Nuclofen Duo is able to increase the plasma level of digoxin, as well as lithium. In the case of a combination of diclofenac with these drugs, it is necessary to monitor the indices of these substances in the body.
Like other NSAIDs, Naklofen Duo is able to inhibit the action of diuretics. When combined with potassium-sparing diuretics, an increase in serum potassium levels is possible (therefore, these values should be carefully monitored). In addition, the combination with potassium drugs can also increase their level inside the serum, which makes it necessary to constantly monitor the patient's health.
Combination with antihypertensive and diuretics (for example, with ACE inhibitors, as well as β-blockers) can only be carried out with reservations, and people (especially the elderly) should be carefully monitored when assessing blood pressure. It will also be necessary to obtain the necessary hydration, and in addition to monitoring the work of the kidneys (not only during combined treatment, but also at its completion - this is especially true for ACE inhibitors and diuretics, since they increase the risk of developing nephrotoxicity).
Although the clinical trials failed to establish the effect of diclofenac on the function of anticoagulants, there is some information that patients who combined these substances had an increased risk of bleeding. Because of this, with this type of treatment, it is recommended to closely monitor the patient.
Combined use of NSAIDs with selective inhibitors of reverse serotonin capture can increase the likelihood of bleeding in the gastrointestinal tract.
Clinical trials have demonstrated that diclofenac is allowed to combine with antidiabetic medications, since it does not change their drug effect. But there is information that sometimes with this combination developed hyper- or hypoglycemia - in such cases, adjustment of dosages of antidiabetic drugs is necessary. Also during the treatment you need to monitor the blood sugar.
It is necessary to combine with caution the NSAIDs with methotrexate (within 24 hours before or after taking the latter), because in these cases it is possible to increase its indices inside the body, as a result of which its toxic effect also increases.
The impact of drugs from the NSAID group (including Naklofen Duo) on the process of renal synthesis of PG can increase the nephrotoxic properties of cyclosporine. As a result, people who use cyclosporine should take diclofenac in low doses.
There is some information about the occurrence of seizures in people who combine NSAIDs with quinoline derivatives.