Dexalgin

The following drug interactions are typical for all NSAIDs, including Dexalgin®.

Undesirable combinations

The simultaneous administration of several NSAIDs, including salicylates in high doses (more than 3 g / day), increases the risk of gastrointestinal bleeding and ulcers due to the synergy of action.

When used simultaneously with oral anticoagulants, heparin in doses exceeding prophylactic doses, and ticlopidine, the risk of bleeding increases due to inhibition of platelet aggregation and damage to the gastrointestinal mucosa.

NSAIDs increase the concentration of lithium in the blood plasma, up to toxic levels, and therefore this indicator must be monitored when prescribing, changing the dose and after discontinuation of NSAIDs.

When used with methotrexate in high doses (15 mg/week or more), the hematological toxicity of methotrexate increases due to a decrease in its renal clearance during NSAID therapy.

When used simultaneously with hydantoins and sulfonamide drugs, there is a risk of increased toxic effects of these drugs.

Combinations requiring caution

If simultaneous use with diuretics and ACE inhibitors is necessary, it should be taken into account that NSAID therapy is associated with the risk of developing acute renal failure in patients with dehydration (decreased glomerular filtration due to inhibition of prostaglandin synthesis). NSAIDs may reduce the hypotensive effect of some drugs. When coadministered with diuretics, ensure that the patient's fluid balance is adequate and monitor renal function before prescribing NSAIDs.

When used simultaneously with methotrexate in low doses (less than 15 mg/week), the hematological toxicity of methotrexate may increase due to a decrease in its renal clearance during NSAID therapy. Blood cell counts should be monitored weekly during the first weeks of concomitant therapy. In the presence of even mild renal dysfunction, as well as in elderly people, careful medical supervision is necessary.

When used simultaneously with pentoxifylline, the risk of bleeding increases. Intensive clinical monitoring and frequent monitoring of bleeding time (blood clotting time) is necessary.

When used concomitantly with zidovudine, there is a risk of increased toxicity to red blood cells due to effects on reticulocytes, with the development of severe anemia one week after administration of NSAIDs. It is necessary to control all blood cells and reticulocytes after 1-2 weeks. after starting NSAID therapy.

It is possible that the hypoglycemic effect of sulfonylurea derivatives may be enhanced due to its displacement from sites of binding to plasma proteins under the influence of NSAIDs.

When used simultaneously with low molecular weight heparin drugs, the risk of bleeding increases.

Combinations to consider

NSAIDs may reduce the hypotensive effect of beta-blockers due to inhibition of prostaglandin synthesis.

When used concomitantly with cyclosporine and tacrolimus, NSAIDs may increase nephrotoxicity, which is mediated by the action of renal prostaglandins. During combination therapy, it is necessary to monitor renal function.

When prescribed simultaneously with thrombolytics, the risk of bleeding increases.

When used concomitantly with probenecid, plasma concentrations of NSAIDs may increase, which may be due to inhibition of renal secretion and/or conjugation with glucuronic acid. This requires NSAID dose adjustment.

NSAIDs can cause an increase in the concentration of cardiac glycosides in the blood plasma.

Due to the theoretical risk of changes in the effectiveness of mifepristone under the influence of prostaglandin synthesis inhibitors, NSAIDs should not be prescribed earlier than 8-12 days after discontinuation of mifepristone.

Data obtained from experimental studies in animals indicate a high risk of developing convulsions when NSAIDs are prescribed during therapy with high doses of ciprofloxacin.

Pharmaceutical interactions

Dexalgin® should not be mixed in the same syringe with a solution of dopamine, promethazine, pentazocine, pethidine or hydroxyzine (a precipitate will form).

Dexalgin® can be mixed in one syringe with a solution of heparin, lidocaine, morphine and theophylline.

A diluted solution of Dexalgin® for infusion should not be mixed with promethazine or pentazocine.

