Topical Piroxicam Research Articles

Formulation and evaluation of topical piroxicam microemulgel for arthritis

Background: Piroxicam is an anti-inflammatory, analgesic, and antipyretic drug. Piroxicam is widely used in the management of chronic pain. The objective of this work was to develop and analyze topical Piroxicam microemulgel to improve drug solubility, enhance permeation, reduce GIT side effects reduce the frequency of the drug. Method: The Piroxicam microemulgel was prepared by drawing the pseudo ternary phase picture and water titration procedure. Formulation was prepared by using isopropyl myristate as an oil, Tween 80 as an surfactant, n-butanol as Co-surfactant and water. It was converted to gel by using 1% Carbopol 940 and few drops of ethanolamine. The prepared formulation was characterized for thermodynamic stability, pH, droplet size, viscosity, FTIR,DSC, electrical conductivity, dye solubility drug content, and in-vitro release using a Franz diffusion cell. Result: Microemulgel formulation was thermodynamically stable on visual inspection after being treated with a freeze-thaw cycle and centrifugation. pH of formulation was 6.5. The mean droplet size for ME gel was 100±0.472nm. The viscosity of the microemulgel was 90.4±0.01 cps which showed Newtonian flow. FTIR and DSC studies showed that microemulgel was compatible with its excipients. Electrical conductivity and dye solubility testing confirmed that the microemulgel was O/W. Piroxicam microemulsion gel showed 89.89% drug content and the release rate of piroxicam was 98±8.63% after 48h. It followed the Korsmeyer Pappas model which means it was a hydrogel-based system. Conclusion: Microemulsion gel formulation obtained remarkably inflated skin retention for piroxicam over the piroxicam gel. It might act as a promising vehicle for the topical delivery of poor water-soluble drugs.

Formulation and evaluation of topical piroxicam microemulgel for arthritis

Background: Piroxicam is an anti-inflammatory, analgesic, and antipyretic drug. Piroxicam is widely used in the management of chronic pain. The objective of this work was to develop and analyze topical Piroxicam microemulgel to improve drug solubility, enhance permeation, reduce GIT side effects reduce the frequency of the drug. Method: The Piroxicam microemulgel was prepared by drawing the pseudo ternary phase picture and water titration procedure. Formulation was prepared by using isopropyl myristate as an oil, Tween 80 as an surfactant, n-butanol as Co-surfactant and water. It was converted to gel by using 1% Carbopol 940 and few drops of ethanolamine. The prepared formulation was characterized for thermodynamic stability, pH, droplet size, viscosity, FTIR,DSC, electrical conductivity, dye solubility drug content, and in-vitro release using a Franz diffusion cell. Result: Microemulgel formulation was thermodynamically stable on visual inspection after being treated with a freeze-thaw cycle and centrifugation. pH of formulation was 6.5. The mean droplet size for ME gel was 100±0.472nm. The viscosity of the microemulgel was 90.4±0.01 cps which showed Newtonian flow. FTIR and DSC studies showed that microemulgel was compatible with its excipients. Electrical conductivity and dye solubility testing confirmed that the microemulgel was O/W. Piroxicam microemulsion gel showed 89.89% drug content and the release rate of piroxicam was 98±8.63% after 48h. It followed the Korsmeyer Pappas model which means it was a hydrogel-based system. Conclusion: Microemulsion gel formulation obtained remarkably inflated skin retention for piroxicam over the piroxicam gel. It might act as a promising vehicle for the topical delivery of poor water-soluble drugs.

Time to consider topical capsaicin for acute trauma pain?

Topical capsaicin is more effective than topical piroxicam at reducing pain in acute upper extremity injuries.

Topical Piroxicam Gel versus Satureja khuzestanica Jamzad 3% Ointment for Pain Relief in Patients with Osteoarthritis of the Knee; A Randomized Controlled Trial

Background: Osteoarthritis (OA) is a common disease without definite and exact treatment. Interventions such as chemical drugs, physiotherapy, and even surgery are suggested for treatment. Herbal medicine, which is currently very popular, has also been suggested for treatment because of fewer side effects, low cost, and the possibility to use it topically home. Satureja khuzestanica jamzad, the native plant of Lorestan and Khuzestan, is known for its analgesic effects. Objective: We aimed to compare the effect of Satureja khuzestanica jamzad 3% ointment with piroxicam gel for pain relief in patients with knee osteoarthritis. Methods: 70 patients with mild to moderate knee OA were randomly divided into experimental groups (essential oil extract of Satureja khuzestanica jamzad 3% or piroxicam gel). The severity of pain was recorded at baseline, and after one and two weeks by visual analogue scale. ANOVA was used for data analysis and the effect size was computed by Cohen’s d. Results: Reduction of pain was seen in both groups and group comparisons also showed a significant difference (P<0.05). The more effect size was detected in the group receiving Satureja khuzestanica jamzad 3% ointment compared with the piroxicam group. Conclusion: The topical use of Satureja khuzestanica jamzad 3% essential oil is a good choice to reduce pain in patients with knee OA. It may be used as a drug in phonophoresis.

