May affect ability to drive & use machines. Contraindicated in pregnancy & lactation. Dexketoprofen: History of allergic conditions. Avoid use w/ other NSAIDs including cyclooxygenase-2 selective inhibitors. W/draw treatment when GI bleeding or ulceration occurs. Identify any history of oesophagitis, gastritis &/or peptic ulcer prior to initiation of treatment; monitor patients w/ GI symptoms or history of GI disease. History of GI disease (eg, ulcerative colitis, Crohn's disease); GI toxicity particularly in elderly. Consider combination therapy w/ protective agents eg, misoprostol or proton pump inhibitors. Concomitant use w/ drug that increase risk of ulceration & bleeding eg, oral corticosteroids, anticoagulants eg, warfarin, SSRIs or anti-platelets eg, acetylsalicylic acid. Renal impairment. Increased risk of nephrotoxicity in patients receiving diuretic therapy or those who could develop hypovolaemia; ensure adequate fluid intake during treatment to prevent dehydration. Hepatic impairment; discontinue therapy in case of increase in liver parameters, AST, ALT, SGOT & SGPT. Appropriate monitoring for patients w/ history of HTN &/or mild to moderate CHF, cardiac disease, in particular those w/ previous episodes of heart failure. Small increase in the risk of arterial thrombotic events eg, MI or stroke particularly at high doses & in long term use. Uncontrolled HTN, CHF, established ischaemic heart disease, peripheral arterial disease, &/or cerebrovascular disease. Not recommended in patients who are receiving other therapy that interferes w/ haemostasis eg, warfarin or other coumarins or heparins. Risk of exfoliative dermatitis, Stevens-Johnson syndrome & toxic epidermal necrolysis; discontinue at the 1st appearance of skin rash, mucosal lesions or any other signs of hypersensitivity. Patients w/ congenital disorder of porphyrin metabolism; dehydration; directly after major surgery; w/ asthma combined w/ chronic rhinitis, chronic sinusitis &/or nasal polyposis; suffering from haematopoietic disorders, SLE or mixed connective tissue disease. Avoid in case of varicella. Childn & adolescents, elderly. Tramadol HCl: Addicted patients, patients w/ head injury, shock, reduced level of consciousness of uncertain origin, disorders of the resp centre or function, increased intracranial pressure; patients sensitive to opiates. Patients w/ resp depression, or if concomitant CNS depressant drugs are being administered, or if the recommended dosage is significantly exceeded. Increased risk of convulsions when doses exceed the recommended upper daily dose limit (400 mg); patients taking drugs that lower seizure threshold. Epilepsy. Tolerance, psychic & physical addiction may develop, especially after long-term use. Tendency to drug abuse or dependence. Concomitant use w/ sedatives eg, benzodiazepines or related drugs that may result to sedation, resp depression, coma & death. CYP2D6 deficiency. Extreme caution in childn for post-op pain relief & closely monitor for symptoms of opioid toxicity including resp depression. Not recommended for use in childn in whom resp function might be compromised including neuromuscular disorders, severe cardiac or resp conditions, upper resp or lung infections, multiple trauma or extensive surgical procedures. Na content.