Potentially Hazardous Interactions: Increased levels of lithium, digoxin and methotrexate. potentiates potassium-sparing diuretics. Reduced serum levels of salicylates.

Pain and inflammation

Potentially Life Threatening Reaction:

Bleeding or perforation through peptic ulcer, rarely blood dyscrasias or anaphylaxis, acute renal failure.GI disturbances, nephrotic syndrome, epigastric pain, nausea, vomiting, diarrhoea, hepatitis, rash, pruritus, wheezing, bronchospasm, prolonged bleeding time.

Hypersensitivity, acute peptic ulcer or GI bleeding, history of allergic responses to aspirin or other NSAIDs, acute porphyria. Special precaution: Analgesic nephropathy, renal or hepatic impairment,hypertension, cardiac failure, bronchospasm, patients taking diuretics and elderly.

Pain and inflammation 1 tab three times a day

EVIDENCE BASED MEDICINE (April 2003) Pain of Osteoarthiritis Comparative effectiveness of various interventions Beneficial

1. Systemic simple analgesics (eg paracetamol for short term pain relief, and improvement in function)

2. Systemic NSAIDs (short term pain relief and improvement in function)

3. Topical agents (short term pain relief)

Likely to be beneficial

1. Education, dietary advice,empowerment and support ( improved knowledge of disease and pain relief)

2. Physical support (pain relief and improvement in function)

KEY POINTS

1. There is no good evidence that NSAIDs were superior to simple analgesics such as paracetamol or to suggest that any one of the many available NSAIDs had greater efficacy in relieving pain of osteoarthritis.

2. One systematic review of randomised controlled trials has found that topical agents provide pain relief in patients with osteoarthritis and offer a non-toxic alternative to systemic drug treatment. However there is no evidence to indicate whether the prescribed agents were superior to less expensive, non-prescribtion drugs over the counter (OTC) alternatives, or to other local treatments such as hot or cold packs.