Gastro-intestinal blood loss with high dose tilcotil (Ro 12-0068) and aspirin: an open crossover clinical trial and pharmacokinetic assessment in normal volunteers

Intravenous tenoxicam reduces uterine cramps after Cesarean delivery

PURPOSE

Postpartum uterine contraction pain is a common phenomenon after Cesarean delivery. We investigated the effectiveness of tenoxicam in reducing uterine contraction pain.

METHODS

We enrolled 120 consecutive non-breastfeeding women who were scheduled for elective Cesarean delivery. After the administration of spinal anesthesia with bupivacaine and intrathecal morphine 0.15 mg injection, the patients were randomly divided into two groups. Group I received placebo (normal saline) iv injection, and Group II received tenoxicam 40 mg iv injection after clamping the umbilical cord. Verbal analogue scale of wound pain and uterine contraction pain were recorded at two, four, eight,16, and 24 hr after Cesarean delivery.

RESULTS

There was no significant difference in wound pain scores between the two groups (all scores < or =3). However, the tenoxicam group had significant lower uterine contraction pain scores and required less supplemental meperidine medication than did the placebo group (8.5% vs 41.4%, P <0.05). The incidences of nausea or vomiting, pruritus, and bleeding were not significantly different between groups.

CONCLUSION

Intravenous tenoxicam 40 mg significantly reduced the intensity of uterine cramps in patients undergoing Cesarean delivery without increasing side effects.

Tenoxicam. An update of its pharmacology and therapeutic efficacy in rheumatic diseases

Tenoxicam administered orally, rectally or parenterally is an effective analgesic and anti-inflammatory agent for the symptomatic treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis and various rheumatic conditions such as tendinitis, bursitis, sciatica, back pain and gouty arthritis. In clinical trials its efficacy is at least equivalent to that of other NSAIDs and it is at least as well tolerated as piroxicam and probably better tolerated than diclofenac, indomethacin and ketoprofen. Compared with many other NSAIDs, tenoxicam offers certain advantages in that it is conveniently administered once daily and dosage adjustment is not required in the elderly or in patients with renal or hepatic impairment.

A comparison of blood loss caused by two prolonged-release formulations of indomethacin ('Flexin Continus' and 'Indocid' R) in normal healthy male volunteers

Faecal blood loss arising from two prolonged-release formulations of indomethacin was compared in a double-blind, parallel group study in 12 healthy male volunteers. After a 1-week run-in period on placebo, subjects were allocated at random to receive 150 mg indomethacin per day, either as controlled-release 'Flexin Continus' tablets or as slow-release 'Indocid' R capsules, for 2 weeks and followed up for a further 1 week. Faecal specimens were collected over a 4-day period in each week and blood loss calculated using a 51Chromium-labelled red cell count method. Mean blood loss during the placebo run-in period was 2.6 ml/4 days in both study groups. Mean blood loss during treatment Weeks 2 and 3 with 'Flexin Continus' was 8.6 ml/4 days and 7.9 ml/4 days, respectively, and during treatment with 'Indocid' R capsules was 13.9 ml/4 days and 14.2 ml/4 days, respectively. There was a carry-over effect from both preparations as seen by a steady decrease in blood loss during the week after treatment. The mean value for 'Flexin Continus' was 6.9 ml/4 days and for 'Indocid' R was 8.3 ml/4 days during the wash-out week. Faecal blood loss was not statistically significantly different between the two formulations. No significant deterioration in haematological or biochemical results occurred in either group. Adverse symptoms were less frequent with 'Flexin Continus' tablets.

