Precaution in patients with gastrointestinal disorders, a history suggestive of gastrointestinal ulceration, ulcerative colitis or crohn's disease.
Owing to the importance of prostaglandins in maintaining renal blood flow, particular caution is called for in patients with impaired cardiac or renal function, as well as in elderly patients, patients taking diuretics and patients with extracellular volume depletion of any aetiology, e.g. before or after major surgery. Monitoring of renal function is recommended as a precautionary measure if Zobid Injection is administered in such cases. There is normally a return to the pre-treatment state after discontinuation of Zobid Injection.
Like other NSAIDs, Zobid Injection increases the activity of one or more liver enzymes. It is therefore advisable as a precautionary measure to monitor hepatic function during prolonged treatment with Zobid Injection.
Zobid Injection should be discontinued if hepatic disorders persist or worsen, and if clinical signs or symptoms indicative of liver disease or other manifestations of hepatic dysfunction (e.g., eosinophilia, skin rash) occur. Hepatitis can occur without prodromal symptoms. Caution should be exercised when using Zobid Injection in patients with hepatic porphyria, because the substance may trigger an attack.
Blood counts are recommended during prolonged treatment with Zobid Injection as is the case with other NSAIDs.
Like other NSAIDs, Zobid Injection may trigger allergic reactions, including anaphylactic / anaphylactoid reactions even if the patient is receiving the preparation for the first time. 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. Patients who suffer from asthma, hayfever, nasal polyps or chronic airways' infection and patients with hypersensitivity to analgesic and rheumatism drugs of all types are threatened with asthma attacks when using Diclofenac Sodium (so-called analgesic intolerance, analgesic-induced asthma). Discontinue diclofenac sodium immediately if rash occurs.
Effects on the ability to drive or operate machineries: Patients experiencing dizziness or other disturbances of the central nervous system during treatment with Zobid Injection should not drive or operate machinery.
Use in Pregnancy: Diclofenac sodium should not be prescribed during pregnancy unless there is some compelling reason to do so. This applies particularly to the last 3 months of pregnancy (owing to the possibility of suppression of the uterine activity and/ or premature closure of the ductus arteriosus).
Use in Lactation: Because of the potential for serious adverse reactions in nursing infants from diclofenac, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Use in Elderly: Caution is indicated in elderly patients on fundamental medical grounds in particular. It is advisable for those who are either frail or low body weight to be given the lowest effective dose.