Piroxicam

Indications & Dose:

Rheumatic  disease:

ADULT:

• BY MOUTH

initially 20 mg daily, maintenance 10-30 mg daily, in single or divided doses.

Acute musculoskeletal disorders

• BY MOUTH

40 mg daily in single or divided doses for 2 days, then 20 mg daily for 7-14 days.

Acute gout

• BY MOUTH

40 mg initially then 40 mg daily in single or divided doses for 4-6 days.

Musculoskeletal disorders:

• BY MOUTH

Initially 40mg daily for 2 days then 20mg daily for 714 days.

Postoperative and post-traumatic pain:

• BY MOUTH

40mg daily in single or divided doses for first two days, then 20mg once daily.

Primary dysmenorrhoea:

• BY MOUTH

40mg once daily for first two days, then 20mg once daily for 2-3 days.

• DEEP INTRAMUSCULAR

injection into gluteal muscle, for initial treatment of acute conditions, as dose by mouth (on short-term basis). For maintenance use oral preparations.

Dental & minor surgery

BY MOUTH

20mg daily as a single dose.

Orthopaedic surgery:

• BY MOUTH

 40 mg daily for 2 days than 20mg daily as a single dose

Dispersable tablets may be swallowed whole or dispersed in 50ml of water

Elderly

Use lowest effective dose, monitor for GI bleeding for 4 weeks after initiation of therapy.

Children

(over 6 years) by mouth, juvenile arthritis, less than 15kg,  5 mg daily; 16-25 kg, 10 mg; 26-45 kg, 15 mg; over 46 kg, 20 mg.

Children

Under 6 years not recommended . 

Contraindications:

Bronchospasm, nasal polyps and angioedema precipitated by aspirin or other NSAIDs

Side Effects:

Cautions:

Precautions:

History of GI ulceration, bleeding, or perforation; renal dysfunction, hypertension. or cardiac conditions aggravated by fluid retention and edema, history of liver dysfunction, history of coagulation 

Interaction:

Drugs

Aminoglycosides: Reduced clearance with elevated aminoglycoside levels and, potential for toxicity (especially indomethacin in premature infants; other NSAIDs probably)

Anticoagulants: Excessive hypoprothrombinernia, decreased platelet aggregation with increased risk of GI bleeding

Antihypertensives (a-blockers, angiotensin-converting enzyme inhibitors, angiotensin ll receptor blockers, β blockers, diuretics): Inhibition of antihypertensive and other favorable hemodynamic effects

Corticosteroids: Increased risk of GI ulceration

Cyclosporine: Increased nephrotoxicity risk

Lithium: Decreased clearance of lithium (mediated via prostaglandins) resulting in elevated serum lithium levels and risk of toxicity

Methotrexate: Decreased renal secretion of methotrexate resulting in elevated methotrexate levels and risk of toxicity

Phenylpropaoalamine: Possible acute hypertensive reaction

Potassium-sparing diuretics: Additive hyperkalemia is potential

Triamterene: Acute renal failure reported with addition of indomethacin; caution with other NSAIDs  

Warnings:

Adverse Effects:

Lactations:

(avoid administration near term); excreted into breast milk: approximately 1 % of mother’s serum levels; should not present a risk to nursing infant 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, confusion, depression, dizziness, drowsiness, fatigue, headache, insomnia, tremors
CV: Dysrhythmias, palpitations, peripheral edema, tachycardia
EENT: Blurred vision, hearing loss, tinnitus .
GI: Anorexia, bleeding, cholestatic hepatitis, constipation, cramps, diarrhea, dry mouth, flatulence, jaundice, nausea, perforation, ulceration, vomiting
GU: Nephrotoxicity
HEME: Blood dyscrasias
SKIN: Photosensitivity, pruritus, purpura, rash, sweating 

Patient And Carer Advice: