piroxicam

It is used in the treatment of certain inflammatory conditions like rheumatoid and osteoarthritis, primary dysmenorrhoea, and postoperative pain; it acts as an analgesic, especially where there is an inflammatory component. The European Medicines Agency issued a review of its use in 2007 and recommended that its use be limited to the treatment of chronic inflammatory conditions, as it is only in these circumstances that its risk-benefit ratio proves to be favourable.{{cite web|title=Committee for medicinal products for human use (CHMP) opinion following an Article 31(2) referral for Piroxicam containing medicinal products|work=European Medicines Agency|date=20 September 2007|location=London, UK|access-date=24 June 2014|url=http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Piroxicam_31/WC500011770.pdf}}

{{See also|Nonsteroidal anti-inflammatory drug}}

As with other NSAIDs the principal side effects include: digestive complaints like nausea, discomfort, diarrhoea and bleeds or ulceration of the stomach, as well as headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances (such as tinnitus), high blood pressure, oedema, light sensitivity, skin reactions (including, albeit rarely, Stevens–Johnson syndrome and toxic epidermal necrolysis) and rarely, kidney failure, pancreatitis, liver damage, visual disturbances, pulmonary eosinophilia and fibrosing alveolitis.{{cite book | isbn = 978-0-85711-084-8 | title = British National Formulary (BNF) | last1 = Joint Formulary Committee | year = 2013 | publisher = Pharmaceutical Press | location = London, UK | edition = 65 | pages = [https://archive.org/details/bnf65britishnati0000unse/page/665 665, 673–674] | url = https://archive.org/details/bnf65britishnati0000unse/page/665 }} Compared to other NSAIDs it is more prone to causing gastrointestinal disturbances and serious skin reactions.

In October 2020, the U.S. Food and Drug Administration (FDA) required the drug label to be updated for all nonsteroidal anti-inflammatory medications to describe the risk of kidney problems in unborn babies that result in low amniotic fluid. They recommend avoiding NSAIDs in pregnant women at 20 weeks or later in pregnancy.{{cite press release | title=FDA Warns that Using a Type of Pain and Fever Medication in Second Half of Pregnancy Could Lead to Complications | website=U.S. Food and Drug Administration (FDA) | date=15 October 2020 | url=https://www.fda.gov/news-events/press-announcements/fda-warns-using-type-pain-and-fever-medication-second-half-pregnancy-could-lead-complications | access-date=15 October 2020}} {{PD-notice}}{{cite web | title=NSAIDs may cause rare kidney problems in fetuses| website=U.S. Food and Drug Administration | date=21 July 2017 | url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic | access-date=15 October 2020}} {{PD-notice}}

{{See also|Nonsteroidal anti-inflammatory drug}}

Piroxicam is an NSAID and, as such, is a non-selective COX inhibitor possessing both analgesic and antipyretic properties.

Piroxicam exists as alkenol tautomer in organic solvents and as zwitterionic form in water.{{cite journal |vauthors=Ivanova D, Deneva V, Nedeltcheva D, Kamounah FS, Gergov G, Hansen PE, Kawauchi S, Antonov L | title = Tautomeric transformations of piroxicam in solution: a combined experimental and theoretical study | journal = RSC Advances | volume = 5 | issue = 40 | pages = 31852–31860 | year = 2015 | doi=10.1039/c5ra03653d| bibcode = 2015RSCAd...531852I | doi-access = free }}

The project that produced piroxicam began in 1962 at Pfizer; the first clinical trial results were reported in 1977, and the product launched in 1980 under the brand name "Feldene".{{cite journal | vauthors = Lombardino JG, Lowe JA | title = The role of the medicinal chemist in drug discovery--then and now | journal = Nature Reviews. Drug Discovery | volume = 3 | issue = 10 | pages = 853–862 | date = October 2004 | pmid = 15459676 | doi = 10.1038/nrd1523 | s2cid = 11225541 | doi-access = free }}. See: [http://www.nature.com/nrd/journal/v3/n10/box/nrd1523_BX1.html] Box 1: Discovery of piroxicam (1962–1980){{cite journal | vauthors = Weintraub M, Jacox RF, Angevine CD, Atwater EC | title = Piroxicam (CP 16171) in rheumatoid arthritis: a controlled clinical trial with novel assessment techniques | journal = The Journal of Rheumatology | volume = 4 | issue = 4 | pages = 393–404 | year = 1977 | pmid = 342691 }} Major patents expired in 1992 and the drug is marketed worldwide under many brandnames.{{cite web | work = Drugs.com | url = https://www.drugs.com/international/piroxicam.html | title = International listings for piroxicam | access-date = 3 July 2015 }}

• Meloxicam
• Isoxicam
• Lornoxicam

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• {{cite book | title=Medical Genetics Summaries | chapter=Piroxicam Therapy and CYP2C9 Genotype | chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK537367/ | veditors=Pratt VM, McLeod HL, Rubinstein WS, Scott SA, Dean LC, Kattman BL, Malheiro AJ | display-editors=3 | publisher=National Center for Biotechnology Information (NCBI) | year=2019 | pmid=30742401 | id=Bookshelf ID: NBK537367 | vauthors=Dean L | url=https://www.ncbi.nlm.nih.gov/books/NBK61999/ }}

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{{Anti-inflammatory and antirheumatic products}}

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