Piroxicam use. Gel "Piroxicam": instructions for use and analogues. Interaction of Piroxicam with other drugs

Gross formula

C 15 H 13 N 3 O 4 S

Pharmacological group of the substance Piroxicam

Nosological classification (ICD-10)

CAS code

36322-90-4

Characteristics of the substance Piroxicam

White or white with a slightly yellowish tint crystalline powder. Soluble in chloroform (1:100), in warm ethanol and methanol (1:1000), sparingly soluble in water.

Pharmacology

pharmachologic effect- anti-inflammatory, antipyretic, antiaggregatory, analgesic.

Inhibits the activity of cyclooxygenase (COX-1 and COX-2), reduces the synthesis of PG, incl. PGE 1, PGE 2, PGE 2alpha and thromboxanes. Suppresses phagocytosis, platelet aggregation.

After ingestion, it is well absorbed from the gastrointestinal tract, Cmax is reached after 3-5 hours. The equilibrium concentration in the blood is established within 7-12 days. Plasma protein binding is 97-99%. Metabolized in the liver (oxidized and conjugated), the main metabolites - 5-hydroxypiroxicam, N-methyl-benzosulfonamide, etc. - are pharmacologically inactive. T 1/2 about 50 hours, may increase with liver disease. It is excreted by the kidneys and the gastrointestinal tract (2 times more is determined in the urine than in the feces), mainly in the form of glucuronides (5% is excreted unchanged). Passes through the placenta and passes into breast milk. Does not accumulate.

Contributes to the weakening of pain, symptoms of inflammation with any method of application. With articular syndrome, it reduces or relieves inflammation and pain in the joints at rest and during movement, reduces morning stiffness and swelling of the joints.

Subacute and chronic toxicity studies performed in rats, mice, dogs and monkeys have shown that the most common manifestation of toxicity in animals with long-term administration of piroxicam, like other NSAIDs, is renal papillary necrosis and gastrointestinal lesions. There was no effect on fertility and teratogenicity in animals.

Increases the likelihood of pathological childbirth and delayed labor in animals, like other drugs that inhibit the synthesis and release of PG. The toxic effect on the gastrointestinal tract is especially pronounced in women in the third trimester of pregnancy, compared with the effect in the first and second trimesters and in non-pregnant women.

Application of the substance Piroxicam

Inflammatory and degenerative diseases of the joints and spine, accompanied by pain, incl. rheumatoid arthritis, rheumatism, ankylosing spondylitis (Bekhterev's disease), osteoarthritis, juvenile chronic arthritis, tendinitis, tendovaginitis, shoulder syndrome, humeroscapular periarthritis, acute attack of gout; pain syndrome of various origins: neuralgia, myalgia, primary dysmenorrhea, postoperative and post-traumatic pain, incl. with sports injuries (bruise, dislocation, sprain), pain and swelling in the joints, tendons and muscles due to overstrain, etc .; acute infectious and inflammatory diseases of the upper respiratory tract.

Contraindications

Hypersensitivity, incl. to other NSAIDs, erosive and ulcerative lesions of the gastrointestinal tract (in the acute stage), "aspirin" asthma, severe violations of the liver and / or kidneys, hemorrhagic diathesis, changes in the blood picture of unknown origin (including history), inflammatory changes or bleeding in the rectum and anus, incl. proctitis (when using suppositories); pregnancy, breastfeeding, childhood and adolescence (injection solution - up to 18 years; gel, ointment, suppositories - up to 14 years).

Application restrictions

History of erosive and ulcerative lesions of the gastrointestinal tract, bronchial asthma, allergic diseases, heart failure and other diseases accompanied by edema, arterial hypertension.

Use during pregnancy and lactation

Contraindicated in pregnancy.

At the time of treatment should stop breastfeeding.

Side effects of Piroxicam

From the nervous system and sensory organs: dizziness, headache, irritability, drowsiness or insomnia, weakness, depression, hallucinations, tinnitus, blurred vision, eye irritation.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): increase or decrease in blood pressure, palpitations, anemia, thrombopenia, leukopenia, eosinophilia, decrease in hemoglobin and hematocrit, hemorrhages.

From the digestive tract: dry mouth, stomatitis, gastrointestinal irritation, nausea, belching, anorexia, diarrhea or constipation, flatulence, bleeding gums, pain in the epigastric region, erosive and ulcerative lesions of the gastrointestinal tract and the occurrence of bleeding, impaired liver function (increased liver transaminase activity).

From the genitourinary system: renal failure, acute interstitial nephritis.

Others: allergic reactions (itching, redness of the skin; edema, including the face, hands; Stevens-Johnson syndrome, Lyell's syndrome, very rarely - anaphylactic reactions, bronchospasm, photosensitivity, rash), edema (mainly of the lower extremities in patients with impaired function heart), sweating, increased urea, hyperkalemia, hypo- or hyperglycemia, weight gain or loss.

Local reactions: irritation of the mucous membrane of the rectum, tenesmus, pain and an unpleasant feeling of heaviness in the anal region (suppositories); when applied to the skin - irritation, incl. itching, redness, rash, burning (with prolonged use).

Interaction

Displaces other drugs from the connection with blood proteins. Reduces the effectiveness of antihypertensive drugs. Against the background of other NSAIDs and corticosteroids, the risk of ulcerogenic action increases. Increases the risk of hyperkalemia when combined with potassium-sparing diuretics and other potassium-containing drugs. Increases the concentration of phenytoin and lithium in the blood. Anticoagulants increase the risk of bleeding. Acetylsalicylic acid reduces the concentration of piroxicam in the blood to 80% of the original.

Overdose

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

Treatment: gastric lavage, activated charcoal, antacids (to reduce absorption), symptomatic therapy.

Routes of administration

Inside, in / m, rectally, externally.

Precautions Substance Piroxicam

Before use, incl. local, patients with bronchial asthma, allergic rhinitis, with polyps of the nasal mucosa, chronic obstructive respiratory diseases should consult a doctor. During the period of treatment, it is necessary to control the cellular composition of the blood, the function of the kidneys and liver.

During the period of treatment, you can not drink alcoholic beverages.

Avoid getting the gel or ointment on mucous membranes, eyes, open wounds, etc.

Interactions with other active substances

Trade names

Name	The value of the Wyshkovsky Index ®

Piroxicam is a drug with analgesic, antipyretic, anti-inflammatory action.

Release form and composition

Dosage forms of Piroxicam release:

• Tablets (20 pcs. in plastic jars or test tubes, 1 jar or test tube in a cardboard box);
• Coated tablets (20 pcs in blister packs, 1 pack in a carton box);
• Capsules: size no. 3; 10 mg each - white body and cap; 20 mg each - white body, blue cap; capsules contain cream-colored to white with a creamy tint powder (10 pcs in blisters, 2 blisters in a carton box; 10 or 20 pcs in blister packs, 1-3, 10 or 20 packs in a carton pack, 5 or 7 pieces in blister packs, 2 or 4 packs in a carton box);
• Rectal suppositories (5 pcs in blisters, 2 blisters in a cardboard box);
• Gel for external use: transparent from greenish-yellow to light yellow, has the smell of ethyl alcohol, opalescence is acceptable (30, 50 or 100 g in aluminum tubes, 1 tube in a cardboard box; 10, 15, 20, 25, 30 or 50 g in dark glass jars, 1 jar in a cardboard box).

The composition of 1 tablet includes the active substance: piroxicam - 20 mg.

The composition of 1 film-coated tablet includes:

• Active substance: piroxicam - 10 mg;
• Auxiliary components: dibasic calcium phosphate, sodium lauryl sulfate, gelatin, starch, hydroxypropyl cellulose, magnesium stearate.

The composition of 1 capsule includes:

• The active substance is piroxicam 10 or 20 mg;
• Other Ingredients: Powdered cellulose, sodium carboxymethyl starch (sodium starch glycolate), potato starch, sodium lauryl sulfate, magnesium stearate, gelatin or titanium dioxide, proprietary blue color.

The composition of 1 rectal suppository includes the active substance: piroxicam - 10 or 20 mg.

The composition of 100 mg gel includes:

• Active substance: piroxicam 0.5 or 1 mg;
• Auxiliary components: triethanolamine (trolamine), propylene glycol, 95% ethyl alcohol (ethanol), nipagin (methyl parahydroxybenzoate), carbomer 940 (carboxyvinyl polymer), purified water.

Indications for use

• Degenerative and inflammatory diseases of the musculoskeletal system, including gouty and rheumatoid arthritis, osteoarthritis, ankylosing spondylitis (Bekhterev's disease);
• Pain syndrome: algomenorrhea, myalgia, sciatica, tendovaginitis, arthralgia, bursitis, neuralgia, sciatica, postoperative and post-traumatic pain syndrome, accompanied by inflammation, etc.

Piroxicam has no effect on the progression of the disease, it reduces pain and inflammation at the time of use (symptomatic therapy).

Contraindications

Pills

• peptic ulcer;
• Diseases of the kidneys and liver;
• Hematopoietic disorders;
• Bronchial asthma;

Coated tablets
Absolute:

• Allergic diseases;
• Bronchial asthma;
• Exacerbation of peptic ulcer of the stomach and duodenum;
• Pregnancy and the period of breastfeeding;

• Anamnestic data on peptic ulcer of the stomach and duodenum;
• Enterocolitis;
• Chronic gastritis;
• Functional disorders of the kidneys and liver.

Capsules
Absolute:

• Combination (full or partial) of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses with intolerance to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (including indications in history);
• Blood clotting disorders: hemophilia, bleeding tendency, prolongation of bleeding time, hemorrhagic diathesis;
• Erosive and ulcerative lesions of the gastrointestinal tract in the acute stage;
• Active gastrointestinal bleeding;
• Confirmed hyperkalemia;
• Severe renal failure (with creatinine clearance up to 30 ml / min);
• progressive kidney disease;
• Diseases of the gastrointestinal tract of inflammatory etiology;
• Condition after coronary artery bypass grafting;
• active liver disease or severe liver failure;
• Age up to 14 years;
• Pregnancy and the period of breastfeeding;
• Hypersensitivity to the components of the drug.

Relative (the appointment of Piroxicam requires caution):

• Cardiac ischemia;
• Cerebrovascular diseases;
• Hyperlipidemia and/or dyslipidemia;
• Diabetes;
• Diseases of peripheral arteries;
• Smoking;
• Functional disorders of the kidneys (with creatinine clearance up to 60 ml / min);
• Ulcerative lesions of the gastrointestinal tract (anamnestic data);
• Presence of Helicobacter pylori infection;
• Prolonged use of non-steroidal anti-inflammatory drugs;
• Alcoholism;
• Severe somatic diseases;
• Age over 65;
• Combined use with selective serotonin reuptake inhibitors, oral glucocorticoids, anticoagulants, antiplatelet agents.

suppositories

• Bronchial asthma;
• Peptic ulcer of the stomach and duodenum;
• Cardiovascular insufficiency;
• Diseases of the liver and kidneys;
• Age up to 14 and over 65 years;
• Pregnancy and the period of breastfeeding;
• Hypersensitivity to the components of the drug, incl. to other non-steroidal anti-inflammatory drugs.

Gel
Absolute:

• Violation of the integrity of the skin;
• "Aspirin" asthma;
• Age up to 12 years;
• Pregnancy and the period of breastfeeding;
• Hypersensitivity to Piroxicam, acetylsalicylic acid or other non-steroidal anti-inflammatory drugs.

Relative (the appointment of Piroxicam requires caution):

• Bronchial asthma;
• Chronic heart failure;
• Hepatic porphyria (with exacerbation);
• Severe impairment of kidney and liver function;
• Erosive and ulcerative lesions of the gastrointestinal tract;
• Childhood and old age.

