Usage
- Aceclofenac + Eperisone is prescribed for the relief of pain and inflammation associated with muscle spasms in conditions such as low back pain, neck pain, and musculoskeletal injuries like sprains and strains. It can also be used for myofascial pain syndrome and fibromyalgia.
- Pharmacological Classification: This drug is a combination of a Non-Steroidal Anti-Inflammatory Drug (NSAID) and a centrally-acting muscle relaxant.
- Mechanism of Action: Aceclofenac inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin production, thereby decreasing pain and inflammation. Eperisone acts centrally to reduce muscle stiffness and spasms.
Alternate Names
- While there isn’t a universally recognized alternate name for the combination, the individual components have other names. Aceclofenac is sometimes referred to as Aceclofenacum. Eperisone is also known as Eperisoni Hydrochloridum.
- Brand Names: This combination is marketed under various brand names such as Acemyoset-P, Myospas, and Nucoxia P.
How It Works
- Pharmacodynamics: Aceclofenac provides analgesic and anti-inflammatory effects by inhibiting COX-1 and COX-2 enzymes, leading to decreased prostaglandin synthesis. Eperisone relaxes skeletal muscles through its central action, probably by suppressing reflex pathways in the spinal cord. This dual mechanism effectively reduces pain, inflammation, and muscle spasms.
- Pharmacokinetics: Both drugs are absorbed orally. Aceclofenac is metabolized in the liver and primarily excreted in urine. Eperisone is also metabolized in the liver and eliminated via both renal and biliary routes.
- Mode of Action: Aceclofenac binds to COX enzymes, blocking their activity. Eperisone’s exact cellular mechanism is unclear, but it’s believed to modulate neuronal activity in the central nervous system.
- Elimination Pathways: Aceclofenac is primarily excreted via renal pathways. Eperisone is eliminated by hepatic metabolism and excretion through both urine and bile.
Dosage
Standard Dosage
Adults:
- The standard dose is one tablet of Aceclofenac 100mg + Eperisone 75mg twice daily, after meals.
Children:
- This combination is not recommended for children due to a lack of safety and efficacy data.
Special Cases:
- Elderly Patients: A reduced dose is advisable, along with close monitoring for adverse effects.
- Patients with Renal Impairment: Dose reduction is necessary in moderate to severe renal impairment.
- Patients with Hepatic Dysfunction: Caution and possible dose adjustments are needed in patients with hepatic impairment.
- Patients with Comorbid Conditions: Close monitoring and dose adjustments may be necessary in patients with cardiovascular disease or gastrointestinal bleeding history.
Clinical Use Cases
Aceclofenac + Eperisone is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. It’s primarily used for outpatient management of musculoskeletal pain and spasms.
Dosage Adjustments
Adjustments should be based on renal and hepatic function, age, and concomitant medications.
Side Effects
Common Side Effects:
- Nausea, vomiting, abdominal pain, heartburn, diarrhea, indigestion, flatulence, loss of appetite, headache, weakness, drowsiness, dizziness, and skin rash.
Rare but Serious Side Effects:
- Gastrointestinal bleeding, peptic ulcers, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylactoid reactions, hepatotoxicity, renal impairment.
Long-Term Effects:
- Chronic NSAID use may increase cardiovascular and renal risks.
Adverse Drug Reactions (ADR):
- Severe allergic reactions, gastrointestinal bleeding, acute liver or kidney injury.
Contraindications
- Hypersensitivity to either drug, active peptic ulcer, severe hepatic or renal impairment, severe heart failure, history of asthma, urticaria, or allergic reactions after taking aspirin or other NSAIDs, myasthenia gravis, third-trimester pregnancy.
Drug Interactions
- Other NSAIDs, anticoagulants (e.g., warfarin), corticosteroids, SSRIs, diuretics, antihypertensives, alcohol.
Pregnancy and Breastfeeding
- Contraindicated in the third trimester. Use cautiously during the first and second trimesters only if benefits outweigh the risks. Not recommended during breastfeeding.
Drug Profile Summary
- Mechanism of Action: Aceclofenac: COX inhibitor; Eperisone: Centrally acting muscle relaxant.
- Side Effects: Nausea, vomiting, abdominal pain, drowsiness, dizziness, rash, gastrointestinal bleeding (rare).
- Contraindications: Hypersensitivity, active peptic ulcer, severe hepatic/renal impairment, pregnancy (third trimester).
- Drug Interactions: Other NSAIDs, anticoagulants, alcohol.
- Pregnancy & Breastfeeding: Avoid during pregnancy, not recommended during breastfeeding.
- Dosage: Aceclofenac 100mg + Eperisone 75mg twice daily.
- Monitoring Parameters: Liver and kidney function tests, blood pressure.
Popular Combinations
- Aceclofenac + Eperisone + Paracetamol: Provides enhanced analgesic effect.
- Aceclofenac + Eperisone + Thiocolchicoside: Strengthens muscle relaxant action.
Precautions
- Pre-existing gastrointestinal disorders, hepatic/renal impairment, cardiovascular disease should be cautiously considered before prescribing.
- Pregnant Women: Avoid, especially in the third trimester.
- Breastfeeding Mothers: Not recommended.
- Children & Elderly: Not recommended for children, reduced dose for the elderly.
- Lifestyle Considerations: Avoid alcohol, caution when driving or operating machinery due to drowsiness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Aceclofenac + Eperisone?
A: The standard adult dosage is one tablet of Aceclofenac 100mg + Eperisone 75mg twice daily. Dosage should be adjusted in elderly patients and those with hepatic or renal impairment. Not recommended for children.
Q2: What are the common side effects?
A: Common side effects include nausea, dizziness, drowsiness, gastrointestinal upset, and skin rash.
Q3: Can this combination be used during pregnancy?
A: It is contraindicated in the third trimester and should be used cautiously in the first and second trimesters only if the potential benefits outweigh the risks.
Q4: What are the drug interactions I should be aware of?
A: This medication can interact with other NSAIDs, anticoagulants like warfarin, and alcohol. It is important to inform your doctor about all medications you are taking.
Q5: Is it safe to drive while on this medicine?
A: Use caution while driving or operating machinery as it can cause drowsiness and dizziness.
Q6: How does Aceclofenac + Eperisone work?
A: Aceclofenac reduces pain and inflammation by inhibiting COX enzymes, and Eperisone reduces muscle spasms via its central action.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s almost time for the next dose. Don’t double the dose.
Q8: When should I avoid using this medication?
A: Avoid use in cases of hypersensitivity, active peptic ulcer, severe hepatic/renal impairment, severe heart failure, and during the third trimester of pregnancy.
Q9: Can this medication be used long-term?
A: Long-term use of NSAIDs can increase the risk of cardiovascular and renal problems. Your doctor will monitor you accordingly.
Q10: What are the signs of an overdose?
A: Signs of an overdose may include increased side effects such as gastrointestinal disturbances, severe dizziness, and skin reactions. Seek immediate medical attention if an overdose is suspected.
