Diclofenac, properties, how to use, side effects

Diclofenac ( diclofenac ) or medicines that are commonly known by the trade name Abu Rafi Mackinac ( Bufenac ),  the feed Abilene ( Difelene ), Mendoza Mackinac ( Dosanac ) or V. The Warren E. Thomas. The gel ( Voltaren emulgel ) is a drug in the group of nonsteroidal anti-inflammatory drugs (NSAIDs). And is one of the most frequently used drugs in our home With properties as a pain reliever with mild to moderate symptoms Help relieve menstrual pain Migraine headache Arthritis pain from causes such as rheumatoid arthritis Severe degeneration Chronic spinal inflammation, etc. ^[1]

Note : This drug is not for treating arthritis. They only help relieve symptoms. ^[8]

Example of diclofenac

Diclofenac drug(Common name) with trade names such as Ammivotara (Ammi – Votara), Amminac (Amminac), Antenac (Antenac), Arclonac (Arclonac), Buphynae. Bufenac, Cataflam, Catanac, Cencenac, Chinclona-50 (Chinclona-50), Chinclonac-25, Clofec gel, Covonac, D-Flam, Demac, Demac gel, diclo SR 100 (Diclo SR 100), diclofenac TO (Diclofenac TO), dicloflex, diclogel, diclogesic, dicloflex Diclosian, Diphenol (Difaren), Diphenene (Difelene), Dipylene gel, Difenac, Dipheno (Difeno), Diphen Difensic, Dinac, Dolonil SR 100 (Dolonil SR 100), Dosanac, Dosanac gel, Phenac. (Fenac), Fenacaine, Fenacil, Flexy gel, Inflamma-50 (Inflamma-50),Inflanac, Klyzen, Lesflam, Manfenac, Masaren, Myfenax, meonae Myonac, Myonac gel, N-ZEN gel, N-ZEN tab, Ostaren, Os Ostaren cream, Ostaren Injection, Pai-Noren, Painelief, Remethan, Ri Methan gel (Remethan gel), Rhumanol creamagel (Rhumanol creamagel), Sefnac, Sefnac gel, Tarjen, apply. Tarjena, Uniren, V-Therlen Patar, Vasalen, Veenac, Ventarone ), Vesconac, Vesconac Injection (Vesconac Injection), Volfen, Volnac, Voltanac, Voltanac. Taren (Voltaren), Voltaren emulgel (Voltaren emulgel), Voltaren of tha (Voltaren ophtha), Voren (Voren),Votamed, etc.

Diclofenac dosage form

• Tablets of 25 and 50 mg.
• Long-acting tablets of 75, 100 and 150 mg.
• 100 mg / 5 ml (1 teaspoon) syrup
• 75 mg / ampoule (3 ml) injection
• Rectal suppositories, 50 and 100 mg.
• Gel for topical application

NOTE : Diclofenac tablets are available in four forms: tablet, coated tablet, and enteric coated tablet. (Enteric-coated tablet) and long-acting tablets. (Extended-release tablet)

IMAGE SOURCE: buraphaosoth.com (Buphenac 25 mg, Buphenac Gel)

IMAGE SOURCE: www.doctor-9.com (50 mg red box diphylene, 1% diphenyl gel)

IMAGE SOURCE: okusurikan.com, www.mims.com (Dozanac 50mg, Dozanac Gel).

IMAGE SOURCE: pantip.com (by yodsri) (Voltaren Emulsel Gel)

Properties of diclofenac

1. It is used as a pain reliever for mild to moderate symptoms ^{[1], [6].}
2. Used to relieve migraine headache (Migraine), menstrual cramps. (Dysmenorrhea), toothache, pain and inflammation in bone disease, ureteral stone pain, pain in kidney and gallstone stones, pain after surgery and childbirth, acute pain with shock , Tenderness, pain and inflammation from the injury ^{[1], [3], [5], [6], [7]}
3. It is used as a pain reliever and anti-inflammatory from arthritic conditions such as rheumatoid arthritis, severe osteoarthritis. (Osteoarthritis), Chronic Ankylosing spondylitis, Bursitis, Gout ^{[1], [8].}
4. Used as a medicine to reduce inflammation of muscles and tendons, such as tendonitis. (Tendinitis), sprain joints (Sprain), etc. ^[8]
5. Currently, this drug has been developed as a topical gel in the form of a gel that is intended to be applied topically to relieve pain, swelling, inflammation from osteoarthritis. And from muscle, ligament and joint injuries such as muscle pain after playing sports or from sweating ^{[3], [7]}
6. Diclofenac can also be used as a fever reducer ^[3].
7. This medication may also be used to treat another medical condition or condition, if in doubt ask your doctor or pharmacist ^.

