Usage
- This combination medication is primarily prescribed for short-term relief of pain and inflammation associated with musculoskeletal and joint disorders such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, muscle pain, back pain, and bone and joint pain. It may also be used to alleviate pain related to dental procedures, earaches, throat pain, and other similar conditions.
- Pharmacological Classification: Analgesic (pain reliever), Anti-inflammatory, Proteolytic enzyme.
Alternate Names
While “Diclofenac + Paracetamol + Trypsin Chymotrypsin” is the standard generic name, some regional or international variations may exist. Brand names for this combination medication may vary, with examples such as Chymoflam and Chymova-AP. However, brand names are numerous and vary by region.
How It Works
- Pharmacodynamics: Diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis, thereby mitigating pain and inflammation. Paracetamol (acetaminophen) is an analgesic and antipyretic that also contributes to pain relief. Trypsin and chymotrypsin are proteolytic enzymes that break down proteins, facilitating the removal of damaged tissue and promoting healing at the site of inflammation.
- Pharmacokinetics: Diclofenac is well-absorbed orally, metabolized primarily in the liver, and excreted through the kidneys. Paracetamol is also readily absorbed, metabolized in the liver, and eliminated renally. Trypsin and chymotrypsin, when administered orally, are absorbed in the gastrointestinal tract.
- Mode of Action: The combined action of diclofenac and paracetamol offers synergistic pain relief, targeting both peripheral and central pain pathways. Trypsin and chymotrypsin aid in reducing inflammation locally by removing damaged proteins and debris.
- Elimination Pathways: Primarily renal excretion for diclofenac and paracetamol, while trypsin and chymotrypsin are metabolized and excreted.
Dosage
Standard Dosage
Adults: The typical dosage is one tablet containing Diclofenac 50mg + Paracetamol 325mg + Trypsin Chymotrypsin 50000 AU, taken orally with food, two to three times a day. Dosage can be adjusted depending on pain level and the patient’s response to the medication.
Children: This combination is generally not recommended for children under 12 years of age. Safety and efficacy in pediatric patients have not been fully established.
Special Cases:
- Elderly Patients: Dose adjustments may be needed depending on renal function and overall health status. Start with the lowest effective dose.
- Patients with Renal Impairment: Careful dose adjustment is crucial. The dosage should be reduced based on the degree of impairment.
- Patients with Hepatic Dysfunction: Diclofenac and paracetamol are metabolized in the liver, so dose reduction may be necessary.
- Patients with Comorbid Conditions: Consider individual patient factors like cardiovascular disease, diabetes, and other conditions, and adjust the dosage if necessary.
Clinical Use Cases
The combination is not typically used in specialized clinical settings such as intubation, surgical procedures, mechanical ventilation, ICU care, or emergency situations. Its use is generally limited to the management of pain and inflammation from musculoskeletal conditions.
Dosage Adjustments
Dosages should be individualized based on patient response and clinical status. Renal and hepatic function, other medications, and comorbidities influence dosing.
Side Effects
Common Side Effects
Nausea, vomiting, stomach pain, loss of appetite, indigestion, diarrhea, drowsiness, dizziness, headache.
Rare but Serious Side Effects
Allergic reactions (rash, itching, swelling), gastrointestinal bleeding, liver damage, kidney problems.
Long-Term Effects
Long-term use of NSAIDs can lead to gastrointestinal complications.
Adverse Drug Reactions (ADR)
Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome, gastrointestinal bleeding, acute liver failure, kidney damage.
Contraindications
- Hypersensitivity to any of the components.
- Active peptic ulcer disease, gastrointestinal bleeding.
- Severe hepatic or renal impairment.
- Aspirin triad (asthma, nasal polyps, aspirin sensitivity).
- Pregnancy (especially third trimester).
- Patients with Coronary Artery Bypass Graft (CABG) surgery.
Drug Interactions
- Anticoagulants (warfarin, heparin).
- Antiplatelet drugs (aspirin, clopidogrel).
- Diuretics (furosemide).
- Lithium.
- Methotrexate.
- Cyclosporine.
- Other NSAIDs.
- Antihypertensive medications.
- Alcohol can increase the risk of gastrointestinal side effects.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Not recommended, especially in the third trimester. Diclofenac may cause premature closure of the ductus arteriosus in the fetus.
- Breastfeeding: Small amounts of the drugs may be present in breast milk. Potential risks to the infant should be considered.
Drug Profile Summary
- Mechanism of Action: Diclofenac and paracetamol provide analgesic and anti-inflammatory effects; trypsin chymotrypsin facilitates breakdown of proteins at inflammation site.
- Side Effects: Nausea, vomiting, gastrointestinal distress, drowsiness, dizziness. Serious side effects include GI bleeding and hepatic/renal damage.
- Contraindications: Hypersensitivity, active peptic ulcers, severe liver or kidney disease, pregnancy (third trimester).
- Drug Interactions: Anticoagulants, antiplatelet drugs, diuretics, lithium, methotrexate, other NSAIDs, alcohol.
- Pregnancy & Breastfeeding: Use with caution and only if benefits outweigh potential risks. Not recommended during the third trimester.
- Dosage: Adults: 1 tablet two or three times daily. Pediatric use not established.
- Monitoring Parameters: Liver and renal function tests, blood pressure.
Popular Combinations
This combination itself is commonly prescribed and not often part of other multi-drug regimens. It may be prescribed along with antacids to mitigate gastric side effects.
Precautions
- Assess renal and hepatic function before starting therapy.
- Use cautiously in patients with cardiovascular disease.
- Monitor for signs of gastrointestinal bleeding.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Diclofenac + Paracetamol + Trypsin Chymotrypsin?
A: The usual adult dose is one tablet (Diclofenac 50mg + Paracetamol 325mg + Trypsin Chymotrypsin 50000 AU) taken orally two or three times a day with food.
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: Nausea, vomiting, stomach pain, indigestion, diarrhea, drowsiness, and dizziness.
Q4: What are the serious side effects?
A: Allergic reactions, gastrointestinal bleeding, liver or kidney problems.
Q5: Can pregnant or breastfeeding women take this medication?
A: It’s generally not recommended during pregnancy, especially in the third trimester, and should be used cautiously during breastfeeding. Consult a doctor before use.
Q6: What are the contraindications?
A: Hypersensitivity, active peptic ulcer, severe liver/kidney disease, and certain other medical conditions.
Q7: Does this medication interact with other drugs?
A: Yes, it can interact with anticoagulants, antiplatelet drugs, diuretics, and others. Inform your doctor about all medications you are taking.
Q8: How should this medicine be stored?
A: Store it in a cool, dry place away from direct sunlight and out of reach of children.
Q9: Can this medicine be taken on an empty stomach?
A: It is recommended to take it with food to reduce the risk of gastrointestinal upset.
