Pain Care

• Pregnancy: The safety of this combination during pregnancy is not well-established. Use only if clearly needed, and consult a healthcare provider before use. 
• Lactation: Benzocaine, Turpentine Oil, and Paradichlorobenzene are minimally absorbed systemically when applied topically, but consult a doctor before use, especially if breastfeeding.

• Overdose is unlikely with proper use, as the ear drops are applied locally and not absorbed in significant quantities. 
• Symptoms of overdose could include excessive irritation or burning sensation in the ear, or severe allergic reactions if an individual is sensitive to any of the ingredients. 

• Store the ear drops at room temperature (15–25°C). 
• Keep the bottle tightly closed and out of reach of children. 
• Avoid exposure to direct sunlight or extreme temperatures. 
• Do not refrigerate or freeze the product. 
• Check the expiry date and discard the product once it has expired.

• Not recommended, especially in the third trimester. 
• Thiocolchicoside has shown teratogenic effects in animal studies. 
• Paracetamol is generally considered safe but not when combined with other agents unless advised by a physician.

• Gastrointestinal: Nausea, vomiting, dyspepsia, diarrhoea, gastritis. 
• Neurological: Drowsiness, dizziness. 
• Hepatic: Elevated liver enzymes. 
• Dermatologic: Rash, allergic reactions. 
• Others: Renal dysfunction (rare), hypersensitivity reactions.

• Paracetamol overdose can cause severe hepatotoxicity. 
• Aceclofenac overdose may cause GI bleeding, renal dysfunction, CNS depression. 
• Thiocolchicoside overdose may cause seizures.

• Store in a cool, dry place. 
• Protect from direct sunlight and moisture. 
• Keep out of reach of children.

• Category C (first and second trimester), Category D (third trimester). 
• Contraindicated in third trimester due to risk of premature closure of the ductus arteriosus and prolonged labour. 
• Avoid in breastfeeding unless benefit outweighs risk.

• Common: Nausea, abdominal pain, dyspepsia, headache, dizziness. 
• Serious: GI bleeding, peptic ulceration, renal dysfunction, hypertension, hypersensitivity reactions, bronchospasm.

• Store below 25°C in a cool, dry place. 
• Protect from light and moisture. 
• Keep out of reach of children

• Avoid in 3rd trimester due to potential for premature ductus arteriosus closure (NSAIDs). 
• Use in 1st and 2nd trimester only if clearly necessary. 
• Not recommended during lactation unless benefits outweigh risk.

• Gastrointestinal: Nausea, dyspepsia, epigastric pain, ulcers. 
• Renal: Elevated serum creatinine, reduced GFR (rare). 
• Hepatic: Elevated liver enzymes (with paracetamol). 
• Allergic: Rash, itching, rarely angioedema or anaphylaxis. 
• Enzymes: Mild nausea, altered taste, rarely allergic reactions.

• Store at 15–25°C in a cool, dry place. 
• Protect from light and moisture. 
• Keep out of reach of children.

• Not recommended in the 3rd trimester – risk of premature ductus arteriosus closure. 
• Use with caution in 1st and 2nd trimesters if benefits outweigh risks. 
• Avoid in lactating women, unless prescribed.

• GI: Nausea, vomiting, abdominal pain, dyspepsia, ulcers, bleeding. 
• Hepatic: Elevated liver enzymes. 
• Renal: Nephrotoxicity (rare). 
• CNS: Headache, dizziness. 
• Hypersensitivity: Rash, itching, urticaria. 
• Enzymatic: Rare GI upset, altered taste, allergic reactions.

• Store in a cool, dry place below 25°C. 
• Protect from light and moisture. 
• Keep out of reach of children.

• Apply a small quantity (2–4 g) to the affected area 3–4 times daily. 
• Gently massage until fully absorbed. 
• Do not use on broken or irritated skin. 
• Wash hands after application unless hands are the treated area. 

• Avoid during third trimester due to risk of premature ductus arteriosus closure. 
• Use in first and second trimesters only if clearly needed. 
• Avoid during lactation on or near the chest area.

