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نشرة الممارس الصحي نشرة معلومات المريض بالعربية نشرة معلومات المريض بالانجليزية صور الدواء بيانات الدواء
  SFDA PIL (Patient Information Leaflet (PIL) are under review by Saudi Food and Drug Authority)

• Exxara is a non-steroidal anti-inflammatory drug and antirheumatic drug (NSAID) of the oxicam
class. It is intended for short term treatment of acute mild to moderate pain.
• Exxara is indicated for adults 18 years of age and older.


Do not take Exxara
• If you are allergic to lornoxicam or any of the other ingredients of this medicine (listed in section 6);
• If you are taking other NSAIDs such as acetylsalicylic acid (for instance, aspirin); ibuprofen and
COX-2 inhibitors;
• If you are hypersensitive to other NSAIDs including acetylsalicylic acid (for instance, aspirin);
• If you suffer from thrombocytopenia (low blood platelet count which increases risk of bleeding or
bruising);
• If you suffer from severe heart failure;
• If you suffer from gastrointestinal bleeding, rupture and bleeding of a blood vessel in the brain, or
other bleeding disorders;
• If you have a history of gastrointestinal bleeding or perforation, related to previous therapy with
NSAIDs;
• If you suffer from an active peptic ulcer or have a history of recurrent peptic ulcer;
• If you suffer from severe liver impairment;
• If you suffer from severe kidney impairment;
• If you are in the last three months of your pregnancy.
Warnings and precautions
• Talk to your doctor or pharmacist before taking Exxara. This is particularly important:
• If you have impaired kidney function;
• If you have a history of high blood pressure and/or heart failure;
• If you suffer from ulcerative colitis or Crohn’s disease;
• If you have a history of bleeding tendency;
• If you have a history of asthma;
• If you suffer from SLE (lupus erythematosus, a rare immunological disease).
- Your doctor may have to monitor you by laboratory tests on a frequent basis if
• You suffer from blood coagulation disorder,
• You suffer from impaired liver function,
• You are elderly,
• Or you will be treated with Exxara for more than 3 months.
- You should inform your doctor if you are going to be treated with heparin or tacrolimus, while taking
at the same time Exxara.
- If you experience any unusual abdominal symptoms such as abdominal bleeding, skin reactions
such as skin rash, damage to the internal lining of the nostrils, mouth, eyelids, ears, genitals or anus,
or other signs of hypersensitivity, you should stop taking Exxara and contact your doctor immediately.
- Medicines such as Exxara may be associated with a small increase of the risk of heart attack
(myocardial infarction) or stroke. Any risk is more likely with high doses and prolonged treatment. Do
not exceed the recommended dose or the duration of treatment.
- You should discuss your treatment with your doctor or pharmacist if
• You have heart problems,
• You had previously a stroke,
• Or you think that you might be at risk of developing these conditions (for example, if you have high
blood pressure, diabetes or high cholesterol, or you are a smoker).
- Avoid using Exxara during varicella (chickenpox) infections.
Other medicines and Exxara
• Tell your doctor or pharmacist if you are taking, have recently taken or might take any other
medicines.
- Do not take Exxara if you are taking other NSAIDs such as acetylsalicylic acid (for instance, aspirin),
ibuprofen and COX-2 inhibitors. Ask your doctor or pharmacist if you are uncertain.
Exxara may interfere with other medicines. Be particularly careful if you are taking any of the following:
• Cimetidine - used in the treatment of heartburn and peptic ulcers;
• Anticoagulants, such as heparin or phenprocoumon - used to prevent the formation of blood clots;
• Corticosteroids;
• Methotrexate - used in treatment of cancer and immunological diseases;
• Lithium;
• Immunosuppressive agents, such as ciclosporin or tacrolimus;
• Heart medicines, such as digoxin, ACE-inhibitors, beta-adrenergic blockers;
• Diuretics;

• Quinolone antibiotics;
• Anti-platelet agents - medicines used to prevent heart attacks and strokes;
• SSRI (Selective Serotonin Reuptake Inhibitors) – used in the treatment of depression;
• Sulphonylureas, for instance glibenclamide - used in the management of diabetes;
• Inducers and inhibitors of CYP2C9-isoenzymes (such as the antibiotic rifampicin or the antifungal
medicine fluconazole), as they might have an effect on the way in which your body breaks down
Exxara;
• Angiotensin II receptor blocker - used to treat high blood pressure, kidney damage due to diabetes
and congestive heart failure;
• Pemetrexed - used to treat some forms of lung cancer.
Exxara with food and drink
• Exxara film-coated tablets are intended for oral use. Take this medicine before meals with a
sufficient amount of liquid.
• Taking this medicine with food is not recommended because this may reduce its effectiveness.
Pregnancy, breast-feeding and fertility
• If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby,
ask your doctor or pharmacist for advice before taking this medicine.
Fertility
• Using Exxara may impair fertility and is not recommended for women attempting to become
pregnant. Women who have difficulties becoming pregnant, or who are undergoing investigation of
infertility, should consult with a doctor and consider stopping treatment with Exxara.
Pregnancy
• During the first 6 months of pregnancy treatment with Exxara is not recommended, unless explicitly
advised by your doctor.
• You must not take Exxara during the last three months of your pregnancy.
Breast-feeding
• If you are breast-feeding treatment with Exxara is not recommended, unless explicitly advised by
your doctor.
Driving and using machines
• Exxara has negligible or no influence on the ability to drive or use machinery.


• Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist
if you are not sure.
• The usual dose for adults is 8-16 mg divided in doses of 8 mg: 8 mg taken twice a day or 16 mg
taken once a day.
• On the first day you take Exxara the dose can be 16 mg followed by 8 mg 12 hours later. After the
first day do not take more than 16 mg a day.
• Exxara tablets must be swallowed with sufficient amounts of liquid. Do not take Exxara with a
meal, as food can reduce the effectiveness of Exxara.
• Exxara is not recommended for children and adolescents below 18 years old, due to lack of data
on safety and efficacy.
If you take more Exxara than you should
• Please contact your doctor or the pharmacist if you have taken more Exxara than prescribed.
• In case of an overdose, you may expect the following symptoms: nausea, vomiting, symptoms
associated with central nervous system (such as dizziness or disturbances in vision).
If you forget to take Exxara
• Do not take a double dose to make up for a forgotten tablet.
If you have any further questions on the use of this product, ask your doctor or pharmacist.


• Like all medicines, this medicine can cause side effects, although not everybody gets them.
• Medicines such as Exxara may be associated with a small increase in the risk of heart attack or
stroke.
• If you experience any unusual abdominal symptoms such as abdominal bleeding, skin reactions
such as skin rash, damage to the internal lining of the nostrils, mouth, eyelids, ears, genitals or anus,
or other signs of hypersensitivity, you should stop taking Exxara and contact your doctor immediately.
• If you get any of the following side effects, stop taking this medicine and tell your doctor
immediately, or contact the emergency department at your nearest hospital:
• Shortness of breath, chest pains, or ankle swelling appear or get worse;
• Severe or continuous stomach pain or your stools become black;
• Yellowing of the skin and eyes (jaundice) – these are signs of liver problems;
• An allergic reaction - which can include skin problems such as ulcers or blistering, or swelling of the
face, lips, tongue, or throat which may cause difficulty in breathing;
• Fever, blistering eruption or inflammation especially on hands and feet or in the mouth area
(Stevens-Johnson syndrome);
• Exceptionally, serious infections of the skin in case of varicella (chickenpox). Undesirable effects
associated with using Exxara are given below.
Common side effects (may affect up to 1 in 10 people)
• Mild and passing headache and dizziness,
• Nausea, abdominal pain, upset stomach, diarrhea and vomiting.
Uncommon side effects (may affect up to 1 in 100 people)
• Weight loss (anorexia), inability to sleep, depression;
• Eye discharges (conjunctivitis);
• Feeling dizzy, ringing in the ears (tinnitus);
• Cardiac failure, irregular heartbeat, heart rate, feeling blushed;
• Constipation, excessive wind (flatulence), belching, dry mouth, gastritis, peptic ulcer, upper abdominal
pain, duodenal ulcer, mouth ulcers;
• Increase in liver function tests (as seen from blood tests) and feeling unwell (malaise);
• Rash, itching, increased sweating, redness of the skin (erythema), angiooedema (swelling of the
deeper layers of skin, usually of the face), hives (urticaria), oedema, stuffy nose as a result of an
allergy (rhinitis);
• Hair loss;
• Arthralgia (pain in the joints).
Rare side effects (may affect up to 1 in 1,000 people)
• Sore throat;
• Anaemia, reduction in the blood cell count (thrombocytopenia and leukopenia), weakness;

• Hypersensitivity, anaphylactoid reaction and anaphylaxis (organism reaction characterized usually by
face swelling, flushing, difficulties breathing and lightheadedness);
• Confusion, nervousness, agitation, feeling sleepy (somnolence), paraesthesia (tingling sensations),
abnormal sense of taste, tremor, migraine, visual disturbances;
• Elevated blood pressure, hot flush;
• Bleeding, haematoma (bruising), prolonged bleeding time;
• Difficulty in breathing (dyspnoea), cough, bronchospasm;
• Perforated ulcer, vomiting of blood, gastrointestinal bleeding, black tarry stools;
• Inflammation in the mouth, oesophagitis (inflammation of the gullet), gastro-oesophageal reflux, difficulty
in swallowing, aphthous stomatitis (ulcers), inflammation of the tongue,
• Abnormal liver function;
• Skin problems, such as eczema, rash;
• Bone pain, muscle cramp, muscle pain;
• Urinary problems, such as the need to wake up and urinate during the night (nocturnia) or an increase
in the levels of urea and creatinine in the blood.
Very rare side effects (may affect up to 1 in 10,000 people)
• liver damage, hepatitis (inflammation of the liver), jaundice, cholestasis (interrupted flow of bile from
the liver);
• Bruising, oedema, severe skin disorder (Stevens-Johnson syndrome, Toxic epidermal necrolysis);
• Aseptic meningitis;
• NSAID class effects: neutropenia, agranulocytosis, aplastic anaemia, hemolytic anaemia, kidney
toxicity.

To report any side effect(s):
• Saudi Arabia

The National Pharmacovigilance and Drug Safety Centre (NPC)
• Fax: +966-11-205-7662
• Call NPC at +966-11-2038222, Exts: 2317-2356-2353-2354-2334-2340.
• Toll free phone: 8002490000
• E-mail: npc.drug@sfda.gov.sa
• Website: www.sfda.gov.sa/npc
Other GCC States:

Please contact the relevant competent authority.


- Keep this medicine out of the sight and reach of children.
• Store below 30ºC.
• Do not use this medicine after the expiry date which is stated on the carton or on the blister after EXP.
The expiry date refers to the last day of that month.
• Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to
throw away medicines you no longer use. These measures will help to protect the environment.


• The active substance is lornoxicam
• One film-coated tablet contains 8 mg lornoxicam
• The other ingredients are:
Core: Lactose monohydrate, Microcrystalline cellulose PH-101, Microcrystalline cellulose PH-102, Povidone
K 30, Croscarmellose sodium, Magnesium stearate.
Film: Macrogol, Titanium dioxide (E171), Talc, Hypromellose.


• Exxara 8 mg is white, oval, biconvex film coated tablet. • Exxara is distributed in pack sizes of 20 film-coated tablets.

Middle East Pharmaceutical Industries Co Ltd (Avalon Pharma)
P.O.Box 4180 Riyadh 11491, Kingdom of Saudi Arabia
2nd Industrial City, Riyadh, Kingdom of Saudi Arabia
Tel: +966 (11) 2653948 -2653427
Fax: +966 (11) 2654723


This leaflet was approved in [01/2018]
  نشرة الدواء تحت مراجعة الهيئة العامة للغذاء والدواء (اقرأ هذه النشرة بعناية قبل البدء في استخدام هذا المنتج لأنه يحتوي على معلومات مهمة لك)

- اكسارا هو دواء مضاد للالتهابات غير ستيرويدي ومضاد للروماتيزم )NSAID( من مجموعة أوكسيكام. و يستخدم كعلاج قصير الأمد للآلام الحادة الخفيفة إلى المتوسطة.
- يوصى باستخدام كسارا للبالغين من سن 18 عام وأكثر.

لا تتناول دواء اكسارا في الحالات التالية:
؛) - إذا كنت تعاني من حساسية تجاه لورنوكسيكام أو أي من المكونات الأخرى للدواء )مدرجة في الفقرة 6
- إذا كنت تتناول أي عقاقير مضادة للالتهاب غير ستيرويدية أخرى مثل حمض الأسيتيل ساليسيليك )على سبيل المثال، الأسبرين(؛
؛ أيبوبروفين ومثبطات كوكس 2
- إذا كنت تعاني من حساسية مفرطة تجاه مضادات الالتهاب الغير ستيرويدية بما في ذلك حمض الأسيتيل ساليسيليك )على سبيل
المثال، الأسبرين(؛
- إذا كنت تعاني من قلة الصفيحات )انخفاض في صفائح الدم والذي يزيد من خطورة حدوث نزيف أو كدمات(؛
- إذا كنت تعاني من قصور حاد في القلب؛
- إذا كنت تعاني من نزيف في الجهاز الهضمي وتمزق ونزيف في الأوعية الدموية في الدماغ، أو غير ذلك من الاضطرابات الناتجة
عن النزيف؛
- إذا كان لديك تاريخ للإصابة بنزيف أو ثقب في الجهاز الهضمي، متعلق بعلاج مسبق بمضادات الالتهاب الغير ستيرويدية؛
- إذا كنت تعاني من قرحة هضمية نشطة أو لديك تاريخ للإصابة بقرحة معوية متكررة؛
- إذا كنت تعاني من قصور حاد في الكبد؛
- إذا كنت تعاني من قصور حاد في الكلى؛
- إذا كنتِ في الأشهر الثلاثة الأخيرة من الحمل.
التحذيرات والاحتياطات
• تحدث إلى طبيبك أو الصيدلي قبل تناول اكسارا. فهذا مهم وخاصةً:
• إذا كنت تعاني من قصور في وظائف الكلى.
• إذا كان لديك تاريخ للإصابة بضغط الدم المرتفع و/أو قصور في القلب؛
• إذا كنت تعاني من التهاب القولون التقرحي أو داء كرون؛
• إذا كان لديك تاريخ من الميل إلى النزيف؛
• إذا كانت لديك تاريخ للإصابة بمرض الربو؛
• إذا كنت تعاني من مرض الذئبة الحمراء )الذئبة الحمامية، وهو مرض مناعي نادر(.
- قد يحتاج طبيبك إلى ملاحظة حالتك من خلال اختبارات معملية بشكل دوري متكرر إذا:
• كنت تعاني من اضطراب تخثر الدم،
• كنت تعاني من قصور في وظائف الكبد،
• كنت من كبار السن،
• كنت ستخضع للعلاج باستخدام اكسارا لأكثر من 3 أشهر.
- يجب أن تُخطر طبيبك إذا كنت ستخضع للعلاج باستخدام يهبارين أو تاكروليمس، بالتزامن مع تلقي دواء اكسارا.
- إذا واجهت أي أعراض غير مألوفة بالمعدة، مثل نزيف في البطن أو تفاعلات الجلد مثل طفح جلدي أو تلف بالبطانة الداخلية لفتحتي
الأنف أو الفم أو الجفون أو الأذنين أو الأعضاء التناسلية أو الشرج، أو أعراض أخرى من الحساسية المفرطة، ، يجب عليك التوقف
عن تناول اكسارا والاتصال بطبيبك على الفور.
- إن تلقي أدوية مثل اكسارا قد يصاحبه أعراض مثل زيادة بسيطة في خطر التعرض لنوبة قلبية )احتشاء عضلة القلب( أو سكتة
دماغية. ومن المرجح أن تحدث الخطورة بسبب الجرعات الكبيرة والعلاج بالدواء لفترة طويلة. لذا، لا تتجاوز الجرعة الموصى بها
أو فترة العلاج.
- يجب أن تتناقش مع الطبيب أو الصيدلي حول علاجك إذا:
• كنت تعاني من مشاكل في القلب،
• كنت قد تعرضت مسبقًا لسكتة دماغية،
• كنت تعتقد أنك معرض لخطر الإصابة بتلك الحالات )على سبيل المثال، إذا كنت عانيت من ارتفاع في ضغط الدم أو مرض السكري
أو ارتفاع في نسبة الكوليسترول أو كنت شخص مدخن(.
- تجنب استخدام اكسارا أثناء الإصابة بعداوى الحُماق )الجدري الماء(.
أدوية أخرى واستخدامها مع اكسارا
- أخبر الطبيب أو الصيدلي إذا كنت تتناول أدوية أخرى أو قد تناولت مؤخرًا أو قد تتناول أي أدوية أخرى.
لا تتناول اكسارا إذا كنت تتناول أدوية أخرى مضادة للاتهاب غير ستيرويدية مثل حمض الأسيتيل ساليسيليك )على سبيل المثال،
الأسبرين( إيبوبروفين ومثبطات كوكس- 2. اسأل الطبيب أو الصيدلي إذا كنت غير متأكد.
- قد يتداخل اكسارا مع أدوية أخرى. لذا، توخى الحذر الشديد إذا كنت تتناول أي من الأدوية التالية:
• سيميتيدين – المستخدم في علاج حرقة المعدة والقرحة الهضمية؛
• مضادات التخثر، مثل هيبارين أو فينوبروكومون – المستخدمة في تجنب تكوين جلطات الدم؛
• الكورتيكوستيرويد؛
• الميثوتركسيت – المستخدم في علاج السرطان والأمراض المناعية؛
• الليثيوم؛
• الأدوية الكابتة للمناعة، مثل سيكلوسبورين أو تاكروليموس؛
• أدوية القلب، مثل ديوكسين، مثبط إنزيم محول الأنجيوتنسين، العوامل المحصرة للأدرينيات البيتا؛
• مدرات البول؛

• مضادات الكينولون الحيوية؛
• العوامل المضادة للصفيحات الدموية- أدوية مستخدمة لمنع النوبات القلبية والسكتات الدماغية؛

• مثبطات امتصاص السيروتونين الانتقائية )SSRI( مستخدمة في علاج الاكتئاب؛ –

•سلفونيل يوريا، على سبيل المثال جليبينكلاميد – المستخدم في علاج مرض السكري؛

• محفزات ومثبطات نظير إنزيم سيتوكروم isoenzymes-CYP2C92C9 مثل ريفامبيسين المضاد الحيوي أو فلوكونازول (الدواء المضاد للفطريات(، لأن قد يكون لها تأثيرًا على الطريقة التي يفتت بها جسدك دواء اكسارا؛

• مضادات مستقبلات أنجيوتنسين II مستخدم في علاج ضغط الدم المرتفع والفشل الكلوي الناتج عن مرض السكري وقصور  القلب الاحتقاني؛
• بيميتريكسيد – مستخدم في علاج بعض أنواع سرطان الرئة.

اكسارا مع الطعام والشراب
- إن أقراص اكسارا المغلفة بطبقة رقيقة تستخدم عن طريق الفم. تناول الدواء قبل الوجبات مع شرب كمية كافية من السوائل.
- لا يوصى بتناول هذا الدواء أثناء تناول الطعام لأن هذا من شأنه تقليل فعالية الدواء.
الحمل والرضاعة الطبيعية والخصوبة
- إذا كنتِ حاملً أو تقومين بالرضاعة الطبيعية، أو تعتقدين أنك قد تكونين حاملً أو تخططين لإنجاب طفل، فاستشيري الطبيب
المسؤول عن حالتك أو الصيدلي قبل أخذ هذا الدواء.
الخصوبة
- إن استخدام دواء اكسارا قد يُضعف الخصوبة ولا توصى السيدات اللاتي يحاولن الحمل بتناول الدواء. بالنسبة للسيدات اللاتي
يجدن صعوبة في الحمل، أو اللاتي يخضعن لكشف للتحقق من الخصوبة، يجب عليهن استشارة طبيب والنظر في وقف العلاج
باستخدام اكسارا.
الحمل
- أثناء الشهور الستة الأولى من الحمل، لا يوصى بالعلاج باستخدام اكسارا، ما لم ينصح الطبيب صراحة بذلك.
- ينبغي عدم تناول اكسارات خلال الأشهر الثلاثة الأخيرة من الحمل.
الرضاعة الطبيعية
إذا كنت تُرضعين رضاعة طبيعية فلا يوصى بتناول اكسارا، ما لم ينصح الطبيب صراحة بذلك.
القيادة واستخدام الأجهزة
- إن تأثير اكسارا على القيادة واستخدام الأجهزة ضئيل أو لا يؤثر عليها على الإطلاق.

https://localhost:44358/Dashboard

- احرص دائمًا على تناول هذا الدواء حسب تعليمات الطبيب. استشر طبيبك أو الصيدلي المسؤول عن حالتك إذا كنت غير متأكد
من طريقة تناول الدواء.
- تتراوح الجرعة المعتادة للبالغين من 8 إلى 16 ملغم مقسمة إلى جرعات 8 ملغم: 8 ملغم تؤخذ مرتين يوميًا أو 16 ملغم تؤخذ
مرة واحدة يوميًا.
- في اليوم الأول الذي تتناول فيه اكسارا يمكن أن تكون الجرعة 16 ملغم تتبعها جرعة 8 ملغم بعد 12 ساعة. بعد اليوم الأول لا
تتناول أكثر من 16 ملغ يوميًا.
- يجب ابتلاع أقراص اكسارا مع كمية كافية من السوائل. لا تتناول اكسارا مع الوجبات، لأن الطعام يُمكن أن يسبب الحد من
فعالية الدواء.
- لا يوصى بأن يتناول الأطفال والمراهقين دون 18 عام اكسارا، بسبب نقص بيانات الفعّالية و السلامة في هذا الصدد.
في حالة تناولك جرعة زائدة من دواء اكسارا
- يُرجى الاتصال بالطبيب أو الصيدلي المسؤول عن حالتك إذا كنت قد تناولت كمية من اكسارا أكثر من تلك الجرعة المقررة لك.
- في حالة الجرعة الزائدة، قد تتوقع ظهور الأعراض التالية: غثيان، قيء، أعراض مرتبطة بالجهاز العصبي المركزي )مثل
الدوخة أو اضطراب الرؤية(.
في حالة نسيان تناول اكسارا
- لا تتناول جرعة مضاعفة لتعويض الجرعة التي نسيت تناولها.
إذا كانت لديك أي أسئلة أخرى حول استخدام هذا المنتج، اسأل الطبيب أو الصيدلي المسؤول عن حالتك.

- مثل جميع الأدوية، قد يُسبب هذا الدواء آثارًا جانبية، بالرغم من أنها لا تظهر على الجميع.
- قد يرتبط تناول أدوية مثل اكسارا بزيادة بسيطة في خطر التعرض لنوبة قلبية أو سكتة دماغية.
- إذا واجهت أي أعراض غير مألوفة بالمعدة، مثل نزيف في البطن أو تفاعلات الجلد مثل طفح جلدي أو تلف بالبطانة الداخلية
لفتحتي الأنف أو الفم أو الجفون أو الأذنين أو الأعضاء التناسلية أو الشرج، أو أعراض أخرى من الحساسية المفرطة، يجب عليك
التوقف عن تناول اكسارا والاتصال بطبيبك على الفور.
في حالة ظهور أي من الآثار الجانبية التالية عليك، توقف عن تناول الدواء وأخبر طبيبك على الفور، أو اتصل بقسم الطوارئ
بأقرب مستشفى:
• في حالة وجود ضيق في التنفس أو آلام بالصدر أو تورم الكاحل أو تفاقم أي من هذه الأعراض؛
• ألم شديد أو مستمر في المعدة أو تغير لون البراز إلى اللون الأسود؛
• إصفرار الجلد والعيون )اليرقان( – وهذه أعراض توضح وجود مشاكل في الكبد؛
• رد فعل تحسسي– والذي قد يتضمن مشاكل في الجلد مثل التقرحات أو تبثر أو تورم الوجه أو الشفتين أو اللسان، أو الحلق والذي
قد يسبب صعوبة في التنفس؛
• الحمى، أو تبثر و تورم التقرحات خاصة على اليدين والقدمين أو في منطقة الفم )متلازمة ستيفنز جونسون(؛
• عَرَض استثنائي، التهابات خطيرة في الجلد في حالة الحماق )جدري الماء(؛
فيما يلي أعراض غير مرغوب فيها مرتبطة باستخدام اكسارا
الآثار الجانبية الشائعة )قد تؤثر على 1 من بين 10 أشخاص(
• صداع ودوار معتدل وعابر،
• غثيان وألم بالبطن واضطراب في المعدة وإسهال وقيء.
الآثار الجانبية غير الشائعة )قد تؤثر على 1 من بين 100 شخص(
• فقدان الوزن )فقدان الشهية(، عدم القدرة على النوم، اكتئاب؛
• خروج إفرازات من العين )التهاب الملتحمة(؛
• الشعور بدوار وطنين في الأذن )صوت صفير(؛
• فشل القلب، عدم انتظام ضربات القلب، ومعدل ضربات القلب، الشعور بإحمرار مصاحب بسخونة؛
• إمساك وغازات مفرطة، تجشؤ، جفاف الحلق، التهاب المعدة، قرحة هضمية، ألم في الجزء العلوي من البطن، قرحة اثنى عشر،
تقرحات في الفم؛
• حدوث زيادة في نسبة اختبارات وظائف الكبد )كما يتضح من اختبارات الدم( والشعور بتوعك )ضيق(؛
• طفح جلدي، وحكة، وزيادة التعرق، وإحمرار الجلد )حمامي(، الوذمة الوعائية )تورم الطبقات السفلية من الجلد، وعادة في الوجه(،
الشرى وانسداد الأنف نتيجة لحساسية )الأنف(؛

• تساقط الشعر؛
• ألم مفصلي )ألم في المفاصل(.
الآثار الجانبية النادرة )قد تؤثر على 1 من بين 1000 شخص(
• التهاب الحلق؛
• فقر الدم، وانخفاض في عدد خلايا الدم )قلة الصفيحات وسرطان الدم(، ضعف؛
• فرط الحساسية ورد فعل تحسسسي وحساسية مفرطة )يتميز رد الفعل الكائن الحي عادة بتورم في الوجه واحمرار وصعوبة في
التنفس ودوخة(؛
• ارتباك وعصبية وتهيج وشعور بالنعاس ومذل )إحساس بالوخز( واضطراب حاسة التذوق، ورعاش وصداع نصفي واضطراب
بصري؛
• ضغط دم مرتفع، احمرار مصاحب بسخونية؛
• نزيف وورم دموي )كدمات والنزف لفترة طويلة؛
• صعوبة في التنفس )ضيق التنفس(، وسعال وتشنج قصبي؛
• قرحة ثاقبة وتقيء دم ونزيف معدي معوي وبراز أسود؛
• التهاب في الفم، التهاب المريء، ارتجاع معدي مريئي، وصعوبة في البلع، التهاب الفم القلاعي )قرحة(، والتهاب اللسان،
• اختلال في وظائف الكبد؛
• مشاكل الجلد مثل الأكزيما والطفح الجلدي؛
• ألم العظام، وتشنج عضلي وألم في العضلات؛
• مشاكل في المسالك البولية، مثل الحاجة إلى الاستيقاط والتبول أثناء الليل )التبول المفرط ليلً( أو زيادة في مستويات اليوريا
والكرياتينين في الدم.
الآثار الجانبية النادرة جدًا )قد تؤثر على 1 من بين 10,000 شخص(
• تلف الكبد، والتهاب الكبد )تورم الكبد(، واليرقان، وركود صفراوي )توقف التدفق المرة من الكبد(؛
• كدمات، وذمة، واضطراب حاد في الجلد )متلازمة ستيفنز جونسون، تقشر الانسجة المتموتة البشروية التسممي(؛
• التهاب السحايا العقيم؛

• تأثيرات الشعبة NSAID: نقص الخلايا المتعادلة، ندربة المحببات، فقر الدم الاتنسجي، وفقر الدم الانحلالي، سمية الكلى. :

للإبلاغ عن الأعراض الجانبية:
• المملكة العربية السعودية:

- المركز الوطني للتيقظ والسلامة الدوائية
7662-205-11- فاكس: + 966 ▪
+966-11- للاتصال بالإادارة التنفيذية للتيقظ وإدارة الأزمات . هاتف: 2038222 ▪
2340-2334-2354-2353-2356- تحويلة: 2317 ▪
الهاتف المجاني: 8002490000 ▪
npc.drug@sfda.gov.sa : البريد الإلكتروني ▪
www.sfda.gov.sa/npc : الموقع الإلكتروني ▪

• دول الخليج الأخرى:

- الرجاء الاتصال بالمؤسسات والهيئات الوطنية في كل دولة.

- يحفظ بعيدًا عن متناول ورؤية الأطفال
- يحفظ في درجة حرارة أقل من 30 درجة مئوية.
- لا تستخدم الدواء بعد تاريخ انتهاء الصلاحية المدون على العبوة الكرتونية أو الشريط بعد كلمة )انتهاء الصلاحية(. يُشير تاريخ
انتهاء إلى آخريوم من ذلك الشهر.
- لا تتخلص من أي أدوية عن طريق مياه الصرف الصحي أو النفايات المنزلية. اسأل الصيدلي عن كيفية التخلص من الأدوية التي
لم تعد تستخدمها. فإن هذه التدابير ستساعد على حماية البيئة.

- المادة الفعالة هي لورنوكسيكام
- قرص واحد مغلف بطبقة رقيقة يحتوي على 8 ملغم لورنوكسيكام
- المكونات الأخرى هي:

الجزء الداخلي: مونوهيدرات اللاكتوز، سليلوز دقيق التبلور (PH 101( ، سليلوز دقيق التبلور (PH-102)، بوفيدون كي 30، وسكارميلوز، ماغنيسيوم ستيرات.

طبقة الغشاء الرقيق: ماكروغول، ثنائي أكسيد التيتانيوم (E171)، تلك، هيدروكسي بروبيل ميثيل سيللوز.

- اكسارا 8 ملغم هو عبارة عن قرص أبيض، بيضاوي الشكل و ثنائي التحدب، مغلف بطبقة رقيقة
- يوزع اكسارا في عبوات بحجم 20 قرص مغلف بطبقة رقيقة.

شركة الشرق الأوسط للصناعات الدوائية المحدودة. )أفالون فارما(
ص.ب. 4180 الرياض 11491 ، المملكة العربية السعودية
المدينة الصناعية الثانية، الرياض، المملكة العربية السعودية
هاتف 00966112653948- 2563427

فاكس 00966112654723

01/2018
 Read this leaflet carefully before you start using this product as it contains important information for you

Exxara 8 mg film-coated tablets

One film-coated tablet contains 8 mg lornoxicam. For the full list of excipients, see section 6.1.

Film-coated tablet White, oval, biconvex film coated tablet debossed with “A2” on one side and plain on the other side.

Short-term relief of acute mild to moderate pain.


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

Acute pain:
8-16 mg lornoxicam given in doses of 8 mg. An initial dose of 16 mg followed by 8 mg 12 hours later can be given on the first treatment day. After the first treatment day, the maximum recommended daily dose is 16 mg.
Additional information on special populations
Children and adolescents
Lornoxicam is not recommended for use in children and adolescents below age 18 because of a lack of data on safety and efficacy.
Elderly:
No special dosage modification is required for elderly patients above age 65 unless renal or hepatic function is impaired. Lornoxicam should be administered with precaution as gastrointestinal adverse effects are less well tolerated in this group (see section 4.4).
Renal impairment:
Reduction of dose frequency of Exxara to once daily in patients suffering from renal impairment is recommended.
Hepatic impairment:
Reduction of dose frequency of Exxara to once daily in patients suffering from hepatic impairment is recommended.
Undesirable effects may be minimized by using the lowest effective dose for the shortest duration necessary to control symptoms (see section 4.4.).

Method of Administration:
Exxara film-coated tablets are supplied for oral administration and should be taken with a sufficient quantity of liquid.


-Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 -Thrombocytopenia -Hypersensitivity (symptoms like asthma, rhinitis, angioedema or urticaria) to other NSAIDs including acetylsalicylic acid -Severe heart failure -Gastro-intestinal bleeding, cerebrovascular bleeding or other bleeding disorders -History of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy -Active or history of recurrent peptic ulcer/hemorrhage (two or more distinct episodes of proven ulceration or bleeding) -Severe hepatic impairment -Severe renal impairment (Serum creatinine > 700 μmol/l) -The third trimester of pregnancy (see section 4.6).

For the following disorders, lornoxicam should only be administered after careful risk-benefit assessment:
-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.
The use of lornoxicam with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided.
Undesirable effects may be minimised by using lowest effective dose for the shortest duration necessary to control symptoms (see section 4.2, and GI and cardiovascular risks below).
Gastrointestinal bleeding, ulceration and perforation: GI bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs at any time during treatment, with or without warning symptoms or a previous history of serious GI events.
The risk of GI bleeding, ulceration or perforation is higher with increasing NSAID doses, in patients with a history of ulcer, particularly if complicated with hemorrhage or perforation (see section 4.3), and in the elderly. These patients should commence treatment on the lowest dose available. Combination therapy with protective agents (e.g. misoprostol or proton pump inhibitors) should be considered for these patients, and for patients requiring concomitant low dose acetylsalicylic acid or other active substances likely to increase gastrointestinal risk (see below and section 4.5). Clinical monitoring at regular intervals is recommended.
Patients with a history of GI toxicity, particularly when elderly, should report any unusual abdominal symptoms (especially GI bleeding) particularly in the initial stages of treatment.
Caution should be advised in patients receiving concomitant medicinal products, which could increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin-reuptake inhibitors or anti-platelet agents such as acetylsalicylic acid (see section 4.5).
When GI bleeding or ulceration occurs in patients receiving lornoxicam, the treatment should be withdrawn.
NSAIDs should be given with care to patients with a history of gastrointestinal disease (ulcerative colitis, Crohn's disease) as their condition may be exacerbated (see section 4.8).
The elderly has an increased frequency of adverse reactions to NSAIDs especially gastrointestinal bleeding and perforation, which may be fatal (see section 4.3).
Caution is required in patients with a history of hypertension and/or heart failure, as fluid retention and oedema have been reported in association with NSAID therapy.
Appropriate monitoring and advice are required for patients with a history of hypertension and/or mild to moderate congestive heart failure, as fluid retention and oedema have been reported in association with NSAID therapy.
Clinical trial and epidemiological data suggest that use of some NSAIDs (particularly at high doses and in long term treatment) may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke). There are insufficient data to exclude such a risk for lornoxicam.
Patients with uncontrolled hypertension, congestive heart failure, established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease should only be treated with Lornoxicam after careful consideration. Similar consideration should be made before initiating longer-term treatment of patients with risk factors for cardiovascular disease (e.g. hypertension, hyperlipidemia, diabetes mellitus, smoking).
Concomitant treatment with NSAIDs and heparin in the context of a spinal or epidural anesthesia increases the risk of spinal/epidural hematoma (see section 4.5).
Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs (see section 4.8). Patients appear to be at highest risk of these reactions early in the course of therapy, the onset of the reaction occurring in the majority of cases within the first month of treatment. Lornoxicam should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.
Caution is required if administered to patients suffering from, or with a previous history of, bronchial asthma since NSAIDs have been reported to precipitate bronchospasm in such patients.
In patients with systemic lupus erythematosus (SLE) and mixed connective tissue disorders there may be an increased risk of aseptic meningitis.
Lornoxicam reduces platelet aggregation and prolongs bleeding time and consequently care should be taken when administering to patients with increased bleeding tendency.
Concomitant treatment of NSAIDs and tacrolimus may increase the risk of nephrotoxicity owing to reduced synthesis of prostacyclin in the kidney. Renal function must therefore be monitored closely in patients receiving combination therapy.
As with most NSAIDs occasional increase in serum transaminases level, increase in serum bilirubin or other liver function parameters, as well as increases in serum creatinine and blood urea nitrogen as well as other laboratory abnormalities have been reported. Should any such abnormality prove significant or persist the administration of lornoxicam should be stopped and appropriate investigations prescribed.
The use of lornoxicam, as with any drug known to inhibit cyclooxygenase/prostaglandin synthesis, may impair fertility and is not recommended in women attempting to conceive. In women who have difficulties conceiving or who are undergoing investigation of infertility, withdrawal of lornoxicam should be considered.
Exceptionally, varicella can be at the origin of serious cutaneous and soft tissues infectious complications.
To date, the contributing role of NSAIDs in the worsening of these infections cannot be ruled out. Thus, it is advisable to avoid use of lornoxicam in case of varicella.


Concomitant administration of lornoxicam and
- Cimetidine: Increased plasma concentrations of lornoxicam. (No interaction between lornoxicam and ranitidine, or lornoxicam and antacids has been demonstrated).
- Anti-coagulants: NSAIDs may enhance the effects of anti-coagulants, such as warfarin (see section 4.4). Careful monitoring of INR should be undertaken.
- Phenprocoumon: Decreased effect of phenprocoumon treatment.
- Heparin: NSAIDs increase the risk of spinal or epidural haematoma when given concomitantly to heparin in the context of spinal or epidural anaesthesia (see section 4.4.).
- ACE inhibitors: The antihypertensive effect of the ACE inhibitor may decrease.
- Diuretics: Decreased diuretic and antihypertensive effect of loop diuretics, thiazide diuretics, and potassium sparing diuretics.
- Beta-adrenergic blockers: Decreased antihypertensive efficacy.
- Angiotensin II receptor blocker: Decreased antihypertensive efficacy.
- Digoxin: Decreased renal clearance of digoxin.
- Corticosteroids: Increased risk of gastrointestinal ulceration or bleeding (see section 4.4).
- Quinolone antibiotics: Increased risk of seizures.
- Anti-platelet agents: Increased risk of gastrointestinal bleeding (see section 4.4).
- Other NSAIDs: Increased risk of gastrointestinal bleeding.
- Methotrexate: Increased serum concentration of methotrexate. Increased toxicity may result. When concomitant therapy has to be used careful monitoring should be undertaken.
- Selective serotonin reuptake inhibitors (SSRIs): Increased risk of gastrointestinal bleeding (see section 4.4).
- Lithium: NSAIDs inhibit renal clearance of lithium, thus the serum concentration of lithium may increase above toxicity limits. Therefore, serum lithium levels require monitoring, especially during initiation, adjustment and withdrawal of treatment.
- Cyclosporine: Increased serum concentration of cyclosporine. Nephrotoxicity of cyclosporine may be enhanced via renal prostaglandin mediated effects. During combined treatment, renal function should be monitored.
- Sulphonylureas (e.g. glibenclamide): Increased risk of hypoglycaemia.
- Known inducers and inhibitors of CYP2C9 isoenzymes: Lornoxicam (as other NSAIDs depending on the cytochrome P450 2C9 (CYP2C9 isoenzyme)) has interactions with known inducers and inhibitors of CYP2C9 isoenzymes (see section 5.2 Biotransformation).
- Tacrolimus: Increase the risk of nephrotoxicity owing to reduced synthesis of prostacyclin in the kidney. During combined treatment, renal function should be monitored (see section 4.4).
- Pemetrexed: NSAIDs may reduce renal clearance of pemetrexed resulting in increased renal and gastrointestinal toxicity, and myelosuppression.
Exxara film-coated tablets show a delayed absorption of lornoxicam when given with food. Therefore, Exxara film-coated tablets should not be taken with food when a quick onset of efficacy (relief of pain) is required.
Food may decrease the absorption with about 20% and increase Tmax.


Pregnancy:
Lornoxicam is contraindicated on the third trimester of pregnancy and should not be used during pregnancy in the first and second trimesters and delivery, as no clinical data on exposed pregnancies are available.
There are no adequate data from the use of lornoxicam in pregnant women. Studies in animals have shown reproductive toxicity (see section 5.3).
Inhibition of prostaglandin synthesis may adversely affect the pregnancy and/or the embryo/foetal development. Data from epidemiological studies suggest an increased risk of miscarriage and of cardiac malformation after use of a prostaglandin synthesis inhibitor in early pregnancy. The risk is believed to increase with dose and duration of therapy. In animals, administration of a prostaglandin synthesis inhibitor has been shown to result in increased pre- and post-implantation loss and embryo-foetal lethality. During the first and second trimester of pregnancy, prostaglandin synthesis inhibitors should not be given unless clearly necessary.
Prostaglandin synthesis inhibitors administered during the third trimester of pregnancy may expose the foetus to cardiopulmonary toxicity (premature closure of the ductus arteriosus and pulmonary hypertension) and renal dysfunction which may lead to renal failure and hence a reduced quantity of amniotic fluid. At the end of pregnancy, prostaglandin synthesis inhibitors may expose the mother and the foetus to increased bleeding time and inhibition of uterine contractions, which may delay or prolong the labour. Therefore, the use of lornoxicam is contraindicated during the third trimester of pregnancy (see section 4.3).
Breastfeeding:
There are no data on the excretion of lornoxicam in human breast milk. Lornoxicam is excreted in milk of lactating rats in relatively high concentrations. Therefore, lornoxicam should not be used in breastfeeding women.


Patients showing dizziness and/or sleepiness under treatment with lornoxicam should refrain from driving or operation machinery.


The most commonly observed adverse events of NSAIDs are gastrointestinal in nature. Peptic ulcers, perforation or GI bleeding, sometimes fatal, particularly in the elderly, may occur (see section 4.4). Nausea, vomiting, diarrhea, flatulence, constipation, dyspepsia, abdominal pain, melaena, hematemesis, ulcerative stomatitis, exacerbation of colitis and Crohn's disease (see section 4.4) have been reported following administration of NSAIDs. Less frequently, gastritis has been observed.
Approximately 20% of patients treated with lornoxicam can be expected to experience adverse reactions. The most frequent adverse effects of lornoxicam include nausea, dyspepsia, indigestion, abdominal pain, vomiting, and diarrhea. These symptoms have generally occurred in less than 10% of patients in available studies.
Oedema, hypertension, and cardiac failure, have been reported in association with NSAID treatment.
Clinical trial and epidemiological data suggest that use of some NSAIDs (particularly at high doses and in long term treatment) may be associated with an increased risk of arterial thrombotic events (for example myocardial infarction or stroke) (see section 4.4).
Exceptionally, occurrence of serious cutaneous and soft tissues infectious complications during varicella.
Listed below are undesirable effects, which generally occurred in more than 0.05% of the 6.,17 patients treated in clinical phase II, III and IV trials.
Very common (≥1/10); Common (≥1/100 to <1/10); Uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); Very rare (<1/10,000), not known (cannot be estimated from the available data).
Infections and infestations
Rare: Pharyngitis.
Blood and lymphatic system disorders
Rare: Anaemia, thrombocytopenia, leukopenia, prolonged bleeding time
Very rare: Ecchymosis. NSAIDs have been reported to cause potentially severe hematological disorders like neutropenia, agranulocytosis, aplastic anemia, and hemolytic anemias as class effects.
Immune system disorders
Rare: Hypersensitivity, anaphylactic reaction and anaphylaxis.
Metabolism and nutrition disorders
Uncommon: Anorexia, weight changes.
Psychiatric disorders
Uncommon: Insomnia, depression.
Rare: Confusion, nervousness, agitation.
Nervous system disorders
Common: Mild and transient headache, dizziness.
Rare: Somnolence, paraesthesia, dysgeusia, tremor, migraine.
Very rare: Aseptic meningitis in patients with SLE and mixed connective tissue disorder (see 4.4).
Eye disorders
Uncommon: Conjunctivitis.
Rare: Visual disturbances.
Ear and labyrinth disorders
Uncommon: Vertigo, tinnitus.
Cardiac disorders
Uncommon: Palpitations, tachycardia, oedema, cardiac failure.
Vascular disorders
Uncommon: Flushing, oedema.
Rare: Hypertension, hot flush, haemorrhage, haematoma.
Respiratory, thoracic and mediastinal disorders
Uncommon: Rhinitis.
Rare: Dyspnoea, cough, bronchospasm.
Gastrointestinal disorders
Common: Nausea, abdominal pain, dyspepsia, diarrhoea, vomiting.
Uncommon: Constipation, flatulence, eructation, dry mouth, gastritis, gastric ulcer, abdominal pain upper, duodenal ulcer, mouth ulceration.
Rare: Melaena, haematemesis, stomatitis, oesophagitis, gastrooesophageal reflux, dysphagia, aphthous stomatitis, glossitis, perforated peptic ulcer, gastrointestinal haemorrhage.
Hepatobiliary disorders
Uncommon: Increase in liver function tests, SGPT (ALT) or SGOT (AST).
Very rare: Hepatotoxicity resulting in e.g. hepatic failure, hepatitis, jaundice and cholestasis.
Skin and subcutaneous tissue disorders Uncommon: Rash, pruritus, hyperhidrosis, rash erythematous, urticaria and angioedema, alopecia.
Rare: Dermatitis and eczema, purpura.
Very rare: Oedema and bullous reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
Musculoskeletal and connective tissue disorders
Uncommon: Arthralgia.
Rare: Bone pain, muscle spasms, myalgia.
Renal and urinary disorders
Rare: Nocturia, micturition disorders, increase in blood urea nitrogen and creatinine levels.
Very rare: Lornoxicam may precipitate acute renal failure in patients with pre-existing renal impairment, who are dependent on renal prostaglandins for maintenance of renal blood flow (see 4.4). Nephrotoxicity in various forms including nephritis and nephrotic syndrome has been associated with NSAIDs as class effect.
General disorders and administration site conditions
Uncommon: Malaise, face oedema.
Rare: Asthenia.
To report any side effect(s)

The National Pharmacovigilance and Drug Safety Centre (NPC)
o Fax: +966-11-205-7662
o Call NPC at +966-11-2038222, Exts: 2317-2356-2353-2354-2334-2340.
o Toll free phone: 8002490000
o E-mail: npc.drug@sfda.gov.sa
o Website: www.sfda.gov.sa/npc


At this time, there is no experience of overdose to permit definition of the consequence of an overdose, or to suggest specific managements. However, it can be expected that after an overdose with lornoxicam, the following symptoms can be seen: Nausea, vomiting, cerebral symptoms (dizziness, disturbances in vision). Severe symptoms are ataxia ascending to coma and cramps, liver and kidney damages and maybe coagulation disorders.
In the case of a real or suspected overdose, the medicinal product should be withdrawn. Due to its short half-life, lornoxicam is rapidly excreted. Lornoxicam is not dialyzable. No specific antidote is known to date. The usual emergency measures including gastric lavage should be considered. Based on principles, only administering activated charcoal immediately after the intake of lornoxicam can lead to diminished absorption of the preparation. Gastrointestinal disorders can for example be treated with a prostaglandin analogue or ranitidine.


Pharmacotherapeutic group: Anti-inflammatory and antirheumatic products, non-steroids, oxicams
ATC code: M01 AC05
Mechanism of action
Lornoxicam is a non-steroidal anti-inflammatory drug with analgesic properties and belongs to the class of oxicams. Lornoxicams mode of action is mainly related to the inhibition of the prostaglandin synthesis (inhibition of the cyclooxygenase enzyme) leading to desensitisation of peripheral nociceptors and consequently inhibition of inflammation. A central effect on nociception, which seems to be independent of anti-inflammatory effects has also been suggested.
Pharmacodynamic effects
Lornoxicam has no effect on vital signs (e.g. body temperature, respiratory rate, heart rate, blood pressure, ECG, spirometry).
Clinical efficacy and safety
The analgesic properties of lornoxicam have been demonstrated successfully in several clinical trials during development of the drug.
Due to a local gastrointestinal irritation and a systemic ulcerogenic effect related to the inhibition of prostaglandin (PG)-synthesis, gastrointestinal sequelae are common undesirable effects after treatment with lornoxicam as seen with other NSAIDs.
In a clinical study in patients with pain after surgical removal of an impacted third molar lornoxicam Rapid film-coated tablets showed a faster onset of action compared to lornoxicam film-coated tablets.


Absorption
Lornoxicam is absorbed rapidly and almost completely from the gastrointestinal tract. Maximum plasma concentrations are achieved after approximately 30 minutes. The Cmax for Exxara film-coated tablets is higher than Cmax for Exxara film-coated tablets and equivalent to Cmax for the parenteral formulation of lornoxicam. The absolute bioavailability of Exxara film-coated tablets is 90-100% which is equivalent to Exxara film-coated tablet. No first-pass effect has been observed. The mean elimination half-life is 3-4 hours.
No data are available on simultaneous intake of Exxara film-coated tablets with meals, but based on data for Exxara film-coated tablets a reduction of Cmax, an increase in Tmax, and a reduction in the absorption (AUC) of lornoxicam may be expected.
Distribution
Lornoxicam is found in the plasma in unchanged form and as its hydroxylated metabolite. The plasma protein binding of lornoxicam is 99% and not concentration dependent.
Biotransformation
Lornoxicam is extensively metabolised in the liver, primarily to the inactive 5–hydroxylornoxicam by hydroxylation. CYP2C9 is involved in this biotransformation of lornoxicam. Due to genetic polymorphism, slow and extensive metabolisers exist for this enzyme, which could result in markedly, increased plasma levels of lornoxicam in slow metabolisers. The hydroxylated metabolite exhibits no pharmacological activity. Lornoxicam is metabolised completely, and approximately 2/3 is eliminated via the liver and 1/3 via the kidneys as inactive substance.
When tested in animal models, lornoxicam did not induce liver enzymes. From clinical trial data there is no evidence of accumulation of lornoxicam after repeated administrations, when given according to recommended dosage. This finding was supported by drug monitoring data from one year studies.
Elimination
The mean elimination half-life of the parent compound is 3 to 4 hours. After oral administration about 50% is excreted in the faeces and 42% through the kidneys, mainly as 5-hydroxylornoxicam. The elimination half-life of 5-hydroxylornoxicam is about 9 hours after a parenteral single or twice daily dose.
In elderly patients above age 65, the clearance is reduced with 30-40%. Apart from reduced clearance, there is no significant change in the kinetic profile of lornoxicam in elderly patients.

There is no significant change in the kinetic profile of lornoxicam in patients with renal or hepatic failure, except for accumulation in patients with chronic liver disease after 7 days of treatment with daily doses of 12 and 16 mg.
Absorption
Lornoxicam is absorbed rapidly and almost completely from the gastrointestinal tract. Maximum plasma concentrations are achieved after approximately 30 minutes. The Cmax for Exxara film-coated tablets is higher than Cmax for Exxara film-coated tablets and equivalent to Cmax for the parenteral formulation of lornoxicam. The absolute bioavailability of Exxara film-coated tablets is 90-100% which is equivalent to Exxara film-coated tablet. No first-pass effect has been observed. The mean elimination half-life is 3-4 hours.
No data are available on simultaneous intake of Exxara film-coated tablets with meals, but based on data for Exxara film-coated tablets a reduction of Cmax, an increase in Tmax, and a reduction in the absorption (AUC) of lornoxicam may be expected.
Distribution
Lornoxicam is found in the plasma in unchanged form and as its hydroxylated metabolite. The plasma protein binding of lornoxicam is 99% and not concentration dependent.
Biotransformation
Lornoxicam is extensively metabolised in the liver, primarily to the inactive 5–hydroxylornoxicam by hydroxylation. CYP2C9 is involved in this biotransformation of lornoxicam. Due to genetic polymorphism, slow and extensive metabolisers exist for this enzyme, which could result in markedly, increased plasma levels of lornoxicam in slow metabolisers. The hydroxylated metabolite exhibits no pharmacological activity. Lornoxicam is metabolised completely, and approximately 2/3 is eliminated via the liver and 1/3 via the kidneys as inactive substance.
When tested in animal models, lornoxicam did not induce liver enzymes. From clinical trial data there is no evidence of accumulation of lornoxicam after repeated administrations, when given according to recommended dosage. This finding was supported by drug monitoring data from one year studies.
Elimination
The mean elimination half-life of the parent compound is 3 to 4 hours. After oral administration about 50% is excreted in the faeces and 42% through the kidneys, mainly as 5-hydroxylornoxicam. The elimination half-life of 5-hydroxylornoxicam is about 9 hours after a parenteral single or twice daily dose.
In elderly patients above age 65, the clearance is reduced with 30-40%. Apart from reduced clearance, there is no significant change in the kinetic profile of lornoxicam in elderly patients.
There is no significant change in the kinetic profile of lornoxicam in patients with renal or hepatic failure, except for accumulation in patients with chronic liver disease after 7 days of treatment with daily doses of 12 and 16 mg.


Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, and carcinogenic potential.
Lornoxicam caused renal toxicity and gastrointestinal ulceration single- and repeat-dose toxicity studies in several species.
In animals, administration of prostaglandin synthesis inhibitor has been shown to result in increased pre- and post-implantation loss and embryo-foetal lethality. In addition, increased incidences of various malformations, including cardiovascular, have been reported in animals given a prostaglandin synthesis inhibitor during the organogenetic period.

In rat, lornoxicam impaired fertility (effects on ovulation and implantation), and affected the pregnancy and delivery. In rabbit and rat, lornoxicam caused premature closure of the ductus arteriosus due to inhibition of cyclooxygenase.


Core:
Lactose monohydrate [90 mg/tablet]
Microcrystalline Cellulose PH-101 [41.5 mg/tablet]
Povidone K 30 [4.0 mg/tablet]
Croscarmellose sodium [14.0 mg/tablet]
Magnesium stearate [1.0 mg/tablet]
Microcrystalline Cellulose PH-102 [41.5 mg/tablet]
Film:
Opadry White 03F580000(Macrogol, Titanium dioxide ,Talc,Hypromellose) [6.0 mg/tablet]


Not applicable.


2 years

Store below 30°C.


Aluminum/PVC-PVDC blister
Pack size: 20 film-coated tablets


No special requirements.


Middle East Pharmaceutical Industries Co. Ltd (Avalon Pharma) - Riyadh, KSA. TEL: +966(011)2653948. For any information about this medicinal product or to report a suspected adverse drug event please contact the Marketing Authorization Holder: E-mail: pharmacovigilance@avalon.com.sa Call: +966-11-4635247 Ext: 3328

01/2018
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