Dexak 50

Leaflet attached to the packaging: information for the user

Warning! The leaflet should be kept. Information on the immediate packaging in a foreign language.

Dexak 50 (Viaxal)

50 mg/2 ml
solution for injection/infusion
Dexketoprofen
Dexak 50 and Viaxal are different trade names for the same medicine.

You should carefully read the contents of the leaflet before using the medicine because it contains important information for the patient.

• You should keep this leaflet so that you can read it again if you need to.
• If you have any doubts, you should consult a doctor or pharmacist.
• This medicine has been prescribed to a specific person. It should not be given to others. The medicine may harm another person, even if the symptoms of their illness are the same.
• If the patient experiences any side effects, including any side effects not listed in this leaflet, they should tell their doctor, pharmacist, or nurse. See section 4.

Table of contents of the leaflet:

• 1. What is Dexak 50 and what is it used for
• 2. Important information before using Dexak 50
• 3. How to use Dexak 50
• 4. Possible side effects
• 5. How to store Dexak 50
• 6. Contents of the packaging and other information

1. What is Dexak 50 and what is it used for

Dexak 50 is a pain reliever belonging to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).
It is used for the symptomatic treatment of moderate and severe acute pain when oral administration is not appropriate, e.g. post-operative pain, pain in renal colic, and pain in the lumbar-sacral area.

2. Important information before using Dexak 50

When not to use Dexak 50:

• If the patient is allergic to dexketoprofen or any of the other ingredients of this medicine (listed in section 6);
• If the patient is allergic to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (NSAIDs);
• If the patient has asthma or has had asthma attacks in the past, acute allergic rhinitis (short-term inflammation of the nasal lining), nasal polyps (growths in the nose caused by allergy), hives (blistering rash), or angioedema (swelling of the face, eyes, lips, tongue, or respiratory distress) after taking acetylsalicylic acid or another NSAID;
• If the patient has had hypersensitivity reactions to sunlight: photoallergic or phototoxic reactions (in particular, redness and/or blisters on the skin exposed to the sun) while taking ketoprofen (a non-steroidal anti-inflammatory drug) or fibrates (drugs used to lower blood lipid levels);

(non-steroidal anti-inflammatory drug) or fibrates (drugs used to lower blood lipid levels);

• If the patient has stomach or duodenal ulcer disease or gastrointestinal bleeding or if they have had gastrointestinal bleeding, ulceration, or perforation in the past;
• If the patient has certain chronic gastrointestinal diseases (e.g. indigestion, heartburn);
• If the patient has had gastrointestinal bleeding or perforation due to the use of NSAID pain relievers;
• If the patient has intestinal diseases with chronic inflammation (Crohn's disease or ulcerative colitis);
• If the patient has severe heart failure, moderate or severe kidney failure, or severe liver failure;
• If the patient has a tendency to bleed excessively or has bleeding disorders;
• If the patient is severely dehydrated (excessive fluid loss from the body) due to vomiting, diarrhea, or inadequate fluid intake;
• If the patient is in the third trimester of pregnancy or breastfeeding.

Warnings and precautions

Before starting to take Dexak 50, you should discuss it with your doctor or pharmacist:

• If the patient has had chronic inflammatory bowel disease (ulcerative colitis, Crohn's disease) in the past;
• If the patient has other stomach or intestinal diseases;
• If the patient is taking other medicines that increase the risk of stomach ulcers and (or) duodenal ulcers or gastrointestinal bleeding, such as oral steroids, certain antidepressants (SSRI drugs, e.g. serotonin reuptake inhibitors), or anticoagulant drugs such as acetylsalicylic acid or warfarin. In such cases, the doctor may decide to administer an additional protective medicine (e.g. misoprostol or drugs that inhibit stomach acid production);
• If the patient has heart problems, has had a stroke, or is at risk of these conditions (e.g. due to high blood pressure, diabetes, high cholesterol, or smoking). In such cases, the doctor should be consulted before taking Dexak 50. Taking such medicines as Dexak 50 may be associated with a small increased risk of heart attack (myocardial infarction) or stroke. This risk increases with long-term use of high doses of the medicine. Higher doses and longer treatment periods than recommended should not be used;
• If the patient is elderly: there is an increased risk of side effects (see section 4). In this case, the doctor should be contacted immediately;
• If the patient has an allergy or has had allergy problems in the past;
• If the patient has kidney, liver, or heart problems (hypertension and (or) heart failure), as well as fluid retention or if any of these problems have occurred in the patient in the past;
• In patients taking diuretics or in patients with decreased hydration and reduced blood volume due to excessive fluid loss (e.g. frequent urination, diarrhea, or vomiting);
• In women with fertility problems or undergoing infertility tests (Dexak 50 may affect female fertility and is not recommended for women planning pregnancy or undergoing fertility treatment);
• In women in the first and second trimester of pregnancy;
• If the patient has blood disorders or blood cell problems;
• If the patient has systemic lupus erythematosus or mixed connective tissue disease (immune system disorders affecting connective tissue);
• If the patient has an infection - see below, section entitled "Infections";
• If the patient has asthma and chronic rhinitis, chronic sinusitis, and (or) nasal polyps, the risk of hypersensitivity to acetylsalicylic acid and (or) NSAIDs is higher than in the rest of the population. Administration of this medicine may cause asthma attacks or bronchospasm, especially in patients with hypersensitivity to acetylsalicylic acid and (or) NSAIDs.

Infections

Dexak 50 may mask the symptoms of infection, such as fever and pain. Therefore, Dexak 50 may delay the use of appropriate infection treatment and consequently lead to increased risk of complications. This has been observed in bacterial pneumonia and bacterial skin infections related to chickenpox. If the patient is taking this medicine during an infection and the symptoms of the infection persist or worsen, they should consult their doctor immediately.
It is recommended to avoid using this medicine during chickenpox.

Children and adolescents

The use of this medicine in children and adolescents has not been studied. The safety and efficacy of this medicine have not been established, and therefore, it should not be used in children and adolescents.

Dexak 50 and other medicines

The patient should tell their doctor about all medicines they are currently taking or have recently taken, as well as any medicines they plan to take.
Certain medicines should not be taken at the same time as Dexak 50, and in the case of other medicines, the dose may need to be changed due to concurrent use of Dexak 50.
The patient should always inform their doctor, dentist, or pharmacist if they are taking any of the following medicines with Dexak 50:

• Concomitant use is not recommended:
• Acetylsalicylic acid, corticosteroids, or other anti-inflammatory drugs.
• Warfarin, heparin, or other anticoagulant drugs.
• Lithium used to treat certain mood disorders.
• Methotrexate (anticancer or immunosuppressive drug) used in high doses of 15 mg per week.
• Hydantoin derivatives and phenytoin used to treat epilepsy.
• Sulfamethoxazole used to treat bacterial infections.
• Concomitant use requiring caution:
• ACE inhibitors, diuretics, and angiotensin II antagonists used to treat high blood pressure and heart disease.
• Pentoxifylline and oxypentifylline used to treat ulcers in chronic venous insufficiency.
• Zidovudine used to treat viral infections.
• Aminoglycoside antibiotics used to treat bacterial infections.
• Sulfonylurea derivatives (chlorpropamide and glibenclamide) used to treat diabetes.
• Methotrexate used in low doses, below 15 mg per week.
• Concomitant use requiring special consideration:
• Quinolone antibiotics (e.g. ciprofloxacin, levofloxacin) used to treat bacterial infections.
• Cyclosporine and tacrolimus used to treat immune system diseases and in transplants.
• Streptokinase and other thrombolytic or fibrinolytic drugs, i.e. drugs used to dissolve clots.
• Probenecid used to treat gout.
• Digoxin used to treat chronic heart failure.
• Mifepristone used as an abortifacient (to induce abortion).
• Antidepressant drugs from the group of selective serotonin reuptake inhibitors (SSRIs).
• Antiplatelet drugs used to reduce platelet aggregation and blood clot formation.
• Beta-adrenergic blockers used to treat high blood pressure and heart disease.
• Tenofovir, deferasirox, pemetrexed.