Method of application and dosage

Pills
Piroxicam is taken orally with plenty of liquid, preferably during or after a meal.

• Rheumatoid arthritis, osteoarthritis, spondylitis: 20 mg;
• Acute diseases of the musculoskeletal system: the first 2 days - 40 mg, then for 7-14 days - 20 mg;
• Acute attack of gout: 40 mg, course duration - 5-7 days.

Coated tablets
Piroxicam is taken orally, preferably with food.

The scheme of application is determined by the doctor individually.

• Diseases of the musculoskeletal system: the first 2 days - 40 mg (once or in several doses), maintenance dose - 20 mg;
• Rheumatoid arthritis, deforming osteoarthritis, ankylosing spondylitis: initial and maintenance dose - 20 mg (sometimes 10 mg is sufficient for maintenance therapy, in exceptional cases it is possible to increase the dose to 30 mg once or in divisible doses);
• Pain of postoperative and post-traumatic etiology: initial dose - 20 mg (sometimes - 40 once or in divisible doses); maximum - 40 mg per day.

Capsules
Piroxicam is taken orally.

• Acute diseases of the skeletal muscles: the first 2 days - 40 mg in 1 or several doses, then for 7-10 days - 20 mg each;
• Rheumatoid arthritis, osteoarthritis and Bechterew's disease: 10-30 mg in 1 dose, for a long time;
• Algodysmenorrhea: the first 2 days (when the first symptoms appear) - 40 mg in 1 or 2 doses, then for 1-3 days - 20 mg each;
• Attacks of gout: the first 2 days - 40 mg once, then for 4-6 days, 40 mg in 1 or 2 doses;
• Juvenile rheumatoid arthritis: children from 14 years old with a body weight of 46 kg - 20 mg.

Gel
The gel should be applied to the skin in the area of ​​pain. The dose is determined by the size of the area (on average, a column 3 cm long). Piroxicam should be evenly distributed and rubbed into the skin.

Multiplicity of application - 3-4 times a day.

suppositories
Piroxicam in suppositories is used rectally.

The drug is prescribed at 20 mg per day (1 suppository of 20 mg or 2 suppositories of 10 mg with a break of 12 hours).

With attacks of gout - every 12 hours, 1 suppository of 20 mg.

Side effects

Tablets, suppositories
Erosive and ulcerative lesions of the gastrointestinal tract, drowsiness, edema, dizziness, headache, allergic skin reactions.

Coated tablets
Swelling of the legs, dyspepsia, increased levels of transaminases and urea in the blood (with prolonged therapy).

Capsules

• Digestive system: flatulence, nausea, abdominal pain, loss of appetite, diarrhea or constipation, erosive and ulcerative lesions of the gastrointestinal tract, bleeding and perforation of the gastrointestinal tract, increased activity of hepatic transaminases, abnormal liver function, stomatitis, dry mouth;
• Nervous system: insomnia, dizziness, headache, drowsiness, lethargy, depression, irritability, paresthesia, hallucinations, mood changes;
• Cardiovascular system: increase or decrease in blood pressure, rarely - shortness of breath, palpitations;
• Urinary system: interstitial nephritis, impaired renal function, nephrotic syndrome, papillary necrosis;
• Hemopoietic organs and hemostasis system: aplastic, hemolytic and other types of anemia, thrombocytopenia, eosinophilia, leukopenia, hemorrhagic vasculitis (Schonlein-Genoch disease), a decrease in hematocrit;
• Allergic reactions: bronchospasm, skin rash, itching, swelling of the larynx and face, shock, malignant exudative erythema (Stevens-Johnson syndrome), vasculitis, photosensitivity, serum sickness;
• Others: swelling of the feet and legs, increased sweating, hypoglycemia, increased urea concentration.

Gel

• Local reactions: eczema, contact dermatitis (in the form of itching, redness, swelling of the treated area of ​​the skin, papules, vesicles, peeling);
• Systemic reactions: generalized skin rash, allergic reactions (in the form of urticaria, angioedema, bronchospastic reactions).

special instructions

When Piroxicam is taken orally by patients after major surgical interventions, elderly patients, with impaired function of the gastrointestinal tract, bronchial asthma or chronic obstructive pulmonary disease in history, it is necessary to monitor the hemoglobin content in the blood (due to the likelihood of bleeding), liver and kidney function .

Due to the influence of the active substance on the tone of the myometrium in women, the effectiveness of intrauterine contraceptives may decrease.

At the time of therapy, the use of ethanol (alcohol) must be excluded.

To reduce the likelihood of unwanted adverse reactions from the gastrointestinal tract, it is necessary to use the minimum effective dose in the shortest possible courses.

Piroxicam gel should be applied only to intact skin, avoiding contact with open wounds. Occlusive dressings should not be applied. Do not allow the gel to get on the mucous membranes and in the eyes.

During the period of treatment, it is recommended to be careful while driving, as well as when performing other potentially hazardous types of work that require quick psychomotor reactions and high concentration.

drug interaction

With the combined use of Piroxicam with certain drugs / substances, the following effects may be observed:

• Drugs that bind strongly to plasma proteins: displacing them from their association with proteins (the combination requires caution due to possible competitive inhibition of binding);
• Other non-steroidal anti-inflammatory drugs and corticosteroids: increased risk of ulcerogenic action (increased likelihood of gastrointestinal bleeding), the likelihood of developing adverse reactions from the digestive tract and allergic reactions;
• Indirect anticoagulants: increased anticoagulant effect and increased risk of bleeding (combination requires caution);
• Cimetidine, probenecid and sulfinpyrazone: an increase in the concentration of piroxicam in the blood;
• Potassium-sparing diuretics and other potassium-containing drugs: increased risk of hyperkalemia;
• Phenytoin: increase in the concentration of piroxicam;
• Phenobarbital: decrease in the concentration of piroxicam in the blood plasma;
• Methotrexate (with combined use within 24 hours): an increase in its concentration in the blood serum and an increase in its toxicity;
• Antihypertensive drugs, diuretics: a decrease in their effectiveness (due to fluid retention, potassium and sodium ions);
• Drugs with myelotoxic action: increased manifestation of hematotoxicity of piroxicam;
• Sulfonamides, nalidixic acid, oral hypoglycemic drugs, triiodothyronine, cyclophosphamide: an increase in their concentration in blood plasma.

