofen– a highly effective drug, long-term use is not recommended due to possible complications. Price – 50 rub.
5. Milgamma– in addition to the main active ingredient, the composition includes B vitamins. Price – 210-700 rubles.
6. Ketorolac- a powerful analgesic. Price – 90 rub.
7. Tenoxicam– has a powerful anti-inflammatory effect. Price – 350 rub.

Let's celebrate! Each of these drugs has its own characteristics and should not be used interchangeably. This can only be done by a specialist if there are appropriate indications.

Quick tips:

• You should not self-medicate, it can harm your health.
• Avoid alcohol while taking the medication.
• During treatment, laboratory monitoring of renal and liver function is necessary.
• It is recommended to avoid activities that require increased attention (driving a car, working with machinery).

Diclofenac is a drug from the group, one of the dosage forms of which is a solution for intramuscular administration. Let us consider the pharmacological characteristics of this form of medication in detail.

Composition of the injection form of Diclofenac

One milliliter of injection solution contains 25 mg of the active ingredient diclofenac sodium. The structure of the active component of the drug is a derivative of phenylacetic acid. The solution is available in ampoules of 3 milliliters. Its additional components include purified water and benzyl alcohol. Diclofenac for injection is produced in cardboard packages of 5 or 10 ampoules.

Pharmacodynamics of the drug

The medicine Diclofenac has the following effects:

• anti-inflammatory;
• analgesic;
• antipyretic.

The explanation for the effectiveness of the active substance lies in the inhibitory effect on cyclooxygenase. In connection with it, the reactions of prostaglandin formation are inhibited, and platelet aggregation reactions are suppressed.

Diclofenac eliminates joint stiffness and restores their functionality. If necessary, use in cases of post-traumatic and postoperative complications helps relieve spontaneous pain and pain during movements.

Pharmacokinetics of the drug

Features of the pharmacokinetics of the injection form of Diclofenac are presented in the table.

Suction	After entering the muscle tissue, absorption starts immediately. The maximum content in the blood is reached 10-20 minutes after the injection. If the preferred time intervals between injections of the drug are observed, then cumulation does not occur
Distribution	99.7% of the active substance binds to blood proteins (99.4% to albumin). The active component of the drug has the ability to penetrate into the joint fluid. Here the maximum value of its content is possible after 2-4 hours. After 2 hours after reaching the peak content of diclofenac in the blood, the content of the drug component in the joint fluid exceeds that in the serum. High concentrations of the active substance in the joint fluid persist for another 12 hours
Biotransformation	Metabolic transformations of diclofenac consist of glucuronidation of the original molecules (partially), methoxylation and hydroxylation (mainly) of the substance to the formation of intermediate metabolites, which are subsequently converted into glucuronic conjugated molecules
Removal	The half-life of diclofenac is 1-2 hours. Its metabolites have a slightly longer half-life. 60% of the drug is excreted in the form of glucuronic conjugates in the urine. The remaining amount of the active ingredient after a series of metabolic transformations is excreted in bile and subsequently in feces

Range of indications for injections

Indications for the use of Diclofenac solution for intramuscular injection:

• joint pathologies of inflammatory origin (gout, rheumatic,);
• degenerative-dystrophic (, arthrosis);
• myalgia, neuralgia, sciatica, lumbago;
• pathologies of extra-articular structures (bursitis, rheumatic lesions);
• complications after injuries and operations.

What does the drug in injection form help with, besides diseases of the musculoskeletal system? Diclofenac is also prescribed for adnexitis, migraine attacks, hepatic and renal colic, infectious processes of the airways, and pneumonia.

You cannot prescribe this medicine yourself. This can cause serious undesirable consequences from the cardiovascular, nervous, digestive and other systems. The medication can be prescribed by the attending physician if there are indications and there are no restrictions on use.

How to use and dose the medicine

The instructions for use of the injection form of Diclofenac suggest the following dosage regimen: 75 mg of the active substance (one ampoule) once a day. The dosage for adults can be adjusted to a maximum of 150 mg (two ampoules) per day. How many days this drug can be injected is determined by the attending physician, based on the characteristics of the patient’s condition. However, the course of treatment with Diclofenac should not exceed 5 days.

Most often, this medicine is prescribed as an initial therapy. How many injections of Diclofenac can be given depends on whether the injection form of the medication is combined with rectal or tablet form, since the total dose of the active ingredient per day should not exceed 150 mg. If you use or drink at the same time, you can inject the medicine only in the volume of one ampoule (75 mg).

How to give Diclofenac injections? The injection solution is drawn into a syringe and injected intramuscularly into the uppermost gluteal quadrant; You must first disinfect the injection site. The next day, the injection is given in the other buttock.

The attending physician should explain how to inject and how often Diclofenac injections can be given. It is important to follow the recommendations of a specialist.

Side effects

Side effects from Diclofenac injections can be divided into groups presented in the table below.

Organ system or group of symptoms	Side effects
Infectious pathologies	In rare situations, a post-injection abscess may develop if the rules for disinfecting the skin before an injection are not followed.
Hematopoietic system	Leukopenia and agranulocytosis, thrombocytopenia, aplastic and hemolytic variants of anemia
Immune system	Hypersensitivity, including anaphylactic shock, angioedema
Nervous system	Headaches and dizziness, deterioration of sleep, memory, sensory impairment, convulsions, aseptic meningitis, strokes
Mental disorders	Unreasonable attacks of anxiety, irritability, depression, nightmares, disorientation in space
Visual analyzer	Diplopia, blurred vision
Hearing analyzer	Tinnitus, hearing loss
Cardiovascular system	Arrhythmias, symptoms of heart failure, myocardial infarction, pain, increased blood pressure, vasculitis
Respiratory system	Bronchial asthma, pneumonitis
Gastrointestinal tract	Abdominal pain, vomiting and nausea, indigestion, bloating, diarrhea, gastritis, peptic ulcer, gastrointestinal bleeding. Rare negative consequences from the gastrointestinal tract include glossitis and stomatitis, dysgeusia (taste disturbance), formation of intestinal diaphragm-like structures, colitis, pancreatitis, constipation
Liver and bile ducts	Hepatitis, deterioration of the functional state of the liver, a jump in the activity of transaminase enzymes in the blood
Dermatological pathologies	Rash, dermatitis, erythema, eczema, Lyell and Stevens-Johnson syndromes, purpura, alopecia, photosensitivity
Excretory system	Nephrotic syndrome, nephritis, proteinuria and hematuria, insufficient renal function
General symptoms	Soreness and the formation of a compaction at the injection site, less often swelling and necrotic changes at the injection site

To reduce the risk of negative consequences, it is necessary to use the minimum dose of the drug that can be effective, and the duration of the course should be short. If the duration of the course of use of Diclofenac exceeds the recommended one and/or too high a dosage is used, the risk of negative consequences from the cardiovascular system, including stroke and myocardial infarction, increases significantly.

Any reactions of the body to the administration of the drug must be reported to the doctor immediately. If pathological signs appear, Diclofenac injections should be stopped immediately.

Contraindications

Absolute contraindications to the use of diclofenac solution for intramuscular administration:

• hypersensitivity to the active component and other non-steroidal anti-inflammatory substances;
• dysfunction of the hematopoietic system;
• peptic ulcer;
• intestinal pathologies of destructive-inflammatory origin in the acute stage;
• bronchial asthma;
• age up to 15 years;
• periods of bearing a child and breastfeeding.

During pregnancy, injections of the drug should not be prescribed at any time; if it is necessary to use the drug during breastfeeding, lactation is stopped until the course of therapeutic correction is completed.

Strict medical supervision if it is necessary to administer Diclofenac injections and subject to an analysis of the risk-benefit ratio for the patient is necessary in the following situations:

• systemic connective tissue diseases (lupus erythematosus, collagenosis);
• induced porphyria;
• history of inflammatory and ulcerative pathological conditions of the gastrointestinal tract;
• impaired liver function;
• impaired functionality of the organs of the excretory system;
• hypertension;
• heart failure;
• diabetes mellitus;
• lipid metabolism disorders;
• early postoperative period;
• tendency to hypersensitivity reactions;
• chronic obstructive pathologies of the airways;
• chronic infectious and inflammatory diseases of the respiratory system;
• old age;
• alcohol abuse.

The drug is used with caution if concomitant drug treatment is necessary with anticoagulant, antiplatelet drugs, for internal use, antidepressants from the group of selective serotonin reuptake inhibitors.

Since the administration of Diclofenac can provoke dizziness and excessive fatigue, during the course of use of the drug you should refrain from driving vehicles and other complex equipment.

Interaction between Diclofenac and other medications

Characteristics of the simultaneous use of the drug and some medications are given in the table.

Medicines	Result of interaction
Digoxin, phenytoin, lithium-containing drugs	An increase in the concentration of the active components of these drugs in the blood
Antihypertensive drugs, diuretics	Weakening the effectiveness of drugs
Potassium-sparing diuretics.	Hyperkalemia
NSAIDs	Increased risk of adverse reactions from the digestive system
Cyclosporine	Increased nephrotoxicity of Diclofenac
Antidiabetic drugs	Sharp fluctuations in blood glucose levels, both upward and downward
	Increasing the concentration of this drug and enhancing its toxic properties
Quinolone derivatives	Convulsive conditions

The patient must notify the doctor about the medications he is already taking. This measure will minimize the risk of possible consequences of drug interactions.

Overdose symptoms

If the dosage regimen for the injectable form of Diclofenac is not observed and the permissible amount of the administered drug is exceeded, the following symptoms may appear:

• clouding of consciousness;
• headaches and dizziness;
• convulsive states of myoclonic type;
• vomiting, nausea, sharp abdominal pain;
• impairment of the functional state of the kidneys and liver.

In case of overdose, it is advisable to carry out symptomatic treatment, the goals of which are to reduce blood pressure, correct impaired renal function, negative reactions from the gastrointestinal tract, depressed breathing, and convulsions. There is no specific antidote substance. Hemodialysis and forced diuresis have low effectiveness and are not used.

Diclofenac analogues and comparative costs of drugs

The price of Diclofenac Akos (manufactured by Sintez OJSC) for injection is not at all high; you can buy it from 16 rubles per package, which contains 5 ampoules of the medicinal solution. The cost of the medicine can be found in the table:

If it is impossible to use Diclofenac in injection form for some reason, then the doctor should select analogue injections that are safer. Only the action should be similar, and not the composition of the solution for intramuscular injection.

At a doctor's appointment: frequently asked questions from patients

During a consultation with a specialist, the patient can ask questions about the use of the medication. Let's look at some of the most common questions and their answers.

Tablets or injections, which is better?

The specific form of Diclofenac is prescribed depending on the characteristics of the clinical case. It cannot be said that any of them is better. Injections of the drug are effective in the early stages of the development of pathologies, and tablets are prescribed to continue the course of therapy.

Is it possible to combine Diclofenac and Milgamma injections?

Milgamma is a good complex of B vitamins, and prescribing this drug at the same time as Diclofenac is quite acceptable and rational.

Which is better: Diclofenac or Voltaren injections?

Voltaren contains the same active ingredient as the classic Diclofenac, so these drugs are equivalent in action.

How to replace Diclofenac in injections?

If the risk of developing negative consequences from the gastrointestinal tract increases, it is rational to prescribe selective inhibitors of type 2 cyclooxygenase instead of Diclofenac, which affects both isoforms of this enzyme. Such medications include, therefore, in a number of situations, the answer to the question will be in favor of the first medication.

And the answers to questions about which injections are better than Diclofenac than replacing Diclofenac in injections can only be given by the attending physician.

Bardukova Elena Anatolyevna
neurologist, homeopath, work experience 23 years
✔ Article checked by a doctor

Famous Japanese rheumatologist:“IT'S MONSTERAL! Russian methods of treating joints and spine cause only bewilderment. See what doctors offer to treat your back and joints in Russia: Voltaren, Fastum gel, Diclofenac, Milgamma, Dexalgin and other similar drugs. However, these drugs DO NOT TREAT JOINTS and BACK, they only relieve the symptoms of the disease - pain, inflammation, swelling. Now imagine that...” Read the full interview"

Here is complete information about Diclofenac for osteochondrosis. Over the past few decades, more than 1 billion patients have appreciated the effective effect of Diclofenac in osteochondrosis. Doctors very often prescribe the drug for the treatment of osteochondrosis of the cervical and lumbar spine.

The drug is available in the form of injection ampoules, tablets, ointments, gels and suppositories. Injections bring the greatest therapeutic results - they quickly eliminate pain and inflammation, improve mobility in the joints.

Remember, the main side effect when using Diclofenac is stomach complications.

Dosage forms of Diclofenac

Stories from site readers:“My name is Ekaterina, I’m 42 years old. Several years ago I had a severe flu, after which I ended up in the hospital with complications. One of the complications was the inflammatory process in the lower back and joints. X-ray showed initial signs of lumbar osteochondrosis and hernia. And at that time I was 39 years old. When walking and climbing stairs, there was aching pain in the lower back and leg. I tried a lot: Voltaren, Milgamma, Meloxicam... Some helped more, some less. But only this new remedy took away the terrible pain. The last x-ray showed nothing. I just want to wave this photo in front of the doctors, who said that it could get worse, but it won’t get better. I keep the product on hand and recommend it to everyone. It saved me, that’s for sure.” Read more"

The drug is available in the following forms:

Pills

Modifications of tablets: film-coated, sugar-coated or enteric-coated, instant tablets and dragees.

Injections

Despite the high effectiveness of tablets for osteochondrosis, often only injections will help cope with severe pain in the neck or lower back.

The main advantage of Diclofenac injections for back pain is the fast speed of action. The patient will feel the effect of the medicine within 15-25 minutes after the injection.

How to inject Diclofenac for back and lower back pain?

The injection is given deep into the upper part of the buttock. Injections are placed in the left and right buttocks alternately. Before use, the solution must be warmed in the palms of your hands so that the medicine acts faster.

Candles

Suppositories are often prescribed to patients who use similar tablets or injections for treatment. In this case, in the morning the patient takes pills or is given an injection, and before going to bed he uses suppositories for treatment. This treatment regimen allows you to achieve the maximum therapeutic effect and significantly accelerate the recovery of the body in the acute stage of osteochondrosis. The approximate course of treatment with suppositories is no more than 10-12 days.

The maximum dose of the drug in suppositories + tablets + injections should be no more than 150 mg.

Children aged 6 to 15 years are allowed to use suppositories at a dosage of 25 mg. The dose can be calculated using the formula: 0.5 – 2 mg per 1 kg of child’s weight, depending on the severity of the disease.

Adolescents 16-18 years old can be given rectal suppositories of 50 mg.

Advantages of suppositories for osteochondrosis

1. Does not cause discomfort in the gastrointestinal tract.
2. There are few side effects compared to other forms of the drug.
3. Suppositories are suitable for those patients for whom tablets or injections are contraindicated. For example, this is for patients with lumbar osteochondrosis.
4. Rectal suppositories are very convenient for use at home.
5. They relieve pain well at the early stages of osteochondrosis.
6. Suppositories are effective for inflammation and swelling of cartilage and bone tissue.

How to place candles correctly?

Instructions: How to place candles correctly

1. Diclofenac suppositories for back pain are administered rectally - into the rectum through the anus after preliminary cleansing of the intestines.
2. The suppository should be inserted with the pointed end as deep as possible into the rectum. To make the candle pass more easily, you can squat or bend over.
3. The maximum daily dose of the drug is 100 mg, which can be divided into two times. But it is advisable not to do this, otherwise the drug will be less absorbed. It is best to light candles at night.

Important! Despite the fact that suppositories do not have serious complications compared to injections and injections, when using them, bleeding in the intestines can sometimes occur. Therefore, they cannot be used by those patients who have difficulties with blood clotting.

Side effects

Stories from site readers:“My wife has long suffered from acute pain in her joints and back. Over the past 2 years, pain has always been present. Previously, I could not imagine that a person could scream like that in pain. It was terrible, especially in the middle of the night, when blood-curdling screams were heard in complete silence. According to her, it was like dogs chewing her legs and back. And there was nothing to help her, I just held her hand and reassured her. She injected herself with painkillers and fell asleep, and after a while everything happened again... In the morning, when she woke up, she cried more often. The smile completely disappeared from my face, the sun left our house forever. She also had difficulty moving - her knee joints and sacrum made it possible to even turn around. The first night after using this new remedy was the first time without screaming. And in the morning a cheerful woman came up to me and said with a smile: “But there’s no pain!” And for the first time in these 2 years I saw my beloved wife happy and smiling. She flutters around the house like a swallow, the rays of life play in her eyes.” Read more"

When using the drug, many side effects may occur.

From the gastrointestinal tract:

From the central nervous system:

• Migraines and headaches of moderate to severe intensity.
• Increased sleepiness.
• Sleep disturbance - insomnia.
• Depression and irritability.
• Vision problems.
• Dizziness.
• Tremor
• Spasms in the bronchi.
• Exacerbation of liver or kidney diseases.

Sometimes when using Diclofenac, allergic reactions in the form of a rash may occur.

Important! The medicine can cause surges in blood pressure and disruption of menstruation. It was also found that using the drug increases the risk of heart attack by 40%! You can use the product for a long time if you cannot find analogues.

If the patient exceeds the permitted dosage, the following may occur:

To eliminate the symptoms of an overdose of Diclofenac, you should drink activated charcoal, do a gastric lavage and, if necessary, take medications that lower blood pressure.

If desired, you can have your blood or stool tested from time to time to prevent an overdose of the drug.

Compatibility with other drugs

Stories from site readers: How I helped my mother heal her joints. My mother is 79; she has worked as a literature teacher all her life. When she first started having problems with her back and joints, she simply hid them from me so that I would not spend money on medicine. Mom tried to be treated only with decoctions of sunflower root, which, of course, did not help. And when the pain became unbearable, she borrowed money from a neighbor and bought painkillers at the pharmacy. When my neighbor told me about this, at first I was a little angry with my mother - I asked to leave work and immediately came to her by taxi. The next day, I made an appointment for my mother to see a rheumatologist at a paid clinic, despite her requests not to spend money. The doctor diagnosed him with arthritis and osteochondrosis. He prescribed treatment, but my mother immediately protested that it was too expensive. Then the doctor came to his senses and suggested an alternative option - home exercise and a herbal-based drug. This was cheaper than injections with chondroprotectors and did not even cause possible side effects. She started using the drug and doing physical therapy. When I visited her a couple of days later, I found her in the garden. She was tying up tomatoes, and apparently had already done a lot. She greeted me with a smile. I understood: the drug and physical exercise helped, the pain and swelling went away.” Read more"

Acetylsalicylic acid (found in Aspirin) reduces the effectiveness of Diclofenac.

Diclofenac reduces the effect of blood pressure lowering medications, medications for diabetics, and sleeping pills.

When using diuretics (Diacarb, Veroshpiron), Diclofenac reduces their effect and also helps to increase potassium ions in the blood.

Taking St. John's wort with Diclofenac may cause bleeding.

Paracetamol. The use of Paracetamol enhances the toxic effect of Diclofenac.

Baralgin. Is it possible to inject Diclofenac and Baralgin at the same time? Since these are drugs from different groups of drugs, they can be injected in different syringes (without mixing) within one day.

Doctors have found that Ketorol is more effective than Diclofenac in the treatment of osteochondrosis. Judging by the research of doctors, Ketorol causes fewer side effects than with Diclofenac.

What is stronger: Diclofenac or Ketorol for osteochondrosis?

Ketorol tablets are stronger. And the injections are approximately the same in effectiveness. Ketorol has a longer analgesic effect than Diclofenac (about 2 times).

Which is better: Diclofenac or Baralgin?

Baralgin is a combination drug that relieves muscle spasms, pain and fever. If you compare drugs, Diclofenac relieves pain, and Baralgin in the main cases only relieves spasms.

Which is better: Diclofenac or Dexalgin?

Dexalgin

Dexalgin is more effective than Diclofenac, especially with severe pain. Both drugs have the same side effects. These drugs cannot be used at the same time. According to doctors, the drugs have similar side effects and complications.

Which is better: Diclofenac or Ibuprofen?

Many patients are interested in what is better for osteochondrosis: Diclofenac or Ibuprofen? For osteochondrosis, Diclofenac is more effective, because its action is aimed only at eliminating the symptoms of diseases of the musculoskeletal system. Ibuprofen is a widely used medicine that can only relieve fever and pain. It does not eliminate inflammation.

Which is better: Diclofenac or Chondroxide?

These medications belong to different groups. Diclofenac belongs to the group of non-steroidal anti-inflammatory drugs, it relieves inflammation and pain, and Chondroxide belongs to the group of chondroprotectors, it restores cartilage tissue. Usually, after the acute stage of osteochondrosis, doctors prescribe the use of chondroprotectors.

Which is better: Diclofenac or Neurodiclovit?

Neurodiclovit

Neurodiclovit acts faster than Diclofenac. Neurodiclovit can also be used at high temperatures and heat. This drug additionally contains B vitamins, which have a positive effect on the human nervous system. Neurodiclovit is an analogue of Diclofenac, it costs more. Judging by the reviews of patients, many note the high effectiveness of Neurodiclovit. The side effects of both drugs are the same, but when taking Neurodiclovit they are not so pronounced.

Which is better: Diclofenac or Naklofen?

Naklofen is safer than Diclofenac. It relieves pain and stiffness in the morning, reduces swelling in the joints, eliminates fever

Which is better: Diclofenac or Indovazin?

Indovazin

The action of Indovazin (analogues: Indomethacin and Troxevasin) is aimed at reducing edema and hematomas, improving the condition of the circulatory system, pain relief for bruises and injuries, and treatment of thrombophlebitis. Diclofenac will be more effective in the treatment of osteochondrosis, because its action is aimed at relieving the main symptoms of the disease: inflammation and pain.

Which is better: Diclofenac or Ketonal?

Ketonal is better tolerated and causes fewer side effects and complications compared to Diclofenac. Therefore, the main difference between Diclofenac and Ketonal is only safety; these drugs have the same effect.

Which is better: Diclofenac or Voltaren?

Voltaren forms

The drugs are identical in composition. Diclofenac is better than Voltaren in terms of cost, it is much cheaper. Doctors note that Voltaren is of better quality due to good purification of the active substance, and therefore its side effects are lower than those of Diclofenac.

According to patient reviews, Voltaren injections are equally effective as Diclofenac. On the contrary, Voltaren ointment relieves pain better. Voltaren tablets have a longer effect; they are usually prescribed for long-term treatment of osteochondrosis.

Which is better: Diclofenac or Ketanov?

Ketanov relieves pain better than Diclofenac.

Patient Questions

How many injections of Diclofenac can be given for osteochondrosis?

Often injecting Diclofenac with osteochondrosis is strictly contraindicated, otherwise serious complications may occur, such as gastric bleeding. Also, doctors do not recommend injecting the drug every day.

It is recommended to give one injection every other day. In total, 2 injections will be required to treat osteochondrosis. Injections should be given in different buttocks. The doctor may prescribe a double dose of the injection in severe cases. In the future, the patient should take similar tablets, ointments or suppositories.

The maximum daily dose of the drug is 150 mg. In most cases, patients benefit from just one injection of the drug.

Does Diclofenac injection help with back pain?

Diclofenac remarkably relieves pain by reducing inflammation in the affected area. The drug in the form of injections is more effective, followed by tablets, suppositories, and ointments.

What to inject Diclofenac with for osteochondrosis?

Many patients ask: what vitamin should I take Diclofenac with? Doctors often prescribe simultaneous injections of Diclofenac and B vitamins - Milgamma or Combilipen.

Milgamma and Combilipen

Vitamins and Diclofenac should not be mixed in the same syringe. Vitamin injections can be given in the arm or leg an hour after the Diclofenac injection. You can also use vitamins in the form of tablets - Neuromultivit, Neurovitan or Doppelhertz active magnesium plus.

Why can’t you inject Diclofenac for a long time?

This can lead to serious complications: increased blood pressure, pain and bleeding in the stomach, negative effects on the kidneys and liver.

Do I need to dilute Diclofenac?

There is no need to dilute the drug. Injection ampoules are already ready for use. Do not forget that it must be injected deep into the upper part of the gluteal muscle.

What to do if your back hurts and Diclofenac doesn’t help?

If Diclofenac does not help with osteochondrosis, then you should consult a specialist as soon as possible and not self-medicate.

How to take Diclofenac if you have a pinched nerve in your back?

1. Tablets: adults over 18 years old, 50 mg, children over six years old, 2 mg per 1 kg of weight. You can drink 1-3 times a day.
2. Suppositories are given in the same dosage as tablets.
3. Injections: adults over 18 years old, 75 mg; injections are prohibited for children.

Does Diclofenac treat osteochondrosis?

The drug only relieves the main symptoms of osteochondrosis, such as inflammation and pain. Diclofenac does not eliminate the very cause of osteochondrosis.