NSAIDs include- Propionic acid- Fenoprofen, Flurbiprofen, Ibiprofen, Ketoprofen, Naproxen, Naproxen Sodium, Oxaprozin Acetic acids- Diclofenac sodium, Etodolac, Indomethicin, Ketorolac, Nabumetone, Sulindac, Tolmetin Fenamates (anthralic acids) - Meclofenamate, Mefenamic acxid Oxicams- Piroxicam Refer- Ibuprofen

Bile salts sequestrants + Piroxicam

Bile salts seques decr piroxicam elimination may be enhanced by cholestyramine

May potentiate anticoagulants.

Diuretics increase risk of renal damage.

Monitor lithium levels.

Aspirin reduces serum levels.

NSAIDs include- Propionic acid- Fenoprofen, Flurbiprofen, Ibiprofen, Ketoprofen, Naproxen, Naproxen Sodium, Oxaprozin Acetic acids- Diclofenac sodium, Etodolac, Indomethicin, Ketorolac, Nabumetone, Sulindac, Tolmetin Fenamates (anthralic acids) - Meclofenamate, Mefenamic acxid Oxicams- Piroxicam Refer- Ibuprofen 

Thrombocytopenia,acute nephropathy. GI disturbances, oedema, peptic ulcer. GI bleeding, headache, dizziness, blurred vision, tinnitus, skin rashes, pruritus.

Hypersens.Acute or history of peptic ulcer. History of allergy to aspirin or NSAIDs, porphyria.

Special precautions:

Asthma.Surgery. Impaired renal or hepatic function. Haemorrhagic disorders. May mask sign of infection. Hypertension. Pregnancy, lactation. Children below 12 years. Periodic opthmological monitoring.

Indications:

Osteoarthritis, rheumatoid arthritis.

Dosage:

Initiate and maintain a single dose of 20 mg. May divide daily dose. Children - Use in children not established.

List of entries 1. Rheumatoid Arthritis 2. Juvenile Rheumatoid Arthritis 3. Ankylosing spondylosis 4. Reiters Syndrome 5. Osteomyelitis 6. Cervical spondylosis 7. Gout 1. Rheumatoid arthritis Rheumatoid arthritis (RA) is a chronic sytemic disease of unknown etiology, manifested primarily by inflammatory arthritis of the peripheral joints,usally in a symetrical distribution. Systemic manifestations include hematologic, pulmonary, neurological and cardiovascular abnormalities. 2. Juvenile Rheumatoid arthritis Juvenile arthritis (JRA) consists of several distinct syndromes. Three main subgroups have been identified: systemic-onset disease, polyarticular disease, and pauciarticular disease. In addition, ankylosing spondylosis and rheumatoid arthritis indistinguishable from adult onset disease may begin from childhood. 3. Ankylosing spondylosis Ankylosing spondylosis, a disease that has been called by many names, including rheumatoid spondylosis and Marie-Strumpell disease, is a chronic and usually progressive inflammatory disease invloving the articulations of the spine and adjacent soft tissues. The sacroiliac joints are always affected. Involvement of the hip and shoulder joints commonly occurs: peripheral joints are affected less frequently The disease predominantly affects young men and begin most often in the third decade. A high association has been found between this disorder and the histocompatibility antigen HLA-B27. The clinical features of this disease are distinctly different from those of rheumatoid arthritis. The etiology is unknown. 4. Reiters Syndrome Reiters syndrome is characterized by arthritis, urethritis, conjunctivitis, and mucocutaneous lesions. The complete syndrome may not be present at any given time. The diagnosis should be entertained when arthritis is associated with any of the other manifestations. The HLA-B27 is present in majority of the patients. 5. Osteomyelitis Osteomyelitis denotes infection of bone. While many types of microorganisms, including viruses and fungi may cause ostyeomyelitis, it is usually bacterial in origin 6. Cervical spondylosis The cervical intervertebral disks degenerate to some degree in the majority of individuals by the sixth and seventh decades of life. This results in narrowing of the disks especially in the most mobile parts of the cervical spine (fourth to fifth cervical, fifth to sixth cervical, sixth to seventh cervical and seventh cervical to first thoracic segments) and spur formation on the margins of the adjacent vertebrae. There are anterior beaking and posterior osteophytes which protude centrally with narrowing of the spinal canal or laterally so as to impinge on spinal roots in the intervertebral canal. This condition is incorrectly called hypertrophic arthritis, but there is no consistent association with arthritis of this type of joints. The more appropiate term cervical spondylosis refers to a wear and tear (traumatic) phenomenon. 7. Gout Gout is the term representing hetrogenous group of diseases found exclusively in humans which in their full d evelopment are manifested by a. an increase in serum urate cocentrations b. recurrent attacks of characterstic type of acute arthritis in which crystals of monosodium urate are demonstrable in leukocytes of synovial fluid c. aggregated deposits of monosodium urate monohydrate( tophi) chiefly in around the joints of the extremities and sometimes leading to severe crippling or deformity d. renal disease involving intestinal tissues and blood vessels and e. uric acid nephrolithiasis These may occur singly or in combination ================================================================================= Name: Piroxicam Classification: Analgesics Patent position: Major brands BREXIC WOCKHARDT DOLONEX RANGE PFIZER MARKET LEADER MOVON IPCA PIROX RANGE CIPLA TOLDIN TORRENT Ceiling price Price/Rs Notification PIROXICAM 2990/kg Domestic production 93/94 2.32T Demand projection 93/94 1.7T Imports Exports Raw materials: 1.Saccharin 2.Methyl chloroacetate 3.Sodium methoxide 4.Dimethyl sulfoxide 5.Dimethyl formamide 6.Amino pyridine ** 7.Methyl hydroxy-2H-benzarhioazone -1-1-dioxide ** 8.3-carboxylic methyl ester ** Concessional duty Manufacturers: 1.Tamil Nadu Dadha Ltd. 2.Wochardt Ltd. - 2T

1. NSAIDs can cause discomfort and rarely more serious side effects such as GI bleeding which may result in hospitalisation and even fatalities.

2.Avoid aspirin and alcoholic beverages while taking medication.

3. If GI upset occurs, take with food, milk or antacids. For GI upset with tolmetin, use antacids other than sodium bicarbonate.

4. Notify physician, if skin rash, itching, visual disturbances, weight gain, edema occurs

5. Mefanamic acid and metclofenate: if rash, diarrhoea, or digestive problem occr discontinue use and consult physician

6. Ibuprofen- Do not take for more than 3 days for fever or 10 days for pain. If these symptoms persists,consult a physican.

Refer NSAIDs- Ibuprofen

Absorption reduced but not significant

Refer NSAIDs- Ibuprofen