TIDIP

Diclofenac potassium 50 mg + paracetamol 325 mg + tizanidine 2 mg

Diclofenac potassium possess analgesic, anti-inflammatory and antipyretic action. It inhibits the enzyme cyclo-oxygenase and there by inhibits the synthesis of Prostaglandins (PGs). It is more potent against cyclo-oxygenase-2 enzyme as compared to other NSAIDs Paracetamol has analgesic and antipyretic action. It is more active on cyclo-oxygenase enzyme in brain. Peripherally it is a poor inhibitor of prostaglandin synthesis. It raises the pain threshold and produces analgesic effect. It lowers fever by direct action on the thermoregulatory centre in the Hypothalamus and block the effects of endogenous pyrogen

Tizanidine is a centrally acting alpha2 agonist at alpha2-adrenergic receptor sites and presumably reduces spasticity by increasing presynaptic inhibition of motor neurons. This results the blocking of nerve impulses (or pain sensations) that are sent to your brain.

Indications

• Fractures
• Sprains
• Spondylitis
• Lumbago (lower back and buttock pain)
• Rheumatoid arthritis
• Postoperative trauma
• Sports injuries

Dosage

1-2 tablets twice daily or as directed by the physician

Contraindications

Hypersensitivity to the drug or any ingredients of it
Peptic ulcer
Asthma

Precautions

• Caution should be exercised in patients with history of prolonged QT interval, liver or kidney disease, children, elderly, low blood pressure
• Pregnancy and breastfeeding.
• Monitor LFT(Liver Function test) regularly
• Stop treatment if liver enzymes are raised persistently greater than 3 times upper limit of normal range.
• Avoid abrupt withdrawal of therapy
• It may make you drowsy. Do not drive a car or operate machinery while taking this medication

Side effects

Dry mouth, increased spasm or tone of muscles, dizziness, dilatation of blood vessels, postural hypotension, abnormal heart rhythm, abdomen pain, diarrhea, blood in stool, difficulty in swallowing, nausea, loss of appetite, increase in liver enzymes, liver damage, unusual bleeding, high blood cholesterol, anemia, decrease in white blood cells, systemic inflammatory response syndrome, swelling of leg, hypothyroidism, weight loss, autoimmune neuromuscular disease, back pain, sedation, depression, anxiety, tingling, hallucinations, sinusitis, pneumonia, inflammation of bronchus, rash, sweating, skin ulcer, itching, dry skin, acne, hair loss, hives, ear pain, tinnitus, deafness, glaucoma, conjunctivitis, eye pain, optic nerve disease, inflammation of middle ear, eye bleeding, visual field defect, urinary urgency, heavy menstrual bleeding, urinary tract infection, urinary retention, kidney stone, increase in size of uterine fibroids, vaginal yeast infections, inflammation of vagina

Drug interaction

• Lithium & Digoxin : Blood levels of lithium and digoxin increased leading to enhanced efficacy and posible toxicity.
• Diuretics : Inhibits diuretics but efficacy of potassium sparing diuretics enhanced.
• Methotrexate : Toxicity enhanced.
• Salicylates : Efficacy of salicylates reduced.
• Cyclosporine : Increases nephrotoxicity of both agents.
• Hydantoins : Increases serum levels resulting in toxicity
• Cholestyramine: Reduces absorption of paracetamol.
• Charcoal: Activated, administered immediately reduces absorption of paracetamol.
• Domperidone and metochlopramide: Enhance absorption of paracetamol.
• Alcohol: Chronic excessive ingestion of alcohol potentiates hepatotoxicity of paracetamol.
• Zidovudine: Effects zidovudine may be decreased
• Alcohol & other CNS depressants : CNS effects of tizanidine potentiated