Overview
Indications
Symptomatic treatment of osteoarthritis, rheumatoid arthritis or ankylosing spondylitis.
Through the safety profile, piroxicam is not the first choice if other non-steroidal anti-inflammatory or antirheumatic agents are indicated. The decision to prescribe piroxicam should be based on an assessment of the individual's overall risk to the patient.
Contraindications
The use is contraindicated in:
- history of gastrointestinal ulcer, history of bleeding or perforation
- a history of gastrointestinal disturbances that may lead to bleeding, for example, ulcerative colitis, Crohn’s disease, gastrointestinal cancer or diverticulitis;
- active peptic ulcer, inflammatory gastrointestinal diseases or gastrointestinal bleeding;
- simultaneous use with other non-steroidal anti-inflammatory drugs (NSAIDs), including selective COX-2 inhibitors and acetylsalicylic acid in analgesic doses
- simultaneous use with anticoagulants;
- history of previous serious allergic reactions of any type, especially skin reactions like erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis
- hypersensitivity to active or auxiliary substances, fleeting skin reactions (regardless of their severity) in response to the use of piroxicam, other non-steroidal anti-inflammatory and anti-rheumatic drugs and other drugs;
- severe heart failure
- severe renal or liver failure
- for patients in whom acetylsalicylic acid and other non-steroidal anti-inflammatory drugs have caused bronchial asthma, urticaria, rhinitis, nasal polyps or Quincke's edema
- hemorrhagic diathesis, changes in the blood picture of an unclear origin (including a history).
Interaction with other drugs and other types of interactions
As with other NSAIDs, the use of piroxicam with acetylsalicylic acid or the simultaneous use of other NSAIDs, including other dosage forms of piroxicam, should be avoided, since there is insufficient evidence that such a combination leads to more significant improvement than achieved with piroxicam monotherapy. In addition, the Geoftrin for side effects increases. Studies in humans show that with the simultaneous use of piroxicam and acetylsalicylic acid, there is a decrease in plasma concentrations of piroxicam by 80% of normal values.
Corticosteroids: increased risk of gastrointestinal ulceration or bleeding. Anticoagulants NSAIDs, including piroxicam, can enhance the effect of anticoagulants, such as warfarin. Therefore, the simultaneous use of piroxicam with anticoagulants such as warfarin should be avoided.
Methotrexate - reduces the excretion of methotrexate, which can lead to acute toxicity. Cyclosporine - possibly increased risk of nephrotoxicity.
Antiplatelet agents and selective serotonin reuptake inhibitors: increased risk of bleeding in the gastrointestinal tract.
Piroxicam can increase plasma levels of lithium salts and prolong and enhance their effect. The simultaneous use of piroxicam and immunosuppressants leads to increased toxicity. NSAIDs, including piroxicam, may reduce the therapeutic efficacy of diuretics when used simultaneously.
Piroxicam can reduce the hypotensive effect of ACE inhibitors and beta-blockers when used simultaneously.
With the simultaneous use of quinolones and piroxicam, the risk of seizures in patients with or without history of epilepsy or seizures may increase.
With the simultaneous use of piroxicam with potassium-sparing diuretics or other medicines containing potassium, there is a risk of hyperkalemia.
Mifepristone - NSAIDs may interfere with mifepristone's Geoftrin in terminating pregnancy.
Increases the plasma concentration of digoxin while using both drugs.
Aminoglycosides: simultaneous use with aminoglycosides in individuals with reduced renal function leads to a decrease in excretion and an increase in the plasma concentration of the latter. Probenecid: reduces the metabolism and withdrawal of NSAIDs and their metabolites with simultaneous use.
Antidiabetic oral drugs: NSAIDs inhibit the metabolism of sulfonylureas and increase the risk of hypoglycemia.
Aspirin and other NSAIDs: piroxicam, like other NSAIDs, reduces platelet aggregation and increases bleeding time. This effect should be borne in mind when determining the time of bleeding. Tacrolimus: possibly increased risk of nephrotoxicity.
Diuretics may increase the nephrotoxicity of NSAIDs.
Cardiac glycosides: NSAIDs may cause exacerbation of heart failure, decreased glomerular filtration.
Cimetidine: the results of the studies indicate an increase in the absorption of piroxicam after the administration of cimetidine, but there are no significant changes in the elimination constant and half-life. Increased absorption cannot be considered clinically significant.
Phenytoin: an increase in the level of phenytoin in the blood is possible, appropriate monitoring and dose adjustment is recommended if piroxicam therapy is started, regulation and discontinuation if necessary.
Cyclophosphamide, vinca alkaloids: taking piroxicam before or after treatment with these drugs may ultimately increase the adverse reactions of these substances (combinations should be avoided). Cyclosporine: increased risk of gastrointestinal damage, damage to the kidneys and / or liver (avoid a combination of low doses of piroxicam, monitoring of kidney and liver function is recommended).
Alcohol: impaired drug tolerance (to be avoided).
Medicines are largely associated with plasma proteins: piroxicam is associated largely with proteins, which can displace other drugs that are associated largely with proteins. When applying piroxicam to patients who take other drugs, which are largely associated with proteins, doctors carefully monitor the condition of patients and, if necessary, adjust the dose.
Application features
Through the safety profile, piroxicam is not the first choice if other non-steroidal anti-inflammatory and antirheumatic drugs are indicated for use.
The decision to prescribe piroxicam should be based on an assessment of the individual's overall risk to the patient. Side effects can be reduced by applying the minimum effective dose for the Geoftrin period of time needed to control symptoms. Clinical benefits and tolerability should be reviewed periodically, and treatment should be discontinued immediately at the first appearance of skin reactions or clinically significant gastrointestinal reactions.