• Local: Rash, redness, pruritus, burning sensation. 
• Systemic (rare): Headache, nausea, dizziness (with overuse or prolonged use).

• Topical overdose is rare. 
• Symptoms: Local irritation, redness, or rash. 
• Management: Wash area thoroughly with soap and water. Symptomatic care.

• Store in a cool, dry place below 25°C. 
• Protect from light and moisture. 
• Keep out of reach of children.

• Benzydamine: Category B 
• Chlorhexidine: Generally considered safe topically 
• Can be used during pregnancy and breastfeeding under medical supervision; avoid prolonged use.

• Common: Mild burning, dry mouth, oral numbness, taste alteration. 
• Less common: Tooth discoloration, tongue staining. 
• Rare: Allergic reactions, including rash, swelling, or difficulty breathing.

• Store at 15–25°C in a cool, dry place. 
• Protect from direct sunlight and heat. 
• Do not freeze. 
• Keep tightly closed and out of reach of children.

• Piroxicam 20mg Dispersible Tablets are indicated for: 
• Osteoarthritis (joint pain and stiffness) 
• Rheumatoid arthritis (joint inflammation and damage) 
• Ankylosing spondylitis (spinal arthritis) 
• Acute musculoskeletal disorders (e.g., sprains, strains) 
• Postoperative pain management
  

General 

• Use the lowest effective dose for the shortest duration to minimize side effects.
• Increases the risk of gastrointestinal (GI) ulcers, bleeding, and perforation, especially in elderly patients.
• May cause fluid retention and worsen heart failure or hypertension. 
• Long-term use is associated with renal toxicity—monitor kidney function regularly.
  

Warnings 

• GI Risk: May cause ulcers, bleeding, or perforation, especially in the elderly. 
• Cardiovascular Risk: Increases risk of heart attack and stroke; avoid in CVD patients. 
• Kidney Toxicity: Can cause renal failure, especially in those with CKD. 
• Liver Damage: May lead to hepatitis or liver failure. 
• Blood Disorders: Can cause anemia, bleeding, or thrombocytopenia. 
• Fluid Retention & Hypertension: Worsens heart failure and high blood pressure. 
• Allergic Reactions: Risk of anaphylaxis, Stevens-Johnson syndrome (SJS). 
• Fertility Issues: May impair female ovulation.
  

Contraindications 

• Allergy to NSAIDs or Piroxicam 
• Active peptic ulcer or GI bleeding 
• Severe heart disease (recent heart attack, stroke, heart failure) 
• Severe kidney or liver impairment 
• Bleeding disorders or anticoagulant use ∙Pregnancy (third trimester) 
• Children under 12 years
  

Drug Interaction

• Anticoagulants (Warfarin, Heparin) - Increased bleeding risk - Monitor INR/bleeding signs 

  
  

  Antihypertensives (ACE inhibitors, ARBs, Beta-blockers) - Reduced effectiveness - Monitor BP 

  
  

  Diuretics (Furosemide, Thiazides) - Reduced diuretic effect - Monitor kidney function 

  
  

  Corticosteroids (Prednisolone, Dexamethasone) - Increased GI ulcer risk - Use gastroprotective agents 

  
  

  Methotrexate - Increased toxicity risk - Monitor blood levels 

  
  

  Lithium - Increased lithium toxicity - Monitor lithium levels 

  
  

Symptoms of Overdose 

• Severe nausea, vomiting, and stomach pain 
• Drowsiness, confusion, dizziness 
• Severe GI bleeding (black stools, vomiting blood) 
• Seizures, respiratory depression, kidney failure 

Management 

• No specific antidote—treatment is symptomatic and supportive. 
• Gastric lavage & activated charcoal may help if ingestion was recent. 
• Proton pump inhibitors (PPIs) or H2 blockers to protect the stomach. 
• IV fluids and electrolyte correction for dehydration. 
• Haemodialysis is NOT effective due to high protein binding.

• Store at room temperature (15–30°C), away from moisture and heat. 
• Keep the tablets in their original packaging. 
• Protect from direct sunlight. 
• Keep out of reach of children. 
• Do not use beyond the expiry date printed on the package.