Mechanism of action of diclofenac

Diclofenac inhibits the production of protaglandin. (Prostaglandin) in the body, which is the lead to inflammation. By interrupting the activity of the enzyme cyclooxygenase (Cyclooxygenase) both type 1 (Cox-1) and type 2 (Cox-2), which are an integral part of the protaglandin synthesis process. This drug has anti-inflammatory properties of various tissues (especially inflammation of the joints, bones, pleura, pericardium), relieves pain, reduces fever, prevents and relieves menstrual pain. But at the same time, the drug inhibits the mechanism of mucus covering the epithelium in the stomach. As a result, the gastric mucosa becomes irritated by gastric juice and becomes a disease of Epe. (Gastric ulcer and duodenal ulcer) and gastric inflammation easily ^[1]

Before using diclofenac,

When prescribing all drugs, including diclofenac Here are some things to tell your doctor or pharmacist:

• A history of allergy to diclofenac, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and all other drugs, including allergies to other substances such as food, preservatives, or Colors and symptoms from drug or substance allergy, such as increased nausea, rash or tightness, rash or tightness, difficulty breathing / such as medication ^{, [3]}
• Various underlying diseases and prescription and over-the-counter medications Including dietary supplements, vitamins, and various herbal drugs that are currently or are currently being used. Because diclofenac may exacerbate the symptoms of the underlying disease. Or drug interactions with other drugs and / or other dietary supplements (In some cases, drugs that interact with the drug cannot be used together. But in some cases it may be necessary to use those two drugs together. Although there may be interactions between drugs that can occur In this case, the doctor may adjust the dosage or increase the caution when using it) ^{[2], [3], [8]} such as

• • Taking diclofenac with anticoagulants (Anticoagulants) such as Abciximab (Abciximab), Dicumarol (Dicumarol), Heparin (Heparin), Warfarin (Warfarin) drugs will synergistically and cause bleeding in Easy stomach
  • Taking diclofenac with a heart medication (Digitalis), such as digoxin, increases the effect of heart medication and can be toxic to the body. It may result in arrhythmia, nausea, vomiting, blurred vision.
  • Taking diclofenac with blood pressure medications such as Atenolol, Candesartan, Losartan, Metoprolol. ), Propranolol will decrease the antihypertensive effect of these drugs.
  • Taking diclofenac with antipsychotics such as lithium may increase the side effects of antipsychotics.
  • Taking diclofenac along with probenecid antacids increases the levels of diclofenac and has an increased chance of side effects.
  • Taking diclofenac with phenytoin may increase blood levels of both drugs.
  • Taking diclofenac drug together with drinking alcoholic beverages. It increases the risk of bleeding in the stomach and intestines.
  • Other drugs that may interact with these drugs include methotrexate. (Methotrexate), cyclosporine (Cyclosporine), antibiotic or bactericidal drug (such as Amikacin), Cephalospolin (Cephalospolin), cypophloxacin. Ciprofloxacin, Enoxacin, Gentamicin, Ketoconazole, Itraconazole, Levophloxacin. (Levofloxacin) norfloxacin (Norfloxacin) Ophloxacin (Ofloxacin) Streptomycin (Streptomycin), etc.), Antifungal drugs Fluconazole. (Fluconazole), diuretics (Diuretics drugs), ACE inhibitors antihypertensive drugs (such as Enalapril (Enalapril), Ramipril (Ramipril), etc.), Valproic acid seizures (Valproic acid)
• If being advised to eat a low-sodium or low-sugar diet This is because some drugs may contain sodium and sugar.
• Are people under the age of 18 or over 65, who drink more than 3 glasses of alcohol or alcohol a day, or who smoke.
• Having any of these conditions include stomach or intestinal problems (such as bleeding), stomach or intestinal ulcers, colitis. Inflammation of the small intestine Diverticulitis, viral infection (e.g. influenza, chickenpox), or have or have ever had fluid congestion (e.g. swelling of hands, arms, calves, feet or ankles), low platelet counts, white blood cell counts Low, have had a stroke, had liver disease, had or have had kidney disease, had kidney stones or had kidney stones, had vascular or heart problems, or had a circulatory condition Unusual, have or have had a history of bleeding easily, Anemia, Temporal arteritis, Diabetes, High blood pressure, Asthma (especially aspirin-induced asthma), Epilepsy, Allergy, SLE, Oral disease (Dental disease), Mental problems, Parkinson’s disease, Rhinitis, Have sores or white patches in the mouth (May indicate serious drug side effects), Porphyria, rectal irritation or bleeding from the anus, Hemorrhoids, Multiple rheumatoid arthritis Joint, Coronary bypass graft surgery has been done within 2 weeks before using the drug.^{[2], [4], [5], [8]}
• If it’s a lady Should report that there is a pregnancy Or are planning a pregnancy Or are breastfeeding This is because many drugs can pass through the placenta or milk and enter the baby, potentially causing adverse effects on the baby ^.

Contraindications / precautions for use of diclofenac

• Do not use this medication on people with a history of allergic reactions to diclofenac, aspirin, or non-steroidal anti-inflammatory drugs (NSAIDs), as this can cause a severe allergic reaction to the drug. Such as swollen eyes, an abnormally fast heartbeat Abnormal breathing, wheezing, fainting, discoloration of the face Swollen skin In which, if there are any of these symptoms, others should be taken to the hospital. (You should not drive yourself and keep your body warm by raising your feet higher than your head) ^[2]
• Do not take paracetamol. (Paracetamol) or aspirin (Aspirin) with diclofenac for more than 2-3 days and do not take it with ketorolac while taking this drug. Unless your doctor tells you to and see your doctor as scheduled ^[8]
• Do not use this drug in patients with epigastric ulcer disease. (Gastric ulcer and duodenal ulcer) ^[1] , people with heart disease or new heart surgery ^[3] , people with dengue fever
• Do not use this drug in patients with asthma, urticaria, colds, allergies who have experienced a relapse from aspirin or other drugs of this class ^.
• Do not use this medication in children under 2 years and in pregnant women in the second trimester of 2-3 ^{[1], [8]} because it may cause heart or circulatory disorders in the developing fetus. Blood can In addition, the use of this drug at the end of pregnancy has an effect on extending the pregnancy Lengthening labor or causing problems during labor (If there is a need for pain relievers Always choose paracetamol first) ^[2]
• Do not use this drug in a nursing woman. Because this drug can be passed out through milk. But if this drug is needed, stop breastfeeding ^[2].
• Do not share this drug with others and do not use expired medication.
• It is not recommended for use in children under 14 years of age because its effectiveness and safety are not known ^[1].
• Avoid using diclofenac with aspirin, steroid drugs, and alcoholic beverages. This may increase the risk of developing peptic ulcer disease ^[1].
• The unnecessary use of diclofenac injections, such as injections, should be avoided for general pain relief, mild joint pain. Because it is at risk of serious side effects, including bronchospasm (Bronchospasm), anaphylactic shock (Anaphylactic shock), anaphylactic shock. (Anaphylactoid) and infection of the muscles and tendons. (Myofasciitis) at the injection site. This can become severe, even bloody, toxic and dangerous ^[1].
• The use of this drug should be cautioned in patients with hemorrhagic disease (blood disease) and anticoagulants. (Anticoagulants) ^[1]
• Caution should be exercised in patients with cirrhosis, renal failure, heart failure ^[1] , high blood pressure. And the elderly This is because older adults are more likely to have drug side effects and their severity than younger adults. The side effects that may occur in the elderly are confusion, swelling of the face, feet or calf, stomach ulcers. A sudden drop in the amount of urine, etc. ^[2]
• This medicine may cause confusion, dizziness, lightheadedness, feeling light-headed, less dizzy, lethargic, or fainting, and possibly blurry or unusual vision. Therefore, while using this drug, it is best not to drive or operate machinery, as this could lead to an accident ^{[1], [8].}

How to use diclofenac?

