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Pharmacologic class: Oxicam derivative, nonsteroidal anti-inflammatory drug (NSAID)
Therapeutic class: Analgesic, anti-inflammatory, antipyretic
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 (which can be fatal). 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 (which can be fatal). 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.
Inhibits cyclooxygenase (an enzyme needed for prostaglandin synthesis), stimulating anti-inflammatory response and blocking pain impulses
Capsules: 10 mg, 20 mg
Indications and dosages
➣ Inflammatory disorders (such as arthritis)
Adults: 20 mg P.O. daily as a single dose or in two divided doses
• Hepatic or renal impairment
• Elderly patients
• Ankylosing spondylitis
• Hypersensitivity to drug or other NSAIDs (including aspirin)
• Active GI bleeding or ulcer disease
• Third trimester of pregnancy
Use cautiously in:
• renal impairment, severe cardiovascular or hepatic disease
• history of ulcer disease
• pregnant patients in first or second trimester
• breastfeeding patients (not recommended)
• children (safety not established).
• Give with milk, antacids, or food to minimize GI upset.
CNS: headache, drowsiness, dizziness
CV: edema, hypertension, vasculitis, tachycardia, arrhythmias
EENT: blurred vision, tinnitus
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, dyspepsia, anorexia, severe GI bleeding
GU: proteinuria, renal failure
Hematologic: anemia, blood dyscrasias
Hepatic: jaundice, hepatitis
Other: allergic reactions including anaphylaxis
Drug-drug. Acetaminophen (chronic use), cyclosporine, gold compounds: increased risk of adverse renal reactions Anticoagulants, cefamandole, cefoperazone, cefotetan, clopidogrel, eptifibatide, heparin, plicamycin, thrombolytics, ticlopidine, tirofiban, valproic acid, vitamin A: increased risk of bleeding
Antineoplastics: increased risk of hematologic toxicity
Aspirin: decreased piroxicam blood level and efficacy
Corticosteroids, other NSAIDs: additive adverse GI reactions
Diuretics, other antihypertensives: decreased response to these drugs Insulin, oral hypoglycemics: increased risk of hypoglycemia
Lithium: increased lithium blood level and risk of toxicity
Probenecid: increased piroxicam blood level and risk of toxicity
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatinine, electrolytes, lactate dehydrogenase: increased levels
Bleeding time: prolonged Hematocrit, hemoglobin, 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, borage oil, buchu, capsaicin, cat's claw, celery, chaparral, cinchona bark, clove oil, coenzyme Q10, dandelion, danshen, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo, guggul, papaya extract, red clover, rhubarb, safflower oil, skullcap, St. John's wort: increased anticoagulant effect, greater bleeding risk
• Monitor vital signs and cardiovascular status. Stay alert for hypertension and arrhythmias.
• Monitor kidney and liver function tests, hearing, and CBC.
☞ Watch for signs and symptoms of drug-induced hepatitis and GI toxicity, including ulcers and bleeding.
• Monitor for signs and symptoms of infection, which drug may mask.
• Advise patient to take with milk, antacids, or food to minimize GI upset.
• Tell patient drug may mask signs and symptoms of infection. Instruct him to contact prescriber if he suspects he has an infection.
☞ Teach patient to recognize and immediately report signs and symptoms of allergic reaction or GI bleeding.
• Inform patient that many herbs increase the risk of GI bleeding. Caution him not to use herbs without prescriber's approval.
• Instruct patient to drink plenty of fluids and to report decreased urination.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell female patient to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.