Pharmacology Case No 22.Analgesic And Antipyretic Drug Management

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Pharmacology Case No 22.Analgesic And Antipyretic Drug Management

1.Non –Opioid Analgesics

2.Non-Steroidal- Anti-Inflammatory Drugs(NSAIDs).

3.Preparation For Oral Ulceration and Inflammation.

Descriptation :

1.Non –Opioid Analgesics:-

1.Ketorolac Tromethamine :-

Ketorolac Tromethamine is indicated for the short-term management of moderate to severe acute post-operative pain. Ketorolac ophthalmic solution helps relieve pain, inflammation, and light sensitivity after ocular surgery. It may also be used to decrease eye inflammation or redness caused by seasonal allergies.

Description of Ketorolac Tromethamine:-

Ketorolac Tromethamine is a drug of pyrrolo-pyrrole group of nonsteroidal anti-inflammatory drug (NSAID). Chemically it is known as 5 benzoyle-2,3-dihydro-1H-pyrroligine-1-carboxylic acid, compound with 2 – amino-2-(hydroxymethyl)-1,3-propanediol (1:1). Ketorolac Tromethamine inhibits synthesis of prostaglandins and may be considered as a peripherally acting analgesic. The biological activity of Ketorolac Tromethamine is associated with the S-form. Pharmacokinetic property of Ketorolac Tromethamine is linear. It is highly protein bound and is largely metabolized in liver. The products of metabolism and some unchanged drugs are excreted in the urine.

Pharmacology Ketorolac Tromethamine:-

Ketorolac Tromethamine is a potent analgesic of the non-steroidal anti-inflammatory drugs (NSAIDs). It acts by inhibiting the cyclooxygenase enzyme system and hence inhibits the prostaglandin synthesis. It demonstrates a minimal anti-inflammatory effect at its analgesic dose.

Dosage & Administration Ketorolac Tromethamine :-

Tablet: Recommended dose is 10 mg every 4-6 hours. It should be used short-term only (up to 7 days) and are not recommended for chronic use. Doses exceeding 40 mg/day is not recommended.

Injection: Ketorolac injection may be used as a single or multiple doses, on a regular or when necessary schedule for the management of moderately severe, acute pain that requires analgesia at the opioid level, usually in a postoperative setting. When administering Ketorolac injection, the IV bolus must be given over no less than 15 seconds. The IM administration should be given slowly and deeply into the muscle. The analgesic effect begins within 30 minutes with maximum effect in 1 to 2 hours after dosing IV or IM. Duration of analgesic effect is usually 4 to 6 hours.

Single-Dose Treatment-
IM Dosing (Adult):

Patients <65 years of age: One dose of 60 mg.
Patients >65 years of age, renally impaired and/or less than 50 kg of body weight: One dose of 30 mg.

IV Dosing (Adult):

Patients <65 years of age: One dose of 30 mg.
Patients >65 years of age, renally impaired and/or less than 50 kg of body weight: One dose of 15 mg.

IV or IM Dosing (2 to 16 years of age):

IM Dosing: One dose of 1 mg/kg up to a maximum of 30 mg.
IV Dosing: One dose of 0.5 mg/kg up to a maximum of 15 mg.

Multiple-Dose Treatment (IV or IM)-

Patients <65 years of age: The recommended dose is 30 mg Ketorolac injection every 6 hours. The maximum daily dose should not exceed 120 mg. Patients >65 years of age, renally impaired patients and patients less than 50 kg: The recommended dose is 15 mg Ketorolac injection every 6 hours. The maximum daily dose for these populations should not exceed 60 mg. For breakthrough pain, do not increase the dose or the frequency of Ketorolac Tromethamine.
Conversion from Parenteral to Oral Therapy: Ketorolac tablets may be used either as monotherapy or as follow-on therapy to parenteral Ketorolac. When Ketorolac tablets are used as a follow-on therapy to parenteral Ketorolac, the total combined daily dose of ketorolac (oral + parenteral) should not exceed 120 mg in younger adult patients or 60 mg in elderly patients on the day the change of formulation is made. On subsequent days, oral dosing should not exceed the recommended daily maximum of 40 mg. Ketorolac IM should be replaced by Ketorolac tablet as soon as feasible. The total duration of combined parenteral and oral treatment should not exceed 5 days

Interaction Ketorolac Tromethamine :-

Other NSAIDs or aspirin: Increase the side effects of ketorolac Tromethamine.
Anti-coagulants: Enhance anti-coagulant effect.
Beta Blocker: Reduce the anti-hypertensive effect .
ACE Inhibitors: Increase the risk of renal impairment.
Methotrexate: Enhance the toxicity of methotrexate.

Contraindications Ketorolac Tromethamine:-

Ketorolac is contraindicated in patients having hypersensitivity to this drug or other NSAIDs. It should not be used in children under 16 years of age. lt is also contraindicated as prophylactic analgesic before surgery.

Side Effects Ketorolac Tromethamine :-

Commonly occurring side effects are nausea, vomiting, gastro-intestinal bleeding, melana, peptic ulcer, pancreatitis, anxiety, drowsiness, headache, excessive thirst, fatigue, bradycardia, hypertension, palpitation, chest pain, infertility in female and pulmonary edema.

Pregnancy & Lactation Ketorolac Tromethamine :-

US FDA Pregnancy category of Ketorolac Tromethamine is C. So, Ketorolac Tromethamine should be avoided in pregnancy and lactation unless the potential benefits to the other outweigh the possible risks to the fetus.

Precautions & Warnings Ketorolac Tromethamine :-

Caution should be exercised in patients over the age of 65 years. Caution should also be taken in patients with active or suspected peptic ulcer or gastrointestinal bleeding or asthma and liver dysfunction.

Eye Drops: Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs and should be closely monitored for corneal health. Lopadol ophthalmic solution should not be administered while wearing contact lenses.

Therapeutic Class Ketorolac Tromethamine :-

Drugs used for Rheumatoid Arthritis, Non-Opioid Analgesics

Tablet 1.Etorac 10 mg (AS A Ketorolac Tromethamine AS A Drugs used for Rheumatoid Arthritis, Non-Opioid Analgesics)

Tablet 2.Etorac MDT 10.(Dispersible Tablet).

Injection 2.Etorac IM/IV 30 Mg/ml,1ml Ampoule (AS A Ketorolac Tromethamine Drugs used for Rheumatoid Arthritis, Non-Opioid Analgesics.).

Injection 2. Etorac IM/IV 60mg/2ml 2Ampoule (AS A Ketorolac Tromethamine Drugs used for Rheumatoid Arthritis, Non-Opioid Analgesics.).

