Usage
Lornoxicam + Paracetamol is prescribed for short-term relief of mild to moderate acute pain, and for the symptomatic relief of pain and inflammation associated with osteoarthritis and rheumatoid arthritis. It falls under the pharmacological classifications of analgesic (pain reliever), anti-inflammatory, and antipyretic (fever reducer).
The mechanism of action involves Lornoxicam inhibiting cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis, thereby mitigating inflammation and pain. Paracetamol’s precise mechanism is not fully understood but involves central inhibition of prostaglandin synthesis and additional effects on the serotonergic and endocannabinoid systems. The combined effect provides synergistic pain relief.
Alternate Names
While “Lornoxicam + Paracetamol” is the generic name, specific brand names vary depending on the manufacturer and region. Lorexam Plus is one example of a brand name for this combination.
How It Works
Pharmacodynamics: Lornoxicam primarily exerts its effects by non-selectively inhibiting COX-1 and COX-2 enzymes. This leads to decreased prostaglandin production, mitigating inflammation and pain. Paracetamol is thought to primarily work centrally, inhibiting COX enzymes in the brain and also potentially influencing the endocannabinoid and serotoninergic systems.
Pharmacokinetics: Lornoxicam is well-absorbed orally, reaching peak plasma concentrations within 1-2 hours. It undergoes hepatic metabolism, primarily by CYP2C9, and is excreted mainly through the kidneys. Paracetamol is also rapidly absorbed, with peak plasma levels occurring within 30-60 minutes. It is metabolized in the liver, primarily by glucuronidation and sulfation, with a small fraction undergoing CYP450-mediated metabolism to a potentially hepatotoxic metabolite. It is excreted renally.
Mode of Action: At the cellular level, Lornoxicam’s COX inhibition reduces the production of inflammatory mediators like prostaglandins, thereby decreasing inflammation, pain, and fever. Paracetamol’s central action on prostaglandin synthesis, and possible modulation of other pathways in the CNS, contributes to its analgesic and antipyretic effects.
Elimination: Both drugs are primarily eliminated through the kidneys, either as unchanged drug or as metabolites following hepatic metabolism.
Dosage
Standard Dosage
Adults: Oral administration of one tablet containing Lornoxicam 8 mg + Paracetamol 325 mg, once or twice daily, depending on pain severity. The maximum recommended daily dose of Lornoxicam is 16 mg. Paracetamol’s maximum daily dose is 4000 mg.
Children: The combination of Lornoxicam and Paracetamol isn’t typically recommended for children below 18 years due to limited safety and efficacy data. Paracetamol dosage in children is weight-based, usually 10-15 mg/kg per dose, every 4-6 hours, not exceeding 4 doses in 24 hours. Lornoxicam is contraindicated in children.
Special Cases:
- Elderly Patients: Start with lower doses and monitor closely, as elderly patients may be more susceptible to adverse effects, especially gastrointestinal issues.
- Patients with Renal Impairment: Dose reduction of Lornoxicam may be necessary in moderate to severe renal impairment.
- Patients with Hepatic Dysfunction: Use Lornoxicam with caution due to its hepatic metabolism. Paracetamol dosage should be reduced in patients with severe hepatic impairment.
- Patients with Comorbid Conditions: Exercise caution in patients with cardiovascular disease, diabetes, and other relevant comorbidities.
Clinical Use Cases
Dosage in specific clinical settings should be guided by patient-specific factors and pain severity. General recommendations align with the standard adult dosing.
- Intubation/Surgical Procedures/Mechanical Ventilation/ICU Use/Emergency Situations: Lornoxicam, usually administered parenterally, is preferred in these settings. Paracetamol can be administered intravenously. The combined drug is usually given orally when the patient is capable of taking medication by mouth.
Dosage Adjustments
Dose adjustments are crucial for patients with renal or hepatic impairment, certain metabolic disorders, and potential genetic polymorphisms affecting drug metabolism (e.g., CYP2C9 for Lornoxicam).
Side Effects
Common Side Effects: Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, dizziness, headache, and rash.
Rare but Serious Side Effects: Gastrointestinal bleeding or ulceration, severe allergic reactions (anaphylaxis, angioedema), Stevens-Johnson syndrome, and cardiovascular events (myocardial infarction, stroke).
Long-Term Effects: With prolonged use, potential complications include renal impairment, gastrointestinal issues, and cardiovascular risks.
Contraindications
- Hypersensitivity to Lornoxicam or Paracetamol.
- History of asthma, urticaria, or allergic-type reactions after taking NSAIDs or aspirin.
- Active peptic ulcer or gastrointestinal bleeding.
- Severe hepatic impairment.
- Severe renal impairment.
- Severe heart failure.
- Third trimester of pregnancy.
- Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
Drug Interactions
- Anticoagulants (e.g., warfarin): Increased risk of bleeding.
- Antihypertensives: May reduce their efficacy.
- Other NSAIDs: Increased risk of gastrointestinal adverse effects.
- Lithium: Increased lithium levels.
- Methotrexate: Increased methotrexate toxicity.
- CYP2C9 inhibitors: Increased Lornoxicam levels.
- Alcohol: Increased risk of gastrointestinal bleeding.
Pregnancy and Breastfeeding
Lornoxicam is contraindicated in the third trimester of pregnancy. It should be used with caution during the first and second trimesters only if clearly needed. Paracetamol is generally considered safe during pregnancy and breastfeeding at recommended doses.
Drug Profile Summary
(Refer to respective sections for detailed information)
Popular Combinations
No specific combination is generally recommended with this medicine.
Precautions
(Refer to respective sections for detailed information)
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lornoxicam + Paracetamol?
A: The typical adult dose is one tablet (Lornoxicam 8mg + Paracetamol 325mg), taken once or twice daily, with or after meals.
Q2: Can Lornoxicam + Paracetamol be used in children?
A: Not recommended for children under 18 years of age.
Q3: What are the most common side effects?
A: Nausea, dyspepsia, vomiting, diarrhea, and abdominal pain.
Q4: What should I do if a patient experiences gastrointestinal bleeding while on this medication?
A: Discontinue the medication immediately and provide appropriate supportive care.
Q5: Can this combination be used in patients with renal impairment?
A: Use with caution and consider dose reduction, especially with moderate to severe impairment.
Q6: Are there any significant drug interactions I should be aware of?
A: Yes, significant interactions exist with anticoagulants, other NSAIDs, and some antihypertensives.
Q7: Is it safe to take Lornoxicam + Paracetamol during pregnancy?
A: Lornoxicam is contraindicated in the third trimester. Use in the first and second trimesters only if clearly needed and under close monitoring. Paracetamol is generally considered safe.
Q8: How does this combination work to reduce pain and inflammation?
A: Lornoxicam primarily inhibits COX enzymes, reducing prostaglandin synthesis. Paracetamol’s mechanism isn’t fully understood but likely involves central COX inhibition and other pathways. Together, they provide synergistic pain relief.
Q9: What are the long-term effects of Lornoxicam + Paracetamol?
A: Potential long-term effects include renal issues and cardiovascular risks with chronic use, particularly with Lornoxicam. Monitor patients closely for these effects.