Patient-reported outcomes of topical therapies in actinic keratosis: A systematic review.

Patients' perspectives on actinic keratosis treatments may have an impact on treatment adherence and, therefore, therapeutic outcomes. We performed a systematic review to assess patients' perspectives of topical, field‐directed treatments for actinic keratoses. A literature search was conducted, and 14 studies were identified encompassing 4433 patients. Only four studies were focused on face and/or scalp, which are the locations that typically impact patients' quality of life. Four studies were clinical trials. One study utilized a validated patient‐reported outcomes (PRO) instrument specifically developed for actinic keratosis. In general, treatment adherence and patient satisfaction were better with shorter‐duration treatment regimens such as ingenol mebutate gel. Imiquimod improved quality of life in one study but not in another. No data was available on topical piroxicam. The findings underscore the need for effective and well‐tolerated, short‐duration topical treatment for actinic keratosis.

Comparison of ibuprofen and piroxicam gel in the treatment of trauma pain: A randomized double-blind trial of geriatric population

ObjectiveThis study aimed to compare the analgesic efficacy of topical ibuprofen and topical piroxicam for acute musculoskeletal injuries. MethodsIn this prospective, randomized, controlled, double-blinded study, geriatric patients were assigned to groups to receive either topical ibuprofen (n = 70) or topical piroxicam (n = 69). The first dose of gel was applied in the emergency department and the remaining doses were self-administered at home by the patients thrice daily for 72 h. For each patient, the initial baseline visual analog scale (VAS) score (V 0) was compared with the VAS scores at the 60 min (V1), 120 min (V2), 24 h (V3) and 72 h (V4) time points. The decreases in VAS scores, clinical effectiveness of the treatments, and incidence of adverse events were evaluated. ResultsIn the topical ibuprofen group, the VAS scores were significantly lower at each measurement time point compared to baseline (p < .001). The results were as follows: V0 –V: 1.08, 95% CI: 0.56–1.61; V0 –V2: 1.09, 95% CI: 0.49–1.69; V0 –V3: 1.44, 95% CI: 0.81–2.07; V0 –V4: 1.59, 95% CI: 0.91–2.26. The mean percentage decrease in the VAS scores in the topical ibuprofen group was significantly higher than that in the topical piroxicam group (p < .001). The clinical effect of treatment was found to be significantly higher for the ibuprofen gel group (p < .001). There was no substantial difference in treatment-related adverse events between the groups (p > .05). ConclusionIbuprofen gel, which is a safe treatment option for geriatric patients, is more clinically effective than piroxicam gel. Response to Reviewers:

Comparison of topical capsaicin and topical piroxicam in the treatment of acute trauma-induced pain: A randomized double-blind trial

BackgroundThis study aimed to compare the analgesic efficacy of topical capsaicin and topical piroxicam in acute musculoskeletal injuries. MethodsThis is a prospective, randomized, controlled, double-blinded study. The data for the 67 patients in the piroxicam group and the 69 in the capsaicin group were examined. The initial visual analog scale (VAS) scores were compared with the 60th and 120th minute as well as the 24th and 72nd hour values. Differences between the VAS scores, clinical effectiveness of the treatment and side effects were evaluated. ResultsIn the capsaicin group, the mean difference in the delta VAS scores was significantly higher at each measurement time. The mean of the percentage of reduction in the VAS scores of the topical capsaicin group was significantly higher than that in the topical piroxicam group. The highest difference in terms of both outcomes was determined at the 72nd hour VAS change. Mean differences were 1.53 (95% CI: 0.85–2.221) and 19.7 (95% CI: 12.4–27.2) respectively (p < 0.001). In the capsaicin group, the clinical effect of the treatment was found significantly higher (p < 0.01). The difference between the clinical effectiveness of the groups regarding the treatment outcomes was also statistically significant (p < 0.001). There was no significant difference between the patient groups regarding the presence of side effects. ConclusionTopical capsaicin can be used as an alternative to topical piroxicam initially and at follow-up in patients presenting to the emergency department with acute pain as there were no observable differences in side-effects between the two groups.

