Panoxen, 50 mg+500 mg, film-coated tablets, 20 pcs.

Release form and composition

The dosage form of Panoxen is film-coated tablets: capsule-shaped, almost white or white, with a line on one side; the surface of the tablet may be slightly rough (10 pieces in blisters, 2 or 10 blisters in a cardboard box).

Active ingredients in 1 tablet:

• Paracetamol – 500 mg;
• Diclofenac sodium – 50 mg.

Additional components: propyl parahydroxybenzoate (propylparaben) - 4 mg, methyl parahydroxybenzoate (methylparaben) - 17.5 mg, microcrystalline cellulose - 70 mg, talc - 10 mg, corn starch - 290 mg, cellulose acetylphthalyl (cellacephate) - 15 mg, diethyl phthalate - 2, 5 mg, magnesium stearate – 10 mg, titanium dioxide – 13 mg, povidone K-30 – 18 mg, white tablet coating TC 1005 (talc – 10.8 mg, hydroxypropyl methylcellulose (hypromellose) – 5.5 mg, propylene glycol – 4, 3 mg, titanium dioxide – 7.98 mg) – 28.5 mg.

Indications for use

• Neuralgia, sciatica, lumbago, myalgia;
• Inflammatory diseases of the musculoskeletal system: ankylosing spondylitis, rheumatoid arthritis, psoriatic, chronic and juvenile arthritis, acute gouty arthritis (to reduce pain and inflammation at the time of use);
• Diseases of periarticular tissues: bursitis, tendovaginitis;
• Degenerative diseases of the musculoskeletal system: osteochondrosis, deforming osteoarthritis;
• Toothache;
• Post-traumatic pain syndromes occurring with inflammation.

Contraindications

Absolute:

• Complete or incomplete combination of bronchial asthma with recurrent polyposis of the paranasal sinuses and nose and intolerance to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (including indications in the medical history);
• Erosive and ulcerative lesions of the gastrointestinal tract (including the duodenum);
• Inflammatory bowel diseases;
• Active liver diseases;
• Active gastrointestinal bleeding;
• Severe renal (with creatinine clearance <30 ml per minute), liver or heart failure;
• Progressive kidney diseases;
• Hyperkalemia;
• The period after coronary artery bypass surgery;
• Childhood;
• Pregnancy and breastfeeding (lactation);
• Hypersensitivity to the components of the drug, as well as to other derivatives of aniline or phenylacetic acid.

Relative (Panoxen is prescribed with caution in the presence of the following diseases/conditions):

• Hepatic porphyria, benign hyperbilirubinemia (including Gilbert's syndrome);
• Peptic ulcer of the stomach and duodenum (remission or presence of indications in the anamnesis);
• Granulomatous enteritis;
• Ulcerative colitis;
• History of liver disease;
• Significant decrease in circulating blood volume (including after extensive surgical interventions);
• Arterial hypertension;
• Viral hepatitis;
• Alcoholism, alcoholic liver damage;
• Chronic heart failure of mild or moderate severity;
• Bronchial asthma;
• Peripheral arterial diseases;
• Cardiac ischemia;
• Cerebrovascular diseases;
• Diabetes;
• Increased levels of lipoproteins and/or lipids in the blood;
• Smoking;
• Chronic renal failure (with creatinine clearance 30-60 ml per minute);
• Presence of Helicobacter pylori infection;
• Long-term use of non-steroidal anti-inflammatory drugs;
• Severe somatic diseases;
• Glucose-6-phosphate dehydrogenase deficiency;
• Combined use with glucocorticosteroids, anticoagulants, antiplatelet agents, selective serotonin reuptake inhibitors;
• Elderly age.

Substitutes for Panoxen

Nurofen

Only a doctor can select analogues for Panoxen. He will take into account all side effects, features of use, the patient’s condition, and other factors. There are substitutes for the medicine in composition and with a similar mechanism of action.

Medicines are replaced if intolerance to the drug occurs. You cannot replace the drug yourself to avoid serious complications. The effectiveness of similar medicines may differ from the original. Then the dosage will have to be changed, only an experienced specialist will do it correctly, it is better to consult a doctor and not self-medicate.

Summarizing

Aspirin

Panoxen successfully combines two important medicinal properties - it reduces pain and reduces inflammation. It is well tolerated and acts quickly with a single dose. In this regard, it is popular: it is convenient to use for people leading an active lifestyle - on a hike, athletes, fishermen, rock climbers.

It is important to remember that this medicine only relieves symptoms, it does not have a significant effect on the development of the disease. In order to get rid of the disease, it is necessary to use other medicines and methods.

The optimal use of Panoxen is the minimum dosage in a short course. Relieving pain and initial inflammation to alleviate a person’s condition in order to open the way for the use of other medications is its main purpose, but the situation changes in different situations. Your doctor may recommend another use to achieve a positive effect.

