Chlorzoxazone + Diclofenac + Paracetamol

Indications

Chlorzoxazone + Diclofenac + Paracetamol is used for: Relief of mild to moderate pain & fever, inflammatory & degenerative forms of rheumatism, RA, ankylosing spondylitis, OA, painful post-op & post-traumatic inflammation, swelling & dysmenorrhoea. Adjunct to physical therapy in treatment of painful musculoskeletal disorders.

Adult Dose

Adult 1 tab tds. Muscle spasm 1 tab increased to 2 tab in severe spasm, tds-qds.

Child Dose

Renal Dose

Administration

Should be taken with food.

Contra Indications

Hypersensitivity to aspirin & aspirin-type drugs. History of peptic ulceration. Renal or hepatic insufficiency.

Precautions

Renal or hepatic disease. Do not use continuously for >10 days. Patients w/ asthma. Elderly.

Pregnancy-Lactation

Interactions

Aspirin, lithium, digoxin, glucocorticoids or other NSAIDs, barbiturates, metoclopramide, probenecid.

Adverse Effects

Side effects of Chlorzoxazone + Diclofenac + Paracetamol : Diclofenac Na: GI disorders, peptic ulceration, GI bleeding, vertigo, headache, skin rashes, pruritus, tinnitus, depression, drowsiness, nervousness, insomnia, irritability, agitation, minor hearing disorders, edema, palpitations, blurred vision, ocular reactions; hypersensitivity reactions; abnormalities in liver function tests. Paracetamol: Skin rashes & other allergic reactions. Chlorzoxazone: GI disturbances, drowsiness, nausea, dizziness, lightheadedness, malaise or overstimulation.

Mechanism of Action

Diclofenac sodium is a nonsteroidal compound, a phenylacetic acid derivative with analgesic, antipyretic and anti-inflammatory effects. Diclofenac sodium inhibits the biosynthesis and release of prostaglandins which are known to be implicated in the pathogenesis of inflammation, pain and fever. Absorption occurs in the GIT to give peak plasma concentration approximately 2 hrs after ingestion. There is at least 99% binding to plasma proteins and excretion of metabolites is mainly in the urine. Paracetamol has analgesic and antipyretic effects similar to those of aspirin. However, it has no anti-inflammatory effect and does not share the antirheumatic properties of the salicylates. It is rapidly and practically completely absorbed from the GIT. The concentration in plasma reaches a peak in 30-60 min and the plasma t½ is about 2 hrs after therapeutic doses. It is distributed into most body tissues. It crosses the placenta and is present in breast milk. Chlorzoxazone is a centrally-acting muscle relaxant. Chlorzoxazone acts primarily at the level of the spinal cord and subcortical areas of the brain where it inhibits multisynaptic reflex arcs involved in producing and maintaining skeletal muscle spasm of varied etiology. Chlorzoxazone is rapidly absorbed from the GIT. It is metabolized to 6-hydroxychlorzoxazone and then eliminated in the urine.