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Piroxicam

Piroxicam (Feldene)


  • Generic name: Piroxicam
  • Trade names: Feldene, Roxam
  • Pharmacologic category: Nonsteroidal Anti-inflammatory Drug, Oxicams
  • FDA approved: April 6, 1982
  • Manufacturer: Pfizer
  • Pregnancy risk factor: C

Medical uses

Piroxicam (Feldene) is a cyclooxygenase inhibiting, nonsteroidal anti-inflammatory drug (NSAID). Piroxicam is used for rheumatoid arthritis, osteoarthritis, and dysmenorrhoea.

There is evidence, that piroxicam has no negative effects on cartilage matrix formation.

Pharmacological characteristics

  • Onset of action: 1 hour
  • Metabolism: Hepatic
  • Elimination half-life: 45-50 hours
  • Excretion: Primarily urine and feces (small amounts) as unchanged drug (5%) and metabolites

Benefits

  • A primary advantage of the Oxicam family of drugs is their long half-life which permits once-day dosing.
  • Less cardiovascular side effects.

Disadvantages

  • Slow onset of action. Not good choice for acute pain and inflammation.
  • High risk of gastrointestinal side effects. Appears to have the highest incidence of serious gastrointestinal side effects.
  • High risk of skin reactions. Evidence from observational studies suggests that piroxicam may be associated with a higher risk of serious skin reactions (including Stevens-Johnson syndrome and toxic epidermal necrolysis) than other non-oxicam NSAIDs. Patients seem to be at highest risk of these reactions early in the course of therapy: most cases occur within the first month.
  • Cardiovascular side effects. Piroxicam may cause cardiovascular problems, including heart attack, stroke, and new onset or worsening of preexisting hypertension.

Unlabeled uses

  • Ankylosing spondylitis
  • Menstrual cramps
  • Pain
  • Juvenile rheumatoid arthritis
  • Postoperative pain

Mode of action

Inhibits prostaglandin synthesis, acts on the hypothalamus heat-regulating center to reduce fever, blocks prostaglandin synthetase action which prevents formation of the platelet-aggregating substance thromboxane A2; decreases pain receptor sensitivity. Other proposed mechanisms of salicylate anti-inflammatory action are lysosomal stabilization, kinin and leukotriene production, alteration of chemotactic factors, and inhibition of neutrophil activation. This latter mechanism may be the most significant pharmacologic action to reduce inflammation.

Piroxicam also inhibits platelet aggregation and prolongs bleeding time. Piroxicam has immunomodulatory properties2.

Piroxicam is almost equipotent with indomethacin and more potent than ibuprofen, tolmetin, naproxen, fenoprofen, phenylbutazone, and aspirin in the inhibition of prostaglandin biosynthesis by methylcholanthrene-transformed mouse fibroblasts (MC-5) assay.

References

  • 1. U.S. FDA Piroxicam (Feldene) Prescribing Information PubMed
  • 2. Beyer I, Njemini R, Bautmans I, Demanet C, Mets T. Immunomodulatory effect of NSAID in geriatric patients with acute infection: effects of piroxicam on chemokine/cytokine secretion patterns and levels of heat shock proteins. A double-blind randomized controlled trial. Cell Stress Chaperones. 2012 Mar;17(2):255-65. PubMed
  • 3. Dingle JT. The effects of NSAID on the matrix of human articular cartilages. Z Rheumatol. 1999 Jun;58(3):125-9. PubMed

By HealthyStock Research Group, September 2009
Medical resources reviewed: August 2018

Interesting facts

feldene

  • Piroxicam was synthesized by ring-expansion reactions of saccharin derivatives.
  • Evidence from epidemiological studies suggests that piroxicam poses a significantly greater risk of serious gastrointestinal toxicity than other NSAIDs, including gastrointestinal haemorrhage, ulceration, and perforation.

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