Lornoxicam is a nonsteroidal anti-inflammatory drug (NSAID) marketed under the brand name Xefo. It is commonly prescribed to relieve moderate to severe pain and reduce inflammation.
This medication is used to treat conditions such as postoperative pain, musculoskeletal disorders, and inflammatory joint diseases. It works by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, which leads to decreased production of prostaglandins, compounds that mediate pain and inflammation.
The primary gene involved in lornoxicam metabolism is CYP2C9, a liver enzyme responsible for breaking down many NSAIDs. Variations in CYP2C9 can change how quickly the drug is processed and cleared from the body.
People with certain CYP2C9 genetic variants may metabolize lornoxicam faster or slower than average. Metabolism refers to the chemical processes in the body that convert medications into forms that can be easily eliminated. Changes in enzyme activity can affect drug levels in the blood and impact both efficacy and risk of side effects.
Genetic variations in CYP2C9 define metabolizer phenotypes—from ultra-rapid to poor—that influence lornoxicam plasma levels, therapeutic effect, and risk of adverse events. Rapid metabolizers may clear the drug too quickly, reducing pain relief, while poor metabolizers may have elevated levels, increasing the chance of side effects.
The following dosing guidelines are based on the CPIC recommendations for lornoxicam therapy according to CYP2C9 genotype.
| Phenotype | Clinical Consequence | Guideline Recommendation |
|---|---|---|
| Normal Metabolizer (AS 2) | Your body processes this drug normally | Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals. |
| Intermediate Metabolizer (AS 1.5) | Your body slows the drug down slightly, but usually the normal starting dose is fine. | Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals. |
| Intermediate Metabolizer (AS 1) | Your body slows the drug noticeably, so you should start at a lower dose and increase carefully if needed. | Initiate therapy with lowest recommended starting dose. Titrate dose upward to clinical effect or maximum recommended dose with caution. Carefully monitor adverse events such as blood pressure and kidney function. |
| Poor Metabolizer (AS 0.5) | Your body processes the drug very slowly, so you should start at a much lower dose, increase carefully, or use a different drug. | Initiate therapy with 25–50% of the lowest recommended starting dose. Titrate upward cautiously after steady state is reached. Monitor for adverse events; consider alternate therapy not metabolized by CYP2C9. |
| Poor Metabolizer (AS 0) | Your body processes the drug very slowly, so you should start at a much lower dose, increase carefully, or use a different drug. | Initiate therapy with 25–50% of the lowest recommended starting dose. Titrate upward cautiously after steady state is reached. Monitor for adverse events; consider alternate therapy not metabolized by CYP2C9. |
| Indeterminate | Unknown impact | Initiate therapy with recommended starting dose. |
| Not available | Unknown impact | Initiate therapy with recommended starting dose. |
Examples from CPIC guidelines include considering alternate therapies not metabolized by CYP2C9 or those less impacted by CYP2C9 variants. Always consult a healthcare professional before changing therapy.
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