Terms and conditions of storage

Store in a dark, dry place out of the reach of children.

Best before date:

• Tablets - 5 years at a temperature of 15-25 ° C;
• Coated tablets, capsules - 3 years at temperatures up to 25 ° C;
• Suppositories - 2 years at a temperature of 15-21 ° C;
• Gel - 2 years at temperatures up to 20 ° C.

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Photo of the preparation

Latin name: Piroxicam

ATX code: M01AC01

Active substance: Piroxicam (Piroxicam)

Producer: PRODUCTION OF MEDICINES (Russia), PHARMACEUTICAL WORKS JELFA (Poland), SOPHARMA (Bulgaria)

The description applies to: 27.01.18

Piroxicam is an anti-inflammatory, analgesic, antipyretic drug.

Active substance

Piroxicam.

Release form and composition

Available in the form of capsules and tablets for oral administration, as well as in the form of a gel for external use.

• Capsules are sold in blister packs (5, 7 and 10 capsules each), placed in cardboard packs of 1, 2 or 4 pcs.
• Coated tablets are sold in blister packs (20 tablets each) placed in cardboard packs of 1 pc.
• Gel for external use is sold in glass jars (10, 15, 20, 25, 30 and 50 g each) or aluminum tubes (30 and 50 g each) placed in cardboard packs of 1 pc.

Indications for use

Indications for the appointment are the following diseases and conditions:

• Lumbago, neck and shoulder syndrome, sciatica.
• Joint diseases: ankylosing spondylitis, chronic polyarthritis, osteoarthritis, rheumatoid arthritis, Reiter's syndrome, Bechterew's disease, arthrosis (gonarthrosis, coxarthrosis, polyarthrosis and spondylarthrosis), psoriatic polyarthritis.
• Gout.
• Soft tissue diseases: tendonitis, bursitis, periarthritis.
• Cystitis, adnexitis, dysmenorrhea (in patients older than 12 years).
• Post-traumatic conditions (pain syndrome with fractures, dislocations, sprains).
• Pain after orthopedic, surgical, dental, gynecological interventions.

For tablets and gel additionally: acute infectious and inflammatory diseases of the upper respiratory tract, myalgia, neuralgia, pain in the spine.

Contraindications

• Contraindications to taking the drug are:
• Peptic ulcer of the duodenum and stomach in the acute stage.
• Severe functional disorders of the kidneys and liver.
• A history of acute rhinitis, urticaria, bronchial asthma associated with treatment with acetylsalicylic acid and other NSAIDs.
• Violations of the picture of peripheral blood of unknown origin (including in the patient's history).
• Children and adolescents up to 14 years of age.
• The period of pregnancy and breastfeeding (lactation).
• Increased individual sensitivity to the active substance and the constituent components of the drug.

Instructions for use Piroxicam (method and dosage)

Capsules and tablets

Intended for oral use. The drug must be drunk during meals. The recommended dose and duration of therapy is determined by the attending physician.

• In diseases of the musculoskeletal system in the acute stage in the first 2 days, the patient is prescribed 40 mg / day in divided doses or once, and then 20 mg / day for 1-2 weeks.
• In an acute attack of gout, the patient should take 40 mg of the drug for 3-5 days.
• In diseases of the joints (spondylitis, osteoarthritis, rheumatoid arthritis) - 10-20 mg / day for 1 or 2 doses. If necessary, a temporary increase in dose to 30 mg / day, in divisible doses or once, or a decrease to 10 mg / day is acceptable.
• For post-traumatic pain, the recommended starting dose is Piroxicam 20 mg once daily. In some cases, it is advisable to increase the dose in the first 2 days to 40 mg, in divisible doses or once.
• In dysmenorrhea, therapy should be started as soon as the first signs appear at an initial dose of 40 mg/day in divided doses or once for 2 days. In the next 1-3 days, the drug is prescribed at a dose of 20 mg / day, once.
• It is forbidden to exceed the recommended doses, as this increases the risk of side effects.
• The maximum daily dose of the drug for adult patients should not exceed 40 mg.

Gel

Designed for outdoor use. The frequency of use in this dosage form is 3-4 times / day.

Side effects

The use of the drug can cause the following side effects:

• Central and peripheral nervous system: Headache, dizziness, sleep disturbances, drowsiness, mood changes, nervousness, depression, weakness, hallucinations, sensory disturbances, visual disturbances and eye irritation symptoms, eye swelling are possible.
• Digestive system: often - attacks of nausea, heartburn, constipation or diarrhea, flatulence, loss of appetite, epigastric pain, stomatitis, bleeding gums (as a result of inhibition of platelet aggregation); sometimes - erosive and ulcerative lesions of the digestive tract with possible perforations and bleeding, jaundice, a transient increase in the activity of liver enzymes, liver necrosis with a fatal outcome. These side effects develop, as a rule, with prolonged use of Piroxicam in doses of more than 30 mg per day.
• Urinary system: interstitial nephritis in the acute phase, acute renal failure (with symptoms of hemorrhagic vasculitis).
• Hematopoietic systems: eosinophilia, leukopenia, thrombocytopenia, anemia (rarely hemolytic or aplastic).
• Metabolism: rarely - changes in body weight, hyper- or hypoglycemia, hyperkalemia; in some cases - uremia along with hyperkalemia, a transient increase in the concentration of creatinine and residual nitrogen in the blood.
• Local reactions: possible tenesmus, irritation of the rectal mucosa.
• Allergic manifestations: allergic swelling of the skin of the hands and face, redness, itching, rashes, pemphigus vulgaris; in rare cases - Lyell's syndrome, Stevens-Johnson syndrome; sometimes - bronchospasm, anaphylactic reactions, angioedema, urticaria, serum sickness, vasculitis.
• Dermatological reactions: rarely - alopecia, onycholysis, photosensitivity.
• For external use: rarely - itching and erythema at the site of application.
• Other: Possible nosebleed.

Overdose

Overdose symptoms: attacks of nausea, vomiting (at high doses - bloody), meniere-like phenomena, melena, tonic and clonic convulsions, tinnitus, hemorrhagic diathesis, aplastic anemia, agranulocytosis, urticaria, bullous or petechial rash, typhoid or measles-like rashes, toxic-allergic shock (in predisposed patients), coma.

Treatment is symptomatic.

Analogues

Analogues for the ATX code: Calmopyrol, Pirocam, Pyroxifer, Remoxicam, Sanikam, Felden.

Do not make the decision to change the drug yourself, consult your doctor.

pharmachologic effect

Piroxicam is a non-steroidal anti-inflammatory drug from the oxicam group, which has anti-inflammatory, analgesic and antipyretic effects.

• The mechanism of action is associated with inhibition of prostaglandin synthesis due to inhibition of cyclooxygenase activity.
• Reduces pain, inflammation and pain in the joints at rest and during movement, morning stiffness and swelling of the joints, increases the range of motion.
• The analgesic effect occurs 30 minutes after ingestion. The anti-inflammatory effect is manifested by the end of the first week of therapy. After a single dose, the effect lasts for 24 hours.

special instructions

• The drug must be used with extreme caution in the joint appointment of oral anticoagulants, with bleeding from the gastrointestinal tract and erosive and ulcerative lesions (Crohn's disease, ulcerative colitis) in history, chronic heart failure, arterial hypertension, dyspeptic symptoms, functional disorders of the kidneys and liver, coagulation disorders blood, bronchial asthma, infectious diseases, allergic manifestations to acetylsalicylic acid and other NSAIDs in history. Piroxicam should also be used with extreme caution in elderly patients.
• During treatment, it is necessary to control the pattern of peripheral blood and the functional state of the liver.
• In violation of the integrity of the skin should not be used externally. It is recommended to avoid getting the drug on the mucous membranes or in the eyes.
• During the use of the drug, the simultaneous intake of alcoholic beverages should be avoided.
• During the period of treatment, it is not recommended to perform work that requires the speed of psychomotor reactions and increased concentration of attention.

During pregnancy and breastfeeding

During pregnancy and lactation is contraindicated.

In childhood

Do not take the drug to patients under 14 years of age.

In old age

Information is absent.

For impaired renal function

The drug should not be taken with severe renal impairment.

For impaired liver function

The drug should not be taken with severe liver disorders.

drug interaction

• With the simultaneous use of Piroxicam with oral anticoagulants, sulfonamides, nalidixic acid, oral hypoglycemic drugs, triiodothyronine, cyclophosphamide, an increase in their concentration in blood plasma is observed.
• When taken simultaneously with other NSAIDs, GCS increases the risk of allergic reactions and side effects from the gastrointestinal tract.
• When taken simultaneously, it can weaken the effects of diuretics and antihypertensive drugs.
• When taken simultaneously with lithium preparations, an increase in the content of lithium in the blood plasma is observed.
4

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To treat symptoms of pain and inflammation, doctors often prescribe Piroxicam - instructions for use of the drug describe its main components, indications for use, dosage of a certain form of medication for various diseases. Their list includes osteoarthritis, rheumatoid arthritis, neuralgia, sciatica and a number of other pathologies. For ease of use, Piroxicam is available in several forms: capsules, tablets, gel, suppositories and injections. Each of them has its own indications and dosage.

Piroxicam - instruction

The drug belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs). It has analgesic, anti-inflammatory and antipyretic effects. The mechanism of action is associated with inhibition of the enzyme cyclooxygenase. With regular consumption, Piroxicam reduces pain. Externally, this drug is used in the form of a gel or ointment, which stop inflammation in the joints and help increase motor activity. According to the instructions for use, the analgesic effect appears within half an hour after ingestion.

Compound

The active ingredient of Piroxicam is the substance of the same name, the concentration of which depends on the form of release. The capsule and tablets contain 10 or 20 mg. Auxiliary substances are:

• wheat starch;
• glycine;
• magnesium stearate;
• colloidal silicon dioxide;
• talc;

Rectal suppositories include 0.02 grams of piroxicam. Auxiliary components are polyethylene oxide 400 and polyethylene oxide 1500. Piroxicam gel contains 0.005-0.01 g of active ingredient. Additional components are:

• trolamine;
• ethanol 95%;
• carbomer;
• propylene glycol;
• water;
• methyl parahydroxybenzoate.

Release form

The drug is available in almost all possible forms of drugs. Piroxicam capsules and tablets are used for oral administration, and gel for external use. Suppositories are administered rectally. The last form of release is a solution for injection. It is used to quickly get the effect of the drug, since in this way it enters the body bypassing the stomach. The specific form of release is chosen taking into account the disease and the required dosage, because each type of medicine contains a certain amount of active substance.

Pills

The standard form of release of Piroxicam is film-coated tablets in blister packs of 20 pieces each. In a cardboard pack, there is often one such record. Tablets contain 0.01 or 0.02 g of active ingredient. Auxiliary components of this form of release of Piroxicam are:

• sodium lauryl sulfate;
• calcium phosphate disubstituted;
• magnesium stearate;
• starch;
• hydroxypropyl cellulose.