1. For mild to moderate pain(pain) in adults, take 50 mg three times a day ^{[1], [6].}
2. For migraine headache(Migraine) in adults, take a single dose of 50 mg once when symptoms are present ^[6].
3. For menstrual pain (Dysmenorrhea) in adults, 50 mg orally three times a day ^{[1], [6].}
4. Forrheumatoid arthritis (Rheumatoid arthritis) in adults, take 150-200 mg of the drug per day, divided three to four times a day (maximum 225 mg per day). Satisfied The dose should be reduced to the lowest dose that can control symptoms. They are typically given 25 mg orally three times a day ^{[1], [2], [6].}
5. For severe osteoarthritis (Osteoarthritis) in adults: 100-150 mg / day, divided by 2-3 times a day (maximum 150 mg per day). After satisfactory results of treatment have been achieved. The dose should be reduced to the lowest dose that can still control symptoms ^{[1], [2], [6].}
6. Forankylosing spondylitis in adults, take 100-125 mg of the drug per day, divided by 2-4 times a day (up to 125 mg per day) after satisfactory results have been achieved. The dose should be reduced to the lowest dose that can still control symptoms ^{[1], [2], [6].}
7. For acute gout(Gout) in adults, take the first dose of 75-100 mg and continue taking 50 mg every 6-8 hours until symptoms resolve ^[1].
8. Forureteric stone pain in adults, use injectable drugs. Intramuscular injection, 1 ampoule (75 mg) at a time ^[1]
9. For the use of topical ointments for the treatment of pain, swelling, inflammation of the joints. And from injuries to muscles, ligaments and joints, apply 2-4 grams (sufficient for approximately 400-800 square centimeters of skin area) by applying 3-4 times a day, spreading over the affected area and massaging. Lightly medicate and wash your hands after applying the medication ^[7].

Note : The above oral dosage is for tablets, coated tablets and enteric-coated tablets. (Enteric-coated tablet) is not a long acting tablet size. (Extended-release tablet)

Instructions for use of diclofenac

• Take this drug with a glass of water (swallow the tablet whole Do not break, split or chew tablets), preferably with or after food. And to drink lots of water to reduce irritation in the stomach. You should not lie down for 15-30 minutes after taking the drug as it can irritate the upper digestive tract (eg the esophagus), which can cause problems with swallowing ^[2].
• When taking this drug, avoid drinking alcohol. Do not take NSAIDs, painkillers, or flu drugs that contain NSAIDs. And avoid bright sunlight ^[5] (Taking two or more NSAIDs together may increase the chance of side effects. As for the use of paracetamol, aspirin or ketorolac. While taking this drug, it may increase the chance of side effects. The risk depends on the number of drugs taken each day. And depending on how long the drug is taken together)
• Diclofenac is classified as a dangerous drug and has many side effects. Patients are therefore advised not to buy this drug for themselves. Also, the size used in children and adults for each symptom is different. Therefore, advice on the use of this medicine should only be obtained from a doctor or pharmacist.
• Patients should take this medication strictly as directed on the label or as directed by a physician. Always take your medication on time. And do not use less or more of the drug If in doubt, ask your doctor or pharmacist.
• The use of this drug in children is only at the discretion of a doctor. This is because there is information about the use of diclofenac in young children.
• Do not buy this drug to treat yourself for more than 1 week, if you have to use it for a long time, consult your doctor or pharmacist.
• If you need to take this medication for a long time, you should see your doctor as scheduled to monitor any side effects that may occur after using this medication ^[8] and should be taken to prevent ulceration. Patik ^{[1] for} example

• • Mara Dean (Ranitidine) for Dosage 300 mg 2 times a day.
  • Omega omeprazole (Omeprazole) for Dosage 20 mg 2 times a day.
  • Mizo Prosser Atholl (Misoprostol), the drug prostaglandin synthesis. Give each time 100-200 micrograms 4 times a day
  • Antacids (Antacids) for Dosage 30 ml per day, 7 times.
• If going to have surgery (Including oral surgery), tell your doctor or dentist that you are using this drug. Because the drug may slow blood clotting And there is an increased chance of bleeding during and after surgery. Sometimes it may be necessary to temporarily stop taking this drug or switch to another NSAIDs that cause less bleeding.
• If this medication has been used for extreme abdominal pain or cramping, abdominal pain or pain, burning in the stomach, black stools, severe or prolonged nausea, heartburn, indigestion or bloody vomiting. Or a color like coffee Stop using the drug and consult a doctor ^[8].
• During use of diclofenac if flu-like symptoms such as fever, chills, muscle aches occur. In combination with rash Should seek immediate medical attention to the hospital ^[8]

How do i store Diclofenac?

• Keep this medication in the original container it came in, tightly closed, and kept out of the reach of children and pets.
• This drug should be stored at room temperature. Keep the drug away from direct sunlight and heat. Keep the medication away from hot temperatures above 30 ° C and do not store the medication in wet or humid areas (such as in the bathroom, freezer of the refrigerator), as heat or humidity can cause deterioration of the drug.
• Discard any drug that is worn out or has expired.

