diclofenac and misoprostol, Arthrotec (cont.)

Pharmacy Author:
Medical and Pharmacy Editor:

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Tablets (diclofenac/misoprostol): Arthrotec 50 (50 mg/200 g), Arthrotec 75 (75 mg/200 g) .

STORAGE: The tablets should be kept at room temperature, 15-30 C (59-86 F).

PRESCRIBED FOR: Arthrotec is used for treating signs and symptoms of rheumatoid arthritis or osteoarthritis in patients at risk for developing ulcers and complications of ulcers due to NSAIDs.

DOSING: For osteoarthritis the recommended dose is Arthrotec 50 given three times daily. Patients who cannot tolerate this regimen may be treated with Arthrotec 50 or 75 twice daily. The recommended dose for treating rheumatoid arthritis is Arthrotec 50 given 3-4 times daily. If this regimen is not tolerated, Arthrotec 50 or 75 twice a day may be used. Administering Arthrotec twice daily is less effective for preventing ulcers. Taking Arthrotec with food may reduce stomach upset. It is recommended that Arthrotec not be taken with alcohol because of the increased risk for ulcers.

DRUG INTERACTIONS: (Please also see the drug information for diclofenac.) Diclofenac is generally used with caution in patients taking blood thinning medications (anticoagulants), such as warfarin (Coumadin), because of the increased risk of bleeding.

Patients taking lithium (Eskalith, Lithobid) can develop toxic blood levels of lithium because diclofenac may inhibit the elimination of lithium from the body by the kidney.

Side effects from methotrexate (Rheumatrex, Trexall) and cyclosporine also may be increased by diclofenac.

Diclofenac may reduce the effectiveness of blood pressure-lowering drugs. Since prostaglandins are important in the control of blood pressure.

Antacids reduce the absorption of misoprostol and may delay absorption of diclofenac. Magnesium-containing antacids worsen misoprostol-associated diarrhea. Therefore, Arthrotec should not be administered with magnesium-containing antacids.

Combining NSAIDs with angiotensin receptor blockers (for example, valsartan [Diovan], losartan [Cozaar], irbesartan [Avapro]) or angiotensin converting enzyme inhibitors (for example, enalapril [Vasotec], captopril [captopril]) in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.



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