Action and Spectrum

Mechanism of action 

The mechanism of piroxicam is through inhibition of the cyclooxygenase (COX), which is responsible for the production of prostaglandins. Prostaglandins play a role in inflammation, pain, and fever. By inhibiting COX, piroxicam reduces the production of prostaglandins, reducing inflammation, pain, and fever. 

Spectrum 

The spectrum of piroxicam includes its ability to relieve pain and inflammation and reduce fever. piroxicam primarily treats chronic inflammatory conditions such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Still, it can also be used for other conditions, such as acute gout and menstrual cramps 

Drug Interaction

Adverse Reaction

Frequency defined:  

Anorexia 

Constipation 

Flatulence  

Vomiting 

Headache 

Pruritis 

Tinnitus 

Edema 

Abdominal pain 

Diarrhea 

Nausea 

Dizziness 

Vertigo 

Rash 

Uncommon 

Stomatitis 

Blurred vision 

Palpitations 

Drowsiness 

Post-marketing reports 

Congestive heart failure 

Anemia 

Fever 

Sepsis 

Appetite changes 

Asthma 

Alopecia 

Cystitis 

Polyuria 

Renal failure 

Fluid retention 

Hyperglycemia 

Pancytopenia 

Dysuria 

Hearing impairment 

Black Box Warning

Black box warning 

Non-steroidal anti-inflammatory drugs (NSAIDs) such as piroxicam can have severe cardiovascular and gastrointestinal risks. These risks are associated with the inhibition of the cyclooxygenase (COX) enzyme, which leads to a reduction in prostaglandins synthesis. Prostaglandins play a role in maintaining the integrity of the gastrointestinal and cardiovascular systems. 

NSAIDs, including piroxicam, can increase the risk of serious cardiovascular thrombotic events, such as myocardial infarction (MI) and stroke, which can be fatal. This risk may increase with the duration of use, and patients with risk factors for or existing cardiovascular disease may be at greater risk. Additionally, NSAIDs are contraindicated for perioperative pain in the setting of coronary artery bypass graft (CABG) surgery, as they increase the risk of MI and stroke. 

NSAIDs can also increase the risk of serious gastrointestinal adverse events, such as bleeding, ulceration, and perforation of the stomach or intestines, which can also be fatal. These events may occur at any time during use and without warning symptoms. Elderly patients are at a greater risk for serious gastrointestinal events. 

Contraindication / Caution

Contraindications 

Absolute contraindications for NSAIDs such as piroxicam include a known allergy to aspirin (ASA) and other NSAIDs, as the individual is at a higher risk of having an allergic reaction. 

Relative contraindications include bleeding disorders, duodenal/gastric/peptic ulcer, stomatitis, systemic lupus erythematosus (SLE), ulcerative colitis, upper gastrointestinal (GI) disease, and late pregnancy. In the case of bleeding disorders, using piroxicam can increase the risk of bleeding and bruising. 

Caution 

• Cardiovascular and gastrointestinal risks: It can increase the risk of severe cardiovascular and gastrointestinal events, such as myocardial infarction (MI), stroke, bleeding, ulceration, and perforation of the stomach or intestines. These risks may be increased in patients with a history of cardiovascular disease, gastrointestinal disease, or bleeding 1disorders or in patients who are elderly. 
• Renal impairment: It can cause renal impairment, particularly in patients with pre-existing renal disease or those who are dehydrated. Patients with renal impairment should use piroxicam cautiously and under close medical supervision. 
• Hepatic impairment: It can cause liver damage, particularly in patients with pre-existing liver disease or in patients taking other medications that can cause liver damage. Patients with hepatic impairment should use piroxicam cautiously and under close medical supervision. 
• Interactions: It can interact with other medications, including blood-thinning medications, diuretics, and certain antidepressants. It is essential to inform your healthcare provider of all medications and supplements you are taking before starting piroxicam. 
• Pregnancy and breast-feeding: It should be used with caution during pregnancy and breastfeeding. It can cause premature closure of the ductus arteriosus in late pregnancy and may be excreted in breast milk. 

Pregnancy / Lactation

Pregnancy consideration: It should be used with caution during pregnancy and breastfeeding. It can cause premature closure of the ductus arteriosus in late pregnancy. 

Lactation: Excretion of the drug in human breast milk is known 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.   

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology 

It is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation caused by conditions such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. The drug falls under the category of oxicam class of NSAIDs. 

The mechanism of piroxicam is through inhibition of the cyclooxygenase (COX), which is responsible for the production of prostaglandins. Prostaglandins play a role in inflammation, pain, and fever. By inhibiting COX, piroxicam reduces the production of prostaglandins, reducing inflammation, pain, and fever. 

Pharmacodynamics 

The drug works by inhibiting the enzyme cyclooxygenase (COX), which is responsible for the production of prostaglandins. Prostaglandins play a role in inflammation, pain, and fever. By inhibiting COX, piroxicam reduces the production of prostaglandins, reducing inflammation, pain, and fever 

Pharmacokinetics 

Absorption: It is well absorbed after oral administration, with a bioavailability of about 50-60%. The drug reaches peak plasma concentrations in 2-4 hours.  

Distribution: It is highly protein-bound (99%) and distributes into the tissues, including synovial fluid, bone, and fat.  

Metabolism: It is metabolized by the liver, primarily by oxidation and glucuronidation. The primary metabolites are 5-hydroxypiroxicam, 8-hydroxypiroxicam, and piroxicam glucuronide.  

Elimination and excretion: It is excreted primarily in the urine as metabolites and a small amount in the feces. The elimination half-life of piroxicam is around 50 hours. 

Adminstartion

Administration 

It is a medication typically administered orally as a tablet or capsule. The dosage and frequency of administration will depend on the condition being treated and the individual patient. 

The usual adult dose for treating osteoarthritis and rheumatoid arthritis is 10-20 mg daily, usually given as a single dose or as two divided doses. The maximum recommended daily dose is 20 mg. 

For the treatment of ankylosing spondylitis, the usual adult dose is 20 mg per day, usually given as a single dose. 

Taking piroxicam with food or a glass of milk is essential to reduce the risk of stomach upset. Also, it is essential to note that long-term use of piroxicam may increase the risk of severe side effects such as stomach ulcers, bleeding, and cardiovascular events. Therefore, it is essential to use the lowest effective dosage for the shortest possible duration. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: piroxicam 

Pronounced: [ peer-OX-i-kam ] 

Why do we use piroxicam? 

piroxicam is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation caused by various conditions. The main uses of piroxicam include: 

• Rheumatoid arthritis: It relieves pain, swelling, and stiffness associated with rheumatoid arthritis, an autoimmune inflammatory disorder that affects the joints and other tissues. 
• Osteoarthritis relieves pain and inflammation associated with osteoarthritis, a degenerative joint disease affecting the cartilage and bone. 
• Ankylosing spondylitis: It is used to relieve pain and stiffness associated with ankylosing spondylitis, a form of inflammatory arthritis that affects the spine and other joints. 
• Acute gout: It is used to relieve pain and inflammation associated with acute gout, a type of arthritis caused by the buildup of uric acid crystals in the joints. 
• Menstrual cramps: It is used to relieve pain associated with menstrual cramps.