When forgetting to take diclofenac

If forgetting to take diclofenac To take the medicine as soon as possible But if it is close to the next meal You can skip taking the next pill straight away. Without increasing the dose twice or more than usual

Side effects of diclofenac

• The main side effect of this drug is that it may cause peptic ulcer and gastritis, especially in the elderly. Which may cause bleeding (Vomiting blood or black stools) or perforation of the stomach ^[1]
• It can cause headache, dizziness, blurred vision, ringing in your ears, nausea, vomiting, drowsiness, weakness, abdominal pain, constipation or diarrhea. Hepatitis or liver enzymes (AST, ALT) elevated, recurrent allergy. Low white blood cells Low blood platelets Anemia from bone marrow atrophy ^[1]
• อาจทำให้ร่างกายคั่งน้ำ (Fluid retention) ทำให้มือเท้าบวม ความดันโลหิตสูงได้ และอาจทำให้ผู้ที่มีภาวะหัวใจวายเกิดอาการกำเริบได้^[1]
• อาจทำให้เกิดภาวะไตวายเรื้อรังได้ หากใช้ยานี้ติดต่อกันเป็นเวลานาน^[1] นอกจากนี้การใช้ยาในกลุ่มเอ็นเสด (NSAIDs) ซึ่งรวมถึงยาไดโคลฟีแนค จะเป็นการเพิ่มความเสี่ยงต่อการเกิดโรคกล้ามเนื้อหัวใจขาดเลือด และโรคหลอดเลือดสมอง ซึ่งความเสี่ยงนี้จะเพิ่มขึ้นเมื่อใช้ยาเป็นเวลานาน และยังมีปัจจัยเสี่ยงต่อการเกิดโรคหัวใจและหลอดเลือดอีกด้วย^[5]
• ถ้าใช้ยานี้ในขนาดสูง อาจยับยั้งการจับตัวของเกล็ดเลือด ทำให้เลือดออกได้ จึงควรระมัดระวังการใช้ยานี้ในผู้ป่วยที่มีภาวะเลือดออกง่าย (โรคเลือด) และผู้ป่วยที่ใช้ยาต้านการแข็งตัวของเลือด^[1]
• อาจทำให้เกิดอาการแพ้ยา เป็นลมพิษ ผื่นคัน หอบหืด กลุ่มอาการสตีเวนส์จอห์นสัน (Stevens-Johnson syndrome) ภาวะช็อกจากการแพ้ (Anaphylactic shock)^[1]
• อาจเกิดภาวะช็อกจากปฏิกิริยาอะนาไฟแล็กทอยด์ (Anaphylactoid) ในผู้ที่ใช้ยานี้เป็นครั้งแรก^[1]
• อาจทำให้เกิดโรคภูมิแพ้ชนิดรุนแรง (Anaphylaxis) แม้ว่าจะพบได้น้อยมากแต่ก็อาจเกิดขึ้นได้ในผู้ป่วยที่เคยมีประวัติแพ้ยาแอสไพริน (Aspirin) หรือยาต้านการอักเสบที่ไม่ใช่สเตียรอยด์ (NSAIDs) ซึ่งจะทำให้ผู้ป่วยมีอาการหายใจเร็วมากและผิดปกติ อ้าปากหายใจหอบ หายใจเข้ามีเสียงหวีด หรือเป็นลม อาการเตือนอื่น ๆ เช่น สีผิวของใบหน้าเปลี่ยนแปลง ชีพจรเต้นเร็วและผิดปกติ ผิวหนังบวมมีลักษณะคล้ายรังผึ้ง และหนังตาหรือรอบ ๆ ตาบวมหรือพอง ถ้ามีอาการเหล่านี้เกิดขึ้น ต้องรีบได้รับการรักษาอย่างเร่งด่วน^[8]
• ผู้ป่วยบางรายที่ใช้ยาไดโคลฟีแนคอาจไวต่อแสงมากกว่าปกติ ซึ่งการสัมผัสแสงแดดเพียงไม่นานก็อาจเป็นสาเหตุทำให้เกิดผิวหนังไหม้เกรียมผิดปกติ เกิดถุงน้ำใต้ผิวหนัง เกิดผื่น แดง คัน หรือสีซีดจางลงได้ (ควรหลีกเลี่ยงการสัมผัสแสงแดดโดยตรง โดยเฉพาะแสงแดดในช่วงเวลา 10.00-15.00 น. สวมเสื้อผ้าปกปิดผิวหนัง และหมั่นทาครีมกันแดดเป็นประจำ โดยเฉพาะในรายที่มีผิวบอบบาง)^[8]

