Daypro


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oxaprozin

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.

Action

Unclear. Thought to inhibit prostaglandin synthesis by blocking cyclooxygenase (COX-2), thereby reducing inflammation.

Availability

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).

Dosage adjustment

• Mild disease
• Renal impairment
• Low body weight

Contraindications

• Hypersensitivity to drug
• Concurrent use of other NSAIDs (including aspirin)
• Active GI bleeding or ulcer disease

Precautions

Use cautiously in:
• severe cardiovascular or hepatic disease, renal impairment
• history of ulcer disease
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Give with food or after meals if GI upset occurs.
• Use lowest effective dosage to minimize adverse reactions.

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

Hematologic: anemia

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

Interactions

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

Patient monitoring

• 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.

Patient teaching

• 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.

oxaprozin

(ox-a-proe-zin) ,

Daypro

(trade name)

Classification

Therapeutic: antirheumatics
Pregnancy Category: C (first and second trimester)
Pregnancy Category: D (third trimester)

Indications

Osteoarthritis.Rheumatoid arthritis.Juvenile rheumatoid arthritis.

Action

Inhibits prostaglandin synthesis.

Therapeutic effects

Suppression of pain and inflammation.

Pharmacokinetics

Absorption: Well absorbed following oral administration (80%); 35% is rapidly converted to an active metabolite.
Distribution: Unknown.
Protein Binding: 99.9%.
Metabolism and Excretion: The active metabolite is metabolized by the liver to inactive compounds.
Half-life: 42–50 hr.

Time/action profile (antirheumatic action)

ROUTEONSETPEAKDURATION
POwithin 7 daysunknownunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Cross-sensitivity may exist with other NSAIDs, including aspirin;Active GI bleeding or ulcer disease;Peri-operative pain from coronary artery bypass graft (CABG) surgery; Lactation: Lactation.
Use Cautiously in: Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, especially with prolonged use);Severe hepatic disease;Renal impairment (lower initial dose may be necessary);History of ulcer disease; Obstetric: May cause premature closure of the ductus arteriosus; not recommended for use in the second half of pregnancy; Pediatric: Children <6 yr (safety not established); Geriatric: Appears on Beers list; at ↑ risk of GI bleeding; may require ↓ dose due to age-related ↓ in renal function.

Adverse Reactions/Side Effects

Central nervous system

  • agitation
  • anxiety
  • confusion
  • depression
  • dizziness
  • drowsiness
  • fatigue
  • headache
  • insomnia
  • malaise
  • weakness

Ear, Eye, Nose, Throat

  • abnormal vision
  • tinnitus

Respiratory

  • dyspnea
  • hypersensitivity pneumonitis

Cardiovascular

  • edema
  • vasculitis

Gastrointestinal

  • gi bleeding (life-threatening)
  • abdominal pain (most frequent)
  • diarrhea (most frequent)
  • dyspepsia (most frequent)
  • ↑ liver enzymes
  • anorexia
  • cholestatic jaundice
  • constipation
  • dry mouth
  • duodenal ulcer
  • flatulence
  • gastritis
  • increased appetite
  • nausea
  • stomatitis
  • vomiting

Genitourinary

  • albuminuria
  • azotemia
  • interstitial nephritis

Dermatologic

  • exfoliative dermatitis (life-threatening)
  • stevens-johnson syndrome (life-threatening)
  • toxic epidermal necrolysis (life-threatening)
  • ↑ sweating
  • photosensitivity
  • pruritus
  • rash

Hematologic

  • prolonged bleeding time

Metabolic

  • weight gain

Neurologic

  • paresthesia
  • tremor

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)
  • angioneurotic edema (life-threatening)

Interactions

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/Dosage

Osteoarthritis or Rheumatoid Arthritis
Oral (Adults) 1200 mg once daily; onset may be more rapid with an initial 1800-mg dose. Patients with low body weight, mild disease, or renal impairment may be started at 600 mg/day (not to exceed 1800 mg/day or 26 mg/kg/day). Daily doses >1200 mg should be given in 2–3 divided doses. Consideration should be given to decreasing dose to lowest effective amount.
Juvenile Rheumatoid Arthritis
Oral (Children 6–16 yr) ≥55 kg—1200 mg once daily; 32–54 kg—900 mg once daily; 22–31 kg—600 mg once daily.

Availability (generic available)

Tablets: 600 mg

Nursing implications

Nursing assessment

  • 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 Diagnoses

Acute pain (Indications)

Implementation

  • 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.

Patient/Family Teaching

  • 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.

Evaluation/Desired Outcomes

  • 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.

Daypro

(dā′prō′)
A trademark for the drug oxaprozin.
References in periodicals archive ?
Searle's Daypro, which is used in the treatment of rheumatoid disease, and has a U.