piroxicam
Meaning of piroxicam: A long acting anti-inflammatory taken once a day, which is also why its effects on the stomach accumulate.
Definition of piroxicam
Piroxicam is a nonsteroidal anti-inflammatory drug used for pain and swelling in arthritis and other inflammatory joint conditions. It blocks cyclooxygenase, the enzyme that manufactures prostaglandins, the local chemicals that produce swelling, heat and pain. It stays in the body far longer than most drugs in its class, so a single daily dose is enough.
How does it relieve pain and swelling?
Injured tissue releases a fatty acid from its own cell membranes, and cyclooxygenase converts that fatty acid into prostaglandins. These local messengers widen small vessels, make them leak, sensitize nerve endings and reset the body temperature control upward. Piroxicam blocks the enzyme, so fewer prostaglandins are made. Swelling settles, the sensitized nerves quieten and fever falls. It does not repair the underlying joint damage and it does not slow the disease.
Why does the same action cause its side effects?
Prostaglandins have housekeeping duties as well as inflammatory ones, and a drug that blocks the enzyme cannot separate the two.
| Normal prostaglandin job | What blocking it does |
|---|---|
| Maintains the stomach lining and its mucus | Irritation, ulcers, bleeding |
| Keeps blood flowing through the kidney under strain | Reduced kidney function, fluid retention |
| Balances constriction and clotting in vessels | Raised blood pressure, added cardiovascular risk |
How does it compare with other drugs in its class?
As a nonsteroidal anti-inflammatory drug it does the same job as ibuprofen or naproxen, but two features set it apart. It is an oxicam, a different chemical family from the more familiar propionic acid drugs. And it is cleared very slowly, so levels persist between doses and take days to fall away after the last one. Convenience comes at a price: exposure to the stomach lining is continuous rather than intermittent, and reviews of comparative safety have placed it among the higher risk options for gut bleeding. Serious skin reactions have also been reported with it more often than with several alternatives, and regulators in some countries have restricted its use as a result.
Who is most affected by its risks?
Age is the strongest factor, since the stomach lining and the kidneys both become less resilient. A history of ulcer or gut bleeding, treatment with a blood thinner or a steroid, heart failure and reduced kidney function all raise the stakes. Alcohol adds to the irritation of the stomach lining.
Also known as
Used in a sentence
Piroxicam was stopped after the patient developed epigastric pain and a fall in hemoglobin.
Good to know
Piroxicam is cleared slowly, so exposure of the stomach lining is continuous between doses, and comparative reviews place it among the nonsteroidal drugs with higher gut bleeding and serious skin reaction risk.