May affect ability to drive & use machines. Not to be used in severe hepatic & moderate to severe renal dysfunction. May impair female fertility. Not recommended in women of childbearing potential. Not to be used during pregnancy & lactation. Not to be used in childn & adolescents. Elderly >75 yr. Dexketoprofen: Discontinue use at 1st appearance of skin rash, mucosal lesions or any other sign of hypersensitivity. Avoid use in patients w/ varicella infection. History of allergic conditions. Increased risk of GI bleeding, ulceration or perforation, history of GI disease; increased risk of nephrotoxicity; history of cardiac disease, uncontrolled HTN, CHF, established ischaemic heart disease, peripheral arterial & cerebrovascular disease; congenital disorder of porphyrin metabolism eg, acute intermittent porphyria; dehydration; directly after major surgery; asthma in combination w/ chronic rhinitis, sinusitis &/or nasal polyposis; haematopoietic disorders, SLE or mixed connective tissue disease. May mask symptoms of infectious diseases. Ensure adequate fluid intake during therapy. Avoid concomitant use w/ other NSAIDs including COX-2 selective inhibitors. Concomitant use w/ oral corticosteroids, anticoagulants, SSRIs or antiplatelets; diuretics. Tramadol HCl: Addicted patients, patients w/ head injury, shock, reduced level of consciousness of uncertain origin, resp centre or function disorders or increased ICP; opiate sensitivity; risk for resp depression including patients w/ substantially decreased resp reserve, hypoxia, hypercapnia or pre-existing resp depression. Increased risk of convulsions, seizures. Tolerance, psychic & physical addiction may develop during long-term use. CYP2D6 ultra rapid metabolisers. Concomitant use of sedatives eg, benzodiazepines or related drugs. Not recommended in childn w/ compromised resp function. Post-op pain relief in childn.
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