Eye Drop 3.Lopadol 0.5% 5ml Drop (AS A Ketorolac Tromethamine AS A Drugs used for Rheumatoid Arthritis, Non-Opioid Analgesics).

Nasal Spray 4.Rolac-NS 15.75mg/Actuation 5ml Nasal spray (AS A Ketorolac Tromethamine AS A Drugs used for Rheumatoid Arthritis, Non-Opioid Analgesics).

2.Nefopam Hydrochloride :-

Indications of Nefopam Hydrochloride :-

Nefopam Hydrochloride is indicated for the relief of acute pain, including post-operative, dental, musculo-skeletal and acute traumatic pain. It is also indicated in chronic pain like cancer pain.

Pharmacology of Nefopam Hydrochloride:-

Nefopam Hydrochloride is a centrally acting analgesic with a rapid onset of action. The main site of action appears to be in the central nervous system both at the brain and spinal levels. In vitro experiments have shown Nefopam to inhibit the re-uptake of various catecholamines (including noradrenaline, serotonin and dopamine). It is possible that the mechanism of action of nefopam is at least in part by altering the levels of these neuromodulators in the brain and at the spinal level.

Dosage & Administration of Nefopam Hydrochloride:-

Tablet-

Adults: Dosage may range from 30 to 90 mg three times daily depending on response. The recommended starting dosage is 2 tablets three times daily.
Elderly: Elderly patients may require reduced dosage due to slower metabolism. It is strongly recommended that the starting dose does not exceed 1 tablet 3 times daily.

Injection-

Adult: 20 mg by IM injection, repeated every 6 hours if necessary. It also be given by slow IV injection in similar dose.

Children: Not recommended for children under the age of 12 years.

Contraindications of Nefopam Hydrochloride:-

Nefopam Hydrochloride is contraindicated in patients with a history of convulsive disorders and should not be given to patients taking monoamine oxidase (MAO) inhibitors. It is also should not be used in the treatment of myocardial infarction.

Side Effects of Nefopam Hydrochloride:-

Nefopam Hydrochloride is generally well tolerated. However the most common side-effects are nausea, nervousness, dry mouth, lightheadedness and urinary retention. The less common side-effects are vomiting, blurred vision, drowsiness, sweating, insomnia, headache, confusion, hallucinations, tachycardia and aggravation of angina.

Pregnancy & Lactation of Nefopam Hydrochloride:-

Nefopam Hydrochloride is not recommended for pregnant women. Evidence suggests that nefopam is excreted in human milk. A decision should made whether to discontinue nursing or discontinue the medication, taking into account the potential for adverse effects for the foetus and the importance of treatment to the mother.

Precautions & Warnings of Nefopam Hydrochloride:-

Nefopam Hydrochloride should be used with caution in patients with glaucoma and with or at risk of urinary retention. Caution should be exercised when Nefopam is administered concurrently with tricyclic antidepressants. Caution should also be exercised in patients with a history of ischaemic heart disease.

Overdose Effects of Nefopam Hydrochloride:-

Nefopam toxicity is manifested by neurological symptoms (convulsions, hallucinations, agitation) and cardiovascular response (tachycardia with hyperdynamic circulation). Supportive treatment is suggested including gastric lavage, forced emesis and diuresis. Oral administration of activated charcoal may help prevent absorption. Convulsions and hallucinations may be controlled with diazepam. Beta-adrenergic blockers may be of use in controlling the cardiovascular complications.

Therapeutic Class of Nefopam Hydrochloride:-

Non opioid analgesics, Non-Opioid Analgesics

Tablet 1.Neforex 30 mg( AS A Nefopam Hydrochloride AS A Non opioid analgesics, Non-Opioid Analgesics).

Injection 2. Neforex IM/IV 20mg/ml 1ml Ampoule ( AS A Nefopam Hydrochloride AS A Non opioid analgesics, Non-Opioid Analgesics).

2.Non-Steroidal- Anti-Inflammatory Drugs(NSAIDs).(Total 29 types Drug under this NSAIDs Group).

1.Aceclofenac.

2.Cetalkonium Chloride +Choline Hydrochloride.

3.Dexibuprofen.

4.Dexketoprofen.

5.Diclofenac Potassium.

6.Diclofenac Sodium.

7. Diclofenac Sodium+Lidocaine Hydrochloride.

8. Diclofenac Sodium+Methyl Salicylate +Linseed Oil+Menthol.

9. Diclofenac Sodium+Misoprostol.

10.Etodolac.

11.Etoricoxib.

12.Flurbiprofen.

13.Ibuprofen.

14.Indomethacin (Oral).

15. Indomethacin(Rectal).

16.Ketoprofen.

17. Ketoprofen(Topical).

18.Lornoxicam.

19.Mefenamic Acid.

20.Meloxicam.

21.Naproxen Sodium.

22. Naproxen Sodium+Esomeprazole Magnesium.

23.Oxaprozin.

24.Paracetamol +Tramadol Hydrochloride .

25.Parecoxib.

26.Salsalate.

27.Sulindac.

28.Tenoxicam.

29.Tolfenamic Acid.

Descriptation:-

1.Aceclofenac:-

Indications of Aceclofenac:-

Aceclofenac is indicated for the relief of pain and inflammation in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, toothache, trauma and lumbago.

Pharmacology Aceclofenac:-

Aceclofenac is a non-steroidal drug with anti-inflammatory and analgesic properties. It is a potent inhibitor of the enzyme cyclooxygenase, which is involved in the production of prostaglandin. After oral administration, it is rapidly and completely absorbed an unchanged drug.

Dosage & Administration Aceclofenac:-

Extended release tablet: The recommended dose in adults is one 200 mg Aceclofenac tablet daily or as prescribed by the physician.
Film coated tablet: The recommended dose in adults is 100 mg, twice daily.

Interaction Aceclofenac:-

No significant drug interactions has not been observed but close monitoring of patients is required when it is used with:

Lithium and Digoxin: may increase plasma concentration of lithium and digoxin.
Diuretics: may interact the activity of diuretics.
Anticoagulants: may enhance the activity of anticoagulant.
Methotrexate: may increase the plasma level of methotrexate.

Contraindications Aceclofenac:-

Aceclofenac is contraindicated in patients with known hypersensitivity to it or in whom aspirin or NSAIDs precipitate attacks of asthma.

Side Effects Aceclofenac:-

Pregnancy & Lactation Aceclofenac:-

The use of Aceclofenac should be avoided in pregnancy and lactation unless the potential benefits to the other outweigh the possible risks to the fetus.

Precautions & Warnings Aceclofenac:-

Caution should be exercised to patients with active or suspected peptic ulcer or gastro-intestinal bleeding moderate to severe hepatic impairment and cardiac or renal impairment. Caution should also be exercised in patients suffering from dizziness or urticaria.

