A fixed-dose combination (FDC) of a selective COX-2 inhibitor (Etoricoxib) and a centrally-acting muscle relaxant (Thiocolchicoside). It provides synergistic action for the management of acute painful musculoskeletal conditions by reducing inflammation, pain, and associated muscle spasm. This combination is widely used in India for conditions like low back pain, cervical spondylosis, and post-operative orthopedic pain.
Adult: One tablet (Etoricoxib 60mg + Thiocolchicoside 4mg) twice daily, after meals. Maximum duration: 7-10 days.
Note: Take with or after food to minimize gastrointestinal upset. Swallow whole with a full glass of water. Do not crush or chew. The tablet can be split if scored. Use for the shortest duration necessary to control symptoms.
The combination works via two distinct but complementary pathways. Etoricoxib selectively inhibits the cyclooxygenase-2 (COX-2) enzyme, reducing the synthesis of prostaglandins (PGs) at sites of inflammation, thereby decreasing pain, swelling, and fever. Thiocolchicoside acts as a centrally-acting muscle relaxant by competitively antagonizing strychnine-sensitive glycine receptors in the brainstem and spinal cord, and also potentiating GABA-A receptor-mediated inhibitory neurotransmission, leading to reduced muscle tone and 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. Not recommended.
Driving: May impair ability to drive or operate machinery. Thiocolchicoside can cause dizziness, drowsiness, and blurred vision. Patients should not engage in these activities until their response is known.
| Warfarin, Acenocoumarol | Increased risk of bleeding due to additive antiplatelet effect of etoricoxib and protein binding displacement. | Major |
| Aspirin (low-dose cardioprotective) | Increased risk of GI ulceration and bleeding. May attenuate cardioprotective effect of aspirin. | Major |
| Lithium | Etoricoxib can decrease renal clearance of lithium, leading to lithium toxicity. | Major |
| Methotrexate | Etoricoxib may reduce renal clearance of methotrexate, increasing risk of bone marrow suppression. | Major |
| Diuretics (Furosemide, Thiazides) | Reduced diuretic and antihypertensive efficacy. Increased risk of renal impairment. | Moderate |
| ACE Inhibitors (Ramipril, Enalapril) / ARBs (Losartan) | Reduced antihypertensive efficacy. Increased risk of renal impairment, especially in volume-depleted patients. | Moderate |
| Corticosteroids (Prednisolone) | Significantly increased risk of GI ulceration and bleeding. | Major |
| SSRIs (Fluoxetine, Sertraline) | Increased risk of upper GI bleeding. | Moderate |
| Rifampicin | Decreases etoricoxib plasma levels by inducing CYP enzymes. | Moderate |
| Ketoconazole, Fluconazole | Increases etoricoxib plasma levels by inhibiting CYP3A4. | Moderate |
| Other CNS Depressants (Alprazolam, Clonazepam, Alcohol) | Additive sedation and dizziness with thiocolchicoside. | Moderate |
Same composition (Etoricoxib (60mg) + Thiocolchicoside (4mg)), different brands: