How should a patient take diclofenac (dicetel) and a laxative (emolax)?

Guidance on Taking Dicetel and Emolax

For optimal management of constipation while taking dicetel (pinaverium bromide), patients should take dicetel 50mg three times daily before meals, while emolax (polyethylene glycol) should be taken at a dose of 17g once daily with a full glass of water, preferably in the morning, separated by at least 2 hours from dicetel administration.

Understanding Dicetel (Pinaverium Bromide)

• Dicetel is a selective calcium channel blocker that acts on the gastrointestinal tract
• It helps optimize gastrointestinal motility and relieves symptoms of intestinal dyspepsia 1
• Dosing recommendations:
  • Take 50mg three times daily
  • Take before meals for optimal absorption
  • Swallow tablets whole with water

Understanding Emolax (Polyethylene Glycol/PEG)

• Emolax is an osmotic laxative recommended as first-line treatment for constipation 2
• Dosing recommendations:
  • Standard dose: 17g daily (typically one sachet)
  • Mix with a full glass of water (approximately 240ml)
  • Best taken in the morning
  • May take 24-48 hours to produce a bowel movement

Timing Considerations

• Separate dicetel and emolax administration by at least 2 hours
• Take dicetel before meals
• Take emolax in the morning, preferably not with meals
• This separation helps prevent potential interference with absorption

Supporting Measures for Constipation Management

• Increase fluid intake to adequate levels 3, 2
• Increase dietary fiber if fluid intake is adequate 3, 2
• Engage in physical activity as tolerated 3, 2
• Optimize toileting habits:
  • Attempt defecation twice daily, 30 minutes after meals 2
  • Maintain privacy and comfort during bowel movements 3
  • Use proper positioning (a small footstool may help) 3

Monitoring and Adjustments

• Monitor bowel movement frequency and consistency
• If constipation persists despite emolax:
  • Consider increasing emolax dose to 34g daily
  • Consider adding bisacodyl 10-15mg as a rescue therapy 3, 2
  • For severe constipation, consider glycerin suppositories 3

Important Precautions

• Avoid bulk-forming laxatives like psyllium when taking medications that may cause constipation 3, 2
• If using diclofenac (not dicetel), be aware of potential gastrointestinal side effects 4, 5
• For elderly patients, be particularly cautious with dosing of both medications 2
• If constipation is severe (no bowel movement for >3 days, abdominal pain, vomiting), seek medical attention 2

Common Pitfalls to Avoid

• Taking medications too close together, which may reduce effectiveness
• Inadequate fluid intake when using osmotic laxatives like emolax
• Overuse of laxatives leading to dependence
• Ignoring underlying causes of constipation
• Using bulk-forming laxatives which are ineffective for medication-induced constipation 2

Remember that consistent timing of medication administration and adherence to supporting measures are key to managing constipation effectively while on dicetel therapy.