oxaprozin potassium

oxaprozin potassium

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)

FDA Boxed 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

Caplets: 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.

Route	Onset	Peak	Duration
P.O.	Unknown	3-5 hr	Unknown

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, safflower 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.