What are the side effects of piroxicam

Piroxicam

This is how piroxicam works

Like other non-steroidal anti-inflammatory drugs, piroxicam inhibits the enzyme cyclooxygenase (COX) when taken in the body. Cyclooxygenases occur in a variety of ways in different tissue types and organs, where they form tissue hormones (prostaglandins). On the one hand, these tissue hormones are involved in various physiological processes in the body, such as blood clotting, vasoconstriction and the regulation of gastric acid production. On the other hand, certain prostaglandins are formed as a messenger substance during inflammatory processes in the body: They attract immune cells (to combat pathogens that may have penetrated), make the tissue swell (so that the immune cells can migrate better and any toxins can be better transported away) and convey pain stimuli to the brain mediate so that it becomes aware of the damaged part of the body.

Before the development of oxicams, to which piroxicam belongs, you had to take NSAIDs two to three times a day, because the body breaks them down quickly and the duration of action is correspondingly short. In addition, you sometimes had to take the active ingredients daily on a gram scale to ensure sufficient potency, which, however, also increased the extent of side effects.

With piroxicam it was possible to produce a comparatively strong substance that also works for a sufficiently long time. This reduced unwanted side effects and increased patient compliance.

Uptake, breakdown and excretion of piroxicam

After ingestion, the active ingredient is partly absorbed in the stomach and partly in the intestine. The maximum blood levels are reached after two to three hours. If piroxicam is used not as a tablet but as a suppository, the highest blood levels can be measured after five to six hours. Because the body partially excretes the active ingredient via the liver with the bile into the intestine, where it is reabsorbed into the blood, a second rise in blood levels occurs after six to ten hours. This mechanism contributes to the prolonged duration of action of piroxicam. A large part of the ineffective breakdown products is excreted via the kidneys with the urine. After about two days, half of the active ingredient is eliminated from the body.

When is piroxicam used?

The pain reliever piroxicam is approved for anti-inflammatory and pain relief in chronic inflammatory and acutely inflamed rheumatic diseases. It is used as a second choice when other NSAIDs cannot be used or do not work well enough.

Since the maximum effect of piroxicam is only reached after five to ten days, a faster-acting pain reliever must be administered to treat acute pain.

The duration of treatment is usually limited to two weeks, but can be exceeded under medical supervision.

This is how piroxicam is used

The active ingredient is often used in the form of tablets. Dosages of ten to 20 milligrams of piroxicam once a day during or after a meal are common. It should be taken with a glass of water and always at about the same time of day.

To avoid gastrointestinal complaints, the doctor sometimes also prescribes proton pump inhibitors (for example omeprazole or pantoprazole) or other gastric acid inhibitors (for example misoprostol).

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

What are the side effects of piroxicam?

More than ten percent of those treated experience adverse drug effects (ADRs) such as heartburn, abdominal pain, nausea, vomiting, flatulence, diarrhea, constipation and minor gastrointestinal bleeding while taking piroxicam.

One in ten to one hundred patients experience piroxicam side effects such as headache, dizziness, tiredness, ringing in the ears (tinnitus), ulcers in the gastrointestinal tract, stomach inflammation, rash, and increases in liver enzymes and urea blood levels.

What should be considered when taking piroxicam?

No other NSAIDs (such as acetylsalicylic acid, diclofenac, ibuprofen) should be taken while taking piroxicam, as these also inhibit the COX enzyme and thus compete with piroxicam.

The risk of bleeding in the digestive tract increases if piroxicam is taken together with glucocorticoids ("cortisone"), anticoagulants (warfarin, phenprocoumon, ASA, clopidogrel, ticagrelor, prasugrel) or drugs against depression (fluoxetine, citalopram, sertraline).

Piroxicam can increase the blood levels of the anti-epileptic drug phenytoin and the mood stabilizer lithium, which is why close monitoring of the blood levels is advisable, especially at the beginning of combined use.

When taken at the same time, NSAIDs such as piroxicam can weaken the effect of water tablets (diuretics) and high blood pressure drugs such as ACE inhibitors (ramipril, captopril, lisinopril) and sartans (candesartan, irbesartan, valsartan) and, especially in elderly patients, worsen kidney function. In extreme cases, this can lead to kidney failure.

Since piroxicam increases the risk of miscarriages during pregnancy and passes into breast milk, pregnant women and breastfeeding women should not take the active ingredient.

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 pre-existing renal impairment.

How to get medication with piroxicam

Painkillers with the active ingredient piroxicam require a prescription in every dosage, so they can only be purchased with a prescription in the pharmacy.

How long has piroxicam been known?

In 1962, the pharmaceutical company Pfizer began developing piroxicam with the aim of producing a long-acting and powerful NSAID. Almost two decades later it was Piroxicam approved in 1980 as the first representative of the class of oxicams in Europe.

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