FELVIN 20 CAPSULES

Indications

• Rheumatoid arthritis
• Osteoarthritis
• Ankylosing spondylitis
• Pain relief in musculoskeletal conditions

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing information.

Adults: Up to 20 mg once daily, or apply 0.5% gel 3-4 times a day.

Mechanism of action

Piroxicam exerts its anti-inflammatory effects primarily through the reversible inhibition of cyclooxygenase (Cox-1), resulting in decreased synthesis of prostaglandins. This inhibition leads to reduced inflammation and pain. Additionally, Piroxicam inhibits leukocyte migration to sites of inflammation and prevents the formation of thromboxane A2, which is involved in platelet aggregation.

Pharmacodynamics

As an NSAID, Piroxicam reduces hormones that promote inflammation and pain in the body. Its efficacy is particularly noted in alleviating symptoms associated with rheumatoid arthritis and osteoarthritis, thereby improving patient mobility and quality of life.

Pharmacokinetics

Piroxicam is well absorbed from the gastrointestinal tract and reaches peak plasma concentrations within 1 to 2 hours after oral administration. It has a long half-life, allowing for once-daily dosing. Piroxicam is extensively metabolized in the liver and primarily excreted through the urine. The pharmacokinetics may be affected in patients with liver impairment or those taking other medications that influence hepatic metabolism.

Contra-indications

• Active gastrointestinal bleeding
• Active gastrointestinal ulceration
• History of gastrointestinal bleeding
• History of gastrointestinal perforation
• History of gastrointestinal ulceration
• Severe heart failure
• History of renal disease
• Patients with connective tissue disorders who may be especially susceptible

Adverse effects

• Anaemia
• Decreased appetite
• Constipation
• Diarrhoea
• Dizziness
• Drowsiness
• Eosinophilia
• Headache
• Hyperglycaemia
• Leucopenia
• Oedema
• Rash (discontinue if occurs)
• Thrombocytopenia
• Tinnitus
• Vertigo
• Vomiting
• Weight changes
• Hypoglycaemia
• Palpitations
• Stomatitis
• Blurred vision
• Nephritis
• Tubulointerstitial nephritis
• Renal failure
• Alopecia
• Angioedema
• Aplastic anaemia
• Confusion
• Depression
• Embolism and thrombosis
• Eye irritation
• Eye swelling
• Fertility decreased in females
• Fluid retention
• Hallucination
• Hearing impairment
• Hepatic disorders

Interactions

• Other NSAIDs
• Proton pump inhibitors
• Anticoagulants
• Diuretics
• Antihypertensives

Precautions

• Caution in elderly patients
• Caution in patients with dehydration
• Caution in patients at risk of NSAID-associated duodenal or gastric ulcers
• Monitor renal function in patients with a history of renal impairment

Pregnancy

Piroxicam should be avoided during pregnancy, especially in the third trimester, due to potential adverse effects on fetal development and labor.

Breast-feeding

Piroxicam is excreted in breast milk; caution is advised when administering to nursing mothers.

Storage

Store below 25 degrees Celsius. Keep the container tightly closed and protect from moisture.

Mechanism of action

The antiinflammatory effect of Piroxicam may result from the reversible inhibition of cyclooxygenase, causing the peripheral inhibition of prostaglandin synthesis. The prostaglandins are produced by an enzyme called Cox-1. Piroxicam blocks the Cox-1 enzyme, resulting into the disruption of production of prostaglandins. Piroxicam also inhibits the migration of leukocytes into sites of inflammation and prevents the formation of thromboxane A2, an aggregating agent, by the platelets.

Pharmacodynamics

Piroxicam is in a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Piroxicam works by reducing hormones that cause inflammation and pain in the body. Piroxicam is used to reduce the pain, inflammation, and stiffness caused by rheumatoid arthritis and osteoarthritis.