Use in Special Populations Aceclofenac:-

There are no clinical data on the use of Aceclofenac in children.

Therapeutic Class Aceclofenac:-

Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Tablet 1.Reservix 100 mg (AS A Aceclofenac Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Tablet 2.Reservix SR 200MG (Sustained Release). (AS A Aceclofenac Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

2.Cetalkonium Chloride +Choline Hydrochloride :-

Indications of Cetalkonium Chloride +Choline Hydrochloride:-

This is indicated for the fast relief of pain, discomfort and inflammation caused by Mouth ulcer/Aphthous ulcer/Canker sore, Cold sore/Fever blister, Denture sore, Irritation from braces, Gum swelling, and sore spots due to orthodontic device.

Pharmacology of Cetalkonium Chloride +Choline Hydrochloride:-

Choline salicylate has an analgesic & anti-inflammatory effect. Like salicylic acid Choline salicylate has no antithrombotic activity. The pharmacological actions of choline salicylate are thought to be primarily mediated through inhibition of prostaglandin production. Cetalkonium chloride is an antiseptic, being bactericidal towards both Gram-positive and Gram-negative organisms.

Absorption: Choline salicylate is absorbed from the gut
Distribution: Throughout extracellular water and most tissues
Plasma Half-life: 2-4 hours
Excretion: Mainly in the Urine
Protein binding: 80-90%

Dosage & Administration of Cetalkonium Chloride +Choline Hydrochloride:-

Adult: Wash hands, apply ½ inch of gel on to the sore area. This can be repeated after every 3 hours.

Interaction of Cetalkonium Chloride +Choline Hydrochloride:-

Salicylates may enhance the effect of anticoagulants and inhibit the action of uricosurics.

Contraindications of Cetalkonium Chloride +Choline Hydrochloride:-

Not to be used in:

If allergic to salicylates, e.g. Aspirin
If have an active peptic ulcer

Side Effects of Cetalkonium Chloride +Choline Hydrochloride:-

Salicylates may produce bronchospasm and induce asthma attacks in susceptible patients.

Pregnancy & Lactation of Cetalkonium Chloride +Choline Hydrochloride:-

There is clinical evidence of the safety of salicylates in pregnancy. This medicine may pass into breast milk in very small amounts but is unlikely to have any adverse effects on a nursing infant.

Precautions & Warnings

Do not exceed the recommended dose.

Therapeutic Class of Cetalkonium Chloride +Choline Hydrochloride:-

Non-steroidal Anti-inflammatory Drugs (NSAIDs), Preparations for Oral Ulceration & Inflammation

Oral Gel 1.Bongel (0.01%+8.714%) 10gm Tube (Cetalkonium Chloride + Choline Salicylate) (AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs), Preparations for Oral Ulceration & Inflammation)

3.Dexibuprofen:-

Indications of Dexibuprofen :-

Dexibuprofen is indicated in-

The relief of sign and symptoms of osteoarthritis.
Indicated in rheumatoidal disorders such as osseous rheumatism, ankylosing spondilitis, juvenile arthritis, muscular rheumatism, degenerative joint diseases.
Acute symptomatic treatment of painful menstruation (primary dysmenorrhoea)
Common headache and fever
Symptomatic treatment of mild to moderate pain, such as muscle pain, headache and dental pain
As an adjuvant with common cold and influenza associated with headache.

Pharmacology of Dexibuprofen :-

Dexibuprofen (S (+)-ibuprofen) is considered as the pharmacologically active enantiomer of racemic ibuprofen. Like racemic ibuprofen, Dexibuprofen is a non-steroidal anti-inflammatory drug with analgesic action. Like ibuprofen, Dexibuprofen acts by inhibiting prostaglandin synthesis.

Pharmacokinetics: Dexibuprofen is absorbed primarily from the small intestine. After metabolic transformation in the liver (hydroxylation, carboxylation) the pharmacologically inactive metabolites are completely excreted, mainly by the kidneys (90%), but also in the bile. The elimination half-life is 1.8-3.5 hours; the plasma protein binding is about 99%. Maximum plasma levels are reached about 2 hours after oral administration. The administration of dexibuprofen with a meal delays the time to reach maximum concentrations (from 2.1 hours after fasting conditions to 2.8 hours after non-fasting conditions) and decreases the maximum plasma concentrations (from 20.6 to 18.1 mcg/ml, which is of no clinical relevance), but has no effect on the extent of absorption.

Dosage & Administration of Dexibuprofen :-

The dosage must be adjusted to the seriousness of the syndrome and the complaints of the patient. During chronic pain, the dosage must be adapted to the lowest effective dose.

The recommended dosage: 600-900 mg Dexibuprofen per day, at 2-3 divided doses. The dosage can be raised temporarily up to 1200 mg Dexibuprofen per day in patients with acute disorders or exacerbations. The maximum daily dose is 1200 mg.

At dysmenorrhea: A dosage of 600 up to 900 mg Dexibuprofen per day, at a divided dose.

Interaction of Dexibuprofen :-

The reported drug interactions of Dexibuprofen are similar to that of racemic mixture of ibuprofen. Drug interactions is noticed with simultaneous use of anticoagulant, hydantoine and sulfonamide, ticlopidine, lithium, other NSAID’s, ACE inhibitors, beta blockers, cyclosporine, tacrolimus, corticosteroids, digoxin, methotrexate, pentoxyfiline, phenytoine, probenecid, sulfinpyrazon, sulfonylurea, thiazide and thiazide type diuretics, and zidovudine.

Contraindications of Dexibuprofen :-

Dexibuprofen is contraindicated in patients with previous history of hypersensitivity to Dexibuprofen, or another NSAID, or any other component of the product. Patients, who experience attack of asthma, arouse bronchospasm, acute rhinitis, urticaria or edema after use of similar drugs (e.g. aspirin or other NSAID’s). It is also contraindicated in patients with active or suspected hemorrhage, Crohn’s disease or ulcerative colitis, patients with serious heart diseases, kidney function impairment (GFR <30ml/min), and liver function impairment.

Side Effects of Dexibuprofen :-

Clinical experience has shown that adverse effects of Dexibuprofen are similar to those of racemic ibuprofen. Common side-effects are dyspepsia, diarrhea, fatigue, and headache, nausea, vomiting, abdominal pain, hypersensitivity reactions – bleeding, ulcer.

Pregnancy & Lactation of Dexibuprofen :-

Pregnancy: Although no teratogennic impact has been observed in the animal-experimental research with dexibuprofen or ibuprofen, the use should be avoided during the pregnancy. However, animal reproduction studies are not always predictive of human response. Because of the known effects of nonsteroidal anti-inflammatory drugs on the fetal cardiovascular system (closure of ductus arteriosus), use during late pregnancy should be avoided.

