active ingredient: diclofenac;
1 tablet contains diclofenac potassium 25 mg or 50 mg
excipients: internal contents of the tablet - silicon colloidal dioxide, calcium phosphate, magnesium stearate, corn starch, povidone, sodium starch (type A)
coating tablets-microcrystalline cellulose, iron oxide red (E172), titanium dioxide (E 171), povidone, polyethylene glycol 8000, sucrose, talc.
Basic physico-chemical properties:
50 mg tablets-red-brown round biconvex tablets, coated with sugar
tablets of 25 mg-pale red round biconvex tablets, coated with sugar.
Nonsteroidal anti-inflammatory drugs. Acetic acid derivatives and related compounds. Code ATH M01A B05.
Diclofenac, the active ingredient drug Voltaren rapid is a NSAID (NSAID) with pronounced analgesic, anti-inflammatory and antipyretic effects. The main mechanism of action - inhibition of prostaglandin biosynthesis, which play a major role in the occurrence of inflammation, pain and fever.
In vitro , at concentrations equivalent to those achieved in humans, diclofenac does not inhibit the biosynthesis of proteoglycan in cartilaginous tissue.
Voltaren rapid tablets, due to the rapid absorption, are appropriate for the treatment of acute conditions, accompanied by pain and inflammation, in which it is desirable to start the action quickly (within 30 minutes). With post-traumatic pain and inflammation, diclofenac quickly relieves both spontaneous pain and pain during movements, as well as reduces swelling during inflammation and swelling in the wound area.
In addition, the active substance can relieve pain and reduce bleeding in primary dysmenorrhea. Diclofenac also leads analgesic effect in other conditions, accompanied by moderate and severe pain.
In migraine attacks, the drug Voltaren rapid has demonstrated its effectiveness in relieving headache and weakening associated with nausea symptoms.
Diclofenac is rapidly and completely absorbed. Absorption begins immediately after the use of the drug, and the amount of the absorbed substance corresponds to the amount that is absorbed by taking an equivalent dose of diclofenac sodium, used in the form of gastrezistentnyh tablets. The maximum concentration in blood plasma is 3.9 µmol/l and is achieved within 20-60 minutes after administration of the tablet at a dose of 50 mg. When using the drug during meals there is no effect on the amount of absorbed diclofenac, although the beginning and rate of absorption may be somewhat slower.
Diclofenac is 99.7% bound with plasma proteins, mainly to albumin (99.4 per cent). The volume of distribution is 0.12-0.17 l/kg.
Diclofenac penetrates the synovial fluid, where its maximum concentration is achieved 2-4 hours after reaching peak values in the blood plasma. The imaginary half-life of synovial fluid is 3-6 hours. After 2:00 after reaching peak levels in plasma, concentrations of active substance in the synovial fluid than in the plasma, and remain still for 12:00.
The metabolism of diclofenac partially occurs by glucuronidation of the intact molecule, but mainly by single and multiple hydroxylation and methoxylation, resulting in the formation of several phenolic metabolites (3'-hydroxy-, 4'-hydroxy-, 5'-hydroxy-, 4 ', 5' - dihydroxy-and 3'-hydroxy-4 ' -methoxy-diclofenac), most of which later turn into glucuronic conjugates. Two of these phenolic metabolites are pharmacologically active, but to a much lesser extent than diclofenac. Diclofenac has been detected in low concentrations (100 ng/ml) in breast milk in a single nursing mother. The estimated amount of the drug enters the baby's body with breast milk, equivalent to a dose of 0.03 mg/kg/day.
The total systemic clearance of diclofenac from blood plasma is 263 ± 56 ml/min (mean ± standard deviation). The final half-life is 1-2 hours. The half-life of 4 metabolites, including 2 active metabolites, is 1-3 hours. In fact, an inactive metabolite, 3'-hydroxy-4 ' -methoxy-diclofenac, has a much longer half-life.
Repeated use of the drug Voltaren rapid for 8 days in a daily dose of 50 mg three times a day does not lead to the accumulation of diclofenac in blood plasma.
Approximately 60% of the dose is excreted in the urine as metabolites, and less than 1% - as a unchanged substance. The rest of the dose is excreted as metabolites through the bile in feces.
Pharmacokinetics in certain groups of patients.
There were no significant differences in absorption, metabolism and excretion of the drug, depending on the age of the patient.
In patients with impaired renal function, the kinetics of a single dose of the drug does not indicate the existence of any form of cumulation of the unchanged active substance in the usual scheme of use of the drug. In patients with creatinine clearance less than 10 ml/min, the theoretical equilibrium concentrations of metabolites in blood plasma are approximately 4 times higher than in healthy patients. However, eventually, these metabolites are excreted with bile.
In patients with impaired liver function (patients with chronic hepatitis or compensated liver cirrhosis), the pharmacokinetics and metabolism of diclofenac are similar in patients without liver diseases.
Voltaren rapid 25 mg and 50 mg
Short-term treatment (maximum 2 weeks) of such acute conditions:
post-traumatic pain, inflammation and swelling, for example, due to stretching;
post-operative pain, inflammation and swelling, e.g. after dental or orthopedic surgery;
pain and/or inflammation accompanying inflammatory gynecological diseases, such as primary dysmenorrhea or adnexitis;
pain syndromes of the spinal column;
rheumatic diseases of soft tissues.;
as an aid infections of ENT-organs, for example, when pharyngotonsillitis, otitis, accompanied by severe pain and inflammation.
Voltaren rapid 50 mg adult patients
migraine attacks with or without harbingers.
According to conventional approaches to the treatment of infectious and inflammatory diseases, the use of etiotropic agents is also necessary. An isolated temperature rise is not an indication for the use of Voltaren rapid.
Hypersensitivity to the active substance or to other components of the drug
allergic reactions in the anamnesis in the form of asthma attacks, bronchospasm, urticaria, acute rhinitis, nasal polyps or symptoms similar to allergies, after the use of acetylsalicylic acid or other nonsteroidal anti-inflammatory drugs;
bleeding or perforation of the gastrointestinal tract in anamnesis associated with previous NSAID treatment of active gastric and/or duodenal ulcers or recurrent peptic ulcer/bleeding in anamnesis (two or more distinct episodes of established ulcers or bleeding)
inflammatory bowel disease (Crohn's disease or ulcerative colitis);
liver failure (class C by child-Pugh)
renal failure (creatinine clearance
congestive heart failure (NYHA III-IV);
treatment of PERIOPERATIVE pain in coronary artery bypass grafting (or use a heart-lung machine)
coronary heart disease in patients with angina pectoris, myocardial infarction
cerebrovascular diseases in patients who have had a stroke or have episodes of transient ischemic attacks;
peripheral arterial disease
The third trimester of pregnancy.
Interaction with other medicinal products and other forms of interaction
The following types of interactions were observed when using the drug Voltaren rapid and/or other doses and forms of diclofenac.
Lithium. With simultaneous use diclofenac can increase the concentration of lithium in plasma. It is recommended to monitor the level of lithium in serum.
Digoxin. With simultaneous use diclofenac can increase the concentration of digoxin in blood plasma. It is recommended to monitor the level of digoxin in the blood serum.
Diuretics and antihypertensive agents. As with other NSAIDs, concomitant use of diclofenac and diuretics or antihypertensive drugs (e.g. beta-blockers, ACE inhibitors (ACE)) may cause decreased antihypertensive effect. Therefore, a combination of these drugs should be used with caution; patients, especially the elderly, should periodically monitor blood pressure. Patients need to get the right amount of fluid, should also be monitored kidney function after the start of combination therapy, and in the future - regularly, especially when using diuretics and ACE inhibitors due to the increased risk of nephrotoxicity.
Drugs that cause hyperkalemia. Concomitant treatment with potassium-sparing diuretics, cyclosporine, tacrolimus or trimethoprim may be associated with an increase in the level of potassium in the serum, so check the status of patients should be carried out more often.
Other NSAIDs, including selective COX-2 inhibitors and corticosteroids. Simultaneous use of diclofenac with other systemic effects of NSAIDs or corticosteroids may increase the incidence of adverse reactions from the gastrointestinal tract. Simultaneous use of two or more NSAIDs should be avoided.
Anticoagulants and antithrombotic agent. Assign with caution, because the simultaneous use of diclofenac may increase the risk of bleeding.
Although clinical studies do not indicate that diclofenac affects on the action of anticoagulants, there are separate reports of an increased risk of bleeding in patients, while taking diclofenac and anticoagulants. Recommended constant monitoring of the condition of such patients. Like other nonsteroidal anti-inflammatory agents, diclofenac in high doses may temporarily inhibit platelet aggregation.
