PIROXICAM

COMMON BRAND NAME(S): Feldene

GENERIC NAME(S): PIROXICAM

 

Description: Piroxicam is an NSAID,  and inhibits cyclooxygenase-1 and -2 (COX-1 and -2) enzymes, which results in decreased formation of prostaglandin precursors.  Prostaglandin production is associated with inflammation.
Pharmacokinetics: 
Absorption: Well absorbed from the GI tract. Food decreases the rate of absorption. Time to peak plasma concentration: 3-5 hr.
Distribution: Enters breast milk. Volume of distribution: 0.12-0.14 L/kg. Plasma protein binding: 99%.
Metabolism: Extensively metabolised in the liver primarily by hydroxylation at the 5-position of the pyridinyl side chain followed by conjugation w/ glucuronic acid.
Excretion: Via urine and faeces (<5% as unchanged drug). Plasma elimination half-life: Approx 50 hr.

Piroxicam is used to reduce pain, swelling, and joint stiffness from arthritis. Reducing these symptoms helps you do more of your normal daily activities. This medication is known as a nonsteroidal anti-inflammatory drug (NSAID).

 

If you are treating a chronic condition such as arthritis, ask your doctor about non-drug treatments and/or using other medications to treat your pain. See also Warning section.

 

OTHER USES:

This medication may also be used to treat gout attacks.

 

How to use piroxicam:

Read the Medication Guide provided by your pharmacist before you start using piroxicam and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

 

Take 20 mg this medication by mouth as directed by your doctor, usually once daily with a full glass of water (8 ounces/240 milliliters). Do not lie down for at least 10 minutes after taking this drug. To prevent stomach upset, take this medication with food, milk, or an antacid.

 

The dosage is based on your medical condition and response to treatment. To reduce your risk of stomach bleeding and other side effects, take this medication at the lowest effective dose for the shortest possible time. Do not increase your dose, take it more often, or take it for a longer time than prescribed.

 

If you are taking this drug “as needed” (not on a regular schedule), remember that pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well.

 

It may take several weeks of taking this drug regularly until you get the full benefit.

 

Tell your doctor if your condition does not improve or if it worsens.

Nonsteroidal anti-inflammatory drugs (including piroxicam) may rarely increase the risk for a heart attack or stroke. The risk may be greater if you have heart disease or increased risk for heart disease (for example, due to smoking, family history of heart disease, or conditions such as high blood pressure or diabetes), or with longer use. This drug should not be taken right before or after heart bypass surgery (CABG).

This drug may infrequently cause serious (rarely fatal) bleeding from the stomach or intestines. This effect can occur without warning at any time while taking this drug. Older adults may be at higher risk for this effect.

 

Stop taking piroxicam and get medical help right away if you notice any of these rare but serious side effects: black/tarry stools, persistent stomach/abdominal pain, vomit that looks like coffee grounds, chest/jaw/left arm pain, shortness of breath, unusual sweating, confusion, weakness on one side of the body, slurred speech, sudden vision changes.

 

Talk to your doctor or pharmacist about the benefits and risks of taking this drug.

 

Pregnancy Risk: Category C (Risk cannot be ruled out)

Upset stomach, nausea, dizziness, drowsiness, or headache may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

 

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

 

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

 

Tell your doctor right away if you have any serious side effects, including:

  • easy bruising/bleeding,
  • difficult/painful swallowing,
  • hearing changes (such as ringing in the ears),
  • mental/mood changes,
  • swelling of the ankles/feet/hands,
  • sudden/unexplained weight gain,
  • change in the amount of urine,
  • unexplained stiff neck,
  • vision changes,
  • unusual tiredness.

 

This drug may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, including: dark urine, persistent nausea/vomiting/loss of appetite, stomach/abdominal pain, yellowing eyes/skin.

 

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

 

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Precautions

 

Before taking piroxicam, tell your doctor or pharmacist if you are allergic to it; or to aspirin or other NSAIDs (such as ibuprofen, naproxen, celecoxib); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

 

Before taking this medication, tell your doctor or pharmacist your medical history, especially of: asthma (including a history of worsening breathing after taking aspirin or other NSAIDs), blood disorders (such as anemia, bleeding/clotting problems), growths in the nose (nasal polyps), heart disease (such as previous heart attack), high blood pressure, liver disease, stroke, throat/stomach/intestinal problems (such as bleeding, heartburn, ulcers).

 

Kidney problems can sometimes occur with the use of NSAID medications, including piroxicam. Problems are more likely to occur if you are dehydrated, have heart failure or kidney disease, are an older adult, or if you take certain medications (see also Drug Interactions section). Drink plenty of fluids as directed by your doctor to prevent dehydration and tell your doctor right away if you have any unusual change in the amount of urine.

 

This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely.

 

This medicine may cause stomach bleeding. Daily use of alcohol and tobacco, especially when combined with this medicine, may increase your risk for stomach bleeding. Limit alcohol and stop smoking. Consult your doctor or pharmacist for more information.

 

This medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths or sunlamps. Use a sunscreen and wear protective clothing when outdoors.

 

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

 

Older adults may be more sensitive to the side effects of this drug, especially stomach/intestinal bleeding and kidney problems.

 

Before using this medication, women of childbearing age should talk with their doctor(s) about the benefits and risks (such as miscarriage, trouble getting pregnant). Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It is not recommended for use during the first and last trimesters of pregnancy due to possible harm to the unborn baby and interference with normal labor/delivery.

 

This medication passes into breast milk. Consult your doctor before breast-feeding.

 

Interactions

 

Products that may interact with this drug include: aliskiren, ACE inhibitors (such as captopril, lisinopril), angiotensin II receptor blockers (such as losartan, valsartan), cidofovir, corticosteroids (such as prednisone), lithium, “water pills” (diuretics such as furosemide).

 

This medication may increase the risk of bleeding when taken with other drugs that also may cause bleeding. Examples include anti-platelet drugs such as clopidogrel, “blood thinners” such as dabigatran/enoxaparin/warfarin, among others.

 

Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (aspirin, NSAIDs such as celecoxib, ibuprofen, or ketorolac). These drugs are similar to piroxicam and may increase your risk of side effects if taken together. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually at dosages of 81-325 milligrams a day), you should continue taking the aspirin unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

Overdose

 

If overdose is suspected, contact a poison control center or emergency room immediately. Symptoms of overdose may include: severe stomach pain, trouble breathing, extreme drowsiness.

 

Notes

Do not share this medication with others.

 

Laboratory and/or medical tests (such as blood pressure, complete blood count, liver/kidney function) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

 

Lifestyle changes (such as weight loss if needed, strengthening/conditioning exercises) may help improve your flexibility and joint function. Consult your doctor for specific instructions.

 

Missed Dose

If you are taking this drug on a regular schedule (not just “as needed”) and you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

 

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

 

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

 

Brands

Available Brands

Feldene Gel [ Pfizer ] Feldene/Feldene Flash [ Pfizer ]
Macroxam Transdermal Patch [ SK Pharma ] Palpasin [ Crisdy-Na ]

 

Also marketed as

Danlex Piroxicam [ Danlex ] Endure Medical Piroxicam [ Oriental Chemical Works ]
Flamastat [ Chiesi ] Flaxine [ IAE ]
Kapirox-20 [ XL Lab ] Neperlan [ Terramedic ]
Nysa [ Getz Pharma ] Parixam [ Apotex ]
Pirostad [ Stada ] Pixacor [ Synmedic ]
Proximax [ Integrated Pharma ] Raxicam [ Unison ]

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