Sulfasalazine
Contraindicated
Textbook
Exacerbation of inflammatory bowel disease (IBD).
Avoid combining sulfasalazine with traditional NSAIDs.
Source: G&G 14e · p1112
Drug reference
Aceclofenac
NSAID (non-selective COX inhibitor) · Analgesic
Also known as (2-[2-[2-(2,6-dichlorophenyl)aminophenyl]acetyl]oxyacetic acid), Aclonac, Hifenac, Aceclofen, Zepol
START
Start 100 mg BD with food; check baseline renal function and BP
TYPICAL MAX
200 mg/day maximum; do not exceed
STOP IF
GI bleeding, severe rash, jaundice, eGFR <30, or signs of heart failure
WATCH
BP, renal function, LFTs, GI symptoms
CDSCO approvedSchedule HJan AushadhiATC M01AB16
KDIGO 2024 + manufacturer label
- ONSET
- 1h · Onset of analgesia
- PEAK
- 2.5h · Peak plasma concentration
- t½
- 4.5h · Elimination half-life
- DURATION
- 8h · Duration of effect
EXCRETION
Renal (conjugated metabolites)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid in third trimester; use only if clearly needed in first and second trimesters due to fetal risk
FDA category + note
Top interactionssee all 12 →
- SulfasalazineContraindicatedTextbookG&G 14e · p1112
- AminoglycosideSevereTextbookKDT 7e · p746
- AminoglycosidesSevereTextbookKDT 7e
- AnticoagulantsSevereTextbookKDT 7e
Available in India
773 branded formulations and 8,173 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Inhibits cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin synthesis, with additional scavenging of oxygen free radicals and inhibition of neutrophil adhesion
Indications
OsteoarthritisRheumatoid arthritisAnkylosing spondylitis
Dosing
- Adult
- 100 mg twice daily
- Pediatric
- Not recommended in children under 18 years
- Renal adjustment
- Avoid if eGFR <30 mL/min; use lowest effective dose if eGFR 30-60 mL/min
- Hepatic adjustment
- Avoid in severe hepatic impairment; reduce dose and monitor LFTs in mild-moderate impairment
- Geriatric
- Start at lowest effective dose; increased risk of GI bleeding and renal impairment
- Max dose
- 200 mg/day
Pharmacokinetics
Onset
1-2 hours
Peak effect
2-3 hours (Tmax); 4-6 hours (active metabolite diclofenac)
Duration
8-12 hours
Half-life
4-5 hours (parent); 12-15 hours (metabolite)
Bioavailability
~60%
Protein binding
>99%
Metabolism
Hepatic CYP2C9 to diclofenac (active), then hydroxylation and conjugation
Excretion
Primarily renal (conjugated metabolites); ~25% biliary/fecal
Contraindications
- Active peptic ulcer disease
- History of GI bleeding or perforation with NSAIDs
- Severe heart failure
- Severe hepatic impairment
- Third trimester pregnancy
- Hypersensitivity to aceclofenac or other NSAIDs
Side effects
Common
DyspepsiaAbdominal painNauseaDiarrheaFlatulenceHeadacheDizzinessElevated transaminases
Serious
- GI bleeding or perforation
- Hepatotoxicity
- Nephrotoxicity
- Hypersensitivity reactions
- Cardiovascular thrombotic events
- Stevens-Johnson syndrome
Pregnancy & lactation
Pregnancy
Avoid in third trimester; use only if clearly needed in first and second trimesters due to fetal risk
Lactation
Excreted in breast milk in small amounts; use with caution during breastfeeding
Drug interactions
Aminoglycoside
Severe
Textbook
Increased risk of nephrotoxicity.
Avoid concurrent use.
Source: KDT 7e · p746
Aminoglycosides
Severe
Textbook
Increased aminoglycoside levels and potential toxicity.
Monitor aminoglycoside levels and renal function; adjust dosage as needed.
Source: KDT 7e
Anticoagulants
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider alternative analgesics or gastroprotective agents.
Source: KDT 7e
Ciprofloxacin
Severe
Textbook
Enhanced CNS toxicity, seizures reported.
Source: KDT 7e
Citalopram
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents or alternative analgesics.
Source: KDT 7e
Clopidogrel
Severe
Textbook
Increased bleeding risk.
Exercise extra caution and monitor for signs of bleeding.
Source: G&G 14e
Corticosteroids
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents.
Source: KDT 7e
Dapoxetine
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents or alternative analgesics.
Source: KDT 7e
Enalaprilat
Severe
Textbook
Reduced effectiveness of ACE inhibitors. Marked hyperkalemia, potentially leading to cardiac arrhythmia.
Use with caution, especially in the elderly and in patients with hypertension, diabetes mellitus, or ischemic heart disease.
Source: G&G 14e · p836
Escitalopram
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents or alternative analgesics.
Source: KDT 7e
Escitalopram + Clonazepam
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents or alternative analgesics.
Source: KDT 7e
Related guidelines
Ask House about Aceclofenac
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19