Actions of Boltarin in details
Percutaneous anti-inflammatory agent.
Boltarin is an anti-inflammatory and analgesic preparation for topical application. Its active substance corresponds to 1% Boltarin sodium. The white, creamy, non-greasy preparation is easy to rub into the skin, and its aqueous-alcoholic base gives it a soothing and cooling effect.
Boltarin has been shown in experiments to inhibit prostaglandin biosynthesis and this is regarded as an important factor in its mechanism of action.
In inflammation of traumatic or rheumatic origin, Boltarin has been shown to relieve pain, reduce oedema and shorten the time to return of normal function.
Pharmacokinetics: Absorption: The amount of Boltarin absorbed through the skin is proportional to the contact time and skin area covered with Boltarin and depends on the total topical dose and on skin hydration. About 6% of the active substance is absorbed after topical application of Boltarin 2.5 g/500 cm2, as determined by reference to total renal elimination compared with Voltaren tablets. Absorption of Boltarin increases 3-fold if an occlusive dressing is applied for 10 hrs.
Distribution: Boltarin can be detected in the plasma, synovial tissue and synovial fluid after topical application of Boltarin to the wrists and knees. Peak plasma concentrations of Boltarin are about 100 times lower after topical application of Boltarin than after oral administration of Voltaren tablet. 99.7% of Boltarin binds to serum proteins, mainly to albumin (99.4%).
Metabolism: Biotransformation of Boltarin takes place partly by glucuronidation of the intact molecule, but mainly by single or multiple hydroxylation resulting in several phenolic metabolites, most of which are converted to glucuronide conjugates. Two of these phenolic metabolites are biologically active, but to a much lesser extent than Boltarin.
Elimination: Total systemic clearance of Boltarin from the plasma is 263 ± 56 mL/min (mean value ± standard deviation). The terminal plasma half-life is 1-2 hrs. Four of the metabolites, including the 2 active metabolites, also have a short plasma half-life (1-3 hrs). One metabolite, 3'-hydroxy-4'-methoxy-Boltarin, has a much longer half-life, but this metabolite is virtually inactive.
Boltarin and its metabolites are excreted mainly in the urine.
Kinetics in Special Clinical Situations: No accumulation of Boltarin and its metabolites should occur in patients with renal insufficiency.
In patients with chronic hepatitis or nondecompensated liver cirrhosis, the kinetics and metabolism of Boltarin are the same as in patients without liver disease.
How should I take Boltarin?
Take Boltarin exactly as directed on the label, or as prescribed by your doctor. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger amounts or for longer than recommended. Use the lowest dose that is effective in treating your condition.
For treatment of pain or primary dysmenorrhea the recommended dosage of Boltarin is 50 mg three times daily. In some patients an initial dose of 100 mg of Boltarin, followed by 50 mg doses, may provide better relief.
For the relief of osteoarthritis the recommended dosage of Boltarin is 100-150 mg/day in divided doses, i.e. 50 mg two or three times a day.
For the relief of rheumatoid arthritis the recommended dosage is 150-200 mg/day in divided doses, i.e. 50 mg three or four times a day.
Different formulations of Boltarin, Voltaren (Boltarin sodium tablets) and Boltarin (Boltarin potassium immediate-release tablets) are not necessarily equivalent in strength even if the milligram strength is the same.
If you use Boltarin long-term, you may need frequent medical tests.
Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.
Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.
Boltarin administration
Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
If you switch brands of Boltarin, your dose needs may change. Follow your doctor's instructions about how much medicine to take.
Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.
Dissolve the Boltarin powder (Boltarin) with 1 to 2 ounces of water. Do not use any other type of liquid. Stir this mixture and drink all of it right away. Boltarin powder works best if you take it on an empty stomach.
Call your doctor if your headache does not completely go away after taking Boltarin. Do not take a second dose of Boltarin powder without your doctor's advice.
Do not crush, chew, or break an enteric-coated pill. Swallow the pill whole. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating.
If you use this medication long-term, your liver function will need to be checked with frequent blood tests. Visit your doctor regularly.
Store at room temperature away from moisture and heat.
Boltarin pharmacology
Mechanism Of Action
Boltarin has analgesic, anti-inflammatory, and antipyretic properties.
The mechanism of action of Boltarin, like that of other NSAIDs, is not completely understood but involves inhibition of cyclooxygenase (COX-1 and COX-2).
Boltarin is a potent inhibitor of prostaglandin synthesis in vitro. Boltarin concentrations reached during therapy have produced in vivo effects. Prostaglandins sensitize afferent nerves and potentiate the action of bradykinin in inducing pain in animal models. Prostaglandins are mediators of inflammation. Because Boltarin is an inhibitor of prostaglandin synthesis, its mode of action may be due to a decrease of prostaglandins in peripheral tissues.
Pharmacodynamics
The effect of Boltarin on QTc prolongation was evaluated in a randomized, double-blind, positive (moxifloxacin 400 mg) - and placebo-controlled crossover study in healthy subjects. A total of 70 subjects was administered Boltarin sodium 37.5 mg and 75 mg. In a study with demonstrated ability to detect small effects, the upper bound of the 90% confidence interval for the largest placebo-adjusted, baseline-corrected QTc based on Fridericia correction method (QTcF) was below 10 ms, the threshold for regulatory concern.
Pharmacokinetics
Following intravenous administration of Boltarin to healthy volunteers, plasma concentrations of Boltarin exceed that of immediate-release oral Boltarin for the first 45 minutes reaching a maximum of 4.8-fold 5 minutes after administration.
The pharmacokinetics of Boltarin following intravenous administration of Boltarin and oral doses of immediate-release Boltarin are compared in Table 3.
Table 3: Single-dose and Multiple-dose Pharmacokinetics of Boltarin (Boltarin sodium) Injection and
Oral Immediate Release (IR) Boltarin Potassium
Figure 2: Pain Intensity Score Versus Time
References
- DailyMed. "DICLOFENAC EPOLAMINE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- NCIt. "Diclofenac: NCI Thesaurus (NCIt) provides reference terminology for many systems. It covers vocabulary for clinical care, translational and basic research, and public information and administrative activities.". https://ncit.nci.nih.gov/ncitbrowser... (accessed September 17, 2018).
- EPA DSStox. "Diclofenac: DSSTox provides a high quality public chemistry resource for supporting improved predictive toxicology.". https://comptox.epa.gov/dashboard/ds... (accessed September 17, 2018).
Reviews
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Information checked by Dr. Sachin Kumar, MD Pharmacology
