Panoksen

Panoksen – the combined drug having the anesthetizing effect.

Form of release and structure

Dosage form of release of Panoksen – a tablet, coated: a kapsulovidny form, almost white or white, on one party – risk; the surface of a tablet can be slightly rough (on 10 pieces in blisters, on 2 or 10 blisters in a cardboard pack).

Active agents as a part of 1 tablet:

• Paracetamol – 500 mg;
• Sodium diclofenac – 50 mg.

Additional components: пропилпарагидроксибензоат (propylparaben) – 4 mg, methylparahydroxybenzoate (methylparaben) – 17,5 mg, microcrystallic cellulose – 70 mg, talc – 10 mg, corn starch – 290 mg, an atsetilftaliltsellyuloza (целлацефат) – 15 mg, diethyl phthalate – 2,5 mg, magnesium stearate – 10 mg, titanium dioxide – 13 mg, K-30 povidone – 18 mg, a white tablet covering of the CU 1005 (talc – 10,8 mg, a gidroksipropilmetiltsellyuloz (gipromelloz) – 5,5 mg, propylene glycol – 4,3 mg, titanium dioxide – 7,98 mg) – 28,5 mg.

Indications to use

• Neuralgia, sciatica, lumbago, mialgiya;
• Inflammatory diseases of a musculoskeletal system: an ankylosing spondylitis, a pseudorheumatism, psoriasis, chronic and juvenile arthritis, acute gouty arthritis (for reduction of a pain syndrome and an inflammation at the time of use);
• Diseases of circumarticular fabrics: bursitis, tendovaginitis;
• Degenerative diseases of a musculoskeletal system: the osteochondrosis deforming an osteoarthrosis;
• Dentagra;
• The posttraumatic pain syndromes proceeding with an inflammation.

Contraindications

Absolute:

• Full or incomplete combination of bronchial asthma with recuring polipozy okolonosovy bosoms and a nose and intolerance of acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (including instructions in the anamnesis);
• Digestive tract erosive cankers (including duodenum);
• Inflammatory diseases of intestines;
• Active diseases of a liver;
• Active gastrointestinal bleeding;
• Heavy renal (at clearance of creatinine <30 ml a minute), liver or heart failure;
• The progressing diseases of kidneys;
• Hyperpotassemia;
• The period after performing aortocoronary shunting;
• Children's age;
• Pregnancy and period of breastfeeding (lactation);
• Hypersensitivity to drug components, and also to other derivatives of aniline or phenylacetic acid.

Relative (Panoksen appoint with care in the presence of the following diseases / states):

• Hepatic porphyria, high-quality hyperbilirubinemias (including Gilbert's syndrome);
• Peptic ulcer of a stomach and duodenum (remission or existence of instructions in the anamnesis);
• Granulematozny enteritis;
• Ulcer colitis;
• Liver diseases in the anamnesis;
• Considerable decrease in volume of the circulating blood (including after carrying out extensive surgical interventions);
• Arterial hypertension;
• Viral hepatitis;
• Alcoholism, alcoholic damages of a liver;
• Chronic heart failure easy or moderate severity;
• Bronchial asthma;
• Diseases of peripheral arteries;
• Coronary heart disease;
• Cerebrovascular diseases;
• Diabetes mellitus;
• The increased level of lipoproteins and/or lipids in blood;
• Smoking;
• Chronic renal failure (at clearance of creatinine of 30-60 ml a minute);
• Existence of an infection Helikobakter of a pilora;
• Prolonged use of non-steroidal anti-inflammatory drugs;
• Serious somatic illnesses;
• Deficit glyukozo-6-fosfatdegidrogenazy;
• The combined use with glucocorticosteroids, anticoagulants, antiagregant, selective serotonin reuptake inhibitors;
• Advanced age.

Route of administration and dosage

Panoksen it is necessary to accept inside in time or after food, washing down with a small amount of water. It is impossible to chew tablets.

The recommended dosing mode: a single dose – 1 tablet, frequency rate of reception – 2-3 times a day (as much as possible – 3 tablets (in terms of diclofenac – 150 mg)).

Duration of a course will be defined by indications:

• The acute and quickly stopped states – several days;
• Degenerative or chronic inflammatory diseases – it is long.

When performing long-term treatment it is regularly necessary to control a state (because of probability of development of an erosion of a mucous membrane of digestive tract with the subsequent gastrointestinal bleeding). For early detection of a possible hepatotoxic of drug carrying out functional trials of a liver is shown.

