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Indications:

Treatment of acute or long-term use of rheumatoid arthritis and osteoarthritis

Contraindications:

Known allergy or hypersensitivity to aspirin, iodides, or any NSAID, including piroxicam.

Adverse reactions:

Cardiovascular Edema; weight gain; CHF; alterations in BP; vasodilation; palpitations; tachycardia. CNS Headache; malaise; dizziness; somnolence; vertigo; depression; insomnia; nervousness. Dermatologic Pruritus; rash; sweating; erythema; bruising; desquamation; erythema multiforme; toxic epidermal necrolysis. EENT Tinnitus; swollen eyes; blurred vision; eye irritation; rhinitis; pharyngitis. GI Epigastric distress; nausea; vomiting; anorexia; constipation; stomatitis; abdominal discomfort; diarrhea; flatulence; abdominal pain; indigestion; toxicity (bleeding, ulceration, perforation); heartburn; dyspepsia; anorexia. Genitourinary Hematuria; proteinuria; increased BUN and serum creatinine; acute renal insufficiency and failure; papillary necrosis; interstitial nephritis; nephrotic syndrome; hyperkalemia; hyponatremia. Hematologic Increased bleeding time; decreased Hgb and Hct; anemia; leukopenia; eosinophilia, thrombocytopenia. Hepatic Increased LFTs; elevated liver enzymes. Respiratory Bronchospasm; laryngeal edema; dyspnea; hemoptysis; shortness of breath.

Interactions:

Alcohol May augment risk of GI bleeding. Anticoagulants May increase effect of anticoagulants because of decreased plasma protein binding and inhibition of platelet aggregation. May increase risk of gastric erosion and bleeding. Beta-blockers Antihypertensive effect may be decreased. Cholestyramine Effects of piroxicam may be decreased. Lithium May decrease lithium Cl. Methotrexate May increase methotrexate levels and toxicity. Ritonivir May increase concentrations and possibly the toxicity of piroxicam by inhibiting its metabolism. Laboratory Test Interactions May prolong bleeding time. May reversibly increase BUN and serum creatinine.

Warnings:

Pregnancy Category C . Lactation Undetermined. Children Safety and efficacy not established. Elderly Increased risk of adverse reactions. May require decreased dosage. Asthma In certain patients (aspirin-allergic, nasal polyps) may precipitate asthma attacks. CV disease May worsen CHF and hypertension. Coagulation disorders Increases risk of bleeding. Dermatologic effects Combination of dermatologic/allergic signs and symptoms (ie, arthralgias, pruritus, fever, fatigue, rash including vesiculobullous reactions, exfoliative dermatitis) suggestive of serum sickness have occurred. GI effects Serious GI toxicity can occur at any time, with or without warning symptoms. Renal disease Drug may accumulate, increasing the risk of toxicity. In cases of advanced kidney disease, treatment with piroxicam is not recommended.

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Consultants Corner

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

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