About this pathway
Background
Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) approved for use in Osteoarthritis and Rheumatoid Arthritis. The FDA label suggests consideration of dose reduction in CYP2C9 poor metabolizers.
The CPIC Dosing Guideline for piroxicam recommends that CYP2C9 poor metabolizers and intermediate metabolizers with activity score of 1 should choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life. See full guideline for further details and supporting evidence.
Metabolism
Piroxicam is primarily metabolized to an inactive metabolite 5’-hydroxypiroxicam via CYP2C9 [Articles:7021122, 16198655, 32164968]. Secondary metabolism to a glucuronide also occurs although candidate genes for this are not published [Article:7908879]. A minor route of dealkylation also occurs that is not well documented and no candidate genes published [Article:7021122].
Reactions & interactions (4)
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Biochemical Reaction
piroxicam → desmethyl piroxicam
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Biochemical Reaction
piroxicam → piroxicam glucuronide
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Biochemical Reaction
piroxicam → 5'-hydroxypiroxicam
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Catalysis
CYP2C9 → Biochemical Reaction
Edit history (3)
- 2021-07-01 Create
- 2021-09-29 Update Spelled out and linked OA and RA
- 2025-03-20 Update fixed typo