A diluted solution of Dexalgin® for infusion is compatible with the following injection solutions: dopamine, heparin, hydroxyzine, lidocaine, morphine, pethidine and theophylline.

When diluted solutions of Dexalgin® for infusion are stored in plastic containers or when using infusion systems made from ethyl vinyl acetate, cellulose propionate, low-density polyethylene or polyvinyl chloride, absorption of the active substance by the listed materials does not occur.

Dexalgin®

Undesirable side effects can be minimized by using the drug in the lowest effective dose with the minimum duration of use necessary to relieve pain.

Gastrointestinal disorders

Erosive and ulcerative lesions of the gastrointestinal tract, gastrointestinal bleeding or perforation (in some cases, fatal) were observed with the use of any NSAIDs at different stages of treatment and regardless of the presence of characteristic symptoms or a history of serious gastrointestinal pathology. If gastrointestinal bleeding or ulcerative lesions occur, use of Dexalgin® should be discontinued.

The risk of serious gastrointestinal complications increases with increasing doses of NSAIDs in elderly patients. Elderly patients have a higher incidence of side effects, especially gastrointestinal bleeding and perforation, which can be fatal. In this category of patients, the maximum daily dose is 50 mg (see section “Dosage and Administration”).

As with any NSAID, it is necessary to ascertain the patient's history of esophagitis, gastritis and/or peptic ulcers before prescribing treatment with dexketoprofen. Patients with gastrointestinal symptoms or a history of gastrointestinal disease should be monitored for the occurrence of digestive disorders, especially gastrointestinal bleeding.

The simultaneous administration of gastroprotectors (misoprostol or proton pump blockers) is recommended for such patients, as well as patients who require the simultaneous use of low doses of acetylsalicylic acid or other drugs that increase the risk of gastrointestinal complications (see section “Interaction with other drugs”).

Patients with a history of gastrointestinal drug toxicity, especially elderly patients, should report any gastrointestinal symptoms (especially bleeding), especially during initiation of therapy.

Patients concomitantly taking corticosteroids, antiplatelet agents (for example, aspirin) or anticoagulants (for example, warfarin), selective serotonin reuptake inhibitors should be under close medical supervision, as they have an increased risk of gastrointestinal bleeding.

Kidney disorders

Caution should be exercised in patients with impaired renal function. The use of NSAIDs may lead to deterioration of renal function, fluid retention and edema.

Caution should be exercised when using Dexalgin® in patients concomitantly taking diuretics and patients who may develop hypovolemia, due to the increased risk of nephrotoxicity.

Like other NSAIDs, Dexalgin® can lead to increased concentrations of creatinine and nitrogen in the blood plasma.

Like other prostaglandin synthesis inhibitors, Dexalgin® may have side effects on the urinary system, which can lead to the development of glomerulonephritis, interstitial nephritis, papillary necrosis, nephrotic syndrome and acute renal failure.

When using the drug Dexalgin®, it is necessary to consume a sufficient amount of fluid to prevent the development of dehydration and possible toxic effects on the kidneys. Renal dysfunction is more likely in elderly patients (see section "Dosage and Administration").

Liver disorders

Caution must be exercised when using Dexalgin® in patients with impaired liver function. As with the use of other NSAIDs, during therapy with Dexalgin®, a slight transient increase in laboratory parameters characterizing liver function and a significant increase in the activity of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) may be observed. In case of a significant increase in the corresponding indicators, the use of the drug Dexalgin should be discontinued. Elderly patients are more likely to develop liver problems.

Cardiovascular and cerebrovascular complications

Before starting to use Dexalgin® in patients with arterial hypertension and/or mild to moderate heart failure, caution should be exercised and consult a doctor, since in this category of patients the use of NSAIDs can lead to fluid retention, edema and increased blood pressure .

Clinical studies and epidemiological data suggest that NSAIDs, especially in high doses and with long-term use, may lead to a slight increase in the risk of acute myocardial infarction or stroke. There is insufficient data to exclude the risk of these events when using dexketoprofen.

