Diclac 150 Duo

Leaflet attached to the packaging: information for the user

Warning! Keep the leaflet! Information on the immediate packaging in a foreign language.

Diclac 150 Duo (Diclac ID 150 mg), 150 mg, tablets with modified release

Diclofenac sodium
Diclac 150 Duo and Diclac ID 150 mg are different trade names for the same medicine.

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

• You should keep this leaflet, so that you can read it again if necessary.
• In case of 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 or pharmacist. See section 4.

Table of contents of the leaflet

• 1. What is Diclac 150 Duo and what is it used for
• 2. Important information before using Diclac 150 Duo
• 3. How to use Diclac 150 Duo
• 4. Possible side effects
• 5. How to store Diclac 150 Duo
• 6. Contents of the packaging and other information

1. What is Diclac 150 Duo and what is it used for

Diclac 150 Duo contains diclofenac sodium, which belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs), with anti-rheumatic, anti-inflammatory, analgesic, and antipyretic properties. The mechanism of action of Diclac 150 Duo involves the inhibition of prostaglandin biosynthesis, which plays a fundamental role in the pathogenesis of inflammation, pain, and fever.
Diclac 150 Duo is used to treat:

• inflammatory or degenerative forms of rheumatic disease: rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, psoriatic arthritis, spondyloarthritis, and extra-articular rheumatism;
• pains caused by post-traumatic and post-operative inflammatory conditions and edema, e.g., after dental or orthopedic procedures;
• painful and/or inflammatory conditions in gynecology, e.g., primary dysmenorrhea or adnexitis.

Control tests during the use of Diclac 150 Duo

In patients with diagnosed heart disease or significant risk factors for cardiovascular disease, the doctor will periodically assess the patient's need for symptomatic treatment and their response to the medicine, especially if the treatment lasts longer than 4 weeks.
During treatment, the doctor will order regular blood tests to monitor liver function (aminotransferase activity), kidney function (creatinine levels), and blood cell count (white and red blood cells and platelets). Based on the test results, the doctor will decide whether to discontinue treatment with Diclac 150 Duo or change the dose of the medicine.

2. Important information before using Diclac 150 Duo

When not to use Diclac 150 Duo:

• if the patient is allergic to diclofenac or any of the other ingredients of this medicine (listed in section 6),
• if the patient has ever had an allergic reaction after using anti-inflammatory or analgesic drugs (i.e., acetylsalicylic acid, diclofenac, or ibuprofen). Reactions may include asthma, rhinitis, skin rash, urticaria, facial edema, lip edema, tongue edema, pharyngeal edema, and/or limb edema (symptoms of angioedema). If the patient thinks they may be allergic, they should consult a doctor.
• if the patient has active or past stomach or duodenal ulcers, bleeding, or perforation; if the patient has experienced discomfort in the stomach area or heartburn after taking anti-inflammatory drugs,
• if the patient is in the third trimester of pregnancy,
• if the patient has liver failure,
• if the patient has kidney failure,
• if the patient has heart disease and/or cerebrovascular disease, e.g., after a heart attack, stroke, transient cerebral ischemia (mini-stroke), or vascular occlusion of the heart or brain, or after a revascularization or bypass procedure,
• if the patient has circulatory disorders (peripheral vascular disease).

The patient should inform their doctor about the presence of these diseases.

Warnings and precautions

Before using Diclac 150 Duo, the patient should discuss it with their doctor if:

• the patient has diagnosed cardiovascular disease (see above) or significant risk factors, such as high blood pressure, elevated lipid levels (cholesterol, triglycerides), or if the patient is a smoker, as the dose of the medicine should not be increased above 100 mg per day if the treatment lasts longer than 4 weeks;
• the patient has had a gastrointestinal ulcer or is elderly. The use of diclofenac may cause gastrointestinal bleeding, ulcers, or perforation (with possible fatal outcome). This effect may be particularly dangerous in the case of high doses of the medicine. If any unusual abdominal symptoms occur during the use of Diclac 150 Duo (especially gastrointestinal bleeding), the medicine should be discontinued immediately and the doctor consulted;
• the patient has ulcerative colitis or Crohn's disease, as diclofenac may exacerbate the disease;
• the patient has asthma, allergic rhinitis, nasal polyps, chronic obstructive pulmonary disease, or chronic respiratory infections, as they are more likely to experience an allergic reaction to diclofenac (exacerbation of asthma, angioedema, or urticaria). This warning also applies to patients allergic to other substances (e.g., those who experience skin reactions, itching, or urticaria). The medicine should be used with caution (preferably under medical supervision);
• the patient has liver function disorders, as diclofenac may worsen the course of the disease. The patient should strictly follow the doctor's recommendations regarding liver function tests;
• the patient has porphyria, as diclofenac may trigger a porphyria attack.

Before taking diclofenac, the patient should inform their doctor if:

• they smoke,
• they have diabetes,
• they have angina pectoris, thrombosis, hypertension, elevated cholesterol levels, or elevated triglyceride levels.

The patient should use the smallest dose of Diclac 150 Duo that provides relief from pain and/or inflammation and use it for the shortest possible time to minimize the risk of side effects.
If the patient experiences any symptoms suggesting heart or blood vessel problems, such as chest pain, shortness of breath, weakness, or slurred speech, they should immediately contact their doctor or the emergency department.
The use of diclofenac may rarely (especially at the beginning of treatment) cause life-threatening skin reactions (e.g., exfoliative dermatitis, Stevens-Johnson syndrome with widespread rash, high fever, and joint pain, and toxic epidermal necrolysis with skin and mucous membrane changes, high fever, and severe general condition). After the first signs of rash, mucous membrane changes, or other symptoms of an allergic reaction, the medicine should be discontinued and the doctor consulted.
The medicine may mask the symptoms of infection (e.g., headache, elevated body temperature) and make it difficult to diagnose. During medical examinations, the patient should inform their doctor about the use of the medicine.
The patient should not use Diclac 150 Duo at the same time as other systemic non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase-2 inhibitors.
Before using the medicine, the patient should inform their doctor or pharmacist about the presence of the above-mentioned diseases.
Taking such medicines as Diclac 150 Duo 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.
The patient should not use higher doses or longer treatment than recommended.
In case of heart problems, a history of stroke, or suspected risk of these disorders (e.g., high blood pressure, diabetes, elevated cholesterol levels, smoking), the patient should discuss the treatment with their doctor or pharmacist.
The medicine may temporarily inhibit platelet aggregation.

Children and adolescents

The medicine should not be used in children and adolescents due to the large dose.

Elderly patients (65 years and older)

Elderly patients may respond more strongly to the medicine than other adult patients. The patient should follow the recommendations in the leaflet, use the smallest effective dose according to the doctor's recommendations, and report all side effects that occur during treatment to their doctor.

Diclac 150 Duo 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.

The patient should inform their doctor especially about taking the following medicines:

• lithium or antidepressant drugs (selective serotonin reuptake inhibitors)
• digoxin - a medicine used to treat heart conditions
• diuretics - medicines that increase urine production
• angiotensin-converting enzyme (ACE) inhibitors, beta-blockers - a group of medicines used to treat hypertension and heart failure
• non-steroidal anti-inflammatory drugs (e.g., acetylsalicylic acid or ibuprofen) and corticosteroids (a group of medicines used to alleviate inflammatory conditions)
• anticoagulant and antiplatelet drugs
• antidiabetic drugs (except insulin)
• methotrexate - a medicine used to treat certain cancers or arthritis
• cyclosporine and tacrolimus - medicines used in patients with organ transplants
• trimethoprim - a medicine used to prevent and treat urinary tract infections
• quinolone antibacterials - medicines used to treat infections
• cholestyramine and colestipol - medicines that lower cholesterol levels in the blood
• voriconazole - a medicine used to treat fungal infections
• phenytoin - a medicine used to treat epileptic seizures

Using Diclac 150 Duo with food and drink

The tablets should be swallowed whole, with a glass of water, preferably during a meal.

Pregnancy, breastfeeding, and fertility

If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a child, they should consult their doctor before using this medicine.
Diclac 150 Duo should not be used during the first two trimesters of pregnancy, unless the doctor considers it absolutely necessary.
As with other anti-inflammatory drugs, the use of Diclac 150 Duo in the last three months of pregnancy is contraindicated, as it may seriously harm the fetus or have an adverse effect on labor.
Diclac 150 Duo may cause kidney and heart problems in the unborn child. It may increase the risk of bleeding in the mother and child and prolong or delay labor.
From the 20th week of pregnancy, Diclac 150 Duo may cause kidney function disorders in the unborn child if used for more than a few days. This may lead to a low level of amniotic fluid surrounding the child (oligohydramnios). If treatment is required for a longer period, the doctor may recommend additional monitoring.
Diclac 150 Duo should not be used in breastfeeding women, as it may harm the infant.
The doctor will discuss the potential risks of using Diclac 150 Duo during pregnancy and breastfeeding with the patient.
Taking Diclac 150 Duo may make it difficult to become pregnant. If the patient plans to become pregnant or is having trouble becoming pregnant, they should inform their doctor.

Driving and using machines

The use of Diclac 150 Duo is unlikely to affect the ability to drive or use machines.

