Piroxicam
CLINICAL USE
NSAID and analgesic
DOSE IN NORMAL RENAL FUNCTION
Rheumatic disease: 20–30 mg daily Acute gout: 40 mg in single or divided dosesAcute musculoskeletal disorders: 40 mg daily for 2 days, then 20 mg daily
PHARMACOKINETICS
Molecular weight :331.3 %Protein binding :99 %Excreted unchanged in urine : <5 Volume of distribution (L/kg) :0.14half-life – normal/ESRD (hrs) :50/Unchanged DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
20 to 50 : Dose as in normal renal function, but avoid if possible 10 to 20 : Dose as in normal renal function, but avoid if possible <10 : Dose as in normal renal function, but only use if on dialysis DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD :Not dialysed. Dose as in GFR <10 mL/min. HD :Not dialysed. Dose as in GFR <10 mL/min. HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min. CAV/VVHD :Not dialysed. Dose as in GFR=10–20 mL/min IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsACE inhibitors and angiotensin-II antagonists: antagonism of hypotensive effect; increased risk of nephrotoxicity and hyperkalaemiaAnalgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects); avoid with ketorolac (increased risk of side effects and haemorrhage)Antibacterials: possibly increased risk of convulsions with quinolonesAnticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarinsAntidepressants: increased risk of bleeding with SSRIs and venlafaxineAntidiabetic agents: effects of sulphonylureas enhancedAnti-epileptics: possibly increased phenytoin concentrationAntivirals: increased risk of haematological toxicity with zidovudine; concentration increased by ritonavirCiclosporin: may potentiate nephrotoxicity Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinib Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect; hyperkalaemia with potassium-sparing diuretics Lithium: excretion decreased Pentoxifylline: increased risk of bleeding Tacrolimus: increased risk of nephrotoxicity ADMINISTRATION
Reconstition
– Route
Oral, IM, topical Rate of Administration
–Comments
– OTHER INFORMATION
Inhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease – avoid if possible; if not, check serum creatinine 48–72 hours after starting NSAID – if serum creatinine is increased, stop NSAIDUse normal doses in patients with CKD 5 if on dialysis and do not pass any urineUse with caution in renal transplant recipients – can reduce intrarenal autocoid synthesisWater soluble inactive metabolites may be removed by HD and CAPD
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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