Nurasic

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Nurasic

Method of action: Miorelaxant

Treatment option:

Medically reviewed

Marina Burgos

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Nurasic

Quick Facts: Nurasic

Property Description
Active ingredients Acetaminophen, Orphenadrine
Form Tablet (Oral Dosage Form)
Pharmacological class Skeletal Muscle Relaxant and Analgesic Combination
Common use Relief of acute musculoskeletal pain and spasm
Origin Synthetic (Fixed-dose combination product)

Definition and Classification

Nurasic is a synthetic, fixed-dose combination medication classified as a Skeletal Muscle Relaxant and Analgesic Combination, administered via the oral route as a tablet. This medication utilizes Acetaminophen as the non-opioid analgesic and Orphenadrine (typically the citrate salt) as the centrally acting muscle relaxant.

The inclusion of Orphenadrine provides a distinctive feature. As an agent belonging to the ethanolamine antihistamine chemical class, it operates by influencing nerve signals centrally, an action that helps to ease involuntary muscle contraction. This fixed-dose nature differentiates it from regimens where these two components might be dosed separately.

Composition and General Purpose

The medication’s composition leverages the effect of its two active pharmaceutical ingredients (APIs). Acetaminophen works to dampen the overall sensation of pain within the central nervous system, while Orphenadrine helps to promote the relaxation of tight, spastic muscles by influencing the nerve signals involved in muscle tension. This dual mechanism is utilized in scenarios requiring simultaneous management of pain and tension, often associated with strains or localized muscular injuries. This medicine is designed to address both the feeling of pain and the underlying muscle tightness for acute musculoskeletal discomfort.

Regulatory References

  1. Orphenadrine: MedlinePlus Drug Information

What side effects are possible with Nurasic?

Possible Side Effects and Safety Information

The safety profile for this combination medication (Acetaminophen and Orphenadrine) is defined by established regulatory classifications and potential adverse reactions documented by government health authorities.

Adverse effects are categorized by the physiological systems affected, reflecting the properties of the muscle relaxant component. These documented reactions include effects on the Nervous System such as drowsiness, dizziness, and lightheadedness. Gastrointestinal Disorders may manifest as dry mouth, nausea, vomiting, and constipation. Other classified effects involve the Cardiac System (palpitation, tachycardia) and Eye Disorders (blurred vision, increased ocular tension).

Serious adverse reactions are explicitly noted in regulatory labeling, primarily concerning the risks associated with the analgesic component. These include the potential for severe hepatotoxicity (liver damage), particularly in cases of overdose, and rare but serious skin reactions, such as Stevens-Johnson syndrome, linked to acetaminophen use. Very rare reports of aplastic anemia have also been associated with the orphenadrine component.

Regulatory documents specify safety restrictions and limitations. For instance, the medicine is officially constrained in patients with pre-existing conditions such as glaucoma, myasthenia gravis, and certain urinary or gastrointestinal obstructions (e.g., pyloric obstruction). Population-specific notes indicate that older adults may infrequently experience mental confusion. For prolonged use, periodic monitoring of blood and liver function values is recommended, as established by prescribing information.

Overdose and Emergency Response

Overdose: When to Seek Immediate Medical Help

There is no specific, dedicated overdose information published in major global regulatory databases for a product officially identified as Nurasic. Information on managing a suspected overdose must therefore be based on the established clinical profile of its potential therapeutic class and known components, such as combinations containing muscle relaxants and analgesics.

Overdoses involving combination products containing anticholinergic agents and salicylates (aspirin) may present with a complex set of symptoms. These can include signs related to the central nervous system and cardiovascular system, as well as indications of salicylate toxicity.

Overdose Symptoms and Manifestations

System Affected Potential Clinical Manifestations (Observed in related compounds)
Neurological Confusion, delirium, hallucinations, profound drowsiness, seizures, or coma
Gastrointestinal Nausea, vomiting, diarrhea, dry mouth, or abdominal distress
Systemic/Cardiac Ringing in the ears (tinnitus), decreased or troubled breathing, irregular or very fast heartbeat, flushing, or clammy skin

If an overdose is suspected, immediate medical attention is required. Due to the risk of severe complications, including respiratory depression and cardiotoxicity, contact emergency medical services or a poison control center right away, even if the person appears stable or symptoms are mild. Do not wait for symptoms to worsen.

Therapeutic Uses of Nurasic

What Nurasic Treats: Main Uses and Benefits

Nurasic is applied across domains where additional symptomatic support may be relevant. Its therapeutic relevance involves supportive management of discomfort associated with acute musculoskeletal conditions.


Therapeutic Domains for Symptom Management

Nurasic is commonly used across conditions presenting with acute episodes, recurrent manifestations, or symptoms that create noticeable physiological strain. This makes it relevant when supportive symptom management is appropriate, particularly where short-term assistance is helpful. This is intended for use during difficult episodes where easing the overall symptom load is required.

Quick Fact: Relevant for Symptom Management


Focus on Functional Stability

The medicine's use is applicable in clinical settings that involve acute symptom patterns, addressing discomfort related to physical discomfort, systemic imbalance, and heightened physiological activity. Applied during phases of increased distress, it is used to address stability when symptoms are more noticeable and helps improve day-to-day comfort during symptomatic periods.

Eligibility and Restrictions for Use

The official eligibility profile for Nurasic (Orphenadrine and Acetaminophen) is defined by mandatory exclusions and specific caution requirements documented in governmental regulatory sources. Eligibility status is strictly determined by pre-existing conditions, organ function, and demographic factors, as summarized below.

Eligibility Status Patient Groups and Conditions
Contraindicated (Must Not Use) Absolute prohibition applies to patients with Glaucoma, Myasthenia gravis, Prostatic hypertrophy, Bladder neck obstruction, or Pyloric/duodenal obstruction. The medicine is also strictly contraindicated for those with Severe hepatic impairment or severe active liver disease.
Not Recommended Use is not recommended for children under 12 years of age. The medicine should not be taken during lactation, and its use is not recommended during pregnancy.

Use with Caution/Restrictions: Use requires caution in patients with non-severe impaired kidney or liver function, certain cardiac conditions (such as tachycardia or cardiac arrhythmias), and those with depleted glutathione reserves, including individuals with chronic heavy alcohol use or severe malnutrition. Older adults require cautious use due to greater susceptibility to anticholinergic effects.

What should I know about interactions with other medicines?

The official interaction profile for Nurasic (Rimegepant) is primarily defined by the drug's metabolism and transport. Nurasic is a substrate for the metabolic enzyme Cytochrome P450 3A4 (CYP3A4) and the efflux transporters P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP), meaning other substances can significantly alter its concentration in the body.

Pharmacokinetic and Transporter Interactions

Interacting Substance/Class Regulatory Constraint Reason for Constraint
Strong CYP3A4 Inhibitors Avoid concomitant administration. Significant increase in Nurasic exposure.
Moderate CYP3A4 Inhibitors Avoid another dose within 48 hours. May result in increased Nurasic exposure.
Strong or Moderate CYP3A Inducers Avoid concomitant administration. Significant reduction in Nurasic exposure, leading to potential loss of efficacy.
P-gp or BCRP Inhibitors Avoid concomitant administration. Significant increase in Nurasic exposure.

Food and Herbal Product Interactions

Grapefruit and Grapefruit Juice should be avoided as they may increase the drug's exposure. The use of St. John's Wort, a potent enzyme inducer, is also discouraged as it may substantially decrease the effectiveness of Nurasic.

Mechanism of Action

Nurasic (Orphenadrine) primarily acts as a muscarinic acetylcholine receptor antagonist within the central nervous system (CNS), particularly in the basal ganglia. This action inhibits cholinergic signaling, which is implicated in the regulation of motor activity.

Simultaneously, Nurasic functions as an antagonist at several ionotropic glutamate receptors, including NMDA 1, 2D, 3A, and 3B subunits. Antagonism of these glutamatergic receptors modulates excitatory neurotransmission and contributes to the drug's central effects.

The molecule also exhibits interaction with monoamine transporters and other receptors. It acts as an inhibitor of the sodium-dependent noradrenaline transporter (NET), which increases the synaptic concentration of norepinephrine. Furthermore, Nurasic is an antagonist at the Histamine H1 receptor.

