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Last Updated on March 16, 2024

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What is piroxicam?

Piroxicam is an analgesic and anti-inflammatory chosen from the oxycam group. It is classified as aspirin, ibuprofen and diclofenac in the group of non-steroidal anti-inflammatory drugs (NSAIDs), but unlike them it has a longer duration of action. Here you can read all you need to know about piroxicam : effects, uses and exchange, side effects.

How does piroxicam works?

Like other NSAIDs, piroxicam inhibits the enzyme cyclooxygenase (COX) in the body. Cyclooxygenases are found in different tissue types and organs and form tissue hormones (prostaglandins). These tissue hormones are involved in various physiological processes in the body, such as blood clotting, vasoconstriction and regulation of gastric acid production. Secondly, certain prostaglandins are formed as messengers in inflammatory processes in the body: they attract immune cells (to fight any invading pathogens), make the tissue swell (so that the immune cells can better invade and any toxins can be better transported) and transmit pain stimuli to the brain to direct attention to the injured part of the body.

Before the development of oxicam, piroxicam, you had to take NSAIDs two to three times a day because they were broken down quickly in the body and had a short duration of action. In addition, you had to take partially active day on a gram scale to ensure sufficient potency, but this operation also the degree of side effects in the air.

With piroxicam, it has been possible to produce a comparatively potent substance with a sufficiently long duration of action. Unwanted side effects have been reduced and patient compliance has been increased.

The pharmacokinetics and metabolism of piroxicam

After taking the medicine, it is absorbed partly in the stomach and partly in the intestines. Maximum blood levels are reached after two to three hours. If piroxicam is taken as a suppository rather than a tablet, the highest blood levels can be measured after five to six hours. Because the body partly removes the drug from the liver with the bile into the intestine, where it is reabsorbed into the blood, there is a second rise in blood levels after six to ten hours. This mechanism contributes to the prolonged duration of action of piroxicam. Much of the inactive metabolite is excreted in the urine through the kidneys. Half of the drug is eliminated from the body after about two days.

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When is piroxicam used?

The painkillers piroxicam has been approved for anti-inflammation and pain relief in chronic inflammatory and acutely inflamed rheumatic diseases. It is used as a means of second choice if other NSAIDs can not be applied or not sufficiently effective.

Since the maximum effect of piroxicam is reached only after five to ten days, a faster anesthetic drug should be administered for the treatment of acute pain.

Usually, the duration of treatment is limited to two weeks, but may be exceeded under a doctor’s supervision.

How piroxicam is taken?

The drug is often used in the form of tablets. Are usual doses of ten to 20 milligrams of piroxicam once per day during or after a meal. It may be taken with a glass of water and always about the same time each day.

In order to avoid gastrointestinal discomfort the doctor prescribes sometimes additional proton pump inhibitor (for example) or other stomach acid inhibitors (eg, misoprostol).

Piroxicam is in the form of suppositories, as an infusion solution and a cream available.

What are the side effects of piroxicam?

For more than ten percent of those treated occurs while taking piroxicam to adverse drug reactions (ADRs) such as heartburn, abdominal pain, nausea, vomiting, flatulence and minor gastrointestinal bleeding.

With a ten to one hundred patients show piroxicam side effects such as headache, dizziness, fatigue, ringing in the ears (tinnitus), ulcers in the gastrointestinal tract, stomach irritation, skin rash and increases in liver enzymes and urea blood levels.

What should I watch for while taking piroxicam?

Do not take other NSAIDs (e.g. aspirin, diclofenac, ibuprofen) while taking piroxicam as they also inhibit the COX enzyme and therefore compete with piroxicam.

The risk of gastrointestinal bleeding increases if piroxicam is taken with glucocorticoids (“cortisone”), anticoagulants (warfarin, phenprocoumon, aspirin, clopidogrel, ticagrelor, prasugrel) or antidepressants (fluoxetine, citalopram, sertraline).

Piroxicam increases the blood levels of the anti-epileptic drug phenytoin and the mood stabiliser lithium, so close monitoring of blood levels is recommended, especially at the start of concomitant use.

Co-administration of NSAIDs such as piroxicam may antagonise the effects of diuretics and high blood pressure medications such as ACE inhibitors (ramipril, captopril, lisinopril) and sartans (candesartan, irbesartan, valsartan) and impair kidney function, especially in the elderly, which may in extreme cases lead to kidney failure.

As piroxicam increases the risk of miscarriage during pregnancy and is excreted in breast milk, it should not be used by pregnant or breastfeeding women.

Patients younger than 18 years or older than 80 years should not take piroxicam. The dose of piroxicam may need to be reduced in patients over 70 years of age or with existing kidney dysfunction.

How to get medicines with piroxicam

Painkillers containing piroxicam are available only on prescription.

Since when piroxicam is known?

In 1962, the development of piroxicam began with the pharmaceutical company Pfizer with the goal of winning a long-acting and potent NSAIDs. Almost two decades later, in 1980, piroxicam was approved in Europe as the first member of the oxicam class.