Lornoxicam + Paracetamol + Trypsin Chymotrypsin

Usage

• This combination medication is prescribed for the relief of pain and inflammation associated with various conditions, including:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Post-operative pain
  • Acute musculoskeletal conditions (e.g., sprains, strains, low back pain)
  • Primary dysmenorrhea (painful menstrual periods)

• Pharmacological Classification: Non-steroidal anti-inflammatory drug (NSAID) combined with analgesic and proteolytic enzymes.

• Mechanism of Action: This combination targets different pain pathways for a synergistic effect. Lornoxicam inhibits COX enzymes, reducing prostaglandin production (mediators of pain and inflammation). Paracetamol acts centrally to alter pain perception and reduce fever. Trypsin and chymotrypsin are proteolytic enzymes that break down proteins at the inflammation site, promoting healing and reducing edema.

Alternate Names

• Lornoxicam-Paracetamol-Trypsin Chymotrypsin
• Brand Names: Lorchek Ptc, others (availability varies by region)

How It Works

• Pharmacodynamics: Lornoxicam exerts its anti-inflammatory and analgesic effects by inhibiting both COX-1 and COX-2 enzymes, reducing the formation of prostaglandins. Paracetamol is believed to act centrally on the hypothalamic heat-regulating center and inhibit prostaglandin synthesis in the CNS. Trypsin and chymotrypsin facilitate the breakdown of proteins involved in the inflammatory response.

• Pharmacokinetics:

  • Lornoxicam is well-absorbed orally, extensively metabolized in the liver (primarily by CYP2C9), and excreted mainly by the kidneys.
  • Paracetamol is rapidly absorbed, also metabolized in the liver by conjugation with glucuronide and sulfate, with a small fraction undergoing CYP450-mediated oxidation to a reactive metabolite that is detoxified by glutathione. Excretion is primarily renal.
  • Trypsin and chymotrypsin are absorbed from the GI tract, undergo metabolism, and are eventually excreted.

• Elimination Pathways:

  • Lornoxicam: Primarily renal excretion.
  • Paracetamol: Primarily renal excretion.
  • Trypsin Chymotrypsin: Metabolic and excretory pathways not fully characterized.

Dosage

Standard Dosage

Adults:

• One tablet containing 8mg Lornoxicam, 325mg Paracetamol, and 150,000 AU Trypsin Chymotrypsin, two to three times per day.
• Maximum daily dose of lornoxicam: 16mg.
• Maximum daily dose of paracetamol: 4g.

Children:

• Not recommended for children and adolescents below 18 years of age. Safety and efficacy have not been established in this population.

Special Cases:

• Elderly Patients: Use with caution. Close monitoring and potential dose adjustments may be necessary.
• Patients with Renal Impairment: Use with caution. Dose adjustment may be necessary depending on the degree of impairment. Contraindicated in severe renal failure.
• Patients with Hepatic Dysfunction: Use with caution. Dose adjustment may be necessary. Contraindicated in severe hepatic failure.
• Patients with Comorbid Conditions: Caution is advised in patients with conditions such as diabetes, cardiovascular disease, hypertension, and bleeding disorders. Monitor closely for potential drug interactions.

Clinical Use Cases

• Dosage in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, and emergencies is individualized based on patient status and pain assessment. Consult specialists for guidance.

Dosage Adjustments

• Modifications may be needed based on individual patient factors, including renal/hepatic dysfunction, comorbid conditions, concomitant medications, and patient response.

Side Effects

Common Side Effects

• Nausea, vomiting, abdominal pain/discomfort, indigestion, diarrhea, headache, dizziness, drowsiness, skin rash.

Rare but Serious Side Effects

• Allergic reactions (itching, shortness of breath, swelling, shock), gastrointestinal bleeding, peptic ulcers, hepatic necrosis, renal impairment.

Long-Term Effects

• Potential for gastrointestinal complications, renal dysfunction, and cardiovascular issues with prolonged NSAID use.

Adverse Drug Reactions (ADR)

• Severe allergic reactions, gastrointestinal bleeding, Stevens-Johnson syndrome, toxic epidermal necrolysis.

Contraindications

• Hypersensitivity to any component.
• Active peptic ulcer/hemorrhage.
• Severe heart, hepatic, or renal failure.
• History of asthma, urticaria, or allergic reactions after taking aspirin or other NSAIDs.
• Third trimester of pregnancy.

Drug Interactions

• Anticoagulants, antiplatelets, diuretics, lithium, methotrexate, antihypertensives, corticosteroids, alcohol, other NSAIDs.

Pregnancy and Breastfeeding

• Pregnancy: Contraindicated in the third trimester. Use during the first and second trimesters should be avoided unless the potential benefit justifies the potential risk to the fetus.
• Breastfeeding: Safety not established. Avoid use or discontinue breastfeeding.

Drug Profile Summary (See information above)

Popular Combinations

• The combination of Lornoxicam, Paracetamol, and Trypsin Chymotrypsin is itself a popular combination for pain management.

Precautions (See information above)

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Lornoxicam + Paracetamol + Trypsin Chymotrypsin?

A: Standard adult dosage is one tablet (8mg Lornoxicam, 325mg Paracetamol, 150,000 AU Trypsin Chymotrypsin) two to three times daily. Not recommended for children under 18. Dosage adjustments needed for elderly patients and those with renal or hepatic impairment.

Q2: What are the common side effects?

A: Nausea, vomiting, abdominal discomfort, diarrhea, headache, dizziness, and skin rashes are common.

Q3: What are the serious side effects I should watch out for?

A: Allergic reactions, gastrointestinal bleeding, and liver or kidney problems are rare but serious.

Q4: Can I take this medication if I am pregnant or breastfeeding?

A: Contraindicated during the third trimester of pregnancy and generally avoided during breastfeeding. Consult a doctor if you are pregnant or breastfeeding.

Q5: What other medications should I avoid while taking this combination?

A: Avoid alcohol and other NSAIDs. Caution with anticoagulants, antiplatelets, diuretics, lithium, methotrexate, antihypertensives, and corticosteroids. Always inform your doctor about all other medications you are taking.

Q6: Are there any contraindications to this medication?

A: Yes. Contraindications include hypersensitivity to any of the ingredients, active peptic ulcer, severe heart, liver, or kidney failure, and a history of asthma/urticaria following NSAID use.

Q7: How does this combination work differently from taking paracetamol or lornoxicam alone?

A: This combination targets multiple pain pathways, offering potentially enhanced pain relief and reduced inflammation compared to single-agent therapy. Trypsin chymotrypsin adds anti-inflammatory effect by breaking down proteins at the site of injury.

Q8: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember, unless it is almost time for the next dose. Do not double the dose.

Q9: Should I take this medicine with food?

A: It can be taken with or without food, but it is best to take it at a fixed time for optimal results.

Q10: What are the long-term implications of using this drug?

A: Chronic use, especially of the NSAID component (lornoxicam), can increase the risk of gastrointestinal issues, kidney problems, and cardiovascular events. Regular monitoring is recommended for long-term use.