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Drug Interactions between antithrombin (recombinant) and piroxicam

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

piroxicam antithrombin recombinant

Applies to: piroxicam and antithrombin (recombinant)

MONITOR CLOSELY: Coadministration of nonsteroidal anti-inflammatory drugs (NSAIDs) such as piroxicam may potentiate the risk of bleeding in patients treated with anticoagulants or other drugs that affect hemostasis. In a one-year observational study of a population of coumarin anticoagulant users, the relative risk of bleeding complications due to concomitant NSAID use was 5.8 compared to anticoagulant use alone. Some investigators suggest that the risk of hemorrhagic peptic ulcers in particular may be substantially increased, especially in elderly or debilitated patients. A retrospective epidemiologic study of patients aged 65 years or older reported a nearly 13-fold increase in the risk of developing hemorrhagic peptic ulcer disease in concurrent users of oral anticoagulants and NSAIDs compared with nonusers of either drug. Fatalities have been reported. The pharmacologic effects of NSAIDs that contribute to this interaction include gastrointestinal irritation, prolongation of prothrombin time, and inhibition of platelet adhesion and aggregation. Administration of piroxicam at dosages greater than 20 mg per day carries an increased risk of GI side effects, and evidence from observational studies suggests that piroxicam may also be associated with a higher risk of serious gastrointestinal toxicity relative to other NSAIDs.

MANAGEMENT: NSAIDs including piroxicam should be administered with anticoagulants only if benefits are expected to outweigh the increased risk of bleeding complications. The lowest effective dosage of the NSAID should be used for the shortest duration possible. Patients and physicians should remain alert for signs and symptoms of GI ulceration or bleeding such as severe abdominal pain, dizziness, lightheadedness, and the appearance of black, tarry stools. Selective use of prophylactic anti-ulcer therapy (e.g., misoprostol, proton pump inhibitors) should be considered. Some authorities consider the concomitant treatment of piroxicam with anticoagulants to be contraindicated.

References (21)
  1. Flessner MF, Knight H (1988) "Prolongation of prothrombin time and severe gastrointestinal bleeding associated with combined use of warfarin and ketoprofen." JAMA, 259, p. 353
  2. Ku LL, Ward CO, Durgin SJ (1970) "A clinical study of drug interaction and anticoagulant therapy." Drug Intell Clin Pharm, 4, p. 300-6
  3. Koch-Weser J, Sellers EM (1971) "Drug interactions with coumarin anticoagulants (second of two parts)." N Engl J Med, 285, p. 547-58
  4. Rhodes RS, Rhodes PJ, Klein C, Sintek CD (1985) "A warfarin-piroxicam drug interaction." Drug Intell Clin Pharm, 19, p. 556-8
  5. Dahl SL, Ward JR (1982) "Pharmacology, clinical efficacy, and adverse effects of piroxicam, a new nonsteroidal anti-inflammatory agent." Pharmacotherapy, 2, p. 80-9
  6. Self TH, Evans WE, Ferguson T (1975) "Drug enhancement of warfarin activity." Lancet, 2, p. 557-8
  7. Buchanan GR, Martin V, Levine PH, et al. (1977) "The effects of "anti-platelet" drugs on bleeding time and platelet aggregation in normal human subjects." Am J Clin Pathol, 68, p. 355-9
  8. Udall JA (1970) "Drug interference with warfarin therapy." Clin Med, 77, p. 20-5
  9. Kaufman DW, Kelly JP, Sheehan JE, Laszlo A, Wiholm BE, Alfredsson L, Koff RS, Shapiro S (1993) "Nonsteroidal anti-inflammatory drug use in relation to major upper gastrointestinal bleeding." Clin Pharmacol Ther, 53, p. 485-94
  10. Wells PS, Holbrook AM, Crowther NR, Hirsh J (1994) "Interactions of warfarin with drugs and food." Ann Intern Med, 121, p. 676-83
  11. Serlin MJ, Breckenridge AM (1983) "Drug interactions with warfarin." Drugs, 25, p. 610-20
  12. Brouwers JRBJ, Desmet PAGM (1994) "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet, 27, p. 462-85
  13. Schafer AI (1995) "Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis." J Clin Pharmacol, 35, p. 209-19
  14. Gabb GM (1996) "Fatal outcome of interaction between warfarin and a non-steroidal anti-inflammatory drug." Med J Aust, 164, p. 700-1
  15. Knijff-Dutmer EA, Schut GA, van de Laar MA (2003) "Concomitant coumarin-NSAID therapy and risk for bleeding." Ann Pharmacother, 37, p. 12-6
  16. Shorr RI, Ray WA, Daugherty JR, Griffin MR (1993) "Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease." Arch Intern Med, 153, p. 1665-70
  17. Penning-van Beest F, Erkens J, Petersen KU, Koelz HR, Herings R (2005) "Main comedications associated with major bleeding during anticoagulant therapy with coumarins." Eur J Clin Pharmacol, 61, p. 439-44
  18. (2023) "Product Information. APO Piroxicam (piroxicam)." Apotex Incorporated
  19. (2024) "Product Information. Feldene (piroxicam)." Pfizer Ltd
  20. (2024) "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals Group, SUPPL-53
  21. (2024) "Product Information. moBILis (piroxicam)." Alphapharm Pty Ltd

Drug and food interactions

Moderate

piroxicam food

Applies to: piroxicam

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References (1)
  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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