Coumarin-type anticoagulants and lithium interactions may cause coagulation disturbances or lithium toxicity. Diuretics may be less effective. Concomittant potassium-sparing diuretics may result in hyperkalemia.

Rheumatic disorders Acute muculoskletal disorders 

At the recommended doses PBD is well tolerated. The usual side effects are gastrointestinal - Nausea, epigastric distress, constipation or diarrhea, Gastric ulcers with or without bleeding, Acute renal failure, uremia with hyperkalemia,

Acute intestinal nephritis may occur occassionally. Hypersensitivity reactions may include rash, photoxicity, Epidermal necrolysis, bronchospasm, etc.

Other side effects may include headache, vertigo, Blood dyscrasias, ocular disturbances, Jaundice, oedema, Heart failure, and Stevens Johnson syndrome.

Hypersensitivity patients developing allergy to aspirin or other NSAIDs, active peptic ulcer disease. Relative contraindications are pregnancy, lactation, and concurrent anticoagulant therapy.

Special precautions:

Patients on long term therapy with piroxicam 30mg/day should be observed for signs and symptoms of peptic ulcer disease. Elderly and debilated patients are more susceptible.

Long term use of Piroxicam has been associated with renal damage. The drug should be used with caution in patients at risk are those with heart failure, pre-existing renal impairment, on diuretics and the elderly.

Since fluid retension may occur piroxicam should be used with caution in patients with hypertension or cardiac decompensation. NSAIDs may cause elevation of serum transaminases,

PBD should be given with caution if there is evidence of liver damage

Platelet function should be monitored during piroxicam therapy in patients with coagulation disturbances.

Overdose management- gastric lavage, activated charcoal 50 - 100mg repeated as required and other supportive measures. Diazepam 5- 10 mg IV may control rare convulsions.

Rheumatic disorders Acute muculosletal disorders

Dosage

PBD can be given in single daily dosage of 20mg. Higher doses of 30mg daily may be given but there may be greater incidence of GI side effects.

Acute musculo-skeletal conditions : 20mg/day as a single dose.

EVIDENCE BASED MEDICINE (April 2003) Pain of Osteoarthiritis Comparitive effectiveness of various interventions Beneficial 1. Systemic simple analgesics (eg paracetamol for short term pain relief, and improvement in function) 2. Systemic NSAIDs (short term pain relief and improvement in function) 3. Topical agents (short term pain relief) Likely to be beneficial 1. Education, dietary advice,empowerment and support ( improved knowledge of disease and pain relief) 2. Physical support (pain relief and improvement in function) KEY POINTS 1. There is no good evidence that NSAIDs were superior to simple analgesics such as paracetamol or to suggest that any one of the many available NSAIDs had greater efficacy in relieving pain of osteoarthritis. 2. One systematic review of randomised controlled trials has found that topical agents provide pain relief in patients with osteoarthritis and offer a non-toxic alternative to systemic drug treatment. However there is no evidence to indicate whether the prescribed agents were superior to less expensive, non-prescribtion drugs over the counter (OTC) alternatives, or to other local treatments such as hot or cold packs.

Pharmacology: Piroxicam is an NSAID possesing the basic activity profile of the group.. Thus it has antinflammatory and and analgesic actions, causes some inhibition of platelet aggregation and makes the gastric mucosa more suseptible to acid effects. Proxicam inhibits the enzyme cyclo-oxygenase which catalyses the production of postagladin from arachidonic acid. In arthiritic patients piroxicam reduces the synovial fluid levels of PGE1 and PGE2 alpha. Piroxicam has potent analgesic activity. Like other NSAIDs, piroxicam inhibits the secondary phase of ADP- induced platelet aggregation in healthy subjects as well as arthiritic patients. Piroxicam has no significant effects on blood pressure or heart rate, or pressor responses to catecholamines. If given late in pregnancy, piroxicam can delay or prolong labour. Pharmacokinetics: The major feature of piroxicam-Beta Cyclodextrin is the rapid absorption after oral administration. Piroxicam is well distributed and reaches higher levels in inflammed tissue. Plasma binding is 99%. Piroxicam is excreted into breast milk. It is metaboliseed in the liver and metabolites are excreted in the urine. terminal half-life is about 40-55hrs. Kinetics are not altered by old age. and renal impairment. Cirrhosis can inhibit metabolism and increase plasma levels of piroxicam.

Use contraindicated during pregnancy and lactation Observe caution if required to be administered. If given late in pregnancy, piroxicam can delay or prolong labour.