Diclac 150 Duo contains lactose monohydrate and sodium

If the patient has previously been diagnosed with intolerance to some sugars, they should consult their doctor before taking the medicine.
The medicine contains less than 1 mmol (23 mg) of sodium per tablet, which means it is considered "sodium-free".

3. How to use Diclac 150 Duo

This medicine should always be used as directed by the doctor. In case of doubts, the patient should consult their doctor or pharmacist.
The patient should not exceed the recommended dose. If Diclac 150 Duo is used for more than a few weeks, the patient should regularly undergo medical check-ups to rule out any unnoticed side effects.
The dose of the medicine is determined by the doctor individually for each patient. The rule is to use the smallest effective dose for the shortest possible time.
If the patient feels that the effect of the medicine is too strong or too weak, they should consult their doctor.
Adults
1 tablet of Diclac 150 Duo (150 mg of diclofenac sodium) once a day. The patient should not use a daily dose higher than 150 mg.
Use in children and adolescents
Due to the large dose, Diclac 150 Duo should not be used in children and adolescents under 18 years of age.
Elderly patients (65 years and older)
The medicine should be used with caution in elderly patients. In elderly patients and those with low body weight, the smallest effective dose is recommended.
Diagnosed cardiovascular disease or significant cardiovascular risk factors
Patients with diagnosed cardiovascular disease or significant risk factors for cardiovascular events should take diclofenac only after the doctor has assessed the situation and only at a dose of ≤100 mg per day if the treatment lasts longer than 4 weeks.
Kidney function disorders
The use of Diclac 150 Duo in patients with kidney failure is contraindicated.
No special studies have been conducted in patients with kidney function disorders, so no specific dosage recommendations can be made. In patients with mild to moderate kidney function disorders, caution is recommended.
Liver function disorders
The use of Diclac 150 Duo in patients with liver failure is contraindicated. No special studies have been conducted in patients with liver function disorders, so no specific dosage recommendations can be made. In patients with mild to moderate liver function disorders, caution is recommended.

Method of administration

If the symptoms are most pronounced at night or in the morning, Diclac 150 Duo should be taken in the evening. The tablets should be swallowed whole, with a glass of water, preferably during a meal. The tablets should not be divided or chewed.

How long to use Diclac 150 Duo

Diclac 150 Duo should always be used as directed by the doctor.
If the patient is taking Diclac 150 Duo for a long time, they should regularly consult their doctor to ensure that no side effects have occurred.
In case of doubts about how long to use the medicine, the patient should consult their doctor or pharmacist.

Using a higher than recommended dose of Diclac 150 Duo

Overdose of Diclac 150 Duo does not cause characteristic symptoms, but the following may occur: vomiting, gastrointestinal bleeding, diarrhea, dizziness, tinnitus, or convulsions. In case of significant poisoning, acute kidney failure and liver damage may occur.
In case of accidental ingestion of a higher dose of tablets than recommended, the patient should immediately consult their doctor, pharmacist, or go to the emergency department.

Missing a dose of Diclac 150 Duo

If the patient misses a dose, they should take it as soon as they remember.
However, if more than half of the time between two doses has passed, the patient should not take the missed dose but take the next tablet according to the previous dosing schedule. The patient should not take a double dose to make up for the missed dose.

4. Possible side effects

Like all medicines, Diclac 150 Duo can cause side effects, although not everybody gets them.
The following side effects are described below for diclofenac in the form of tablets with modified release and diclofenac in other pharmaceutical forms, used for a short or long time.

Side effects

Common(may occur in less than 1 in 10 people taking the medicine):

• headache, dizziness,
• nausea, vomiting, diarrhea, indigestion, abdominal pain, bloating, decreased appetite,
• increased aminotransferase activity,
• rash.

Uncommon(may occur in less than 1 in 100 people taking the medicine):

• myocardial infarction, heart failure, palpitations, chest pain.

Rare(may occur in less than 1 in 1000 people taking the medicine):

• hypersensitivity, anaphylactic and pseudo-anaphylactic reactions (including sudden drop in blood pressure and shock),
• drowsiness,
• asthma (including shortness of breath),
• gastritis, gastrointestinal bleeding, hematemesis, melena,
• peptic ulcer disease (with or without bleeding and perforation),
• hepatitis, jaundice, liver function disorders,
• urticaria,
• edema.