• ผลข้างเคียงที่อาจเกิดขึ้นได้โดยไม่จำเป็นต้องได้รับการรักษา เนื่องจากร่างกายจะปรับตัวเข้ากับยาได้เอง แต่หากมีอาการดังกล่าวติดต่อกันเป็นเวลานานควรปรึกษาแพทย์ ซึ่งอาการที่พบบ่อย ได้แก่ ปวดศีรษะเล็กน้อยถึงปานกลาง, วิงเวียนศีรษะ, เซื่องซึมหรือง่วงนอน, รู้สึกหวิว ๆ, แสบยอดอก, อาหารไม่ย่อย, คลื่นไส้หรืออาเจียน, ปวดเกร็งหรือไม่สบายท้องหรือกระเพาะอาหารในระดับเล็กน้อยถึงปานกลาง ส่วนอาการที่พบได้น้อย^[2],[8] ได้แก่

• • กระวนกระวาย, ควบคุมตัวเองไม่ได้, สั่น, กระตุก, มีปัญหาเรื่องการนอนหลับ, ระคายเคืองทวารหนัก (โดยเฉพาะเมื่อใช้ยาในรูปแบบเหน็บทวาร)
  • หน้าแดง, รู้สึกเหมือนไม่สบาย, ตาทนแสงไม่ได้, ปากแห้ง ระคายเคืองหรือเจ็บ, ผิวหนังไวต่อแสงแดด, เหงื่อออกมากขึ้น, หัวใจเต้นเร็วหรือแรง
  • การรับรสเปลี่ยนไปหรือรู้สึกขมปาก, ไม่อยากอาหาร, มีลมในกระเพาะอาหาร, ท้องผูก
  • น้ำหนักตัวลดลงโดยไม่ทราบสาเหตุ, มีอาการเหนื่อยล้า อ่อนแรงผิดปกติโดยไม่มีอาการอื่นร่วมด้วย
• ผลข้างเคียงที่ควรไปพบแพทย์ทันที อาการที่พบได้บ่อย คือ มีผื่นขึ้นที่ผิวหนัง ส่วนอาการที่พบได้น้อยมีหลากหลายอาการ^[8] ได้แก่

• • Severe headache, throbbing headache, confusion, forgetfulness, depression or mood changes, hallucinations, seeing, hearing or feeling things that do not exist, stiff neck or back.
  • Eye pain, irritation, dry eyes, red and swollen eyes, blurred vision, or vision problems
  • Decreased hearing or other hearing impairment, such as a ringing or buzzing sound in the ear
  • High blood pressure, tongue irritation, pale stools
  • Feeling of burning in the throat, chest and stomach, trouble swallowing, coughing
  • Bladder pain, bloody or cloudy urine Or problems with urination, such as incontinence, difficulty urinating, burning pain when urinating The amount of urine is very high or low, abnormal, etc.
  • Excessive bleeding from the vagina for no reason
  • Have fatigue Unusual fatigue, jaundice, yellow eyes
  • The skin is itchy or swollen like a honeycomb Including various skin disorders such as red cyst, change in color, stiffness, burning pain, pale skin, thick, or scarring.
  • Bleeding or sore lips, bleeding from a knife cut Or abrasions that are unusually long
  • Faded or split nails, muscle pain. Muscle weakness, severe lower back or side pain, no hands and feet feeling. It felt like a needle. Pain or weakness, stiff and / or swollen upper stomach, swollen tongue and mouth, swollen and sore glands. In particular, the glands of the neck, constant thirst, difficulty speaking, runny nose or sneezing for no reason.
• Side effects that should be stopped and see your doctor immediately (rare) ^[8] include:
• • Nausea, chest pain and / or persistent indigestion, abdominal pain, abdominal cramps, severe burning pain in the stomach, bloody or black stools
  • Seizures, fever, and with or without chills
  • Pinhead-like red spots on the skin, sore pain, or white spots on the lips or mouth
  • Elevated blood pressure, vomiting bloody or coffee-colored, unexplained bleeding from the nose, bleeding, or unusual bruising.
• Side effects that should stop using the drug and get immediate help from the emergency department. (Very rare) include large facial honeycomb swelling, swollen eyelids around the eyes, mouth and tongue, rapid or irregular breathing, fast or irregular heartbeat, shortness of breath, difficulty breathing, wheezing, chest tightness. , Fainting