Piroxicam
Pronunciation: (pihr-OX-ih-kam)Class: NSAID
Trade Names:
Feldene
- Capsules 10 mg
- Capsules 20 mg
Apo-Piroxicam (Canada)
Gen-Piroxicam (Canada)
Novo-Pirocam (Canada)
Nu-Pirox (Canada)
Pharmacology
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 User Reviews & Ratings
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Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis.
Pharmacokinetics
Absorption
Slight delay in the rate of absorption with food. Steady state is 7 to 12 days, up to 2 to 3 wk. T max is 3 to 5 h. Well absorbed. C max is 3 to 8 mcg/mL (multiple doses), 1.5 to 2 mcg/mL (single doses).
Distribution
Vd is 0.14 L/kg. Protein binding is 99%. Excreted in breast milk.
Metabolism
In the liver by hydroxylation; no active metabolites.
Elimination
The t 1/2 is approximately 50 h. Eliminated primarily in the urine, small amount in feces; 5% excreted unchanged.
Peak
Therapeutic effect is 3 to 5 h.
Special Populations
Hepatic Function ImpairmentEffect not established; however, the drug is extensively metabolized in the liver and may require reduced doses.
Indications and Usage
Treatment of acute or long-term use of rheumatoid arthritis and osteoarthritis.
Unlabeled Uses
Symptomatic relief of primary dysmenorrhea, pain, sunburn, juvenile rheumatoid arthritis.
Contraindications
Known allergy or hypersensitivity to aspirin, iodides, or any NSAID, including piroxicam.
Dosage and Administration
Rheumatoid Arthritis, OsteoarthritisAdults
PO Initiate and maintain at 20 mg/day in 1 to 2 divided doses.
Storage/Stability
Store at room temperature.
Drug Interactions
AlcoholMay augment risk of GI bleeding.
AnticoagulantsMay increase effect of anticoagulants because of decreased plasma protein binding and inhibition of platelet aggregation. May increase risk of gastric erosion and bleeding.
Beta-blockersAntihypertensive effect may be decreased.
CholestyramineEffects of piroxicam may be decreased.
LithiumMay decrease lithium Cl.
MethotrexateMay increase methotrexate levels and toxicity.
RitonivirMay increase concentrations and possibly the toxicity of piroxicam by inhibiting its metabolism.
Laboratory Test Interactions
May prolong bleeding time. May reversibly increase BUN and serum creatinine.
Adverse Reactions
Cardiovascular
Edema; weight gain; CHF; alterations in BP; vasodilation; palpitations; tachycardia.
CNS
Headache; malaise; dizziness; somnolence; vertigo; depression; insomnia; nervousness.
Dermatologic
Pruritus; rash; sweating; erythema; bruising; desquamation; erythema multiforme; toxic epidermal necrolysis.
EENT
Tinnitus; swollen eyes; blurred vision; eye irritation; rhinitis; pharyngitis.
GI
Epigastric distress; nausea; vomiting; anorexia; constipation; stomatitis; abdominal discomfort; diarrhea; flatulence; abdominal pain; indigestion; toxicity (bleeding, ulceration, perforation); heartburn; dyspepsia; anorexia.
Genitourinary
Hematuria; proteinuria; increased BUN and serum creatinine; acute renal insufficiency and failure; papillary necrosis; interstitial nephritis; nephrotic syndrome; hyperkalemia; hyponatremia.
Hematologic
Increased bleeding time; decreased Hgb and Hct; anemia; leukopenia; eosinophilia, thrombocytopenia.
Hepatic
Increased LFTs; elevated liver enzymes.
Respiratory
Bronchospasm; laryngeal edema; dyspnea; hemoptysis; shortness of breath.
Precautions
Pregnancy
Category C .
Lactation
Undetermined.
Children
Safety and efficacy not established.
Elderly
Increased risk of adverse reactions. May require decreased dosage.
Asthma
In certain patients (aspirin-allergic, nasal polyps) may precipitate asthma attacks.
CV disease
May worsen CHF and hypertension.
Coagulation disorders
Increases risk of bleeding.
Dermatologic effects
Combination of dermatologic/allergic signs and symptoms (ie, arthralgias, pruritus, fever, fatigue, rash including vesiculobullous reactions, exfoliative dermatitis) suggestive of serum sickness have occurred.
GI effects
Serious GI toxicity can occur at any time, with or without warning symptoms.
Renal disease
Drug may accumulate, increasing the risk of toxicity. In cases of advanced kidney disease, treatment with piroxicam is not recommended.
Overdosage
Symptoms
Drowsiness, dizziness, mental confusion, disorientation, lethargy, paresthesia, numbness, vomiting, GI irritation, headache, tinnitus, seizure, increased BUN.
Patient Information
- Explain that increased response may be seen after weeks of therapy.
- Caution patient to avoid exposure to sunlight, and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
- Identify signs and symptoms patient should report to health care provider, including changes in how food tastes, nausea, vomiting, constipation, diarrhea, cramping, black or red stool, discolored urine, changes in urination, fever, rash, unusual bruising or bleeding.
- Explain that taking medication with food will minimize GI distress.
- Inform patient to avoid aspirin and alcohol during therapy.
- Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness until the effects of the drug are known.
- Encourage patient to maintain adequate fluid intake.
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More Piroxicam resources
piroxicam - Includes detailed dosage instructions.
Compare Piroxicam with other medications for the treatment of:
Osteoarthritis, Pain, Rheumatoid Arthritis, Temporomandibular Joint Disorder, Frozen Shoulder