Lactation: Studies at people have shown that racimic ibuprofen proceed in small to negligible degree in mother milk. So, Dexibuprofen should be used with cautions in nursing mothers.

Precautions & Warnings

Dexibuprofen should be used with particular caution in patients with bronchial asthma or other chronic diseases of the pulmonary tract as well as in persons prone to allergy. The drug should be used in patients with hepatic, renal or cardiac insufficiency and with hypertension not responding to any treatment. Consultation with a doctor is recommended for patients with systemic lupus or with other autoimmunological disease before beginning therapy using the drug. Dexibuprofen should be used with extreme cautions in active and suspected hemorrhagic conditions such as gastro-duodenal ulcers, ulcerative colitis, Crohn’s disease, alcoholism. Allergic reactions to the drug may appear even for the first-time user and in such case, it should immediately be stopped.

Use in Special Populations of Dexibuprofen :-

Hepatic impairment: Patients with mild to moderate liver function impairments must start with low amounts, and must closely be monitored. Dexibuprofen should not be used in patients with serious liver function impairments.

Renal impairment: The start amount must be reduced at patients with mild to moderate kidney function impairments. Dexibuprofen cannot be used patients with serious kidney function impairments.

Children Dose: Although Dexibuprofen is not licensed for use in children under 18 years of age in the UK, some countries permit such use. For example, in Switzerland, Dexibuprofen has been given to children aged 6 years and over at a dose of 10 to 15 mg/kg daily in 2-4 divided doses.

For elderly people: Lowest effective dose is recommended. The dosage can be raised to adult dosage if well tolerated.

Overdose Effects of Dexibuprofen :-

Dexibuprofen has low acute toxicities. Symptoms of toxicity occur at doses between 80 and 100 mg/kg body weight. Mild symptoms are abdominal pain, nausea, vomiting, lethargy, headache, tinnitus and ataxia. Moderate to serious symptoms, such as flatulence, hypotension, hypothermia, metabolic acidosis, reduced kidney function, coma, and apnoea. The treatment must be symptomatic: there is no specific antidote. In case of large quantities of Dexibuprofen, activated charcoal should be administered. Vomiting can be induced only when life-threatening quantities of the substance ingested and the procedure can be carried out within 60 minutes after ingestion. Dialysis and hemodialysis are of little value as Dexibuprofen binds strongly to plasma protein.

Therapeutic Class of Dexibuprofen :-

Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Tablet 1.Purifen 400mg,200mg,300mg (AS A Dexibuprofen AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Oral suspension 2.Purifen 100mg/5ml 100ml Bottle (AS A Dexibuprofen AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

4.Dexketoprofen:-

Indications of Dexketoprofen:-

Dexketoprofen is indicated in symptomatic treatment of pain and inflammation of mild or moderate intensity, such as musculo-skeletal pain, menstrual pain, & dental pain.

Pharmacology of Dexketoprofen:-

Dexketoprofen is the S(+)-enantiomer of Ketoprofen and is responsible for the analgesic and anti-inflammatory activity of Ketoprofen. The inactive R(-)-enantiomer does not contribute to the therapeutic properties of Ketoprofen but adds to the metabolic load. Dexketoprofen has been formulated as a trometamol salt. Its high solubility in water means a rapid absorption through the gut wall which results in a more rapid onset of action than Ketoprofen. Peak plasma concentrations are attained more quickly than other widely used analgesics with an onset of action of 30 minutes. Dexketoprofen trometamol, given as a tablet, is rapidly absorbed, with a time to maximum plasma concentration (t_max) of between 0.25 and 0.75 hours, whereas the t_max for the S-enantiomer after the racemic drug, administered as tablets or capsules prepared with the free acid, is between 0.5 and 3 hours. Peak plasma concentrations of 1.4 and 3.1 mg/L are reached after administration of Dexketoprofen trometamol 12.5 and 25 mg, respectively. From 70 to 80% of the administered dose is recovered in the urine during the first 12 hours, mainly as the acyl-glucuronoconjugated parent drug. No R(-)-Ketoprofen is found in the urine after administration of Dexketoprofen [S(+)-Ketoprofen], confirming the absence of bioinversion of the S(+)-enantiomer in humans. The anti-inflammatory potency of Dexketoprofen was always equivalent to that demonstrated by twice the dose of Ketoprofen.

Dosage & Administration of Dexketoprofen:-

The dose of Dexketoprofen 25 mg tablets depends on the type, severity, and duration of pain. The recommended dose is generally 1 tablet every 8 hours, with no more than 3 tablets daily. The elderly and patients with renal or hepatic impairment should start treatment with a total daily dose of no more than 2 tablets. Normally it is recommended to take the tablets with food. In the case of acute pain, it is recommended that tablets be taken at least 30 minutes before meals. Dexketoprofen is not recommended for children.

Interaction of Dexketoprofen:-

Any of the following drugs cannot be used at the same time while taking Dexketoprofen. Other non-steroidal anti-inflammatory drugs, anticoagulant medicines; lithium; methotrexate; hydantoins (a type of medicine used for epilepsy) or some antibiotics of sulphonamide type (e.g. sulfamethoxazole); medications used to treat high blood pressure (ACE inhibitors, diuretics and beta-blockers); pentoxifylline; zidovudine; cyclosporine or tacrolimus; some oral medicines for diabetes (sulphonylureas); thrombolytic medicines; probenecid; cardiac glycosides; mifepristone; and quinolone antibiotics.

Contraindications of Dexketoprofen:-

Dexketoprofen tablets are not recommended to use in patients who are allergic to this product or aspirin or other non-steroidal anti-inflammatory medicines; who have suffered attacks of asthma, bronchospasm, acute rhinitis, nasal polyps, urticaria, angioedema (swollen face, eyes, lips, or tongue, or difficulty in breathing) after taking aspirin or other non-steroidal anti-inflammatory medicines; who have or previously suffered from a peptic ulcer or chronic gastro-intestinal disorders; who had previously gastro-intestinal haemorrhage (bleeding); who have suffered bronchial asthma; who have severe heart failure, moderate to severe renal dysfunction or severely impaired hepatic function; who have a bleeding disorder, a blood clotting disorder or are taking an anticoagulant; and who are pregnant or breast-feeding.

Side Effects of Dexketoprofen:-

As with all medicines, Dexketoprofen 25 mg tablets may cause some unwanted effects in some patients. These are described below and are characteristic of non-steroidal antiinflammatory drugs:

Common (1-10%): nausea, vomiting, diarrhoea, stomach pain or heartburn.
Uncommon (0.1-1%): sleep disorders, nervousness, headache, dizziness, vertigo, palpitations, constipation, dry mouth, flatulence, skin rash, fatigue, hot flushes, shivering, general malaise.
Rare (0.01 0.1%): stomach ulceration, gastric haemorrhage or perforation; pins and needles, high blood pressure, water retention, slowed breathing rate, hepatic enzymes increased, increased sweating.
Very rare/isolated cases (<0.01%): blurred vision, ringing in the ear, low blood pressure, haematological reactions, hepatic or renal damage, dermatological and photosensitivity reactions, bronchospasm or anaphylaxis.

In patients with systemic lupus erythematosus or mixed connective tissue disease, antiinflammatory medicines may rarely cause isolated cases of fever, headache and rigidity of the nape (back of the neck).

Pregnancy & Lactation of Dexketoprofen:-

The use of Dexketoprofen tablets during pregnancy or breast-feeding is not recommended.

Precautions & Warnings

Precaution should be exercised during using Dexketoprofen tablets in patient who are allergic to any other NSAIDs; who have kidney disease, liver disease, heart disease or fluid retention conditions; and who have blood disorder, systemic lupus erythematosus or mixed connective tissue disease.

Use in Special Populations

Should not be given to children.

Therapeutic Class of Dexketoprofen:-

Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Tablet 1.Actidex 25mg AS A Dexketoprofen (AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

5.Diclofenac Potassium:-

Indications of Diclofenac Potassium:-

Short-term treatment in the following acute conditions:

Post-traumatic pain, inflammation and swelling, e.g. due to sprains.
Post-operative pain, inflammation and swelling, e.g. following dental or orthopaedic surgery.
Painful and/or inflammatory conditions in gynaecology, e.g. primary dysmenorrhoea or adnexitis.
Migraine attacks.
Painful syndromes of the vertebral column
Non-articular rheumatism.
As an adjuvant in severe painful inflammatory infections of the ear, nose, or throat, e.g. pharyngotonsillitis, otitis.

Pharmacology of Diclofenac Potassium:-

The mechanism of action of Diclofenac Potassium, like that of other NSAIDs, is not completely understood but involves inhibition of cyclooxygenase (COX-1 and COX-2).

Diclofenac is a potent inhibitor of prostaglandin synthesis in vitro. Diclofenac concentrations reached during therapy have produced in vivo effects. Prostaglandins sensitize afferent nerves and potentiate the action of bradykinin in inducing pain in animal models. Prostaglandins are mediators of inflammation. Because diclofenac is an inhibitor of prostaglandin synthesis, its mode of action may be due to a decrease of prostaglandins in peripheral tissues.

Dosage & Administration of Diclofenac Potassium:-

Adults: Following an initial loading dose of 50 mg, 25-50 mg is to be taken every eight hours if necessary.

Migraine: An initial loading dose of 50 mg, then if necessary a further 25-50 mg after 2 hours. The maximum daily dose is 150 mg. The tablets should be swallowed whole with liquid, preferably before meals.

Children: Children over 14 years of age: upto 75 mg daily in divided doses.

Interaction of Diclofenac Potassium:-

Diclofenac may have the following drug interactions:

Lithium and Digoxin: Diclofenac may increase plasma concentrations of Lithium and Digoxin.
Anticoagulant:There are isolated reports of and increased risk of haemorrhage with the combined use of Diclofenac and anticoagulant therapy.
Cyclosporin: Cases of nephrotoxicity have been reported in patients receiving Cyclosporin and Diclofenac concomitantly.
Methotrexate: Cases of serious toxicity have been reported when Methotrexate and NSAIDs are given within 24 hours of each other.
Diuretics: Like other NSAIDs, Diclofenac may inhibit the activity of diuretics.
Other NSAIDs and steroids; Co-administration of Diclofenac with other systemic NSAIDs and steroids may increase the frequency of unwanted effects.

Contraindications of Diclofenac Potassium:-

Diclofenac Potassium tablets are contraindicated in patients with known hypersensitivity to Diclofenac. Diclofenac should not be given to patients who have experienced asthma, urticaria, or allergic type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients. Diclofenac is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.

Side Effects of Diclofenac Potassium:-

Side-effects of Diclofenac are usually mild and transient. However, if serious side-effects occur. Diclofenac should be discontinued. Occasional: epigastric pain, other gastro-intestinal disorders (e.g., nausea, vomiting, diarrhoea, abdominal cramps, dyspepsia,flatulence,anorexia). Rare: gastro-intestinal bleeding, peptic ulcer (with or without bleeding or perforation), bloody diarrhoea.

Pregnancy & Lactation of Diclofenac Potassium:-

Diclofenac should not be prescribed during pregnancy, unless there are compelling reasons for doing so. The lowest effective dosage should be used. This type of drugs are not recommended during the last trimester of pregnancy. Very small quantities of diclofenac may be detected in breast milk, but no undesirable effects on the infant are to be expected.

Therapeutic Class of Diclofenac Potassium:-

Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Tablet 1.Nopain 25mg/50mg (AS A Diclofenac Potassium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

6.Diclofenac Sodium:-

Indications of Diclofenac Sodium:-

Diclofenac Sodium is indicated in-

Rheumatology: Inflammatory and degenerative forms of rheumatism, chronic involutive, polyarthritis, ankylosing spondylarthritis, osteoarthritis, spondylarthroses, acute gout, peri-articular rheumatic disorders.

Surgery and Traumatology: Sprain, bruises, dislocations, fractures, softtissue injuries, surgical interventions.

Obstetrics and Gynecology: Primary dysmenorrhoea, episiotomy, adnexitis, endometritis, parametritis, salpingitis, and mastitis.

Otorhinolaryngology: As pre-operative medication for the prevention of pain, inflammation, and swelling.

Dentistry: Post-operative and post-traumatic pain, inflammation, and swelling.

Other indications: For the prevention of pain and treatment of inflammation and swelling of patients operated in the urogenital tract, renal and biliary colic.

Pharmacology of Diclofenac Sodium:-

Dilofenac Sodium is a potent non-steroidal anti-inflammatory drug (NSAID) with pronounced anti-rheumatic, anti-inflammatory, analgesic and antipyretic properties. It has also some uricosuric effect. Diclofenac exerts its effect by inhibiting prostaglandin biosynthesis which plays a major role in causing inflammation, pain and fever. Diclofenac is rapidly and completely absorbed from the gastro-intestinal tract when taken with or after meal. Peak plasma concentrations are reached within an average of 2 hours after ingestion of it. At therapeutic concentrations, it is 99.7% bound to plasma proteins. Diclofenac is metabolized in the liver and undergoes first pass metabolism.

Dosage & Administration of Diclofenac Sodium:-

Diclofenac FC Tablet: Adults: 75-150 mg daily in 2 to 3 divided doses, preferably after food. Dose should be reduced in long term use.

