Flexilor 4mg Glenmark treatment for osteoarthritis, rheumatoid arthritis (10 blisters x 10 tablets)

Like other NSAIDs, Lornoxicam's anti-inflammatory and analgesic activity is related to the inhibitory activity of the drug on prostaglandin and summarized thromboxan through inhibition of both COX-1 and COX-2. This leads to anti -inflammatory, analgesic, antipyretic through intermediaries by prostaglandin.

However, the exact mechanism of Lornoxicam, like other NSAIDs, has not been fully determined.

pharmacokinetic

absorption

Lornoxicam is absorbed quickly and almost completely from the gastrointestinal tract, the peak concentration in plasma is 270 mcg/l after the dose of 4mg 2.5 hours. The absolute bioavailability of Lornoxicam is 80 - 100%. There is no effect of initial metabolism through the liver.

Simultaneous use of Lornoxicam and CMAX meals decreased by approximately 30%, TMAX increased from 1.5 to 2.3 hours, Lornoxicam's absorption decreased by 20%. Use Lornoxicam simultaneously with antacids that do not affect the pharmacokinetics of the drug.

distribution

Lornoxicam is found in plasma in constant form and in the form of hydroxylate metabolism.

Like other oxicams, linked to Lornoxicam's plasma proteins is 99%. The apparent distribution of Lornoxicam is low (0.2L/kg). However, it easily penetrates into the interstitial compartments around the circuit, including the epidemic.

For patients with rheumatoid arthritis, in the epidemic of the knee joint, the ratio of Lornoxicam concentration in the epidemic/ Lornoxicam concentration in plasma is about 0.5% after using 4mg daily twice a day in 5 days.

transformation

Lornoxicam is strongly metabolized in the liver into a metabolic substance that does not have the activity of 5’hydroxy-lornoxicam. Lornoxicam is metabolized by cytochrome P4502C9.

Hydroxyl metabolites have no pharmacological effects.

Therefore people with polymorphic metabolism of drugs are so fast and slow, in slow metabolites that can lead to significantly increased Lornoxicam levels in plasma.

Excretion

nearly 51% of radioactive markers are excreted in feces and 42% of the drug is excreted through the kidneys in the form of metabolism without activity. The half -life of the drug is 3-4 hours. Lornoxicam's oral clearance for healthy patients volunteered to use 4 - 8mg daily 2 times from 1.5 to 3.4L/ hour.

Special patients

Elderly patients

For elderly patients, the clearance decreases by about 30-40%. Except for the reduction of clearance, there is no significant change in pharmacokinetics of Lornoxicam in elderly patients.

Pediatric patients

There is no research data on pharmacokinetics for pediatric patients.

Patients with liver failure

There is no significant change in lornoxicam pharmacokinetics in patients with mild liver failure. However, the accumulation of main metabolites occurs in patients with liver function.

Patients with renal failure

There is no significant change in lornoxicam pharmacokinetics in patients with mild renal impairment (60ml creatinine clearance), however, there is no data on doses. Increasing the clearance of the liver - intestines of the drug can compensate for reducing the elimination through the kidneys in people with severe renal function. However, the clinical significance of this is not known.

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Precautions when using

Pediatric patients

Do not use lornoxicam for pediatric patients.

Elderly patients

No dose adjustment for elderly patients, unless used for patients with hepatic and renal failure, in these cases, dose reduced.

Patients with liver failure

For patients with liver failure, the maximum recommendation is 12mg.

Patients with renal failure

For patients with renal failure, the daily recommended dosage is 12mg.

The ability to drive and operate machinery

Be cautious when driving or operating machinery because the drug can cause headaches, dizziness, sleep.

Pregnancy

Not for pregnant women.

Breastfeeding period

Not used for breastfeeding women.

Medicinal interaction

Warfarin and anticoagulants: simultaneous use of Lornoxicam with anticoagulant drugs or platelet accumulation inhibitors that can increase bleeding time.

Sulphonyl Urea: Concomitance Lornoxicam may increase hypoglycemic effects.

Aspirin and other nonsteroidal anti -inflammatory drugs: simultaneous use of Lornoxicam increases the risk of side effects of the drug.

Diuretics: Concomitance Lornoxicam reduces the effects of diuretics. The nonsteroidal anti -inflammatory drugs reduce the diuretic effect of Furosemide.

ACE inhibitors: simultaneously use Lornoxicam to reduce the effect of ACE inhibitors, which can lead to the risk of acute renal failure.

Lithium: simultaneously using Lornoxicam can lead to increased lithium peaks leading to increased side effects of the drug. Avoid simultaneous use with lithium if not checked for frequent plasma lithium concentrations.

methotraxate: simultaneously use Lornoxicam to increase the serum concentration of methotraxate. Caution should be used if both anti -inflammatory and methotrexate anti -inflammatory drugs within 24 hours.

cimetidine: Increases the serum concentration of lornoxicam (there is no interaction between lornoxicam and ranitidine, or lornoxicam and acid neutralizing drugs).

Digoxin: Lornoxicam reduces the clearance of Digoxin through the kidneys.

Cyclosporin: Lornoxicam increases toxicity to the kidneys of cyclosporin.

Lornoxicam interacts with the agents of induction and inhibition of CYP2C9 ISOENZYM known as phenytoin, amidarone, miconazole, tranylcypromine and rifampicin.