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Oral (fast dissolving) piroxicam versus IM diclofenac for renal colic

Three Part Question

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

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.

Search Strategy

Medline 1966-08/01 using the OVID interface.
[exp Diclofenac OR exp diclofenac sodium OR OR] AND [exp piroxicam OR OR] AND [renal OR exp ureteral calculi OR exp renal calculi]

Search Outcome

2 papers were identified of which one was found to be relevant.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Supervia A et al,
80 sequential patients with a clinical diagnosis of renal colic confirmed by either urinalysis or ultrasoundDouble blind randomised controlled trialPain as measured by visual analogue score at 30 minutesBoth treatments significantly reduced pain scores at 30 minutes post administration. No significant difference evident between treatments in terms of efficacy of pain relief.Relatively small numbers with no power study so possible type II error


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.


  1. Supervia A, Pedro-Botet J, Nogues X et al. Piroxicam fast-dissolving dosage form vs diclofenac sodium in the treatment of acute renal colic: a double-blind controlled trial. British Journal of Urology 1998;81(1):27-30.