Aceclofenac

CLINICAL USE

NSAID and analgesic

DOSE IN NORMAL RENAL FUNCTION

100 mg twice daily

PHARMACOKINETICS

Molecular weight :354.2

%Protein binding :>99

%Excreted unchanged in urine : 66 (mainly as metabolites)

Volume of distribution (L/kg) :25 litres

half-life – normal/ESRD (hrs) :4/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function but use with caution

10 to 20 : Dose as in normal renal function but avoid if possible

<10 : Dose as in normal renal function but only if on dialysis

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function.

HD :Not dialysed. Dose as in normal renal function.

HDF/high flux :Unknown dialysability. Dose as in normal renal function.

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

ACE inhibitors and angiotensin-II antagonists: antagonism of hypotensive effect; increased risk of nephrotoxicity and hyperkalaemia

Analgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects); avoid with ketorolac (increased risk of side effects and haemorrhage)

Antibacterials: possible increased risk of convulsions with quinolones

Anticoagulants: effects of coumarins enhanced; possible increased risk of bleeding with heparins and coumarins

Antidepressants: increased risk of bleeding with SSRIs and venlafaxine

Antidiabetic agents: effects of sulphonylureas enhancedAnti-epileptics: possibly increased phenytoin concentration

Antivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavir

Ciclosporin: may potentiate nephrotoxicity

Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinib

Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect, hyperkalaemia with potassium-sparing diureticsLithium: excretion decreased

Pentoxifylline: increased risk of bleeding

Tacrolimus: increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

OTHER INFORMATION

Use with caution in uraemic patients predisposed to gastrointestinal bleeding or uraemic coagulopathies

Inhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease – avoid if possible; if not, check serum creatinine 48–72 hours after starting NSAID therapy – if raised, discontinue NSAID therapy

Use normal doses in patients with ESRD on dialysis if they do not pass any urine

Use with great caution in renal transplant recipients; it can reduce intrarenal autocoid synthesis

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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