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Apo-Oxaprozin (CA), Daypro, Rhoxal-Oxaprozin (CA)
Pharmacologic class: Propionic acid derivative, nonsteroidal anti-inflammatory drug (NSAID)
Therapeutic class: Anti-inflammatory, analgesic
Pregnancy risk category C (first and second trimesters), D (third trimester)
Pregnancy risk category C (first and second trimesters), D (third trimester)
FDA Box Warning
• Drug may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke. Risk may increase with duration of use. Patients with cardiovascular disease or risk factors for it may be at greater risk.
• Drug increases risk of serious GI adverse events, including bleeding, ulcers, and stomach or intestinal perforation. These events can occur at any time during use and without warning. Elderly patients are at greater risk.
• Drug is contraindicated for treatment of perioperative pain in setting of coronary artery bypass graft surgery.
Unclear. Thought to inhibit prostaglandin synthesis by blocking cyclooxygenase (COX-2), thereby reducing inflammation.
Tablets: 600 mg
⊘Indications and dosages
➣ Rheumatoid arthritis; osteoarthritis
Adults: 1,200 mg daily in two to three divided doses. Maximum daily dosage is 1,800 mg (1,200 mg for potassium form).
• Mild disease
• Renal impairment
• Low body weight
• Hypersensitivity to drug
• Concurrent use of other NSAIDs (including aspirin)
• Active GI bleeding or ulcer disease
Use cautiously in:
• severe cardiovascular or hepatic disease, renal impairment
• history of ulcer disease
• pregnant or breastfeeding patients
• children (safety not established).
• Give with food or after meals if GI upset occurs.
• Use lowest effective dosage to minimize adverse reactions.
CNS: dizziness, fatigue, headache, agitation, anxiety, confusion, depression, insomnia, malaise, paresthesia, tremor
CV: edema, vasculitis, blood pressure changes
EENT: abnormal vision, tinnitus
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, gastritis, dyspepsia, duodenal ulcer, flatulence, stomatitis, dry mouth, anorexia, GI bleeding
GU: albuminuria, azotemia, interstitial nephritis, acute renal failure
Hepatic: cholestatic jaundice, hepatitis
Respiratory: dyspnea, hypersensitivity pneumonitis
Skin: rash, pruritus, diaphoresis, photosensitivity, angioedema, Stevens-Johnson syndrome
Other: appetite and weight increases, allergic reactions including anaphylaxis
Drug-drug.Alcohol, aspirin and other NSAIDs, corticosteroids, potassium supplements: additive adverse GI effects and toxicity
Anticoagulants, cefamandole, cefoperazone, cefotetan, clopidogrel, eptifibatide, plicamycin, thrombolytics, ticlopidine, tirofiban, vitamin A: increased risk of bleeding
Antineoplastics: increased risk of adverse hematologic reactions
Insulin, oral hypoglycemics: increased hypoglycemic effects of these drugs
Methotrexate: increased risk of methotrexate toxicity
Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatinine, lactate dehydrogenase, potassium: increased levels
Bleeding time: prolonged (for up to 2 weeks after drug discontinuation)
Creatinine clearance, glucose, hemoglobin, hematocrit, platelets, white blood cells: decreased levels
Liver function tests: abnormal results
Drug-herbs.Alfalfa, anise, arnica, astragalus, bilberry, black currant seed oil, bladderwrack, bogbean, boldo (with fenugreek), borage oil, buchu, capsaicin, cat's claw, celery, chamomile, chapparal, chincona bark, clove, clove oil, dandelion, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, guggul, licorice, papaya extract, red clover, rhubarb, saf-flower oil, skullcap, tan-shen: increased anticoagulant effect and bleeding risk
• Monitor kidney and liver function tests, coagulation studies, and CBC.
☞ Watch for signs and symptoms of acute renal failure, nephritis, hepatitis, bleeding tendency, and anemia.
