piroxicam (Feldene)
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Introduction
Tradename: Feldene.
Indications
- temporary relief of minor aches, pains, fever & inflammation
- symptomatic treatment of acute & chronic rheumatoid arthritis
- osteoarthritis
- ankylosing spondylitis
Dosage
- 20 mg PO QD
- do not assess effect of therapy for 2 weeks
- use with caution or reduced doses in the elderly
Tabs: 10, 20 mg.
Pharmacokinetics
- food delays absorption[5]
- metabolized in the liver by cyt P450 2C9
- onset of action is several hours
- duration of action is 24 hours
- elimination 1/2life is 48 hours
- 5% of drug is excreted unchanged in the urine
elimination via liver
1/2life = 14-158 hours
protein binding = >99 %
elimination by hemodialysis = -
elimination by peritoneal dialysis = -
Monitor
liver function tests periodically[6]
Adverse effects
- common (> 10%)
- less common (1-10%)
- uncommon (< 1%)
- congestive heart failure, hypertension, arrhythmias, epistaxis, confusion, hallucinations, aseptic meningitis, depression, peripheral neuropathy, urticaria, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, gastritis, GI ulceration, cystitis, agranulocytosis, anemia, hemolytic anemia, bone marrow depression, leukopenia, thrombocytopenia, hepatitis, angioedema, allergic rhinitis, toxic amblyopia, blurred vision, conjunctivitis, dry eyes, decreased hearing, polyuria, shortness of breath, polydypsia, tachycardia, hot flashes, drowsiness, insomnia, acute renal failure
- other
- GI effects & bleeding may be more prominent with piroxicam than with other NSAIDs
- high incidence of phototoxic skin eruptions
- worsening of renal insufficiency ;;;********|**********|**********|**********|**********|*********|**********|*********
Drug interactions
- corticosteroids
- increase clearance of salicylates
- increased nephrotoxicity
- increased GI toxicity
- decreased anti-hypertensive effects of ACE inhibitors
- coumadin: prolonged bleeding time
- piroxicam decreases clearance & increases toxicity of:
- any drug which inhibits cyt P450 2C9 can increase piroxicam levels
- any drug which induces cyt P450 2C9 can diminish piroxicam levels
- drug interaction(s) of direct oral anticoagulants (DOAC) with NSAIDs
- drug interaction(s) of cholinesterase inhibitors with NSAIDs
- drug interaction(s) of lithium carbonate with NSAIDs
- drug interaction(s) of NSAIDs with oral contraceptive
- drug interaction(s) of NSAIDs with SSRIs
- drug interaction(s) of NSAIDs with antidepressants
- drug interaction(s) of aspirin with NSAIDs
- drug interaction(s) of apixaban with NSAIDs
- drug interaction(s) of warfarin with NSAIDs
- drug interaction(s) of NSAIDs with beta blockers
- drug interaction(s) of NSAIDs with ARBs
- drug interaction(s) of NSAIDs with aldosterone antagonis
- drug interaction(s) of NSAIDs with glucocorticoid
- drug interaction(s) of NSAIDs, diuretics & angiotensin II receptor antagonists
- drug interaction(s) of NSAIDs, diuretics & ACE inhibitors
- drug interaction(s) of NSAIDs with ACE inhibitors
- drug interaction(s) of NSAIDs & antihypertensives
- drug interaction(s) of NSAIDs & loop diuretics
- drug interaction(s) of NSAIDs & aspirin
Laboratory
Mechanism of action
- oxicam class NSAID
- analgesic, antipyretic, anti-inflammatory
- non-selective cyclooxygenase inhibitor
More general terms
- non-steroidal anti-inflammatory agent (NSAID)
- peroxisome proliferator; PPAR agonist; PPAR gamma agonist
Additional terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
- ↑ 5.0 5.1 Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 470
- ↑ 6.0 6.1 Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Liver Function Test Scheduling Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260704&pb=PRL (subscription needed) http://www.prescribersletter.com