Effects of topical piroxicam and sun filters in actinic keratosis evolution and field cancerization: a two-center, assessor-blinded, clinical, confocal microscopy and dermoscopy evaluation trial

Background: Actinic keratosis (AK) is considered an “in situ” non-melanoma skin cancer induced by ultraviolet chronic exposure. Sunscreen and topical anti-inflammatory agents like diclofenac could improve the evolution of this kind of lesions. A topical product containing piroxicam 0.8% and sun filters (50 SPF) (ACTX) has been shown to be very effective in reducing AK lesions. So far, no data are available regarding the effects of this product on skin modifications evaluated by reflectance confocal microscopy (RCM) and dermoscopy at the lesion sites and on the skin around the lesions (field cancerization).Study aim: To evaluate in a two-center, assessor-blinded, prospective trial the effect of ACTX on AK number, RCM and dermoscopy parameter evolution of a target lesion in subjects with multiple AK lesions.Subjects and methods: A total of 54 subjects (42 men and 12 women; mean age 65 years) with AK lesions grade I–III located on the scalp (n = 36) or face (n = 18) were enrolled after their written informed consent. ACTX was applied twice daily on the face and scalp for six consecutive months. AK lesion count was performed at baseline and after 3 and 6 months. Lesion count was assessed in a blind fashion evaluating digital color high definition images performed at each visit and coded in a blinded fashion. RCM evaluations were performed at the same time-points. A dermoscopy evaluation was performed at baseline and after 6 months. RCM and dermoscopy were assessed on a pre-specified target lesion. The RCM severity score was used evaluating 11 items, examining stratum corneum, stratum granulosum, stratum spinous and dermal layers (maximum score 11 points). The dermoscopy score evaluated erythema, scaling and follicular plugs (from 0 to 4 for each item) and pigmentation (from 0 to 5).Results: Forty-nine subjects (90%) concluded the trial. At baseline, the mean (SD) number of AK lesions was 9.6 (5.2). AK lesions significantly decreased to 5.9 and to 5.6 after 3 and 6 months of ACTX treatment (p = .001; intention to treat analysis), representing a −42% reduction. A reduction of AK lesion numbers >50% in comparison with baseline was observed in 51% of subjects at month 6. New AK lesions appeared in five subjects (9%). The RCM mean (SD) severity score at baseline was 6.4 (2.0). ACTX treatment was associated with a progressive and significant (p = .002) reduction to 4.9 after 3 months and to 4.8 (2.3) at month 6 (a −25% reduction). The dermoscopy score at baseline was 5.5 (2) and it was reduced significantly (p = .007) to 4.5 (2) at the end of the study. The product was in general very well tolerated.Conclusion: A 6 month application of ACTX in subjects with AK lesions was associated with an improvement in AK lesion count and with a reduction in the RCM/dermoscopy severity scores of the target lesion.Trial registration number: ISRCTN22070974.

Effects of topical 0.8% piroxicam and 50+ sunscreen filters on actinic keratosis in hypertensive patients treated with or without photosensitizing diuretic drugs: an observational cohort study.

BackgroundPhotosensitizing diuretics use (especially thiazide compounds) is associated with a significantly higher risk of squamous cell carcinoma (SCC). Actinic keratosis (AK) is a precursor of SCC.Study aimTo evaluate in a prospective cohort study the efficacy of topical piroxicam 0.8% and sunscreen 50+ (ACTX) in the treatment of AK in hypertensive subjects with or without TD treatment.Subjects and methodsA total of 119 hypertensive subjects with multiple AK (39 under chronic TD treatment; and 80 treated with other non-TD, non-photosensitizing antihypertensive drugs) were enrolled after their informed consent in a 6-month observational cohort study. All the subjects were treated with ACTX twice daily. The primary endpoint was the evolution of AK lesions at baseline, after 3 and 6 months. The secondary endpoint was the clearance of AK target lesions and field of cancerization by dermoscopic evaluation using a score evaluating erythema, scaling, pigmentation, and follicular plugs (ESPFP score; ranging from 0 to 20). An investigator, unaware of the type of antihypertensive treatments (TD or non-TD), performed all the clinical and dermoscopy evaluations.ResultsAt baseline, AK mean (SD) lesion number in TD group was 14.1(4) and 14.6(4) in the non-TD group. ESPFP mean (SD) score at baseline was 5.8(1.2) in both groups. A significant reduction of AK lesions in comparison with baseline was observed in both groups. A statistically significant greater reduction was observed in TD in comparison with the non-TD group (−54% vs −32%). ESPFP score was reduced in a higher proportion in the TD group in comparison with the non-TD group (−60% vs −37%, respectively). ACTX treatment was very well tolerated.ConclusionIn hypertensive subjects with multiple AK, the topical use of ACTX is associated with a significant reduction of lesions count with an improvement in the field cancerization. The clinical efficacy is more pronounced in subjects under thiazide diuretics treatment.

Efficacy of Piroxicam Patch Compared to Lidocaine Patch for the Treatment of Postherpetic Neuralgia

The lidocaine patch has been effectively used as a first-line therapy to treat neuropathic pain such as postherpetic neuralgia (PHN). To evaluate the safety and efficacy of the topical piroxicam patch as a treatment option for the treatment of PHN. Eighteen patients completed a 3-session study, applying three different patches (lidocaine, piroxicam and control) in random order. A maximum of three patches were applied to the most painful area for three consecutive days (12 hours on followed by 12 hours off). Each session was conducted at least seven days apart. The changes in visual analog scale (VAS) scores based pain intensity, quality of sleep and adverse effects were recorded. When compared to the control, both the lidocaine and piroxicam patches significantly reduced the mean VAS scores of pain intensity of all different types. However, the lidocaine patch was better at reducing allodynia, whereas the piroxicam patch was more effective for dull pain. The lidocaine patch worked faster than the piroxicam patch for the response to overall pain relief. The results of this study suggest the use of the piroxicam patch for dull pain and in patients where the lidocaine patch is contraindicated.

Topical piroxicam in vitro release and in vivo anti-inflammatory and analgesic effects from palm oil esters-based nanocream

IntroductionDuring recent years, there has been growing interest in use of topical vehicle systems to assist in drug permeation through the skin. Drugs of interest are usually those that are problematic when given orally, such as piroxicam, a highly effective anti-inflammatory, anti-pyretic, and analgesic, but with the adverse effect of causing gastrointestinal ulcers. The present study investigated the in vitro and in vivo pharmacodynamic activity of a newly synthesized palm oil esters (POEs)-based nanocream containing piroxicam for topical delivery.MethodsA ratio of 25:37:38 of POEs: external phase: surfactants (Tween 80:Span 20, in a ratio 80:20), respectively was selected as the basic composition for the production of a nanocream with ideal properties. Various nanocreams were prepared using phosphate-buffered saline as the external phase at three different pH values. The abilities of these formulae to deliver piroxicam were assessed in vitro using a Franz diffusion cell fitted with a cellulose acetate membrane and full thickness rat skin. These formulae were also evaluated in vivo by comparing their anti-inflammatory and analgesic activities with those of the currently marketed gel.ResultsAfter eight hours, nearly 100% of drug was transferred through the artificial membrane from the prepared formula F3 (phosphate-buffered saline at pH 7.4 as the external phase) and the marketed gel. The steady-state flux through rat skin of all formulae tested was higher than that of the marketed gel. Pharmacodynamically, nanocream formula F3 exhibited the highest anti- inflammatory and analgesic effects as compared with the other formulae.ConclusionThe nanocream containing the newly synthesized POEs was successful for trans-dermal delivery of piroxicam.

A clinical comparison of topical piroxicam and EMLA cream for pain relief and inflammation in laser hair removal

The aim of this study was to compare the efficacy of topical piroxicam and EMLA cream on pain control and subsequent inflammation in neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064 nm laser hair removal in female volunteers. Fifty female volunteers were enrolled in this prospective, randomized, double-blind, clinical study over a 6-month period. Patients were randomly assigned to receive topical piroxicam as group Piroxicam or EMLA cream as group EMLA. Topical analgesics were applied to the treatment sites for 60 min. The pain scores [on a visual analog scale (VAS)] and side effects were recorded before the hair removal, during the hair removal, at the end of the hair removal, and 1 h, 2 h and 24 h after the hair removal. Patients' characteristics and the treatment settings of the Nd:YAG 1,064 nm laser were similar in the two groups. The pain scores (VAS) were similar, and satisfaction was high in both groups after the hair removal. The number of blanching and erythema episodes were significantly higher in group E than in group P (P < 0.001). Inflammatory side effects were less frequent in group P than in group E after the procedure (P < 0.001). This study showed that topical piroxicam and EMLA provided adequate and similar pain relief after Nd:YAG 1,064 nm laser hair removal in female volunteers. Topical piroxicam was associated with fewer inflammatory side effects than was EMLA cream, because of its anti-inflammatory effect after the procedure.

