PIROXICAM 0.5% W/W GEL - summary of medicine characteristics

1 NAME OF THE MEDICINAL PRODUCT

Piroxicam 0.5% w/w Gel

2 QUALITATIVE AND QUANTITATIVE COMPOSITION

Piroxicam 0.5% w/w

Each gram of gel contains 5 mg of piroxicam (0.5% w/w).

Excipient(s) with known effect

Each gram of gel contains 150 mg propylene glycol

For the full list of excipients, see section 6.1.

3 PHARMACEUTICAL FORM

Gel for topical application

Transparent light yellow gel

4 CLINICAL PARTICULARS

4.1 Therapeutic indications

Piroxicam Gel is a non-steroidal anti-inflammatory agent used for the treatment of a variety of conditions characterised by pain and inflammation or stiffness.

It is effective in the treatment of osteoarthritis of superficial joints, such as knee, acute musculo-skeletal injuries, periathritis, epicondylitis, tendonitis and tenosynovitis.

4.2 Posology and method of administration

Posology

Adults:

No occlusive dressings should be employed. Apply 1 g of gel, corresponding to 3 cm, and rub into the affected site three to four times daily leaving no residual material on the skin. Therapy should be reviewed after 4 weeks.

Paediatric population

Dosage recommendations and indications for the use of Piroxicam Gel in children have not been established.

Use in the Elderly:

No special precautions are required

Method of administration

Piroxicam Gel is for external use only.

4.3 Contraindications

Hypersensitivity to the active substance(s) or to any of the excipients listed in section 6.1.

The potential exists for cross sensitivity to aspirin and other non-steroidal antiinflammatory agents. Piroxicam Gel should not be given to patients in whom aspirin and other non-steroidal anti-inflammatory agents induce the symptoms of asthma, nasal polyps, angioneurotic oedema or urticaria.

4.4 Special warnings and precautions for use

Life-threatening cutaneous reactions (Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)) have been reported with the systemic administration of piroxicam. These reactions have not been associated with topical piroxicam, but the possibility of occurring with topical piroxicam cannot be excluded.

Patients should be advised of the signs and symptoms and monitored closely for skin reactions. The highest risk for occurrence of SJS or TEN is within the first weeks of treatment.

If signs or symptoms of SJS or TEN (e.g. progressive skin rash often with blisters or mucosal lesions) are present, piroxicam treatment should be discontinued.

The best results in managing SJS and TEN come from early diagnosis and immediate discontinuation of any suspect drug. Early withdrawal is associated with a better prognosis.

If the patient has developed SJS or TEN with the use of piroxicam, piroxicam must not be re-started in this patient at any time.

Keep away from the eyes and mucosal surfaces. Do not apply to any sites affected by open skin lesions, dermatoses or infection.

Use with care in patients with impaired renal or hepatic function.

Instruct patients not to smoke or go near naked flames – risk of severe burns. Fabric (clothing, bedding, dressings etc) that has been in contact with this product burns more easily and is a serious fire hazard. Washing clothing and bedding may reduce product build-up but not totally remove it.

NSAIDs, including piroxicam, may cause interstitial nephritis, nephrotic syndrome and renal failure. There have also been reports of interstitial nephritis, nephrotic syndrome and renal failure with topical piroxicam, although the causal relationship to treatment with topical piroxicam has not been established. As a result, the possibility that these events may be related to the use of topical piroxicam cannot be ruled out.

Skin reactions

Cases of fixed drug eruption (FDE) have been reported with piroxicam.

Piroxicam should not be reintroduced in patients with history of piroxicam-related FDE. Potential cross reactivity might occur with other oxicams.

This medicinal product contains 150 mg of propylene glycol in each gram of gel.

Propylene glycol may cause skin irritation. If local irritation develops, the use of Piroxicam Gel should be discontinued and appropriate therapy instituted as necessary. Because this medicine contains propylene glycol, Piroxicam Gel should not be used on open wounds or large areas of broken or damaged skin (such as burns).

4.5 Interaction with other medicinal products and other forms of interaction

None known.

4 CLINICAL PARTICULARS

4.6 Fertility, pregnancy and lactation

Pregnancy

There are no studies of the use of topical piroxicam in pregnant women. Studies in animals have shown reproductive toxicity with the systemic formulations (see section 5.3), but their relevance to the use of topical formulations in pregnant women is unknown. As a precautionary measure, it is preferable to avoid the use of topical piroxicam in pregnant women.

