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تاريخ التسجيل : 14/11/2011
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حقن فولتارين voltaren ampoule
حقن فولتارين voltaren ampoule
ديكلوفيناك الصوديوم هو اسم المادة الفعالة المكونة لحقن فولتارين ، و الأمبول الواحد يحتوى على 75 مجم من مادة ديكلوفيناك الصوديوم ، و هى أحد المنتجات الدوائية لشركة نوفارتس .
جدير بالذكر توافر الفولتارين فى عدة اشكال صيدلانية جهازية مختلفة ، مثل الحبوب ، اللبوسات الشرجية .
دواعى استعمال فولتارين حقن
توصف حقن فولتارين فى الحالات التالية :
نوبات النقرس الحادة .
المغص الكلوى و المرارى .
حالات الألم بعد الصدمات و آلم بعد العمليات .
نوبات الصداع النصفى الشديدة .
عند تفاقم حالة الإلتهاب و الألم فى اضطرابات العظام المختلفة .
يمكن استخدام حقن الفولتارين عن طريق التسريب الوريدى ، للعلاج و الوقاية من آلم ما بعد العمليات أثناء التواجد فى المستتشفى .
جرعة و طريقة استعمال حقن فولتارين
كنصيحة عامة ، يجب تعديل الجرعة لتناسب كل مريض بحيث يتم استعمال أقل جرعة علاجية فعالة ، و تعطى لأقل فترة ممكنة .
البالغين : لا يجب أن يعطى محلول فولتارين للحقن ، لمدة تتجاوز اليومين ، و عند الضرورة ، يمكن متابعة العلاج بأقراص أو تحاميل فولتارين .
يجب أن تستخدم كل امبولة مرة واحدة فقط ، و يجب استخدام المحلول بعد فتح الامبول على الفور ، كما يجب ان يتم التخلص من اى محلول لم يتم استخدامة .
لا يجب أن تخلط حقن فولتارين مع اى حقن أخرى .
لا يجب استخدام المحاليل الوريدية إذا ظهرت بها اى ترسيبات .
أولا : الحقن العضلى
يجب اتباع التعليمات التالية للحقن بالعضل لتجنب أى تلف للعصب ، أو أنسجة أخرى فى موضع الحقن .
تكون الجرعة بوجة عام امبولة 75 ملجم يوميا ، تعطى بعمق داخل الإلية فى الربع العلوى الخارجى .
فى الحالات الشديدة ( مثل المغص المرارى أو الكلوى ) ، يمكن زيادة الجرعة اليومية بصورة إستثنائية إلى جرعتين تركيز 75 ملجم ، بينهما عدة ساعات ( حقنة فى كل ردف ) .
و بدلا من ذلك يمكن متابعة العلاج بعد حقن أمبولة تركيز 75 ملجم بتناول اشكال صيدلانية أخرى من الفولتارين ( مثلا أقراص أو تحاميل ) حتى الجرعة القصوى اليومية المسموح بها و هى 150 ملجم .
فى نوبات الصداع النصفى ، تعتبر الخبرة الإكلينيكية مقتصرة على الإستعمال الأولى لأمبولة 75 ملجم ، بحيث تعطى حالما أمكن ، يعقب ذلك تحملية حتى 100 ملجم فى نفس اليوم عند الحاجة ، و يجب أن لا تتجاوز الجرعة الإجمالية 175 ملجم فى اليوم الأول .
ثانيا : التسريب الوريدى
يجب تخفيف محلول فولتارين للحقن ن بمحلول ملحى 9 % ، أو محلول سكرى 5 % للحقن تم تلطيفة بكربونات الصوديوم
يوصى بإعطاء نظامين علاجين متناوبين من محلول فولتارين للحقن .
لعلاج الألم المتوسط و الشديد بعد العمليات ، يتم تسريب 75 ملجم بإستمرار على فترة 30 دقيقة إلى ساعتين ،و عند الضروة ، يمكن إعادة الجرعة بعد ساعات قليلة ، على أن تتجاوز الجرعة 150 ملجم ضمن أى فترة تبلغ 24 ساعة .
لمنع الألم بعد العمليات ، يجب تسريب جرعة تحميلية تبلغ 25 ملجم ، إلى 50 ملجم بعد العملية على فترة 15 دقيقة إلى ساعة ، يعقبها تسريب ممتد لحوالى 5 ملجم بالساعة ، حتى الوصول للجرعة اليومية القصوى و هى 150 ملجم .
ثالثا : الأطفال و المراهقين
بسبب تركيز الجرعة ، فأن محلول فولتارين للحقن لا يناسب الأطفال و المراهقين .
موضوعات ذات صلة
فولتارين و الخطورة على الجهاز الهضمى .
الأعراض الجانبية لفولتارين .
فولتارين خلال فترة الحمل و الرضاعة .
موانع استعمال الفولتارين.
جرعات الفولتارين المقترحة .
فولتارين و مرضى الربــــو .
بدائل حقن فولتارين المتاحة
الاسم بالعربية الاسم بالإنجليزية الشركة السعر بالجنية المصرى
ديكلوفين 75 أمبول Declophen 75 amp Pharco 5.50
إيبيفيناك 75 أمبول Epifenac 75 amp Epico 6
اولفين 75 أمبول Olfen 75 amp Mup/mepha 6.75
رومافين 75 أمبول Rheumafen 75 amp Gsk 8
رومارين 75 امبول Rheumarene 74 amp Sedico 6
رومالكس 75 امبول Romalex 75 amp Alex 6
روفيناك 75 أمبول Rofenac 75 amp Spimaco —
فوتركس 75 أمبول Vortex 75 amp Hikma —
ڤولتك 75 أمبول Voltic 75 amp Jamjoom phar
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Voltaren - Diclofenac General Information
Voltaren and Cataflam are nonsteroidal anti-inflammatory drugs used to relieve the inflammation, swelling, stiffness, and joint pain associated with rheumatoid arthritis, osteoarthritis (the most common form of arthritis), and ankylosing spondylitis (arthritis and stiffness of the spine). Voltaren-XR, the extended-release form of Voltaren, is used only for long-term treatment. Cataflam is also prescribed for immediate relief of pain and menstrual discomfort.
To minimize stomach upset and related side effects, your doctor may recommend taking this medicine with food, milk, or an antacid. However, this may delay onset of relief.
VoltarenDiclofenac which also goes by the name of Voltaren are both medicines that can be used to manage a number of different medical conditions, with the most common medical condition that these drugs are prescribed for being rheumatoid arthritis.
These drugs belong to a category of drugs that are collectively known as non-steroidal anti-inflammatory drugs and the main aim of these drugs when prescribed is to help reduce inflammation and to reduce pain. The way that Diclofenac sodium works is that it can successfully block the production of some of the body chemicals that ultimately end up causing inflammation, pain, stiffness, tenderness and swelling and also increased temperature.
The amount of time that it can take for these drugs to take effect can vary but it is not uncommon for someone to have to wait a couple of weeks after starting a course of these drugs before the benefits start to take effect.
HOW TO PURCHASE VOLTAREN
You may be able to get Voltaren and Diclofenac for free if you have medical insurance or live in one of the countries that offer free prescriptions. However, if you have to pay for your drugs and medicines then it will be advisable for you to shop around and consider buying in bulk, as there can be some large savings to be made.
Should you prefer to purchase Voltaren and Diclofenac online then there are a number of fully approved and licensed websites that can supply these drugs and many of them offer free delivery.
SIDE EFFECTS OF VOLTAREN
Some of the side effects that you could experience when taking these drugs include diarrhoea, feeling dizzy, flatulence, headaches, indigestion, loss of appetite, nausea, skin problems or hypersensitivity reactions, stomach pain, vertigo, vomiting, gastritis, gastrointestinal, lowered blood pressure, oedema, sleepiness and tiredness.
Some of the rarer types of side effects can include blood and bone marrow problems, blood in the urine, blurred vision, chest pain, colitis, constipation, convulsions, depression and difficulty sleeping.
If you do find that after taking this drug that you experience any of the side effects then you should consult medical attention urgently as some of them can lead to additional complications or could be fatal.
VOLTAREN QUESTIONS AND ANSWERS
We are sure that there are going to be many questions regarding both Diclofenac and Voltaren that you will be looking for the answers to, and as such to help you find the answers you are seeking in regards to these two drugs below you will find the most commonly asked questions regarding both of them and the relevant answers to those questions.
If you have any additional questions then you should consult with your Doctor, who is going to enlighten you on whether taking either Diclofenac or Voltaren is going to be suitable for you. Please be aware of the side effects we mentioned and if worried about any of them then do consult your Doctor.
Is rheumatoid arthritis contagious?
You are not at risk of catching rheumatoid arthritis off anyone as it is not a contagious medical condition nor is it a disease. It is however a condition that does affect a lot of people and the amount of pain that this condition can result in a sufferer feeling can often make even the most simplest of day to day tasks become hard. There is help at hand and thanks to the way Voltaren works is can quickly reduce pain resulting from anyone having rheumatoid arthritis.
Will I suffer from rheumatoid arthritis forever?
The condition known as rheumatoid arthritis can sadly be a lifelong ailment, and it is therefore important that anyone suffering from it gets the correct medical treatments at the early onset of this condition. There are now many drugs and medications on the market that can help with the pain caused by rheumatoid arthritis, and as such you should not suffer in silence should you have this conditions as there are plenty of drugs that can be prescribed to you which will help subside the pain of rheumatoid arthritis.
What support groups are available?
There are numerous different support groups for anyone suffering from or anyone caring for someone which rheumatoid arthritis and you can quickly find these groups by searching online or looking in your local telephone directory. It may also be useful for you to have a chat with your local Doctors surgery receptionist for they will be in a good position to point you in the right direct of any local rheumatoid arthritis support groups.
Never suffer in silence if you are suffering from rheumatoid arthritis, for with the right medication and support it can be a condition that can be successfully treated or at the least the pain caused by this condition can be managed successfully.
Why is the pain from rheumatoid arthritis so bad?
The pain from rheumatoid arthritis can be excruciating at times, and whilst some people may only suffer a small amount of pain, when the pain experienced is too much to bear most people may become very despondent and also depressed.
It is therefore important that are the very earliest sign of joint pain you get a Doctors opinion as to the root cause of that pain for if you are found to be suffering from rheumatoid arthritis then the sooner that condition is treated and the soon any medication needed is prescribed the better the chances are that you will not reach the point where the pain become intolerable.
How long will Voltaren take to work?
You will often find that Voltaren can be something of a very fast acting pain relief, and as such you may start to feel the benefits of taking and using it in a short period of time, however it should always be noted that the amount of time when the benefits will kick in will vary from person to person. So do be patient as it may take more than on initial dose for you to start to get the pain relief this drug offers.
Pregnancy and Voltaren
Taking Voltaren when you are pregnant, trying for a baby, or breast-feeding may not be suitable as there are a range of side effects of this drug that may cause a reaction. With this in mind if you are pregnant or are thinking of getting pregnant or are breast feeding a baby then you should ensure your Doctor is aware of these facts. He or she will then be able to take that into account, and may prescribe an alternative course of treatment that will be more suitable to you, as there are many alternatives that are readily available are on offer.
Dosage of Diclofenac and Interactions
Diclofenac should only be taken as prescribed by your Doctor, and whilst there are many different pill sizes and doses of this drug you need to ensure that you are all times taking the prescribed dose as the right time, as there may be a risk of overdoing on this product.
When taking Diclofenac there is also a risk that it may interact with other medications and drugs you are taking, and this is why your should alert and make aware any medical expert or your Doctor of all other drugs you are taking.
Is Diclofenac an Addictive Drug?
Diclofenac can be an addictive drug for some people, and this is why your Doctor should be ensuring that they regularly check up on you regarding the use of this drug when he or she has prescribed it to you. This drug can be taken for both short and long periods of time, however always make sure you are regularly being monitored by your medical expert or your own Doctor or one familiar with your condition.
If you have any problems or are worried about the addictive nature of Diclofenac then please discuss this with your Doctor as there may be other more suitable drugs and medications that he can prescribe instead of this one which will have the same desired effect.
Does Voltaren aid sleep?
Voltaren can and may make you drowsy when you are taking it, whilst everyone will react differently when taking it as there is a chance of you becoming tired or getting a feeling of drowsiness you should be aware of this fact and not drive or operate machinery whilst taking it. You can of course discuss this with your Doctor who will advise you of the best course of action if you are getting tired or sleepy when taking it.
Could I be allergic to Diclofenac?
There could be a very small chance that you will get an allergic reaction when you are taking Diclofenac, and as such at the first signs of any type of allergic reaction you should seek urgent medical attention, and also let the medical staff know that you have taken this drug so as they will know what antidote or medical treatment to give, whilst rare you may, if you do take this drug suffer from an allergic reaction.
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I have a mental basket of drugs that I suspect may be placebos. In that basket were the topical versions of non-steroidal anti-inflammatory drugs (NSAIDs). When the first products were commercially marketed over a decade ago, I found the clinical evidence unconvincing, and I suspected that the modestly positive effects were probably due to simply rubbing the affected area, or possibly due to the effects of the cream or vehicle itself. Frankly, I didn’t think these products worked. So when I recently noticed a topical NSAID appear for sale as an over-the-counter treatment for muscle aches and pains (seemingly only in Canada, for now), I was confident it would make a good case study in bad science.
