Piroxicam

Registered South African indications:

• Pain
• Inflammation

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Patients sensitive to aspirin and other non-steroidal anti-inflammatory drugs

Cautions

• Pregnancy 
• Breastfeeding
• Renal impairment
• Hepatic impairment
• Eyes and mucosal surfaces
• Open skin lesions, dermatoses or infection

Forms avail in SA and covered in this monograph: gel

Pain and inflammation - musculoskeletal and joint

• Topical (gel): Apply 1g (equal to 3cm) to the affected area; 6-8hrly

Treatment should be reviewed after 2 weeks

Do not apply to inflamed or damaged skin 

Not approved for use in South Africa for children

Pregnancy

• Caution
• There are no studies of the use of topical piroxicam in pregnant women. Studies in animals have shown reproductive toxicity with the systemic formulations, but their relevance to the use of topical formulations in pregnant women is unknown. As a precautionary measure, it is preferable to avoid the use of topical piroxicam in pregnant women
• Inhibition of prostaglandin synthesis might adversely affect pregnancy. Data from epidemiological studies suggest an increased risk of spontaneous abortion after the use of prostaglandin synthesis inhibitors in early pregnancy. In animals, administration of prostaglandin synthesis inhibitors has been shown to result in increased pre- and post-implantation loss. Therefore, the use of piroxicam gel during pregnancy is not recommended

Breastfeeding

• Caution; not recommended
• Piroxicam gel is not recommended for use in breastfeeding mothers, as clinical safety has not been established

Renal Impairment

• Caution; no information available

Hepatic Impairment

• Caution; no information available 

Elderly

• No dose adjustment recommended

Porphyria Information

• Not yet classified (NC)

Drugs in Sport

• Permitted - No warnings

Respiratory Disorders

• Bronchospasm 
• Dyspnoea

Gastrointestinal Disorders

• Nausea
• Dyspepsia
• Abdominal pain
• Gastritis

Skin and Subcutaneous Tissue Disorders

• Local irritation
• Erythema
• Pruritus and dermatitis may occur at the application site
• Stevens-Johnson syndrome 
• Toxic epidermal necrolysis 
• Contact dermatitis
• Eczema 
• Photosensitivity skin reaction

• Anticoagulants  
• Antiplatelet agents
• Selective serotonin reuptake inhibitors
• Non-steroidal anti-inflammatory drugs
• Cardiac glycosides
• Ciclosporin
• Tacrolimus
• Cimetidine  
• Corticosteroids
• Diuretics
• Highly protein-bound agents
• Lithium
• Antihypertensives
• Methotrexate
• Quinolone antibiotics
• Mifepristone
• Zidovudine
• Pentoxifyline
• Penicillamine

None routine

Inhibits prostaglandin synthesis and release through a reversible inhibition of the cyclooxygenase enzyme.

Gel (per g) 5mg

• Rheugesic Gel (Cipla)

Also available in the following forms: Tablet and capsule