Aceclofenac

Therapeutic Indications

This drug is mainly used as a pain reliever for various conditions in the body. It is packaged in 100mg and commonly prescribed for conditions such as rheumatoid arthritis, osteoarthritis, and Ankylosing Spondylitis. All these conditions are often associated with pain, stiff and swelling in the joints.  These are conditions that usually affect people that are aged over 50 where cartilage gradually wears down. Rheumatoid arthritis is an autoimmune disease that leads to inflammation of joints. Ankylosing spondylitis is a condition that is associated with the fusion of the vertebrae.

Do I need a prescription?

This is a prescription drug only, which should not be taken without consultation with informed health personnel.

Chemical Composition

The main component of the drug is aceclofenac. It is one of the drugs that are classified under the class of non-steroidal anti-inflammatory drugs or NSAIDs. Drugs of this composition are designed to possess anti-inflammatory and pain-relieving features to help in alleviating such symptoms. To make the drug more palatable or effective, other additives by different manufacturers can include the following: microcrystalline cellulose, sodium croscarmellose polyvidone among others.

Mechanism of action (MOA)

Mode of action of Aceclofenac is blocking the production of prostaglandins, which are hormone-like substances released at the site where the pain is felt. The process of production of prostaglandins works when cyclo-oxygenase (COX) enzymes are produced in the body. They are produced in areas of injury in the body, where tissues or organs are damaged or where there are immune reactions. The main function of prostaglandins in the body is inflammatory response and stimulation of bone to be reabsorbed in diseases. When COX enzymes are produced, they help reduce the production of prostaglandins.

Contraindications

• A patient that has taken mifepristone (drugs that are used to terminate the pregnancy) within 8-12 days should not take Aceclofenac tablets.
• Pregnant women, breastfeeding mothers and all those planning to get pregnant should not take this medication by seeking the attention of a qualified supervising medical personnel such as doctor or pharmacist.
• People suffering from kidney or liver disease
• People with asthma, breathing problems or other respiratory infections
• Patients with a history of peptic ulcers or bleeding in the stomach especially where episodes of perforation have been noted
• Advanced liver diseases
• People with renal issues
• People with heart and related illnesses
• Patients or people with issues with blood circulation
• People that are allergic to aspirins and other NSAIDs. They can tell if they are if they experience the following some or all symptoms:
• Runny nose or those with itching or sneezing issues may be affected by consumption of the drug
• Asthmatic attacks
• If there are raised circular patches on the skin that appear to be a sign of itching or burning sensation
• Other allergic reactions
• Abdominal pains

Side effects

Like many drugs, there are several side effects associated with the use of this drug. Severe side effects include the following:

• Abdominal pain
• Constipation
• Diarrhea
• Nausea and vomiting
• Rashes on the skin

The drug should be stopped immediately and seek further professional help if a user experiences the following side effects that are considered serious.

• A feeling of heartburns or indigestion
• Abdominal pains in the stomach
• Feeling of tiredness and general body weakness. These can be due to disorders related to the blood. Such would include unusual low production of red blood cells of the high breakdown of the red blood cells and low iron content in the blood. Blood disorders can also be suspected by a feeling of breathlessness, aches at joints and frequent infections and bruises.

Elderly people are likely to have more serious side effects. Doctors should allow much less dose over the shortest duration. Other potential side effects can include the following:

Other drug interactions

• Anaphylactic shock, which is an allergic reaction
• Serious side effects such as problems in breathing or wheezing, fever, swelling of face and throat, vomiting. When such cases appear, it is recommended to seek medical attention
• myocardial infarction or heart attack or stroke
• swelling of face and throat
• renal failure

Patients that experience the following symptoms should stop taking the medicine and consult a doctor for further guidance:

• Blood in stools or faces
• Passing of black tarry stool
• Vomiting of blood
• Indigestion or heartburns
• Stomach-aches or other abdominal discomforts

Some symptoms are common and have been noted between 1 in 10 and 1 in 100 people. These include:

• Dizziness (quite common, 1 in 10 people experience this)
• Indigestion
• Diarrhea (1 in 10 people)
• Nausea and a general feeling of sickness
• Production of more liver enzymes in the blood (1 in 10 people)
• Abdominal pains

Some are symptoms, occurring in less than 1 in 1000 but more than 1 in 100 people include the following:

• Vomiting
• Wind or flatulence
• Oral ulcers
• Skin inflation or dermatitis
• Itching
• Rashes
• High levels of urea in blood
• Increased levels of creatinine
• Being highly sensitive to allergies (hypersensitivity)
• Disturbed vision
• Cardiac (heart) failures
• High blood pressure (hypertension)
• Difficulties in breathing
• Internal abdominal in the stomach (gastrointestinal hemorrhage)
• Stomach ulceration

Further, there are very rare cases where the following symptoms are experienced. Frequency is usually 1 in 10,000 people:

• Depression
• Insomnia or lack of sleep
• Headaches
• Severe and uncontrollable shaking
• Tinnitus of ringing sound in the ears
• Breathing problems
• Bad dreams and hallucinations
• Drowsiness
• Weight gain
• Leg cramps
• Hot flushes
• Fast and heavy heartbeats (Palpitations)
• Edema (retention of water and swelling)
• Skin sensitivity to sunlight
• Drowsiness
• Pain in the movement of the eye
• Exacerbated asthma attacks
• Confusion
• High pitched voice
• Stomach perforation leading to bleeding
• Nephrotic syndrome
• Jaundice or yellowing of the skin
• Kidney inflammations

The drug has been found to interact with other drugs that include the following:

• Lithium and Selective serotonin reuptake inhibitors (SSRIs) drugs which reused treat depression and manic depression cases. Such drugs include Citalopram, Escitalopram, Fluoxetine, Sertraline and Vilazodone
• Cardiac glycosides such as Digoxin used to treat heart failure and regularisation of heartbeats
• Corticosteroids
• Antihypertensives (drugs used to treat high blood pressure
• Anticoagulants, which are drugs that are used to influence the rate of blood clotting such as warfarin
• Diuretics, which are drugs that are used to increase the rate or urine removal from the body. Such drugs include furosemide, hydrochlorothiazide, and triamterene.
• Antidiabetic drugs, which are used to reduce blood sugar levels
• Methotrexate (used to treat cancer and arthritis)
• Steroids or corticosteroids, which are synthetic hormones that mimic naturally produced hormones used to reduce inflammation and reduce activity hormone system in the body
• azidothymidine (AZT) or Zidovudine that is used to treat and prevent HIV/AIDS
• Other NSAIDs such as aspirin and ibuprofen
• Quinolone antibiotics

Besides, the drug has been shown to interact with some diseases such as asthma, gastrointestinal toxicity, and impaired kidney function. These are all severe interactions that warrant urgent medical attention. Asthma patients that have a history of interaction with sensitivity to non-steroidal non-inflammatory drugs.

Skipped dose

It is not advisable to miss any dose unnecessarily. However, if missed, you should take it as soon as you remember. This dose can be missed if time to the next dose is close. The usual schedule should then be resumed. Never take a double dose to cover for the missed dose.

Precautions

Patients should be careful to avoid taking substances that can react with the drug. These include alcohol consumption that increases the risk of stomach bleeding.

• Smokers are advised to seek medical advice before taking aceclofenac
• People with diabetes
• Children and elderly people should not take this medication unless advised by a doctor or pharmacist. Side effects of the drug can be severe for people
• People suffering from porphyria are not advised to refrain from taking this drug unless under medical supervision
• People with a history of a heart problem such as heart attack should avoid this medicine. Besides, all those that suspect to have related conditions such as high cholesterol level, diabetes, high blood pressure among others should also seek medical supervision.
• Recently operated on patients should also take precaution when taking this drug.
• The drug is not recommended for people who have problems with the circulation of blood in the brain
• Never stop taking the drug even if one feels the faster rate of improvement unless a doctor has prescribed so.

Different Brands and Manufacturing companies

It is sometimes sold using tradename of Preservex. Some other popular brands and manufacturers include the following:

• Erinac Mr 100 Mg/500 Mg/500 Mg Tablet by Eris Life Sciences Pvt Ltd
• Zerodol 150 MG Injection by Ipca Laboratories Pvt Ltd.
• Acemarc 100 MG Tablet by Marc Pharma
• AcceclowocSp 100 Mg/500 Mg/15 Mg Tablet by Wockhardt Ltd
• AroffBcd Tablet by Unichem Laboratories Ltd
• Rexonac 200 MG Tablet SR by Rexion Healthcare Pvt.Ltd
• Signoflam-Sr 200 MG Tablet SR by Lupin Ltd
• Acimol Forte 100 Mg/325 Mg/15 Mg Tablet by Leeford Healthcare Ltd
• Flexidol 100 MG Tabletby Cipla Ltd
• Zerodol 100 MG Tablet by Ipca Laboratories Pvt Ltd.
• Aceroc 100 MG Tablet by Wockhardt Ltd
• Acenac 100 MG Tablet by Medley Pharmaceuticals
• Afitra 100 MG Tablet by Rapross Pharmaceuticals Pvt Ltd
• Aceron Tc Tablet by Adcock Ingram Healthcare Pvt Ltd
• Aceclo 200 MG and Aceclo 100MG Tablet SR by Aristo Pharmaceuticals Pvt.Ltd
• Hifenac 100 MG Tablet by Intas Pharmaceuticals Ltd
• Pace 100/500 MG Tablet by Commonwealth Pharmaceuticals
• Afitra 200 MG Tablet by Rapross Pharmaceuticals Pvt Ltd
• Zerodol 200 MG Tablet CR by Ipca Laboratories Pvt Ltd
• Acemiz 100 MG Tablet by Lupin Ltd
• Dolowin 100 MG Tablet by Micro Labs Ltd.
• Toroxx A 100MG Tablet by Torrent Pharmaceuticals
• Voltanec 100MG Tablet by Cipla Ltd

Aceclofenac sells under different brand names in different countries and regions. Some of the brand names include following:

• Abdal, produced by Madhav BioTech in India
• Acecl, produced by Aristo in Kenya
• Acecgen, a generic sold in Hungary
• Aceclofar, produced by Julphar in Lebanon among others.

Substitutes

The main alternatives for Aceclofenac include the following:

• Naproxen
• Acetaminophen
• Diclofenac
• Ibuprofen
• Tramadol
• Aspirin
• Diclofenac Sodium
• Etodolac
• Lodine
• Oxycodone

Recommendations

• It is advised that people should take Aceclofenac with or after taking food
• Normal dosage advised for adults is 200mg per day, where these are split into 2, 100mg in the morning and another evening, or after 12 hours.
• Daily recommended dose should be adhered to, never less or more
• This drug should be swallowed with water and never chewed
• This drug is not recommended for people aged below 18 or elderly people. In such cases, a lower dose is given with the shortest duration possible.
• They are normally taken two in a day, in the morning and evening, preferably after a meal or snack.The drug should not be chewed but swallowed whole with water
• People taking this medicine can sometimes feel dizzy; they are advised not to drive or operate machinery to reduce potential risks.
• Aceclofenac should be taken with a lot of water to reduce abnormal irritation
• It should be taken as advised by a doctor
• It is generally well tolerated compared to naproxen although they are prescribed for similar conditions.

References
https://www.ncbi.nlm.nih.gov/pubmed/9132323
https://www.medicines.org.uk/emc/product/4240/smpc
https://www.medicines.org.uk/emc/files/pil.4240.pdf
https://www.drugs.com/uk/pdf/leaflet/1066475.pdf

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