piroxicam (Rx)

Brand and Other Names:Feldene
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 10mg
  • 20mg
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Administration

Take with food or 8-12 oz water to avoid GI effects

Other Indications & Uses

20 mg PO qD or div BID; no more than 30-40 mg/d

Rheumatoid arthritis (incl. juvenile), osteoarthritis

Off-label: gout

<12 years old: not recommended

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Interactions

Interaction Checker

and piroxicam

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Indigestion (3.8-9.5% )

            Upper respiratory infection (up to 8.3% )

            Headache (2.4-8.3% )

            Diarrhea (1.9-7.8% )

            Nausea (2.4-7.2% )

            Abdominal pain (1.9-4.7%)

            Edema (0.6- 4.5% )

            Anemia (up to 4.1% )

            Dizziness (1.1-3.8% )

            Constipation (0.8-2.6% )

            Vomiting

            Fever

            Angina (<2% )

            Congestive heart failure (<2% )

            Hypertension (<2% )

            Myocardial infarction (<2% )

            Gastrointestinal hemorrhage (< 2% )

            Gastrointestinal perforation, gastrointestinal ulcer (< 2% )

            Inflammatory disorder of digestive tract (<2% )

            Decreased platelet aggregation, purpuric disorder (<2% )

            Hepatitis (<2% )

            <1%

            Erythema multiforme, erythroderma

            Stevens-Johnson syndrome

            Toxic epidermal necrolysis

            Jaundice, liver failure

            Anaphylactoid reaction

            Immune hypersensitivity reaction

            Cerebrovascular accident

            Interstitial nephritis, renal failure

            Asthma, bronchospasm

            Angioedema

            Tinnitus, hearing loss

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            Warnings

            Black Box Warnings

            Cardiovascular Risk

            • NSAIDs may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), & stroke, which can be fatal
            • Risk may increase with duration of use
            • Patients with risk factors for or existing cardiovascular disease may be at greater risk
            • NSAIDs are contraindicated for perioperative pain in the setting of coronary artery bypass graft (CABG) surgery (increased risk of MI & stroke)

            Gastrointestinal Risk

            • NSAIDs increase risk of serious GI adverse events including bleeding, ulceration, & perforation of the stomach or intestines, which can be fatal
            • GI adverse events may occur at any time during use & without warning symptoms
            • Elderly patients are at greater risk for serious GI events

            Contraindications

            Absolute: ASA allergy

            Relative: bleeding disorders, duodenal/gastric/peptic ulcer, stomatitis, SLE, ulcerative colitis, upper GI disease, late pregnancy (may cause premature closure of the ductus arteriosus)

            Cautions

            May increase risk of asthma (bronchial), cardiac disease, CHF, hepatic impairment, HTN, renal impairment

            Long-term administration of NSAIDs may result in renal papillary necrosis and other renal injury; patients at greatest risk include the elderly, or those with impaired renal function, hypovolemia, heart failure, liver dysfunction, salt depletion, and individuals taking diuretics, ACE inhibitors, or ARBs

            May cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine when used long term and can be fatal; administer lowest effective dose for short periods; use caution

            NSAIDs including piroxicam can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal

            Not for administration to patients that have experienced aspirin anaphylactoid reactions

            Anemia reported in patients receiving NSAIDs, including piroxicam; may prolong bleeding time; monitor

            NSAIDs may cause adverse eye reactions; consult ophthalmologist if symptoms occur

            Based on mechanism of action, use of prostaglandin-mediated NSAIDs, including piroxicam, may delay or prevent rupture of ovarian follicles, which has been associated with reversible infertility in some women; women who have difficulties conceiving or who are undergoing investigation of infertility, withdrawal of NSAIDs, including piroxicam, should be considered

            Heart Failure(HF) risk

            • NSAIDS have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
            • NSAIDS should be avoided or withdrawn whenever possible
            • AHA/ACC Heart Failure Guidelines; Circulation. 2016; 134
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            Pregnancy & Lactation

            Pregnancy Category: C, D during third trimester of pregnancy (may cause premature closure of the ductus arteriosus)

            The Quebec Pregnancy Registry identified 4705 women who had spontaneous abortions by 20 weeks' gestation; each case was matched to 10 control subjects (n=47,050) who had not had spontaneous abortions; exposure to nonaspirin NSAIDs during pregnancy was documented in approximately 7.5% of cases of spontaneous abortions and in approximately 2.6% of controls. (CMAJ, September 6, 2011; DOI:10.1503/cmaj.110454)

            Lactation: excreted in breast milk; has adverse effect on the nursing infant

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Half-life:14-158 hr (average 50 hr)

            Onset: 15-30 min (single 20 mg dose); 1 hr (multiple 20 mg doses)

            Duration: 48-72 hr

            Peak Plasma

            Time: 3-5 hr (a single 20 mg dose)

            Concentration: 1.5-2 mcg/mL (single 20 mg dose); 3-8 mcg/mL (multiple-dose of 20 mg daily)

            Other Information

            Protein Bound: 99.3% (with plasma concentrations 5-30 mcg/mL)

            Vd: 0.12-0.14 L/kg

            Metabolism: hydroxylation at the 5 position of the pyridyl side chain; conjugation by cyclodehydration, hydrolysis of: amide linkage, decarboxylation, ring contraction, N-demethylation

            Metabolites: hydroxy, parent drug

            Excretion: urine, feces

            Enzymes inhibited: cyclooxygenase

            Mechanism of Action

            Inhibits synthesis of prostaglandins in body tissues by inhibiting cyclooxygenase; at least 2 isoenzymes, cyclooxygenase-1 (COX-1) & -2 (COX-2)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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