Piroxicam (Brexin, Feldene) is a non-selective potent non-steroidal anti-inflammatory drug that has analgesic, antipyretic, and anti-inflammatory actions.
Piroxicam Uses:
-
Arthritis:
- Relief of signs and symptoms of osteoarthritis and rheumatoid arthritis.
-
Off Label Use of Piroxicam in Adults:
- Ankylosing spondylitis
Piroxicam dose in Adults
- Note: Individualize dosage to lowest effective dose for the shortest duration to minimize adverse effects.
Piroxicam dose in the treatment of Osteoarthritis, and rheumatoid arthritis:
- Oral: 20 mg once a day.
Piroxicam dose in the treatment of Ankylosing spondylitis, osteoarthritis, and rheumatoid arthritis (off-label):
- Oral: 10 to 20 mg/day (Kroon 2015)
Piroxicam dose in Children
Piroxicam dose in the treatment of Juvenile idiopathic arthritis (JIA):
-
Children and Adolescents:
- Oral: 0.2 to 0.4 mg/kg/day once a day;
- The maximum daily dose: 20 mg/day (American Pain Society 2016)
Piroxicam Pregnancy Risk Category: C (D in third trimester)
- Some studies have shown that birth defects can be caused by in utero NSAID use. However, the data is inconsistent.
- Following in utero NSAID use, nonteratogenic effects such as prenatal constriction, persistent pulmonary hypertension, oligohydramnios and necrotizing enterocolitis have been observed in the fetus/neonate.
- Additionally, the ductus arteriosus may not close postnatally and may not respond medically.
- Product labeling for piroxicam clearly states that it should not be used after 30 week gestation, as NSAIDs can cause premature closing of the ductus Arteriosus.
- NSAIDs may be used to treat mild rheumatoid-arthritis flares during pregnancy. However, it should be avoided or minimized early and often in the pregnancy.
- Women of reproductive age who have been using NSAIDs for a long time may experience infertility. This can be reversed by stopping the medication.
- Women who have difficulty conceiving or are undergoing fertility treatment should stop using this medication.
- It is possible that NSAIDs taken close to conception can increase the risk of miscarriage (Bermas, 2014; Bloor 2013,).
Piroxicam use during breastfeeding:
- Breast milk contains 1% to 3% Piroxicam.
- NSAIDs can be used postpartum by women who want to breastfeed. However, if a woman has platelet dysfunction or thrombocytopenia, piroxicam should not be used.
- According to the drug manufacturer breastfeeding during treatment should be considered in light of the potential for infant exposure and the benefit to the mother.
Piroxicam Dose in Kidney disease:
-
Mild to moderate impairment:
- There are no dosage adjustments provided in the drug manufacturer’s labeling.
-
Severe impairment:
- Use is not recommended (has not been studied); if therapy must be initiated, close monitoring is recommended.
Piroxicam Dose in Liver disease:
- There are no specific dosage adjustments provided in the drug manufacturer’s labeling; however, a dosage reduction is recommended.
Side Effects of Piroxicam (Brexin, Feldene):
-
Cardiovascular:
- Edema
-
Central Nervous System:
- Dizziness
- Headache
-
Dermatologic:
- Pruritus
- Skin Rash
-
Gastrointestinal:
- Abdominal Pain
- Anorexia
- Constipation
- Diarrhea
- Dyspepsia
- Flatulence
- Gastrointestinal Hemorrhage
- Gastrointestinal Perforation
- Heartburn
- Nausea
- Ulcer (Gastric
- Duodenal)
- Vomiting
-
Hematologic & Oncologic:
- Anemia
- Prolonged Bleeding Time
-
Hepatic:
- Increased Liver Enzymes
-
Otic:
- Tinnitus
-
Renal:
- Renal Function Abnormality
Contraindications to Piroxicam (Brexin, Feldene)):
- Hypersensitivity/Allergy to piroxicam or to any component of the formulation;
- Patients who have had asthma, urticaria or allergic reactions to aspirin or any other NSAIDs after they took them;
- In the setting of coronary bypass graft surgery (CABG).
Canadian labeling: Additional contraindications not in US labeling
- Recent or recurrent history of GI bleeding; active gastric/duodenal/peptic ulcer;
- Active GI inflammatory Disease
- Inflammatory bowel disease
- cerebrovascular bleeding and other bleeding disorders
- Grave liver impairment or active liver disease
- Grave renal impairment (CrCl 30 mg/minute) or deteriorating kidney disease
- Hyperkalemia is a known condition.
- Children and adolescents under 16 years old;
- Use in the third trimester
- Breast-feeding
- Uncontrolled severe heart failure
Warnings and precautions
-
Anaphylactoid reactions
- Even in patients who have never been exposed, anaphylactoid reactions can occur.