It’s not that I’m partial to the oral NSAIDs. Yes, they’re among the most versatile, and probably most well-loved drugs in our modern medicine cabinet. They offer good pain control, reduce inflammation and can eliminate fever. We start using it in our sick and feverish infants, through childhood and adulthood for the aches and pains of modern life, and into our later years for the treatment of degenerative disease like osteoarthritis, which affects pretty much everyone as we age. An astonishing 17 million Americans use NSAIDs on a daily basis, and this number is expected to grow as the population ages. In the running groups I frequent, ibuprofen has the affectionate nickname “Vitamin I”, where it’s perceived as an essential ingredient for dealing with the consequences of training.
But NSAIDs have a long list of side effects. Not only do they cause stomach ulcers and bleeding by damaging the gastrointestinal mucosa, there are heart risks, too. It was the arrival (and departure) of the drugs Bextra and Vioxx that led to documentation of the potential for cardiovascular toxicity. And now there’s data to suggest that these effects are not limited to the “COX-2” drugs – almost all NSAIDs, including the old standbys we have used for years, seem capable of raising the risks of heart attacks and strokes.
So despite my initial skepticism, I took another look at the topical NSAIDs. The data were not what I expected.
The use of NSAIDs
ASA (acetylsalicylic acid, Aspirin) the prototypical NSAID, traces its origin back to willow bark, a natural source of salicylate. All NSAIDs work the same way, interrupting the production of inflammatory and pain-related hormones called prostaglandins. Since ASA’s introduction in 1897, more than two dozen chemically related drugs have come to market. They’re now among the commonly used drugs used worldwide, playing a crucial role in pain management. Given the ubiquity of acute pain conditions, as well as chronic conditions like osteoarthritis, it’s estimated that 1 in 20 physician visits are related to prescriptions for NSAIDs. In general, all NSAIDS have equivalent efficacy at the population level, though individual response, and side effects, can vary between drugs. The discovery of different forms of cyclooxygenase enzymes led to new drugs that targeted COX-2 (at sites of inflammation) rather than COX-1 (which is involved with the stomach mucosa. Inhibit COX-2 rather than COX-1, the thinking went, and you could get the antinflammatory action of a traditional NSAID without the gastrointestinal toxicity. However, as the COX-2 saga demonstrated, effects can include the creation of a significant prothrombic effect – with devastating consequences.
The Risks of NSAIDs
Prescription drugs can and do cause significant morbidity, leading to frequent hospital admissions. While we may think nothing of popping a few ibuprofen now and then, NSAIDs have been linked to about 30% of drug-related hospital admissions, and it’s estimated that 12,000-16,000 Americans die annually as a result of gastrointestinal bleeding caused by NSAIDs.
Stomach bleeding and ulcers are a consequence of an NSAID’s mechanism of action – their effect on prostaglandins. The lining of the gut is weakened, and stomach and duodenal ulcers result. Even very low doses of ASA have been documented to have measurable effects on the mucosal lining of the gastrointestinal tract. The risks of gastrointestinal toxicity are significantly increased in the elderly, in those on high doses of NSAIDs, and when combined with other drugs (e.g., steroids) that suppress normal stomach protection.
The cardiovascular risks of NSAIDs became well documented following the worldwide withdrawal of rofecoxib (Vioxx) and international examinations of the cardiovascular risks of the entire category of drugs. Data have now emerged to convincingly establish that most NSAIDs (except ASA) are associated with an increased risk of cardiovascular events. Chronic (routine) consumption of most drugs is linked to small but real increases in heart attacks and stroke. These effects may be a consequence of interference with the beneficial effects of ASA (Aspirin), direct negative cardiovascular effects, and exacerbations of fluid balance, leading to heart failure.
When it comes to cardiovascular risks, not all NSAIDs are the same. A recently published network meta-analysis summarizes the differences, and the overall risks. Both traditional NSAIDs, like naproxen, ibuprofen, and diclofenac, as well as the COX-2 selective NSAIDs, like celecoxib (Celebrex) and rofecoxib (Vioxx) were studied. Happily for those that use over-the-counter anti-inflammatories only occasionally: naproxen seems to be the safest among the NSAIDs, with little to no increase in risk, and ibuprofen’s elevated risk seems limited to regular doses of 1200mg per day or more. So for the individual consumer, when do the risks outweigh the benefits of NSAIDs? Ultimately this comes down to an individual consideration of reasons for use, risk factors, and expected benefits.
