AKIS 75 mg/ml solution for injection
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor or pharmacist.
- This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
- If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
- In this leaflet AKIS 75 mg/ml solution for injection will be referred to as AKIS.
1. What AKIS is and what it is used for
2. Before you use AKIS
3. How to use AKIS
4. Possible side effects
5. How to store AKIS
6. Further information
AKIS contains the active substance diclofenac sodium. AKIS belongs to a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). Other NSAIDs include aspirin and ibuprofen. These drugs reduce pain and inflammation.
AKIS given by intramuscular or subcutaneous injection is used to treat a number of painful conditions including:
- Flare-ups of joint or back pain
- Attacks of gout
- Pain caused by kidney stones
- Pain caused by injuries, fractures or trauma
- It is also used to prevent or treat pain following an operation.
AKIS given by intravenous injection is used in hospital settings to prevent or treat pain following an operation.
- If you are allergic to diclofenac, aspirin, ibuprofen or other NSAIDs.
- If you are allergic to any of the other ingredients of AKIS (they are listed in section 6 at the end of this leaflet)
- If you have a history of bleeding in your stomach or bowels after you have taken NSAIDs
- If you have had two or more episodes of stomach (gastric) or duodenal (peptic) ulcers or bleeding in the digestive tract. (This may include blood in vomit, bleeding when emptying the bowels, or black, tarry stools)
- If you have, or have had liver failure
- If you have, or have had severe heart failure
- If you have established heart disease and /or cerebrovascular disease e.g. if you have had a heart attack, stroke, mini-stroke (TIA) or blockages to blood vessels to the heart or brain or an operation to clear or bypass blockages
- If you have or have had problems with your blood circulation (peripheral arterial disease)
- If you have, or have had severe kidney failure
- If you have asthma, hives or acute rhinitis (allergy) which are caused by use of NSAIDs or aspirin
- If you have a blood clotting disorder or are currently taking anticoagulants (such as warfarin)
- If you are more than 6 months pregnant (see also ‘Pregnancy, breast-feeding)
- If you are under 18 years of age.
Additionally, do not use AKIS by intravenous injection:
- If you are using other NSAID or anticoagulant (including low dose of heparin)
- If you have an history of bleeding diathesis, specifically cerebrovascular bleeding
- If you have had operation with high risk of haemorrhage
- If you have a history of asthma
- If you have a moderate or severe renal impairment
- If you are dehydrated
- If you have suffered from heavy loss of blood
Make sure your doctor knows, before you are given diclofenac
- If you smoke
- If you have diabetes
- If you have angina, blood clots, high blood pressure, raised cholesterol or raised triglycerides
Side effects may be minimised by using the lowest effective dose for the shortest duration necessary.
Tell your doctor before you are given AKIS:
- If you think you may be allergic to diclofenac, aspirin, ibuprofen or any other NSAID, or to any of the other ingredients of AKIS. (These are listed at the end of the leaflet.) Signs of a hypersensitivity reaction include swelling of the face and mouth (angioedema), breathing problems, chest pain, runny nose, skin rash or any other allergic type reaction.
- If you have ever had an ulcer in the gullet, stomach or upper bowel, or gastrointestinal bleeding.
Symptoms of which may include blood in vomit or when emptying bowels or black, tarry stools
- If you suffer from any bowel disorders including ulcerative colitis or Crohn’s disease
- If you have, or have ever had, kidney or liver problems
- If you have had a history of or suffer from any blood or bleeding disorders
- If you have, or have ever had asthma, chronic obstructive pulmonary disease (COPD), nasal polyps or hayfever
- If you have lupus (systemic lupus erythematosus or SLE) or any similar problem
- If you are planning to become pregnant, as AKIS may interfere with your ability to become pregnant.
- If you recently had or you are going to have a surgery of the stomach or intestinal tract before receiving/taking/using AKIS, as AKIS can sometimes worsen wound healing in your gut after surgery.
- Medicines such as AKIS may be associated with a small increased risk of heart attack (‘myocardial infarction’) or stroke. Any risk is more likely with high doses and prolonged treatment. Do not exceed the recommended dose or duration of treatment
- AKIS is an anti-inflammatory medicine, therefore it may reduce the symptoms of infection, such as headache or high temperature. If you feel unwell and need to see a doctor, remember to tell him or her you are taking AKIS
- Elderly patients are more prone to the side effects associated with AKIS so tell your doctor about any unusual symptoms.
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription (e.g. over-the-counter medicines or those for recreational use). Some medicines may interfere with your treatment.
Tell your doctor if you are taking any of the following medicines:
- Any other NSAID or COX-2 (cyclooxygenase-2) inhibitor, for example aspirin or ibuprofen (medicines for inflammation or pain)
- Medicines to treat diabetes
- Anticoagulants (blood thinning tablets like warfarin or heparin)
- Antiplatelet medicines (to prevent blood clots)
- Diuretics (water tablets)
- Lithium (a medicine to treat some types of depression)
- Phenytoin (a medicine to treat epilepsy)
- Cardiac glycosides (e.g. Digoxin; medicines for heart problems)
- Methotrexate (a medicine for some types of inflammation and cancers)
- Ciclosporin and tacrolimus (medicines for some types of inflammation and after organ transplants)
- Quinolone antibiotics (medicines used to treat some infections)
- Steroids (medicines for inflammation and for treating immune system problems)
- Colestipol (a medicine used to reduce cholesterol)
- Cholestyramine (a medicine used to treat liver problems and Crohn’s disease)
- Sulfinpyrazone (a medicine used to treat gout)
- Voriconazole (a medicine used to treat fungal infections)
- Pemetrexed (a chemotherapy drug used to treat some forms of cancer)
- Deferasirox (a medicine used in patients having long term blood transfusions)
- Mifepristone (a medicine used during termination of pregnancy)
- Medicines for heart problems or high blood pressure, for example beta blockers or ACE Inhibitors
- Tacrolimus (a medicine who decreases the action of the immune system, used to prevent organ rejection in certain patients)
- Medicines used to treat anxiety and depression known as serotonin re-uptake inhibitors (SSRIs)
- Zidovudine (a medicine for human immunodeficiency virus (HIV) infection).
Do not take AKIS if you are in the last 3 months of pregnancy as it could harm your unborn child or cause problems at delivery. It can cause kidney and heart problems in your unborn baby. It may affect your and your baby’s tendency to bleed and cause labour to be later or longer than expected. You should not take AKIS during the first 6 months of pregnancy unless absolutely necessary and advised by your doctor. If you need treatment during this period or while you are trying to get pregnant, the lowest dose for the shortest time possible should be used. If taken for more than a few days from 20 weeks of pregnancy onward, AKIS can cause kidney problems in your unborn baby that may lead to low levels of amniotic fluid that surrounds the baby (oligohydramnios) or narrowing of a blood vessel (ductus arteriosus) in the heart of the baby. If you need treatment for longer than a few days, your doctor may recommend additional monitoring.
You must tell your doctor if you are breast-feeding. If you are breast-feeding your doctor will consider if AKIS should be used.
AKIS may make some people feel dizzy, tired, sleepy or have blurred vision. Do not drive or use any tools or operate machines if you are affected in this way.
This medicine contains less than 1 mmol sodium (23 mg) per dosage unit, that is to say essentially ‘sodium-free’.
Your doctor will decide when and how to treat you with AKIS solution for injection. You will either be given an intramuscular injection (an injection into a muscle usually into the buttocks) or a subcutaneous injection (an injection into the skin usually into the buttocks or thigh) or an intravenous injection (an injection into a vein, generally of an arm).
AKIS must not be given by intravenous (i.v.) infusion.
Adults: The usual starting dose is 25 to 75 mg depending on the severity of your pain. If you are still in severe pain, your doctor may decide to give you a second injection after 6 hours. The maximum daily dose is 150 mg. You will only be given AKIS for one or two days.
Elderly: Your doctor may give you a dose that is lower than the usual adult dose if you are elderly.
Children: Not suitable for children (under 18 years).
A doctor, nurse or pharmacist will prepare the injection for you. A nurse or doctor will usually then give you the injection. Your doctor or nurse will not inject you in the same place twice.
If you have been given too much AKIS you may experience the following symptoms: feeling and being sick, stomach pain, stomach and or bowel bleeding, rarely diarrhoea, dizziness, tinnitus (buzzing, hissing, ringing, whistling or other persistent noises in the ear and occasionally convulsions (fits or seizures). In severe cases, your kidneys or liver may be damaged (symptoms include having difficulty passing water or passing more water than usual, muscle cramps, tiredness, swelling in your hands, feet or face, feeling or being sick, yellowing of your skin).
If you think you have been given too much AKIS immediately tell your doctor or nurse.
Like all medicines, AKIS can cause side effects, although not everybody gets them.
Some side effects can be serious
- Mild cramping and tenderness of the abdomen, starting shortly after the start of the treatment with AKIS and followed by rectal bleeding or bloody diarrhoea usually within 24 hours of the onset of abdominal pain (frequency not known, cannot be estimated from the available data).
- Severe allergic reactions which may include: swelling of face, throat or tongue, breathing difficulties, wheezing, runny nose and skin rashes
- Stomach pain, indigestion, heartburn, wind, feeling sick or being sick
- Any sign of bleeding in the stomach or intestine, for example, blood when emptying your bowels, black, tarry stools or blood in vomit
- Serious skin rashes, itching, hives, bruising, painful red areas, peeling or blistering of skin, giant wheals (burning itchy swollen skin).
These conditions may also affect mouth, lips, eyes nose and genitals
- Yellowing of your skin or the whites of your eyes
- Persistent sore throat or high temperature
- An unexpected change in the amount of urine produced and/or its appearance.
- Bruising more easily than usual or having frequent sore throats or infections.
- Chest pain, which can be a sign of a potentially serious allergic reaction called Kounis syndrome
- Injection site reactions including injection site pain, redness, swelling, hard lump, sores and bruising. This can progress to blackening and death of the skin and underlying tissues surrounding the injection site, that heal with scarring, also known as Nicolau syndrome.
Very common side effects
(likely to affect up to 1 in 10 patients)
- Pain, redness or lumps at the injection site
Common side effects
(likely to affect between 1 in 100 and 1 in 10 patients)
- Feeling sick, discomfort sensation at the injection site
Uncommon side effects
(reported 1 in 1000 to 1 in 100)
- Dizziness and headache
- Diarrhoea, being sick and constipation
- Inflammation of stomach lining causing stomach pain, sickness and loss of appetite
- Liver problems
- Skin rash, itching.
(frequency cannot be estimated from the available data)
- Tissue damage at the injection site.
The following list of side effects have been reported in patients treated with NSAIDs.
Effects on the heart chest or blood
- Medicines such as AKIS may be associated with a small increased risk of heart attack (‘myocardial infarction’) or stroke
- High blood pressure, heart attack, fast or irregular heart beat, chest pain and swelling of body, hands or feet
- Asthma, breathlessness
- Blood disorders such as anaemia (decreased number of red blood cells). Symptoms include tiredness, headache, dizziness, looking pale.
Effects on stomach and digestive system
- Peptic (stomach) ulcers, mouth ulcers, tongue infections, lower gut disorders (including inflammation of gut and worsening of Crohn’s disease)
- Inflammation of pancreas or stomach lining (symptoms of which include severe stomach pain which may extend to your back or shoulder).
Effects on nervous system
- Tingling or numbness, pins and needles of the hands or feet or limbs, tremors, blurred or double vision, hearing loss or impairment, tinnitus (ringing in the ears), drowsiness, tiredness
- Hallucinations (seeing or hearing things that are not there), depression, disorientation, sleep problems, irritability, anxiety, memory problems and convulsions (fits or seizures).
- Inflammation of the layers lining the brain. Symptoms of which include stiff neck, headache, nausea, vomiting, fever or disorientation and extreme sensitivity to bright light.
Effects on liver and kidney
- Liver disorders. Symptoms may include sickness, loss of appetite, generally feeling unwell, sometimes with jaundice
- Kidney disorders or kidney failure. Symptoms include blood in urine, frothy urine, swelling of feet and hands or body.
Effects on skin and hair
- Serious skin rashes such as Stevens-Johnson syndrome and other skin conditions which may be made worse by exposure to sunlight
- Hair loss.
Immune system disorder
- Hypersensitivity reaction
If any of the symptoms get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
By reporting side effects you can help provide more information on the safety of this medicine.
- Keep this medicine out of the sight and reach of children
- Do not use AKIS after the expiry date which is stated on the ampoule as ‘EXP’ (the expiry date refers to the last day of that month)
- Store below 25°C. Do not refrigerate or freeze. Store in the original package in order to protect from light
- Use immediately after opening. Discard any unused product
- Do not use the medicine if it is cloudy or if any small bits can be seen.
After injection of the correct dose your doctor or nurse will dispose of any solution that remains, along with the syringe, needles and containers.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away any medicines you no longer use. These measures will help protect the environment.
The active substance is: diclofenac sodium.
Each 1 ml ampoule contains:
75 mg of diclofenac sodium.
The other ingredients are hydroxypropylbetadex, polysorbate 20, water for injections.
This medicinal product is a clear to slightly amber coloured transparent solution for injection contained in a clear glass container (ampoule).
Pack size of 1, 3 and 5 ampoules.
This medicinal product is also supplied as a prefilled syringe. Not all pack sizes may be marketed.
IBSA Farmaceutici Italia Srl
Via Martiri di Cefalonia 2
Flynn Pharma Ltd
This leaflet was last updated in 09/2022
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