Piroxicam
From Ganfyd
rINN: Piroxicam
Other Names
Feldene®, Brexidol®
Pharmacological Information
Pharmacology Images
Piroxicam in the:
BNF-registration required
BNF for children-registration required
Mechanism of Action
COX inhibitor
Relevant Clinical Literature
RCT with Piroxicam from Pubmed
Systematic reviews from Pubmed
Other Literature
Please read pharmacological data limitations
Contents |
Introduction
Clinical Use
Indications
- Pain and inflammation in rheumatoid arthritis, osteoarthritis
- Ankylosing spondylitis
Administration
Oral 10-30mg daily
max 20mg[1]
IM
Topical
Clinical Issues
It has proven efficiency in soft tissue injury compared to placebo and seems to be widely used in soft tissue injury, sometimes outside its license. It has also been used in acute gout. Its license for these indications were withdrawn in 2007 in the EU due to skin side effects and other relative safety factors.
Piroxicam-containing medicines should no longer be used for the treatment of acute (short-term) pain and inflammation.[2]
Interestingly:
- It doesn't provide pain relief as quickly as paracetamol but does last longer.
- It is not as quick or effective as diclofenac in ankle sprains[3] but appears to be better than aspirin or naproxen.[4]
- The topical preparation may not be as effective as alternatives. "With analysis by drug (at least three trials), ketoprofen (number needed to treat 2.6), felbinac (3.0), ibuprofen (3.5), and piroxicam (4.2) had significant efficacy."[5]
Contra-indications
Cautions and Interactions
Side effects
Commoner important
- Upper gastro-intestinal. All NSAIDs are associated with serious gastrointestinal side effects. For non-selective NSAIDs these were most common with azapropazone and least common with Ibuprofen. Selective cyclo-oxygenase-2 inhibitors are associated with a lower risk of gastrointestinal side effects
- Dyspepsia
- Haemorrhage
- Renal failure (especially in combination with diuretics and drugs acting on angiotensin system)
- Fluid retention
Rarer Important
- Cardiovascular events. This may be related to degree of cyclo-oxygenase-2 inhibition
- Asthma
- In chronic heart failure all NSAIDS have a dose-dependent increase in risk of death and increased risk of hospitalization with some such as diclofenac and coxibs having higher hazard ratios[6]
List of NSAID side-effects - many rare
Some NSAIDs are more likely to cause these side-effects than others but they all appear to be class side-effects
- Gastro-intestinal
- Gastritis
- Duodenitis
- Duodenal ulcer
- Gastric ulcer
- Oesophagitis
- Oesophageal ulcer
- Intestinal stricture
- Haemorrhage
- Colitis
- Diarrhoea
- Nausea
- Renal
- Failure
- Fluid retention/Oedema
- Papillary necrosis
- Interstitial fibrosis
- Hypersensitivity reactions
- Asthma
- Pulmonary eosinophilia
- Rashes
- Stephen-Johnson syndrome
- Toxic epidermal necrolysis
- Photosensitivity
- Nervous system
- Headache
- Dizziness
- Vertigo
- Nervousness
- Depression
- Drowsiness
- Insomnia
- Hearing disturbances
- Tinnitus
- Aseptic meningitis
- Aggravate Parkinsonism
- Other
- Haematuria
- Hepatic damage
- Alveolitis
- Pancreatitis
Special advice
Pharmacology
References
- ↑ EMEA restriction on use piroxicam 2007
- ↑ EMEA restriction on use piroxicam 2007
- ↑ Bahamonde LA, Saavedra H. Comparison of the analgesic and anti-inflammatory effects of diclofenac potassium versus piroxicam versus placebo in ankle sprain patients. J Int Med Res. 1990;18(2):104-11.
- ↑ Heere LP. Piroxicam in acute musculoskeletal disorders and sports injuries. Am J Med. 1988;84(5A):50-5.
- ↑ Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ. Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs. BMJ. 1998;316(7128):333-8. erratum BMJ 1998;316(7137):1059.
- ↑ Gislason GH, Rasmussen JN, Abildstrom SZ, Schramm TK, Hansen ML, Fosbøl EL, Sørensen R, Folke F, Buch P, Gadsbøll N, Rasmussen S, Poulsen HE, Køber L, Madsen M, Torp-Pedersen C Increased Mortality and Cardiovascular Morbidity Associated With Use of Nonsteroidal Anti-inflammatory Drugs in Chronic Heart Failure Arch Intern Med. 2009;169(2):141-149
