No

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

>10%:

Central nervous system: Dizziness

Dermatologic: Rash

Gastrointestinal: Abdominal cramps, heartburn, indigestion, nausea

1% to 10%:

Central nervous system: Headache, nervousness

Dermatologic: Itching

Endocrine & metabolic: Fluid retention

Gastrointestinal: Vomiting

Otic: Tinnitus

<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

Oral:

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 necessary

May be administered with food to decrease GI adverse effect

Occult blood loss, hemoglobin, hematocrit, and periodic renal and hepatic function tests; periodic ophthalmologic exams with chronic use

chloride (S), sodium (S), bleeding time

Dizziness is common; may cause nervousness; may rarely cause drowsiness, confusion, depression, or hallucinations

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 levels

No information available to require special precautions

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 warfarin (Coumadin®).

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 use

Capsule: 10 mg, 20 mg

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