To be clear, the absolute cardiovascular risks of NSAIDs, on an individual level, are low, compared to the other side effects of NSAIDs. They seem to cause three or more excessive events like heart attacks and stroke events, per 1000 patients, per year. Compare this to the 20-40 per 1000 per year that may have a (sometimes fatal) stomach bleed, a risk that’s 4x that of non-users. Still, their risk profile suggests that a consideration of their risk and benefits is warranted, particularly when they’re being contemplated in people with preexisting cardiovascular disease. On balance, when treating short-term conditions, the incremental risk in patients without cardiovascular disease is probably very low. Still, it seems prudent to use safer alternatives first (when possible) and if using NSAIDs, considering the lowest possible dose for the shortest possible duration.
Topical NSAIDs: The evidence
Over the past two decades, evidence has emerged to demonstrate that topical versions of NSAIDs are well absorbed through the skin and reach therapeutic levels in synovial fluid; muscle, and fascia. With topical use, little drug actually circulates in the plasma, leading to levels that are a fraction of comparable oral doses. As adverse events from NSAIDs are largely dose-related, it’s expected (thought not as well documented) that serious side effects should be minimized.
For chronic conditions like osteoarthritis, the data are of fair quality and are persuasive. The National Institutes for Health and Clinical Excellence osteoarthritis guidelines provides a nice summary of the trials. Studies varied by site of osteoarthritis (knee, hand, hip, etc), the type of NSAID studied, the regimen, and trial design. On balance, there’s good evidence to show that topical NSAIDs are clinically- and cost-effective for short term (< 4 weeks) use, especially when pain is localized. Topical and oral versions seem to be similarly effective under these circumstances, and there there’s a significant reduction in non-serious adverse events with topical products. While there’s no conclusive evidence to demonstrate a reduction of serious adverse events, they’re expected to be better than oral products, given the blood levels are much lower. What impressed me is that topical NSAIDs are recommended as a preferred treatment before oral NSAIDs. And given many taking oral NSAIDs need to take stomach protecting drugs like omeprazole, the topical products, while more expensive than their oral versions, may actually be more cost-effective overall.
A Cochrane review from 2010 is equally positive about the treatment of acute pain conditions. Forty-seven trials were included in their analysis that considered topical NSAIDs for strains, sprains, and overuse-type injuries. Compared to placebo, topical NSAIDs were evaluated to be effective, with few side effects, with a number needed to treat (NNT) of 4.5. About 6 or 7 out of 10 users can expect to achieve pain control with a topical NSAID, compared to 4 with a placebo. Side effects are comparable to placebo. And given systemic absorption is lower, the serious toxicity we associate with NSAIDs should be lessened, too. Not bad.
Given there’s no long-term data with topical NSAIDs, the evidence doesn’t give us enough insight to understand the risk profile beyond a few weeks. Consequently it seems reasonable to try using topical products instead of oral products, particularly for intermittent, rather than chronic, pain conditions. While compounding pharmacies have made topical versions of NSAIDs for years, there’s little information on effectiveness and safety of these products. As commercial formulations are supported with pharmacokinetic and clinical studies demonstrating efficacy, they are the preparations of choice.
Conclusion
NSAIDs, which already had a bad side effect profile, cause more harm then we thought. Evidence has emerged to demonstrate that topical NSAIDs are effective for many conditions that might otherwise require oral therapies. There’s little evidence to demonstrate that topical NSAIDs are effective for some types of pain, like back pain, headache, or neuropathic pain. But based on what’s now known about the cardiovascular toxicity of NSAIDs, it’s likely that topical products provide a superior risk/benefit perspective for regular and occasional users. The Cochrane review points out that topical NSAIDs are widely accepted in some parts of the world, but not in others. The reasons why are not clear. But having read the evidence, I’ve changed my opinion. And when I’m recovering from my next marathon, I’ll think about reaching for a topical NSAID, instead of that comforting bottle of vitamin I.
References
Haroutiunian, S., Drennan, D., & Lipman, A. (2010). Topical NSAID Therapy for Musculoskeletal Pain Pain Medicine, 11 (4), 535-549 DOI: 10.1111/j.1526-4637.2010.00809.x
Massey T, Derry S, Moore RA, & McQuay HJ (2010). Topical NSAIDs for acute pain in adults. Cochrane database of systematic reviews (Online) (6) PMID: 20556778
Solomon DH. Up-to-Date: Nonselective NSAIDs: Overview of adverse effects; Nonselective NSAIDs: Overview of adverse effects. From Up-To-Date (Database on the Internet).
Trelle, S., Reichenbach, S., Wandel, S., Hildebrand, P., Tschannen, B., Villiger, P., Egger, M., & Juni, P. (2011). Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis BMJ, 342 (jan11 1) DOI: 10.1136/bmj.c7086
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