Pronunciation:

(oks a PROE zin)

U.S. Brand Names:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Pregnancy Implications:

Lactation:

Contraindications:

Warnings/Precautions:

Use of NSAIDs can compromise existing renal function especially when Clcr<30 mL/minute. CNS adverse effects such as confusion, agitation, and hallucination are generally seen in overdose or high-dose situations; however, elderly may demonstrate these adverse effects at lower doses than younger adults. Do not exceed 3200 mg/day. Withhold for at least 4-6 half-lives prior to surgical or dental procedures.

Rare cases of severe hepatic reactions (including necrosis, jaundice, fulminant hepatitis) have been reported. May cause mild photosensitivity reactions. Safety and efficacy have not been established in children <6 years of age.

Adverse Reactions:

1% to 10%:

Cardiovascular: Edema

Central nervous system: Confusion, depression, dizziness, headache, sedation, sleep disturbance, somnolence

Dermatologic: Pruritus, rash

Gastrointestinal: Abdominal distress, abdominal pain, anorexia, constipation, diarrhea, flatulence, gastrointestinal ulcer, gross bleeding with perforation, heartburn, nausea, vomiting

Hematologic: Anemia, bleeding time increased

Hepatic: Liver enzyme elevation

Otic: Tinnitus

Renal: Dysuria, renal function abnormal, urinary frequency

<1% (effects reported with oxaprozin or other NSAIDs): Acute interstitial nephritis, acute renal failure, agranulocytosis, alopecia, anaphylaxis, angioedema, anxiety, asthma, blurred vision, bruising, CHF, conjunctivitis, cystitis, dream abnormalities, drowsiness, dyspnea, eosinophilia, erythema multiforme, esophagitis, exfoliative dermatitis, fever, gastritis, GI bleeding, glossitis, hearing decreased, hematemesis, hematuria, hemorrhoidal bleeding, hepatitis, hypersensitivity reaction, hypertension, infection, insomnia, jaundice, leukopenia, liver function abnormalities, malaise, melena, menstrual flow increased/decreased, nephrotic syndrome, nervousness, oliguria, palpitation, pancreatitis, pancytopenia, paresthesia, peptic ulcer, photosensitivity, pneumonia, polyuria, proteinuria, pseudoporphyria, pulmonary infection, purpura, rectal bleeding, renal insufficiency, respiratory depression, sepsis, serum sickness, sinusitis, Stevens-Johnson syndrome, stomatitis, syncope, tachycardia,taste alteration, thrombocytopenia, toxic epidermal necrolysis, tremor, upper respiratory tract infection, vertigo, weakness, weight changes, xerostomia

Overdosage/Toxicology:

Drug Interactions:

ACE inhibitors: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure. Oxaprozin may decrease serum concentration of enalapril.

Angiotensin II antagonists: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure.

Anticoagulants (warfarin, heparin, LMWHs) in combination with NSAIDs can cause increased risk of bleeding.

Other antiplatelet drugs (ticlopidine, clopidogrel, aspirin, abciximab, dipyridamole, eptifibatide, tirofiban) can cause an increased risk of bleeding.

Corticosteroids may increase the risk of GI ulceration; avoid concurrent use.

Cyclosporine: NSAIDs may increase serum creatinine, potassium, blood pressure, and cyclosporine levels; monitor cyclosporine levels and renal function carefully.

Hydralazine's antihypertensive effect is decreased; avoid concurrent use.

Lithium levels can be increased; avoid concurrent use if possible or monitor lithium levels and adjust dose. Sulindac may have the least effect. When NSAID is stopped, lithium will need adjustment again.

Loop diuretics efficacy (diuretic and antihypertensive effect) may be reduced.

Methotrexate: Severe bone marrow suppression, aplastic anemia, and GI toxicity have been reported with concomitant NSAID therapy. Avoid use during moderate or high-dose methotrexate (increased and prolonged methotrexate levels). NSAID use during low-dose treatment of rheumatoid arthritis has not been fully evaluated; extreme caution is warranted.

Thiazides antihypertensive effects are decreased; avoid concurrent use.

Warfarin's INRs may be increased by piroxicam. Other NSAIDs may have the same effect depending on dose and duration. Monitor INR closely. Use the lowest dose of NSAIDs possible and for the briefest duration.

Ethanol/Nutrition/Herb Interactions:

Ethanol: Avoid ethanol (may enhance gastric mucosal irritation).

Herb/Nutraceutical: Avoid cat's claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, red clover, horse chestnut, green tea, ginseng (all have additional antiplatelet activity).

Stability:

Mechanism of Action:

Pharmacodynamics/Kinetics:

Absorption: Almost complete

Protein binding: >99%

Metabolism: Hepatic via oxidation and glucuronidation; no active metabolites

Half-life elimination: 40-50 hours

Time to peak: 2-4 hours

Excretion: Urine (5% unchanged, 65% as metabolites); feces (35% as metabolites)

Dosage:

Children 6-16 years: Juvenile rheumatoid arthritis:

22-31 kg: 600 mg once daily

32-54 kg: 900 mg once daily

55 kg: 1200 mg once daily

Adults:

Osteoarthritis: 600-1200 mg once daily; patients should be titrated to lowest dose possible; patients with low body weight should start with 600 mg daily

Rheumatoid arthritis: 1200 mg once daily; a one-time loading dose of up to 1800 mg/day or 26 mg/kg (whichever is lower) may be given

Maximum daily dose: 1800 mg or 26 mg/kg (whichever is lower) in divided doses

Dosing adjustment in renal impairment: 600 mg once daily; dose may be increased to 1200 mg with close monitoring

Dosing adjustment in hepatic impairment: Use caution in patients with severe dysfunction

Monitoring Parameters:

Test Interactions:

Patient Education:

Anesthesia and Critical Care Concerns/Other Considerations:

In short-term use, NSAIDs vary considerably in their effect on blood pressure. When NSAIDs are used in patients with hypertension, appropriate monitoring of blood pressure responses should be completed and the duration of therapy, when possible, kept short. The use of NSAIDs in the treatment of patients with congestive heart failure may be associated with an increased risk for fluid accumulation and edema; may precipitate renal failure in dehydrated patients.

Cardiovascular Considerations:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

International Brand Names: