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Piroxicam

Pronunciation

Pronunciation: pihr-OX-ih-kam
Class: NSAID

Trade Names

Feldene
- Capsules 10 mg
- Capsules 20 mg

Alti-Piroxicam (Canada)
Apo-Piroxicam (Canada)
Gen-Piroxicam (Canada)
Novo-Pirocam (Canada)
Nu-Pirox (Canada)

Pharmacology

Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis.

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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 Impairment

Effect 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, Osteoarthritis
Adults

PO Initiate and maintain at 20 mg/day in 1 to 2 divided doses.

Storage/Stability

Store at room temperature.

Drug Interactions

Alcohol

May augment risk of GI bleeding.

Anticoagulants

May increase effect of anticoagulants because of decreased plasma protein binding and inhibition of platelet aggregation. May increase risk of gastric erosion and bleeding.

Beta-blockers

Antihypertensive effect may be decreased.

Cholestyramine

Effects of piroxicam may be decreased.

Lithium

May decrease lithium Cl.

Methotrexate

May increase methotrexate levels and toxicity.

Ritonivir

May 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

Warnings

NSAIDs may cause an increased risk of serious CV thrombotic events, MI, and stroke, which can be fatal. This risk may increase with length of therapy. Patients with CV disease or risk factors for CV disease may be at greater risk. NSAIDs cause an increased risk of serious GI adverse reactions, including bleeding, inflammation, perforation of the stomach or intestines, and ulceration, which can be fatal. These events can occur any time during use and without warning symptoms. Elderly patients are at greater risk of serious GI events.


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.

Copyright © 2009 Wolters Kluwer Health.

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