These combined molecular interactions—cholinergic antagonism, glutamatergic antagonism, and monoamine reuptake inhibition—lead to a downstream reduction in efferent motor output and modulation of pain perception pathways within the CNS, resulting in a system-level physiological consequence of decreased skeletal muscle tone and centralized antinociception.

Dosage and Administration Information

Nurasic is administered via the oral route as an immediate-release tablet. The administration pattern defines the quantity, frequency, and maximum limit for its application.

Administration Guidelines

The standard regimen for adult use involves the oral ingestion of two tablets per dose. This combination medicine is typically scheduled to be taken three times daily. This schedule is designed to manage drug levels and safety limits, with a minimum time interval of four hours maintained between consecutive doses.

A critical limit is the maximum daily dose of six tablets within a 24-hour period. This restriction is procedural and designed to avoid exceeding the limits of the acetaminophen component. Therefore, the regimen involves not taking any other products containing paracetamol or acetaminophen simultaneously.

Contextual and Time-Bound Use

Nurasic tablets may be taken with or without food. The duration of treatment is generally intended for short-term management of acute conditions, and the course length is determined by a prescribing professional. If a dose is missed, it is typically managed by taking the dose only if remembered within approximately one hour of the scheduled time. Otherwise, the missed dose is skipped, and the schedule resumed; the protocol does not include taking a double dose. Dosing for pediatric patients (children) is not established by the standard adult regimen and requires the determination of a healthcare professional.

Recent Clinical Evidence

Research Evidence for Nurasic

This section summarizes the official research record, including findings from randomized controlled trials, systematic reviews, and regulatory documents that describe the clinical evaluation of the combination product containing Acetaminophen and Orphenadrine (Nurasic). The goal is to describe what has been observed in studies without offering clinical advice.


Evidence for Use in Acute Painful Musculoskeletal Conditions

The research for Nurasic examined the evidence base for discomfort associated with acute painful musculoskeletal conditions—conditions characterized by fluctuating or episodic manifestations, such as strains or short-term low back pain. Researchers utilized short-term, randomized controlled trials (RCTs) to examine the combination product's potential in adult patients experiencing these acute symptoms. These studies primarily focused on research exploring short-term symptom changes, often lasting less than two weeks.

Study Comparisons and Measured Outcomes

Research was examined by comparing Nurasic against an inactive substance (placebo) or against its single component, Acetaminophen, as part of research into the fixed combination. Studies monitored several key endpoints, including objective assessments of pain intensity scores and measurements of functional ability using standardized scales. Trials compared the documentation of observed changes in patient-reported outcomes for Nurasic versus placebo. Some trials described patterns where the fixed combination reported different measurements in specific pain intensity scores during the acute phase compared to placebo. Research provides insight into short-term changes, but not long-term predictive value.


Understanding Short-Term and Long-Term Follow-up

The core body of clinical evidence for Nurasic has focused on the acute treatment phase, meaning that follow-up durations were typically limited to between seven and fourteen days. The design of these trials aligns with the research focus on short-term assistance during periods of heightened symptom activity. Long-term effects are not fully established and evidence is limited regarding the use of Nurasic beyond the short, acute treatment windows examined in the main trials.

Evidence Consistency, Limitations, and Research Gaps

A primary limitation is the short-term duration of most pivotal studies, which means that while findings describe group patterns related to measured outcomes in the acute phase, they offer limited insight into long-term safety or durability of measured functional outcomes. The comparative evidence is lacking in consistency when assessing Nurasic against alternate active regimens for certain functional measures. Data for certain groups, such as older adults, remain insufficient.

Key Studies & References

  1. Real World Effectiveness of Orphenadrine Citrate 35 mg + Paracetamol 450 mg (Norgesic®) on Low Back Pain of Filipino Patients (Observational/Follow-up data)

Frequently Asked Questions (FAQ)

Common questions about Nurasic (FAQ)


Q: How quickly can someone expect Nurasic to start working?

Official documents describe the recommended treatment interval, but typically do not provide an exact time for the onset of effect. The standard regimen specifies that a minimum of four hours must be maintained between consecutive doses. This minimum time interval is a key factor in defining the recommended treatment schedule.


Q: Where can I find the official prescribing information for Nurasic?

