A fixed-dose combination (FDC) analgesic, anti-inflammatory, and centrally-acting muscle relaxant. It is primarily indicated for the short-term management of acute, painful musculoskeletal conditions. The combination provides synergistic action: Diclofenac reduces inflammation and pain at the peripheral site, Paracetamol provides central analgesic and antipyretic effects, and Chlorzoxazone relieves muscle spasm by acting on the spinal cord and subcortical areas of the brain.
Adult: One tablet two to three times daily, or as directed by the physician. The total daily dose should not exceed 3 tablets (Chlorzoxazone 1500mg, Diclofenac 150mg, Paracetamol 975mg).
Note: Take with or after food to minimize gastrointestinal irritation. Swallow whole with a full glass of water. Do not crush or chew. Do not lie down for at least 10 minutes after taking the tablet.
The combination works via complementary mechanisms. Diclofenac inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis responsible for pain, inflammation, and fever. Paracetamol's exact mechanism is unclear but likely involves central COX inhibition and modulation of the endocannabinoid and serotonergic systems. Chlorzoxazone acts primarily at the level of the spinal cord and subcortical areas of the brain by inhibiting polysynaptic reflex arcs involved in producing and maintaining muscle spasm.
Pregnancy: Category C (Diclofenac/Chlorzoxazone) and Category B (Paracetamol) in first and second trimester. Avoid in third trimester (Category D for NSAIDs due to risk of premature closure of ductus arteriosus, oligohydramnios, and prolonged labor). Use only if potential benefit justifies potential fetal risk, at the lowest dose for shortest duration.
Driving: May cause dizziness, drowsiness, blurred vision, or fatigue. Patients should not drive or operate machinery until they know how the medication affects them.
| Anticoagulants (Warfarin, Acenocoumarol) | Increased risk of bleeding due to antiplatelet effect of Diclofenac and protein binding displacement. | Major |
| Other NSAIDs (including Aspirin) | Increased risk of GI toxicity and reduced antiplatelet effect of aspirin. | Major |
| ACE Inhibitors (Ramipril, Enalapril) / ARBs (Losartan) | Reduced antihypertensive effect; increased risk of renal impairment. | Moderate |
| Diuretics (Furosemide, Hydrochlorothiazide) | Reduced diuretic efficacy; risk of renal failure. | Moderate |
| Methotrexate | Increased methotrexate toxicity due to reduced renal clearance. | Major |
| Lithium | Increased serum lithium levels and toxicity. | Major |
| Corticosteroids (Prednisolone) | Markedly increased risk of GI ulceration. | Major |
| Antiplatelets (Clopidogrel) | Increased GI bleeding risk. | Moderate |
| SSRIs (Fluoxetine, Sertraline) | Increased bleeding risk. | Moderate |
| Cyclosporine, Tacrolimus | Increased nephrotoxicity. | Major |
| Antidiabetics (Glibenclamide) | Enhanced hypoglycemic effect. | Moderate |
| Cholestyramine | Reduced absorption of Paracetamol if taken within 1 hour. | Moderate |
| Alcohol | Increased risk of hepatotoxicity (Paracetamol) and GI bleeding (Diclofenac). | Major |
| Enzyme Inducers (Phenobarbital, Carbamazepine, Rifampicin) | Increased risk of Paracetamol hepatotoxicity due to enhanced toxic metabolite formation. | Major |
Same composition (Chlorzoxazone (500mg) + Diclofenac (50mg) + Paracetamol (325mg)), different brands: