Usage
Lornoxicam + Paracetamol + Serratiopeptidase is prescribed for managing pain and inflammation associated with acute musculoskeletal conditions like low back pain, neck pain, strains, and sprains. It is also used in chronic conditions such as osteoarthritis and rheumatoid arthritis, post-operative pain, and primary dysmenorrhea.
Pharmacological Classification:
- Non-Steroidal Anti-Inflammatory Drug (NSAID) - Lornoxicam
- Analgesic and Antipyretic - Paracetamol
- Proteolytic Enzyme - Serratiopeptidase
Mechanism of Action: This combination offers a multi-pronged approach to pain and inflammation management. Lornoxicam inhibits cyclooxygenase (COX) enzymes, primarily COX-2, thereby reducing prostaglandin synthesis, which are mediators of pain and inflammation. Paracetamol’s mechanism is not fully understood, but it is thought to involve inhibition of COX enzymes in the central nervous system, affecting pain perception. It may also interact with endocannabinoid and serotonergic pathways. Serratiopeptidase breaks down inflammatory proteins, facilitating their removal and further reducing swelling and pain.
Alternate Names
There are no widely recognized alternate names for this specific combination. However, the individual components may have other names:
- Paracetamol: Acetaminophen (International Nonproprietary Name)
- Lornoxicam: Xefo (common brand name)
Brand names for the combination vary depending on the manufacturer. Some examples include: Lorox SP, Lornidase P, and others.
How It Works
Pharmacodynamics: Lornoxicam exerts its anti-inflammatory and analgesic effects through COX inhibition. Paracetamol acts centrally to reduce pain and fever. Serratiopeptidase enzymatically degrades inflammatory proteins.
Pharmacokinetics:
- Lornoxicam: Well-absorbed orally, extensively metabolized in the liver (primarily by CYP2C9), and excreted in urine and feces.
- Paracetamol: Rapidly absorbed, metabolized in the liver, and excreted in the urine.
- Serratiopeptidase: Absorbed through the gut, distribution is not precisely characterized, and elimination pathways are not fully defined.
Mode of Action: Lornoxicam inhibits COX-1 and COX-2 enzymes, thereby decreasing prostaglandin production. Paracetamol’s mechanism is not completely elucidated but involves central action on pain pathways. Serratiopeptidase acts by cleaving peptide bonds in proteins involved in inflammation.
Receptor Binding/Enzyme Inhibition: Lornoxicam inhibits COX enzymes. Paracetamol’s mechanism might involve COX inhibition in the CNS. Serratiopeptidase acts as a protease.
Elimination Pathways: Lornoxicam is eliminated through hepatic metabolism and renal/fecal excretion. Paracetamol undergoes hepatic metabolism and renal excretion. Serratiopeptidase’s elimination is not fully understood.
Dosage
Standard Dosage
Adults: One tablet twice daily, taken orally with or after food. The typical dose of lornoxicam is 8 mg. The typical dose of paracetamol is 325-500 mg. The typical dose of serratiopeptidase is 10 mg.
Children: Not recommended for children under 12 years of age.
Special Cases:
- Elderly Patients: Start with the lowest effective dose and increase gradually. Monitor renal and hepatic function.
- Patients with Renal Impairment: Dose adjustment may be necessary.
- Patients with Hepatic Dysfunction: Dose adjustment may be necessary.
- Patients with Comorbid Conditions: Caution is advised for patients with pre-existing conditions like peptic ulcers, gastrointestinal bleeding, severe heart failure, and hypertension. Dose adjustments may be needed.
Clinical Use Cases
Dosage recommendations for specific clinical settings are not explicitly defined for this combination. Dosage is adjusted according to the individual’s pain level and underlying condition.
Dosage Adjustments
Dose adjustments may be necessary in patients with renal or hepatic impairment, elderly patients, and those with other comorbid conditions.
Side Effects
Common Side Effects: Nausea, vomiting, dizziness, headache, skin rash, diarrhea, dyspepsia, abdominal pain, indigestion, drowsiness.
Rare but Serious Side Effects: Gastrointestinal bleeding, liver damage (especially with high paracetamol doses or concomitant alcohol use), kidney injury, allergic reactions (e.g., angioedema, anaphylaxis), Steven-Johnson syndrome, visual disturbances, and hypertension.
Long-Term Effects: Chronic NSAID use like lornoxicam might lead to renal complications, gastrointestinal ulcers, and cardiovascular issues.
Adverse Drug Reactions (ADR): Any signs of a severe allergic reaction, gastrointestinal bleeding, or liver injury require urgent medical intervention.
Contraindications
- Hypersensitivity to any component
- Active peptic ulcer or gastrointestinal bleeding
- Severe liver or kidney disease
- History of aspirin/NSAID-induced asthma, urticaria, or allergic reactions
- Third trimester of pregnancy
Drug Interactions
- Other NSAIDs: Increased risk of gastrointestinal bleeding.
- Anticoagulants: Increased bleeding risk.
- Antiplatelet agents: Increased bleeding risk.
- Corticosteroids: Increased risk of gastrointestinal ulcers.
- Methotrexate: Increased toxicity.
- Lithium: Increased lithium levels.
- Digoxin: Increased digoxin levels.
- Alcohol: Increased risk of liver damage with paracetamol.
Pregnancy and Breastfeeding
Avoid during the third trimester of pregnancy. Safety during the first two trimesters and breastfeeding is not well-established. Consult a doctor before use.
Drug Profile Summary
- Mechanism of Action: Lornoxicam: COX inhibitor; Paracetamol: Central analgesic and antipyretic; Serratiopeptidase: Proteolytic enzyme.
- Side Effects: Nausea, vomiting, dizziness, rash; rarely, GI bleeding, liver/kidney damage, allergic reactions.
- Contraindications: Hypersensitivity, active peptic ulcer, severe hepatic/renal disease, third-trimester pregnancy.
- Drug Interactions: NSAIDs, anticoagulants, corticosteroids, methotrexate, lithium.
- Pregnancy & Breastfeeding: Avoid in the third trimester; caution advised during other stages.
- Dosage: Adults: One tablet twice daily.
- Monitoring Parameters: Liver and kidney function tests.
Popular Combinations
Data on popular combinations specifically with this three-drug combination is limited. The components are, however, often found in combinations with other drugs. For example, paracetamol is frequently combined with other analgesics like tramadol or codeine. Lornoxicam is sometimes used with other NSAIDs and/or gastroprotective agents.
Precautions
- Screen for allergies and organ dysfunction.
- Avoid alcohol.
- Caution in pregnancy/breastfeeding.
- Avoid driving if dizziness or drowsiness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lornoxicam + Paracetamol + Serratiopeptidase?
A: One tablet twice daily for adults. Not recommended for children under 12.
Q2: Can this medication be used during pregnancy or breastfeeding?
A: Contraindicated in the third trimester. Use with caution and under medical supervision during other stages and breastfeeding.
Q3: What are the common side effects?
A: Nausea, vomiting, dizziness, headache, skin rash, and gastrointestinal upset.
Q4: Are there any serious side effects I should be aware of?
A: Yes, rare but serious side effects include gastrointestinal bleeding, liver damage, kidney injury, and allergic reactions. Seek immediate medical attention if these occur.
Q5: What are the contraindications to using this medicine?
A: Hypersensitivity, active peptic ulcers, severe liver or kidney disease, and the third trimester of pregnancy.
Q6: Can I take this medication with other NSAIDs?
A: It’s generally not recommended to combine this medication with other NSAIDs due to the increased risk of gastrointestinal complications. Consult your doctor.
Q7: Does this medication interact with alcohol?
A: Yes, concurrent alcohol consumption can increase the risk of liver damage, especially due to the paracetamol component. Avoid alcohol while taking this medication.
Q8: How should I manage the common side effects like nausea and stomach upset?
A: Taking the medication with food can often minimize gastrointestinal irritation. If symptoms persist, consult your doctor.
Q9: Are there any long-term risks associated with using this medication?
A: Prolonged use of NSAIDs like lornoxicam can potentially increase the risk of kidney problems, gastrointestinal ulcers, and cardiovascular issues. Regular monitoring is recommended for long-term use.
Q10: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it’s nearly time for the next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
