The three active ingredients of Difmetere (indomethacin, caffeine, prochlorperazine ) have shown specific pharmacological activity in the treatment of migraine and headache. Caffeine has a cholinergic analgesic effect on the central nervous system. Prochlorperazine has central cholinergic analgesic properties.
The combination of active ingredients is significantly more effective than each of these substances alone.
Indications for use
Emergency treatment for migraine with and without aura. Treatment of tension headache attacks.
Method of administration and dosage
The drug is recommended to be used as soon as possible after the onset of a headache, although it is also effective if taken later.
It is recommended to take 1 effervescent tablet by mouth (completely dissolved in a glass of cold water) at the first manifestations of a headache.
The choice of dose depends on the severity of the symptoms and the condition of the patient.
In case of insufficient effectiveness of the drug: if the effectiveness of the first dose of the drug within 2 hours after taking Difmetere is insufficient, repeated administration of the same dose of the drug during the same attack may be effective for treating headache.
Re-attack within 24-48 hours: If headache is noted again within 24-48 hours after relief, a second dose of the drug should be taken to treat the relapse.
The maximum daily dose should not exceed 8 tablets. The duration of treatment depends on the type of headache and is determined by the doctor individually.
Elderly patients . The experience of using Difmetere in patients over the age of 65 is limited.
Most often (< 3 %), the following adverse reactions were noted: vertigo , dizziness and tremor.
Adverse reactions that were identified in clinical studies immediately after taking Difmetra were mild or moderate and spontaneously disappeared within a few hours. In addition, these adverse reactions did not affect the effectiveness of Difmetere . If the patient is in the supine position and the dose of the drug is reduced at the next attack, then the frequency of these adverse reactions may decrease.
Hypersensitivity to the active substance or any excipient of the drug. A history of gastrointestinal bleeding or perforation associated with previous active NSAID therapy, or a history of peptic ulcer / bleeding. A history of allergic reaction to acetylsalicylic acid or other NSAIDs. Severe heart failure, severe hepatic or renal failure. Mental illness, epilepsy, Parkinson’s disease. Ulcerative colitis, Crohn’s disease.
Pregnancy period. Childhood.
Symptoms . The clinical manifestations of indomethacin overdose are unknown. Most likely, these symptoms can be associated with the gastrointestinal tract and central nervous system. Caffeine overdose results in minor intoxication. Severe intoxication is manifested by nausea, vomiting, anxiety, tremors, seizures, tachycardia, arrhythmia, arterial hypotension, hypokalemia, and metabolic acidosis.
Possible adverse reactions due to an overdose of prochlorperazine , which is unlikely due to low doses of the drug, are extrapyramidal disorders, which are accompanied by confusion, drowsiness or agitation, impaired attention, seizures and ECG changes.
Treatment . Symptomatic and supportive. It is necessary to wash the stomach as soon as possible. Due to the risk of developing dystonia, the airways must be free. In case of arterial hypotension, ventilation will improve the patient’s condition. The patient should be in the supine position. Norepinephrine or metaraminol should be given slowly . Epinephrine should not be given. Hemodialysis is ineffective.