Piroxicam

A to Z Drug Facts

(pihr-OX-ih-kam)

Feldene,  Alti-Piroxicam, Apo-Piroxicam, Gen-Piroxicam, Novo-Pirocam, Nu-Pirox

Class: Analgesic/NSAID

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

 Indications Treatment of acute or long-term use of rheumatoid arthritis and osteoarthritis. Unlabeled use(s): Symptomatic relief of primary dysmenorrhea, pain, sunburn, juvenile rheumatoid arthritis.

 Contraindications Known allergy or hypersensitivity to aspirin, iodides or any NSAID, including piroxicam.

 Route/Dosage

Rheumatoid Arthritis, Osteoarthritis

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

 Interactions

Alcohol: May augment risk of GI bleeding. Anticoagulants: May increase effect of anticoagulants due to 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 clearance. Methotrexate: May increase methotrexate levels and methotrexate toxicity. Ritonivir: May increase concentrations and possibly the toxicity of piroxicam by inhibiting its metabolism.

 Lab Test Interferences May prolong bleeding time. May reversibly increase BUN and serum creatinine.

 Adverse Reactions

CV: Edema; weight gain; CHF; alterations in BP; vasodilation; palpitations; tachycardia. CNS: Headache; malaise; dizziness; somnolence; vertigo; depression; insomnia; nervousness. DERM: 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. GU: Hematuria; proteinuria; increased BUN and serum creatinine; acute renal insufficiency and failure; papillary necrosis; interstitial nephritis; nephrotic syndrome; hyperkalemia; hyponatremia. HEMA: Increased bleeding time; decreased Hgb and Hct; anemia; leukopenia; eosinophilia, thrombocytopenia. HEPA: Increased liver function tests; elevated liver enzymes. RESP: 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. Cardiovascular 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.

 Administration/Storage

• Give after meals to reduce GI effects.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain baseline vital signs, weight and lab results and monitor throughout therapy.
• Notify physician of any changes in creatinine and electrolyte values and of any signs of renal or liver dysfunction, bleeding, GI discomfort, or vision changes.

 Patient/Family Education

• 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 physician, 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.
• Instruct patient not to take any otc medications without consulting physician.
• 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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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts