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. 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.
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.
Quinolone antibiotics: Increased risk of seizures.
Anti-platelet agents: Increased risk of gastrointestinal bleeding.
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.
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.
Tacrolimus: Increase the risk of nephrotoxicity owing to reduced synthesis of prostacyclin in the kidney. During combined treatment renal function should be monitored.
Pemetrexed: NSAIDs may reduce renal clearance of pemetrexed resulting in increased renal and gastrointestinal toxicity, and myelosuppression.
Lornoxicam tablets show a delayed absorption of lornoxicam when given with food.
Therefore, Larfix 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.