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Reasons for limiting use of piroxicam

Your article ‘Guidance to restrict NSAID prescribing ‘‘is patronising''' (News, 17 October) does not address the reasons behind the Medicines and Healthcare Products Regulatory Agency's guidance.

There are compelling public health reasons for limiting prescribing of piroxicam to those patients who specifically need this drug; given that there are a variety of alternative NSAIDs that are generally as effective, and have been associated with much lower rates of potentially fatal gastrointestinal complications. The rate of serious skin reactions with piroxicam is also higher than with most other NSAIDs.

The recent advice and prescribing restrictions on piroxicam follow a detailed review of the evidence on risks and benefits of the drug and reflect the opinion of the European Committee on Medicinal Products for Human Use. This opinion has been ratified by the European Commission, and the UK (along with all other EU member states) has a legal duty to comply with the EC decision.

The advice on ketoprofen and ketorolac is also based on a thorough Europe-wide review of all the safety evidence.

Dr June Raine, director of vigilance and risk management of medicines, Medicines and Healthcare Products Regulatory Agency

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