Piroxicam

Template:Short description Template:Drugbox Piroxicam is a nonsteroidal anti-inflammatory drug (NSAID) of the oxicam class used to relieve the symptoms of painful inflammatory conditions like arthritis.<ref name = MD/><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Piroxicam works by preventing the production of endogenous prostaglandins which are involved in the mediation of pain, stiffness, tenderness and swelling.<ref name = MD/> The medicine is available as capsules, tablets and, in some countries, as a prescription-free gel 0.5%.<ref name = BNF/> It is also available in a betadex formulation, which allows a more rapid absorption of piroxicam from the digestive tract.<ref name = MD>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Piroxicam is one of the few NSAIDs that can be given parenteral routes.Template:Cn

It was patented in 1968 by Pfizer and approved for medical use in 1979.<ref name=Fis2006>Template:Cite book</ref> It became generic in 1992,<ref name=NRDD/> and is marketed worldwide under many brand names.<ref name=drugsInternat/>

Medical uses

It is used in the treatment of certain inflammatory conditions like rheumatoid and osteoarthritis, primary dysmenorrhoea, and postoperative pain; it acts as an analgesic, especially where there is an inflammatory component.<ref name = MD/> The European Medicines Agency issued a review of its use in 2007 and recommended that its use be limited to the treatment of chronic inflammatory conditions, as it is only in these circumstances that its risk-benefit ratio proves to be favourable.<ref name = BNF/><ref name = EMA>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Adverse effects

As with other NSAIDs the principal side effects include: digestive complaints like nausea, discomfort, diarrhoea and bleeds or ulceration of the stomach, as well as headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances (such as tinnitus), high blood pressure, oedema, light sensitivity, skin reactions (including, albeit rarely, Stevens–Johnson syndrome and toxic epidermal necrolysis) and rarely, kidney failure, pancreatitis, liver damage, visual disturbances, pulmonary eosinophilia and fibrosing alveolitis.<ref name="BNF">Template:Cite book</ref> Compared to other NSAIDs it is more prone to causing gastrointestinal disturbances and serious skin reactions.<ref name = BNF/>

In October 2020, the U.S. Food and Drug Administration (FDA) required the prescribing information to be updated for all nonsteroidal anti-inflammatory medications to describe the risk of kidney problems in unborn babies that result in low amniotic fluid.<ref name="FDA PR 20201015" /><ref name="FDA safety 20201015" /> They recommend avoiding NSAIDs in pregnant women at 20 weeks or later in pregnancy.<ref name="FDA PR 20201015">Template:Cite press release Template:PD-notice</ref><ref name="FDA safety 20201015">{{#invoke:citation/CS1|citation |CitationClass=web }} Template:PD-notice</ref>

Mechanism of action

Piroxicam is an NSAID and, as such, is a non-selective COX inhibitor possessing both analgesic and antipyretic properties.<ref name = BNF/>

Chemical properties

Piroxicam exists as alkenol tautomer in organic solvents and as zwitterionic form in water.<ref>Template:Cite journal</ref> Piroxicam features a sultam, a cyclic sulfonamide.

History

The project that produced piroxicam began in 1962 at Pfizer; the first clinical trial results were reported in 1977, and the product launched in 1980 under the brand name "Feldene".<ref name="NRDD">Template:Cite journal. See: [1] Box 1: Discovery of piroxicam (1962–1980)</ref><ref>Template:Cite journal</ref> Major patents expired in 1992<ref name=NRDD/> and the drug is marketed worldwide under many brandnames.<ref name=drugsInternat>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

See also

• Meloxicam
• Isoxicam
• Lornoxicam
• Ampiroxicam

Further reading

• Template:Cite book