Diclofenac SR Tablet:

Adult: 1 tablet daily, taken whole with liquid, preferably at meal times. If necessary, the daily dose can be increased to 150 mg by supplementation with conventional tablets.
Children: 1-3 mg of diclofenac/kg body wt. daily in divided doses.
Elderly patients: In elderly or debilitated patients, the lowest effective dosage is recommended, although the pharmacokinetics of diclofenac sodium is not impaired to any clinically relevant extent in elderly patients.

Diclofenac Dispersible Tablet:

Adults: The recommended daily dosage is 2-3 tablets and the maximum daily dose is 150 mg. In milder cases, 2 tablets of Diclofenac DT per day are sufficient. Diclofenac DT should preferably be taken before meals.
Children: Diclofenac is not recommended in children for other indications except juvenile rheumatoid arthritis where the recommended dose is 1-3 mg/kg body weight. Diclofenac DT is to be dropped into a half-glass of water and the liquid is to be stirred to aid dispersion before swallowing. There is no information on the use of Diclofenac DT for more than 03 months.

Diclofenac TR Capsule: One capsule daily. Diclofenac TR should be taken preferably after mealtimes.

Diclofenac Suppository: For adults: 50 mg suppository 2-3 times daily. Maximum daily dose is 150 mg.

Diclofenac injection: For adults the usual dose is 1 ampoule daily. In serious cases this dose may be increased up to 2 ampoules daily.

Diclofenac Gel: For external use only. Depending on the size of area to be treated, 2-4 g of Diclofenac gel should be applied to the skin 3-4 times daily. To the affected area gel should be rubbed in lightly. This gel may also be given in addition to further treatment with other dosage forms of Diclofenac.

Interaction of Diclofenac Sodium:-

Diclofenac Sodium may have the following drug interactions:

Lithium and digoxin: Diclofenac may increase plasma concentrations of lithium and digoxin.

Anticoagulants: There are isolated reports of an increased risk of haemorrhage with the combined use of diclofenac and anticoagulant therapy, although clinical investigations do not appear to indicate any influence on anticoagulant effect.

Antidiabetic agents: Clinical studies have shown that diclofenac can be given together with oral antidiabetic agents without influencing their clinical effect.

Cyclosporin: Cases of nephrotoxicity have been reported in patients receiving cyclosporin and diclofenac concomitantly.

Methotrexate: Cases of serious toxicity have been reported when methotrexate and NSAIDs are given within 24 hours of each other.

Quinolone antimicrobials: Convulsions may occur due to an interaction between quinolones and NSAIDs.
Therefore, caution should be exercised when considering concomitant therapy of NSAID and quinolones.

Other NSAIDs and steroids: Co-administration of diclofenac with other systemic NSAIDs and steroids may increase the frequency of unwanted effects. With aspirin, the plasma levels of each is lowered, although no clinical significance is known.

Contraindications of Diclofenac Sodium:-

Contraindicated to the patients hypersensitive to any ingredient of the products. Peptic ulcer, hypersensitivity to Diclofenac like other non-steroid anti-inflammatory agents, Diclofenac is also contra-indicated in asthmatic patient in whom attack with asthma, urticaria or acute rhinitis are precipitated by acetylsalicylic acid or by other drugs with prostaglandin synthetase inhibitor. This Gel should not be used under occlusive airtight dressings.

Side Effects of Diclofenac Sodium:-

Diclofenac Sodium is generally well tolerated. Adverse effects are mild, rare and transient. At the starting of the treatment, however, patients may be sometimes complaining of epigastric pain, eructation, nausea and diarrhea or dizziness or headache. These effects are usually mild in nature. Peripheral edema and skin reactions, such as rash and eczema have also been encountered. Diclofenac Sodium Gel may cause local irritation and reddening of the skin and skin rash.

Pregnancy & Lactation of Diclofenac Sodium:-

During pregnancy, Diclofenac should be employed only for compelling reasons. The lowest effective dose should be used. These types of drugs are not recommended during the first trimester of pregnancy. In view of insufficient clinical data, Diclofenac Sodium Gel is not recommended during pregnancy. A very insignificant quantity of Diclofenac may be detected in breast milk but no undesirable effects on the infant to be expected.

Precautions & Warnings of Diclofenac Sodium:-

In rare instances where peptic ulceration or gastrointestinal bleeding occurs in patients under treatment with Diclofenac. In patients with advanced age should be kept under close observation. Diclofenac Sodium Gel should not be allowed to come in contact with the eyes or mucus membranes, after application the hands should be washed properly and not to be taken by mouth.

Therapeutic Class of Diclofenac Sodium:-

Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Tablet 1.Clofenac 50mg (AS A Diclofenac Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Tablet 2.Clofenac DT (Dispersible tablet) 46.5 mg (AS A Diclofenac Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Tablet 3.Clofenac SR 100MG (Sustained Released) (AS A Diclofenac Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Suppository 4.Clofenac 12.5 mg/50mg (AS A Diclofenac Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Gel 5.Clofenac 1% w/w 20gm tube (AS A Diclofenac Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Injection 6.Diclofen IM 75mg/3ml 3ml Ampoule AS A (AS A Diclofenac Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Topical Spray 7.Volifen 1% V/V 60/150 ml Bottle AS A (AS A Diclofenac Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Diclofenac Sodium Other Component Preparation:-

1.Diclofenac Sodium (Ophthalmic).

Eye Drop 1.Nopain 0.1% 5ml Drop.

Indications of Eye Drop 1.Nopain 0.1% 5ml Drop.

Nopain ophthalmic preparation is indicated in-

Pre-and post-operative cover (e.g., for cataract surgery)
Non-infected chronic conjunctivitis, keratoconjunctivitis
Non-infected post-traumatic conditions of the cornea and conjunctiva

2.Diclofenac Sodium +Methyl Salicylate +Linseed Oil+Menthol:–

Gel 1.Volinac 1% W/W 50gm Tube.

Gel 2.Volinac Max 2% 50gm Tube.

Indicated for the quick relief from pain, swelling and inflammation due to musculo-skeletal disorders such as sprains, strains, tendinitis, bursitis, hands, neck & shoulder pain, sciatica, muscle stiffness, joint pain, back ache and lumbago.

3.Diclofenac Sodium+Lidocaine Hydrochloride :-

Injection 1.Intafenac Plus IM (75mg+20mg)/2ml Ampoule

Indications of Injection 1.Intafenac Plus IM (75mg+20mg)/2ml Ampoule

The injection contains Diclofenac Sodium that is used to relief all grades of pain and inflammation in a wide range of conditions including:

Arthritic conditions such as rheumatoid arthritis, osteoarthritis, juvenile chronic arthritis, ankylosing spondylitis, acute gout.
Acute musculoskeletal disorders such as periarthritis (e.g., Frozen shoulder), tendinitis, tenosynovitis, bursitis.
Other painful conditions resulting from trauma including, fracture, low back pain, sprains, strains, dislocations, control of pain and inflammation in orthopaedic, dental and other minor surgeries, postoperative pain, pain of renal colic etc.

