Piroxicam

Overview

Piroxicam is a nonsteroidal anti-inflammatory drugs (NSAIDs), possesses analgesic and antipyretic properties. Piroxicam is structurally unrelated to other NSAIDs. It has a long half-life and may be administered as a single daily dose, which can be an advantage over other NSAIDs. The anti-inflammatory potential of it has been equated with that of indomethacin, and its analgesic activity has been shown to be greater than that of aspirin. Piroxicam is indicated in the treatment of osteoarthritis and rheumatoid arthritis. It was approved by the FDA in 1982. The anti-inflammatory effects of it may result from the peripheral inhibition of prostaglandin synthesis due to the inhibition of the enzyme cyclooxygenase. It also can inhibit the activation of neutrophils, which may contribute to antiinflammatory effects as well. Prostaglandins sensitize pain receptors, and their inhibition is believed to be responsible for the analgesic effects of it.

Category:

Primary Characterstics

Molecular Structure of Piroxicam
. It is of Synthetic origin and belongs to Oxicam. It belongs to Cyclo-oxygenase inhibitor pharmacological group on the basis of mechanism of action and also classified in Analgesics and Anti-inflammatory Agents pharmacological group.The Molecular Weight of Piroxicam is 331.30.
Its pKa is 6.3.

Pharmacokinetics

Oral absorption of Piroxicam is found to be 100% . Volume of distribution is found to be 0.1 l/kg and plasma protien binding is 99 %. Renal Excretion accounts for 10 % and plasma half life is 30 - 60 hr.

Indications

Contraindications

Piroxicam is contraindicated in conditions like Peptic ulcer,Thrombosis,Impaired hepatic function.

Drug Interactions

Piroxicam is known to interact with other drugs, the details of drug interactions is as follows:

DrugDetailsSeverityOnsetManagement
AspirinCombined use of aspirin with piroxicam aggravate gastrointestinal toxicity. aspirin at higher doses decrease the plasma concentration of piroxicam. ADVICE: Avoid concomitant use of Aspirin with NSAIDs (increased risk of side effects). ModerateDuring concomitant therapy, patient should take medication with food and should immediately report to physician about sign and symptoms of GI ulceration and bleeding.
Benorylate
Choline Magnesium Trisalicylate
Cimetidine (HCl)
MetipranololLikely interaction of PIROXICAM reducing the HYPOTENSIVE effect of METIPRANOLOL [EYE]. Moderate
TorasemidePiroxicam, a strong CYP2C9 inhibitor, may increase the serum concentration of Torasemide, a CYP2C9 substrate, by decreasing Torasemide metabolism and clearance. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of Torasemide if Piroxicam is initiated, discontinued or dose changed.
Warfarin (Na)Piroxicam may enhance the anticoagulant effect of Warfarin.ModerateDelayedPatients receiving Warfarin should be instructed to not initiate Piroxicam without consulting his/her healthcare professional (nonacetylated salicylates might be safer alternatives). Acetaminophen is usually a good antipyretic and analgesic choice for patients taking Warfarin. Monitor for increased signs and symptoms of bleeding if Warfarin and Piroxicam are used concomitantly.

These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Interference in Pathology

  • Complete blood cell count

Side Effects

The severe or irreversible adverse effects of Piroxicam, which give rise to further complications include Skin reactions, Erythema.

Piroxicam produces potentially life-threatening effects which include GI bleeding, Aplastic Anemia, Renal damage, Peptic ulceration, Purpura, Pemphigus vulagris. which are responsible for the discontinuation of Piroxicam therapy.

The signs and symptoms that are produced after the acute overdosage of Piroxicam include Nausea, Vomiting, Diarrhea, Hematuria, GI disturbances, Renal failure, GI hemorrhage, Proteinuria, Hypoprothrombinemia.

The symptomatic adverse reactions produced by Piroxicam are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Headache, Palpitation, Insomnia, Confusion, VertigoX, Hearing loss, Mood swings, Paresthesias, Hypoglycemia.

Available Brands

Click on the appropriate strength of the dosage form to view its available brands.

Single Ingredient

Inj: 20 mg, 20 mg/ml,
Inj-IM: 20 mg/ml,
Syrup: 2 mg/5ml,
Cream: 1 %w/w, 0.5 %w/w,
Gel: 5 mg, 0.5 %, 5 %w/w, 0.5 w/w, 0.5 %w/w,
Tabs: 2 mg, 10 mg, 20 mg,
Caps: 10 mg, 20 mg,

Multi ingredient

Tabs: 20 mg,
Caps: 10 mg, 20 mg,

Dosage

Piroxicam's dosage details are as follows:
Dose Single Dose Frequency Route Instructions

Adult Dosage

20 mg20 (20)24 hourlyPOMaintenance for 1-2 Weeks
40 mg40 (40)24 hourlyPOInitial for 2 Days

Paedriatic Dosage ( 20 Kg. )

0.2 to 0.6 mg/kg0.4 (0.4)24 hourlyOralNot Recommended Under 6 Yrs of Age

Neonatal Dosage ( 3 Kg. )

Not recommended in this age group

High Risk Groups

Drug should not be given to Pregnant Mothers, Geriatrics, and Neonates.

If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

Warning / Precautions

Piroxicam should be used with caution in patients with intrinsic coagulation defects and those on anticoagulant therapy. It should be used with caution in patients with compromised cardiac function, hypertension other condition predisposing to fluid retention. It should be used with extra care in the presence of existing controlled infection. Perform periodic auditory function test during chronic therapy. Discontinue drug if skin reaction occurs.

Storage Conditions

Tab

Store Below 40°C. Protect from Sunlight and Moisture.

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