Oxicam
Drug class
From Wikipedia, the free encyclopedia
Oxicam is a class of non-steroidal anti-inflammatory drugs (NSAIDs),[2] meaning that they have anti-inflammatory, analgesic, and antipyretic therapeutic effects. Oxicams bind closely to plasma proteins.[1] 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.[3]
The most popular drug of the oxicam class is piroxicam.[1] Other examples include: ampiroxicam, droxicam, pivoxicam, tenoxicam, lornoxicam,[1] and meloxicam.
Isoxicam has been suspended as a result of fatal skin reactions.[1]
Chemistry
The physico-chemical characteristics of these molecules vary greatly depending upon the environment.[4]
In contrast to most other NSAIDs, oxicams are not carboxylic acids. They are tautomeric, and can exist as a number of tautomers (keto-enol tautomerism), here exemplified by piroxicam:[2]
Side effects
The use of NSAIDs can, rarely, trigger severe cutaneous adverse reactions such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).[5] Epidemiologic studies and reviews have reported that, among NSAIDs, the oxicam derivatives (e.g., piroxicam, tenoxicam, meloxicam) are associated with a comparatively higher risk of SJS/TEN, particularly early after starting treatment, although the absolute risk remains low.[6][7]
Isoxicam was withdrawn/suspended from marketing after reports of fatal skin reactions.[8]
