A fixed-dose combination (FDC) of a non-steroidal anti-inflammatory drug (NSAID) and a proteolytic enzyme complex. Diclofenac provides potent analgesic, anti-inflammatory, and antipyretic effects by inhibiting cyclooxygenase (COX) enzymes and prostaglandin synthesis. Trypsin-Chymotrypsin, a proteolytic enzyme derived from bovine pancreas, exerts anti-inflammatory, anti-edematous, and fibrinolytic actions, potentially enhancing the resolution of inflammation and tissue repair. This combination is widely used in India for the management of acute inflammatory and painful conditions, particularly in orthopedics, dentistry, and post-surgical care, with the rationale of providing faster and more comprehensive relief than diclofenac alone.
Adult: One tablet (Diclofenac 50mg + Trypsin Chymotrypsin 50000IU) two to three times daily, after meals. The lowest effective dose for the shortest duration should be used.
Note: Swallow the enteric-coated tablet whole with a full glass of water, after meals. Do not crush, chew, or break the tablet. This helps minimize gastric irritation from diclofenac and protects the enzyme from gastric acid.
The combination works via two distinct but potentially complementary pathways. Diclofenac inhibits the cyclooxygenase (COX-1 and COX-2) enzymes, thereby blocking the conversion of arachidonic acid to prostaglandins (PGs) and thromboxanes. This reduces the synthesis of pro-inflammatory, pain-inducing, and fever-causing PGs (like PGE2) at the site of injury. Trypsin-Chymotrypsin, when absorbed systemically, is proposed to exert anti-inflammatory effects by breaking down abnormal exudates, fibrin clots, and necrotic tissue, improving microcirculation, reducing capillary permeability and edema, and modulating inflammatory cytokines. It may also promote tissue repair.
Pregnancy: Category C (first and second trimester): Use only if potential benefit justifies potential fetal risk. Avoid in third trimester (Category D) due to risk of premature closure of ductus arteriosus, oligohydramnios, and inhibition of labor.
Driving: May cause dizziness, vertigo, or drowsiness in some patients. Caution is advised when driving or operating machinery until the individual's response is known.
| Anticoagulants (Warfarin, Acenocoumarol) | Increased risk of bleeding due to antiplatelet effect of diclofenac and impaired hemostasis | Major |
| Anti-platelets (Aspirin, Clopidogrel) | Increased risk of GI bleeding | Major |
| Other NSAIDs (including COX-2 inhibitors) | Increased risk of GI and renal toxicity; no additive therapeutic benefit | Major |
| ACE Inhibitors (Enalapril, Ramipril) / ARBs (Losartan) | Reduced antihypertensive effect; increased risk of renal impairment | Moderate |
| Diuretics (Furosemide, Hydrochlorothiazide) | Reduced diuretic efficacy; risk of renal failure | Moderate |
| Lithium | Increased lithium plasma levels and toxicity | Major |
| Methotrexate | Increased methotrexate toxicity (especially with high-dose therapy) | Major |
| Corticosteroids (Prednisolone) | Increased risk of GI ulceration | Moderate |
| Cyclosporine, Tacrolimus | Increased nephrotoxicity | Major |
| SSRIs (Fluoxetine, Sertraline) | Increased risk of upper GI bleeding | Moderate |
| Antidiabetics (Sulfonylureas) | Potential for hypoglycemia | Moderate |
Same composition (Diclofenac (50mg) + Trypsin Chymotrypsin (50000IU)), different brands: