Usage
Lornoxicam + Thiocolchicoside is prescribed for the short-term management of acute painful musculoskeletal conditions, especially those involving muscle spasms. Examples include low back pain, neck pain, sprains, strains, and other similar conditions.
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Pharmacological Classification: This drug is a combination of an NSAID (Non-Steroidal Anti-Inflammatory Drug) and a muscle relaxant. Lornoxicam is the NSAID component, while Thiocolchicoside provides the muscle relaxant action.
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Mechanism of Action: Lornoxicam inhibits cyclooxygenase (COX) enzymes, reducing the production of prostaglandins, which are mediators of pain and inflammation. Thiocolchicoside’s exact mechanism is not fully understood but is thought to involve action at the spinal cord level, reducing muscle stiffness and spasms without affecting muscle strength.
Alternate Names
There are no widely recognized alternate names for this specific combination drug. However, each individual component may be found marketed internationally under different names or as a part of other combination drugs.
- Brand Names: A few examples of brand names include Lorgen-TH, Lornoxi T, Lornoxi T4, Thionex-LX8, and Relor T. Brand names can vary regionally.
How It Works
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Pharmacodynamics: Lornoxicam provides analgesic, anti-inflammatory, and antipyretic effects. Thiocolchicoside relieves muscle spasms and stiffness.
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Pharmacokinetics:
- Lornoxicam: Well absorbed orally (90-100% bioavailability), highly protein-bound (99%), metabolized by CYP enzymes, eliminated via hepatic (2/3) and renal (1/3) routes. Half-life is 3-5 hours.
- Thiocolchicoside: Well absorbed orally, low protein binding (13%), metabolized to three metabolites, primarily excreted in feces (79%), with about 20% urinary excretion.
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Mode of Action: Lornoxicam blocks COX-1 and COX-2 enzymes, which are involved in prostaglandin synthesis. Thiocolchicoside is thought to interact with GABA receptors, affecting muscle tone and reducing spasms.
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Elimination Pathways: Lornoxicam is primarily eliminated by hepatic metabolism and renal excretion. Thiocolchicoside is primarily eliminated through fecal excretion.
Dosage
Standard Dosage
Adults:
The usual dosage is one tablet containing 8 mg of Lornoxicam and 4 mg or 8 mg of Thiocolchicoside, taken twice daily after meals. Treatment duration should not exceed 7 days.
Children: This combination is not recommended for use in children under 16 years of age.
Special Cases:
- Elderly Patients: Use with caution. Lower doses may be necessary. Monitor for adverse effects.
- Patients with Renal Impairment: Use with caution. Dose adjustments may be required.
- Patients with Hepatic Dysfunction: Use with caution. Dose adjustments may be required.
- Patients with Comorbid Conditions: Use with caution in patients with a history of asthma, peptic ulcer, hypertension, congestive heart failure, or bleeding disorders.
Clinical Use Cases
Dosage recommendations for specific clinical situations like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations are not established for this combination product. Its use is generally limited to short-term management of acute painful musculoskeletal conditions.
Dosage Adjustments
Dose modification is based on renal and hepatic function and other comorbid conditions. Start with the lowest effective dose and adjust based on individual patient response and tolerance.
Side Effects
Common Side Effects: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, headache, dizziness, fatigue.
Rare but Serious Side Effects: Steven-Johnson syndrome, visual disturbances, hypertension, swelling (edema), renal impairment, hepatic dysfunction, gastrointestinal bleeding, allergic reactions.
Long-Term Effects: Prolonged use may lead to gastrointestinal complications, renal or hepatic impairment, and cardiovascular risks.
Contraindications
- Hypersensitivity to either lornoxicam or thiocolchicoside.
- Active or recurrent peptic ulcer/hemorrhage.
- Cerebrovascular or other active bleeding.
- Severe heart failure.
- Severe renal impairment.
- Severe hepatic impairment.
- Third trimester of pregnancy.
- Breastfeeding.
Drug Interactions
- Other NSAIDs: Increased risk of gastrointestinal side effects.
- Anticoagulants: Increased risk of bleeding.
- Corticosteroids: Increased risk of gastrointestinal ulcers.
- Quinolone antibiotics: Possible increased risk of seizures.
- Cimetidine: Increased Lornoxicam blood levels.
- Anticoagulants, Sulfonylureas, Methotrexate, Ciclosporin, Digoxin: Enhanced effects.
- Diuretics, ACE inhibitors: Decreased effects.
- Alcohol: May increase the risk of gastrointestinal side effects.
Pregnancy and Breastfeeding
- Pregnancy: Contraindicated during the third trimester and should be avoided throughout pregnancy due to potential risks to the fetus.
- Breastfeeding: Contraindicated due to excretion in breast milk.
Drug Profile Summary
- Mechanism of Action: Lornoxicam: COX inhibitor, reducing prostaglandin synthesis; Thiocolchicoside: Muscle relaxant, possibly acting on GABA receptors.
- Side Effects: Nausea, vomiting, diarrhea, headache, dizziness, rare but serious effects like Steven-Johnson syndrome and gastrointestinal bleeding.
- Contraindications: Hypersensitivity, active bleeding, severe heart, liver, or kidney disease, pregnancy, breastfeeding.
- Drug Interactions: Other NSAIDs, anticoagulants, corticosteroids, quinolones.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adults: 8 mg lornoxicam + 4 mg/8 mg thiocolchicoside twice daily after meals for up to 7 days.
- Monitoring Parameters: Renal and liver function, blood pressure, signs of gastrointestinal bleeding.
Popular Combinations
This drug is itself a combination product. Combining it with additional medications like other NSAIDs or muscle relaxants should be done cautiously due to the risk of additive adverse effects.
Precautions
- General Precautions: Evaluate renal and hepatic function before initiating therapy. Screen for allergies and history of peptic ulcer disease.
- Specific Populations: Avoid in pregnancy and breastfeeding. Use cautiously in the elderly. Not recommended for children under 16.
- Lifestyle Considerations: Limit alcohol intake. Avoid driving or operating machinery if dizziness or drowsiness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lornoxicam + Thiocolchicoside?
A: The usual adult dose is one tablet containing 8 mg Lornoxicam and 4 mg or 8 mg Thiocolchicoside, twice daily after meals, for a maximum of 7 days.
Q2: Can this medication be used during pregnancy or breastfeeding?
A: No, it is contraindicated in both pregnancy and breastfeeding.
Q3: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, abdominal pain, headache, and dizziness.
Q4: Are there any serious side effects I should be aware of?
A: Yes, rare but serious side effects can occur, such as Steven-Johnson syndrome, gastrointestinal bleeding, and renal or hepatic impairment. Seek immediate medical attention if these occur.
Q5: How does Lornoxicam + Thiocolchicoside interact with other NSAIDs?
A: Combining with other NSAIDs increases the risk of gastrointestinal side effects. It’s important to inform your doctor about all medications you’re taking.
Q6: Can I drink alcohol while taking this medication?
A: Alcohol is not recommended as it can increase the risk of stomach upset and other adverse effects.
Q7: Is this medication safe for children?
A: No, it is not recommended for children under 16.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Q9: Can I drive while taking this medicine?
A: This medication can cause dizziness or drowsiness. Avoid driving or operating machinery until you know how it affects you.
Q10: What conditions is this medication contraindicated for?
A: Contraindications include hypersensitivity to the components, active bleeding, severe heart, liver, or kidney disease, pregnancy, and breastfeeding.
