Can Aceclofenac with Thiocolchicoside Be Given for 1 Week for Severe Vitamin D3 Deficiency Pain?
Yes, you can prescribe aceclofenac with thiocolchicoside for 1 week to manage acute musculoskeletal pain associated with severe vitamin D3 deficiency, but this is purely symptomatic bridge therapy while you simultaneously initiate aggressive vitamin D repletion—the definitive treatment that addresses the root cause. 1, 2, 3
Understanding the Clinical Context
Severe vitamin D deficiency (serum 25-hydroxyvitamin D < 10–12 ng/mL) commonly manifests as symmetric low back pain, proximal muscle weakness, muscle aches, and throbbing bone pain that is tender to pressure over the sternum or tibia. 3 This pain syndrome results from osteomalacia and secondary hyperparathyroidism, not from acute inflammation or mechanical injury. 4, 5
The pain will not resolve with NSAIDs and muscle relaxants alone—you must correct the underlying vitamin D deficiency to achieve lasting relief. 1, 3
Evidence for the Combination Therapy
Efficacy Data
A 2012 Indian study of 30 patients with acute low back pain treated with aceclofenac 100 mg + thiocolchicoside 4 mg + paracetamol 500 mg twice daily for 7 days demonstrated statistically significant pain reduction at rest (p ≤ 0.0014 at day 3, p ≤ 0.0001 at day 7), during movement (p ≤ 0.0001 at both timepoints), and at night (p ≤ 0.0001 at both timepoints). 2
A 2025 systematic review of 9 studies (1,097 patients) found that diclofenac-thiocolchicoside combination therapy produced significant pain reduction and functional improvement compared to placebo or active controls in acute low back pain, though study heterogeneity and methodological limitations prevent definitive conclusions about superiority over other treatments. 6
A 2019 case series of 4 patients with chronic neck and back pain who had failed NSAIDs, physical therapy, and epidural steroid injections reported > 70% symptom improvement after correcting vitamin D deficiency with 50,000 IU weekly for 12 weeks, demonstrating that vitamin D repletion—not NSAIDs—is the definitive therapy. 1
Safety Concerns with Thiocolchicoside
Thiocolchicoside is structurally related to colchicine and carries risks of liver injury, pancreatitis, seizures, blood cell disorders, severe cutaneous reactions, rhabdomyolysis, and reproductive toxicity (teratogenic in animals, altered spermatogenesis including azoospermia in humans). 7
A 2016 Prescrire review concluded there is no justification for exposing patients to thiocolchicoside's adverse effects given its lack of proven efficacy beyond placebo, recommending paracetamol as a safer alternative for muscle pain. 7
NSAIDs like aceclofenac must be used cautiously in elderly patients due to risks of acute kidney injury and gastrointestinal complications; co-prescribe a proton pump inhibitor and monitor patients on ACE inhibitors, diuretics, or antiplatelets for drug interactions. 8
The Correct Treatment Algorithm
Step 1: Confirm Severe Vitamin D Deficiency
Measure serum 25-hydroxyvitamin D; severe deficiency is defined as < 10–12 ng/mL. 4, 5
Check serum calcium to rule out hypocalcemia and establish a baseline before supplementation. 4, 9
Measure serum PTH to confirm secondary hyperparathyroidism (elevated PTH) and exclude hereditary disorders. 9
Step 2: Initiate Aggressive Vitamin D Repletion (The Definitive Treatment)
This is the treatment that will resolve the pain—not the NSAIDs.
Loading phase: Cholecalciferol (vitamin D3) 50,000 IU once weekly for 12 weeks is the standard regimen for severe deficiency (< 10 ng/mL). 4, 5, 3
Cholecalciferol is strongly preferred over ergocalciferol (vitamin D2) because it maintains serum levels longer and has superior bioavailability. 4, 5
Target serum 25-hydroxyvitamin D ≥ 30 ng/mL for anti-fracture efficacy and pain relief. 4, 5
Ensure adequate calcium intake of 1,000–1,500 mg daily from diet plus supplements, as calcium is necessary for clinical response to vitamin D therapy. 4, 9, 5
Recheck serum 25-hydroxyvitamin D and calcium at 3 months to confirm adequate response. 4, 5
Step 3: Provide Short-Term Symptomatic Relief (Bridge Therapy Only)
Use this combination for 1 week maximum while vitamin D repletion takes effect.
Aceclofenac 100 mg + thiocolchicoside 4 mg twice daily for 7 days can provide short-term pain relief and improve mobility. 2
Co-prescribe a proton pump inhibitor to reduce gastrointestinal risk, especially in elderly patients or those on antiplatelet therapy. 8
Warn the patient about potential adverse effects: gastrointestinal discomfort, drowsiness, and rare but serious risks (liver injury, seizures, blood disorders). 6, 7
Do not extend thiocolchicoside beyond 1 week given its unfavorable risk-benefit profile. 7
Step 4: Transition to Safer Analgesics if Needed
If pain persists beyond 1 week, switch to paracetamol (acetaminophen) 1,000 mg every 6 hours, which is safer and non-inferior to NSAIDs for musculoskeletal pain. 8, 7
Avoid prolonged NSAID use in elderly patients due to cumulative renal and gastrointestinal toxicity. 8
Critical Pitfalls to Avoid
Do not rely on aceclofenac-thiocolchicoside as the primary treatment—it only masks symptoms while the underlying osteomalacia persists. 1, 3
Never use active vitamin D analogs (calcitriol, alfacalcidol) to treat nutritional vitamin D deficiency; they bypass normal regulation, do not correct 25-hydroxyvitamin D levels, and increase hypercalcemia risk. 4, 9, 5
Do not prescribe thiocolchicoside to women of childbearing potential without reliable contraception, given its teratogenic potential. 7
Monitor serum calcium every 3 months during high-dose vitamin D therapy; discontinue immediately if calcium exceeds 10.2 mg/dL (2.54 mmol/L). 4, 9
Avoid single ultra-high vitamin D doses (> 300,000 IU), which are inefficient and potentially harmful. 4, 9
Expected Clinical Course
Patients typically report initial pain improvement within 3–7 days from the NSAID-muscle relaxant combination, but this is temporary. 2
Sustained pain relief requires 8–12 weeks of vitamin D repletion to normalize bone turnover and suppress secondary hyperparathyroidism. 1, 3
After 12 weeks of 50,000 IU weekly, transition to maintenance therapy with 1,500–2,000 IU daily or 50,000 IU monthly. 4, 5