|Apo®-Piroxicam; Novo-Piroxicam; Nu-Pirox;
Nonsteroidal Anti-Inflammatory Agent (NSAID)
Management of inflammatory disorders; symptomatic treatment of acute and
chronic rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis; also
used to treat sunburn
B (D in 3rd trimester or near delivery)
Hypersensitivity to piroxicam, any component, aspirin or other nonsteroidal
anti-inflammatory drugs (NSAIDs); active GI bleeding
Use with caution in patients with impaired cardiac function, dehydration,
hypertension, impaired renal function, GI disease (bleeding or ulcers) and
patients receiving anticoagulants; elderly have increased risk for adverse
reactions to NSAIDs
Central nervous system: Dizziness
Gastrointestinal: Abdominal cramps, heartburn, indigestion, nausea
1% to 10%:
Central nervous system: Headache, nervousness
Endocrine & metabolic: Fluid retention
<1%: Congestive heart failure, hypertension, arrhythmias, tachycardia,
confusion, hallucinations, aseptic meningitis, mental depression, drowsiness,
insomnia, urticaria, erythema multiforme, toxic epidermal necrolysis,
Stevens-Johnson syndrome, angioedema, polydipsia, hot flashes, gastritis, GI
ulceration, cystitis, polyuria, agranulocytosis, anemia, hemolytic anemia, bone
marrow suppression, leukopenia, thrombocytopenia, hepatitis, peripheral
neuropathy, toxic amblyopia, blurred vision, conjunctivitis, dry eyes, decreased
hearing, acute renal failure, allergic rhinitis, shortness of breath, epistaxis
Symptoms of overdose include nausea, epigastric distress, CNS depression,
leukocytosis, renal failure
Management of a nonsteroidal anti-inflammatory drug (NSAID) intoxication is
primarily supportive and symptomatic. Fluid therapy is commonly effective in
managing the hypotension that may occur following an acute NSAID overdose,
except when this is due to an acute blood loss.
Seizures tend to be very short-lived and often do not require drug treatment;
although, recurrent seizures should be treated with I.V. diazepam
Since many of the NSAIDs undergo enterohepatic cycling, multiple doses of
charcoal may be needed to reduce the potential for delayed toxicities
CYP2C9 and 2C18 enzyme substrate
Increased effect/toxicity of lithium, warfarin, methotrexate (controversial)
Inhibits prostaglandin synthesis, acts on the hypothalamus heat-regulating
center to reduce fever, blocks prostaglandin synthetase action which prevents
formation of the platelet-aggregating substance thromboxane A2;
decreases pain receptor sensitivity. Other proposed mechanisms of action for
salicylate anti-inflammatory action are lysosomal stabilization, kinin and
leukotriene production, alteration of chemotactic factors, and inhibition of
neutrophil activation. This latter mechanism may be the most significant
pharmacologic action to reduce inflammation.
Onset of analgesia: Oral: Within 1 hour
Peak effect: 3-5 hours
Protein binding: 99%
Metabolism: In the liver
Half-life: 45-50 hours
Elimination: As unchanged drug (5%) and metabolites primarily in urine and to
a small degree in feces
Adults: 10-20 mg/day once daily; although associated with increase in GI
adverse effects, doses >20 mg/day have been used (ie, 30-40 mg/day)
Dosing adjustment in hepatic impairment: Reduction of dosage is
May be administered with food to decrease GI adverse
Occult blood loss, hemoglobin, hematocrit, and periodic renal and hepatic
function tests; periodic ophthalmologic exams with chronic
|Mental Health: Effects
on Mental Status|
Dizziness is common; may cause nervousness; may rarely cause drowsiness,
confusion, depression, or hallucinations
Effects on Psychiatric
May rarely cause agranulocytosis; use caution with clozapine and
carbamazepine; may decrease lithium clearance resulting in an increase in serum
lithium levels and potential lithium toxicity; monitor serum lithium
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
NSAID formulations are known to reversibly decrease platelet aggregation via
mechanisms different than observed with aspirin. The dentist should be aware of
the potential of abnormal coagulation. Caution should also be exercised in the
use of NSAIDs in patients already on anticoagulant therapy with drugs such as
Take this medication exactly as directed; do not increase dose without
consulting prescriber. Do not crush tablets or break capsules. Take with food or
milk to reduce GI distress. Maintain adequate fluid intake (2-3 L/day of fluids
unless instructed to restrict fluid intake). Do not use alcohol, aspirin, or
aspirin-containing medication, and all other anti-inflammatory medications
without consulting prescriber. You may experience drowsiness, dizziness, or
nervousness (use caution when driving or engaging in tasks requiring alertness
until response to drug is known); anorexia, nausea, vomiting, flatulence, or
heartburn (frequent small meals, frequent mouth care, sucking lozenges, or
chewing gum may help); fluid retention (weigh yourself weekly and report unusual
(3-5 lb/week) weight gain). GI bleeding, ulceration, or perforation can occur
with or without pain; discontinue medication and contact prescriber if
persistent abdominal pain or cramping, or blood in stool occurs. Report unusual
swelling of extremities or unusual weight gain; breathlessness, difficulty
breathing, or unusual cough; chest pain, rapid heartbeat, palpitations; unusual
bruising/bleeding; blood in urine, stool, mouth, or vomitus; unusual fatigue;
changes in urinary pattern (polyuria or anuria); skin rash or itching; or change
in hearing or ringing in ears. Pregnancy precautions: Inform prescriber
if you are or intend to be pregnant.
Monitor occult blood loss, hemoglobin, hematocrit, and periodic renal and
hepatic function tests; periodic ophthalmologic exams with chronic
Capsule: 10 mg, 20 mg
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