What is the recommended dose of aceclofenac and tizanidine for an adult with muscle spasms or pain?

Aceclofenac and Tizanidine Dosing for Adults

For adults with muscle spasms and pain, the standard regimen is aceclofenac 100 mg twice daily combined with tizanidine starting at 2 mg three times daily, titrated gradually over 2-4 weeks to an effective dose (typically 6-12 mg/day in divided doses), with maximum doses reaching 24-36 mg/day if needed.

Aceclofenac Dosing

The usual oral dosage of aceclofenac is 100 mg twice daily (total 200 mg/day) for adults 1. This NSAID provides anti-inflammatory and analgesic effects for musculoskeletal pain conditions including osteoarthritis, rheumatoid arthritis, posttrauma inflammation, and back pain 1.

Key Points for Aceclofenac:

• Fixed dosing: 100 mg administered twice daily, no titration required 1
• Better gastrointestinal tolerance compared to other NSAIDs, making it a preferred choice when GI side effects are a concern 1

Tizanidine Dosing

Tizanidine requires individualized dose titration over 2-4 weeks due to wide interpatient variability in effective plasma concentrations 2. The dosing strategy differs significantly from aceclofenac due to its centrally-acting mechanism.

Initial Dosing and Titration:

• Start low: Begin with 2 mg three times daily or 2-4 mg at bedtime 2, 3
• Gradual escalation: Increase slowly over 2-4 weeks based on clinical response and tolerability 2, 3
• Typical effective range: 6-12 mg/day in divided doses for most patients 4
• Maximum doses: Clinical trials have used 2-36 mg/day, though most patients respond to lower doses 2

Timing and Administration:

• Peak effect occurs within 2 hours of administration, so timing doses around periods of increased spasticity or pain is beneficial 2
• Three times daily dosing is standard to maintain therapeutic levels throughout the day 2

Clinical Efficacy of the Combination

Tizanidine for Muscle Spasm:

• Reduction in muscle tone scores of 21-37% compared to 4-9% with placebo 2
• Improvement in muscle tone in 60-82% of patients receiving tizanidine 2
• Quick pain relief in back pain: Initial relief by day 2, complete relief by day 4 when combined with NSAIDs 4

Safety Profile:

• Tizanidine's most common adverse effects are dry mouth and somnolence/drowsiness 2
• Less subjective muscle weakness compared to baclofen or diazepam, making it preferable for maintaining functional strength 2
• Adverse effects occur in <6% of patients when used for back pain, and are typically transient 4
• Global tolerability rated as good to excellent in 44-100% of tizanidine recipients 2

Critical Dosing Considerations

For Tizanidine:

• Never discontinue abruptly - taper gradually to prevent CNS withdrawal symptoms 5
• Start at lower doses (2 mg) and titrate more slowly in elderly patients to minimize sedation, dizziness, and fall risk 5, 3
• Monitor for excessive sedation, hypotension, and dry mouth during titration 2, 3
• Lowest effective dose principle: Most patients achieve pain relief with low daily doses (6-12 mg/day) 4

Combination Therapy Rationale:

• Tizanidine addresses the muscle spasm component through central alpha-2 adrenergic agonism 2
• Aceclofenac provides anti-inflammatory and analgesic effects for the underlying pain and inflammation 1
• Synergistic benefit: The combination targets both peripheral inflammation and central muscle spasm mechanisms 4

Practical Titration Schedule

Week 1: Aceclofenac 100 mg twice daily + Tizanidine 2 mg three times daily 1, 3

Week 2: Continue aceclofenac, increase tizanidine to 4 mg three times daily if tolerated 3

Weeks 3-4: Further titrate tizanidine by 2-4 mg increments every few days until adequate spasm control achieved or side effects limit further increases 2, 3

Maintenance: Most patients stabilize at tizanidine 6-12 mg/day total (2-4 mg three times daily) combined with aceclofenac 200 mg/day 4