Currently, the most comprehensive official information is published by government health authorities. These sources include the national regulator’s approved product information or Summary of Product Characteristics (SmPC). In the United States, current labeling information is posted via the National Library of Medicine’s DailyMed.


Q: What is the risk of dependence or withdrawal with Nurasic?

Official labeling contains required statements concerning the potential for abuse and dependence. These cautions are largely related to the risks associated with the acetaminophen component. The labeling points out that exceeding the recommended dose of the acetaminophen component is associated with a risk of serious liver damage.


Q: Is there a generic version of Nurasic available?

Nurasic is chemically defined by its two active ingredients: Acetaminophen and Orphenadrine. These active ingredients are commonly available together in generic combination products under various other brand names. The availability of a generic equivalent is subject to regulatory approvals in each region.


Q: What happens if Nurasic is suddenly stopped?

Regulatory documents typically focus on proper adherence to the prescribed schedule and provide instructions on how to handle a missed dose. Official guidance does not usually detail the effects of abrupt cessation unless a specific withdrawal syndrome is a known risk. Official information emphasizes adherence to the treatment schedule as determined by a healthcare professional.


Q: Why is Nurasic sometimes called by a different name?

The product is known by its brand name, Nurasic, but its contents are the active ingredients Acetaminophen and Orphenadrine. Because it is a fixed-dose combination product, it may be marketed under multiple different brand names depending on the pharmaceutical company and the country of sale.


Q: Can Nurasic be crushed or split?

Nurasic is approved as an immediate-release tablet for oral ingestion. Its administration instructions describe that it should be swallowed whole. Specific administration instructions regarding whether a tablet can be crushed or split are defined in the official product information. It is noted that certain extended-release forms of the Orphenadrine component must not be altered.


Q: What is the difference between a common side effect and a serious adverse event for Nurasic?

Official regulatory documents categorize adverse reactions based on both frequency and severity. Common side effects are those often reported in studies, such as drowsiness or dry mouth. Serious adverse events are rare but critical reactions, such as severe hepatotoxicity, and these require immediate medical attention.


Q: Can Nurasic affect blood pressure readings?

Regulatory data reports documented effects on the cardiac system, including the possibility of tachycardia (increased heart rate). While official labeling may not explicitly list blood pressure changes, these general cardiac effects are included in the safety information. Official eligibility profiles describe precautions for individuals with pre-existing heart conditions.


Q: Does Nurasic have a 'Black Box Warning' or similar serious caution listed?

US labeling for products containing this combination requires a Boxed Warning—also known as a Black Box Warning—due to the acetaminophen component. This warning highlights the potential risk of severe liver injury (hepatotoxicity). This is a primary caution mandated by the FDA.


Q: What should I do if I suspect an allergic reaction to Nurasic?

Official guidance addresses the rare risk of severe allergic reactions, including serious skin reactions. If signs of a hypersensitivity reaction occur, the official instruction is to discontinue the product immediately. The guidance is that emergency attention is required immediately.


Q: Why is Nurasic only available by prescription?

The medicine is classified as a prescription-only medicine by regulatory authorities. This status is due to the presence of Orphenadrine, which is a centrally acting muscle relaxant. This ingredient requires the oversight of a prescribing professional to ensure appropriate and safe use and monitoring.


Q: How long does the effect of a dose of Nurasic typically last?

The official dosing schedule for the immediate-release tablet is structured around a minimum of four hours between consecutive doses. This interval defines the recommended duration between treatments to maintain appropriate levels of medication. The duration of treatment for acute conditions is generally short-term.

How should Nurasic be stored and disposed of?

How to Store and Dispose of Nurasic

Nurasic (Acetaminophen and Orphenadrine combination) must be stored according to specific regulatory conditions to maintain its stability.

Storage Requirements

Item Requirement
Temperature Store at Controlled Room Temperature between 20 C to 25 C (68 F to 77 F), with excursions permitted up to 30 C (86 F).
Protection Keep in the tightly closed container to protect it from moisture.

Safety and Disposal

Child Safety mandates that the medication be stored out of the reach of children. Regarding disposal, all unused, unwanted, or expired Nurasic must be discarded according to local regulations for pharmaceutical waste.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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