Piroxicam

What it is used for

• Adjunctive therapy of transitional cell carcinomas
• Adjunctive therapy of transitional cell carcinomas/neoplastic diseases
• Cancer pain
• Antiinflammatory/analgesic
• Idiopathic chronic rhinosinusitis
• All uses (e.g., various neoplasms)
• Mucocutaneous squamous cell carcinoma
• Squamous cell carcinoma of the third eyelid after surgical excision
• Fracture associated limb swelling (Rabbits)
• Adjunctive therapy of transitional cell carcinomas, squamous cell carcinomas, and palliative therapy for other neoplastic diseases
• Adjunctive therapy of neoplastic diseases (for dogs who tolerate NSAIDs poorly)
• Adjuvant therapy for splenic hemangiosarcoma (stage II)
• Transitional cell carcinoma after laser ablation of the primary tumor
• Inhibit local recurrence in dogs with incompletely resected soft tissue sarcomas
• Antiinflammatory/analgesic
• Cancer pain
• Adjunctive treatment of Idiopathic lymphoplasmacytic rhinitis (LPR)
• All uses (e.g., transitional cell carcinoma, prostatic carcinoma)
• Colorectal polyps/neoplasia

How it is given

Possible side effects

• Gastrointestinal ulceration and bleeding (melena, hematemesis)
• Vomiting, anorexia, and diarrhea
• Renal papillary necrosis
• Peritonitis (secondary to GI perforation)
• Decreased hematocrit (anecdotal in cats)
• Peripheral edema
• Elevated liver enzymes
• Gastrointestinal toxicity
• Gastric ulceration
• Ulcerative skin lesions (reported in cats)
• Potential precipitation of cardiac failure (known in humans, unknown risk in animals)

Cautions & contraindications

• Hypersensitivity to piroxicam, aspirin, or other NSAIDs
• Active or history of gastrointestinal ulcer disease
• Bleeding disorders
• Gastric ulceration
• Renal disease
• Concurrent use of corticosteroids
• Concurrent use of other NSAIDs
• Dehydration (relative contraindication due to renal risk)
• **Extreme Caution:** Use in cats is controversial and must be done with extreme caution due to lack of safety studies and potential for severe GI/renal toxicity. **Caution:** Use carefully in patients with severely compromised cardiac function due to potential for peripheral edema. The therapeutic window in dogs is very narrow; doses as low as 1 mg/kg daily have caused severe GI ulceration and peritonitis.

Drug interactions

• Aminoglycosides (gentamicin, amikacin): Increased risk for nephrotoxicity
• Anticoagulants (heparin, LMWH, warfarin): Increased risk for bleeding
• Aspirin: Decreased piroxicam plasma levels and increased likelihood of GI adverse effects (blood loss); do not use concurrently
• Bisphosphonates (alendronate): May increase risk for GI ulceration
• Cisplatin: May potentiate the renal toxicity of cisplatin
• Corticosteroids: Significantly increased risk for GI adverse effects and ulceration
• Furosemide: May reduce the saluretic and diuretic effects of furosemide
• Highly protein-bound drugs (phenytoin, valproic acid, sulfonamides): Piroxicam is 99% protein-bound and may displace other drugs, increasing their serum levels and duration of action
• Methotrexate: Serious toxicity has occurred when used concomitantly; use with extreme caution
• Other NSAIDs: Increased risk of severe gastric ulceration and GI toxicity
• Diuretics: Increased risk of nephrotoxicity and renal papillary necrosis
• Aminoglycosides: Increased risk of nephrotoxicity
• Highly protein-bound drugs: Piroxicam is highly protein-bound and may displace other drugs, potentially increasing their free plasma concentrations

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