Usage
- This combination medication is prescribed for the relief of pain and inflammation associated with musculoskeletal and joint disorders. These include sprains, strains, bruises, soft tissue rheumatism, rheumatoid arthritis, osteoarthritis, low back pain, frozen shoulder, spondylitis, and acute gout attacks.
- Pharmacological Classification: Topical non-steroidal anti-inflammatory drug (NSAID), muscle relaxant, and counterirritant.
- Mechanism of Action: This combination works through multiple pathways. Diclofenac and methyl salicylate inhibit cyclooxygenase (COX) enzymes, reducing prostaglandin production and thus inflammation and pain. Thiocolchicoside acts as a muscle relaxant by activating GABA inhibitory pathways in the central nervous system. Linseed oil contributes with its anti-inflammatory properties due to its omega-3 fatty acid content. Menthol provides a cooling sensation and acts as a counterirritant, further relieving pain.
Alternate Names
- No internationally recognized non-proprietary name exists for this combination. It is often referred to by its component ingredients.
- Brand Names: Various brand names exist depending on the manufacturer and region, including Krishat Relief Gel, Thioquest Gel, Duosure Gel, Nifoxide-Plus, Thiozone Gel, Flexodic-Th Gel, and Muscoleve.
How It Works
- Pharmacodynamics: Diclofenac and methyl salicylate primarily exert their analgesic and anti-inflammatory effects by inhibiting COX-1 and COX-2 enzymes. This leads to a decrease in prostaglandin synthesis, which play a crucial role in pain and inflammation. Thiocolchicoside acts centrally as a GABA receptor agonist, leading to muscle relaxation. Linseed oil, rich in omega-3 fatty acids, also contributes to anti-inflammatory effects. Menthol acts as a counterirritant, stimulating cold receptors and interfering with pain signal transmission.
- Pharmacokinetics: When applied topically, the absorption of diclofenac is relatively low, minimizing systemic side effects. Methyl salicylate is also absorbed through the skin, but its systemic effects are generally limited with topical use. Thiocolchicoside’s systemic absorption through the skin is minimal. Menthol and linseed oil are primarily localized to the application site.
- Mode of Action: Diclofenac and methyl salicylate block COX enzymes. Thiocolchicoside activates GABA receptors. Linseed oil provides anti-inflammatory action through omega-3 fatty acids. Menthol acts on TRPM8 receptors.
- Elimination Pathways: Diclofenac is primarily metabolized in the liver and excreted by the kidneys. Methyl salicylate is metabolized and excreted similarly. Thiocolchicoside is also primarily metabolized in the liver.
Dosage
Standard Dosage
Adults:
- Apply a thin layer of the gel/cream to the affected area 3-4 times daily, or as directed by the physician. The amount to be applied depends on the size of the affected area (approximately a 2-4 g or a 4-8 cm strip).
Children:
- Not recommended for children below 12 years of age, or below 15 for some brands as safety and efficacy have not been established in this age group. For children 12 and above, dosage should be determined by the physician.
Special Cases:
- Elderly Patients: Use with caution, as age-related changes in organ function can influence drug clearance. Dosage adjustments may be necessary.
- Patients with Renal Impairment: Use with caution. Dosage adjustment may be required.
- Patients with Hepatic Dysfunction: Use with caution, since diclofenac and thiocolchicoside are mainly metabolized in the liver. Dosage adjustments might be needed.
- Patients with Comorbid Conditions: Patients with asthma, urticaria, or allergic reactions to NSAIDs should avoid this medicine. Exercise caution in patients with cardiovascular disease, gastrointestinal disorders, bleeding disorders and coagulopathies.
Clinical Use Cases
This medication is primarily intended for topical use and is not generally applied in the clinical settings listed (Intubation, Surgical Procedures, Mechanical Ventilation, Intensive Care Unit (ICU) Use, and Emergency Situations).
Dosage Adjustments
- Dosage adjustments should be considered in the elderly, and patients with hepatic or renal impairment.
Side Effects
Common Side Effects
- Application site reactions: burning sensation, itching, redness, irritation, dryness, rash, dermatitis.
Rare but Serious Side Effects
- Allergic reactions (e.g., urticaria, angioedema, bronchospasm).
Long-Term Effects
- With topical application, long-term systemic effects are unlikely due to low absorption. However, prolonged use can potentially lead to skin irritation or sensitization.
Adverse Drug Reactions (ADR)
Contraindications
- Hypersensitivity to any of the components of the gel, including diclofenac, thiocolchicoside, methyl salicylate, linseed oil, menthol, or any other NSAIDs.
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
- Third trimester of pregnancy.
- Open wounds, broken skin, or infected skin.
- Patients with severe hepatic or renal impairment.
Drug Interactions
- Oral anticoagulants (e.g., warfarin): Topical salicylates and menthol may potentiate their effects.
- Antiplatelet agents: May increase the risk of bleeding.
- Other NSAIDs (oral or topical): Increased risk of adverse effects.
- Diuretics, antihypertensives, immunosuppressants: Potential interaction with diclofenac.
- CNS depressants: While unlikely with topical use, additive effects are theoretically possible.
Pregnancy and Breastfeeding
- Pregnancy: Use with caution, especially during the third trimester, as NSAIDs can affect fetal circulation. Consult a doctor before use.
- Breastfeeding: Limited information is available. Consult a doctor before use.
Drug Profile Summary
- Mechanism of Action: COX inhibition (diclofenac, methyl salicylate), muscle relaxation (thiocolchicoside), counterirritant (menthol), anti-inflammatory (linseed oil).
- Side Effects: Burning, itching, redness, irritation at the application site. Rarely, allergic reactions.
- Contraindications: Hypersensitivity, third-trimester pregnancy, open wounds.
- Drug Interactions: Anticoagulants, antiplatelet agents, other NSAIDs.
- Pregnancy & Breastfeeding: Use with caution. Consult a physician.
- Dosage: Apply to affected area 3-4 times daily.
- Monitoring Parameters: Observe for local skin reactions. Monitor for signs of systemic side effects with prolonged use.
Popular Combinations
This is already a combination product, and further combining it with other topical analgesics or NSAIDs is generally not recommended unless specifically prescribed by a doctor.
Precautions
- Avoid contact with eyes, mucous membranes, and open wounds.
- Wash hands thoroughly after application.
- Avoid exposure to sunlight after application.
- Do not use occlusive dressings.
- Consult a doctor if symptoms persist for more than 7 days.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Diclofenac diethylamine + Linseed Oil + Menthol + Methyl Salicylate + Thiocolchicoside?
A: Apply a thin layer to the affected area 3-4 times daily. Adjust for pediatric or elderly patients as directed by the physician.
Q2: Can this gel be used during pregnancy?
A: It should be used with caution, especially during the third trimester. Consult a doctor before using.
Q3: Can this be used on open wounds?
A: No, it is contraindicated for use on open wounds, broken skin, or infected areas.
Q4: What are the common side effects?
A: Burning, itching, redness, irritation at the application site are common.
Q5: Can I use a heating pad after applying the gel?
A: No, it is not advisable to apply heat to the treated area.
Q6: Is it safe to use with blood thinners?
A: Caution is advised as it may potentiate the effect of anticoagulants. Consult your physician.
Q7: How long can I use this gel?
A: Do not use for more than 7 days without consulting a physician.
Q8: Can I use this gel if I’m allergic to aspirin?
A: No. It is contraindicated in individuals with hypersensitivity to NSAIDs.
Q9: What should I do if I accidentally get the gel in my eyes?
A: Rinse the affected eye thoroughly with plenty of water and seek medical advice if irritation persists.
