Oxicam

Oxicam is a subclass of nonsteroidal anti-inflammatory drugs (NSAIDs) that share a common chemical structure and are used to treat pain and inflammation. The class includes drugs such as piroxicam, meloxicam, tenoxicam, lornoxicam, and sudoxicam. Oxicams inhibit the activity of cyclooxygenase enzymes (COX-1 and COX-2), leading to decreased synthesis of prostaglandins that mediate inflammation, pain, and fever. They differ in their degree of COX-1 versus COX-2 inhibition; for example, meloxicam is relatively COX-2 selective at typical therapeutic doses, while piroxicam is generally non-selective.

Clinical use: Oxicams are used for symptomatic relief in rheumatic diseases such as osteoarthritis and rheumatoid arthritis and may be employed for other musculoskeletal conditions. Dosing and choice of agent depend on efficacy, tolerability, and patient factors, with attention to balancing anti-inflammatory benefit against gastrointestinal and cardiovascular risks.

Pharmacokinetics: Most oxicam NSAIDs are taken orally and have good bioavailability. They are largely protein-bound, undergo hepatic metabolism, and are excreted mainly via the kidneys and, to a lesser extent, in feces. Some oxicams have relatively long durations of action, allowing less frequent dosing for certain drugs.

Adverse effects and safety: Common NSAID-associated adverse effects include gastrointestinal irritation, dyspepsia, gastritis, and risk of peptic ulcers and GI bleeding; renal function can be affected; hepatic impairment is possible; hypersensitivity reactions may occur. Caution is advised in older adults, those with a history of GI disease, renal or hepatic impairment, or concurrent anticoagulants or other NSAIDs. They are generally contraindicated in active peptic ulcer disease and severe renal impairment, and use in pregnancy is carefully considered.

History: The oxicam class has been in medical use since the late 20th century, and its members are still employed where appropriate based on individual risk–benefit profiles.