TENOXICAM

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DRUGS
TENOXICAM

Tenoxicam belongs to the class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs).It is used to relieve the inflammation, swelling, stiffness, and pain associated with rheumatoid arthritis, osteoarthritis, ankylosing spondylitis (a type of arthritis involving the spine), tendonitis (inflammation of a tendon), bursitis (inflammation of a bursa, a fluid-filled sac located around joints and near the bones), and periarthritis of the shoulders or hips (inflammation of tissues surrounding these joints).

 

Introduction

Tenoxicam belongs to the class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs). It is used to relieve the inflammation, swelling, stiffness, and pain associated with rheumatoid arthritis, osteoarthritis, ankylosing spondylitis (a type of arthritis involving the spine), tendonitis (inflammation of a tendon), bursitis (inflammation of a bursa, a fluid-filled sac located around joints and near the bones), and periarthritis of the shoulders or hips (inflammation of tissues surrounding these joints).

Pharmacological class: NSAIDs

Indications

  • Arthritis and other inflammatory conditions

  • Dysmenorrhea

Pharamcological Action

Tenoxicam works by blocking the effect of chemicals in your body, called cyclooxygenase (COX) enzymes. These enzymes help to make other chemicals in the body, called prostaglandins.

Some prostaglandins are produced at sites of injury or damage, and cause pain and inflammation. By blocking the effect of COX enzymes, fewer prostaglandins are produced, which means pain and inflammation are eased.

 

Dosage

  • Oral

Pain and inflammation associated with musculoskeletal and joint disorders

20 mg/day as single dose for 7 days in acute disorders, up to 14 days in severe cases. Max: 40 mg/day (short term use).

  • Parenteral

Pain and inflammation associated with musculoskeletal and joint disorders

Adult: Initially, 20 mg IM/IV as a single dose given for 1-2 days.

Pharmacokinetics

Oral absorption of tenoxicam is rapid and complete (absolute bioavailability 100%). Tenoxicam is metabolized in the liver to several pharmacologically inactive metabolites (mainly 5'-hydroxy-tenoxicam). The Biological Half-Life is 72 hours (range 59 to 74 hours).

Contraindications

  • Contraindicated in pregnancy.

  • Contraindicated in patients with active or history of recurrent GI bleed or peptic ulcer.

  • Contraindicated in patients with known hypersensitivity to NSAIDs.

  • Contraindicated in patients with severe heart failure, hemorrhagic diathesis and asthma.

Drug Interactions

  • Risk of nephrotoxicity may be increased with ACE inhibitors, ciclosporin, tacrolimus or diuretics.

  • Increased risk of hyperkalemia with ACE inhibitors and potassium sparing diuretics.

  • Concurrent use increases concentrations of lithium, methotrexate, cardiac glycoside.

  • Concurrent administration with anticoagulants and other NSAIDs increases the risk of bleeding.

 

Side effects

Common (affecting between 1 in10 to 1 in 100)

  • Dyspepsia

  • Nausea

  • Vomiting

  • Abdominal discomfort

  • Anorexia

  • Colitis

  • Constipation

  • Crohn's disease

  • Diarrhea

  • Dizziness

  • Gastritis

  • Gastrointestinal hemorrhage

  • Headache

  • Peptic ulcer

  • Stomatitis

  • Dry mouth

  • Gastrointestinal perforation

Uncommon (affecting 1 in 100 to 1 in 1000)

  • Edema

  • Rash

  • Fatigue

  • Pruritus

  • Erythema

  • Urticaria

Very rare (affecting less than 1 in 10,000)

  • Toxic epidermal necrolysis

  • Stevens-Johnson syndrome

Precautions

  • Avoid in patients with history of peptic ulceration.

  • Avoid in patients with renal, cardiac or hepatic impairment

  • Avoid in pregnancy

  • Avoid in elderly patients

  • Avoid in patients with cerebrovascular disease, fluid retention and inflammatory bowel disease.

 

Clinic Evidence

  • Tenoxicam 20 mg per os once daily (po od) was compared to diclofenac 50 mg per os 3 times a day (po tid) in a 12-week, double blind, randomized, controlled, multicenter, parallel trial. The primary outcome measure was the pain dimension of the WOMAC OA Index. Following an initial screening visit and a 3 to 7 day NSAID-free washout period (i.e., baseline), patients were assessed at Weeks 2, 4 and 12; assessments including some 15 efficacy variables and safety variables. Ninety-eight patients [tenoxicam (n = 48), diclofenac (n = 50)] participated in the trial. Statistically significant (p < or = 0.05) improvements in all 3 dimensions of the WOMAC OA Index and six efficacy variables were noted in both treatment groups. No significant between drug differences were noted on any efficacy variable. Significantly fewer patients reported adverse events in the tenoxicam group (21 vs 33, p = 0.03). Tenoxicam is efficacious and well tolerated in patients with OA of the knee. In this group of patients, it was similar in efficacy and superior in tolerability to diclofenac 150 mg/day (50 mg tid). Thus, benefit/risk ratio of tenoxicam was superior than diclofenac.1

  • The efficacy and safety of tenoxicam was compared to that of piroxicam in 48 Nigerian patients with OA of knee or hips. Of these 31 females and 11 males, with a mean age of 52.5 +/- 11.0 years, were evaluated for comparable efficacy and tolerability. On fulfilling the selection criteria each patient was treated with either tenoxicam 20 mg or piroxicam 20 mg daily for six weeks. Efficacy was evaluated in terms of presence of pain (at rest, with mobility and after one day of normal activity), functional status and physician global assessment of therapeutic efficacy. Clinical efficacy was judged excellent or good in 82.3% of patients with tenoxicam and 76.0% with piroxicam. Tolerability was excellent or good in 88.2% of patients with tenoxicam and 60.0% with piroxicam. The incidence of adverse event was 15.8% with tenoxicam and 21.7% with piroxicam. Overall, when judged on various evaluation parameters, tenoxicam 20 mg/day appears to be more effective and better tolerated than piroxicam 20 mg/day.2

References

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