BRAND NAMES
 MECHANISM OF ACTION
Aceclofenac is a non-steroidal anti-inflammatory drug (NSAID) with marked anti-inflammatory and analgesic properties. Aceclofenac is a potent inhibitor of the enzyme cyclo-oxygenase, which is involved in the production of prostaglandins
Indicated for the relief of pain and inflammation in osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.
The recommended dose in adults is 200 mg a day. One 100mg tablet should be taken in the morning and one in the evening (1 tablet every 12 hours).
- Must not be used in severe heart failure, during pregnancy, moderate to severe renal impairment and in patients with a history of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy.
- In hypersensitivity cases to Aceclofenac, as with other NSAIDs, it is contraindicated in asthmatic patients in whom acetylsalicylic acids and other prostaglandin synthase inhibitor trigger broncho-constriction attacks, urticaria or acute rhinitis.
- Patients with hepatic porphyria (Aceclofenac can trigger an attack)
 WARNINGS AND PRECAUTIONS
- Cardiovascular Risk: NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.
- Gastrointestinal Risk: NSAIDs cause an increased risk of serious gastrointestinal adverse events including inflammation, bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events. To minimize the potential risk for an adverse GI event in patients treated with an NSAID, the lowest effective dose should be used for the shortest possible duration
- Hypertension: NSAIDs, including Aceclofenac, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.
- Heart failure: Fluid retention and edema have been observed in some patients taking NSAIDs, therefore caution is advised in patients with fluid retention or heart failure.
- Aspirin, Ibuprofen, other systemic NSAIDs or Corticosteroids: Concomitant administration of Aceclofenac and other systemic NSAIDs or corticosteroids may increase the frequency of gastrointestinal undesirable effects.
- Anticoagulants (e.g. Warfarin): Caution is recommended since concomitant administration could increase the risk of bleeding.
- Lithium carbonate: If used concomitantly, Aceclofenac may raise plasma concentrations of lithium.
- Diuretics, ACE inhibitors or Beta blockers: concomitant use of Aceclofenac with diuretics or antihypertensive agents (e.g. beta blockers, angiotensin converting enzyme (ACE) inhibitors) may cause a decrease in their antihypertensive effect. Therefore, the combination should be administered with caution and patients, especially the elderly, should have their blood pressure periodically monitored. Diuretics can also increase the risk of nephrotoxicity of NSAIDs.
- Cardiac glycosides (e.g. Digoxin): NSAIDs may exacerbate cardiac failure, reduce GFR (glomerular filtration rate) and increase plasma glycoside levels.
- Selective serotonin reuptake inhibitors (SSRIs): Concomitant administration of systemic NSAIDs and SSRIs may increase the risk of gastrointestinal bleeding
- Methotrexate: Caution is recommended when NSAIDs, including Aceclofenac, are administered less than 24 hours before or after treatment with methotrexate, since blood concentrations of methotrexate may rise and the toxicity of this substance be increased.
- Cyclosporin: Aceclofenac, like other NSAIDs, may increase the nephrotoxicity of cyclosporin due to the effect on renal prostaglandins. Therefore, it should be given at doses lower than those that would be used in patients not receiving cyclosporin.
- Tacrolimus: Possible increased risk of nephrotoxicity when NSAIDs are given with tacrolimus.
- Concomitant treatment with potassium-sparing diuretics (Amiloride, Eplerenone, Potassium canrenoate, Spironolactone,Triamterene) may be associated with increased serum potassium levels, which should therefore be monitored frequently.
- Quinolones: There have been isolated reports of convulsions which may have been due to concomitant use of quinolones and NSAIDs.
- Herbal Extracts: Ginkgo biloba may potentiate the risk of bleeding with NSAIDs
 PREGNANCY AND LACTATION
- Aceclofenac is contraindicated in the last trimester of pregnancy, and should not be used during the first two trimesters of pregnancy or labour unless the potential benefit to the patient outweighs the potential risk to the fetus.
- Aceclofenac should, if possible, be avoided when breastfeeding.
 SIDE EFFECTS
The most commonly-observed adverse events are gastrointestinal, mainly presented as epigastric pain, stomach-ache, vomiting and sensation of fullness.
 RELATED LINKS
|Non-steroidal anti-inflammatory drugs (NSAIDs)|
|Non-selective (COX-1 and COX-2 inhibitors)||Aceclofenac • Acetylsalicylic acid • Benzydamine • Diclofenac • Flurbiprofen • Ibuprofen • Indometacin • Ketoprofen • Ketorolac • Ketorolac • Lornoxicam • Mefenamic acid • Morniflumate • Nabumetone • Naproxen • Niflumic acid • Piroxicam • Tenoxicam|
|Relatively COX-2 selective||Meloxicam • Nimesulide|
|COX-2 selective inhibitors (Coxibs)||Celecoxib • Etoricoxib • Parecoxib|
|Ophthalmic NSAIDs||Bromfenac (ophthalmic) • Diclofenac (ophthalmic) • Flurbiprofen (ophthalmic) • Ketorolac (ophthalmic) • Nepafenac (ophthalmic)|
|Veterinary use||Carprofen • Deracoxib • Firocoxib • Mavacoxib • Robenacoxib|