The injection also contains Lidocaine which acts as a local anaesthetic. Therefore the possibility of pain at the injection site, which is most likely to occur after intramuscular injection, is minimized if the Lidocaine containing injection is used in the above indications.

4.Diclofenac Sodium +Misoprostol :-

Tablet 1.Miclofenac (50mg+200mcg)

Tablet 2. Miclofenac(75mg+200mcg)

Indications of Tablet:-Miclofenac (50mg+200mcg)

Miclofenac is indicated for treatment of the signs and symptoms of osteoarthritis or rheumatoid arthritis in patients at high risk of developing NSAID-induced gastric and duodenal ulcers and their complications.

7. Diclofenac Sodium+Lidocaine Hydrochloride:-

Injection 1.Intafenac Plus IM (75mg+20mg)/2ml Ampoule

Indications of Injection 1.Intafenac Plus IM (75mg+20mg)/2ml Ampoule

The injection contains Diclofenac Sodium that is used to relief all grades of pain and inflammation in a wide range of conditions including:

Arthritic conditions such as rheumatoid arthritis, osteoarthritis, juvenile chronic arthritis, ankylosing spondylitis, acute gout.
Acute musculoskeletal disorders such as periarthritis (e.g., Frozen shoulder), tendinitis, tenosynovitis, bursitis.
Other painful conditions resulting from trauma including, fracture, low back pain, sprains, strains, dislocations, control of pain and inflammation in orthopaedic, dental and other minor surgeries, postoperative pain, pain of renal colic etc.

8. Diclofenac Sodium+Methyl Salicylate +Linseed Oil+Menthol:-

Gel 1.Volinac 1% W/W 50gm Tube.

Gel 2.Volinac Max 2% 50gm Tube.

9. Diclofenac Sodium+Misoprostol:-

Tablet 1.Miclofenac (50mg+200mcg)

Tablet 2. Miclofenac(75mg+200mcg)

Indications of Tablet:-Miclofenac (50mg+200mcg)

10.Etodolac.

Capsule 1.Edopain 300mg (AS A Etodolac AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Capsule 2.Edopain ER 600mg (Extended Released) (AS A Etodolac AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Indications of Etodolac:-

Edopain is indicated-

For acute and long-term use in the management of signs and symptoms: Osteoarthritis, Rheumatoid arthritis
For the management of acute pain
Acute gout

11.Etoricoxib:-

Indications of Etoricoxib:-

Etoricoxib tablet is indicated for the symptomatic relief of-

Osteoarthritis (OA)
Rheumatoid arthritis (RA)
Ankylosing spondylitis, and
The pain and signs of inflammation associated with acute gouty arthritis.
For the short-term treatment of moderate pain associated with dental surgery.

Tablet 1.Tory 60mg,90mg,120 mg (AS A Etoricoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs).

12.Flurbiprofen:-

Tablet 1.Urbifen 50 mg (AS A Flurbiprofen AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs))

Indications of Flurbiprofen:-

Pain and inflammation in rheumatic disease and other musculoskeletal disorders such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, frozen shoulder, low back pain, sprains and strains; mild to moderate pain including dysmenorrhoea; migraine; postoperative analgesia, dental pain; relief of sore throat.

13.Ibuprofen:-

Tablet 1.Advel 200mg AS A Ibuprofen AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Tablet 2.Advel 400 mg

Syrup 3.Advel 100mg/5ml

Topical Gel 4.Flamex 5% w/w 30 gm tube.

Indications of Ibuprofen :-

Advel oral dosage form is indicated in Rheumatoid arthritis, Osteoarthritis, Gouty arthritis, Juvenile polyarthritis, Ankylosing spondylitis, Synovitis, Low back pain, Dysmenorrhoea, Fever, Migraine, Soft tissue injuries, Pain & Inflammation in dental and musculoskeletal origin.

Advel topical gel contains Advel and belongs to a group of medicines called non-steroid anti-inflammatory drugs (NSAIDs). These medicines reduce pain and inflammation and bring down a high temperature. Advel 5% gel is used to treat a number of painful conditions affecting the joints and muscles, such as backache, rheumatic and muscular pain, sprains, strains and sports injuries. It is also used to treat pain from non-serious arthritic conditions and nerve pain (neuralgia).

14.Indomethacin (Oral):-

Indications

Indomethacin is indicated in-

Rheumatoid arthritis
Ankylosing spondylitis
Osteoarthritis (degenerative joint disease)
Gout
Acute non-articular rheumatism (bursitis, synovitis, tendinitis).

Capsule 1.Indomet 25 mg (AS A Indomethacin AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Capsule 2.Indomet SR 75mg Sustained Relesed (AS A Indomethacin AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

15. Indomethacin(Rectal):-

Suppository 1.Indomet 100mg (AS A Indomethacin AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs))

Indications of Indomethacin :-

Indomet is indicated for the treatment of rheumatoid arthritis, ankylosing spondylitis, osteoarthritis (degenerative joint disease), gout, acute non-articular rheumatism (bursitis, synovitis, tendinitis).

16.Ketoprofen:-

Tablet 1.Keto-A (Enteric Coated) 50mg AS A Ketoprofen( AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Tablet 2. Keto-A (Enteric Coated) 100Mg AS A Ketoprofen( AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Injection 3.Keto-A 100mg/2ml 2ml Ampoule IM injection AS A Ketoprofen( AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Suppository 4.Keto-A 100mg AS A Ketoprofen( AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Indications of Ketoprofen:-

The indications of Keto-A are based on its anti-inflammatory, analgesic and antipyretic properties. Keto-A is indicated for symptomatic treatment of:

Rheumatoid arthritis
Degenerative joint diseases
Musculoskeletal and joint disorders such as tendinitis, sprain
Pain, regardless of the origin, such as dental pain, headache and primary dysmenorrhea.

Ketoprofen Other Component Preparation:-

1.Ketoprofen (Topical).

Gel 1.Festam 2.5% W/W 30gm tube/50gm tube (AS A Ketoprofen AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs))

Indications of Ketoprofen:-

Festam gel is indicated for the symptomatic treatment of mild to moderate local pain associated with muscle and/or joints injuries, e.g. sport injuries.

17. Ketoprofen(Topical).

Gel 1.Festam 2.5% W/W 30gm tube/50gm tube (AS A Ketoprofen AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs))

Indications of Ketoprofen:-

Festam gel is indicated for the symptomatic treatment of mild to moderate local pain associated with muscle and/or joints injuries, e.g. sport injuries.

18.Lornoxicam:-

Tablet 1.Lorno 4mg/8mg (AS A Lornoxicam AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Injection 2.Camlor IM/IV 8mg/2ml 8mg vial AS A Lornoxicam AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of Lornoxicam:-

Lorno is indicated in-

Short-term relief of acute mild to moderate pain
Symptomatic relief of pain inflammation in osteoarthritis
Symptomatic relief of pain and inflammation in rheumatoid arthritis.

19.Mefenamic Acid:-

Tablet 1.Myfocin 500mg (AS A Mefenamic Acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Tablet 2.Flamic 250 mg (AS A Mefenamic Acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Syrup 3. Flamic 50mg/5ml 60 ml Bottle (AS A Mefenamic Acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of Mefenamic Acid:-

Myfocin is indicated for-

Fever
Toothache
Headache
Migraine
Primary dysmenorrhoea
Menorrhagia
Mild to moderate pain in rheumatoid arthritis and osteoarthritis
Traumatic pain
Low-back pain
Juvenile chronic arthritis in children etc.

20.Meloxicam:-

Tablet 1.Melcam 15 mg (AS A Meloxicam AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs))

Indications of Meloxicam:-

Melcam is indicated in-

Osteoarthritis,
Rheumatoid arthritis,
Ankylosing spondylitis

21.Naproxen Sodium:-

Tablet 1.Ecless 250mg (AS A Naproxen Sodium Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs))

Tablet 2. Ecless 500 mg (AS A Naproxen Sodium Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs))

Syrup 3. Ecless 125mg/5ml 50 ml Bottle (AS A Naproxen Sodium Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs))

Gel 4. Ecless 10% W/W 15gm Tube (AS A Naproxen Sodium Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of Naproxen Sodium:-

Ecless is indicated for the relief of sign and symptoms of-

rheumatoid arthritis
osteoarthritis
ankylosing spondylitis
juvenile arthritis
tendonitis
bursitis
acute gout

It is also indicated for the management of primary dysmenorrhea & pain.

Naproxen Sodium Other Component :-

1.Naproxen Sodium +Esomeprazole Magnesium:-

Tablet 1.Naprox Plus (Delayed Release ) (500mg+20mg) (AS A Naproxen Sodium +Esomeprazole Magnesium) (AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Tablet 2.Naprox Plus (Delayed Release) (375mg+20 mg ) (AS A Naproxen Sodium +Esomeprazole Magnesium) (AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of (Naproxen Sodium +Esomeprazole Magnesium):-

Naprox Plus tablet is indicated for the relief of signs & symptoms of-

Osteoarthritis
Rheumatoid arthritis
Ankylosing spondylitis &
To decrease the risk of developing gastric ulcers in patients at risk of developing NSAID-associated gastric ulcers.

22. Naproxen Sodium+Esomeprazole Magnesium:-

Indications of (Naproxen Sodium +Esomeprazole Magnesium):-

Naprox Plus tablet is indicated for the relief of signs & symptoms of-

Osteoarthritis
Rheumatoid arthritis
Ankylosing spondylitis &
To decrease the risk of developing gastric ulcers in patients at risk of developing NSAID-associated gastric ulcers.

23.Oxaprozin:-

Tablet 1.Dayprox 600mg (AS A Oxaprozin AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of Oxaprozin:-

Dayprox is indicated for relief of the signs and symptoms of:

Osteoarthritis
Rheumatoid arthritis
Juvenile rheumatoid arthritis

24.Paracetamol +Tramadol Hydrochloride :-

Tablet 1.Anadol Plus (325mg+37.5mg).( AS A ( Paracetamol +Tramadol Hydrochloride).AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of (Paracetamol +Tramadol Hydrochloride):-

This tablet is indicated for-

The management of moderate to moderately severe pain in adults.
The short-term (five days or less) management of acute pain.

Other Combination Of Paracetamol:-

1.Paracetamol +Caffiene:-

Tablet 1.Pyrenol 500mg+65mg (AS A (Paracetamol +Caffiene)AS A Non opioid analgesics).

Indications of (Paracetamol +Caffiene):-

Pyrenol is indicated in the following conditions-

Headache
Migraine
Toothache
Neuralgia
Feverishness
Period pain
Sore throat
Backache
Help to reduce the temperature
Aches and pain of colds and flu

25.Parecoxib:-

Injection 1:-Parix IM/IV 40mg/Vial 40 mg Vial (AS A Parecoxib AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of Parecoxib:-

For the short-term treatment of postoperative pain in adults. The decision to prescribe a selective cyclooxygenase-2 (COX-2) inhibitor should be based on an assessment of the individual patient’s overall risks.

26.Salsalate:-Null.

27.Sulindac:-

Tablet 1.Sulidac 100 mg (AS A Sulindac AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Tablet 2.Sulidac 200 mg (AS A Sulindac AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of Sulindac:-

Sulidac is indicated for the symptomatic treatment of-

Rheumatoid arthritis
Osteoarthritis
Ankylosing spondylitis
Periarticular inflammatory disorders
Acute painful shoulder
Acute gouty arthritis
Diabetic neuropathy
Diabetic retinopathy

28.Tenoxicam:-

Tablet 1.Tenoxim 20 mg (AS A Tenoxicam AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of Tenoxicam:-

Tenoxim is indicated for the symptomatic treatment of the following painful inflammatory and degenerative disorders of the musculoskeletal system:

Rheumatoid arthritis.
Osteoarthritis.
Arthrosis.
Ankylosing spondylitis.
Extra-articular disorders, e.g. tendinitis, bursitis, periarthritis of the shoulders (shoulder-hand syndrome) or hips, strains, and sprains.
Acute gout.

29.Tolfenamic Acid:-

Tablet 1.Migrex 200mg (AS A Tolfenamic Acid AS A Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs), Other drugs for migraine).

Indications of Tolfenamic Acid:-

Migrex is used-

Specifically for relieving the pain of migraine headache and
Recommended for use as an analgesic in post-operative pain and fever.

3.Preparation For Oral Ulceration and Inflammation:-

1.Cetalkonium Chloride+Choline Salicylate :-

Oral Gel 1:-Bongel (0.01%+8.714% )( (AS A Cetalkonium Chloride+Choline Salicylate) (AS A Non-steroidal Anti-inflammatory Drugs (NSAIDs), Preparations for Oral Ulceration & Inflammation)).

Indications of Cetalkonium Chloride+Choline Salicylate:-

Raiyyan Tahsan Date:28-01-2025 Tuesday Time:10-12-45 Pm

Raiyyan Tahsan

Raiyyan Tahsan