Very rare(may occur in less than 1 in 10,000 people taking the medicine):

• thrombocytopenia (decreased platelet count), leukopenia (decreased white blood cell count), anemia (including hemolytic and aplastic anemia), agranulocytosis (decreased or absent granulocytes),
• angioedema (including facial edema),
• disorientation, depression, insomnia, nightmares, irritability, psychotic disorders,
• paresthesia, memory disorders, convulsions, anxiety, tremors, aseptic meningitis, taste disorders, cerebrovascular accident,
• visual disturbances, blurred vision, diplopia,
• tinnitus, hearing disorders,
• hypertension, vasculitis,
• pneumonitis,
• ulcerative colitis (including hemorrhagic colitis and exacerbation of ulcerative colitis and Crohn's disease), constipation, stomatitis (including ulcerative stomatitis), glossitis, esophageal disorders, intestinal stricture, pancreatitis,
• fulminant hepatitis, liver necrosis, liver failure,
• bullous rash, eczema, erythema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), exfoliative dermatitis, alopecia, photosensitivity reactions, purpura, Henoch-Schönlein purpura, pruritus,
• acute kidney failure, hematuria, proteinuria, nephrotic syndrome, interstitial nephritis, renal papillary necrosis.

Frequency not known(frequency cannot be estimated from the available data):

• concomitant occurrence of chest pain and allergic reaction (symptoms of Kounis syndrome).

Taking such medicines as Diclac 150 Duo may be associated with a small increased risk of heart attack (myocardial infarction) or stroke.
In some people, during the use of Diclac 150 Duo, other side effects may occur. If any of the side effects worsen or any side effects not listed in this leaflet occur, the patient should tell their doctor or pharmacist.

If any of the following side effects occur, the patient should stop taking Diclac 150 Duo and inform their doctor:

• discomfort in the stomach, heartburn, or abdominal pain
• hematemesis, melena, or hematuria
• skin disorders such as rash or pruritus
• shortness of breath or dyspnea
• jaundice or yellowing of the eyes
• prolonged sore throat or high fever
• facial edema, peripheral edema, or angioedema
• severe migraine
• chest pain accompanied by cough
• mild painful abdominal cramps and tenderness, starting soon after the initiation of Diclac 150 Duo, followed by rectal bleeding or melena, usually within 24 hours of the onset of abdominal pain (frequency not known).

Some side effects may be serious

These uncommon side effects may occur in 1 to 10 patients per 1000, especially when using high daily doses (150 mg) for a long time

• sudden, crushing chest pain (symptoms of myocardial infarction).
• shortness of breath, difficulty breathing when lying down, swelling of the feet or ankles (symptoms of heart failure).

If the patient is taking Diclac 150 Duo for more than a few weeks, they should regularly consult their doctor to ensure that no side effects have occurred.

Reporting side effects

If side effects occur, including any side effects not listed in this leaflet, the patient should tell their doctor or pharmacist. Side effects can be reported directly to the Department of Drug Safety Monitoring, Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, tel.: +48 22 49 21 301, fax: +48 22 49 21 309;
website: https://smz.ezdrowie.gov.pl.
By reporting side effects, more information can be collected on the safety of the medicine.

5. How to store Diclac 150 Duo

• The medicine should be stored out of sight and reach of children.
• There are no special storage recommendations.
• The medicine should not be used after the expiration date stated on the packaging. The expiration date refers to the last day of the specified month.
• 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. This will help protect the environment.

6. Contents of the packaging and other information

What Diclac 150 Duo contains

• The active substance of the medicine is diclofenac sodium. One tablet with modified release contains 150 mg of diclofenac sodium.
• The other ingredients are: lactose monohydrate, calcium hydrogen phosphate dihydrate, microcrystalline cellulose, magnesium stearate, sodium carboxymethylcellulose (type A), colloidal silicon dioxide, corn starch, iron oxide red (E 172), hypromellose.

What Diclac 150 Duo looks like and contents of the pack

Diclac 150 Duo tablets consist of two layers: pink and white.
They are packaged in PP/Aluminum blisters in a cardboard box. The packaging contains 10 or 20 tablets with modified release.
For more detailed information, the patient should contact the marketing authorization holder or parallel importer.

Marketing authorization holder in Latvia, the country of export:

Sandoz d.d.
Verovškova 57
1000 Ljubljana
Slovenia

Manufacturer:

Salutas Pharma GmbH
Otto-von-Guericke-Allee 1
D-39179 Barleben
Germany
LEK S.A.
ul. Domaniewska 50 C
02-672 Warsaw
Poland

Parallel importer:

InPharm Sp. z o.o.
ul. Strumykowa 28/11
03-138 Warsaw

Repackaged by:

InPharm Sp. z o.o. Services sp. k.
ul. Chełmżyńska 249
04-458 Warsaw
Marketing authorization number in Latvia, the country of export:99-0828
Parallel import authorization number:57/22
Date of leaflet approval: 04.01.2023
[Information about the trademark]