Clinical experience with tenoxicam: a review

Tenoxicam, a new non-steroidal anti-inflammatory agent (NSAID) with a long half-life, has been evaluated in a series of nine clinical studies over the last five years. Early studies against naproxen in osteoarthrosis (OA) and against ibuprofen in rheumatoid arthritis (RA) suggested the drug was efficacious in both of these conditions. A series of faecal blood loss studies showed that the drug produced less gastrointestinal blood loss than aspirin and comparable blood loss to piroxicam. Comparisons of tenoxicam and piroxicam in OA and ankylosing spondylitis (AS) showed both drugs to be approximately equally efficacious. A pharmacokinetic study showed a half-life for tenoxicam of 45 h in synovial fluid when the half-life was 42 h in plasma. A single and multiple oral dose pharmacokinetic study of tenoxicam in the elderly showed no progressive accumulation with peak plasma levels of 2.6 micrograms/ml after the single dose and 12.4 micrograms/ml at steady state.

A double-blind, parallel study of tenoxicam and piroxicam in patients with osteoarthrosis

A double-blind, parallel group study was carried out in 30 patients with osteoarthrosis to compare the efficacy and tolerance of tenoxicam (40 mg/day) and piroxicam (40 mg/day) given over a period of 4 weeks. All had previously been treated with a variety of non-steroidal anti-inflammatory agents and/or analgesics. Patients were allocated at random to one or other treatment group. Clinical and laboratory assessments were made on entry and after 2 and 4 weeks of treatment. The results showed that both drugs improved general pain, the improvement being somewhat greater with tenoxicam. Little change was noted in other symptoms with either treatment. Side-effects reported were mainly gastro-intestinal. Six of the 15 piroxicam-treated patients stopped treatment because of adverse reactions, 1 because of treatment failure and 1 because he preferred previous treatment. Three of the 15 tenoxicam-treated patients discontinued because of adverse reactions. The remaining patients (7 on piroxicam and 12 on tenoxicam) elected at the end of the trial period to remain on their respective treatment instead of their previous medication.

A comparison of faecal blood loss caused by tenoxicam and piroxicam in normal healthy male volunteers

Faecal blood loss arising from tenoxicam at a dose of 20 mg/day was compared to that arising from piroxicam at a dose of 20 mg/day in a double-blind, parallel comparative study in 12 healthy male volunteers. Faecal blood loss was measured for a 1-week run-in on placebo, during 4 weeks of treatment and for a 2-week post-treatment period in both groups. Plasma levels for tenoxicam and piroxicam confirmed good compliance in all subjects. Mean blood loss during the placebo run-in period was 0.35 ml/day. Mean blood loss during treatment with tenoxicam was 0.84 ml/day and with piroxicam 0.81 ml/day. There was no significant difference between these measurements. On cessation of treatment, faecal blood loss continued both in the tenoxicam group (mean 1.30 ml/day) and piroxicam group (mean 1.41 ml/day). The difference between these was not statistically significant. No significant haematological or biochemical abnormality resulted from either of the two trial drugs during the period of the study. Urinalysis and NAG/creatinine ratio also remained unaltered in both treatment groups.

An assessment of faecal blood loss from Ro 21-5521, a novel non-steroidal anti-inflammatory agent, in normal volunteers

Faecal blood loss arising from Ro 21-5521, a novel non-steroidal anti-inflammatory agent with a long plasma half-life of about 41 hours, was evaluated in a double-blind crossover study against matched placebo in 12 volunteers. After a 1-week run-in period to determine baseline values, subjects were allocated at random to receive either 250 mg Ro 21-5521 per day or placebo for 2 weeks before being crossed over to the alternative treatment for 2 weeks. They were then followed-up for a further 2 weeks. Blood loss was calculated from 51Chromium tagged red blood cells in stools collected for a 96-hour period during each week of the study. Plasma levels of Ro 21-5521 were also measured twice weekly throughout the study. The results showed that with a drug of this long half-life, faecal blood loss may continue for at least 4 weeks after cessation of trial therapy of 2 weeks. It is recommended that in the evaluation of faecal blood loss resulting from drugs with a long half-life, a parallel group study, each group receiving only one drug (or one drug crossed against placebo), is the study design of choice.