piroxicam


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piroxicam

 [pēr-ok´sĭ-kam]
a nonsteroidal antiinflammatory drug with a long plasma half-life; used in treatment of arthritis and related conditions, gout, calcium pyrophosphate deposition disease, and dysmenorrhea.

piroxicam

Apo-Piroxicam (CA), Brexidol (UK), Dom-Piroxicam (CA), Feldene, Gen-Piroxicam (CA), Novo-Pirocam (CA), Nu-Pirox (CA) PMS-Piroxicam (CA), PRO-Piroxicam (CA)

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.

Action

Inhibits cyclooxygenase (an enzyme needed for prostaglandin synthesis), stimulating anti-inflammatory response and blocking pain impulses

Availability

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

Dosage adjustment

• Hepatic or renal impairment

• Elderly patients

Off-label uses

• Dysmenorrhea

• Ankylosing spondylitis

• Gout

Contraindications

• Hypersensitivity to drug or other NSAIDs (including aspirin)

• Active GI bleeding or ulcer disease

• Third trimester of pregnancy

Precautions

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).

Administration

• Give with milk, antacids, or food to minimize GI upset.

Adverse reactions

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

Skin: rash

Other: allergic reactions including anaphylaxis

Interactions

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

Patient monitoring

• 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.

Patient teaching

• 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.

piroxicam

(pĭ-rŏk′sĭ-kăm′)
n.
A nonsteroidal anti-inflammatory drug, C15H13N3O4S, used primarily to treat arthritis.

piroxicam

Feldene®Therapeutics An NSAID tightly bound to plasma proteins T1/2 30 hrs; hepatic biotransformation; metabolites excreted in kidneys. See NSAIDs.

piroxicam

A non-steroidal anti-inflammatory drug (NSAID) used mainly to control symptoms in the various forms of ARTHRITIS. A brand name is Feldene.
References in periodicals archive ?
Comparison of aceclofenac with piroxicam in the treatment of osteoarthritis.
Treatment with piroxicam also significantly inhibited arthritic development (2.333 [+ or -] 0.210; P < 0.001) as compared with arthritic control group (Figure 1).
Key Words: Postoperative endodontic pain, Prophylactic Intraligamentary Injection, Piroxicam, Lignocaine, Irreversible pulpitis.
Dado el alto nivel de consumo en Latinoamerica (y particularmente en Brasil) de drogas anti-inflamatorias y anti-hipertensivas, asi como la frecuente identificacion de farmacos en aguas superficiales aledanas o inmersas en comunidades urbanas, los objetivos del presente estudio fueron evaluar la presencia y concentracion de piroxicam y atenolol en el arroyo de la Onca, municipio de Tres Lagoas, Mato Grosso do Sul, Brasil, corriente de agua que recibe el efluente de la PTAR Planalto.
In fact, Piroxicam is more powerful than ibuprofen, and so might have even a better chance of working."
Amin, "Spectrophotometric determination of piroxicam and tenoxicam in pharmaceutical formulations using alizarin," Journal of Pharmaceutical and Biomedical Analysis, vol.
We therefore aimed to compare the use of intraperitoneal dexamethasone, piroxicam and sterile aloe vera extract in the prevention of postoperative adhesion formation.
Piroxicam, for example, is an anti-inflammatory and non-steroid substance which, when used, may lead to strokes and high blood pressure, Dr Al Amiri said.
According to reports issued by the ministry's Drug Control Laboratory, the confiscated samples of the medicine were found to contain harmful substances such as piroxicam and paracetamol that could lead to heart failure, stroke and high blood pressure.