Latest news and product developments

Latest news and product developments

Piroxicam gel, compared to EMLA cream is associated with less pain after venous cannulation in volunteers

To evaluate and compare the analgesic efficacy and anti-inflammatory effects of topical piroxicam gel vs eutectic mixture of local anesthetic (EMLA) cream applied to the peripheral venous cannulation site in adult volunteers. Piroxicam gel and EMLA cream were randomly applied on the dorsum of the right and left hand of ten volunteers who acted as their own control. A venous cannula was inserted (no iv infusion) and removed after one hour. Pain scores and signs of inflammation were noted at the cannulation site up to 48 hr. Pain scores with piroxicam gel were higher on cannulation and on advancement of the cannula (P < 0.05). Thereafter, pain scores were significantly higher with EMLA (P < 0.05). Blanching was present at all the peripheral venous sites treated with EMLA cream. Signs of inflammation (erythema, edema) were not more frequent with EMLA than with piroxicam (P > 0.05). Induration was more frequent with EMLA at six hours. In volunteers EMLA cream is associated with less pain on cannulation and cannula advancement compared to piroxicam gel. Topical application of piroxicam gel before peripheral venous cannulation alleviates pain and, possibly, inflammation in the period subsequent to cannulation itself.

Willingness to pay for topical flurbiprofen vs piroxicam

Willingness to pay for topical flurbiprofen vs piroxicam

Willingness to pay for topical flurbiprofen vs piroxicam

Willingness to pay for topical flurbiprofen vs piroxicam

Preoperative application of piroxicam gel compared to a local anaesthetic field block for postoperative analgesia

The non-steroidal anti-inflammatory drugs inhibit prostaglandin synthesis and hence have an analgesic action. Following topical administration, the drug is concentrated in the tissues and so can have a local analgesic effect. This study investigated the effect of the preoperative application of topical piroxicam on postoperative analgesic requirement compared to a placebo group and a conventional local anaesthetic field block. Forty-two patients presenting for in-patient inguinal hernia repair were randomly allocated on a double-blind basis to have either piroxicam gel 15gm applied preoperatively, or an inguinal field block with 20 ml of 0.375% bupivacaine following induction of anaesthesia, or no treatment. Postoperative Visual Analogue Scores for pain on moving in group P, I or C on admission at 1h, 2h, and 4 h following surgery were: 2 vs 1 vs 6.5; 3 vs 3 vs 5; 3 v 2 vs 4.5; 3 vs 2 vs 5.0, respectively (P < 0.005). Median(range) time to first analgesia was 25.4(15-70) min in group I, 30.3(10-49) min in group P; this was not significantly different from group C21.5(7-70) min. Over the first 24 hours the postoperative morphine requirement was significantly less in the two treatment groups 30(20)mg in group I and 34(17) mg in group P and 71(15) in group C, P < 0.0001. There were no apparent NSAID-induced side-effects, or effects on wound healing. The preoperative administration of piroxicam (15gm) topically compared favourably with a preoperative local anaesthetic field block with respect to VAS scores, time to first analgesia and total morphine consumption. And both treatment groups provided significantly superior analgesia than the control group.

Short-term topical piroxicam has no anti-inflammatory or antinociceptive effects after burn injury

Identical burn injuries were induced on both calves with a 49 °C 15 × 25 mm thermode in 12 normal volunteers. Piroxicam gel 0.5% or placebo (1 gm) was applied in a double-blind and randomized manner on each leg 90 minutes before and immediately after the burn injury. The results showed that piroxicam 0.5% gel had no effect on initial 6-hour postburn changes in heat pain detection thresholds, heat pain tolerance, mechanical (Von Frey hair) pain thresholds, area of secondary hyperalgesia, or degree of inflammation assessed by a skin reflectance spectrometer.

Topical piroxicam and diclofenac are suitable for ankle distortion

Topical piroxicam and diclofenac are suitable for ankle distortion

Topical piroxicam is comparable to oral ibuprofen in osteoarthritis

Topical piroxicam is comparable to oral ibuprofen in osteoarthritis