A fixed-dose combination (FDC) analgesic, anti-inflammatory, and centrally-acting muscle relaxant. Primarily used for the short-term management of acute, painful musculoskeletal conditions. It 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 after food. The total daily dose should not exceed 3 tablets (i.e., Chlorzoxazone 750mg, Diclofenac 150mg, Paracetamol 1500mg). Use the lowest effective dose for the shortest duration.
Note: Take with or immediately after a meal or a glass of milk to minimize gastric 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 exerts a multi-modal action. Diclofenac inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis responsible for pain, inflammation, and fever. Paracetamol's mechanism is complex; it likely inhibits central COX isoforms (COX-2, COX-3) and modulates the endocannabinoid and serotonergic pathways, providing analgesic and antipyretic effects with minimal peripheral anti-inflammatory action. Chlorzoxazone acts primarily at the level of the spinal cord and subcortical areas of the brain by inhibiting polysynaptic reflexes involved in producing and maintaining skeletal muscle spasm.
Pregnancy: Category C (first and second trimester) and Category D (third trimester). Avoid, especially in third trimester due to risk of premature closure of ductus arteriosus, oligohydramnios, and prolonged labor. Use only if potential benefit justifies potential fetal risk.
Driving: May cause dizziness, drowsiness, lightheadedness, or visual disturbances due to Chlorzoxazone. Patients should not drive or operate machinery until they know how the medicine affects them.
| Warfarin/Acenocoumarol | Increased risk of bleeding due to Diclofenac's antiplatelet effect and protein binding displacement. | Major |
| Aspirin/Other NSAIDs | Increased risk of GI toxicity (ulcers, bleeding) with no additional therapeutic benefit. | Major |
| Lithium | Diclofenac can decrease renal clearance of Lithium, leading to toxicity. | Major |
| Methotrexate | Diclofenac may reduce renal excretion of Methotrexate, increasing its toxicity. | Major |
| Diuretics (Furosemide, Thiazides) | Reduced diuretic and antihypertensive efficacy; increased risk of renal impairment. | Moderate |
| ACE Inhibitors (Ramipril) / ARBs (Losartan) | Reduced antihypertensive effect; increased risk of renal impairment. | Moderate |
| Antidiabetics (Glibenclamide) | Diclofenac may potentiate hypoglycemic effect. | Moderate |
| CYP2C9 Inhibitors (Fluconazole, Amiodarone) | Increased Diclofenac levels and toxicity. | Moderate |
| CYP1A2 Inhibitors (Ciprofloxacin, Fluvoxamine) | Increased Chlorzoxazone levels, risk of sedation and hepatotoxicity. | Moderate |
| Alcohol | Increased risk of hepatotoxicity (Paracetamol) and GI bleeding (Diclofenac). | Major |
| Anticoagulants/Antiplatelets (Clopidogrel) | Additive risk of bleeding. | Major |
| Corticosteroids (Prednisolone) | Markedly increased risk of GI ulceration. | Major |
Same composition (Chlorzoxazone (250mg) + Diclofenac (50mg) + Paracetamol (500mg)), different brands: