Piroxicam

FDA label

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Renal Avoid in advanced renal disease unless benefit outweighs risk; monitor renal function in renal/hepatic impairment, HF, dehydration, or hypovolemia

Hepatic Monitor; discontinue if abnormal liver tests persist or worsen or signs of liver disease develop

Instructions

• Use lowest effective dose for shortest duration
• Steady-state not reached for 7-12 days; do not assess effect for 2 weeks
• Avoid at ≈30 weeks gestation and later; limit use 20-30 weeks gestation

Contraindications

• History of asthma, urticaria, or other allergic-type reactions after aspirin or other NSAIDs
• In the setting of CABG surgery

Cautions

• CV thrombotic events
• GI bleeding, ulceration, and perforation
• Hepatotoxicity
• Hypertension
• Heart failure and edema
• Renal toxicity and hyperkalemia
• Anaphylactic reactions
• Aspirin-sensitive asthma
• Serious skin reactions and DRESS
• Fetal toxicity (oligohydramnios, premature ductus closure)
• Hematologic toxicity/anemia

Adverse reactions

• Nausea
• Constipation
• Flatulence
• Abdominal pain
• Diarrhea
• Headache
• Dizziness
• Edema
• Rash

Pregnancy Avoid at ≈30 wk gestation and later (premature ductus arteriosus closure); limit 20-30 wk (oligohydramnios/fetal renal dysfunction).

Lactation Piroxicam is excreted in human milk at ~1-3% of maternal concentration.