Diclowal Supp Tương tác

Diclofenac shouldn't combine with: Oral anticoagulants and heparin: Increase the risk of bleeding (as warfarin and NSAIDs have a synergistic effect on gastrointestinal bleeding).
Quinolones: Diclofenac and other NSAIDs could get increasing side effects on central nervous system of quinolones, leading to seizures (need more research).
Aspirin or glucocorticoids: Reduces diclofenac plasma concentrations and increases the risk and severity of gastrointestinal injury.
Diflunisal: Concomitant administration of diflunisal with diclofenac may increase diclofenac plasma concentrations, decrease diclofenac clearance, and may cause fatal gastrointestinal bleeding.
Lithium: Diclofenac may increase serum lithium concentrations to toxic levels. If co-administration is required, the patient should be carefully monitored for early signs of lithium toxicity and blood levels of lithium should be monitored on a regular basis. The dose of lithium must be adjusted during and after diclofenac treatment.
Digoxin: Diclofenac may increase serum digoxin concentrations and prolong the half-life of digoxin. Concetration of digoxin should be measured and digoxin dose should be reduced if both drugs are used concurrently.
Ticlopidine: Increase the risk of bleeding.
Intrauterine contraceptive device: There are reports that the use of diclofenac reduces the effectiveness of contraception.
Methotrexate: NSAIDs competitively inhibit methotrexate accumulation in the kidney of rabbits. This suggests that they may increase methotrexate toxicity.
Diclofenac could be concomitantly used with following drugs but the patients should be monitored: Cyclosporine: Risk of cyclosporine toxicity. The renal function should be monitored.
Diuretics: Diclofenac reduces the urinary sodium excretion efficiency of furosemide and thiazides. Diclofenac and diuretics may increase the risk of developing secondary renal failure due to decreased renal blood flow because diclofenac inhibits prostaglandins. When this drug is used in combination with NSAIDs, patients should be closely monitored for signs of renal failure, as well as to ensure the diuretic effect of the drug.
Antihypertensives (ACE inhibitors, beta-blockers, diuretics): NSAIDs may reduce the antihypertensive effect of ACE inhibitors.
Administration of antacids may reduce intestinal irritation caused by diclofenac but may decrease serum diclofenac concentrations.
Cimetidine may slightly decrease serum diclofenac concentrations but does not reduce the anti-inflammatory effect of the drug. Cimetidine protects the duodenum from the harmful effects of diclofenac.
Probenecid may double diclofenac concentrations if used concurrently. This may be clinically beneficial in people with joint disease, but diclofenac toxicity can occur, particularly in those with impaired renal function. The effect of uric acid excretion - urine is not affected. If necessary, reduce the dose of diclofenac.