Eperisone Use in Severe Dengue Pain
Do not use eperisone or any muscle relaxant for severe dengue pain—use acetaminophen (paracetamol) exclusively for pain management, as it is the only recommended analgesic that does not increase bleeding risk. 1, 2, 3
Why Muscle Relaxants Are Not Appropriate
Acetaminophen is the sole recommended first-line agent for pain relief in dengue fever, including severe myalgias and arthralgias that characterize the disease 1, 2, 3
NSAIDs and aspirin are absolutely contraindicated due to increased bleeding risk from platelet dysfunction and potential hemorrhagic complications in dengue 1, 2, 3
No evidence supports the use of muscle relaxants like eperisone in dengue management—the available guidelines specifically address only acetaminophen as the safe analgesic option 1, 2, 3
The Critical Safety Concern
The primary concern in dengue pain management is avoiding medications that interfere with platelet function or increase bleeding risk. While eperisone is not an NSAID, there is:
No safety data on eperisone use in dengue patients who already have thrombocytopenia and are at risk for hemorrhagic complications 2, 3
No guideline recommendation supporting muscle relaxants in any phase of dengue management (febrile, critical, or recovery phases) 1, 2, 3
Risk of masking warning signs: Using additional medications beyond acetaminophen may complicate clinical monitoring during the critical phase (days 3-7) when plasma leakage and shock can develop rapidly 2, 3
Recommended Pain Management Algorithm
For severe dengue-related myalgias and arthralgias:
Use acetaminophen at standard doses (typically up to 4 g/day in adults with normal liver function; lower doses if hepatic involvement is present) 1, 2, 3
Ensure adequate hydration with target fluid intake of 2,500-3,000 mL daily, as dehydration can worsen pain perception 1
Implement gradual physical rehabilitation with gentle movement therapies like Tai Chi once the acute phase resolves, which has demonstrated effectiveness in improving post-viral fatigue and pain 1
Provide psychological support, as more than 60% of patients recovering from severe viral infections experience anxiety and depression that can amplify pain perception 1
Post-Dengue Pain Management
If pain persists beyond the acute phase:
Continue acetaminophen as needed for residual myalgias or arthralgias during the recovery phase 1
Strictly avoid aspirin and NSAIDs even during recovery, as bleeding risk may persist 1
Consider alternative cooling measures (tepid water sponging) if fever recurs rather than increasing acetaminophen dose 3
Common Pitfalls to Avoid
Do not prescribe medications without dengue-specific safety data when a proven safe alternative (acetaminophen) exists 1, 2, 3
Do not use combination analgesics that may contain aspirin or NSAIDs, which are absolutely contraindicated 1, 2, 3
Do not overlook hepatic involvement: Dengue commonly causes transaminitis, requiring dose adjustment of acetaminophen and avoiding additional hepatically-metabolized medications 3
Special Considerations
In patients with severe pain unresponsive to acetaminophen:
Reassess for complications including secondary bacterial infections, which occur in less than 10% of cases but may require different management 3
Monitor for warning signs of severe dengue: persistent vomiting, severe abdominal pain, lethargy, restlessness, or mucosal bleeding that would require escalation of care rather than additional analgesics 2, 3
Consider non-pharmacological approaches: rest, hydration, and supportive care are fundamental to dengue management 1, 2
The evidence-based approach is clear: stick with acetaminophen as the sole analgesic for dengue pain management, regardless of severity. There is no role for muscle relaxants like eperisone in this clinical context. 1, 2, 3