Ronac-Plus
Generic Name
Diclofenac Sodium + Lidocaine Hydrochloride
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| ronac plus 75 mg injection | ৳ 15.04 | N/A |
Description
Overview of the medicine
Ronac-Plus 75 mg Injection is a combination of Diclofenac Sodium, a potent non-steroidal anti-inflammatory drug (NSAID), and Lidocaine Hydrochloride, a local anesthetic. It is used for the rapid relief of severe pain, inflammation, and fever, particularly when oral administration is not feasible or rapid onset is required. The addition of Lidocaine helps to minimize pain at the injection site.
Uses & Indications
Dosage
Adults
Usually 75 mg (1 ampoule) once daily by deep intramuscular injection. In severe cases, a second injection may be given after a few hours, preferably at a different site. Total daily dose should not exceed 150 mg. The injection is typically used for 2-3 days, then switched to oral therapy.
Elderly
Lowest effective dose, closely monitor for adverse effects.
Renal_impairment
Caution advised. Dose adjustment may be necessary in severe impairment. Not recommended in severe renal failure.
How to Take
For deep intramuscular injection only. Do not administer intravenously. Inject slowly into the upper outer quadrant of the gluteal muscle.
Mechanism of Action
Diclofenac inhibits cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing the synthesis of prostaglandins, which are mediators of inflammation, pain, and fever. Lidocaine stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action.
Pharmacokinetics
Onset
Analgesic effect of Diclofenac typically begins within 15-30 minutes. Lidocaine provides immediate local anesthetic effect.
Excretion
Diclofenac: Primarily renal (60%) and biliary/fecal (35%). Lidocaine: Primarily renal.
Half life
Diclofenac: 1-2 hours. Lidocaine: 1.5-2 hours.
Absorption
Diclofenac is rapidly absorbed after intramuscular injection, reaching peak plasma concentrations within 10-30 minutes. Lidocaine is also rapidly absorbed from the injection site.
Metabolism
Diclofenac: Primarily hepatic, through hydroxylation and glucuronidation. Lidocaine: Primarily hepatic, by microsomal enzymes.
Side Effects
Contraindications
- Hypersensitivity to diclofenac, lidocaine, or other NSAIDs
- Active gastrointestinal bleeding or peptic ulcer
- Severe hepatic or renal impairment
- Severe heart failure
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Third trimester of pregnancy
- Coronary artery bypass graft (CABG) surgery
Drug Interactions
SSRIs
Increased risk of GI bleeding.
Corticosteroids
Increased risk of GI ulceration.
Antihypertensives
Reduced antihypertensive effect.
Other NSAIDs/Aspirin
Increased risk of GI adverse effects.
Diuretics (e.g., Furosemide)
Reduced diuretic and antihypertensive effects.
Lithium, Digoxin, Methotrexate
Increased plasma levels.
Anticoagulants (e.g., Warfarin)
Increased risk of bleeding.
Storage
Store below 30°C, protected from light and moisture. Do not freeze. Keep out of reach of children.
Overdose
Symptoms: Drowsiness, lethargy, nausea, vomiting, epigastric pain, GI bleeding, dizziness, tinnitus, acute renal failure. In severe cases: convulsions, respiratory depression, coma. Management: Symptomatic and supportive treatment. Maintain airway, monitor vital signs, treat convulsions. Gastric decontamination (if oral overdose), activated charcoal.
Pregnancy & Lactation
Pregnancy: Category C in first and second trimesters; Contraindicated in third trimester due to risk of premature closure of fetal ductus arteriosus. Lactation: Diclofenac and lidocaine are excreted in breast milk in small amounts. Use with caution; consult a doctor.
Side Effects
Contraindications
- Hypersensitivity to diclofenac, lidocaine, or other NSAIDs
- Active gastrointestinal bleeding or peptic ulcer
- Severe hepatic or renal impairment
- Severe heart failure
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Third trimester of pregnancy
- Coronary artery bypass graft (CABG) surgery
Drug Interactions
SSRIs
Increased risk of GI bleeding.
Corticosteroids
Increased risk of GI ulceration.
Antihypertensives
Reduced antihypertensive effect.
Other NSAIDs/Aspirin
Increased risk of GI adverse effects.
Diuretics (e.g., Furosemide)
Reduced diuretic and antihypertensive effects.
Lithium, Digoxin, Methotrexate
Increased plasma levels.
Anticoagulants (e.g., Warfarin)
Increased risk of bleeding.
Storage
Store below 30°C, protected from light and moisture. Do not freeze. Keep out of reach of children.
Overdose
Symptoms: Drowsiness, lethargy, nausea, vomiting, epigastric pain, GI bleeding, dizziness, tinnitus, acute renal failure. In severe cases: convulsions, respiratory depression, coma. Management: Symptomatic and supportive treatment. Maintain airway, monitor vital signs, treat convulsions. Gastric decontamination (if oral overdose), activated charcoal.
Pregnancy & Lactation
Pregnancy: Category C in first and second trimesters; Contraindicated in third trimester due to risk of premature closure of fetal ductus arteriosus. Lactation: Diclofenac and lidocaine are excreted in breast milk in small amounts. Use with caution; consult a doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date
Availability
Available in pharmacies and hospitals
Approval Status
Approved by DGDA (Bangladesh)
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established the efficacy and safety of diclofenac. Specific trials for diclofenac-lidocaine combinations focus on local tolerability and pain reduction.
Lab Monitoring
- Complete blood count (CBC)
- Liver function tests (LFTs)
- Kidney function tests (KFTs)
- Blood pressure monitoring
Doctor Notes
- Use the lowest effective dose for the shortest possible duration.
- Monitor renal function, hepatic function, and blood pressure in patients on long-term therapy.
- Caution in patients with a history of cardiovascular disease, GI disorders, or asthma.
- Ensure proper intramuscular injection technique to avoid complications.
Patient Guidelines
- Report any unusual symptoms, especially severe stomach pain, black stools, or allergic reactions.
- Do not exceed the prescribed dose or duration of treatment.
- Avoid alcohol while on this medication.
- Inform your doctor about all other medications you are taking.
Missed Dose Advice
If a dose is missed, take it as soon as remembered. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose.
Driving Precautions
May cause dizziness or drowsiness; advise caution when driving or operating machinery until effects are known.
Lifestyle Advice
- Maintain a healthy diet.
- Avoid smoking and excessive alcohol consumption, which can exacerbate GI risks.
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