Drug reference
Rheumatoid arthritis (initiated by a specialist) | Osteoarthritis (initiated by a specialist) | Ankylosing spondylitis (initiated by a specialist) ▶BY MOUTH ▶Adult: Up to 20 mg once daily Pain relief in musculoskeletal conditions | Treatment in knee or hand osteoarthritis (adjunct) ▶TO THE SKIN ▶Adult: Apply 3–4 times a day, 0.5% gel to be applied; review treatment after 4 weeks
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▶With systemic use Active gastro-intestinal bleeding. active gastro-intestinal ulceration. history of gastro-intestinal bleeding. history of gastro-intestinal perforation. history of gastro-intestinal ulceration. inflammatory bowel disease. severe heart failure
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▶With systemic use Allergic disorders. cardiac impairment (NSAIDs may impair renal function). cerebrovascular disease. coagulation defects. connective-tissue disorders. dehydration (risk of renal impairment). elderly (risk of serious side-effects and fatalities). heart failure. history of gastro-intestinal disorders. ischaemic heart disease. peripheral arterial disease. risk factors for cardiovascular events. uncontrolled hypertension ▶With topical use Avoid contact with eyes. avoid contact with inflamed or broken skin. avoid contact with mucous membranes. not for use with occlusive dressings. topical application of large amounts can result in systemic effects, including hypersensitivity and asthma (renal disease has also been reported)
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Contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID—which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID.
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CHMP ADVICE—PIROXICAM (JUNE 2007) ▶With systemic use The CHMP has recommended restrictions on the use of piroxicam because of the increased risk of gastro- intestinal side effects and serious skin reactions. The CHMP has advised that: . piroxicam should be initiated only by physicians experienced in treating inflammatory or degenerative rheumatic diseases . piroxicam should not be used as first-line treatment . in adults, use of piroxicam should be limited to the symptomatic relief of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis . piroxicam dose should not exceed 20 mg daily . piroxicam should no longer be used for the treatment of acute painful and inflammatory conditions . treatment should be reviewed 2 weeks after initiating piroxicam, and periodically thereafter . concomitant administration of a gastro-protective agent should be considered. Topical preparations containing piroxicam are not affected by these restrictions.
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→Appendix 1: NSAIDs
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GENERAL SIDE-EFFECTS ▶Common or very common Gastrointestinal discomfort. gastrointestinal disorders. nausea. skin reactions ▶Rare or very rare Severe cutaneous adverse reactions (SCARs) ▶Frequency not known Bronchospasm. dyspnoea. photosensitivity reaction SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With oral use Anaemia. appetite decreased. constipation. diarrhoea. dizziness. drowsiness. eosinophilia. headache . hyperglycaemia. leucopenia. oedema. rash (discontinue) . thrombocytopenia. tinnitus. vertigo. vomiting. weight changes ▶Uncommon ▶With oral use Hypoglycaemia. palpitations. stomatitis. vision blurred ▶Rare or very rare ▶With oral use Nephritis tubulointerstitial. nephrotic syndrome. renal failure. renal papillary necrosis ▶Frequency not known ▶With oral use Alopecia. angioedema. aplastic anaemia. confusion. depression. embolism and thrombosis. eye irritation. eye swelling. fertility decreased female. fluid retention. haemolytic anaemia. haemorrhage. hallucination. hearing impairment. heart failure. hepatic disorders. hypersensitivity. hypertension. malaise. mood altered. nervousness. onycholysis. pancreatitis. paraesthesia. sleep disorders. vasculitis SIDE-EFFECTS, FURTHER INFORMATION For information about cardiovascular and gastrointestinal side-effects, and a possible exacerbation of symptoms in asthma, see Non- steroidal anti-inflammatory drugs. p. 1193 Topical application of large amounts can result in systemic effects.
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▶With systemic use Caution—long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment.
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▶With systemic use Avoid unless the potential benefit outweighs the risk. Avoid during the third trimester (risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn); onset of labour may be delayed and duration may be increased. ▶With topical use Patient packs for topical preparations carry a warning to avoid during pregnancy.
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▶With systemic use Use with caution during breast-feeding. Amount too small to be harmful. ▶With topical use Patient packs for topical preparations carry a warning to avoid during breast-feeding.
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▶With oral use Manufacturer advises caution.
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▶With systemic use Avoid if possible or use with caution. ▶With topical use Deterioration in renal function has also been reported after topical use. Dose adjustments ▶With systemic use The lowest effective dose should be used for the shortest possible duration. Monitoring ▶With systemic use In renal impairment monitor renal function; sodium and water retention may occur and renal function may deteriorate, possibly leading to renal failure.
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Piroxicam orodispersible tablets can be taken by placing on the tongue and allowing to dissolve or by swallowing. ▶With topical use For topical preparations apply with gentle massage only.
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There can be variation in the licensing of different medicines containing the same drug. Orodispersible tablet CAUTIONARY AND ADVISORY LABELS 10, 21 EXCIPIENTS: May contain Aspartame ▶Feldene Melt (Pfizer Ltd) Piroxicam 20 mg Feldene Melt 20mg tablets sugar-free | 30 tablet P £10.53 DT = £10.53 Gel EXCIPIENTS: May contain Benzyl alcohol, propylene glycol ▶Piroxicam (Non-proprietary) Piroxicam 5 mg per 1 gram Piroxicam 0.5% gel | 60 gram P £6.00 DT = £2.12 | 100 gram P £4.80 | 112 gram P £9.41 DT = £3.96 ▶Feldene (Pfizer Ltd) Piroxicam 5 mg per 1 gram Feldene 0.5% gel | 60 gram P £6.00 DT = £2.12 | 112 gram P £9.41 DT = £3.96 Capsule CAUTIONARY AND ADVISORY LABELS 21 ▶Piroxicam (Non-proprietary) Piroxicam 10 mg Piroxicam 10mg capsules | 56 capsule P £5.77 DT = £4.90 Piroxicam 20 mg Piroxicam 20mg capsules | 28 capsule P £5.76 DT = £4.48 ▶Feldene (Pfizer Ltd) Piroxicam 10 mg Feldene 10mg capsules | 30 capsule P £3.86 Piroxicam 20 mg Feldene 20 capsules | 30 capsule P £7.71
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▶With topical use For topical preparations, patients and their carers should be advised to wash hands immediately after use. Photosensitivity Patients should be advised against excessive exposure to sunlight of area treated in order to avoid possibility of photosensitivity. l LESS SUITABLE FOR PRESCRIBING Musculoskeletal system ▶With oral use Piroxicam is less suitable for prescribing.
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Up to 20 mg once daily
First-line fragment. Read the complete Indications and Dose section above.
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Apply 3–4 times a day, 0.5% gel to be applied;
First-line fragment. Read the complete Indications and Dose section above.
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