Piroxicam

Listed in Dosage.

Adult: PO Ankylosing spondylitis; Osteoarthritis; Rheumatoid arthritis As cap/orodispersible tab: Max: 20 mg/day as a single dose, or in divided doses if necessary. Review treatment benefit and tolerability within 14 days. Use lowest effective dose for the shortest possible duration based on individual overall risk assessment. Topical/Cutaneous Pain and inflammation As 0.5% gel: Apply 1,000 mg (3 cm) to the affected area 3-4 times/day. Review treatment benefit and tolerability after 4 weeks.

Should be taken with food.

Hypersensitivity (including history of asthma, bronchospasm, nasal polyps, rhinitis, angioedema, urticaria, or other allergic-type reactions) to piroxicam, aspirin or other NSAIDs. Active peptic ulcer, gastrointestinal bleeding, inflammatory bowel disease; history of gastrointestinal disorders that predispose to bleeding disorders (e.g. ulcerative colitis, Crohn's disease, cancer, diverticulitis); history of gastrointestinal ulceration, bleeding or perforation; history of serious cutaneous allergic reactions (e.g. erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis); severe heart failure. Treatment of perioperative pain in the setting of CABG surgery. Pregnancy (3rd trimester). Concomitant use with aspirin, anticoagulants, and other NSAIDs including COX-2 inhibitors.

Patients with mild to moderate CHF, ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, CV events risk factors (e.g. hypertension, hyperlipidaemia, diabetes mellitus, smoking); bronchial asthma, coagulation disorders, cirrhosis, nephrotic syndrome, overt renal disease, dehydration, hypovolaemia; undergoing surgical or dental procedures. Women with conceiving difficulties, undergoing infertility treatment or on investigation of infertility. Debilitated patients. Renal and hepatic impairment. Elderly. Children (topical). Pregnancy (1st-2nd trimester) and lactation. CYP2C9 poor metabolisers. Patient Counselling This drug may cause dizziness, drowsiness, fatigue and visual disturbances, if affected, do not drive or operate machinery. Topical: Do not apply to sites affected by open lesions, dermatoses or infection. Monitoring Parameters Monitor blood pressure during initiation and throughout therapy; occult blood loss, Hb, haematocrit, serum electrolytes, renal and hepatic function tests periodically. Perform periodic ophthalmologic exam (prolonged use).

Significant: New onset or exacerbation of hypertension, hyperkalaemia, Na and fluid retention, oedema, bronchospasm, reversible female infertility, delayed ovulation, serum sickness, haematologic effects (e.g. anaemia, decreased platelet aggregation, prolonged bleeding time). Rarely, interstitial nephritis, papillary necrosis, nephrotic syndrome, renal failure. Blood and lymphatic system disorders: Leucopenia, eosinophilia, thrombocytopenia. Cardiac disorders: Palpitation. Ear and labyrinth disorders: Tinnitus. Eye disorders: Blurred vision, eye irritation and swelling. Gastrointestinal disorders: Nausea, vomiting, constipation, flatulence, abdominal pain, diarrhoea, dyspepsia, stomatitis. General disorders and administration site conditions: Malaise, application site reactions (e.g. irritation, erythema, pruritus, dermatitis). Hepatobiliary disorders: Jaundice. Investigations: Increased LFTs, increased weight. Metabolism and nutrition disorders: Anorexia, hyperglycaemia, hypoglycaemia. Nervous system disorders: Headache, dizziness, somnolence, vertigo, paraesthesia. Psychiatric disorders: Depression, insomnia, confusion, mood alterations, nervousness, hallucination. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Rash, pruritus, photosensitivity (topical). Vascular disorders: Vasculitis, epistaxis.
Potentially Fatal: Gastrointestinal inflammation, ulceration, bleeding and perforation; CV thrombotic events including MI and stroke, severe hepatic reactions (e.g. fulminant hepatitis, hepatic necrosis, hepatic failure), exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylactoid reactions.

Increased risk of gastrointestinal ulceration or bleeding with antiplatelet agents, SSRIs, corticosteroids. May exacerbate cardiac failure, decrease GFR, and increase plasma levels of cardiac glycosides. Increased risk of nephrotoxicity with ciclosporin and tacrolimus. May interfere with the natriuretic effects of diuretics. May increase plasma levels of lithium. May antagonise the hypotensive effects of antihypertensive agents. May decrease excretion of methotrexate, leading to acute toxicity. May increase risk of convulsion with quinolones. May interfere with mifepristone mediated termination of pregnancy.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

M01AC01 - piroxicam ; Belongs to the class of non-steroidal antiinflammatory and antirheumatic products, oxicams.
S01BC06 - piroxicam ; Belongs to the class of non-steroidal antiinflammatory agents. Used in the treatment of inflammation of the eye.
M02AA07 - piroxicam ; Belongs to the class of non-steroidal antiinflammatory preparations for topical use. Used in the treatment of joint and muscular pains.