DOLOACT MR TABS 100S

Doloact MR is a fixed-dose combination tablet containing three complementary analgesic agents: Chlorzoxazone (a central-acting muscle relaxant that relieves skeletal muscle spasm), Diclofenac Sodium (a non-steroidal anti-inflammatory drug that reduces inflammation and pain), and Paracetamol/Acetaminophen (a non-opioid analgesic and antipyretic).

The modified-release formulation extends drug release over time, providing more sustained pain relief and potentially reducing dosing frequency compared to immediate-release combinations.

In Kenya, Doloact MR is widely used for musculoskeletal pain conditions including acute and chronic low back pain, cervical spondylosis, post-traumatic muscle spasm, sports injuries, and perioperative pain management.

The triple-combination approach addresses the multiple components of musculoskeletal pain, inflammation, spasm, and nociceptive pain, in a single tablet, improving patient adherence.

Usual Adult Dose

1 tablet two to three times daily with food, or as directed by a doctor. Do not exceed 3 tablets in 24 hours.

With Food

Always take with food or milk to reduce the risk of gastric irritation from Diclofenac.

Swallow Whole

Swallow the modified-release tablet whole, do not crush, chew, or break it as this destroys the MR mechanism.

Duration

Use for the shortest effective period. For acute conditions, typically 5–14 days. Chronic use requires medical supervision.

Missed Dose

Take as soon as remembered with food. If close to the next dose time, skip the missed dose. Never double up.

Elderly Patients

Use with extra caution, increased risk of GI bleeding and renal impairment. Use lowest effective dose and shortest duration.

Common Side Effects

·       Nausea, dyspepsia, or stomach discomfort (Diclofenac)

·       Dizziness or lightheadedness (Chlorzoxazone)

·       Drowsiness (Chlorzoxazone, avoid driving)

·       Headache

·       Urine discolouration to orange or purple-red (Chlorzoxazone, harmless)

Uncommon Side Effects

·       Elevated liver enzymes (Chlorzoxazone and Paracetamol, hepatotoxic in overdose)

·       Fluid retention and oedema (Diclofenac)

·       Skin rash or urticaria

·       Constipation or diarrhoea

Serious Side Effects, Seek Immediate Medical Attention

·       GI ulceration or bleeding (Diclofenac, major risk in elderly, on anticoagulants, or high-dose/long-term use)

·       Hepatotoxicity, risk with overdose of paracetamol component or concurrent alcohol use

·       Acute kidney injury (Diclofenac, especially in dehydrated patients or those with pre-existing renal disease)

·       Cardiovascular events (MI, stroke) with long-term NSAID use

·       Severe skin reactions (Stevens-Johnson Syndrome, rare)

·       GI RISK: Always take with food. Consider co-prescribing a proton pump inhibitor (e.g., omeprazole) for patients at risk of GI ulceration.

·       LIVER: Do not use with alcohol. Chlorzoxazone and Paracetamol are both hepatically metabolised; monitor LFTs with prolonged use.

·       DRIVING: Chlorzoxazone causes drowsiness; advise patients not to drive or operate heavy machinery until they know their response.

·       PARACETAMOL OVERDOSE RISK: Do not take additional paracetamol-containing products (cough syrups, other analgesics) concurrently, cumulative toxicity.

·       RENAL: Monitor renal function in elderly and patients with pre-existing renal disease or dehydration.

·       CARDIOVASCULAR: Avoid long-term use in patients with cardiovascular disease; NSAIDs increase MI and stroke risk.

·       PREGNANCY: Avoid in the first and third trimesters. Consult a doctor before use if pregnant.

Anticoagulants (warfarin, heparin): Diclofenac increases bleeding risk; monitor INR closely.

Other NSAIDs / Aspirin: Additive GI toxicity, avoid concurrent use.

Antihypertensives (ACE inhibitors, ARBs, diuretics): Diclofenac reduces their efficacy and increases renal risk.

Methotrexate: Diclofenac reduces methotrexate renal clearance, risk of methotrexate toxicity.

Lithium: NSAIDs increase lithium levels; monitor closely.

Alcohol: Additive hepatotoxicity with paracetamol and chlorzoxazone; strictly avoid.

CNS depressants (sedatives, benzodiazepines): Additive drowsiness with chlorzoxazone.

Cyclosporine: NSAIDs increase nephrotoxicity.

·       Store below 30°C in a cool, dry place.

·       Protect from moisture and direct sunlight.

·       Keep in original packaging.

·       Keep out of reach of children.

·       Do not use after the expiry date printed on the pack.

Doloact MR is available in Kenya with a pharmacist recommendation or doctor's prescription. For chronic musculoskeletal conditions, a formal prescription and medical supervision are recommended. Available at Pharmily.

Doloact MR is a rational triple-combination for musculoskeletal pain but carries significant interaction and toxicity risks. Always screen for concurrent paracetamol-containing products; cumulative hepatotoxicity is a real clinical concern.

Counsel strongly on the GI risk of diclofenac; consider recommending a PPI (e.g., omeprazole 20mg daily) as co-prescription for patients over 60 or those with a history of peptic ulcer.

The chlorzoxazone component causes drowsiness and urine discolouration; pre-emptive counselling prevents unnecessary alarm and improves adherence. The modified-release design means tablets must be swallowed whole. Flag the absolute contraindication in the third trimester of pregnancy due to Diclofenac. Avoid dispensing without enquiry about renal and hepatic status in elderly patients.

Why does Doloact MR say 'Modified Release'?

A: Modified release means the tablet is designed to release the active ingredients slowly over time, providing more sustained pain relief and reducing the need for as frequent dosing.

Can I crush or split a Doloact MR tablet?

A: No. The tablet must be swallowed whole. Crushing or chewing destroys the modified-release mechanism and causes the full dose to be released at once, increasing side effect risk.

Why does my urine turn orange after taking Doloact MR?

A: This is a harmless effect of Chlorzoxazone. The discolouration disappears when the medication is stopped.

Is Doloact MR safe during pregnancy?

A: Avoid in the first and third trimesters. In the third trimester, Diclofenac is strictly contraindicated. Always consult your doctor before taking this medicine if you are pregnant.