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Research ArticleOpen Access

Piroxicam- Induced Hepatotoxicity

Volume 2 - Issue 3

Omar Rashid Sadeq*

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    • Assistant Professor, Faculty of Dentistry, Arab American University Jenin, (AAUJ) Palestine

    *Corresponding author: Omar Rashid Sadeq, Assistant Professor, Faculty of Dentistry, Arab American University Jenin, (AAUJ) Palestine, Email: goldman2007@bigmir.net

Received: January 28, 2018;   Published: February 12, 2018

DOI: 10.26717/BJSTR.2018.02.000752

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Abstract

Piroxiam is an oxicam derivative medication belonging to non steroidal anti-inflammatory drugs (NSAIDs) group, used to treat moderate to severe inflammatory diseases such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis (Bechterew’s disease), tendinitis, bursitis, and for pain that is not related to musculoskeletal system e.g. primary dysmenorrhea and postoperative pain. It reduces pain, joint swelling, morning stiffness, and improves the functionality of the joints during chronic polyarthritis. Piroxicam has been compared to other antiinflammatory agents (e.g. diclofenac, indomethacin, and naproxen) in numerous controlled studies and proved to be equal and sometimes even more efficacious. Piroxicam is unique among NSAIDs in that it is used once daily, and its efficacy is equal to most important clinically employed NSADs (ibuprofen, naproxen and diclofenac) especially in amelioration of postoperative pain, but it is more prone to causing gastrointestinal disturbances and serious skin reactions (Steven-Johnsons syndrome, toxic epidermal necrolysis). It should not be given to patients who have experienced peptic ulcer, asthma, urticaria or allergic-type reactions after taking aspirin or other NSAIDs, as well as patients on anticoagulant therapy, renal, hepatic, diabetic and cardiac patients.

Piroxicam is not recommended for use in lactation, children under 12 years of age and pregnant women since safety has not been established as with any NSAID, caution should be exercised in treating the elderly (65 years and older). Piroxicam is provided in much trade formulation namely feldene, Felcol and pirox, it is available in multiple dose variations 10-20 mg capsules PO 1-2 times/day (no more than 30-40 mg/day) and is taking with or after food, the dose schedule is individual and depends on pathologic condition. Clinically significant drug interactions with piroxicam include bleeding when used with either anticoagulants or other NSAIDs, decreased efficacy of antihypertensive (ACEIs and beta blockers but not Ca channel blockers), reduced the antinatriuretic effect of diuretics such furasemide and hypothiazide, acceleration of the steady state of digoxin, increased nephrotoxicity of methotrexate and cyclosporine and finally concomitant use of corticosteroids with Feldene may increase the risk of GI ulceration or bleeding. The aim of recent study was to estimate the hepatic risk associated with the use of piroxicam, about 32 patients with osteoarthritis (OA) were divided into 2 categories, and were treated by piroxicam, 10-20 mg/d orally in a period of 2 months, patients were investigated for 6 month. CBC, hepatic tests including (bilirubin, ALT and AST) were done before, during and after treatment, ultrasonography and liver biopsy was also provided only for certain patients of II category. The main findings of this research study is that two-month orally prescribed piroxicam, 10 mg/d produces no hepatotoxic effect in OA, but piroxicam, 20 mg/d, produces a mixed hepatocellular-cholestatic reversible injury in about 75% of OA patients, predominantly in female gender.

Keywords: Piroxicam; NSAIDs; Osteoarthritis; Rheumatoid Arthritis; Dysmenorrhea; Polyarthritis; Steven-Johnsons syndrome; Furasemide Hypothiazide; Methotrexate; Digoxin; ultrasonography; cholestasis; Liver Biopsy

Abbreviations: DILI: Drug Induced Liver Injury; NSAIDs: Non-steroidal anti-inflammatory drugs, CIX: Cyclooxygease; ALT: Alanine Amino Transferase; CBC: Complete Blood Count; RF: Rheumatoid Factor; ALP: Alkaline Phosphatase

Abstract| Introduction| Methodology| Methods of Investigation & Discussion| Conclusion| References|