In case of any doubts related to the use of Dexak 50, the patient should consult their doctor or pharmacist.

Pregnancy, breastfeeding, and fertility

Dexak 50 should not be used in the last three months of pregnancy or during breastfeeding.
If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a baby, they should consult their doctor, as the use of Dexak 50 may be inappropriate in this situation.
Women who are pregnant or planning to become pregnant should avoid using this medicine. The use of the medicine during pregnancy should only be done under the doctor's recommendation.
Dexak 50 is not recommended for women planning pregnancy or undergoing fertility treatment. Information on potential fertility effects can also be found in section 2, "Warnings and precautions".

Driving and using machines

Dexak 50 may cause dizziness and drowsiness, and therefore may have a minor influence on the ability to drive vehicles and operate machinery. If such symptoms are observed, the patient should not drive vehicles or operate machinery until the symptoms have resolved. In case of doubts, the patient should consult their doctor.

Dexak 50 contains ethanol and sodium

Each ampoule of the medicinal product Dexak 50 contains 12.35% ethanol (alcohol) by volume, i.e. up to 200 mg per dose, which is equivalent to 5 ml of beer or 2.08 ml of wine per dose.
This may be harmful to individuals with alcohol dependence.
This should be taken into account in pregnant women, breastfeeding women, children, and high-risk groups such as patients with liver disease or epilepsy.
This medicinal product contains less than 1 mmol of sodium (23 mg) per dose, which means it can be considered "sodium-free".

3. How to use Dexak 50

This medicine should always be taken according to the doctor's or pharmacist's recommendations. In case of doubts, the patient should consult their doctor or pharmacist.
The smallest effective dose should be used for the shortest period necessary to alleviate the symptoms. If the symptoms of an infection (such as fever and pain) persist or worsen during treatment, the patient should consult their doctor immediately (see section 2).
The doctor will inform the patient about the dose of Dexak 50, which will depend on the type, severity, and duration of the symptoms in the patient. The recommended dose is 50 mg of dexketoprofen (1 ampoule of Dexak 50) at intervals of 8 to 12 hours. If necessary, the dose can be repeated after 6 hours. The maximum daily dose should not be exceeded, which is 150 mg of dexketoprofen (3 ampoules of Dexak 50).
Dexak 50 is intended for short-term use and should only be used in the acute phase of pain (for no more than 2 days). The doctor will use oral pain relievers when possible.
In elderly patients with kidney failure and in patients with kidney or liver disorders, the dose should not exceed 50 mg of Dexak 50 per day (which corresponds to 1 ampoule of the medicine).

Method of administration:

The medicine can be administered intramuscularly (injected into a muscle) or intravenously (injected into a vein). A detailed description of intravenous administration can be found in section 7.
When administering Dexak 50 intramuscularly, the solution should be injected immediately after opening the ampoule, by slow injection deep into the muscle.
Only clear and colorless solutions should be used.
Children and adolescents
Do not use in children and adolescents under 18 years of age.

Overdose of Dexak 50

In case of suspected overdose, the patient should inform their doctor or pharmacist or go to the emergency department of the nearest hospital. The patient should remember to take the medicine packaging or patient leaflet with them.

Missed dose of Dexak 50

The patient should not take a double dose to make up for a missed dose. The next dose should be taken according to the dosing schedule (see section 3, "How to use Dexak 50").
In case of any further doubts related to the use of this medicine, the patient should consult their doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.
Possible side effects are listed below and are grouped according to their frequency of occurrence.

Common side effects (may affect up to 1 in 10 people):

Nausea and (or) vomiting, pain at the injection site, reactions at the injection site, e.g. inflammation, bruising, or bleeding.

Uncommon side effects (may affect up to 1 in 100 people):

Vomiting blood, low blood pressure, fever, blurred vision, dizziness (of vestibular origin), drowsiness, sleep disorders, headache, anemia, abdominal pain, constipation, indigestion, diarrhea, dry mouth, facial flushing, rash, skin inflammation, itching, increased sweating, fatigue, pain, feeling of cold.