• Monitor hearing and vision, including results of eye exams.
☞ Watch for and promptly report rash or swelling.
• Assess respiratory status closely. Stay alert for dyspnea and pneumonitis.
• Instruct patient to take with food or meal.
• Inform patient that many common over-the-counter drugs (including acetaminophen, aspirin, and other NSAIDs) and herbal preparations increase drug's adverse effects. Tell him to consult prescriber before taking these products.
☞ Instruct patient to immediately report rash, unusual tiredness, yellowing of skin or eyes, easy bruising or bleeding, change in urination pattern, weight gain, arm or leg swelling, vision changes, and black or tarry stools.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient on long-term therapy to have periodic eye exams.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.
Pregnancy Category: D (third trimester)
Time/action profile (antirheumatic action)
|PO||within 7 days||unknown||unknown|
Adverse Reactions/Side Effects
Central nervous system
Ear, Eye, Nose, Throat
- abnormal vision
- hypersensitivity pneumonitis
- gi bleeding (life-threatening)
- abdominal pain (most frequent)
- diarrhea (most frequent)
- dyspepsia (most frequent)
- ↑ liver enzymes
- cholestatic jaundice
- dry mouth
- duodenal ulcer
- increased appetite
- interstitial nephritis
- exfoliative dermatitis (life-threatening)
- stevens-johnson syndrome (life-threatening)
- toxic epidermal necrolysis (life-threatening)
- ↑ sweating
- prolonged bleeding time
- weight gain
- allergic reactions including anaphylaxis (life-threatening)
- angioneurotic edema (life-threatening)
Drug-Drug interaction↑ adverse GI effects and toxicity with aspirin, other NSAIDs, potassium supplements, corticosteroids, or alcohol.Chronic use with acetaminophen may ↑ risk of adverse renal reactions.May ↓ effectiveness of diuretics or antihypertensive therapy.May ↑ hypoglycemic effects of insulin or oral hypoglycemic agents.↑ risk of toxicity from methotrexate.↑ risk of bleeding with cefotetan, cefoperazone, thrombolytic agents, anticoagulants, ticlopidine, clopidogrel, eptifibatide, or tirofiban.↑ risk of adverse hematologic reactions with antineoplastics or radiation therapy.↑ anticoagulant effect and bleeding risk with arnica, chamomile, clove, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others.
Route/DosageOsteoarthritis or Rheumatoid Arthritis
Availability (generic available)
- Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Monitor for rhinitis, asthma, and urticaria.
- Assess pain and range of motion prior to and periodically during therapy.
- Lab Test Considerations: May cause prolonged bleeding time, which may persist for up to 2 wk following discontinuation of therapy.
- Evaluate BUN, serum creatinine, CBC, and liver function tests periodically in patients receiving prolonged therapy. Serum potassium, BUN, serum creatinine, alkaline phosphatase, LDH, AST, and ALT tests may show ↑ levels. Blood glucose, hemoglobin, and hematocrit concentrations, leukocyte and platelet counts, and CCr may be ↓.
Potential Nursing DiagnosesAcute pain (Indications)
- Administration in higher than recommended doses does not provide increased effectiveness but may cause increased side effects. Use lowest effective dose for shortest period of time.
- Oral: Administer with food or antacids to decrease GI irritation.
- Advise patient to take oxaprozin with a full glass of water and to remain in an upright position for 15–30 min after administration.
- Instruct patient to take medication as directed. Take missed doses as soon as remembered but not if almost time for the next dose. Do not double doses.
- May cause drowsiness and dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
- Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, and other OTC or herbal products without consulting health care professional.
- Advise patient to notify health care professional of medication regimen prior to treatment or surgery. Oxaprozin should be discontinued 2 wk prior to surgery.
- Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
- Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs.
- Decreased pain and improved joint mobility. Maximum effectiveness may require 2 wk or more of continuous therapy. Patients who do not respond to one NSAID may respond to another.