A blood thinner such as warfarin coumadin ; cyclosporine gengraf, neoral, sandimmune ; digoxin digitalis, lanoxin ; diuretics water pills such as furosemide lasix ; lithium eskalith, lithobid ; methotrexate rheumatrex, trexall ; probenecid benemid ; steroids prednisone and others ; aspirin or other nsaids non-steroidal anti-inflammatory drugs such as diclofenac voltaren , diflunisal dolobid , etodolac lodine , flurbiprofen ansaid , ibuprofen advil, motrin , ketoprofen orudis , ketorolac toradol , mefenamic acid ponstel , meloxicam mobic , nabumetone relafen , naproxen aleve, naprosyn , piroxicam feldene , and others; or a beta-blocker such as atenolol tenormin , bisoprolol zebeta , labetalol normodyne, trandate , metoprolol lopressor, toprol , nadolol corgard , propranolol inderal, innopran , sotalol betapace , timolol blocadren , and others.
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To minimize the potential risk for an adverse CV event in NSAID-treated patientsuse the lowest effective dose for the shortest duration possiblePhysicians and patients should remain alert for the development of such eventsthroughout the entire treatment courseeven in the absence of previous . CV symptomsPatients should be informed about the symptoms of serious CV events and the steps to take if they occur.
The effects of hepatic disease on piroxicam pharmacokinetics have not been establishedHowevera substantial portion of piroxicam elimination occurs by hepatic metabolismConsequentlypatients with hepatic disease may require reduced doses of piroxicam as compared to patients with normal hepatic function.
Undesirable effects may be minimised by using the minimum effective dose for the shortest duration necessary to control symptomsThe benefit and tolerability of treatment should be reviewed within 14 daysIf continued treatment is considered necessarythis should be accompanied by frequentreview.
Piroxicam pharmacokinetics have been investigated in patients with renal insufficiencyStudies indicate patients with mild to moderate renal impairment may not require dosing adjustmentsHoweverthe pharmacokinetic properties of piroxicam in patients with severe renal insufficiency or those receiving hemodialysis are not known.
Symptoms following acute NSAID overdoses have been typically limited to lethargydrowsinessnauseavomitingand epigastric painwhich are generally reversible with supportive careGastrointestinal bleeding has occurredHypertensionacute renal failurerespiratory depressionand coma have occurredbut were raresee WARNINGS AND PRECAUTIONS
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