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Piroxicam

Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) with anti-inflammatory and pain-relieving properties.

Piroxicam - Chemical Structure

It is available in various pharmaceutical formulations suitable for different routes of administration (oral, rectal, dermal, ocular and parenteral).

From the chemical point of view, piroxicam is a derivative of enolic acid (or oxicam-derived).

Examples of medicinal specialties containing Piroxicam

  • Antiflog Gel ®
  • Brexidol ®
  • Brexin ®
  • Feldene ®
  • Feldene Cremadol ®

Indications

For what it uses

The use of piroxicam is indicated for the treatment of inflammatory and painful states caused by:

  • Osteoarthritis;
  • Rheumatoid arthritis;
  • Ankylosing spondylitis;
  • Trauma to joints, muscles, tendons or ligaments.

Piroxicam is also used to treat inflammation and pain (on a non-infectious basis) of the outer part of the eye.

Warnings

Piroxicam can cause ulceration, perforation and gastrointestinal bleeding. Therefore, if - during treatment with the drug - any gastrointestinal symptom appears, it is necessary to inform the doctor immediately.

In the event of allergic reactions of any kind, treatment with piroxicam must be stopped immediately and the doctor must be contacted immediately.

If deemed necessary, the doctor may decide to prescribe - concomitantly with piroxicam therapy - a therapy based on gastroprotective drugs.

Piroxicam can increase the risk of heart attack and stroke, especially at high doses. Therefore, it is essential never to exceed the recommended drug dose.

In any case, piroxicam must be administered with extreme caution in patients who suffer - or who have suffered - from cardiovascular diseases.

Even in patients with asthma the drug should be administered very carefully.

During treatment with oral, rectal or parenteral piroxicam, concomitant alcohol intake is not recommended. Furthermore, piroxicam administered via these pathways can cause side effects that can alter the ability to drive and / or use machinery, so great care should be taken.

When, on the other hand, piroxicam is administered via the skin, exposure to the sun and UV rays is not recommended, in order to avoid the onset of possible photosensitivity reactions.

Interactions

There are currently no known drug interactions between piroxicam administered dermal or ophthalmic and other medicinal products.

When, on the other hand, piroxicam is administered orally, rectally or parenterally, it is necessary to inform your doctor if you are already taking any of the following drugs:

  • Acetylsalicylic acid or other NSAIDs ;
  • Corticosteroids ;
  • Anticoagulants, such as, for example, warfarin;
  • SSRIs (selective serotonin reuptake inhibitors, antidepressant drugs);
  • Antihypertensive drugs ;
  • Lithium salts (used in the treatment of bipolar disorder);
  • Quinolones (antibiotic drugs).

Furthermore, before starting treatment with piroxicam, women who use intrauterine devices should inform their doctor.

In any case, it is still advisable to inform your doctor if you are taking any type of medication, including prescription-free medicines and herbal and homeopathic products.

Side effects

Piroxicam can cause several side effects, although not all patients experience them.

The type of adverse effects and the intensity with which they occur depend on each individual's sensitivity to the drug.

Listed below are the main side effects that may occur during treatment with piroxicam.

Gastrointestinal disorders

Piroxicam therapy may cause:

  • Nausea and vomit;
  • Diarrhea or constipation;
  • Flatulence;
  • Gastric acidity;
  • Abdominal pain;
  • Gastrointestinal ulceration, perforation and bleeding;
  • Worsening of colitis and Crohn's disease in patients who suffer from it;
  • Pancreatitis.

Cardiovascular disorders

Treatment with piroxicam may favor the onset of:

  • Hypertension;
  • Heart failure;
  • Myocardial infarction;
  • Stroke.

Skin and subcutaneous tissue disorders

Piroxicam therapy can cause:

  • Skin rash;
  • Ulcer formation in various parts of the body;
  • Alopecia;
  • Changes in nail growth;
  • Swelling, blisters and / or peeling of the skin;
  • Purple;
  • Photosensitization reactions;
  • Stevens-Johnson syndrome;
  • Toxic epidermal necrolysis.

Kidney and urinary tract disorders

Treatment with piroxicam can cause kidney failure, urination difficulties and the presence of blood and / or protein in the urine.

Nervous system disorders

Piroxicam therapy can cause headaches, dizziness, tiredness and drowsiness.

Psychiatric disorders

Treatment with piroxicam can promote the onset of insomnia, depression or hyperexcitation.

Blood and lymphatic system disorders

Piroxicam can cause:

  • Piastrinopenia, ie the decrease in the number of platelets in the bloodstream;
  • Leukopenia, ie the decrease in the number of leukocytes in the bloodstream;
  • Eosinophilia, that is the increase in the number of eosinophils in the blood;
  • Anemia.