Selective inhibitors of serotonin reuptake (SSRIs). Co-administration of NSAIDs with systemic action, including diclofenac, and SSRIs may increase the risk of bleeding in the digestive tract.
Antidiabetic drugs. Clinical studies have shown that diclofenac can be administered concurrently with oral hypoglycemic agents without influencing their clinical effect. However, there were isolated reports of hyperglycaemia and hypoglycaemia, which requires dose adjustment of antidiabetic drugs. Recommended control of blood glucose levels during combination therapy. Changes in the interaction process caused by Metformin/metabolic acidosis.
Methotrexate. Be wary of NSAIDs at least 24 hours before or after treatment with methotrexate because of methotrexate concentration in the blood can rise to enhance the toxicity. There have been cases of serious toxicity when methotrexate and NSAIDs including diclofenac, were applied at intervals of 24 hours from each other. This interaction is mediated through the accumulation of methotrexate as a result of impaired renal excretion in the presence of NSAIDs.
Cyclosporine. Diclofenac, like other NSAIDs, can increase the nephrotoxicity of cyclosporin due to the effect on renal prostaglandins. Therefore diclofenac should be used in doses lower than for patients, do not use cyclosporine.
Tacrolimus. With the use of NSAIDs with tacrolimus: increased risk of nephrotoxicity, which may be mediated via renal antiprostaglandin effects NSAID and calcineurin inhibitor.
Quinolone antibiotics. There were separate reports of convulsions, the occurrence of which could be associated with the simultaneous use of quinolones and NSAIDs. This can happen in patients with both the presence and absence of a history of epilepsy or trial. Thus, caution should be exercised when prescribing quinolone to patients who are already receiving NSAIDs.
Colestipol and cholestyramine. These drugs can delay or reduce the absorption of diclofenac. Thus, it is recommended to appoint diclofenac at least 1:00 before or after 4-6 hours after application of colestipol/colestiramine.
Cardiac glycoside. The simultaneous use of cardiac glycosides and NSAIDs may increase heart failure, reduce glomerular filtration rate and increase the level of glycosides in plasma.
Mifepristone. NSAIDs should not be used within 8-12 days after the use of mifepristone, as NSAIDs can reduce the effect of mifepristone.
Strong inhibitors of CYP2C9 . With the caution at the same time diclofenac and inhibitors of CYP2C9 (such as sulfinpirazon and voriconazole) since it may lead to a significant increase in peak concentration in plasma and the action of diclofenac in connection with the inhibition of metabolism of diclofenac.
Phenytoin . When using phenytoin simultaneously with diclofenac, it is recommended to monitor the concentration in the blood plasma of phenytoin due to a possible increase in the influence of phenytoin.
Inducers of CYP2C9.
General measures for the use of systemic nonsteroidal anti-inflammatory drugs:
With all NSAIDs, including diclofenac, there have been cases of gastrointestinal bleeding (vomiting blood, melena), ulceration or perforation which can be fatal and occur anytime during treatment with or without warning symptoms or a previous history of serious events from the gastrointestinal tract. To minimize this risk, the lowest effective dose should be used within a short period of treatment.
Placebo-controlled studies have shown an increased risk of thrombotic cardiovascular and cerebrovascular complications with certain selective COX-2 inhibitors. It is not yet known whether this risk is correlated directly with selective COX-1/COX-2 inhibitors with individual NSAIDs. Since data from comparative clinical studies for long-term treatment with the maximum dose of diclofenac are not currently available, the possibility of increasing the risk in a similar way can not be excluded. Until such data are available, a thorough risk and benefit assessment should be conducted prior to use of diclofenac in patients with clinically confirmed coronary artery disease, cerebrovascular disorders, peripheral artery occlusion disease or significant risk factors (e.g. hypertension, hyperlipidemia, diabetes mellitus, Smoking). Due to this risk, a low effective dose should also be used for a short period of treatment.
Renal effects of NSAIDs include fluid retention with edema and/or hypertension. For this reason, diclofenac should be used with caution in patients with impaired cardiac function and for other reasons that lead to fluid retention. Caution is also recommended for patients who take diuretics or related ACE inhibitors or who have an increased risk of hypovolemia.
Voltaren rapid tablets, coated gastrorezistente do not have coverage. The release of the active substance in the stomach can cause local irritation of the mucous membrane.
The consequences are usually more severe in elderly patients. If gastrointestinal bleeding or ulcers occur in patients treated with Voltarenes, treatment should be discontinued.
Effect on skin.
Very rarely in Association with NSAIDs, including Voltaren rapid, it was reported serious reactions of the skin (in some cases fatal), including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis. The highest risk of such reactions in patients exists at the beginning of treatment, the appearance of these reactions usually occurs during the first month of treatment. The drug Voltaren rapid should be abolished at the first sign of a rash, mucosal lesions or any other sign of hypersensitivity.
Masking signs of infection.
Like other NSAIDs, Voltaren rapid due to its pharmacodynamic properties, can mask the signs and symptoms of infection.
Simultaneous use of Voltaren rapid and other systemic NSAIDs, including selective COX-2 inhibitors, should be avoided, since there is no evidence of the benefits of synergistic action, as well as due to the occurrence of additional side effects.
As the use of all analgesics, long-term use of the drug for the treatment of headache pain you may experience improvement or deterioration (headache due to excessive use of medicines). If the headache occurs as a result of excessive use of analgesics, do not increase the dose of analgesics, in such cases, treatment should be discontinued. Headache due to excessive use of drugs should be suspected in patients with frequent or daily attacks of headache that occur, despite (or through) the regular use of analgesics.
To minimize the side effects, you should use the minimum effective dose for a short period of time. In rare cases, as with other NSAIDs, there may be allergic reactions, including anaphylactic/anaphylactoid reactions, even without prior exposure to diclofenac.
Care should be taken to administer the drug to patients older than 65 years. In particular, it is recommended to prescribe low effective doses to physically weak elderly patients or if the patient's body weight is below normal.
Voltaren rapid tablets contain sucrose and are therefore not recommended for patients with rare forms of hereditary fructose intolerance, glucose-galactose malabsorption or sucrose-isomaltase deficiency.
History of asthma.
In patients with asthma, seasonal allergic rhinitis, swelling of the nasal mucosa (eg, nasal polyps), chronic obstructive pulmonary disease (COPD) or chronic respiratory tract infections (especially with manifestations similar to the symptoms of allergic rhinitis) when taking NSAIDs more often than in other patients, there are side effects such as asthma exacerbation (the so-called intolerance of analgesics or analgesic asthma), edema, urticaria, urticaria. In this regard, such patients need special measures (emergency preparedness). The above also applies to patients with allergic manifestations in the use of other drugs, such as rash, itching, urticaria.
Influence on gastrointestinal tract (GIT).
These phenomena usually have more serious consequences for elderly patients. If patients receiving diclofenac, the phenomena of gastro-enteric bleeding or formation of ulcers, the drug should be discontinued.
As with other NSAIDs, close medical supervision and special caution is required when administering the drug Voltaren rapid patients with symptoms suggestive of disorders of the gastrointestinal tract or indicating an ulcer, bleeding or perforation of the stomach or intestines in history.
The risk of bleeding of the gastrointestinal tract increases with increasing doses of NSAIDs, as well as in patients with a history of ulcers, especially if there were complications (bleeding or perforation), and in elderly patients. To reduce the risk of toxic effects on the gastrointestinal tract in such patients, treatment should be started and maintained at low effective doses. For such patients, as well as for patients who need simultaneous the use of drugs containing acetylsalicylic acid, or other drugs that increase the risk of harmful effects on the gastrointestinal tract, it should be considered to appoint a combination therapy using protective agents (for example, proton pump inhibitors or misoprostol ).
Patients with a history of toxic effects on the gastrointestinal tract, especially the elderly, should inform the doctor about any unusual abdominal symptoms (especially bleeding in the gastrointestinal tract). Used with caution in patients who concurrently use drugs that can increase the risk of ulcers or bleeding (corticosteroids for systemic effects, anticoagulants, antithrombotic drugs, or selective inhibitors of serotonin reuptake). Patients with ulcerative colitis or Crohn's disease need careful medical monitoring and care when using the drug because these conditions can worsen.
The effect on the liver.
Patients with liver disorders should be provided with constant medical supervision, as their condition may deteriorate.
As the use of other NSAIDs, may increase the level of one or more liver enzymes.