Rare side effects (may affect up to 1 in 1,000 people):

Stomach ulcers, gastrointestinal bleeding, or perforation, high blood pressure, fainting, slow breathing rate, superficial vein inflammation due to blood clot (thrombophlebitis), irregular heartbeat (extrasystoles), rapid heartbeat, swelling of limbs, throat swelling, abnormal sensations, feeling of increased body temperature, and tremors, ringing in the ears (tinnitus), itchy rash, jaundice, acne, back pain, kidney pain, increased urination, menstrual disorders, benign prostatic hyperplasia, muscle stiffness, joint stiffness, muscle cramps, abnormal liver function tests (blood tests), high blood sugar levels (hyperglycemia), low blood sugar levels (hypoglycemia), high levels of certain fats in the blood (hypertriglyceridemia), increased excretion of ketone bodies (ketonuria) or protein (proteinuria) in the urine, liver cell damage (hepatitis), acute kidney failure.

Very rare side effects (may affect up to 1 in 10,000 people):

Anaphylactic reactions (acute hypersensitivity reactions that can lead to anaphylactic shock), skin ulcers, ulcers of the lips, eyes, and genital areas (Stevens-Johnson syndrome and Lyell's syndrome), facial swelling or swelling of the lips and throat (angioedema), shortness of breath due to bronchospasm, shortness of breath, pancreatitis, hypersensitivity reactions of the skin and hypersensitivity to sunlight, kidney damage, decreased white blood cell count (neutropenia), decreased platelet count (thrombocytopenia).
The patient should inform their doctor if they notice any side effects, especially those related to the stomach or intestines (e.g. stomach pain, heartburn, or bleeding), if they have had similar side effects in the past due to long-term use of anti-inflammatory drugs, especially in elderly patients.
If a skin rash or any mucous membrane lesions (e.g. in the mouth) or any symptoms of allergy occur, the patient should immediately consult their doctor, who will discontinue treatment with Dexak 50 without delay.
When using non-steroidal anti-inflammatory drugs, fluid retention and swelling (especially of the ankles and feet), increased blood pressure, and heart failure may occur.
Taking such medicines as Dexak 50 may be associated with a small increased risk of heart attack (myocardial infarction) or cerebrovascular events (stroke).
In patients with systemic lupus erythematosus or mixed connective tissue disease (immune system disorders affecting connective tissue), the use of anti-inflammatory drugs may rarely cause fever, headache, and neck stiffness.
The most commonly observed side effects were related to the stomach and intestines. Especially in elderly patients, stomach ulcers, perforation, or gastrointestinal bleeding may occur, in some cases with fatal outcomes.
After the use of the medicine, the following were observed: nausea, vomiting, diarrhea, bloating, constipation, indigestion, abdominal pain, black stools, bloody vomiting, ulcerative stomatitis, exacerbation of ulcerative colitis, and Crohn's disease. Less frequently, stomach inflammation was observed.
As with other NSAIDs, aseptic meningitis may occur, mainly in patients with systemic lupus erythematosus or mixed connective tissue disease, and hematologic reactions (thrombocytopenic purpura, aplastic anemia, and hemolytic anemia, rarely agranulocytosis, and bone marrow failure) may occur.
The patient should immediately inform their doctor if they experience symptoms of infection or worsening of their condition while taking Dexak 50.

Reporting side effects

If side effects occur, including any side effects not listed in the leaflet, the patient should tell their doctor, pharmacist, or nurse. Side effects can be reported directly to the Department of Adverse Reaction Monitoring of Medicinal Products, Medical Devices, and Biocides
Al. Jerozolimskie 181C
02-222 Warsaw
Phone: +48 22 49 21 301
Fax: +48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl
Reporting side effects will help gather more information on the safety of the medicine.

