Usage
Aceclofenac + Trypsin Chymotrypsin is prescribed for pain and inflammation associated with musculoskeletal and joint disorders such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, spondylosis, spondyloarthritis, and other ortho-degenerative disorders. It’s also used to manage pain and inflammation following surgical procedures (dental, orthopedic, gynecological), sports injuries (sprains, strains), and other painful inflammatory conditions like tendonitis and bursitis. This drug’s pharmacological classifications are:
- Aceclofenac: Non-Steroidal Anti-Inflammatory Drug (NSAID)
- Trypsin Chymotrypsin: Proteolytic enzyme
Mechanism of Action: Aceclofenac inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin production, which are mediators of pain, fever, and inflammation. Trypsin and chymotrypsin break down proteins at the inflammation site, reducing swelling and promoting healing by clearing debris and increasing blood supply.
Alternate Names
No internationally recognized alternate names exist for this specific combination. Regional variations may exist. Brand names include Chymoral Forte, Chymogrip, and Mortrip Plus.
How It Works
Pharmacodynamics: Aceclofenac exerts its analgesic and anti-inflammatory effects by inhibiting COX enzymes. Trypsin and chymotrypsin decrease inflammation by breaking down proteins and fibrin at the injured site, facilitating tissue repair.
Pharmacokinetics: Aceclofenac is well-absorbed orally, reaching peak plasma concentrations in 1-3 hours. It is metabolized in the liver and excreted primarily through the kidneys. Trypsin and chymotrypsin are absorbed from the gastrointestinal tract and distributed systemically.
Mode of Action: Aceclofenac acts by non-selective COX inhibition, primarily COX-2, the isoform associated with inflammation. Trypsin and chymotrypsin proteolytically cleave proteins involved in the inflammatory cascade.
Receptor Binding/Enzyme Inhibition: Aceclofenac binds to and inhibits COX enzymes. Trypsin and chymotrypsin act directly on proteins at the site of inflammation, not through receptor binding.
Elimination Pathways: Aceclofenac is eliminated primarily via renal excretion. Trypsin and chymotrypsin are metabolized and eliminated by the body’s natural proteolytic pathways.
Dosage
Standard Dosage
Adults:
The usual dosage is one tablet twice daily, taken orally after meals. Each tablet typically contains 100mg aceclofenac and 50,000 IU of trypsin chymotrypsin.
Children:
This combination is generally not recommended for children under 12 years of age, as safety and efficacy haven’t been established.
Special Cases:
- Elderly Patients: Dose adjustment may be necessary based on renal and hepatic function. Close monitoring for adverse events is recommended.
- Patients with Renal Impairment: Caution is advised in patients with renal impairment, and dosage adjustments may be required.
- Patients with Hepatic Dysfunction: A reduced dose is recommended for patients with hepatic impairment.
- Patients with Comorbid Conditions: Caution should be exercised in patients with cardiovascular disease, hypertension, or a history of gastrointestinal bleeding.
Clinical Use Cases
Specific dosage adjustments for clinical scenarios like intubation, surgical procedures, mechanical ventilation, or ICU use should be determined by the attending physician based on patient needs and condition. No standardized protocols exist for these cases. The combination is not typically used in emergency situations like status epilepticus or cardiac arrest.
Dosage Adjustments
Dose adjustments are necessary for patients with renal or hepatic impairment, and for those with a history of gastrointestinal disorders. Genetic polymorphisms affecting drug metabolism may also require adjustments.
Side Effects
Common Side Effects
Nausea, vomiting, diarrhea, abdominal pain, dizziness, drowsiness, indigestion, heartburn, loss of appetite, headache.
Rare but Serious Side Effects
Allergic reactions (rash, itching, swelling, difficulty breathing), gastrointestinal bleeding or ulcers, liver damage, kidney problems, increased risk of heart attack or stroke.
Long-Term Effects
Chronic use of NSAIDs like aceclofenac carries potential risks of gastrointestinal ulcers, kidney problems, and cardiovascular issues. Long-term use should be carefully considered.
Adverse Drug Reactions (ADR)
Severe allergic reactions, gastrointestinal bleeding, hepatotoxicity, nephrotoxicity, cardiovascular events.
Contraindications
Hypersensitivity to any component, active peptic ulcer, severe hepatic or renal impairment, history of asthma, urticaria, or allergic reactions to NSAIDs, pregnancy (especially third trimester), breastfeeding.
Drug Interactions
Aceclofenac can interact with anticoagulants (warfarin, heparin), other NSAIDs (ibuprofen, naproxen), corticosteroids, antihypertensives, lithium, methotrexate, cyclosporine, and some antibiotics. Alcohol should be avoided as it can increase the risk of gastrointestinal bleeding.
Pregnancy and Breastfeeding
Contraindicated during pregnancy and breastfeeding.
Drug Profile Summary
- Mechanism of Action: Aceclofenac: COX inhibitor; Trypsin Chymotrypsin: proteolytic enzymes.
- Side Effects: Nausea, vomiting, GI upset, dizziness, rare but serious: allergic reactions, GI bleeding, liver/kidney damage.
- Contraindications: Hypersensitivity, peptic ulcer, severe liver/kidney disease, pregnancy, breastfeeding.
- Drug Interactions: Anticoagulants, NSAIDs, corticosteroids, antihypertensives, lithium, methotrexate.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adults: 1 tablet (100mg aceclofenac/50,000 IU trypsin chymotrypsin) twice daily after meals.
- Monitoring Parameters: Renal and liver function, signs of GI bleeding.
Popular Combinations
Aceclofenac is sometimes combined with paracetamol for enhanced pain relief. However, always consider potential drug interactions and side effects before co-prescribing.
Precautions
Screen patients for allergies, renal/hepatic dysfunction, cardiovascular conditions, and history of GI bleeding. Exercise caution in elderly patients, pregnant/breastfeeding women, and children. Avoid alcohol and driving if drowsiness or dizziness occur.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Aceclofenac + Trypsin Chymotrypsin?
A: The standard adult dosage is one tablet containing 100mg Aceclofenac and 50,000 IU Trypsin Chymotrypsin, taken twice daily after meals.
Q2: Can this combination be used in children?
A: It’s generally not recommended for children under 12, as safety and efficacy haven’t been established.
Q3: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, abdominal pain, dizziness, and drowsiness.
Q4: Are there any serious side effects to watch out for?
A: Yes, rare but serious side effects include allergic reactions, gastrointestinal bleeding, and liver or kidney damage.
Q5: Can a patient take this if they have a history of stomach ulcers?
A: No, it’s contraindicated in patients with active or recurrent peptic ulcers.
Q6: Is it safe during pregnancy or breastfeeding?
A: No, it’s contraindicated during both pregnancy and breastfeeding.
Q7: What should I do if a patient misses a dose?
A: They should take the missed dose as soon as they remember, unless it’s close to the next scheduled dose. Do not double the dose.
Q8: Does this medication interact with other drugs?
A: Yes, it can interact with several medications, including anticoagulants, other NSAIDs, and some antihypertensives. A full medication review is essential.
Q9: Can a patient drink alcohol while taking this medication?
A: Alcohol should be avoided as it can increase the risk of gastrointestinal side effects, especially bleeding.
