Drug Safety

, Volume 12, Issue 2, pp 110–119 | Cite as

Tenoxicam and Renal Function

  • Roland C. A. Heintz
Review Article Drug Experience


The association of some nonsteroidal anti-inflammatory drugs (NSAIDs) with adverse effects on renal function has led to the need to systematically determine the risk of clinically relevant renal effects in patients treated with these drugs. Tenoxicam, an NSAID with established efficacy in the treatment of rheumatic diseases, has been studied in a variety of patient populations to evaluate its effects on renal function.

Investigational studies, up to 5 years’ duration, evaluated glomerular filtration rate, renal blood flow and tubular function. There was no evidence of clinically relevant renal toxicity in patients with normal renal function, in elderly patients with age-related renal function, or in patients with mild to moderate renal impairment. There was, however, one patient with pre-existing renal pathology, who experienced raised plasma creatinine after 5 years of treatment. These findings are supported by an analysis of urinary system adverse effects in clinical trials that included over 67 000 patients, 25% of whom were elderly. The prevalence of these events, 0.07%, was similar in patients in both age groups. The most common events were dysuria and renal pain.

Thus, patients treated long term with tenoxicam are at low risk for nephrotoxic effects. It is not recommended, however, that patients with severe pre-existing renal insufficiency receive tenoxicam.


Glomerular Filtration Rate Piroxicam Sulindac Tenoxicam Renal Plasma Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Williams TF. Drugs and the elderly. Drug Info J 1985; 19: 397–400Google Scholar
  2. 2.
    del Favero A. Anti-inflammatory analgesics and drugs used in rheumatoid arthritis and gout. In: Dukes MNG, editor. Side effects of drugs annual. Vol 11. Amsterdam: Elsevier Science Publishers, 1987: 82–88CrossRefGoogle Scholar
  3. 3.
    Nilsen OG, Walstad RA, Eckert M, et al. Single and multiple dose pharmacokinetics of tenoxicam in the elderly. Eur J Clin Pharmacol 1988; 35: 563–6PubMedCrossRefGoogle Scholar
  4. 4.
    Crevoisier C, Heizmann P, Forgo I, et al. Plasma tenoxicam concentrations after single and multiple oral doses. Eur J Drug Metab Pharmacokinet 1989; 14: 23–7PubMedCrossRefGoogle Scholar
  5. 5.
    Horber FF, Guentert TW, Weidekamm E, et al. Pharmacokinetics of tenoxicam in patients with impaired renal function. Eur J Clin Pharmacol 1986; 29: 679–701CrossRefGoogle Scholar
  6. 6.
    Todd PA, Clissold SP. Tenoxicam. An update of its pharmacology and therapeutic efficacy in rheumatic diseases. Drugs 1991; 41: 625–46PubMedCrossRefGoogle Scholar
  7. 7.
    Heintz RCA, Guentert TW, Enrico JF, et al. Pharmacokinetics of tenoxicam in healthy human volunteers. Eur J Rheumatol Inflamm 1984; 7: 33–44PubMedGoogle Scholar
  8. 8.
    Nilsen OG. Clinical pharmacokinetics of tenoxicam. Clin Pharmacokinet 1994; 26: 16–43PubMedCrossRefGoogle Scholar
  9. 9.
    Freestone S, McAuslane JAN, Prescott LF. Effects of tenoxicam on renal function and the disposition of inulin and p-aminohippurate in healthy volunteers and patients with chronic renal failure. Br J Clin Pharmacol 1991; 32: 495–500PubMedCrossRefGoogle Scholar
  10. 10.
    Giovannoni J-L, Ott H, de Torrenté A. Le tenoxicam et la fonction rénale. Schweiz Med Wochenschr 1990; 120: 793–7PubMedGoogle Scholar
  11. 11.
    McAuslane JAN, Freestone S, Cowie J, et al. Tenoxicam: effect on renal function in normal man. Br J Clin Pharmacol 1987; 24: 277Google Scholar
  12. 12.
    Bird HA, Clarke AK, Fowler PD, et al. An assessment of tenoxicam, a nonsteroidal anti-inflammatory drug of long half-life, in patients with impaired renal function suffering from osteoarthritis or rheumatoid arthritis. Clin Rheumatol 1989; 8: 453–60PubMedCrossRefGoogle Scholar
  13. 13.
    Moser U, Gregor M, Bachofen U, et al. Comparative assessment of renal function in rheumatic patients treated with tenoxicam (20mg daily) or diclofenac (100mg daily). APLAR Congress: 1992 Sept 13–18; Bali, IndonesiaGoogle Scholar
  14. 14.
    Schardijn GHC, van Eps LWS. β2-microglobulin: its significance in the evaluation of renal function. Kidney Int 1987; 32: 635–41PubMedCrossRefGoogle Scholar
  15. 15.
    Ghose K, Burch A. Measurement of renal functions by double isotope techniques in elderly patients during tenoxicam therapy. Arch Gerontol Geriatr 1989; 9: 115–22PubMedCrossRefGoogle Scholar
  16. 16.
    Hartmann D, Vetter G, Eckert M. Tenoxicam and renal function in elderly patients. Br J Clin Res 1994; 5: 65–71Google Scholar
  17. 17.
    Horak E, Hopfer SM, Sundermann FW. Spectrophotometric assay for urinary N-acetyl-β-D-glucosaminidase activity. Clin Chem 1981; 27: 1180–5PubMedGoogle Scholar
  18. 18.
    Richards IM, Fraser SM, Capell HA. A survey of renal function in out-patients with rheumatoid arthritis. Clin Rheumatol 1988; 7: 267–73PubMedCrossRefGoogle Scholar
  19. 19.
    Alfred J, Wong W, Kafetz K. Elderly people taking non-steroidal anti-inflammatory drugs are unlikely to have excess renal impairment. Postgrad Med J 1989; 65: 735CrossRefGoogle Scholar
  20. 20.
    Wolfe SM. Suprofen induced transient flank pain and renal failure. N Engl J Med 1987: 316: 1025PubMedCrossRefGoogle Scholar
  21. 21.
    Darwish R, Vaziri ND, Gupta S. Focal renal cortical necrosis associated with zomepirac. Am J Med 1984; 76: 113–7CrossRefGoogle Scholar
  22. 22.
    Richardson CJ, Blocks KLN, Ross SG, et al. Effects of age and sex on Piroxicam disposition. Clin Pharmacol Ther 1985; 37: 13–8PubMedCrossRefGoogle Scholar
  23. 23.
    Lang B, Hauck P, Meske S, et al. Die Nierenfunktion unter Therapie mit nicht steroidalen Antiphlogistika. Eine doppelblinde cross-over Studie mit Diclofenac, Indomethacib und Piroxicam. Z Rheumatol 1991; 50: 366–70PubMedGoogle Scholar
  24. 24.
    Advenier C, Roux A, Gobert C, et al. Pharmacokinetics of ketoprofen in the elderly. Br J Clin Pharmacol 1983; 16: 65–70PubMedCrossRefGoogle Scholar
  25. 25.
    Stafanger G, Larsen HW, Hansen H, et al. Pharmacokinetics of ketoprofen in patients with renal impairment. Scand J Rheumatol 1981; 10: 189–92PubMedCrossRefGoogle Scholar
  26. 26.
    Greenblatt DJ, Abernethy DR, Matlis R, et al. Absorption and disposition of ibuprofen in the elderly. Arthritis Rheum 1984; 27: 1066–9PubMedCrossRefGoogle Scholar
  27. 27.
    Anttila M, Haataja M, Kasanen A. Pharmacokinetics of naproxen in subjects with normal and impaired renal function. Eur J Clin Pharmacol 1980; 18: 263–8PubMedCrossRefGoogle Scholar
  28. 28.
    McVerry RM, Lethbridge J, Martin N, et al. Pharmacokinetics of naproxen in elderly patients. Eur J Clin Pharmacol 1986; 31: 463–8PubMedCrossRefGoogle Scholar
  29. 29.
    Aronoff GR, Ozawa T, De Sante KA, et al. Benoxaprofen kinetics in renal impairment. Clin Pharmacol Ther 1982; 32: 190–4PubMedCrossRefGoogle Scholar
  30. 30.
    Brogard JM, Comte F, Madon M, et al. Pharmacokinetic profile of benoxaprofen in subjects with normal and impaired renal function: plasma level prediction. Curr Ther Res 1981; 30: 161–70Google Scholar
  31. 31.
    Nilsen OG, Wessel-Aas T, Walseth F. Single dose pharmacokinetics of tiaprofenic acid. Effect of food and severe renal insufficiency. Arzneimittel Forschung 1985; 35: 871–5PubMedGoogle Scholar
  32. 32.
    Lamy PP. Renal effects of non-steroidal anti-inflammatory drugs. J Am Geriatr Soc 1986; 34: 361–7PubMedGoogle Scholar
  33. 33.
    Carmichel J, Schankel SW. Effects of non-steroidal anti-inflammatory drugs on prostaglandin and renal function. Am J Med 1985; 78: 992–1000CrossRefGoogle Scholar
  34. 34.
    Whelton A, Stout RL, Spilman PS, et al. Renal effects of ibuprofen, piroxicam and sulindac in patients with asymptomatic renal failure. Ann Intern Med 1990; 112: 568–76PubMedGoogle Scholar
  35. 35.
    del Favero A. Anti-inflammatory analgesics and drugs used in rheumatoid arthritis and gout. In: Dukes MNG, Beeley L, editors. Side effects of drugs annual. Vol. 12. Amsterdam: Elsevier Science Publishers, 1988: 79–100CrossRefGoogle Scholar
  36. 36.
    del Favero A. Anti-intlammatory analgesics and drugs used in rheumatoid arthritis and gout. In: Dukes MNG, Aronson JK, editors. Side effects of drugs annual. Vol. 16. Amsterdam: Elsevier Science Publishers, 1992: 103–20CrossRefGoogle Scholar
  37. 37.
    Hartmann D, Kleinblösem Ch, Lücker PW, et al. Study on possible interaction between tenoxicam and furosemide. Drug Res 1987; 37: 1072–6Google Scholar
  38. 38.
    Heintz RCA. Aspects de la pharmacocinétique du tenoxicam — Tilcotil® — chez l’homme. In: Gaucher A, Pourel J, Netter P, et al., editors. Actualités en Physiopathologie et pharmacologie articulaires. Paris: Masson, 1989Google Scholar
  39. 39.
    Maiche AG. Acute renal failure due to concomitant action of methotrexate and indomethacin. Lancet 1986; 1(8494): 1390PubMedCrossRefGoogle Scholar
  40. 40.
    Rhymer AR. Clinoril (sulindac): a review of effects on renal function and blood pressure. Adv Ther 1985; 2: 293Google Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • Roland C. A. Heintz
    • 1
    • 2
  1. 1.Faculty of PharmacyUniversity Louis PasteurStrasbourgFrance
  2. 2.Faculty of PharmacyF. Hoffmann-La Roche LtdBaselSwitzerland

Personalised recommendations