Tenoxicam

How it works

It inhibits cyclo-oxygenase enzymes, reducing prostaglandin synthesis and thereby producing anti-inflammatory and analgesic effects.

Prescribing in practice

• Like other NSAIDs it increases the risk of serious gastrointestinal bleeding, ulceration and perforation, and cardiovascular and renal adverse events, so it should be used at the lowest effective dose for the shortest duration.
• Caution is needed in older people and in those with cardiovascular disease, renal impairment, asthma or a history of peptic ulceration; gastroprotection should be considered where appropriate.
• It interacts with anticoagulants, antiplatelets, other NSAIDs, diuretics, ACE inhibitors and lithium, increasing the risk of bleeding or renal toxicity.

Monitoring

Monitor renal function and blood pressure, and review for gastrointestinal symptoms, particularly in higher-risk patients and on long-term use.

Counselling the patient

• Take it with or after food and report indigestion, black stools or vomiting blood.
• Avoid taking other anti-inflammatory painkillers at the same time unless advised.
• Seek advice if you develop swelling, breathlessness or reduced urine output.

Evidence & guidelines

NICE and MHRA advise NSAIDs be used at the lowest effective dose for the shortest time owing to gastrointestinal and cardiovascular risks.