In patients with uncontrolled arterial hypertension, coronary heart disease (CHD), congestive heart failure, peripheral arterial disease and/or cerebrovascular disease, Dexalgin® should be used with caution.

A similar approach is applicable to patients with risk factors for cardiovascular disease (eg, hypertension, hyperlipidemia, diabetes mellitus, smoking).

All non-selective NSAIDs can inhibit platelet aggregation and prolong bleeding time by inhibiting prostaglandin synthesis. In this regard, the use of Dexalgin® in patients simultaneously taking drugs that affect the hemostatic system, such as warfarin, coumarin derivatives and heparins, is not recommended.

If the doctor decides on long-term use of dexketoprofen, monitoring of peripheral blood parameters and the functional state of the liver and kidneys is necessary.

Elderly patients

Elderly patients are especially susceptible to adverse reactions when using NSAIDs, including the risk of life-threatening gastrointestinal bleeding and perforation, and decreased renal, liver, and cardiac function. When using the drug Dexalgin® in this category of patients, proper clinical monitoring is necessary.

Elderly patients should take Dexalgin® starting with a lower dose (maximum daily dose is 50 mg). If well tolerated, doses recommended for the general population may be used.

There is evidence of rare cases of severe skin reactions (such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis), including death, with the use of NSAIDs.

It is assumed that the greatest risk of developing toxic skin reactions exists during the initial period of therapy, since in most cases the development of skin reactions was noted during the first month of treatment. At the first manifestations of a skin rash, damage to the mucous membranes or other signs of an allergic reaction, the use of the drug Dexalgin® should be stopped immediately.

In very rare cases, severe hypersensitivity reactions (eg anaphylactic shock) have been observed. If the first signs of a hypersensitivity reaction appear, use of the drug Dexalgin should be stopped and consult a doctor. Depending on the severity of symptoms, the patient should receive specialized medical care.

Like other NSAIDs, dexketoprofen may mask the symptoms of infectious diseases. If signs of infection or deterioration in health are detected while using the drug Dexalgin®, the patient should immediately consult a doctor.

In very rare cases, severe soft tissue skin infections may occur during a chickenpox infection. The use of Dexalgin® for chickenpox should be avoided.

The drug Dexalgin® contains sucrose, therefore patients with hereditary fructose intolerance, sucrase-isomaltase deficiency and glucose-galactose malabsorption syndrome should not take the drug Dexalgin®.

The use of Dexalgin® may adversely affect female fertility and is not recommended for women planning pregnancy. In women who have problems conceiving or are undergoing examination for infertility, it is necessary to consider the possibility of discontinuing the drug Dexalgin®.

The nuances of taking Dexalgin

The instructions draw attention to the following rules for using tablets:

the dosage is calculated by the doctor individually;
a single dose is 0.5-2 tablets (25 mg each), procedures are performed 2-6 times a day;
the maximum daily volume of medication cannot exceed 3 tablets;
The duration of therapy is 5 days.

The injection solution is prescribed according to a specific scheme:

intramuscular administration - 2 ml slowly, every 8-12 hours, 50 mg, daily dosage does not exceed 0.15 g, treatment lasts for 2 days;
intravenous – carried out according to the dosages of intramuscular treatment, the medication is administered for about 15 seconds;
drip – 2 ml of the drug is diluted in 100 ml of physiological solution, the dropper is placed for 15-30 minutes.

Accidentally taking an excess amount of medication provokes sleep disturbances, problems with orientation in space, cephalgia, and nausea. In case of intoxication, symptomatic therapy is used.

Dexalgin® 25 (Dexalgin® 25)

The following interactions are common to all NSAIDs.

Undesirable combinations

With other NSAIDs, including salicylates in high doses (more than 3 g/day):

simultaneous use of several NSAIDs due to the synergistic effect increases the risk of gastrointestinal bleeding and ulcers.

With anticoagulants

: Dexketoprofen, like other NSAIDs, may enhance the effect of anticoagulants such as warfarin due to high plasma protein binding, inhibition of platelet aggregation and damage to the gastrointestinal mucosa. If simultaneous use is necessary, careful monitoring of the patient's condition and regular monitoring of laboratory parameters is necessary.

With heparin:

with simultaneous use, the risk of bleeding increases (due to inhibition of platelet aggregation and damaging effects on the mucous membrane of the gastrointestinal tract). If simultaneous use is necessary, careful monitoring of the patient's condition and regular monitoring of laboratory parameters is necessary.

With glucocorticosteroids:

with simultaneous use, the risk of ulcerative lesions of the gastrointestinal tract and bleeding increases.

With lithium preparations:

NSAIDs increase the concentration of lithium in the blood plasma up to toxic levels, and therefore this indicator must be monitored when used simultaneously with dexketoprofen, changing the dosage, and also after discontinuation of NSAIDs.

With methotrexate in high doses (15 mg/week or more):

it is possible to increase the hematological toxicity of methotrexate due to a decrease in its renal clearance when used simultaneously with NSAIDs.

With hydantoins and sulfonamides:

their toxic effect may be enhanced.
Combinations

requiring caution
With diuretics, angiotensin-converting enzyme (ACE) inhibitors, aminoglycoside antibiotics, angiotensin II :

simultaneous use with NSAIDs is associated with a risk of developing acute renal failure in dehydrated patients (decreased glomerular filtration rate due to decreased synthesis of prostaglandins). When used concomitantly, NSAIDs may reduce the antihypertensive effect of some drugs. When using dexketoprofen and diuretics simultaneously, it is necessary to ensure that the patient has no signs of dehydration, and also monitor renal function at the beginning of simultaneous use.

With methotrexate in low doses (less than 15 mg/week):

it is possible to increase the hematological toxicity of methotrexate due to a decrease in its renal clearance during simultaneous use with NSAIDs. A blood cell count is necessary when coadministration is initiated. In the presence of even mild renal dysfunction, as well as in elderly people, careful medical supervision is necessary.

With pentoxifylline:

there may be an increased risk of bleeding. Close clinical monitoring and regular checking of bleeding time (blood clotting time) is necessary.

With zidovudine:

There is a risk of increased toxicity to red blood cells due to effects on reticulocytes, with the development of severe anemia one week after starting NSAID use. It is necessary to conduct a general blood test with counting the number of reticulocytes 1-2 weeks after starting NSAID therapy.

With oral hypoglycemic agents:

NSAIDs may enhance the hypoglycemic effect of sulfonylureas due to the displacement of sulfonylurea from sites of binding to plasma proteins.

Combinations

that
need to be taken into account
With
beta -blockers:
When used simultaneously with NSAIDs, the antihypertensive effect of beta-blockers may be reduced due to inhibition of prostaglandin synthesis.

With cyclosporine and tacrolimus:

NSAIDs may increase nephrotoxicity, which is mediated by the action of renal prostaglandins. During simultaneous use, it is necessary to monitor renal function.

With thrombolytics:

the risk of bleeding increases.

The risk of bleeding from the gastrointestinal tract increases when used simultaneously with serotonin reuptake inhibitors

(citalopram, fluoxetine, sertraline) and anticoagulants.

With probenecid:

it is possible to increase the concentration of NSAIDs in the blood plasma, which may be due to the inhibitory effect of probenecid on renal tubular secretion and/or conjugation with glucuronic acid; NSAID dose adjustment may be required.

With cardiac glycosides:

simultaneous use with NSAIDs may lead to an increase in the concentration of cardiac glycosides in the blood plasma.

With mifepristone:

Due to the theoretical risk of changes in the effectiveness of mifepristone under the influence of prostaglandin synthesis inhibitors, NSAIDs should not be used earlier than 8-12 days after discontinuation of mifepristone.

With quinolones:

Data obtained from experimental studies in animals indicate a high risk of developing seizures when NSAIDs are used concomitantly with quinolones in high doses.

If necessary, simultaneous use of the drug Dexalgin

®
25 with the above medications, you should consult your doctor.

Adverse reactions

During therapeutic procedures, non-standard effects may occur, manifested by:

vomiting with nausea, high blood pressure;
tachycardia, nettle fever, chills;
redness, skin rashes, dermatitis;
anemic and fainting states, cephalalgia;
sleep disturbances, digestive disorders, bleeding.

Dexalgin tablets can cause discomfort in the epigastric area and heartburn. The injection solution causes pain and local temperature increase in the injection area, hematomas and inflammation.

The medicine must not be mixed with alcoholic beverages. Violation of the rules can provoke severe intoxication with clinical symptoms of poisoning.

Features of the composition and pharmacological action of Dexalgin

The components of one tablet are presented:

dexketoprofen trometamol;
corn starch;
glycerol palmitostearate;
microcrystalline cellulose;
titanium dioxide;
propylene glycol;
sodium carboxymethyl starch;
hypromellose;
Macragol 600.

The injection solution contains a similar active ingredient, additional components are sodium chloride and hydroxide, ethanol, and purified water.

The medicine is included in the subgroup of NSAIDs; half an hour after use, a decrease in pain and temperature is noted. The drug has an anti-inflammatory effect. The maximum concentration of Dexalgin when taken orally occurs after 40 minutes, the half-life by the kidneys does not exceed 2 hours. With MK injections it is achieved after 10 minutes.

Terms of sale and storage

Dexalgin is sold in pharmacies only with a doctor's prescription. The drug is stored in dark rooms at temperatures up to 25 degrees. The medicine is suitable:

tablets - for 2 years, after expiration of the period they are disposed of together with household waste;
solution in ampoules - up to 5 years; after preparation, the medicine retains its properties for no more than one day (provided the temperature is from 3 to 9 degrees and in a dark place).

Dexalgin in ampoules costs from 265 rubles, the price of tablets depends on the number of units in the package and starts from 279 rubles.

Dexalgin film-coated tablets 25 mg 10 pcs

Undesirable side effects can be minimized by using the drug in the lowest effective dose with the minimum duration of use necessary to relieve pain.

The risk of complications from the gastrointestinal tract increases in patients with a history of ulcerative lesions of the gastrointestinal tract, in elderly patients, with an increase in the dose of NSAIDs; therefore, the use of Dexalgin® 25 in this category of patients should begin with the lowest recommended dose.

For patients in the above categories, as well as patients who require simultaneous use of low doses of acetylsalicylic acid or other drugs that increase the risk of gastrointestinal complications, additional simultaneous use of gastroprotectors (misoprostol or proton pump blockers) is recommended.

In patients simultaneously taking antiplatelet agents or anticoagulants, glucocorticosteroids, the risk of gastrointestinal bleeding also increases.

Patients with gastrointestinal disorders or a history of gastrointestinal diseases should be under close medical supervision. If gastrointestinal bleeding or ulcerative lesions occur, use of Dexalgin® 25 should be discontinued.

The drug Dexalgin ®25 should be used with caution in patients with a history of gastrointestinal diseases (ulcerative colitis, Crohn's disease), since exacerbation of these diseases is possible.

All NSAIDs can inhibit platelet aggregation and prolong bleeding time by inhibiting prostaglandin synthesis. In this regard, the use of Dexalgin® 25 in patients simultaneously taking drugs that affect the hemostatic system, such as warfarin, coumarin derivatives and heparins, is not recommended.

