• Reducing pain and inflammation in arthritis, osteoarthritis and ankylosing spondylitis.

• Take your medications exactly as prescribed by your doctor, including at the right times and for the full length of your prescribed treatment.

• This medicine should be taken with or after food.
• This medicine may mask the signs and symptoms of infection, such as fever and inflammation. This may make you think mistakenly that an infection is getting better when it isn't, or that an infection is less serious than it is. For this reason you should tell your doctor if you get an infection while you are taking this medicine.
• Your doctor will prescribe you the lowest effective dose of this medicine for the shortest possible time necessary to relieve your symptoms. This is to minimise the chances of any side effects, particularly those mentioned below. It is important not to exceed the prescribed dose.
• NSAIDs can occasionally cause serious side effects on the gut, such as ulceration, bleeding or perforation of the stomach or intestinal lining. This type of side effect is more likely to occur in elderly people and in people taking high doses of the medicine. The risk can also be increased by taking certain other medicines (see below). It is important that these people, as well as people with a history of disorders affecting the stomach or intestines, are closely monitored by a doctor while taking this medicine. If your doctor thinks you are at high risk of side effects on the gut you may be prescribed an additional medicine to help protect your gut. All people taking this medicine should stop treatment and consult their doctor immediately if they experience any sign of bleeding from the stomach or intestine during treatment, for example vomiting blood and/or passing black/tarry/bloodstained stools.
• Non-steroidal anti-inflammatory drugs such as this one may be associated with a small increase in the risk of experiencing a heart attack or stroke. Any risk is more likely with high doses and prolonged treatment. If you have heart problems, have ever had a stroke, or think that you might be at risk of these conditions (for example if you have high blood pressure, diabetes, high cholesterol or are a smoker) you should discuss your treatment with your doctor or pharmacist.
• Very rarely, NSAIDS may cause serious blistering or peeling skin reactions (eg Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis). For this reason, you should stop taking this medicine and consult your doctor if you get a skin rash or sores inside your mouth while taking this medicine. This side effect is very rare, but if it occurs, is most likely to happen in the first month of treatment.
• If you have cirrhosis of the liver, heart failure or kidney disease, you are on a low sodium diet, or you are taking diuretic medicines, your kidney function should be assessed before starting and regularly throughout treatment with this medicine.
• During long-term treatment with this medicine you should have regular check-ups with your doctor so that you can be monitored for possible side effects of the medicine. This might include routine blood tests to monitor your kidney function, liver function and levels of blood components, particularly if you are elderly.

• Elderly people.
• History of disorders affecting the stomach or intestines.
• Inflammatory bowel disease such as Crohn's disease or ulcerative colitis.
• Kidney disease.
• Liver disease.
• Heart failure.
• High blood pressure (hypertension).
• Heart disease caused by inadequate blood flow to the heart (ischaemic heart disease), eg angina or history of heart attack.
• Disease of the blood vessels in and around the brain (cerebrovascular disease), eg history of stroke or mini-stroke (TIA).
• Poor circulation in the arteries of the legs or feet (peripheral arterial disease).
• Raised levels of fats such as cholesterol in the blood (hyperlipidaemia).
• Diabetes.
• Smokers.
• People with blood clotting problems or taking anticoagulant medicines.
• History of asthma.
• History of allergies.
• Diseases affecting connective tissue, eg systemic lupus erythematosus.

• People in whom aspirin or other NSAIDs, eg diclofenac, cause allergic reactions such as asthma attacks, itchy rash (urticaria), nasal inflammation (rhinitis) or swelling of the lips, tongue and throat (angioedema).
• Active peptic ulcer or bleeding in the gut, or a history of this.
• Severe heart failure.
• Liver failure.
• Kidney failure.
• Third trimester of pregnancy.
• Hereditary blood disorders called porphyrias.
• This medicine is not recommended for children. This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

•Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
• This medicine should not be taken in the third trimester of pregnancy because it may delay labour, increase the length of labour and cause complications in the newborn baby. It is not recommended for use in the first and second trimesters of pregnancy unless considered essential by your doctor. Some evidence suggests that NSAIDs such as this one should also be avoided by women attempting to conceive, as they may temporarily reduce female fertility during treatment and may also increase the risk of miscarriage or malformations. Seek medical advice from your doctor.
• The medicine passes into breast milk in small amounts. At normal doses it is unlikely to harm the nursing infant, however the manufacturer recommends that this medicine should be avoided where possible by women who are breastfeeding. It is important to seek medical advice from your doctor before taking this medicine if you are breastfeeding.

•Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
• Dizziness.
• Disturbances of the gut such as diarrhoea, nausea, indigestion or abdominal pain.
• Alteration in results of liver function tests.
• Wind (flatulence).
• Constipation.
• Vomiting.
• Mouth ulcers.
• Inflammation of the stomach (gastritis).
• Skin reactions, such as itching, rash and dermatitis.
• Increased creatinine and urea in the blood.
• Decrease in the number of red blood cells in the blood (anaemia).
• Hypersensitivity reactions such as narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock.
• Visual disturbances.
• Shortness of breath (dyspnoea).
• Dark coloured, tarry stools, due to the presence of blood altered by the intestinal juices (melaena).
• Swelling of the face, due to fluid retention.
• Difficulty sleeping (insomnia).
• Abnormal dreams.
• Depression.
• Pins and needles (paraesthesia).
• Tremor.
• Abnormal taste.
• Awareness of your heartbeat (palpitations).
• Flushing.
• Spinning sensation (vertigo).
• Headache.
• Fatigue.
• Ulceration or bleeding in the gut.
• Inflammation of the lining of the mouth (stomatitis).
• Inflammation of the pancreas (pancreatitis).
• Excessive fluid retention in the body tissues, resulting in swelling (oedema).
• Kidney, liver or blood disorders.
• Severe skin reactions. The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

•It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before taking this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe. Aceclofenac should not be used in combination with painkilling doses of aspirin or any other NSAID taken by mouth, eg ibuprofen, as this increases the risk of side effects on the stomach and intestines. Selective inhibitors of cyclo-oxgenase 2 such as celecoxib or etoricoxib should also be avoided for the same reason. There may be an increased risk of ulceration or bleeding from the gut if aceclofenac is taken with corticosteroids such as prednisolone. There may also be an increased risk of bleeding from the gut if aceclofenac is taken with the following medicines:
• anti-blood-clotting (anticoagulant) medicines, such as warfarin or heparin
• anti-platelet medicines to reduce the risk of blood clots or 'thin the blood', eg low-dose aspirin, clopidogrel, dipyridamole
• dabigatran
• erlotinib
• selective serotonin re-uptake inhibitors (SSRIs) antidepressants, eg fluoxetine, paroxetine, citalopram
• venlafaxine. Aceclofenac may enhance the effect of blood-thinning or anti-clotting medicines (anticoagulants) such as warfarin. As this may increase the risk of bleeding, people taking aceclofenac with an anticoagulant medicine should be closely monitored by their doctor. There may be an increased risk of side effects on the kidneys if aceclofenac is used with any of the following medicines:
• ACE inhibitors, eg enalapril
• angiotensin II receptor antagonists, eg losartan
• ciclosporin
• diuretics, eg furosemide
• tacrolimus. Aceclofenac may oppose the blood pressure lowering effects of certain medicines to treat high blood pressure, including the following:
• ACE inhibitors such as captopril
• angiotensin II receptor antagonists, eg losartan
• beta-blockers such as propranolol
• diuretics such as furosemide. Aceclofenac may reduce the removal of the following medicines from the body and so may increase the blood levels and risk of side effects of these medicines. People using aceclofenac with any of these should be closely monitored by their doctor:
• digoxin
• lithium
• methotrexate. If this medicine is used in combination with quinolone antibiotics, such as ciprofloxacin or norfloxacin there may be an increased risk of seizures (fits). This may occur in people with or without a previous history of epilepsy or convulsions.

•Read the package insert and/or patient product information sheet that comes with your prescription.
• Most medications should be stored in a dry place away from heat and humidity.
• Some medications also have special instructions for storage. Check for special instructions on your prescription label.
• If your medication needs to be protected from light, it should be stored in a container that filters out light, such as a clean film canister.
• If your medication needs to be refrigerated, and you do not have a fridge available (for example, if you are working outside or on the road all day), try using a cooler with an ice pack. An ordinary cooler found at hardware or sporting goods stores will do.

•Consult your doctor for further instructions and also read the package insert and/or patient product information sheet that comes with your prescription.

• Relieving mild to moderate pain such as headache, migraine, nerve pain (neuralgia), toothache, sore throat, earache, period pain and rheumatic and muscular aches and pains.
• Lowering a high temperature (fever).
• Relieving aches, pains, fever and discomfort associated with colds and flu.

• Paracetamol can be taken either with or without food.
• If symptoms persist get advice from your doctor or pharmacist.
• Do not give this medicine to your child for more than three days without getting medical advice from your doctor or pharmacist.

• Do not exceed the recommended dose.
• Do not take this medicine with any other medicines that contain paracetamol, as this can easily result in exceeding the recommended dose of paracetamol.
• An overdose of paracetamol is dangerous and capable of causing serious damage to the liver and kidneys. You should never exceed the dose stated in the information leaflet supplied with the medicine. Immediate medical advice should be sought in the event of an overdose with this medicine, even if you feel well, because of the risk of delayed, serious liver damage.
• Alcohol increases the risk of liver damage that can occur if an overdose of paracetamol is taken. The hazards of paracetamol overdose are greater in persistant heavy drinkers and in people with alcoholic liver disease.
• Consult your doctor if your headaches become persistent. Taking a painkiller for headaches or migraines too often or for too long can actually make the headaches worse.

• Decreased kidney function.
• Decreased liver function.

•This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

•Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
• There are no known harmful effects when this medicine is used during pregnancy.
• Small amounts of this medicine may pass into breast milk, however there are no known harmful effects when it is used by breastfeeding mothers.

•Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
• Allergic skin reactions such as a rash (very rarely).The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

• You should not take other medicines that contain paracetamol in combination with this medicine, as this can easily result in exceeding the maximum recommended daily dose of paracetamol, or ask your pharmacist for advice.
• Cholestyramine reduces the absorption of paracetamol from the gut. It should not be taken within an hour of taking paracetamol or the effect of the paracetamol will be reduced.
• Metoclopramide and domperidone may increase the absorption of paracetamol from the gut.
• The absorption of paracetamol may be reduced if it is given within four hours after taking a dose of the antidiabetic medicine lixisenatide.
• Long-term or regular use of paracetamol may increase the anti-blood-clotting effect of warfarin and other anticoagulant medicines, leading to an increased risk of bleeding. Regular monitoring of blood clotting times should be performed if paracetamol is used regularly with these medicines. This effect does not occur with occasional pain-killing doses.

•Read the package insert and/or patient product information sheet that comes with your prescription.
• Most medications should be stored in a dry place away from heat and humidity.
• Some medications also have special instructions for storage. Check for special instructions on your prescription label.
• If your medication needs to be protected from light, it should be stored in a container that filters out light, such as a clean film canister.
• If your medication needs to be refrigerated, and you do not have a fridge available (for example, if you are working outside or on the road all day), try using a cooler with an ice pack. An ordinary cooler found at hardware or sporting goods stores will do.

•Consult your doctor for further instructions and also read the package insert and/or patient product information sheet that comes with your prescription.

•Serrapeptase is used for painful conditions including back pain, osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, carpel tunnel syndrome, migraine headache, and tension headache. It is also used for conditions that involve pain and swelling (inflammation) including sinusitis, laryngitis, sore throat, ear infections, swelling after surgery, swelling of a vein with the formation of a blood clot (thrombophlebitis), and inflammatory bowel disease (IBD) including ulcerative colitis and Crohn's disease. Some people use serrapeptase for heart disease and “hardening of the arteries” (atherosclerosis). Women use it for non-cancerous lumpy breasts (fibrocystic breast disease), and nursing mothers use it for breast pain caused by too much milk (breast engorgement). Other uses include treatment of diabetes, leg ulcers, asthma, and pus accumulation (empyema). Facial swelling after surgery to clear the sinuses. Insufficient Evidence for: Chronic bronchitis. Developing research suggests that serrapeptase can significantly reduce coughing and thin secretions in people with chronic bronchitis after about 4 weeks of treatment. Sinus pain (sinusitis). Early research suggests that people with sinusitis who take serrapeptase have significantly reduced pain, nasal secretions, and nasal obstruction after 3-4 days of treatment. Hoarseness (laryngitis). Early research suggests that serrapeptase can significantly reduce pain, secretions, difficulty swallowing, and fever in people with laryngitis after 3-4 days of treatment. Sore throat (pharyngitis). Early research suggests that serrapeptase can significantly reduce pain, secretions, difficulty swallowing, and fever in people with sore throat after 3-4 days of treatment. Back pain. Osteoarthritis. Rheumatoid arthritis. Osteoporosis. Carpel tunnel syndrome. Diabetes. Leg ulcers. Migraine headache. Tension headache. Asthma. Pus accumulation (empyema). Thrombophlebitis. Fibromyalgia. Fibrocystic breast disease. Inflammatory bowel disease (IBD) including ulcerative colitis and Crohn's disease. Breast engorgement. Heart disease. Ear infections. Other conditions.

•The following doses have been studied in scientific research: BY MOUTH: For reducing swelling of the inside of the cheek after sinus surgery: 1 mg of serrapeptase 3 times on the day before surgery, once in the evening after surgery, and then 3 times daily for 5 days following surgery.

•Serrapeptase seems to be safe for adults when taken by mouth, short-term (up to 4 weeks). The long-term safety of serrapeptase is not known.

• Bleeding disorders: Serrapeptase might interfere with blood clotting, so some researchers worry that it might make bleeding disorders worse. If you have a bleeding disorder, check with your healthcare provider before using serrapeptase. Surgery: Serrapeptase might interfere with blood clotting. There is a concern that it might increase bleeding during and after surgery. Stop using serrapeptase at least 2 weeks before a scheduled surgery.

•Contraindicated in patients who are hypersensitive or have intolerance.

•Not enough is known about the use of serrapeptase during pregnancy and breast-feeding. Stay on the safe side and avoid use.

•Along with its needed effects, a medicine may cause some unwanted effects. Ifany side effect occur they may need medical attention. Check with your doctor or nurse immediately if any side effects occur after taking medicine.

•Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs interacts with SERRAPEPTASE Serrapeptase might decrease blood clotting. Therefore, taking serrapeptase along with medications that also slow clotting might increase the chances of bruising and bleeding. Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

•Read the package insert and/or patient product information sheet that comes with your prescription.
• Most medications should be stored in a dry place away from heat and humidity.
• Some medications also have special instructions for storage. Check for special instructions on your prescription label.
• If your medication needs to be protected from light, it should be stored in a container that filters out light, such as a clean film canister.
• If your medication needs to be refrigerated, and you do not have a fridge available (for example, if you are working outside or on the road all day), try using a cooler with an ice pack. An ordinary cooler found at hardware or sporting goods stores will do.

•Apply the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not apply extra medicine to make up the missed dose.