Drug Interaction:
Increased risk of bleeding when NSAIDs given with SSRIs
Avoid concomitant use of NDAIDs with Aspirin (increased side effects) ciclosporind, coumarins,
erlotinab, ketorolac,lithium and methotrexate
NSAIDs possibly enhance efect of phenindione of phenidione, phenytoin, quinolones,
sulphonylureas and venalaxine
Indication:
Acute painful conditions
Adverse Reaction:
Cardiovascular - fluid retentention , hypertension, pedal edema,
pre-existing cardiovascular disease increase risk of myocardial
infarction and thrombotic events
Gastro-intestinal - gastric ulceration, bleeding, or perforation - these may occur
at any time during treatment with or without warning symptoms
Nausea, dyspepsia, and epigastric pain
Others - anemia, inhibition of platelet aggregation, skin raskes, scaling ezema
exfoliative dermatitis, drug fever, sometimes anaphylactoid reactions,
some patients develop verigo, headache and tremors
Cross reactivity - between aspirin and other NSAIDs has been reported, which can
precipiate severe bronchospasm . Dexibuprofen may occassionally precipitate acute
renal failure in patients and papillary necrosis.
Contra-Indications:
History of severe immunologic hypersensitivity reactions eg anaphylaxis, angioedema to
aspirin or other non-steroidal anti-inflammatory agents.
Hypersensitivity to dexiburofen , ibuprofen paracetamol or other ingredents
Safety Precautions/Warnings-
Allergic conditions including asthma, rhinitis, nasal ployps, chronic urticaria angioedema
Bleeding disorders -potential exacerbation
Conditions predisposing to gastrointestinal events (eg history of peptic ulcer, upper
gastrointestinal disease, ulcerative colitis, smoking, dvancing age, concurrent
corticosteroids, alcohlol abuse, stress )
History of mild immunologic sensitivity reactions to aspirin or other NSAIDs
( eg rhinitis, skin rash )
Hypertension or other cardiovascular diseases ( potential for fluid retention,
acute renal failure)
Liver diseases
Renal impairment
Volume depletion/diuretic therapy ( risk of renal failure, especially elderly )
Dosages/ Overdosage Etc:
Indication-
Acute painful conditions
Dosage
1 capsule orally thrice a day
Not recommended for children below 18 years of age
Pharmacology/ Pharmacokinetics:
Pharmacology-
Dexibuprofen inhibits cyclogenase enzymes,which catalyze arachioonic acid to prostaglandins and leukotrienes. Arachidonic acid is released from membranes phosopholipids as a responsde to infalmmatory stimuli. NSAIDs interfere with postaglandins production by inhibiting cyclooxygenase.
The mechanism of action of paracetamol is still not clearly understood. It does not appear to share with NSAIDs the capacity to inhibit peripheral COX activity. Experimental evidence suggests that inhibition of postglandin biosynthesis contributes to paracetamol pharmacological actions.
Pharmacokinetics-
Dexibuprofen is rapidly and extensively absorbed after igestion. It reaches maximum plasma concentration after 5 hr It is extensively bound to plasma albumin and unbound fraction is less than 1%. Distribution is slow and metabolised by oxidative routes with subsequent glucoronidation to hybrid triglycerides incorporating ibuprofen.
Pharmacokinetics of paracetamol are linear. Cmx and Tmax of paracetamol is 8.79 mg/L and 1.48h (10). Although paracetamol is not impaired inpts with chronic benign liver diseases, theagent is contraindicated in those with hepatic insufficiency. It can be used during pregnancy and lactation.
The very low of paracetamol binding to plasma proteins together with its hepatic metabolism mainly through glucoronide or sulphate conjugation account for the low risk of drug interactions with paracetamol.
Interaction with Food:
The drug should be taken after a meal to minimise gastric irritation
Pregnancy and lactation:
It can be used during pregnancy and lactation.
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