Piroxicam - instructions for use, doses, side effects, contraindications

The mechanism of action is related to inhibition of the enzyme cyclooxygenase, which leads to the inhibition of synthesis of prostaglandins from arachidonic acid.

Suppresses the aggregation of platelets.

With systemic application reduces pain syndrome.

With external application weakens or stops inflammation and joint pain at rest and during movement, reduces morning stiffness and swelling of the joints, contributes to an increase in the volume of movements.

Analgesic effect occurs 30 minutes after ingestion. The anti-inflammatory effect is manifested by the end of the first week of treatment.After a single dose, the effect lasts for 24 hours.

Piroxicam in a dose of 20-40 mg once inward with a moderate and pronounced postoperative pain syndrome has an analgesic effect comparable to that with the administration of other NSAIDs or morphine at a dose of 10 mg.

Pharmacokinetics:

After oral administration piroxicam is well absorbed from the digestive tract. The maximum concentration in the plasma is reached within 3-5 hours.

Binding to plasma proteins is 99%. Piroxicam penetrates the placental barrier, excreted in breast milk.

Metabolized in the liver by hydrolysis and conjugation.

Piroxicam is excreted from the body in unchanged form (up to 5%) and in the form of metabolites, which are excreted mainly by the kidneys and in small amounts with feces. Half-lifeis about 50 hours.

In patients with liver disease, the half-life may increase.

Indications:

For systemic and external use: articular syndrome (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout), pain in the spine, neuralgia, myalgia, traumatic inflammation of the soft tissues and musculoskeletal system, postoperative and post-traumatic pain,including sports injuries (bruises, dislocations, sprains), pain and swelling in the joints, tendons and muscles, caused by overexertion, etc.

For systemic use: dysmenorrhea in patients older than 12 years, acute infectious and inflammatory diseases of the upper respiratory tract.

ICD-10

XIII.M15-M19 Osteoarthritis

XIII.M05-M14.M13.9 Arthritis, unspecified

XIII.M05-M14.M06.9 Rheumatoid arthritis, unspecified

XIII.M05-M14.M05 Seropositive rheumatoid arthritis

XIV.N80-N98.N94.5 Secondary dysmenorrhea

XIV.N80-N98.N94.4 Primary dysmenorrhea

XVIII.R50-R69.R52.2 Another constant pain

XVIII.R50-R69.R52.1 Constant unrestrained pain

XIII.M40-M43.M42 Osteocondritis of the spine

XIII.M45-M49.M45 Ankylosing spondylitis

XIII.M70-M79.M79.1 Myalgia

XIII.M70-M79.M79.0 Rheumatism, unspecified

XIII.M05-M14.M10 Gout

XIII.M70-M79.M77.9 Other specified intesopathy

XIX.T08-T14.T14.9 Injury, unspecified

XIX.T08-T14.T14.0 Superficial injury of unspecified area of the body

Contraindications:

Hypersensitivity, aspirin triad (complete or incomplete combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses and intolerance of acetylsalicylic acid and preparations of pyrazolone series), bronchial asthma.

Erosive-ulcerative lesions of the gastrointestinal tract in the phase of exacerbation.

Hepatic and / or renal insufficiency.

Violations of blood clotting (including hemophilia, prolonged bleeding time, a tendency to bleeding, hemorrhagic vasculitis).

Pregnancy, breast-feeding.

Children (up to 6 years) and elderly (over 65 years) age.

With rectal administration - proctitis, anorectal bleeding.

Carefully:

Erosion-ulcerative gastrointestinal lesions in the anamnesis, bronchial asthma, allergic diseases, heart failure and other diseases accompanied by edema, arterial hypertension.

Use with caution for violations of liver function and/or kidney.

Pregnancy and lactation:

Recommendations FDA category X. Piroxicam is contraindicated for use in the III trimester of pregnancy. If it is necessary to apply in pregnancy I and II trimesters, the expected benefit for the mother and the potential risk for the fetus should be correlated with the lack of reliable clinical data confirming the safety of piroxicam application during this period. Under the influence of NSAIDs, premature closure of the botulinum duct in the fetus is possible.

Penetrates into breast milk.If it is necessary to use during the lactation period, the question of stopping breastfeeding should be solved. In experiments on animals, it is shown that the drug suppresses lactation.

