Neuromeal plus

Neuromeal plus

Neuromeal® plus is a  combination of Diclofenac sodium¸ vitamin B1, B6 and B12. Diclofenac belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs) that are used for the treatment of mild to moderate pain, fever, and inflammation. Like all other vitamins, vitamin B1, B6 and B12 are essential nutrients, which the body cannot produce itself. The efficacy of the combined vitamins B1, B6 and B12 is superior to that of the individual vitamins alone. Furthermore, the combination of these vitamins with Diclofenac has an analgesic, anti-inflammatory and synergic neuro-regenerative effect, where the addition of B vitamins to Diclofenac increased its analgesic effect. The effect of Neuromeal® plus in disease of the nervous sys-tem involves compensation of accompanying vitamin B deficiencies and stimulation of natural healing processes in the nervous tissue. Neuromeal® plus tablet works by reducing the substances in the body that cause inflammation and pain, metabolizing carbohydrate thus maintains normal growth which produce antibodies and hemoglobin, by keeping blood sugar level in normal range. 

Each film coated tablet of  Neuromeal® plus contains :-
- diclofenac sodium                                                    50     mg
- Thiamine nitrate ( vitamin B 1 )                               50     mg.
- Pyridoxine hydrochloride  ( vitamin B6 )                 50     mg.
- Cyanocobalamine (vitamin B12 )                             1       mg 

Neuromeal® plus should not be used in cases of: 
-Known hypersensitivity to any of the active components.
-In cases of asthma.
-Alterations of hematopoiesis.
-Esophagitis, gastritis, gastric and duodenal ulcer.
-Children under 6 years
-Liver or kidney failure or in the elderly.
-It should only be used after weighing the risk-benefit ratio in cases of 
 inducible  porphyrias.
-Leber's disease  

-Concomitant treatment of diclofenac with paracetamol may increase risk of renal complictions.
-Alcohol, corticosteroids, corticotropin and potassium supplements together with diclofenac may increase the risk of gastrointestinal adverse effects, including ulceration and bleeding .
-Concomitant treatment of Neuromeal® plus with digoxin or lithium preparations may raise the serum levels of digoxin and lithium which lead to digoxin and lithium toxcitiy . 
-Neuromeal® plus can reduce the action of diuretics and antihypertensive agents; with potassium-sparing diuretics, it can cause hyperkalemia 
-the hypoglycemic effect of oral sulfonylureas antidiabetic agents increases if adminstrated with Neuromeal® plus
-Concomitant use of glucocorticoids and other anti-inflammatories increases the risk of gastrointestinal bleeding. 
-Acetylsalicylic acid reduces the serum concentration of diclofenac. 
-Administered Neuromeal® plus in a 24-hour period with methotrexate, it
raises methotrexate concentration. 
-Simultaneous use with anticoagulants requires convenient control of coagulation state in a preventive manner. 
-Patients  treated with L-dopa should not take preparations containing of vitamin B6. 
-Cefoperazon ,pilamycin  and valproic acid  can produce hypoprothrobinemia that, in addition to the inhibition  of platelets function produced by diclofenac,can lead to gastrointestinal ulceration or bleeding if coadminstrated.
-colchicine with diclofenac can lead to gastrointestinal ulceration and bleeding .
-cyclosporin and gold salt can cause inhibition activity of renal prostaglandin if adminstered with diclofenac which  may increase the risk of nephrotoxicity induced by these drug.

-Because it contains a NSAID Neuromeal® plus should not be administered
during pregnancy unless the physician considers its administration as strictly 
necessary, in which case the loweast possible doses should be used due to the 
risk of inhibition of uterine contractions and early closure of the duct
-The administration of therapeutic doses determines the presence in very small 
amounts of the drug in breast milk,therefore, there is a minimal risk of 
undesirable effects in the infant. 

-These side effects are possible but do not always occur.
-Rarely, various gastrointestinal discomforts (nausea, vomiting, diarrhea) and exceptionally, gastrointestinal bleeding and exacerbation of ulcerative colitis may occur. Likewise, headache, dizziness, fatigue. 
-More rarely, tinnitus, insomnia, irritability or seizures may occur.
-Rare cases of rashes or hives and, exceptionally, Stevens Johnson syndrome, alopecia or photosensitivity have been described. 
-Very isolated cases of acute renal failure, hematuria, nephrotic syndrome and interstitial nephritis have been reported.
-Various degrees of liver dysfunction can occur, including icteric or anicteric hepatitis.  
-Occasionally, anemia, leukopenia, thrombocytopenia or pancytopenia and, less frequently, anaphylactoid reactions have been observed.

-It is advisabl to monitor the liver and kidney function, as well as the blood cell count periodically when administered for prolonged periods.
-Neuromeal® plus should be administered with caution in geriatric patients. 
-Close medical surveillance will be established in patients with a history of
peptic acid disease, ulcerative colitis, Crohn's disease. 
-Neuromeal® plus will be administered with caution in patients with
compromised cardiac or renal function.
-Patients who manifest vertiginous syndrome, drowsiness or other disorders
related to the Central Nervous System should not drive vehicles or use 
machines as a preventive measure.
-Use with caution in people with lactose intolerance

-Blister of 10 tablets, pack of 3 blisters. 

-Store in a dry  place at a temperature below 25°C.