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Strong Opioids +/- adjuvant therapy - page 8 / 38

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Change route of administration

Contraindications and cautions:

IV use contra-indicated in (all NSAIDs):

Cardiac failure (severe)

Concomitant NSAID or anticoagulant use (including low-dose heparin)

History of haemorrhagic diathesis

History of CVS bleeding

Operations with high risk of haemorrhage

History of asthma

Acute porphyria

Caution (all NSAIDs):

Pregnancy (causes closure of ductus arteriosis)

Breast feeding

Renal impairment (monitor RFTs)

Hepatic impairment

Cardiac impairment

Interactions (all NSAIDs): - bold more likely to give problems

Drug

Effect of interaction

ACE inhibitors/ARBs

risk of renal impairment, hypotensive effect

-blockers/-blockers/CCBs

hypotensive effect

SSRIs

risk of bleeding

Heparin (inc Clexane)

risk of haemorrhage

Warfarin

anticoagulant affect therefore risk of haemorrhage

Diuretics

risk of nephrotoxicity

Lithium

excretion of Li2+ therefore risk of toxicity

Methotrexate

excretion of methotrexate therefore risk of toxicity

NSAIDs inc aspirin

side effects – avoid concomitant use

For Diclofenac, the following are most likely to interact and IV infusions should be avoided:

Warfarin

Heparins (including Clexane)

Lithium

Methotrexate

Monitoring

No information on monitoring levels of diclofenac.  Remember to monitor renal function tests etc when giving to patients in whom caution must be taken.

Dose 

Mouth

o

75–150 mg daily in 2–3 divided doses

IM injection into the gluteal muscle

o

Acute exacerbations of pain and postoperative pain, 75 mg once daily (twice daily in severe cases) for max. of 2 days

o

Ureteric colic, 75 mg then a further 75 mg after 30 minutes if necessary

IV infusion (in hospital setting)

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