Piroxicam

Generic name
Piroxicam
Brand name
ATC Code
M01AC01
Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

The following parameters are reported in a pharmacokinteic study in children 6-15 years (n=10) who received 10-20 mg/day as a single dose during 2 weeks (Mäkelä, et al. 1991):

  Range Mean ± SD
Cmax (µg/ml) 3,6-9,8 6,5±1,8
t1/2 (hour) 21,7-40,4 32,6±6,5
Cl/F (ml/kg/hour) 2,1-5,0 3,4±1,1
V/F(ml/kg) 120-250 160±50

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Painmanagement (among which Juvenile Idiopathic Arthritis (JIA))
  • Oral
    • 6 years up to 18 years and 15 up to 26 kg
      • 10 mg/day in 1 dose

      • There is little experience with piroxicam in children. Piroxicam is therefore not a first-choice NSAID.
        Piroxicam should only be prescribed by a pediatric rheumatologist.

    • 6 years up to 18 years and 26 up to 46 kg
      • 15 mg/day in 1 dose

      • There is little experience with piroxicam in children. Piroxicam is therefore not a first-choice NSAID.
        Piroxicam should only be prescribed by a pediatric rheumatologist.

    • 6 years up to 18 years and ≥ 46 kg
      • 20 mg/day in 1 dose

      • There is little experience with piroxicam in children. Piroxicam is therefore not a first-choice NSAID.
        Piroxicam should only be prescribed by a pediatric rheumatologist.

Renal impaiment in children > 3 months

Adjustment in renal impairment as specified:

GFR 50-80 ml/min/1.73 m2
Consider whether use of an NSAID is justified.
If piroxicam is nevertheless prescribed and the patient belongs to a high-risk group: check kidney function before and within 1 week of starting piroxicam.
GFR 30-50 ml/min/1.73 m2
Consider whether use of an NSAID is justified.
If piroxicam is nevertheless prescribed and the patient belongs to a high-risk group: check kidney function before and within 1 week of starting piroxicam.
GFR 10-30 ml/min/1.73 m2
Consider whether use of an NSAID is justified.
If piroxicam is nevertheless prescribed and the patient belongs to a high-risk group: check kidney function before and within 1 week of starting piroxicam.
GFR < 10 ml/min/1.73 m2
A general recommendation is not provided
Clinical consequences

Risk factors are heart failure, cirrhosis of the liver, nephrotic syndrome, chronic kidney disease, causes leading to dehydration (e.g. summer heat too), use of drugs that can reduce kidney function, such as diuretics or RAAS inhibitors.

NSAIDs (including COX-2 inhibitors) can cause acute renal failure due to decreased renal perfusion (due to hypovolaemia). Normally, an excessive decrease in kidney perfusion is prevented by increased prostaglandin synthesis in the kidneys; NSAIDs disrupt this compensation mechanism. Reduced kidney perfusion also leads to water and salt retention, resulting in aggravation or development of hypertension and heart failure.

Patients on dialysis

Hemodialysis / continuous venovenous hemodialysis / hemo (slide) filtration:

• residual kidney function (urine production) IS present: avoid use to save residual kidney function
• residual function of the kidneys (urine production) NOT present: avoidance of use is not necessary

Patients on dialysis have a higher risk of bleeding, probably related to abnormal platelet function. The risk of bleeding can be further increased by using an LMWH at the start of the hemodialysis to prevent coagulation in the extracorporeal circulation.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects

No information is present at this moment.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

In exceptional cases, varicella can lead to serious infectious complications of the skin and soft tissues. To date, it cannot be ruled out that NSAIDs contribute to the worsening of these infections. It is therefore recommended not to use piroxicam in cases of varicella (Prescrire Internat 2010).

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS, NON-STEROIDS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Acetic acid derivatives and related substances
M01AB05
M01AB01
Propionic acid derivatives
M01AE14
M01AE01
M01AE02
Fenamates
M01AG01
Coxibs
M01AH01

References

  1. Williams, P. L., et al., Multicentre study of piroxicam versus naproxen in juvenile chronic arthritis, with special reference to problem areas in clinical trials of nonsteroidal anti-inflammatory drugs in childhood, Br J Rheumatol, 1986, 25(1), 67-71
  2. Mäkelä, A. L., et al, Steady state pharmacokinetics of piroxicam in children with rheumatic diseases., Eur J Clin Pharmacol, 1991, 41(1), 79-81
  3. García-Morteo, O., et al, Piroxicam in juvenile rheumatoid arthritis., Eur J Rheumatol Inflamm, 1987, 8(1), 49-53
  4. <No author listed>, Varicella, herpes zoster and nonsteroidal anti-inflammatory drugs: serious cutaneous complications, Prescrire Internat, 2010, 19, 72-73

Changes

Therapeutic Drug Monitoring


Overdose