This was observed very often in the application of diclofenac in clinical studies (about 15% of patients), but very rarely accompanied by the appearance of clinical symptoms. In most cases, there was an increase to the limit levels. Often (in 2.5% of cases) such increases were moderate (3 to 3
The drug Voltaren rapid is recommended only for a short course of treatment (no more than 1 week). This drug should be discontinued if there is a violation or the deterioration of liver function, if clinical signs or symptoms indicate the development of liver disease or if you experience other symptoms such as eosinophilia, rash.
Hepatitis can occur without prodromal symptoms.
In addition to increased liver enzymes, severe liver reactions, including jaundice and fulminant hepatitis, liver necrosis and liver failure, which in some cases were lethal, were rarely reported.
Be wary of diclofenac in patients with hepatic porphyria through imaginist provoking attack.
The effect on the kidney.
Particular caution should be exercised in patients with cardiac or renal impairment, history of hypertension, elderly patients, patients who are simultaneously diuretics or drugs that can significantly affect renal function , as well as patients with a significant reduction in extracellular fluid, for example, before/after surgery. When administered in such cases, Voltaren rapid monitoring of renal function. After the termination of therapy, the condition of patients is usually normalized.
Cardiovascular and cerebrovascular effects.
A slight increase in the risk of development of arterial thrombotic events (for example myocardial infarction or stroke) may be associated with use of diclofenac, particularly at high doses and prolonged treatment. Treatment with Voltarenes is usually not recommended for patients with established diagnosis of cardiovascular diseases (patients with heart failure, stable coronary artery disease, peripheral artery disease) or uncontrolled arterial hypertension.
To prescribe diclofenac to patients with significant risk factors for cardiovascular events (such as hypertension, hyperlipidemia, diabetes, Smoking) only after careful clinical assessment and only in a dose of ?100 mg daily if the treatment lasts more than four weeks. Since cardiovascular risk of diclofenac may increase with increasing dose and duration of treatment, it should be used as soon as possible and in the most effective dose. You should periodically review the needs of the patient in use of diclofenac for the relief of symptoms and response to therapy. Patients should follow the appearance of serious signs and symptoms of atherothrombosis (eg, chest pain, shortness of breath, weakness, speech impairment), which may occur without warning. Patients should be warned that in this case, you should immediately consult a doctor.
Influence on hematological parameters.
The drug Voltaren rapid is recommended only for a short course of treatment. In the appointment of this drug for a long period it is recommended that (as for other NSAIDs) regularly monitor the hemogram.
Like other NSAIDs, diclofenac may temporarily inhibit platelet aggregation, therefore, should be carefully monitored for patients with disorders of hemostasis, hemorrhagic datacom or hematological disorders.
Systemic lupus erythematosus and mixed connective tissue diseases.
In patients with systemic lupus erythematosus and mixed connective tissue diseases, there may be an increased risk of aseptic meningitis. For patients with history of hypertension and/or congestive heart failure mild or moderate severity it is necessary to conduct appropriate monitoring and advice, as with NSAIDs, including diclofenac, there have been cases of fluid retention and swelling. Data from clinical trials and epidemiological data suggest that use of diclofenac, particularly at high doses (150 mg/day) and long-term treatment may be associated with a slight increased risk of developing arterial thrombotic events (for example myocardial infarction or stroke).
Use during pregnancy or breast-feeding.
Inhibition of prostaglandin synthesis may adversely affect the course of pregnancy and/or embryo/fetus development. Data of epidemiological studies indicate an increased risk of miscarriages and/or the risk of heart defects and gastroschisis after the use of prostaglandin synthesis inhibitor in early pregnancy. The absolute risk of cardiovascular defects was increased with time of treatment.
It was shown that the introduction of prostaglandin synthesis inhibitor in animals leads to an increase in pre - and post-implantation loss and mortality of the embryo/fetus. In addition, in animals treated with the inhibitor of prostaglandin synthesis during the period of organogenesis, was registered a higher incidence of various malformations, including those of the cardiovascular system.
In the I and II trimesters of pregnancy, the preparation Voltaren rapid can be prescribed only when the expected benefit to the mother exceeds the potential risk to the fetus and only in the minimum effective dose, the duration of treatment should be as short as possible. Like other NSAIDs, the drug is contraindicated in the last trimester of pregnancy (it is possible to suppress the contractility of the uterus, cardiovascular toxicity (with premature closure of the arterial duct in the fetus and pulmonary arterial hypertension), impaired renal function in the fetus, accompanied by oligohydrumnion, possible lengthening of bleeding time , antiplatelet effect, which can be observed even at very low doses).
Like other NSAIDs, diclofenac in small quantities enters breast milk; therefore, Voltaren rapid should not be administered during breast feeding in order to avoid the development of side effects in the child. If treatment is important, the child must be transferred to feeding from the bottle.
Like other NSAIDs, Voltaren rapid can affect female fertility and is therefore not recommended for women planning pregnancy. It is necessary to stop the use of this drug for women who cannot get pregnant, as well as women who are examined for infertility.
The ability to influence the reaction rate when driving motor transport or operating other mechanisms.
Patients who have vision disorders, dizziness, drowsiness or other disorders of the Central nervous system (CNS) when using the drug Voltaren rapid should not drive vehicles or work with mechanisms.
Method of application and doses
The drug should be used in the most effective doses for a short period of time, taking into account the objectives of treatment in each individual patient.
The tablets should be swallowed whole, not liquid, squeezed water, preferably before a meal.
The recommended dose is 100-150 mg per day. In the case of moderate severity of symptoms, as a rule, the dose of 75-100 mg per day is sufficient. The daily dose should be divided into 2-3 admission.
Special groups of patients
Children under the age of 14
The daily dose is 50-100 mg, should be divided into 2-3 admission. Data on the use of Voltaren rapid for the treatment of migraine attacks in children under 18 years is currently not.
Elderly patients (aged over 65 years)
There is no need for dose adjustment for elderly patients.
The daily dose of Voltaren rapid should be individualized. The daily dose is usually 50-100 mg as the initial dose usually should take 50 mg. if necessary, you can assign a dose of 100 mg and increased over the next several menstrual cycles to a maximum of 150 mg per day. The use of tablets Voltaren rapid should begin with the appearance of the first symptoms and continue for several days, depending on the reaction and symptoms.
The drug should be used at the first sign of an attack. The recommended single dose is 50 mg. The next 50 mg can be used at 2:00 after the first dose, if sufficient pain relief does not occur. If necessary, you can continue to use the drug after 4-6 hours, but it should be remembered that the maximum dose is 150 mg per day.
Cardiovascular diseases or significant cardiovascular risk factors have been identified
The treatment with Voltaren rapid like generally, it is not recommended for patients with established cardiovascular diseases or uncontrolled hypertension. If needed, patients with established cardiovascular disease, uncontrolled hypertension or significant risk factors for cardiovascular disease should take Voltaren only after careful consideration and only at doses up to 100 mg daily when treatment continues for more than 4 weeks.
Voltaren is contraindicated in patients with renal insufficiency.
There were no specific studies on the use of patients with renal insufficiency, so it is impossible to make any specific recommendations for dose adjustment. Caution is recommended when using Voltaren rapid in patients with mild to moderate renal dysfunction.
Voltaren contraindicated in patients with hepatic insufficiency.
There were no specific studies on the use of the drug in patients with hepatic insufficiency, so it is impossible to make any specific recommendations for dose adjustment. Caution is recommended when using Voltaren rapid in patients with mild to moderate hepatic dysfunction.
The drug is not recommended for children under 14 years due to the high content of the active substance.
Symptoms. There is no typical clinical pattern in the overdose of diclofenac. When overdosing, the following symptoms may occur: vomiting, gastrointestinal bleeding, diarrhea, dizziness, ringing in the ears or convulsions, headache, nausea, epigastric pain, disorientation, excitement, coma, drowsiness. Acute renal failure and liver damage are possible in case of severe intoxication.
Treatment. Treatment of acute poisoning with NSAIDs (NSAIDs), including diclofenac, usually consists in carrying out supportive measures and symptomatic treatment of complications such as hypotension, renal failure, convulsions, disorders of the gastrointestinal tract, respiratory depression.
Carrying out special measures such as forced diuresis, dialysis or hemoperfusion do not contribute to the accelerated removal of NSAIDs from the body due to the high degree of protein binding and extensive metabolism.
In the case of potentially toxic overdose, it is necessary to use activated charcoal in the case of potentially life - threatening overdose-to evacuate the contents of the stomach (cause vomiting, rinse the stomach).
The following side effects include reactions, which were reported under short-or long-term course of the drug Voltaren rapid and/or other pharmaceutical forms of diclofenac.