Piroxicam beta-cyclodextrin

Oral
Ankylosing spondylitis, Osteoarthritis, Rheumatoid arthritis

Hypersensitivity or asthma-type reactions to piroxicam, aspirin or other NSAIDs. History or active GI ulceration, bleeding and perforation; history of GI disorders that predispose to bleeding disorders (e.g. ulcerative colitis, Crohn’s disease, GI cancers or diverticulitis). Treatment of perioperative pain in the setting of CABG surgery. Concomitant use w/ aspirin, other NSAIDs and anticoagulants.

Patient w/ uncontrolled HTN, CHF, established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, risk factors for CV disease, cardiac impairment, history of bronchial asthma. Elderly. Renal and hepatic impairment. Pregnancy and lactation.

Ulcerative stomatitis, anorexia, epigastric or abdominal discomfort or pain, nausea, constipation, flatulence, diarrhoea, vomiting, dyspepsia, melaena, haematemesis; non-specific allergic reactions, asthma, aggravated asthma, bronchospasm, dyspnoea, photosensitivity reactions; interstitial nephritis, glomerulo-nephritis, nephrotic syndrome, renal failure; thrombocytopenia, non-thrombocytopenic purpura, leucopenia, eosinophilia; increased transaminase levels, jaundice; oedema, HTN, cardiac failure; dizziness, headache, somnolence, insomnia, depression, nervousness, hallucinations, mood alterations, dream abnormalities, mental confusion, paraesthesias, vertigo, visual disturbances, optic neuritis, tinnitus, malaise, fatigue, drowsiness, palpitations, hypoglycaemia, wt increase/decrease, positive antinuclear antibodies, hearing impairment.
Potentially Fatal: GI bleeding, ulceration and perforation, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, hepatitis, arterial thrombotic events (e.g. MI or stroke).

Parenteral/PO: Z (NSAIDs caused foetal ductus arteriosus premature closure, foetal renal impairment and persistent pulmonary hypertension. Avoid near term, else use lowest dose for shortest time.)

Symptoms: Headache, vomiting, drowsiness, dizziness and fainting. Management: Supportive and symptomatic treatment including gastric lavage and the use of activated charcoal to reduce absorption. Correction of severe electrolyte abnormalities may be considered.

May reduce the effect of antihypertensive drugs. May interfere w/ the natriuretic effect of diuretics. May increase plasma levels of cardiac glycoside. May displace other protein bound drugs (e.g. sulfonamides, hydantoins). Increased risk of GI bleeding w/ anti-platelet agents and SSRIs. May decrease the elimination of lithium. Increased risk of convulsions associated w/ quinolones. May reduce the effect of mifepristone. May decrease the elimination of methotreaxate. May increase ciclosporin nephrotoxicity. Increased risk of GI ulceration or bleeding w/ corticosteroids. Reduced metabolism and elimination w/ probenecid. May inhibit the metabolism of sulfonylureas resulting to increased risk of hypoglycaemia.
Potentially Fatal: May enhance the effect of anticoagulants (e.g. warfarin). Increased risk of adverse effects, particularly GI effects w/ aspirin and other NSAIDs.

Description:
Mechanism of Action: Piroxicam β-cyclodextrin is the product of supermolecular encapsulation of piroxicam w/ the cyclic oligosaccharide β-cyclodextrin. Its action as an analgesic is more rapid than standard piroxicam.
Pharmacokinetics:
Absorption: More rapidly absorbed than unmodified piroxicam. Time to peak plasma concentration: 30-60 min.
Metabolism: Converted to various sugars in the colon.
Excretion: Plasma half-life: Approx 50 hr.

Source: National Center for Biotechnology Information. PubChem Database. Piroxicam-beta-cyclodextrin, CID=54697648, https://pubchem.ncbi.nlm.nih.gov/compound/Piroxicam-beta-cyclodextrin (accessed on Jan. 22, 2020)

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Dolci G, Ripari M, Pacifici L, Umile A. Analgesic Efficacy and the Tolerance for Piroxicam-Beta-Cyclodextrin Compared to Piroxicam, Paracetamol and Placebo in the Treatment of Postextraction Dental Pain. Minerva Stomatol. 42(5). Accessed 24/11/2014. PMID: 8413108

Buckingham R (ed). Piroxicam. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/11/2014.