Dosing and Administration:

For oral administration, the dose is 10-30 mg once a day. Rectally - 20-40 mg 1-2 times a day. In acute gout, the initial dose is 40 mg once a day for the first 2 days, then 40 mg once a day or 20 mg twice a day for 4-6 days.

In acute conditions or exacerbation of the chronic process can be administered intramuscularly at a dose of 20-40 mg once a day. After relief of the acute process, they switch to maintenance therapy with oral forms.

External apply 3-4 times a day.

For pain and inflammation with juvenile rheumatoid arthritis and other disorders of the musculoskeletal system, children from 6 years of age are prescribed inside. Body weight less than 15 kg - 5 mg per day. Body weight 16-25 kg - 10 mg per day. Body weight is 26-45 kg - 15 mg per day. The body weight is more than 45 kg - 20 mg per day.

Side effects:

From the side digestive system: often - nausea, loss of appetite, stomatitis, epigastric pain, diarrhea or constipation, flatulence, bleeding gums (due to inhibition of platelet aggregation); in isolated cases - erosive and ulcerative lesions of the gastrointestinal tract with possiblebleeding and perforation, transient increase in hepatic transaminase activity, jaundice or liver necrosis with a fatal outcome. As a rule, these side effects develop with long-term admission in doses of more than 30 mg per day.

From the side hematopoiesis system: anemia (less often aplastic anemia or hemolytic anemia), thrombocytopenia, leukopenia, eosinophilia.

From the side CNS and peripheral nervous system: dizziness, headache, drowsiness, sleep disturbances, depression, nervousness, hallucinations, mood changes, weakness, sensitivity disorders, puffiness of the eyes, visual impairment and signs of eye irritation.

From the side metabolism: rarely - hyperkalemia, hypo- or hyperglycemia, changes in body weight; in some cases - a transient increase in the content of residual nitrogen and creatinine, uremia along with hyperkalemia.

From the side urinary system: acute renal failure (with signs of hemorrhagic vasculitis), acute interstitial nephritis.

Allergic reactions: possible itching, redness, rash, pemphigus vulgaris, allergic skin swelling of the face and hands; in some cases -Stevens-Johnson syndrome, Lyell syndrome; in isolated cases - anaphylactic reactions, bronchospasm, urticaria, angioedema, vasculitis, serum sickness.

Dermatological reactions: rarely - photosensitivity; less often - onycholysis, alopecia.

Other: possibly epistaxis.

Local reactions: irritation of the rectal mucosa, tenesmus.

For external use: rarely erythema and itching at the place of application.

A higher risk of side effects in patients with impaired renal function.

Overdose:

Symptoms: drowsiness, impaired vision, at very high doses - loss of consciousness, coma.

Treatment: gastric lavage, reception of activated carbon, antacids (to reduce absorption), symptomatic therapy.

Interaction:

With simultaneous application piroxicam can reduce the effect of diuretics and antihypertensive agents.

With the simultaneous use of potassium-sparing diuretics and potassium preparations, hyperkalemia is possible.

With simultaneous use with NSAIDs, glucocorticosteroids increases the risk of bleeding from the gastrointestinal tract.

With the simultaneous use of lithium salts, it is possible to increase the lithium content in blood plasma.

With simultaneous use with oral anticoagulants, blood clotting disorders are possible; with acetylsalicylic acid - a decrease in the content of piroxicam in the blood plasma.

When piroxicam is used 24 hours before or after taking methotrexate, its concentration in the blood plasma increases and toxicity increases.

With simultaneous application with phenytoin, an increase in the concentration of phenytoin in the blood plasma is possible; with phenobarbital - a decrease in the concentration of piroxicam in the blood plasma; with cimetidine, probenecid, sulfinpyrazone - an increase in the concentration of piroxicam in the blood plasma is possible.

With simultaneous intake of lithium salts, an increase in the concentration of lithium ions in the blood.

Special instructions:

In the process of treatment, it is necessary to monitor the functional state of the liver and the pattern of peripheral blood. Piroxicam can increase and lower the concentration of glucose in the blood plasma.

Do not use topically if the integrity of the skin. Avoid contact with eyes or mucous membranes.

It is not recommended to apply piroxicam simultaneously with acetylsalicylic acid and other NSAIDs.

Instructions

Piroxicam (Piroxicamum)