Like other NSAIDs, Dexalgin® 25 can lead to increased concentrations of creatinine and nitrogen in the blood plasma. Like other prostaglandin synthesis inhibitors, Dexalgin® 25 may have side effects on the urinary system, which can lead to the development of glomerulonephritis, interstitial nephritis, papillary necrosis, nephrotic syndrome and acute renal failure. Caution should be exercised when using the drug in patients concomitantly using diuretics and patients who may develop hypovolemia, due to the increased risk of nephrotoxicity.

As with the use of other NSAIDs, during therapy with Dexalgin® 25, a slight transient increase in the activity of liver enzymes may be observed. In elderly patients, monitoring of liver and kidney function is necessary. In case of a significant increase in the corresponding indicators, the use of the drug Dexalgin® 25 should be discontinued.

Like other NSAIDs, dexketoprofen may mask the symptoms of infectious diseases. If signs of infection or deterioration in health are detected while using the drug Dexalgin® 25, the patient should immediately consult a doctor.

The drug can cause fluid retention in the body, therefore, in patients with arterial hypertension, renal and/or heart failure, Dexalgin® 25 should be used with extreme caution. If the condition worsens, the use of Dexalgin® 25 should be discontinued.

In patients with uncontrolled arterial hypertension, coronary artery disease, congestive heart failure, peripheral arterial disease and/or cerebrovascular disease, the drug should be used with caution. A similar approach is applicable to patients with risk factors for developing cardiovascular diseases (arterial hypertension, hyperlipidemia, diabetes mellitus, smoking).

Caution must be exercised when prescribing Dexalgin® to patients with a history of cardiovascular disease, especially patients with heart failure, due to the possible risk of progression.

Clinical studies and epidemiological data suggest that NSAIDs, especially in high doses and with long-term use, may lead to a small risk of acute myocardial infarction or stroke. There is insufficient data to exclude the risk of these events when using dexketoprofen.

Elderly patients are especially susceptible to adverse reactions when using NSAIDs, including the risk of life-threatening gastrointestinal bleeding and perforation, and decreased renal, liver, and cardiac function. When using the drug Dexalgin® 25 in this category of patients, proper clinical monitoring is necessary.

There is evidence of rare cases of skin reactions (such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis) with the use of NSAIDs. At the first manifestations of a skin rash, damage to the mucous membranes or other signs of an allergic reaction, you should immediately stop taking Dexalgin® 25 and consult a doctor.

Impact on the ability to drive vehicles and other mechanisms

Due to the possible occurrence of dizziness and drowsiness during the period of use of the drug Dexalgin® 25, the ability to concentrate and the speed of psychomotor reactions in patients may decrease, especially in the first hour after administration. Therefore, while using the drug Dexalgin® 25, care should be taken when driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Contraindications and indications for Dexalgin therapy

The instructions recommend using tablets to relieve pain caused by:

surgical interventions - in the postoperative period;
radiculitis, algodismenorrhea;
menstruation, dental diseases;
neuralgia, sciatica;
arthrosis, rheumatoid arthritis;
osteochondrosis, spondyloarthritis;
proliferation of metastases in bone tissue.

The solution in injections is prescribed when it is impossible to take Dexalgin orally - after injuries, operations, and with renal colic.

The drug is contraindicated in patients:

with individual intolerance to the component composition;
pathologies of the gastrointestinal tract, heart, liver and kidneys;
bronchial asthma;
undergoing anticoagulant therapy.

Dexalgin is not prescribed to minors, during pregnancy and breastfeeding.

Analogs

If side effects or signs of intolerance to Dexalgin appear, the drug must be replaced with a suitable remedy. The list of analogues is presented:

Depiofen, Brufen, Bofen;
Vimovo, Brustan, Dexifen;
Zo-tek, Ibuprex, Ibuprom;
Ibunorm, Ibufen, Ibuprofen;
Ibutard, Imet, Ketonal, Ivalgin;
Irfen, Naproff, Majezik-sanovel;
Novigan, Nurofen, Nurosan, Faspik, Promax.

The cost of the original and replacements may vary significantly.