piroxicam: clinical use

Prescribing considerations

• Reserve systemic piroxicam for second-line treatment of licensed arthritic conditions and ensure initiation by an appropriately experienced clinician.
• Assess gastrointestinal, cardiovascular, renal, hepatic, respiratory and serious skin-reaction risks before prescribing.
• Reassess benefit, tolerability and continued need frequently; avoid use in people older than 80 years.

Contraindications and cautions

• Previous or active gastrointestinal ulceration, bleeding or perforation, or a gastrointestinal disorder predisposing to bleeding
• Concomitant anticoagulants, other NSAIDs or analgesic-dose aspirin
• Previous serious allergic drug reaction, previous piroxicam-related skin reaction, or NSAID-triggered asthma, angioedema, nasal polyps or urticaria
• Severe heart failure
• Third trimester of pregnancy

Monitoring

• Consider baseline blood pressure, renal function and full blood count; assess liver function where clinically indicated.
• Individualise monitoring of renal function, blood pressure and blood counts according to risk.
• Monitor for gastrointestinal symptoms, skin or mucosal reactions, oedema, respiratory symptoms and visual complaints.

Clinical pharmacology

Piroxicam is an oxicam NSAID that reversibly inhibits cyclo-oxygenase and prostaglandin synthesis. It is well absorbed orally, highly protein-bound and has a long elimination half-life; reduced CYP2C9 metabolism can increase exposure.

Formulation and product differences

• Fast-dissolving tablets can disperse on the tongue or be swallowed with water; they contain aspartame, a phenylalanine source relevant to phenylketonuria.
• The selected hard capsule is swallowed orally and contains lactose, relevant to specified rare hereditary carbohydrate-intolerance disorders.

Capsule

Route: Oral

Strengths: 10 mg, 20 mg