Efficacy of piroxicam for postoperative pain after lower third molar surgery associated with <em>CYP2C8*3</em> and <em>CYP2C9</em>

Abstract

ObjectiveNonsteroidal anti-inflammatory drugs (NSAIDs) are metabolized by the cytochrome P450 enzymes (CYPs), predominantly CYP2C8 and CYP2C9. The aim of this study was to evaluate the possible association of polymorphisms in the CYP2C8*3 and CYP2C9 genes with the clinical efficacy of oral piroxicam (20 mg daily for 4 days) after lower third molar surgeries with regard to postoperative pain, swelling, trismus, adverse reactions, need for rescue medication and the volunteer’s overall satisfaction.Materials and methodsFor this purpose, 102 volunteers were genotyped for CYP2C8*3 and CYP2C9 polymorphisms. Briefly, genomic DNA was isolated from saliva collected from volunteers subjected to invasive lower third molar surgeries, and the preoperative, intraoperative and postoperative parameters were collected and analyzed.ResultsAn equal amount of piroxicam sufficiently managed postoperative pain and inflammatory symptoms, with visual analog pain scores typically <40 mm for all genotypes investigated. Furthermore, only two out of 102 volunteers heterozygous for CYP2C8*3 and CYP2C9*3 reported adverse side effects.ConclusionIn general, slow metabolizers of piroxicam, who were volunteers with mutant alleles, were indifferent from normal metabolizers with the wild-type alleles and therefore did not require specialized piroxicam doses to manage postoperative pain and inflammation.

Efficacy of Ketoprofen With or Without Omeprazole for Pain And Inflammation Control After Third Molar Removal

“…In addition, in comparison with other studies by our study group evaluating different NSAIDs in bilateral third molar extraction model, ketoprofen 200 mg + omeprazole 20 mg b.i.d. showed as good pain control as other drugs evaluated such as piroxicam, valdecoxib, etoricoxib, meloxicam, ketorolac, naproxen (1,2,8,9,21).…”

“…had a superior analgesic effect when compared to ketoprofen 100 mg b.i.d., with a statistically significant difference in the control of pain, mainly in the periods of 1.5, 7, 8, 10, 12, 16, 24, 48 and 72 h postoperative. It is worth emphasizing at this moment that the acute pain control after the surgeries by both drugs was effective, since the literature reports that pain below 45 mm does not affect the daily routine of the volunteers (17,21,24). The efficacy of ketoprofen 100 mg has also been compared with methylprednisolone in pain control after third molar surgery, with peak pain intensity occurring within the first 12 h with the use of both drugs (12).…”

“…As a rescue analgesic medication, if the volunteer judged that the analgesia produced by the anti-inflammatory drug provided was insufficient, acetaminophen (EMS S/A, Hortolândia/SP, Brazil) was prescribed at 750 mg every 8 h (2,8,9,(17)(18)(19)(20). Throughout the surgical procedure, notations were made such as: the amount of anesthetic administered, the hemodynamic data of the volunteer at each surgical stage through the DX 2021 Dixtal device (Biomédica Ind e Com Ltda, Marília/SP, Brazil), the amount of bleeding and the degree of difficulty of each stage of surgery (incision, flap, osteotomy, tooth section, extraction, cleaning and suturing) (1,2,8,9,(17)(18)(19)21).…”

Pharmacogenomics research and clinical implementation in Brazil

“…PGx studies of CYP2C9 , not related to anticoagulants, explored associations with the antimalarial effect of chloroquine/primaquine therapy and the efficacy of piroxicam for post‐operative pain, with negative results in both cases.…”

A randomized clinical trial of different associations between dexamethasone and non-steroids anti-inflammatories in the lower third molar extractions

“…[9] Nonsteroidal anti-in ammatory drugs (NSAIDs) are mostly used during the postoperative period of third molar surgeries due to their considerable anti-nociceptive effects. [10][11][12] However, recent studies have demonstrated that the preemptive combination of NSAIDs and corticosteroids seems to improve the relief of postoperative symptoms after third molar surgeries, mainly in the acute postoperative period. [4,13,14] A possible explanation for the e cacy of this combination is that when administered before surgical trauma and the onset of pain, the drugs will be present in the bloodstream at the appropriate levels, and at the appropriate time when pain symptoms begin, and the inhibition of cyclooxygenase decreases the production of prostaglandins and other in ammatory cytokines at the surgical site.…”