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The EMEA has recommended restrictions on the use of piroxicam-containing medicinal products due to the risk of gastrointestinal side-effects and serious skin reactions.
The agency concluded that piroxicam should no longer be used for treatment of short-term painful and inflammatory conditions. Piroxicam can still be prescribed for symptomatic relief of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis, but should not be the first choice of nonsteroidal anti-inflammatory drug (NSAID) treatment in these conditions.
It is advised that prescription of piroxicam should always be initiated by a physician experienced in treating patients with inflammatory or degenerative rheumatic diseases, and treatment should be used in the lowest dose (no more than 20mg/day) and for the shortest duration possible. In any case, the treatment should be reviewed after 14 days of starting.
The CHMP also recommended new contraindications and strengthened warnings for piroxicam.
A full assessment of piroxicam
