Flamadex, 10 pcs., 25 mg, film-coated tablets
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 oral anticoagulants, heparin in doses exceeding prophylactic ones - the risk of bleeding increases;
- with ticlopidine - the risk of bleeding increases due to inhibition of platelet aggregation and damage to the gastrointestinal mucosa;
- with lithium preparations - NSAIDs increase the concentration of lithium in the blood, up to toxic levels, and therefore this indicator must be monitored when using, changing the dose and after discontinuation of NSAIDs;
- 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;
- with hydantoins and sulfonamides - the risk of increasing the toxic effect of these drugs.
Combinations requiring caution
- with diuretics, ACE inhibitors - NSAID therapy is associated with the risk of developing acute renal failure in dehydrated patients (decreased CP due to reduced PG synthesis). NSAIDs may reduce the antihypertensive effect of some drugs;
- with methotrexate in low (less than 15 mg/week) doses - the hematological toxicity of methotrexate increases due to a decrease in its renal clearance during NSAID therapy. It is necessary to conduct weekly blood cell counts 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;
- with serotonin reuptake inhibitors (citalopram, fluoxetine, sertraline), oral corticosteroids - increased risk of developing gastrointestinal bleeding;
- with pentoxifylline - the risk of bleeding increases.
Intensive clinical monitoring and frequent monitoring of bleeding time or clotting time are necessary;
- with zidovudine - the risk of increased toxic effects on erythrocytes due to the effect on reticulocytes, with the development of severe anemia a week after the administration of NSAIDs. It is necessary to conduct a complete blood count with a reticulocyte count 1–2 weeks after starting NSAID therapy;
- with oral hypoglycemic agents - NSAIDs can enhance the hypoglycemic effect of sulfonylurea due to its displacement from sites of binding to blood plasma proteins;
- with low molecular weight heparin preparations - increased risk of bleeding.
Combinations to consider
- with β-blockers - NSAIDs can reduce the hypotensive effect of β-blockers, which is due to inhibition of PG synthesis;
- with cyclosporine and tacrolimus - NSAIDs can increase nephrotoxicity, which is mediated by the action of renal PGs. During concomitant therapy, renal function should be monitored;
- with thrombolytics - the risk of bleeding increases;
- with probenecid - plasma concentrations of NSAIDs may increase, which may be due to the inhibitory effect of probenecid on renal tubular secretion and/or conjugation with glucuronic acid, which requires dose adjustment of NSAIDs;
- with cardiac glycosides - NSAIDs can lead to an increase in the concentration of glycosides in the blood plasma;
- with mifepristone - due to the theoretical risk of changes in the effectiveness of mifepristone under the influence of PG synthesis inhibitors; NSAIDs should not be prescribed 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 using NSAIDs during therapy with quinolones in high doses.
Flamadex® (FLAMADEX®)
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 a synergistic effect increases the risk of gastrointestinal bleeding and ulcers.
With oral anticoagulants, heparin in doses exceeding prophylactic doses, and ticlopidine: increased risk of bleeding due to inhibition of platelet aggregation and damage to the gastrointestinal mucosa.
With lithium preparations: NSAIDs increase the concentration of lithium in the blood, up to toxic levels, and therefore this indicator must be monitored when using, changing the dose and after discontinuation of NSAIDs.
With methotrexate in high doses (15 mg/week or more): increased hematological toxicity of methotrexate due to a decrease in its renal clearance during NSAID therapy.
With hydantoins and sulfonamides: the risk of increased toxic effects of these drugs.
Combinations requiring caution
With diuretics, angiotensin-converting enzyme inhibitors: NSAID therapy is associated with a risk of acute renal failure in dehydrated patients (decreased glomerular filtration rate due to decreased prostaglandin synthesis). NSAIDs may reduce the antihypertensive effect of some drugs.
With methotrexate in low doses (less than 15 mg/week): increased hematological toxicity of methotrexate due to a decrease in its renal clearance during NSAID therapy. It is necessary to conduct weekly blood cell counts 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.
With serotonin reuptake inhibitors (citalopram, fluoxetine, sertraline), oral glucocorticosteroids: increased risk of gastrointestinal bleeding.
With pentoxifylline: increased risk of bleeding. Intensive clinical monitoring and frequent checking of bleeding time (blood clotting time) is necessary.
With zidovudine: 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 conduct a complete blood count with a reticulocyte count 1-2 weeks after starting NSAID therapy.
With oral hypoglycemic agents: NSAIDs may enhance the hypoglycemic effect of sulfonylureas due to their displacement from sites of binding to plasma proteins.
With low molecular weight heparin preparations: increased risk of bleeding.
Combinations to consider
With beta-blockers: NSAIDs may reduce the hypotensive effect of beta-blockers due to inhibition of prostaglandin synthesis.
With cyclosporine and tacrolimus: NSAIDs may increase nephrotoxicity, which is mediated by the action of renal prostaglandins. During concomitant therapy, renal function should be monitored.
With thrombolytics: increased risk of bleeding.
With probenecid: NSAID plasma concentrations may increase, which may be due to the inhibitory effect of probenecid on renal tubular secretion and/or conjugation with glucuronic acid, requiring NSAID dose adjustment.
With cardiac glycosides: NSAIDs may lead to increased plasma concentrations of glycosides.
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 prescribed earlier than 8-12 days after discontinuation of mifepristone.
With quinolones: data obtained from experimental animal studies indicate a high risk of seizures when using NSAIDs during high-dose quinolone therapy.
Flamadex tablet p/o film 25mg 10 pcs
Undesirable side effects can be minimized when 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 Flamadex 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 ulceration occurs, use of Flamadex® should be discontinued.
Flamadex® 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 Flamadex® in patients simultaneously taking drugs that affect the hemostatic system, such as warfarin, coumarin derivatives and heparins, is not recommended.
Like other NSAIDs, Flamadex® can lead to increased concentrations of creatinine and nitrogen in the blood plasma. Like other prostaglandin synthesis inhibitors, Flamadex® 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 Flamadex®, 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 Flamadex 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 Flamadex®, the patient should immediately consult a doctor.
The drug can cause fluid retention in the body, so Flamadex* should be used with extreme caution in patients with arterial hypertension, renal and/or heart failure. If the condition worsens, the use of Flamadex® 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 should be exercised when prescribing Flamadex® 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 Flamadex® in this category of patients, proper clinical supervision 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 Flamadex® and consult a doctor.
Effect on the ability to drive vehicles and machinery Due to the possible occurrence of dizziness and drowsiness during the period of use of dexketoprofen, 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 Flamadex®, care should be taken when driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