5. How to store Dexak 50

The medicine should be stored out of sight and reach of children!
Do not use this medicine after the expiry date stated on the carton and ampoule.
The expiry date refers to the last day of the month stated.
Ampoules should be stored in the outer packaging to protect them from light. This medicine should not be used if the solution is not clear and colorless and signs of contamination are visible (e.g. particles). Dexak 50 solution for injection or infusion is intended for single use only and should be used immediately after opening. Unused solution should be discarded (see "Disposal" below).
Medicines should not be disposed of via wastewater or household waste. The patient should ask their pharmacist how to dispose of medicines that are no longer needed and how to handle used needles and syringes. This will help protect the environment.

6. Contents of the packaging and other information

What Dexak 50 contains

• The active substance of the medicine is dexketoprofen (in the form of dexketoprofen trometamol). Each ampoule contains 50 mg of dexketoprofen.
• Other ingredients are: alcohol (96% ethanol, see section 2, Dexak 50 contains ethanol and sodium), sodium chloride, sodium hydroxide, and water for injections.

What Dexak 50 looks like and contents of the packaging

Dexak 50 is a solution for injection or infusion. The packaging contains 5 ampoules made of brown glass (type I), in a blister pack, in a cardboard box, each containing 2 ml of a clear and colorless solution.
For more detailed information, the patient should contact the marketing authorization holder or parallel importer.

Marketing authorization holder in Greece, the country of export:

Laboratorios Menarini SA
Alfonso XII, 587
08918 Badalona, Spain

Manufacturer:

• A. Menarini Manufacturing Logistics and Services Srl Via Sette Santi 3, 50131 Florence, Italy

Alfasigma S.p.A.
Via Enrico Fermi, 1, 65020 Alanno (Pescara), Italy

Parallel importer:

Delfarma Sp. z o.o.
ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź

Repackaged by:

Delfarma Sp. z o.o.
ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź
Marketing authorization number in Greece, the country of export: 58337/12-9-2008

Parallel import authorization number: 381/21

This medicinal product is authorized in the Member States of the European Economic Area under the following names:
Spain (RMS), Austria, Belgium, Denmark, Finland, France, Iceland, Italy, Luxembourg, Norway, Portugal, Sweden: Ketesse
Cyprus, Greece: Nosatel
Austria, Czech Republic: Dexoket
Estonia, Latvia, Lithuania: Dolmen
Germany: Sympal
Hungary: Ketodex forte
Ireland, Malta: Keral
Poland: Dexak 50
Slovakia: Dexadol
Slovenia: Menadex
Netherlands: Stadium
Date of leaflet approval:21.06.2022
[Information about the trademark]

7. Information intended for healthcare professionals only

Intravenous administration:

Intravenous infusion:the contents of 1 ampoule (2 ml) of Dexak 50 should be diluted in a volume of 30 ml to 100 ml of sodium chloride solution, 5% glucose solution, or Ringer's solution.
The diluted solution should be administered as a slow intravenous infusion over a period of 10 minutes to 30 minutes. The solution should always be protected from daylight.
Intravenous bolus:if necessary, the contents of 1 ampoule (2 ml) of Dexak 50 can be administered as a slow intravenous bolus over a period of not less than 15 seconds.

Due to the ethanol content, Dexak 50 should not be administered directly into the spinal canal (intrathecally or epidurally).

Instructions for handling the medicinal product:

When administering Dexak 50 as an intravenous bolus, the solution should be injected immediately after withdrawal from the colored ampoule.
When administered as an intravenous infusion, the solution should be diluted under aseptic conditions and protected from daylight.
Only clear and colorless solutions should be used.

Compatibility information:

It has been shown that Dexak 50 is compatible when mixed (e.g. in a syringe) with heparin, lidocaine, morphine, and theophylline injection solutions.
The diluted solution is a clear solution. Dexak 50 diluted of normal saline or glucose solution is compatible with the following medicines in injection solutions: dopamine, heparin, hydroxyzine, lidocaine, morphine, pethidine, and theophylline.
No absorption of the active substance was observed when diluted solutions of Dexak 50 were stored in plastic bags or infusion devices made of ethyl vinyl acetate (EVA), cellulose propionate (CP), low-density polyethylene (LDPE), or polyvinyl chloride (PVC).