Tenoxicam

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Tenoxicam
Tenoxicam FormulaV1.svg
Clinical data
AHFS/Drugs.com International Drug Names
Routes of
administration 		Oral
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
  • UK: POM (Prescription only)
Pharmacokinetic data
Protein binding High
Elimination half-life 30–140 hours
Identifiers
  • (3E)-3-[hydroxy(pyridin-2-ylamino)methylene] -2-methyl-2,3-dihydro-4H-thieno[2,3-e] [1,2]thiazin-4-one 1,1-dioxide
CAS Number
PubChem CID
ChemSpider
UNII
KEGG
ChEBI
CompTox Dashboard (EPA)
ECHA InfoCard 100.149.365 OOjs UI icon edit-ltr-progressive.svg
Chemical and physical data
Formula C13H11N3O4S2
Molar mass 337.37 g·mol−1
Melting point 209 to 213 °C (408 to 415 °F) (dec.)
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Tenoxicam, sold under the brand name Mobiflex among others, is a nonsteroidal anti-inflammatory drug (NSAID). It is used to relieve inflammation, swelling, stiffness, and pain associated with rheumatoid arthritis, osteoarthritis, ankylosing spondylitis (a type of arthritis involving the spine), tendinitis (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). [1]

Contents

Tenoxicam belongs to the class of NSAIDs known as oxicams.

It was patented in 1974 by Roche and approved for medical use in 1987. [2] It is available as a prescription-only drug in the United Kingdom and other countries, but not in the US. Outside the United Kingdom, tenoxicam is also marketed under brand names including Tilatil, Tilcitin, and Alganex. [1] [3]

Contraindications

The drug is contraindicated for patients who are seniors who have been given anesthesia or surgery; are at risk of increased bleeding or kidney failure; have an active inflammatory disease involving the stomach or intestine (like ulcerative colitis); have an active stomach or intestinal ulcer; have had an acute asthmatic attack, hives, rhinitis (inflammation of the inner lining of the nasal passage), or other allergic reactions caused by aspirin or other nonsteroidal anti-inflammatory drugs (for example diclofenac, ibuprofen, indomethacin, naproxen). [4] [5]

Common side effects that have been observed with tenoxicam include peptic ulceration, dyspepsia, nausea, constipation, abdominal pain, diarrhea, rash, headache, edema, renal failure, and vertigo. [6] [5] [7] In rare cases, tenoxicam and other NSAIDs can contribute to thrombotic events, Stevens-Johnson Syndrome, and toxic epidermal necrolysis. [8] [9] [10]

Pregnancy and breastfeeding

It is not recommended that women who are trying to conceive, who are pregnant, or who are breastfeeding take tenoxicam. Tenoxicam can be taken in the first and second trimester when necessary, but it is a contraindication in the third trimester. Some studies have looked at whether or not NSAIDs are able to enter the breast milk and the first few studies have found evidence that NSAIDs can be found in breast milk. Therefore, it is not recommended that women take tenoxicam while breastfeeding. [6] [5] [7]

Interactions

Taking tenoxicam with other drugs can increase the chance of side effects or alter the therapeutic effect of tenoxicam or the other drug, depending on the combination. Drug types the tenoxicam may interact with include: other analgesic NSAIDs, salicylates such as aspirin, antacids, anticoagulants, cardiac glycosides, ciclosporin, quinolone antibiotics, lithium therapy, diuretics and anti-hypertensives, methotrexate, oral anti-diabetics, colestyramine, dextromethorphan, mifepristone, corticosteroids, anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs), tacrolimus, zidovudine, and gold/penicillamine. [6] [5] [7]

Mechanism of action

Like all NSAIDs, the exact mechanism of action of tenoxicam is unknown.[ dubious – discuss ] Involved in the mechanism of action is inhibition of cyclooxygenase (COX-1 and COX-2) which leads to the potential adverse effect of increased bleeding. [6]

Society and culture

Tenoxicam is sold in the form of 20 mg tablets with the price of treatment ranging from US$1.29–2.73 per tablet. [11] Recommended dosing calls for tenoxicam to be taken once daily with food. One week is the typical length for treatment, but the treatment length may be extended. [6]

In 2008, the reported sales level for Tilcotil (tenoxicam) was 70 million SEK (approximately US$10.5 million). [11] [12]

Research

The first members of the oxicam family of NSAIDs were brought to market in France in 1982. [13] Shortly thereafter, tenoxicam went to phase III clinical trials for approval as use as an analgesic began in the 1980s. The general consensus from clinical studies is that tenoxicam has about equal analgesic effect as other NSAIDs and does not elicit any important side effects. More recent clinical trials for tenoxicam are examining the use of tenoxicam independently and in combination with other drugs for more specialized analgesic purposes in surgical operations such as third molar extraction and labor pains. [14] [15] [16]

See also

Related Research Articles

<span class="mw-page-title-main">Aspirin</span> Medication

Aspirin, also known as acetylsalicylic acid (ASA), is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and/or inflammation, and as an antithrombotic. Specific inflammatory conditions which aspirin is used to treat include Kawasaki disease, pericarditis, and rheumatic fever.

<span class="mw-page-title-main">Nonsteroidal anti-inflammatory drug</span> Class of therapeutic drug for relieving pain and inflammation

Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of use, but largely include an increased risk of gastrointestinal ulcers and bleeds, heart attack, and kidney disease.

<span class="mw-page-title-main">Ibuprofen</span> Medication used for treating pain, fever, and inflammation

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to relieve pain, fever, and inflammation. This includes painful menstrual periods, migraines, and rheumatoid arthritis. It may also be used to close a patent ductus arteriosus in a premature baby. It can be used orally or intravenously. It typically begins working within an hour.

<span class="mw-page-title-main">Methotrexate</span> Chemotherapy and immunosuppressant medication

Methotrexate (MTX), formerly known as amethopterin, is a chemotherapy agent and immune-system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancies. Types of cancers it is used for include breast cancer, leukemia, lung cancer, lymphoma, gestational trophoblastic disease, and osteosarcoma. Types of autoimmune diseases it is used for include psoriasis, rheumatoid arthritis, and Crohn's disease. It can be given by mouth or by injection.

<span class="mw-page-title-main">Diclofenac</span> Nonsteroidal anti-inflammatory drug


Diclofenac, sold under the brand name Voltaren, among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammatory diseases such as gout. It is taken by mouth or rectally in a suppository, used by injection, or applied to the skin. Improvements in pain last for as much as eight hours. It is also available in combination with misoprostol in an effort to decrease stomach problems.

<span class="mw-page-title-main">Naproxen</span> Nonsteroidal anti-inflammatory drug (NSAID) used to treat pain

Naproxen, sold under the brand name Aleve among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain, menstrual cramps, inflammatory diseases such as rheumatoid arthritis, gout and fever. It is taken orally. It is available in immediate and delayed release formulations. Onset of effects is within an hour and lasts for up to twelve hours.

COX-2 inhibitors (coxibs) are a type of nonsteroidal anti-inflammatory drug (NSAID) that directly target cyclooxygenase-2, COX-2, an enzyme responsible for inflammation and pain. Targeting selectivity for COX-2 reduces the risk of peptic ulceration and is the main feature of celecoxib, rofecoxib, and other members of this drug class.

<span class="mw-page-title-main">Mefenamic acid</span> Chemical compound

Mefenamic acid is a member of the anthranilic acid derivatives class of nonsteroidal anti-inflammatory drugs (NSAIDs), and is used to treat mild to moderate pain.

<span class="mw-page-title-main">Piroxicam</span> Chemical compound

Piroxicam is a nonsteroidal anti-inflammatory drug (NSAID) of the oxicam class used to relieve the symptoms of painful inflammatory conditions like arthritis. Piroxicam works by preventing the production of endogenous prostaglandins which are involved in the mediation of pain, stiffness, tenderness and swelling. The medicine is available as capsules, tablets and as a prescription-free gel 0.5%. It is also available in a betadex formulation, which allows a more rapid absorption of piroxicam from the digestive tract. Piroxicam is one of the few NSAIDs that can be given parenteral routes.

<span class="mw-page-title-main">Ketorolac</span> Nonsteroidal anti-inflammatory drug (NSAID; analgesic)

Ketorolac, sold under the brand names Toradol, and Biorolac among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain. Specifically it is recommended for moderate to severe pain. Recommended duration of treatment is less than six days, and in Switzerland not more than two days. It is used by mouth, by nose, by injection into a vein or muscle, and as eye drops. Effects begin within an hour and last for up to eight hours.

Diclofenac/misoprostol, sold under the brand name Arthrotec, is a fixed-dose combination medication that contains:

<span class="mw-page-title-main">Diflunisal</span> NSAID analgesic and anti-inflammatory drug

Diflunisal is a salicylic acid derivative with analgesic and anti-inflammatory activity. It was developed by Merck Sharp & Dohme in 1971, as MK647, after showing promise in a research project studying more potent chemical analogs of aspirin. It was first sold under the brand name Dolobid, marketed by Merck & Co., but generic versions are now widely available. It is classed as a nonsteroidal anti-inflammatory drug (NSAID) and is available in 250 mg and 500 mg tablets.

<span class="mw-page-title-main">Deracoxib</span> NSAID analgesic veterinary drug

Deracoxib is a nonsteroidal anti-inflammatory drug (NSAID) of the coxib class, used in dogs to treat pain associated with osteoarthritis, or to prevent pain following orthopedic or dental surgery. It is available as beef-flavored tablets.

<span class="mw-page-title-main">Tolmetin</span> NSAID analgesic medication

Tolmetin is a nonsteroidal anti-inflammatory drug (NSAID) of the heterocyclic acetic acid derivative class.

<span class="mw-page-title-main">Meclofenamic acid</span> Chemical compound

Meclofenamic acid is a drug used for joint, muscular pain, arthritis and dysmenorrhea. It is a member of the anthranilic acid derivatives class of nonsteroidal anti-inflammatory drugs (NSAIDs) and was approved by the US FDA in 1980. Like other members of the class, it is a cyclooxygenase (COX) inhibitor, preventing the formation of prostaglandins.

<span class="mw-page-title-main">Oxicam</span> Drug class

Oxicam is a class of non-steroidal anti-inflammatory drugs (NSAIDs), meaning that they have anti-inflammatory, analgesic, and antipyretic therapeutic effects. Oxicams bind closely to plasma proteins. Most oxicams are unselective inhibitors of the cyclooxygenase (COX) enzymes. The exception is meloxicam with a slight (10:1) preference for COX-2, which, however, is only clinically relevant at low doses.

NSAIDhypersensitivity reactions encompass a broad range of allergic or allergic-like symptoms that occur within minutes to hours after ingesting aspirin or other NSAID nonsteroidal anti-inflammatory drugs. Hypersensitivity drug reactions differ from drug toxicity reactions in that drug toxicity reactions result from the pharmacological action of a drug, are dose-related, and can occur in any treated individual. Hypersensitivity reactions are idiosyncratic reactions to a drug. Although the term NSAID was introduced to signal a comparatively low risk of adverse effects, NSAIDs do evoke a broad range of hypersensitivity syndromes. These syndromes have recently been classified by the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity.

<span class="mw-page-title-main">Isoxicam</span> Withdrawn NSAID analgesic drug

Isoxicam is a nonsteroidal anti-inflammatory drug (NSAID) that was taken or applied to reduce inflammation and as an analgesic reducing pain in certain conditions. The drug was introduced in 1983 by the Warner-Lambert Company. Isoxicam is a chemical analog of piroxicam (Feldene) which has a pyridine ring in lieu of an isoxazole ring. In 1985 isoxicam was withdrawn from the French market, due to adverse effects, namely toxic epidermal necrolysis resulting in death. Although these serious side effects were observed only in France, the drug was withdrawn worldwide.

Prostaglandin inhibitors are drugs that inhibit the synthesis of prostaglandin in human body. There are various types of prostaglandins responsible for different physiological reactions such as maintaining the blood flow in stomach and kidney, regulating the contraction of involuntary muscles and blood vessels, and act as a mediator of inflammation and pain. Cyclooxygenase (COX) and Phospholipase A2 are the major enzymes involved in prostaglandin production, and they are the drug targets for prostaglandin inhibitors. There are mainly 2 classes of prostaglandin inhibitors, namely non- steroidal anti- inflammatory drugs (NSAIDs) and glucocorticoids. In the following sections, the medical uses, side effects, contraindications, toxicity and the pharmacology of these prostaglandin inhibitors will be discussed.

<span class="mw-page-title-main">Antiarthritics</span> Drug class

An antiarthritic is any drug used to relieve or prevent arthritic symptoms, such as joint pain or joint stiffness. Depending on the antiarthritic drug class, it is used for managing pain, reducing inflammation or acting as an immunosuppressant. These drugs are typically given orally, topically or through administration by injection. The choice of antiarthritic medication is often determined by the nature of arthritis, the severity of symptoms as well as other factors, such as the tolerability of side effects.

References

  1. 1 2 "Medicines A-Z - Tenoxicam". NHS. Retrieved July 3, 2015.
  2. ↑ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 519. ISBN   9783527607495.
  3. ↑ "Drugs.com international listings for Tenoxicam". Drugs.com. Retrieved July 3, 2015.
  4. ↑ NHS Patient warnings Page accessed July 3, 2015
  5. 1 2 3 4 "Mobiflex Tablets 20mg - Summary of Product Characteristics (SPC) - (eMC)". www.medicines.org.uk. Retrieved 2015-12-07.
  6. 1 2 3 4 5 "Incepta Pharmaceuticals | Product details". www.inceptapharma.com. Retrieved 2015-12-07.
  7. 1 2 3 Tilcotil. (2010). New Zealand Consumer Medicine Information. http://www.medsafe.govt.nz/consumers/cmi/t/tilcotil.pdf
  8. ↑ Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bouwes Bavinck JN, et al. (January 2008). "Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study". The Journal of Investigative Dermatology. 128 (1): 35–44. doi: 10.1038/sj.jid.5701033 . PMID   17805350.
  9. ↑ Harr T, French LE (December 2010). "Toxic epidermal necrolysis and Stevens-Johnson syndrome". Orphanet Journal of Rare Diseases. 5 (1): 39. doi: 10.1186/1750-1172-5-39 . PMC   3018455 . PMID   21162721.
  10. ↑ "Assessment report for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and cardiovascular risk" (PDF). European Medicines Agency. 18 October 2012.
  11. 1 2 "Tenoxicam 20 mg Price Comparisons - Online Pharmacies and Discount Coupons". www.pharmacychecker.com. Retrieved 2015-12-07.
  12. ↑ "Exchange Rate Average (Swedish Krona, US Dollar) - X-Rates". www.x-rates.com. Retrieved 2015-12-07.
  13. ↑ Penso D, Roujeau JC, Guillaume JC, Revuz J, Touraine R (February 1986). "Toxic epidermal necrolysis after oxicam use". Journal of the American Academy of Dermatology. 14 (2 Pt 1): 275–276. doi:10.1016/s0190-9622(86)80342-5. PMID   3485122.
  14. ↑ "Search of: tenoxicam - List Results - ClinicalTrials.gov". www.clinicaltrials.gov. Retrieved 2015-12-07.
  15. ↑ Ilhan O, Agacayak KS, Gulsun B, Koparal M, Gunes N (January 2014). "A comparison of the effects of methylprednisolone and tenoxicam on pain, edema, and trismus after impacted lower third molar extraction". Medical Science Monitor. 20: 147–152. doi:10.12659/MSM.890239. PMC   3915002 . PMID   24473372.
  16. ↑ Mathias Filho AP, Sidi A (1985). "Long-term study with Ro 12-0068 (tenoxicam) in the treatment of rheumatoid arthritis". European Journal of Rheumatology and Inflammation. 8 (1): 3–8. PMID   3915886.
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