Avonac Special Precautions

Severe cutaneous reactions, including Stevens- Johnson syndrome and toxic epidermal necrolysis (Lyell's syndrome), have been reported with diclofenac sodium. Patients treated with diclofenac sodium should be closely monitored for signs of hypersensitivity reactions.
Discontinue diclofenac sodium immediately if rash occurs.
Adverse effects: Dermatological: Occasional - rashes or skin eruptions.
Cases of hair loss, bullous eruptions, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), and photosensitivity reactions have been reported.
For the treatment of chronic disease: All patients who are receiving long-term treatment with NSAIDs should be monitored as a precautionary measure, e.g. renal, hepatic function (elevation of liver enzymes may occur) and blood counts.
Non-drug treatment should be considered.
For the treatment of acute disease: Treatment according to the pain and the level of fever.
Avoid using the same kind of drugs for a long time.
Notice the status of the patients if side effects are happened during the treatment.
Using carefully for: Severe hepatic or renal damage. Peptic ulceration of gastrointestinal bleeding. Asthma. Bronchospasm. Cardiovascular disease. Elderly.
Cardiovascular effects: Treatment with NSAIDs including diclofenac, particularly at high dose and in long term, may be associated with an increased risk of serious cardiovascular thrombotic events (including myocardial infarction and stroke).
Treatment with diclofenac is generally not recommended in patients with established cardiovascular disease (congestive heart failure, established ischemic heart disease, peripheral arterial disease) or uncontrolled hypertension. If needed, patients with established cardiovascular disease, uncontrolled hypertension, or significant risk factors for cardiovascular disease (e.g. hypertension, hyperlipidaemia, diabetes melilitus and smoking) should be treated with diclofenac only after careful consideration and only at doses ≥ 100 mg daily when treatment continues for more than 4 weeks.
As the cardiovascular risk of diclofenac may increase with dose and duration of exposure, the lowest effective daily dose should be used for the shortest duration possible. The patient's need for symptomatic relief and response to therapy should be re-evaluated periodically, especially when treatment continues for more than 4 weeks.
Patients should remain alert for the signs and symptoms of serious arteriothrombotic events (e.g. chest pain, shortness of breath, weakness, slurring of speech), which can occur without warnings. Patients should be instructed to see a physician immediately in case of such an event.
Effects on ability to drive and use machines: It is advisable not to drive or operate machinery if visual disturbances, headaches, dizziness or drowsiness occur while taking Diclofenac sodium.