Inhibition of prostaglandin synthesis might adversely affect pregnancy. Data from epidemiological studies suggest an increased risk of spontaneous abortion after use of prostaglandin synthesis inhibitors in early pregnancy. In animals, administration of prostaglandin synthesis inhibitors has been shown to result in increased pre- and post- implantation loss. Therefore, the use of Piroxicam Gel during pregnancy is not recommended.

Breastfeeding

Piroxicam Gel is not recommended for use in nursing mothers as clinical safety has not been established.

Fertility

Based on the mechanism of action, the use of NSAIDs, including piroxicam may delay or prevent rupture of ovarian follicles, which has been associated with reversible infertility in some women. In women who have difficulties conceiving or who are undergoing investigation of infertility, withdrawal of NSAIDs, including topical piroxicam should be considered.

4.7 Effects on ability to drive and use machines

None known.

4.8 Undesirable effects

Piroxicam Gel is well tolerated. Mild to moderate local irritation, erythema, pruritus and dermatitis may occur at the application site. The systemic absorption of Piroxicam Gel is very low. In common with other topical NSAIDs, systemic reactions occur infrequently and have included minor gastrointestinal side-effects such as nausea and dyspepsia. Cases of abdominal pain and gastritis have been reported rarely. There have been isolated reports of bronchospasm and dyspnoea (See also section 4.3).

Severe cutaneous adverse reactions (SCARs): Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported very rarely (see section 4.4).

Contact dermatitis, eczema and photosensitivity skin reaction have also been observed from post-marketing experience.

Unknown : fixed drug eruption (see section 4.4)

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9 Overdose

Overdose is unlikely to occur with this topical preparation.

5 PHARMACOLOGICAL PROPERTIES

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Anti-inflammatory preparations, non-steroids for topical use

ATC code: M02AA07

Piroxicam is a non-steroidal anti-inflammatory agent useful in the treatment of inflammatory conditions. Although the mode of action for this agent is not precisely understood, piroxicam inhibits prostaglandin synthesis and release through a reversible inhibition of the cyclo-oxygenase enzyme. New data presented on the anti-inflammatory and analgesic effects of piroxicam gel compared with its vehicle and indomethacin 1% gel in rats and guinea pigs. Using established animal models of pain and inflammation, piroxicam gel was as effective as oral piroxicam and indomethacin 1% gel and significantly more effective than its vehicle.

5.2 Pharmacokinetic properties

On the basis of various pharmacokinetic and tissue distribution studies in animals, with piroxicam 0.5 % gel, the highest concentrations of piroxicam were achieved in tissues below the site of application with low concentrations being reached in the plasma. Piroxicam 0.5% gel was continuously and gradually released from the skin to underlying tissues, equilibrium between skin, and muscle or synovial fluid appeared to be reached rapidly, within a few hours of application.

From a pharmacokinetic study in man, 2 g of gel was applied to the shoulders of normal volunteers twice daily (corresponding to 20 mg piroxicam/day) for 14 days, plasma levels of piroxicam rose slowly, reaching steady state after about 11 days. The plasma levels at this time were between 300–400 ng/ml, or one-twentieth of those observed in subjects receiving 20 mg orally.

The serum half-life of piroxicam is approximately 50 hours.

5.3 Preclinical safety data

In reproductive toxicity studies, piroxicam increases the incidence of dystocia and delayed parturition in animals, when drug administration is continued during pregnancy. Administration of prostaglandin synthesis inhibitors has also been shown to result in increased pre-and post-implantation loss. These observations were made using parenteral dosing, and as noted in section 5.2, equilibrium plasma levels of piroxicam obtained in patients using the topical gel are only approximately 5% of those achieved using an equivalent dose of parenteral product.

In animal studies with the topical gel, there were no treatment-related adverse effects using 1 gram of gel daily for up to 30 days, nor was there evidence of photo-allergy or skin sensitisation.

6.1

Propylene glycol

Isopropyl alcohol,

Macrogol 7 glycerol cocoate

Hypromellose

Sodium hydroxide

Sodium metabisulphite

Potassium dihydrogen phosphate

Purified water.

6.2 Incompatibilities

None known.

6.3 Shelf life

Unopened: 36 months

After opening: 6 months

6.4 Special precautions for storage

Do not store above 25°C

6.5 Nature and contents of container

Aluminium tubes incorporating epoxy phenol internal lacquer with a membrane fitted with a polypropylene cap containing either 50g, 60g, 100g, or 112g of Piroxicam 0.5% w/w Gel.

Not all pack sizes may be marketed.

6.6 Special precautions for disposal

No special requirements

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.

7 MARKETING AUTHORISATION HOLDER

8   MARKETING AUTHORISATION NUMBER(S)

9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION

5th November 2004