Side effects

• Cardiovascular system: stethalgia, heart consciousness, increase in arterial pressure, heart failure, vasculitis, myocardial infarction;
• Alimentary system: an esophagitis, an exacerbation of ulcer colitis or disease Krone, anorexia, epigastric pain, dyspepsia, nausea, diarrhea, vomiting, a meteorism, increase in activity of hepatic aminotransferases, gastritis, a proctitis, bleeding from digestive tract (a tar-like chair, vomiting with blood, diarrhea with blood impurity), an ulceration of a mucous membrane of digestive tract (with perforation or bleeding or without them), hemorrhagic colitis, hepatitis, jaundice, functional disturbances of a liver, a glossitis, stomatitis, pancreatitis, a lock, fulminant hepatitis;
• Urinary system: papillary necrosis of kidneys, nephrotic syndrome, hamaturia, acute renal failure, proteinuria, intersticial nephrite;
• Respiratory system: a pneumonitis, bronchial asthma (including an asthma);
• Nervous system: sleeplessness, headache, tremor, drowsiness, dizziness, sensitivity disturbance (including paresthesia), dysmnesias, spasms, aseptic meningitis, alarm, cerebrovascular disturbances, depression, disorientation, irritability, dreadful dreams, mental disturbances;
• System of a hemopoiesis: agranulocytosis, leukopenia, thrombocytopenia, anemia, including hemolitic or aplastic, methemoglobinemia;
• Sense bodys: a hearing disorder, вертиго, a sonitus, a vision disorder (in the form of an illegibility of visual perception, a diplopia), disturbance of flavoring feelings;
• Integuments: photosensitization, Lyell's disease, skin rash (including violent), erythema, including mnogoformny and Stephens-Johnson's syndrome, itch, exfoliative dermatitis, hair loss, purpura;
• Allergic reactions: an allergic purpura, a small tortoiseshell, anaphylactoid/anaphylactic reactions (including shock and the expressed lowering of arterial pressure), a Quincke's disease (including persons);
• Others: hypostases.

Special instructions

For reduction of probability of development of the undesirable phenomena from the alimentary system Panoksen it is necessary to accept in the smallest effective doses the courses, minimum on duration.

Because of an important role of prostaglandins in maintenance of a renal blood-groove it is necessary to show extra care at Panoksen's appointment at a heart or renal failure, and also at therapy of the patients of advanced age receiving diuretics, and patients with a reduced volume of the circulating blood (for example, after carrying out extensive surgical interventions). At purpose of drug monitoring procedure of function of kidneys is recommended to such patients (as a precautionary measure).

For action approach acceleration Panoksen it is necessary to accept in 30 minutes prior to food. In other cases it is recommended to be accepted to, at the same time or after meal, washing down with water in enough.

Against the background of Panoksen's use at quantitative determination of content of uric acid and glucose in plasma results of laboratory researches can be distorted.

At control of motor transport and performance of other types of the works demanding bystry psychomotor reactions and the increased concentration of attention it is necessary to be careful.

Medicinal interaction

Medicinal interaction of Panoksen is caused by properties of the active agents which are its part.

At the combined use of diclofenac with some medicinal means / substances the following effects can be observed:

• Hypotensive, somnolent drugs: decrease in their efficiency;
• Digoxin, lithium drugs: increase in their concentration;
• Kaliysberegayushchy diuretics: strengthening of risk of development of a hyperpotassemia;
• Diuretics: decrease in their efficiency;
• Anticoagulants, antiagregant, trombolitik (Streptokinasa, alteplaza, urokinase): increase in probability of development of bleedings (is more often – from digestive tract);
• Non-steroidal anti-inflammatory drugs, glucocorticosteroids: increase in probability of development of side effects (in the form of bleeding from digestive tract);
• Gold drugs, cyclosporine: increase in influence of diclofenac on synthesis of prostaglandins in kidneys and, therefore, nephrotoxicity;
• Methotrexate: increase in its toxicity and concentration in plasma;
• Acetylsalicylic acid: decrease in concentration of diclofenac in blood;
• The drugs blocking canalicular secretion: increase in concentration of diclofenac in plasma and, therefore, its efficiency and toxicity;
• Cyclosporine: increase in its concentration in plasma and nephrotoxicity;
• Hypoglycemic means: reduction of their effect;
• Paracetamol: increase in probability of development of nefrotoksichny effects of diclofenac;
• The means causing a photosensitization: increase in the sensibilizing effect of diclofenac to ultra-violet radiation;
• Ethanol, colchicine, corticotropin, drugs of the St. John's Wort which is made a hole: increase in risk of development of bleedings from digestive tract;
• Antibacterial agents of group of a hinolon: increase in risk of development of spasms;
• Plikamitsin, цефамандол, цефотетан, цефоперазон, valproic acid: increase in frequency of development of a prothrombinopenia;
• Selective serotonin reuptake inhibitors: increase in probability of development of bleedings from digestive tract.

At the combined use of paracetamol with some medicinal means / substances the following effects can be observed:

• Gepatotoksichny means, ethanol, inductors of microsomal enzymes of a liver (barbiturates, Phenytoinum, phenylbutazone, rifampicin, tricyclic antidepressants): increase in products of hydroxylated active metabolites and probability of developing of heavy intoxications even at small overdose;
• Uricosuric means: decrease in their efficiency;
• Anticoagulants (high doses of paracetamol): increase in their efficiency;
• Barbiturates (long use): decrease in efficiency of paracetamol;
• Salicylates (the prolonged combined use with high doses of paracetamol): increase in risk of development of cancer of kidney or bladder;
• Ethanol: development of acute pancreatitis;
• Inhibitors of microsomal enzymes of a liver (including Cimetidinum): decrease in risk of a hepatotoxic action;
• Non-steroidal anti-inflammatory drugs (prolonged combined use): increase in risk of development of a papillary necrosis of kidneys and aggravation of a renal failure (approach of an end-stage), and also "analgetic" nephropathy;
• Myelotoxic means: strengthening of manifestation of a gematotoksichnost of paracetamol;
• Diflunisal: increase in plasma concentration of paracetamol and, therefore, probability of development of a hepatotoxic.

Terms and storage conditions

To store in protected from light, the place, dry, unavailable to children, at a temperature up to 25 °C.

Period of validity – 3 years.