Usage
This combination medication is prescribed for the relief of pain and inflammation associated with musculoskeletal and joint disorders, such as:
- Osteoarthritis
- Rheumatoid arthritis
- Ankylosing spondylitis
- Muscle pain, spasms, and stiffness
- Low back pain
- Neck pain
- Musculoskeletal injuries (sprains and strains)
- Myofascial pain syndrome
- Fibromyalgia
Pharmacological Classification:
- Aceclofenac: Non-Steroidal Anti-Inflammatory Drug (NSAID)
- Eperisone: Centrally-acting Muscle Relaxant
- Paracetamol: Analgesic and Antipyretic
Mechanism of Action: Aceclofenac inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis, thus decreasing pain and inflammation. Paracetamol acts centrally on the hypothalamus to reduce fever and peripherally to block pain impulse generation. Eperisone acts on the central nervous system (spinal cord and brain) to relax skeletal muscles, reduce muscle tone, and suppress overactive muscle reflexes that cause spasms and stiffness. It also improves blood flow to the muscles.
Alternate Names
How It Works
Pharmacodynamics: Aceclofenac reduces pain and inflammation by inhibiting COX enzymes and prostaglandin synthesis. Paracetamol reduces fever by acting on the hypothalamus and provides analgesia through central and peripheral mechanisms. Eperisone induces muscle relaxation by acting on the central nervous system.
Pharmacokinetics: The individual components are absorbed orally. Metabolism and elimination pathways involve both hepatic and renal routes. Specific pharmacokinetic data for the combination product are limited.
Mode of Action: Aceclofenac inhibits COX-1 and COX-2 enzymes. Paracetamol’s mechanism is not fully understood but likely involves serotonin pathways and possibly prostaglandin inhibition or cannabinoid receptor influence. Eperisone’s action is primarily on the central nervous system, affecting muscle tone and reflexes.
Receptor binding, enzyme inhibition, or neurotransmitter modulation: Aceclofenac inhibits COX enzymes. Paracetamol may modulate serotonin pathways and influence cannabinoid receptors. Eperisone’s precise mechanism is not fully elucidated.
Elimination pathways: Primarily renal and hepatic for all three components.
Dosage
Dosage information for this combination is limited and varies by brand. Consult the prescribing information for the specific product used.
Standard Dosage
Adults: A common regimen is one tablet twice daily.
Children: This combination is generally not recommended for children as safety and efficacy haven’t been established.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary based on renal and hepatic function.
- Patients with Renal Impairment: Caution and dose adjustments are advised.
- Patients with Hepatic Dysfunction: Caution and dose adjustments are advised.
- Patients with Comorbid Conditions: Consider adjustments for cardiovascular disease, hypertension, diabetes, asthma, etc.
Clinical Use Cases
Dosage recommendations for specific clinical use cases like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations are not established for this specific combination.
Dosage Adjustments
Dose modifications may be necessary based on patient-specific factors like renal/hepatic dysfunction, metabolic disorders, or genetic polymorphisms.
Side Effects
Common Side Effects:
- Nausea
- Vomiting
- Stomach pain/discomfort
- Diarrhea
- Loss of appetite
- Heartburn
- Dizziness
- Drowsiness
- Headache
- Fatigue
- Rash
- Hives
Rare but Serious Side Effects:
- Allergic reactions (anaphylaxis)
- Stevens-Johnson Syndrome
- Toxic epidermal necrolysis
- Liver damage
- Kidney damage
- Gastrointestinal bleeding
- Myocardial infarction
- Stroke
Long-Term Effects: Long-term effects of this combination are not well-established. Long-term NSAID use carries cardiovascular and gastrointestinal risks.
Contraindications
- Hypersensitivity to any component
- Active peptic ulcer or gastrointestinal bleeding
- Severe hepatic impairment
- Severe renal impairment
- Severe heart failure
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Recent coronary artery bypass graft surgery
- Third trimester of pregnancy
Drug Interactions
- Other NSAIDs (aspirin, ibuprofen)
- Anticoagulants (warfarin)
- Corticosteroids
- SSRIs (fluoxetine, sertraline)
- Diuretics
- Antihypertensives
- Methocarbamol
- Cholestyramine
- Tizanidine
- Metoclopramide
- Domperidone
- Alcohol
Pregnancy and Breastfeeding
Contraindicated in the third trimester. Safety during the first and second trimesters has not been established. Not recommended during breastfeeding. Consult a physician before use during pregnancy or breastfeeding.
Drug Profile Summary
- Mechanism of Action: See above.
- Side Effects: See above.
- Contraindications: See above.
- Drug Interactions: See above.
- Pregnancy & Breastfeeding: Not recommended.
- Dosage: Varies; see product information.
- Monitoring Parameters: Liver function tests, renal function tests, blood pressure, complete blood count.
Popular Combinations
Specific popular combinations are not established for this triple drug therapy. The individual drugs are often combined with other medications depending on the specific condition being treated.
Precautions
- General Precautions: Evaluate for allergies, metabolic disorders, and organ dysfunction.
- Specific Populations: See Pregnancy and Breastfeeding, Elderly Patients, and Patients with Renal/Hepatic Impairment above.
- Lifestyle Considerations: Avoid alcohol. May cause drowsiness, affecting driving and operating machinery.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Aceclofenac + Eperisone + Paracetamol?
A: Dosage varies depending on the specific product. Refer to the product’s prescribing information. A common adult dosage is one tablet twice daily.
Q2: What are the common side effects?
A: Common side effects can include nausea, vomiting, stomach discomfort, diarrhea, dizziness, drowsiness, headache, and fatigue.
Q3: Can pregnant or breastfeeding women take this medication?
A: It’s contraindicated in the third trimester and not recommended during breastfeeding. Consult a physician before use during pregnancy or lactation.
Q4: What are the serious side effects?
A: Rare but serious side effects include allergic reactions, liver or kidney damage, gastrointestinal bleeding, heart attack, and stroke.
Q5: What are the major drug interactions?
A: It interacts with other NSAIDs, anticoagulants (e.g., warfarin), alcohol, and some other medications. Consult the Drug Interactions section above for a complete list.
Q6: What conditions is this medication used for?
A: It’s primarily used to treat pain and inflammation associated with musculoskeletal and joint disorders.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is close to the time for your next dose. Do not double the dose to catch up.
Q8: Can this medication be used in children?
A: This combination is generally not recommended for use in children, as safety and effectiveness have not been established.
Q9: Are there any dietary restrictions while taking this medication?
A: Avoid alcohol while taking this medication. It may increase the risk of stomach bleeding and other side effects. You should also discuss any other dietary restrictions with your doctor.