Hepatobiliary disorders

Piroxicam therapy can alter liver function values ​​and promote the occurrence of hepatitis and jaundice.

Other side effects

Other side effects that may occur during treatment with piroxicam are:

  • Allergic reactions, even serious, in sensitive subjects;
  • Stomatitis;
  • Hypoglycemia or hyperglycemia;
  • Changes in body weight;
  • Dry mouth;
  • Reduction of female fertility;
  • Malaise;
  • Vision disorders;
  • Tinnitus;
  • Nose blood;
  • Shock.

Overdose

At present, no cases of overdose have been reported following the use of piroxicam via the skin or via the eye.

On the other hand, if excessive doses of piroxicam are taken orally, rectally or parenterally, symptoms such as:

  • He retched;
  • Headache;
  • Dizziness;
  • Drowsiness;
  • Syncope.

If piroxicam overdose is suspected, contact your doctor immediately or go to the nearest hospital.

Action mechanism

Piroxicam is an NSAID and, as such, exerts its anti-inflammatory and analgesic action by inhibiting the activity of cyclooxygenase (COX).

Cyclooxygenase is an enzyme of which three different isoforms are known: COX-1, COX-2 and COX-3.

COX-1 is a constitutive isoform, normally present in cells and involved in the mechanisms of cellular homeostasis.

COX-2, on the other hand, is an inducible isoform that is produced by inflammatory cells (inflammatory cytokines) activated.

The task of these enzymes is to convert arachidonic acid into prostaglandins, prostacyclines and thromboxanes.

In particular, prostaglandins are involved in inflammatory processes and mediate pain responses.

Piroxicam is able to inhibit COX-2 with a certain selectivity and, in doing so, prevents the synthesis of prostaglandins responsible for inflammation and pain.

Mode of Use - Posology

Piroxicam is available for:

  • Oral administration in the form of tablets, effervescent tablets, granules for oral solution, soluble tablets, sublingual tablets and hard capsules.
  • Rectal administration in the form of suppositories.
  • Dermal administration in the form of cream, gel, skin foam and medicated plaster.
  • Ophthalmic administration in the form of eye drops.
  • Parenteral administration as an injectable solution for intramuscular use.

To avoid the occurrence of dangerous adverse effects, it is very important to follow the doctor's instructions, both in terms of the amount of piroxicam to be taken and the duration of treatment.

Below are some indications on the doses of piroxicam usually used in therapy. However, to know the exact dosage of each pharmaceutical formulation, see the illustrative leaflets of the individual medicinal products.

Oral and rectal administration

When administered orally or rectally, the dose of piroxicam usually used in adults is 20 mg, to be taken in a single dose once a day. This dose must not be exceeded under any circumstances.

Cutaneous administration

When using piroxicam in the form of cream, gel or dermal foam, it is advisable to apply 2-3 applications a day directly on the affected area.

When using the piroxicam-based medicated plaster, on the other hand, it is advisable to apply only one patch at a time which should be replaced after 24 hours.

Ocular administration

When using piroxicam eye drops, it is recommended to instill 1-2 drops of the product inside the eye three times a day. Generally, the treatment lasts 4-10 days, according to a medical prescription.

Parenteral administration

In this case, the dose of piroxicam usually used is 20 mg a day, to be administered as a single dose intramuscularly.

Pregnancy and breastfeeding

Because of the damage it can cause both to the mother, to the fetus or to the child, the use of piroxicam is contraindicated in pregnancy and during breastfeeding.

Contraindications

The use of piroxicam orally and parenterally is contraindicated in the following cases:

  • In patients with known hypersensitivity to the same piroxicam or to other NSAIDs (even when the drug is administered through the skin and eye);
  • In patients who have suffered - or still suffer - from ulcer, perforation or gastrointestinal bleeding;
  • If you suffer - or have suffered in the past - from ulcerative colitis, Crohn's disease, gastrointestinal cancer or diverticulitis;
  • In patients already on therapy with other NSAIDs, with acetylsalicylic acid or with selective COX-2 inhibitors;
  • In patients on anticoagulant therapy;
  • In patients with severe blood disorders;
  • In patients with a predisposition to frequent bleeding;
  • In patients with moderate or severe heart failure;
  • In severely hypertensive patients;
  • In patients suffering from severe liver and / or renal diseases;
  • In patients under 18 years of age;
  • In pregnancy (even when the drug is administered via the skin);
  • During lactation (even when the drug is administered via the skin).

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