Piroxicam; Uses, Dosage, Side Effects, Interactions

Piroxicam is a nonsteroidal oxicam derivative with anti-inflammatory, antipyretic and analgesic properties. As a non-selective, nonsteroidal anti-inflammatory drug (NSAID), piroxicam binds and chelates both isoforms of cyclooxygenases (COX1 and COX2), thereby stalling phospholipase A2 activity and conversion of arachidonic acid into prostaglandin precursors at the rate limiting cyclooxygenase enzyme step. This results in inhibition of prostaglandin biosynthesis. As a second, independent effect, piroxicam inhibits the activation of neutrophils thereby contributing to its overall anti-inflammatory effects.

Piroxicam is a cyclooxygenase inhibiting, non-steroidal anti-inflammatory agent (NSAID) that is well established in treating rheumatoid arthritis and osteoarthritis and used for musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily.

Mechanism of action of Piroxicam

The antiinflammatory effect of Piroxicam may result from the reversible inhibition of cyclooxygenase, causing the peripheral inhibition of prostaglandin synthesis. The prostaglandins are produced by an enzyme called Cox-1. Piroxicam blocks the Cox-1 enzyme, resulting into the disruption of production of prostaglandins. Piroxicam also inhibits the migration of leukocytes into sites of inflammation and prevents the formation of thromboxane A2, an aggregating agent, by the platelets.

Indications of Piroxicam

• Ankylosing Spondylitis
• Migraines
• Rheumatoid arthritis
• Osteoarthritis
• Acute and chronic rheumatoid arthritis,
• Mild to moderate pain associated with musculotendinous trauma (sprains and strains),
• Postpartum pain.
• Treatment of some pain, especially nerve pain such as
• Sciatica,
• Postherpetic neuralgia
• Referred pain for radiculopathy.
• Pauciarticular juvenile rheumatoid arthritis
• Polyarticular juvenile rheumatoid arthritis, chronic or unspecified
• Frozen shoulder
• Pain with itching ,
• Tendonitis
• Bursitis
• Indicated for relief of the signs and symptoms of osteoarthritis. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
• Used for the management of the signs and symptoms of rheumatoid arthritis in adults. In the management of rheumatoid arthritis in adults, NSAIAs may be useful for initial symptomatic treatment; however, NSAIAs do not alter the course of the disease or prevent joint destruction.

Contra Indications of Piroxicam

• Systemic mastocytosis
• Increased risk of bleeding due to clotting disorder
• Alcoholism
• High blood pressure
• Chronic heart failure
• Disease of the heart and blood vessels
• Stroke
• Ulcer from stomach acid
• Stomach or intestinal ulcer
• Liver problems
• Bleeding of the stomach or intestines
• Kidney stone
• Systemic lupus erythematosus
• Visible water retention
• Pregnancy
• A mother who is producing milk and breastfeeding
• A rupture in the wall of the stomach or intestine
• Increased cardiovascular event risk
• Time immediately after coronary bypass surgery
• chronic kidney disease stage 4 (severe)

Dosage of Piroxicam

Strengths: 10 mg; 20 mg

Osteoarthritis

• Recommended dose: 20 mg orally once a day

Rheumatoid Arthritis

• Recommended dose: 20 mg orally once a day

Side Effects of Piroxicam

The common

• stomach pain
• abdominal or stomach pain, cramping, or burning (severe)
• bloody or black, tarry stools
• blurred vision or any change in vision
• chest pain
• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• convulsions (seizures)
• fast or irregular breathing
• fast, irregular heartbeat or pulse
• indigestion
• nausea, vomiting
• diarrhea

More common

• Acid or sour stomach
• constipation
• headache
• heartburn
• nausea or vomiting
• skin rash
• stomach pain
• constipation
• gas
• rash

Less common

• Excess air or gas in the stomach or intestines
• itching skin
• passing gas
• stomach cramps
• swelling
• weight loss
• diarrhea
• indigestion or heartburn
• nausea
• dizziness
• headache
• itching or rash

Rare

• Anxiety
• change in vision
• seizures
• abnormal or fast heart rate
• weight loss
• chest pain or tightness
• confusion
• cough
• Agitation
• arm, back, or jaw pain
• blurred vision
• chest pain or discomfort
• convulsions
• extra heartbeats
• hallucinations
• headache
• irritability
• muscle pain or cramps
• pale or yellowed skin, dark colored urine, fever, confusion or weakness;
• jaundice (yellowing of the skin or eyes);
• sore throat, and headache with a severe blistering, peeling, and red skin rash;
• swelling, rapid weight gain, feeling short of breath (even with mild exertion); or
• increased thirst, loss of appetite, urinating less than usual or not at all.

Drug Interactions of Piroxicam

Piroxicam may interact with following drugs, supplyments & may change the efficacy of drugs

• aminoglycoside antibiotics (e.g., amikacin, gentamicin, tobramycin)
• angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril, enalapril, captopril, quinapril)
• angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
• “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
• bisphosphonates (e.g., alendronate, etidronate)
• carbamazepine
• celecoxib
• cilostazol
• clopidogrel
• cyclosporine
• dabigatran
• dasatinib
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• fluvastatin
• haloperidol
• heparin
• ibrutinib
• methotrexate
• multivitamins (with vitamins A, E) with or without minerals
• nilotinib
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
• omega-3 fatty acids
• omeprazole
• oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
• pentoxifylline
• phenobarbital
• phenytoin
• quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g.,  duloxetine, venlafaxine)
• sulfasalazine
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine

Pregnancy & Lactation of Piroxicam

 FDA Pregnancy Category C

Pregnancy

Piroxicam may make it more difficult to become pregnant. You should inform your doctor if you are planning to become pregnant or if you have problems becoming pregnant. Piroxicam should not be taken during the first 6 months and must not be taken in the last 3 months of pregnancy. If you are breast-feeding, you should not take Piroxicam capsules.

Lactation

Low amounts of piroxicam in milk and failure to detect piroxicam or its metabolites in the urine of 2 older infants indicates that it would not be expected to cause adverse effects in older breastfed infants. Because there is no published experience with piroxicam during breastfeeding in the newborn period, shorter-acting agents may be preferred while nursing a newborn or preterm infant.

References