Directions for use and dosage

Panoxen should be taken orally during or after meals with a small amount of water. Do not chew the tablets.

Recommended dosage regimen: single dose - 1 tablet, frequency of administration - 2-3 times a day (maximum - 3 tablets (in terms of diclofenac - 150 mg)).

The duration of the course will be determined by the following indications:

• Acute and quickly relieved conditions – a few days;
• Degenerative or chronic inflammatory diseases – long-term.

During long-term treatment, the condition must be regularly monitored (due to the likelihood of erosion of the gastrointestinal mucosa with subsequent gastrointestinal bleeding). For early detection of possible hepatotoxicity of the drug, liver function tests are indicated.

Side effects

• Cardiovascular system: chest pain, palpitations, increased blood pressure, heart failure, vasculitis, myocardial infarction;
• Digestive system: esophagitis, exacerbation of ulcerative colitis or Crohn's disease, anorexia, epigastric pain, dyspepsia, nausea, diarrhea, vomiting, flatulence, increased activity of hepatic aminotransferases, gastritis, proctitis, bleeding from the gastrointestinal tract (tarry stools, vomiting with blood, diarrhea mixed with blood), ulceration of the mucous membrane of the gastrointestinal tract (with or without perforation or bleeding), hemorrhagic colitis, hepatitis, jaundice, functional liver disorders, glossitis, stomatitis, pancreatitis, constipation, fulminant hepatitis;
• Urinary system: papillary renal necrosis, nephrotic syndrome, hematuria, acute renal failure, proteinuria, interstitial nephritis;
• Respiratory system: pneumonitis, bronchial asthma (including shortness of breath);
• Nervous system: insomnia, headache, tremor, drowsiness, dizziness, sensory disturbances (including paresthesia), memory disorders, convulsions, aseptic meningitis, anxiety, cerebrovascular disorders, depression, disorientation, irritability, nightmares, mental disorders;
• Hematopoietic system: agranulocytosis, leukopenia, thrombocytopenia, anemia, incl. hemolytic or aplastic, methemoglobinemia;
• Sense organs: hearing impairment, vertigo, tinnitus, visual impairment (in the form of blurred visual perception, diplopia), impaired sense of taste;
• Skin: photosensitivity, Lyell's syndrome, skin rash (including bullous), erythema, incl. multiforme and Stevens-Johnson syndrome, itching, exfoliative dermatitis, hair loss, purpura;
• Allergic reactions: allergic purpura, urticaria, anaphylactoid/anaphylactic reactions (including shock and marked decrease in blood pressure), angioedema (including the face);
• Others: swelling.

Overdose

An overdose of Diclofenac is manifested by symptoms: vomiting, gastrointestinal bleeding, diarrhea, tinnitus, lethargy and drowsiness, convulsions, and rarely - respiratory depression and coma .

An overdose of Paracetamol has distinctive symptoms: abdominal pain, impaired glucose metabolism and metabolic acidosis . Impaired liver function appears after 24-48 hours. A hepatotoxic effect is observed when taking more than 4 g per day. In severe cases, liver failure with encephalopathy , coma, possible death and acute renal failure .

Treatment begins with gastric lavage, taking sorbents, then symptomatic therapy. With a significantly increased concentration of paracetamol in the blood - administration of SH-group donors , methionine and acetylcysteine ​​in the first 8-9 hours.

special instructions

To reduce the likelihood of developing adverse events from the digestive system, Panoxen should be taken in the smallest effective doses in courses of minimal duration.

Due to the important role of prostaglandins in maintaining renal blood flow, special caution should be exercised when prescribing Panoxen for heart or renal failure, as well as when treating elderly patients receiving diuretics, and patients with reduced circulating blood volume (for example, after extensive surgery) . When prescribing the drug to such patients, monitoring of renal function is recommended (as a precautionary measure).

To speed up the onset of action, Panoxen should be taken 30 minutes before meals. In other cases, it is recommended to take it before, simultaneously or after meals, with plenty of water.

During the use of Panoxen, the results of laboratory tests may be distorted when quantitatively determining the content of uric acid and glucose in plasma.

When driving vehicles and performing other types of work that require quick psychomotor reactions and increased concentration, you must be careful.

Possible unwanted effects

In most cases, Panoxen tablets, instructions for use and patient reviews indicate this, are well tolerated, in rare cases the following side effects appear:

• dyspeptic disorders;
• anorexia;
• exacerbation of gastrointestinal pathologies;
• stomatitis;
• memory impairment;
• persistent pain impulses in the head;
• dizziness;
• tremor of the limbs;
• sleep disturbance;
• convulsive conditions;
• bacteriuria;
• decreased libido;
• nephritis;
• various arrhythmias;
• pancytopenia.

After its cancellation, the above negative conditions are quickly eliminated.

Drug interactions

The drug interaction of Panoxen is due to the properties of the active substances included in its composition.

When diclofenac is used in combination with certain drugs/substances, the following effects may be observed:

• Antihypertensive, hypnotic drugs: decreased effectiveness;
• Digoxin, lithium preparations: increasing their concentration;
• Potassium-sparing diuretics: increased risk of hyperkalemia;
• Diuretics: decrease in their effectiveness;
• Anticoagulants, antiplatelet agents, thrombolytics (streptokinase, alteplase, urokinase): increased likelihood of bleeding (more often from the gastrointestinal tract);
• Nonsteroidal anti-inflammatory drugs, glucocorticosteroids: increased likelihood of side effects (in the form of bleeding from the gastrointestinal tract);
• Gold preparations, cyclosporine: increasing the effect of diclofenac on the synthesis of prostaglandins in the kidneys and, consequently, nephrotoxicity;
• Methotrexate: increased toxicity and plasma concentrations;
• Acetylsalicylic acid: decreased concentration of diclofenac in the blood;
• Drugs that block tubular secretion: increase the concentration of diclofenac in plasma and, consequently, its effectiveness and toxicity;
• Cyclosporine: increased plasma concentrations and nephrotoxicity;
• Hypoglycemic agents: reducing their effect;
• Paracetamol: increased likelihood of developing nephrotoxic effects of diclofenac;
• Drugs that cause photosensitization: increased sensitizing effect of diclofenac to ultraviolet radiation;
• Ethanol, colchicine, corticotropin, St. John's wort preparations: increased risk of bleeding from the gastrointestinal tract;
• Antibacterial agents of the quinolone group: increased risk of seizures;
• Plicamycin, cefamandole, cefotetan, cefoperazone, valproic acid: increased incidence of hypoprothrombinemia;
• Selective serotonin reuptake inhibitors: increased likelihood of bleeding from the gastrointestinal tract.

When using paracetamol in combination with certain drugs/substances, the following effects may be observed:

• Hepatotoxic drugs, ethanol, inducers of microsomal liver enzymes (barbiturates, phenytoin, phenylbutazone, rifampicin, tricyclic antidepressants): increased production of hydroxylated active metabolites and the likelihood of severe intoxication even with a slight overdose;
• Uricosuric drugs: decrease in their effectiveness;
• Anticoagulants (high doses of paracetamol): increasing their effectiveness;
• Barbiturates (long-term use): decreased effectiveness of paracetamol;
• Salicylates (long-term combined use with high doses of paracetamol): increased risk of developing kidney or bladder cancer;
• Ethanol: development of acute pancreatitis;
• Inhibitors of microsomal liver enzymes (including cimetidine): reducing the risk of hepatotoxicity;
• Non-steroidal anti-inflammatory drugs (long-term combined use): increased risk of developing papillary necrosis of the kidneys and worsening renal failure (the onset of the terminal stage), as well as “analgesic” nephropathy;
• Myelotoxic drugs: increased manifestation of hematotoxicity of paracetamol;
• Diflunisal: increased plasma concentrations of paracetamol and, therefore, the likelihood of developing hepatotoxicity.

History of pain management

Panoxen belongs to the combined non-steroidal anti-inflammatory drugs

Humanity has always tried to overcome these symptoms. 2.5 thousand years ago in ancient Egypt they used many means for this, including willow bark. A thousand years later, Hippocrates strongly recommended willow decoctions against fever. In the middle of the 18th century, poppy seeds began to be added to willow decoction to reduce pain. At the beginning of the 19th century, the chemical structure of aspirin was practically discovered, but the therapeutic effects were offset by side effects - nausea, severe abdominal pain.

Gradually, the drugs improved their characteristics. A whole group appeared - non-steroidal anti-inflammatory drugs, which had better properties. If opium (steroid) drugs were previously used, the new ones did not cause drowsiness, respiratory depression, headaches or drug dependence. The most well-known non-steroidal drugs are Diclofenac, Ibuprofen, Aspirin.

The successful use of non-steroidal drugs simultaneously against pain and inflammation has expanded the range of their use, and they have become very popular. But it turned out that they can pose a threat to the kidneys and digestive system.

Ibuprofen

Another ingredient of Panoxen, paracetamol (a non-narcotic pain reliever and fever reducer), was introduced into active use in the 19th century. In the 21st century, this is a very advertised remedy. It is added to many medications and is available in different forms under other names, for example, Panadol.

Overdose and prolonged use of paracetamol have a detrimental effect on the liver, biliary system, and digestive tract. Since 2009, the United States began a program to reduce the content of paracetamol as an additional substance in tablets. Several other countries have adopted the principles of this program in their pharmaceutical industries.

Modern pharmacists combine substances to achieve their best interaction. In Panoxen, the composition is selected in such a way that the active ingredients activate each other and help achieve enhanced beneficial properties.

Diclofenac sodium