Capsules

A more convenient form of release of Piroxicam for use is cylindrical capsules of white-blue or white-green color. The first contains 10 mg of the active substance, and the second - 20 mg. The powder inside the capsules has a yellowish tint. It also includes additional components. Piroxicam capsules consist of gelatin, purified water, titanium dioxide, yellow iron oxide and food coloring. They are produced in aluminum blisters, placed 2-4 pieces in a cardboard box. Inside contains instructions for use.

Piroxicam gel

Piroxicam gel is used externally, produced in aluminum tubes of different volumes: 30, 50 or 100 g. Each of them is placed in a cardboard box along with instructions for use. The gel has a transparent from light yellow to greenish-yellow color and the smell of ethyl alcohol. The agent is applied to the diseased area of ​​​​the body with a strip of up to about 3 cm. According to the instructions, when rubbing the drug, healthy skin is also affected, distributing the gel evenly over the entire surface.

Ointment

For external use, an ointment can be used, but Piroxicam does not have this form of release. So often mistakenly called the gel, which is sold in aluminum tubes. He is confused not only with ointment, but also with cream. In this form, Piroxicam is also not available. External treatment can only be carried out with a gel. It is indicated for the same diseases as Piroxicam tablets or capsules, it differs only in the way the instructions for use.

suppositories

Candles for rectal use Piroxicam have an oval shape with a pointed tip and a yellow-green tint. They are used by insertion into the rectum. With this method of application, the active substance is well absorbed. In addition, it is excreted through the intestines to a lesser extent. This is an advantage of this form of drugs, because it helps to avoid many possible side effects.

Piroxicam injections

Solution for injection Piroxicam is available in ampoules of 1 or 2 ml. The first contain about 0.02 g of the active substance, and the second - 0.04 g. The ampoules themselves are made of dark glass, packed in contour cells of 10 pieces and packaged in cardboard boxes. Injections are used for severe pain to get a faster effect from Piroxicam. After a few days with injections, the patient is transferred to capsules or tablets.

Indications for use

The analgesic and anti-inflammatory effects of Piroxicam led to its use in several areas of medicine. Injuries, bruises, soreness of the tendons, swelling of the joints, dislocations and sprains are just some of the indications. Piroxicam is recommended for inflammation of the respiratory system or joints and pathologies of the spine. In general, the instructions for use of this drug indicate the following indications:

• tendovaginitis;
• gout;
• rheumatism;
• tendinitis;
• periarthritis;
• osteoarthritis;
• myalgia;
• neuralgia;
• dysmenorrhea (pain during the menstrual cycle);
• sciatica;
• cardiac ischemia;
• humeroscapular syndrome;
• bursitis;
• post-traumatic pain;
• spondylitis;
• cystitis;
• adnexitis.

Contraindications

The list of contraindications to the use of Piroxicam includes factors common to all forms of the drug, in which the drug cannot be used. Before taking the drug, you should make sure that you do not have the following diseases, such as:

• ulcerative colitis;
• Crohn's disease;
• uncompensated heart failure;
• stomach or duodenal ulcer;
• chronic or acute renal failure;
• bleeding, including cerebrovascular;
• pregnancy, breastfeeding;
• hypersensitivity to the components of the drug, acetylsalicylic acid and other NSAIDs;
• advanced age over 65 years.

Method of application and dosage

Instructions for use Piroxicam indicates the specific dosage of each form of release of the drug. The gel is rubbed 3-4 times a day into the affected area, affecting small healthy areas nearby. The dose is determined individually. It depends on the size of the affected area. On average, a strip of gel 3 cm long is required. Instructions for use of other forms of Piroxicam release:

1. Suppositories. Enter rectally 1 suppository of 20 mg immediately or 2 to 10 mg with a break of 12 hours. For attacks of gout, doha is 1 suppository of 20 mg every 12 hours.
2. Capsules. According to the instructions, they are also taken once or twice a day with meals, but not exceeding the maximum dose of 20 mg. You can increase it to 40 mg with severe clinical symptoms. The course of treatment lasts 7-10 days.
3. Pills. In diseases of the musculoskeletal system, the first 2 days, the dose is 40 mg in divided doses or once, and then a maintenance dose of 20 mg is used. It is also indicated for rheumatoid arthritis. Post-traumatic and postoperative pain is treated with an initial dose of 20 mg, and sometimes 40 mg, but not more than this amount.
4. Injections. Indicated in acute conditions or exacerbation of chronic processes. For their treatment intramuscularly administered 20-40 mg 1 time per day. 1-2 days after stopping the process, maintenance therapy with oral forms of Piroxicam is prescribed.

Side effects

In case of an overdose, the drug Piroxicam can cause a number of side effects from different body systems. With regard to digestion, this can be nausea, vomiting, flatulence, diarrhea or constipation, bleeding in the gums, loss of appetite, stomatitis, and in isolated cases, erosive and ulcerative lesions of the gastrointestinal tract (GIT). There are other side effects from the side:

1. Hematopoiesis. Anemia, leukopenia, thrombocytopenia, eosinophilia can be manifested here.
2. Central and peripheral nervous systems. Sleep disturbances, depression, eye puffiness, drowsiness, visual disturbances, dizziness and headache, weakness, hallucinations are possible.
3. Urogenital system. Acute interstitial nephritis, acute renal failure.
4. Metabolism. Hyperglycemia or hyperkalemia, changes in body weight, uremia.
5. Skin. Possible allergic reactions, manifested by itching, rash, redness, swelling of the face, swelling of the face and hands, bronchospasm, vasculitis.
6. Other side effects. These include erythema, photosensitivity, onycholysis, alopecia, epistaxis, irritation of the rectal mucosa.

special instructions

Piroxicam should be used with caution in certain diseases that the patient had in the past or are currently experiencing. These include bleeding and erosive and ulcerative lesions of the gastrointestinal tract, dyspeptic symptoms, bronchial asthma, chronic heart failure. In the process of treatment with Piroxicam, it is necessary to control the pattern of peripheral blood and the functional state of the liver. It is not recommended to use the drug:

• in case of violation of the integrity of the skin (concerns the gel);
• simultaneously with acetylsalicylic acid and other NSAIDs;
• in the presence of a history of blood clotting disorders, allergies to NSAIDs;
• while taking anticoagulants, diuretics and antihypertensive drugs due to the weakening of their action and a possible violation of blood clotting.

