📋 Indications & Clinical Dosage
*Pain and inflammation in osteoarthritis:*
Adult & Children above 16 yrs: 30 mg once daily, increased if necessary to 60 mg once daily.
*Pain and inflammation in rheumatoid arthritis, Ankylosing spondylitis:*
Adult & Children above 16 yrs: 60 mg once daily, increased if necessary to 90 mg once daily.
*Acute gout:*
Adult & Children above 16 yrs: 120 mg once daily for max. 8 days.
*Dental pain:*
Adult & Children above 16 yrs: 90 mg once daily; max 3 days.
⛔ Contraindications
Active or recurrent GI bleeding or ulceration, cerebrovascular disease, history of GI bleeding or GI perforation related to previous NSAID therapy, history of recurrent GI haemorrhage, ischaemic heart disease, heart failure, peripheral arterial disease, moderate to severe renal impairment, aspirin/anti-inflammatory induced allergy
⚠️ Precautions & Warnings
Renal, hepatic or cardiac impairment. GI disease, allergic disorders, avoid in acute porphyrias, coagulation defects, connective-tissue disorders, Crohns disease (may be exacerbated), elderly, oedema, risk factors for cardiovascular events, ulcerative colitis (may be exacerbated)
🔄 Drug Interactions
Oral anticoagulants, ACE inhibitors, angiotensin II antagonists, diuretics, other NSAIDs, cyclosporin, tacrolimus, lithium, methotrexate, digoxin, oral contraceptives, HRT, salbutamol, minoxidil, rifampicin.
⚠️ Adverse Reactions / Side Effects
Angioedema, blood disorders, bronchospasm, colitis, Crohns disease, depression, diarrhoea, dizziness, drowsiness, fluid retention, GI bleeding and ulceration, GI disturbances, haematuria, headache, hearing disturbances, hypersensitivity reactions, insomnia, nausea, nervousness, photosensitivity, raised blood pressure, rashes, renal failure (especially in patients with preexisting renal impairment), tinnitus, vertigo. Rare: hepatic damage, interstitial fibrosis associated with NSAIDs, Stevens-Johnson syndrome, toxic epidermal necrolysis, visual disturbances, local irritation with use of rectal suppositories
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated in pregnancy.
Lactation / Breastfeeding:
Contraindicated or not recommended.
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.