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Piroxicam is a non-steroidal anti-inflammatory agent used in musculoskeletol and joint disorders .

Piroxicam is well absorbed from the gastro-intestinal tract; peak plasma concentrations area reached 3 to 5 hours after oral dose. It is metabolised in the liver by hydrosylation and conjugation with glucuronic acid and excreted predominantly in the urine with smaller amounts in the faeces. Enterohepatic recycling occurs. Less than 5 % of the dose is excreated unchanged. Piroxicam is extensively bound to plasma proteins (about 99%) and has a long plasma half-life of approximately 50 hours. ADVERSE EFFECTS The most frequent adverse effect occuring with Piroxicam are local irritation and erythema , pruritus, dermatitis, photosensitivity. Oedema, Vomiting, Nausea, Heartburn, Epigastric distress, tinnitus, skin rash. A report of the adverse reactions associated with piroxicam received by the Medicines Safety Centre in South Africa including two reactions, paraesthesia and hair loss, not previously recorded in the literature - Gerver D. Adverse reaction of piroxicam. Drug intell din Pharm 1987 ; 21: 707-10

EFFECT ON SKIN; As with other NSAIDs, rash has occurred in patients taking piroxicam. Phototoxic reactions have been described, Seroius skin reaction attributed to piroxicam therapy include toxic epidermal necrolysis and pemphigus vulgaris. EFFECTS ON THE BLOOD : Decrease in haemoglobin and haematocrit not associated with obvious gastro-intestinal bleeding, have occurred in patients taking piroxicam. Thrombocytopenia, thrombocytopenic purpura and aplastic anaemia have been described in patients on piroxicam.

EFFECTS ON THE ELECTROLYTES : Reversible hyperkalaemic hyperchloraemic acidosis in patients receiving piroxicam.

EFFECTS ON GASTRO-INTESTINAL TRACT ; In the past it has been suggested that piroxicam may have a higher incidence of gastrointestinal adverse effects than other NSAIDs. However, while the commonest side effects of piroxicam are indeed gastro-intestinal, it would appear from the present evidence that the overall incidence of such reactions is not appreciably higher with piroxicam than with other non-steroidal anti- inflammatory agents.

EFFECTS ON KIDNEYS ; Acute nephropathy with characteristic features of Henoch-Schonlein purpura, acute renal failure, uraemia with hyperkalaemia, and acute intestinal nephritis have been associated with piroxicam. EFFECTS ON LIVER: A report of a patient who presented with features of acute hepatocellular injury after taking piroxicam 40 mg daily for 3 days; the liver disorder progressed to subacute hepatic necrosis and the patient died. DRUG INTERACTION : Anticoagulants : Potentiation. Diuretics : Increased risk of renal damage. Aspirin : Reduces serum piroxicam. Corticosteroids, oral anticoagulants and NSAIDs : Increased risk of bleeding. Lithium : Incresed serum lithium, Antihypertensives : reduces the beneficial effects pf piroxicam. OVERDOSAGE mx Emesis, Gastric lavage, Activated Charcoal. Monitor vital functions. General supportive and symptomatic treatment.