Loricam

For all patients, the appropriate dosing regimen should be based upon individual response to treatment.

Pain: 8-16 mg lornoxicam daily divided into 2 or 3 doses. The Maximum recommended daily dose is 16 mg.

Osteoarthritis and Rheumatoid arthritis: Initial recommended dose is 12 mg lornoxicam daily divided into 2 or 3 doses. The maintenance dose should not exceed 16 mg lornoxicam daily. Lornoxicam film-coated tablets are supplied for oral use and should be taken with a sufficient quantity of liquid.

Children and adolescents: Lornoxicam is not recommended for use in children and adolescents below age 18 due to a lack of data on safety and efficacy.

Elderly: No special dosage modification is required for elderly patients above age 65, but Lornoxicam should be administered with precaution as gastrointestinal adverse effects are less well tolerated in this group.

Renal impairment: For patients with mild to moderate renal impairment the maximum recommended daily dose is 12 mg divided in 2 or 3 doses.

Hepatic impairment: For patients with moderate hepatic impairment the maximum recommended daily dose is 12 mg divided in 2 or 3 doses.

Lornoxicam is a non-steroidal anti-inflammatory drug (NSAID) that belongs to the oxicam class. As with other NSAIDS, lornoxicam is a potent inhibitor of the cyclooxgenase enzymes, which are responsible for catalyzing the formation of prostaglandins (act as messenger molecules in the process of inflammation) and thromboxane from arachidonic acid. Unlike some NSAIDS, lornoxicam's inhibition of cyclooxygenase does not lead to an increase in leukotriene formation, meaning that arachidonic acid is not moved to the 5-lipoxygenase cascade, resulting in the minimization of the risk of adverse events.

Like other NSAIDS, lornoxicam's anti-inflammatory and analgesic activity is related to its inhibitory action on prostaglandin and thromboxane synthesis through the inhibition of both COX-1 and COX-2. This leads to the reduction of inflammation, pain, fever, and swelling, which are mediated by prostaglandins. However, the exact mechanism of lornoxicam, like that of the other NSAIDs, has not been fully determined.

Renal impairment: Lornoxicam should be administered with precaution in patients with mild (serum creatinine 150-300 µmol/l) to moderate (serum creatinine 300 – 700 µmol/l) renal impairment due to dependency on renal prostaglandins for maintenance of renal blood flow. Treatment with lornoxicam should be discontinued if renal function deteriorates during treatment. Renal functions should be monitored in patients who undergo major surgery, with cardiac failure, receiving treatment with diuretics, receiving concomitant treatment with drugs that are suspected to or known to be able to cause kidney damage.

Patients with blood coagulation disorders: Careful clinical monitoring and laboratory assessment is recommended (e.g. APTT).

Hepatic impairment (e.g. liver cirrhosis): Clinical monitoring and laboratory assessments at regular intervals should be considered in patients with hepatic impairment as accumulation of lornoxicam (increase in AUC) may occur after treatment with daily doses of 12-16 mg. Apart from that, hepatic impairment does not seem to affect pharmacokinetic parameters of lornoxicam as compared to healthy subjects.

Long term treatment (longer than 3 months): Regular laboratory assessments of haematology (haemoglobin), renal functions (creatinine) and liver enzymes are recommended.

Elderly patients above 65 years: Monitoring of renal and hepatic function is recommended. Precaution is advised in elderly postoperative patients.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)