During pregnancy and breastfeeding

The instructions for use of Piroxicam indicate the 3rd trimester of pregnancy as an absolute contraindication. In the first and second, the drug is approved for use, but before prescribing, the doctor compares the intended benefit with the possible risk to the woman and child. There are no clinical data confirming that Piroxicam is safe for pregnant women. Due to the use of NSAIDs in the fetus, the botulal duct may close prematurely. Piroxicam should not be used during lactation. If you need to take the drug, you should stop breastfeeding.

In childhood

Piroxicam is contraindicated for use in children, but different forms of release have certain age restrictions. They are as follows:

• tablets, suppositories and capsules are contraindicated under 18 years of age;
• The gel should not be used by children under 14 years of age.

With impaired liver and kidney function

According to the instructions, Piroxicam should not be used for severe violations of the functional functioning of the kidneys and liver. They are absolute contraindications. This also includes the decompensated stage of liver failure and the active phase of liver disease. In other cases, the drug is used with caution. This applies to violations of kidney or liver function.

Analogues

Instructions for use Piroxicam indicates a number of analogues that can be used instead of this medication. They are characterized by a similar composition or principle of action. Among the analogues for external use, Finalgel stands out. The main substance of this medicine is piroxicam. The release form is tubes of different volumes: 35 or 50 g. Instructions for use of Piroxicam indicate a number of other analogues of the drug:

1. Revmoxicam. The drug is based on another substance - meloxicam, but is similar to Piroxicam in terms of the mechanism of action. It also has several forms of release: tablets, suppositories, solutions. The difference from Piroxicam is the possibility of buying without a prescription. The disadvantage is a large number of side effects. The price is 200-350 rubles.
2. Ksefokam. The main substance is lornoxicam, the release forms are tablets and powders for the preparation of solutions for injection. The drug also belongs to the group of NSAIDs. According to the instructions, it has an analgesic and anti-inflammatory effect. You can buy it even with home delivery only with a prescription, like Piroxicam. The price is 200-300 rubles.

Price for Piroxicam

This drug can be classified as budget. The cost of Piroxicam in most cases does not exceed 100 rubles. The drug is dispensed by prescription. Approximate prices for Piroxicam in different pharmacies reflect the table:

Place of purchase	Release form	Dosage	Quantity, pcs.
Pharmacy ZDRAV
Pharmacy Wer.ru
	Piroxicam gel 1%
	Pills

The drug Piroxicam is produced by pharmacological companies in the form of a gel for external use and in the form of capsules intended for oral use. Piroxicam belongs to the group of non-steroidal anti-inflammatory drugs. Regardless of the form of production, the compositions have a pronounced anti-inflammatory, analgesic, analgesic and antipyretic effect.

Dosage form

Piroxicam is produced in the form of capsules with a dosage of the active substance of 20 and 40 mg. Also, the product is produced in the form of a gel intended for external use in tubes of 30 and 50 g.

Description and composition

Piroxicam capsules are small in size, covered with a dense gelatin shell, have a white body and a blue or orange cap, depending on the content of the dose of the active substance. Inside the capsule contains a white powder.

The active substance of the drug is piroxicam.

As part of the tool there are auxiliary components, their list is presented in the following form:

• wheat starch;
• magnesium stearate;
• cellulose microcrystalline;
• colloidal silicon dioxide;
• food talc;
• titanium dioxide;
• iron oxide as a coloring component;
• gelatin.

The gel, intended for external use, has a homogeneous consistency, transparent, the manifestation of air bubbles in the medicinal mass is acceptable. The active ingredient of the composition is piroxicam. The list of auxiliary components include:

• carbomer;
• ethanol;
• trolamine;
• methyl parahydroxybenzoate;
• water;
• propylene glycol.

Pharmacological group

Non-steroidal anti-inflammatory drug, belongs to the group of oxycams. It has anti-inflammatory, analgesic and antipyretic effects.

The principle of the reaction is associated with the inhibition of the COX enzyme, which ensures the inhibition of the synthesis of prostaglandins from arachidonic acid.

The drug in capsule format, when taken systemically, inhibits platelet aggregation.

When used systemically, it reduces pain.

When used externally, it reduces or relieves inflammation and pain in the joints at rest and during physical activity, reduces morning stiffness and swelling of the joints, and helps to increase the range of motion.

Pain relief can be seen 30 minutes after oral administration. The anti-inflammatory effect is manifested by the end of the first week of drug exposure. After a single consumption, the action lasts for a day. After oral administration, the active substance is rapidly absorbed from the gastrointestinal tract, the maximum concentration of the component in the blood plasma can be traced 3-5 hours after administration. The active ingredient in sufficient quantities penetrates the placental barrier and is excreted in breast milk. The half-life of the composition is more than 50 hours; in patients with impaired liver and kidney function, the duration of such a time period can be increased.

Indications for use

The list of indications for the use of the composition is presented in the following form:

• rheumatoid arthritis;
• osteoarthritis;
• ankylosing spondylitis;
• gout;
• various diseases associated with articular syndrome;
• intense pain in various parts of the spine;
• neuralgia and myalgia;
• inflammation of soft tissues associated with disorders in the functioning of the musculoskeletal system.

In oral form, the drug can be used to treat dysmenorrhea in patients over the age of 14 years. To the list of indications for use acute infectious and inflammatory processes involving the upper respiratory tract.

for adults

If there are indications for use and there are no contraindications, the composition in the form of a gel for external use and tablets for oral use can be used in such cases:

• inflammatory processes covering the joints and periarticular tissues;
• multiple joint lesions in severe psoriasis associated with destruction of bone tissue;
• dystrophy or dysfunction of the musculoskeletal system;
• periarthritis, bursitis, tendinitis;
• pain syndrome that occurs after surgical interventions;
• post-traumatic pain syndrome;
• gout.

The drug in the form of tablets is often used in gynecological practice to eliminate the painful manifestations of various inflammatory processes.

for children

The use of gel for external use is possible only on small areas of the body. The treatment of significant areas can cause the rapid spread of the drug throughout the woman's body and its penetration through the placental barrier. The use of tablets during pregnancy is unacceptable, the drug is rapidly absorbed into the systemic circulation and distributed throughout the body. The effect of piroxicam on the developing fetus has not been fully studied, but in the course of laboratory tests its ability to inhibit respiratory function was revealed.

The use of Piroxicam, regardless of the form of release, by women during lactation is unacceptable. The active substance in large quantities penetrates into breast milk and adversely affects the child's body. The use of the drug can cause allergic reactions in the newborn.

Contraindications

The list of contraindications to the use of the drug in the form of tablets and gel is presented as follows:

• erosive or ulcerative lesions involving the gastrointestinal tract;
• the presence of fixed cases of manifestation of asthma attacks during the period of use of non-steroidal anti-inflammatory drugs;
• pronounced disorders of porphyrin metabolism;
• disorders in the liver;
• disturbances in the functioning of the renal pelvic system;
• the period of pregnancy and breastfeeding;
• children's age up to 12 years;
• hypersensitivity of the patient's body to the active substance of the drug.

Before you start using the drug, you should familiarize yourself with the list of contraindications. The use of compounds is dangerous for certain categories of people.

Applications and doses

Dosage for oral administration is determined on an individual basis, depending on the available indications for use.

The medicinal composition in the gel format for external use is applied to the affected area 3-4 times a day until the signs of inflammation are completely eliminated.

for adults

for children

The composition in pediatric practice is not used; the appointment of the drug is possible only in relation to children over the age of 12 years. Dosages are determined individually.

for pregnant women and during lactation

The drug is not used during pregnancy and lactation, the composition may have a negative effect on the process in the womb.

Side effects

Side effects on the background of the use of the medicinal composition are quite rare.

From the digestive tract:

• nausea;
• loss of appetite;
• epigastric pain;
• diarrhea or;
• flatulence.

Allergic reactions:

• angioedema;
• generalized pruritus;
• redness;
• bronchospasm;
• serum sickness;
• Lyell's syndrome.

From the side of the central nervous system:

• dizziness;
• headache;
• drowsiness;
• sleep disorders;
• depression;
• nervousness;
• hallucinations;
• mood changes;
• weakness.

Interaction with other drugs

The active substance piroxicam may interact with the following components:

• nalidixic acid;
• direct anticoagulants;
• sulfonamides;
• oral medicines;
• cyclophosphamide;
• triiodothyronine;
• antihypertensive drugs;
• diuretics;
• lithium components.

It is worth notifying the attending specialist about the use of such funds in combination with Piroxicam.

special instructions

Before you start taking Piroxicam capsules, you need to carefully study the instructions for the remedy. The patient should pay attention to a number of special instructions presented in the following list:

1. The drug is not recommended for use in acute pathologies associated with disorders in the intestines.
2. Elderly patients undergo dose adjustments.
3. During the use of the drug, it is necessary to exclude the possibility of taking alcoholic beverages.
4. when administered orally, activities that require increased concentration of attention from the patient should be limited.

The drug is dispensed to the public through a network of pharmacies on free sale, however, patients should be aware that uncontrolled use can cause a sharp deterioration in well-being.

Overdose

• nausea, ending in vomiting;
• darkening of the stool;
• manifestation of tinnitus;
• muscle cramps;
• hemorrhagic;
• manifestation of a rash on the skin;
• confusion;
• anemia.

In severe cases, it is possible to open bleeding in the organs of the digestive tract. Therapy consists in washing the stomach and intestines. To eliminate the symptoms of intoxication, sorbents are used. Symptomatic therapy is determined in a hospital setting.

When using Piroxicam in the form of a gel, the risk of overdose is minimized.

Storage conditions

Piroxicam in the form of capsules should be stored at a temperature not exceeding 25 degrees, out of the reach of children. The duration of the shelf life is 3 years from the date of production.

Piroxicam in the form of a gel for external use should be stored in a dry, child-proof place at a temperature of 15 to 25 degrees. The duration of the shelf life is 3 years from the production date indicated on the tube.

It is impossible to use drugs after the expiration date, their use can harm the human body.

Analogues

The list of analogues of the drug Piroxicam can be presented in the following form:

• . Russian drug that has antipyretic, analgesic effect, stops inflammation. It is available in tablets for oral administration, rectal suppositories, in ampoules. Such a variety of dosage forms helps to choose the best way to use the drug.
• . Non-steroidal anti-inflammatory drug, which is produced by Pharmstandard-UfaVita OJSC. In the pharmacy it can be found in tablets and injections. The drug rarely causes adverse reactions from the gastrointestinal tract. But it can be taken by patients over 18 years of age.
• Meloflex. Romanian drug belonging to the group of nonsteroidal drugs. It is a selective COX-2 inhibitor, so it rarely causes unwanted reactions from the digestive system. It is approved for use in patients over 18 years of age. Its injectable form allows the use of the drug in patients who cannot take the medicine by mouth.
• . Russian drug that belongs to NSAIDs. Since it selectively blocks the activity of COX-2 and has less effect on COX-1, side effects from the digestive organs are less common during therapy. You can prescribe a medication for the treatment of patients older than 12 years.

You can replace Piroxicam with an analogue after consultation with a specialist. The patient's attention should be stopped on the fact that not all the drugs presented in the list of analogues are available in several dosage forms.

Price

The cost of Piroxicam is an average of 93 rubles. Prices range from 19 to 235 rubles.