Dosage of Dexketoprofeno Neredal in details
Tablet: General Population: According to the nature and severity of pain, the recommended dosage is generally 12.5 mg every 4-6 hrs or 25 mg every 8 hrs. The total daily dose should not exceed 75 mg. Undesirable effects may be minimized by using the lowest effective dose for the shortest duration necessary to control symptoms.
Dexketoprofeno Neredal tablets are not intended for long-term use and the treatment must be limited to the symptomatic period.
Concomitant administration with food delays the absorption rate of the drug, thus in case of acute pain, it is recommended that administration is at least 30 min before meals.
Elderly: In elderly patients it is recommended to start the therapy at the lower end of the dosage range (50 mg total daily dose). The dosage may be increased to that recommended for the general population only after good general tolerance has been ascertained.
Hepatic Dysfunction: Patients with mild to moderate hepatic dysfunction should start therapy at reduced doses (50 mg total daily dose) and be closely monitored. Dexketoprofeno Neredal tablets should not be used in patients with severe hepatic dysfunction.
Renal Dysfunction: The initial dosage should be reduced to 50 mg total daily dose in patients with mildly impaired renal function. Dexketoprofeno Neredal tablets should not be used in patients with moderate to severe renal dysfunction.
Injection: Adults: The recommended dose is 50 mg every 8-12 hrs. If necessary, the administration can be repeated 6 hrs apart. The total daily dose should not exceed 150 mg.
Dexketoprofeno Neredal solution for injection or concentrate for solution for infusion is intended for short-term use and the treatment must be limited to the acute symptomatic period (not >2 days). Patients should be switched to an oral analgesic treatment when possible.
Undesirable effects may be minimized by using the lowest effective dose for the shortest duration necessary to control symptoms.
In case of moderate to severe postoperative pain, Dexketoprofeno Neredal solution for injection or concentrate for solution for infusion can be used in combination with opioid analgesics, if indicated, at the same recommended doses in adults.
Elderly: No dosage adjustment is generally necessary in elderly patients. However, because of the physiological decline in renal function in elderly patients a lower dose is recommended in case of mild renal function impairment: 50 mg total daily dose.
Liver Disease: The dosage should be reduced to 50 mg total daily dose in patients with mild to moderate (Child-Pugh score 5-9) hepatic impairment and hepatic function should be closely monitored. Dexketoprofeno Neredal solution for injection or concentrate for solution for infusion should not be used in patients with severe hepatic dysfunction (Child-Pugh score 10-15).
Renal Dysfunction: The dosage should be reduced to 50 mg total daily dose in patients with mildly impaired renal function (CrCl 50-80 mL/min). Dexketoprofeno Neredal solution for injection or concentrate for solution for infusion should not be used in patients with moderate to severe renal dysfunction (CrCl <50 mL/min).
Administration: Injection: Dexketoprofeno Neredal solution for injection or concentrate for solution for infusion can be administered either by IM or IV route:
Intramuscular Use: The content of 1 ampoule (2 mL) of Dexketoprofeno Neredal solution for injection or concentrate for solution for infusion should be administered by slow injection deep into the muscle.
Intravenous Use:
Intravenous Infusion: The diluted solution, should be administered as a slow IV infusion, lasting 10-30 min. The solution must be always protected from natural daylight.
Intravenous Bolus: If necessary, the content of 1 ampoule (2 mL) of Dexketoprofeno Neredal solution for injection or concentrate for solution for infusion can be administered in a slow IV bolus over no less than 15 sec.
Instructions on Handling: When Dexketoprofeno Neredal is administered IM or as IV bolus, the solution should be injected after its removal from the colored ampoule. For administration as IV infusion, the solution should be diluted aseptically and protected from natural daylight.
Dexketoprofeno Neredal interactions
The following interactions apply to NSAIDs in general: Inadvisable Combinations: Other NSAIDs, Including High Doses of Salicylates (≥3 g/day): Administration of several NSAIDs together may increase the risk of gastrointestinal ulcers and bleeding, via a synergistic effect.
Anticoagulants: NSAIDs may enhance the effects of anticoagulants eg, warfarin, due to the high plasma protein-binding of Dexketoprofeno Neredal and the inhibition of platelet function and damage to the gastroduodenal mucosa. If the combination cannot be avoided, close clinical observation and monitoring of laboratory values should be carried out.
Heparins: Increased risk of hemorrhage (due to the inhibition of platelet function and damage to the gastroduodenal mucosa). If the combination cannot be avoided, close clinical observation and monitoring of laboratory values should be carried out.
Corticosteroids: There is an increased risk of gastrointestinal ulceration or bleeding.
Lithium (Described with Several NSAIDs): NSAIDs increase blood lithium levels, which may reach toxic values (decreased renal excretion of lithium). This parameter therefore requires monitoring during the initiation, adjustment and withdrawal of treatment with Dexketoprofeno Neredal.
Methotrexate Used at High Doses of ≥15 mg/week: Increased hematological toxicity of methotrexate via a decrease in its renal clearance by anti-inflammatory agents in general.
Hydantoins and Sulphonamides: The toxic effects of these substances may be increased.
Combinations Requiring Precautions: Diuretics, Angiotensin-converting Enzyme (ACE) Inhibitors and Angiotensin II Receptor Antagonists: Dexketoprofeno Neredal may reduce the effect of diuretics and other antihypertensive drugs. In some patients with compromised renal function (eg, dehydrated or elderly patients with compromised renal function), the co-administration of agents that inhibit cyclooxygenase and ACE inhibitors or angiotensin II receptor antagonists may result in further deterioration of renal function, which is usually reversible. In case of combined prescription of Dexketoprofeno Neredal and a diuretic, it is essential to ensure that the patient is adequately hydrated and to monitor renal function at the start of the treatment.
Methotrexate Used at Low Doses <15 mg/week: Increased hematological toxicity of methotrexate via a decrease in its renal clearance by anti-inflammatory agents in general. Weekly monitoring of blood count during the 1st weeks of the combination. Increased surveillance in the presence of even mildly impaired renal function, as well as in the elderly.
Pentoxyfylline: Increased risk of bleeding. Intensify clinical monitoring and check bleeding time more often.
Zidovudine: Risk of increased red cell line toxicity via action on reticulocytes, with severe anemia occurring 1 week after the NSAID is started. Check complete blood count and reticulocyte count 1-2 weeks after starting treatment with the NSAID.
Sulfonylureas: NSAIDs can increase the hypoglycemic effect of sulfonylureas by displacement from plasma protein-binding sites.
Combinations Needing to be Taken Into Account: Beta-blockers: Treatment with an NSAID may decrease their antihypertensive effect via inhibition of prostaglandin synthesis.
Cyclosporin and Tacrolimus: Nephrotoxicity may be enhanced by NSAIDs via renal prostaglandin mediated effects. During combination therapy, renal function has to be measured.
Thrombolytics: Increased risk of bleeding.
Anti-platelet Agents and Selective Serotonin Reuptake Inhibitors (SSRIs): Increased risk of gastrointestinal bleeding.
Probenecid: Plasma concentrations of Dexketoprofeno Neredal may be increased; this interaction can be due to an inhibitory mechanism at the site of renal tubular secretion and of glucuronoconjugation and requires adjustment of the dose of Dexketoprofeno Neredal.
Cardiac Glycosides: NSAIDs may increase plasma glycoside concentration.
Mifepristone: Because of a theoretical risk that prostaglandin synthetase inhibitors may alter the efficacy of mifepristone, NSAIDs should not be used for 8-12 days after mifepristone administration.
Quinolone Antibiotics: Animal data indicate that high doses of quinolones in combination with NSAIDs can increase the risk of developing convulsions.
Incompatibilities: Injection: Dexketoprofeno Neredal solution for injection or concentrate for solution for infusion must not be mixed in a small volume (eg, in a syringe) with solutions of dopamine, promethazine, pentazocine, pethidine or hydroxyzine, as this will result in a precipitation of the solution.
The diluted solutions for infusion obtained as stated in Instructions for Use and Handling under Cautions for Usage, must not be mixed with promethazine or pentazocine.
Dexketoprofeno Neredal must not be mixed with other medicinal products except those mentioned in Instructions for Use and Handling under Cautions for Usage.
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Information checked by Dr. Sachin Kumar, MD Pharmacology
