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Oral (fast dissolving) piroxicam or intramuscular diclofenac for renal colic
  1. Russell Boyd, Consultant in Emergency Medicine,
  2. Polly Terry, Specialist Registrar in Emergency Medicine
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

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Report by Russell Boyd, Consultant in Emergency Medicine Checked by Polly Terry, Specialist Registrar in Emergency Medicine

Clinical scenario

You have just seen a patient with presumed renal colic. You have prescribed a dose of IM diclofenac as per departmental policy but wonder if a newer fast dissolving oral piroxicam agent would be as effective as the usual parenteral diclofenac agent.

Three part question

In [renal colic] is [oral fast dissolving piroxicam or IM diclofenac] better [at reducing pain]?

Search strategy

Medline 1966–08/01 using the OVID interface. [exp Diclofenac/ OR exp diclofenac sodium/ OR diclofenac.mp OR voltarol.mp] AND [exp piroxicam/ OR piroxicam.mp OR feldene.mp] AND [renal colic.mp OR exp ureteral calculi/ OR exp renal calculi]

Search outcome

Two papers were identified of which one was found to be relevant (table 3).

Table 3

Comment(s)

A fast dissolving NSAID preparation of piroxicam seems effective at relieving renal colic pain and appears as effective as the standard diclofenac IM treatment in terms of speed to onset and relief of pain intensity. In terms of patient acceptability and ease of administration the oral format would intuitively seem to have advantages.

Clinical bottom line

There is reasonable evidence to suggest the use of oral fast dissolving piroxicam is as effective as IM diclofenac.

Report by Russell Boyd, Consultant in Emergency Medicine Checked by Polly Terry, Specialist Registrar in Emergency Medicine

References

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