A pharmacokinetic study of piroxicam in children

Summary Feldene MeltTM (piroxicam) is commonly used for analgesia following day case surgery. The manufacturer's recommended paediatric dose is 0.4 mg.kg−1 once daily. In children, plasma piroxicam levels of 3–5 μg.ml−1 are associated with effective analgesia. However, in adults a single dose of 20 mg piroxicam (0.4 mg.kg−1 for a 50‐kg adult) produces plasma levels of only 1.5–2.2 μg.ml−1. We therefore studied plasma levels achieved by 0.4 mg.kg−1 or 1.0 mg.kg−1 piroxicam in 22 children aged between 3 and 16 years, undergoing elective orthopaedic surgery, in order to investigate the adequacy of single dosing. The first 12 patients received 0.4 mg.kg−1 Feldene MeltTM pre‐operatively. Following assay of plasma piroxicam levels, a further 10 patients received 1.0 mg.kg−1 Feldene MeltTM. In both groups, five blood samples were taken at 2‐hourly intervals. The mean (95% CI) piroxicam level following 0.4 mg.kg−1 was 2.90 (2.33–3.54) μg.ml−1, compared to 5.87 (4.58–7.16) μg.ml−1 following 1.0 mg.kg−1 (p = 0.0003).