- Patients with the "aspirin trifecta" (bronchial asthma and aspirin intolerance, rhinitis, etc.) could be at greater risk.
- Patients who have rhinitis or bronchospasm due to NSAID therapy or NSAID use are not advised to use.
-
Cardiovascular events: [US Boxed Warn]
- Non-steroidal anti-inflammatory drug (NSAIDs), can increase the risk of severe (and possibly fatal) adverse cardiovascular thrombotic reactions, such as MI and stroke.
- This risk can occur during treatment, and it may increase as the duration of treatment is continued.
- The relative risk seems to be the same in people with and without cardiovascular disease, or risk factors for it.
- However, patients with known cardiovascular diseases or risk factors had a higher absolute rate of cardiovascular events.
- Exacerbation or new-onset hypertension can occur. NSAIDs could also affect the response to ACE inhibitors, thiazide or loop diuretics; may cause cardiovascular events. Monitor blood pressure.
- Patients with edema may experience sodium and fluid retention.
- Patients with heart disease should not use this product.
- Patients with MI should not be used unless the benefits are greater than the risk to their cardiovascular health.
- To reduce the risk of heart attacks, use the lowest effective dose for the most time. Patients at high risk should consider alternate treatments.
-
CNS effects
- This may cause blurred vision, drowsiness, dizziness, blurred sight, or other neurologic effects that could impair your physical or mental capabilities. Patients should be cautious about tasks that require mental alertness such as operating machinery or driving.
- If you have blurred or reduced vision, discontinue using the product and consult an ophthalmologist.
- All patients undergoing long-term therapy should be evaluated periodically for vision.
-
[US Boxed Warning]: GI events
- NSAIDs can increase the risk of serious GI side effect such as GI inflammation and bleeding that could be fatal.
- Patients with a history of PUD or GI bleeding and elderly patients are more at risk.
- These events can occur without warning and may happen at any stage of therapy.
- Patients with active GI bleeding should not be used.
- Avoid non-aspirin NSAIDs in patients who have had a history or recent experience with acute lower GI bleeding.
- This is especially important if the bleeding occurs due to angioectasia, diverticulosis, or other causes.
- Patients with a history of GI bleeding, concordant therapy that can exaggerate the risk (eg, aspirin and anticoagulants, SSRIs), smoking or elderly patients should be cautious.
- To minimize the risk of GI adverse reactions, use the lowest effective dose for the shortest time. Patients at high risk should consider other treatments.
- When used adjacently with aspirin, a substantial exacerbation in the risk of GI complications (eg, ulcer) occurs; adjacent gastroprotective therapy (eg, proton pump inhibitors) is recommended.
-
Hematologic effects
- Patients with coagulation disorders and those on anticoagulants need to be closely monitored for platelet adhesion or aggregation.
- Anemia can occur. Patients on long-term NSAID therapy need to be closely monitored.
- Rarely, NSAIDs have been associated with severe blood dyscrasias, such as thrombocytopenia, agranulocytosis and aplastic anemia.
-
Hyperkalemia:
- NSAIDs may increase the risk of hyperkalemia in older people, diabetics, those with renal disease and those who use other agents that can cause hyperkalemia (e.g. ACE-inhibitors).
- Monitor potassium closely.
-
Ovulation
- Reversible infertility may occur if the ovarian follicles are not ruptured. Some studies also show a delay or reversible decrease in ovulation.
- Women who have difficulties conceiving or are infertile should consider discontinuing treatment.
-
Serum sickness:
- Rarely, a serum sickness-like reaction may occur. Be aware of joint pains, fever, fatigue, and other symptoms.
-
Reactions to skin:
- NSAIDs can cause severe skin adverse reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis and exfoliative dermatitis (TEN).
- Stop using the medication immediately if you develop skin rash or hypersensitivity.
-
Asthma
- Patients with asthma that is aspirin-sensitive should not be given medication; severe bronchospasm can occur.
- Patients with other forms or asthma should be cautious.
-
Bariatric surgery
- Gastric ulceration: After bariatric surgery, avoid the use of non-selective oral NSAIDs for long periods.
- The development of anastomotic ulcerations/perforations may occur.
- Short-term use of celecoxib or IV ketorolac is recommended as part of a multimodal pain management strategy for postoperative pain.
-
Coronary bypass surgery for coronary artery bypass: [US Boxed Warn]
- In the case of coronary bypass graft (CABG), surgery, it is not recommended to use.
- After CABG surgery, stroke and MI risk may increase.
-
Hepatic impairment
- Patients with reduced hepatic function should be cautious.
- Monitor patients with abnormal LFT closely.
- Rare, sometimes fatal, severe hepatic reactions have been reported with NSAIDs.
- If you experience liver disease symptoms, persistent or worsening abnormal hepatic function testing, discontinue use.
-
Hypertension:
- Be careful, as you may increase your risk of developing hypertension.
- At initiation and throughout piroxicam therapy, monitor your blood pressure.
-
Renal impairment
- NSAIDs can cause impairment of renal function. Dose-dependent decreases may occur in prostaglandin synthesis due to NSAID use.
- This could lead to reduced renal blood flow, which may lead to renal decompensation.
- Patients with impaired renal function, hypovolemia and heart failure, as well as those who take diuretics and ACE inhibitors and angiotensin II receptor blocking drugs, are more at risk for renal toxicity.
- Before starting treatment, hydrate the patient and monitor your renal function.
- Patients with advanced renal disease should not use this medication. If you have persistent or worsening abnormal kidney function tests, discontinue use.
- Long-term NSAID treatment may cause renal papillary necrosis.
Piroxicam: Drug Interaction
|
5-Aminosalicylic Acid Derivatives |
Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of 5-Aminosalicylic Acid Derivatives. |
|
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.) |
May enhance the antiplatelet effect of other Agents with Antiplatelet Properties. |
|
Alcohol (Ethyl) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. |
|
Aliskiren |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Management: Monitor renal function periodically in patients receiving aliskiren and any nonsteroidal anti-inflammatory agent. Patients at elevated risk of renal dysfunction include those who are elderly, are volume depleted, or have pre-existing renal dysfunction. |
|
Alpelisib |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). |
|
Aminoglycosides |
Nonsteroidal Anti-Inflammatory Agents may decrease the excretion of Aminoglycosides. Data only in premature infants. |
|
Aminolevulinic Acid (Topical) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). |
|
Angiotensin II Receptor Blockers |
May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. |
|
Angiotensin-Converting Enzyme Inhibitors |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Anticoagulants |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin. |
|
Anticoagulants |
Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin. |
|
Beta-Blockers |
|
|
Bisphosphonate Derivatives |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern. |
|
Cephalothin |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased. |
|
Collagenase (Systemic) |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased. |
|
Corticosteroids (Systemic) |
May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents (Nonselective). |
|
CYP2C9 Inducers (Moderate) |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). |
|
CYP2C9 Inhibitors (Moderate |
May decrease the metabolism of CYP2C9 Substrates (High risk with Inhibitors). |
|
Dasatinib |
May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Deferasirox |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. |
|
Deoxycholic Acid |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased. |
|
Desmopressin |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Desmopressin. |
|
Digoxin |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Digoxin. |
|
Drospirenone |
Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Drospirenone. |
|
Eplerenone |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone. |
|
Fat Emulsion (Fish Oil Based) |
May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. |
|
Felbinac |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Glucosamine |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Haloperidol |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Haloperidol. Specifically including drowsiness and confusion. |
|
HydrALAZINE |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of HydrALAZINE. |
|
Ibritumomab Tiuxetan |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding. |
|
Ibrutinib |
May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. |
|
Inotersen |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Limaprost |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Lumacaftor |
May decrease the serum concentration of CYP2C9 Substrates (High Risk with Inhibitors or Inducers). Lumacaftor may increase the serum concentration of CYP2C9 Substrates (High Risk with Inhibitors or Inducers). |
|
Multivitamins/Fluoride (with ADE) |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Multivitamins/Minerals (with ADEK, Folate, Iron) |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Multivitamins/Minerals (with AE, No Iron) |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Naftazone |
May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Obinutuzumab |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased. |
|
Omega-3 Fatty Acids |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Pentosan Polysulfate Sodium |
May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents. |
|
Pentoxifylline |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Porfimer |
Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. |
|
Potassium-Sparing Diuretics |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. |
|
PRALAtrexate |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Closely monitor for increased pralatrexate serum levels and/or toxicity if used concomitantly with an NSAID. Monitor for decreased pralatrexate serum levels with NSAID discontinuation. |
|
Probenecid |
May increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. |
|
Prostacyclin Analogues |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Prostaglandins (Ophthalmic) |
Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic). |
|
Quinolones |
Nonsteroidal Anti-Inflammatory Agents may enhance the neuroexcitatory and/or seizure-potentiating effect of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Quinolones. |
|
Rifapentine |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). |
|
Salicylates |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result. |
|
Serotonin/Norepinephrine Reuptake Inhibitors |
May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). |
|
Tacrolimus (Systemic) |
Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tacrolimus (Systemic). |
|
Thiazide and Thiazide-Like Diuretics |
May enhance the nephrotoxic effect of Nonsteroidal AntiInflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. |
|
Thrombolytic Agents |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents. |
|
Tipranavir |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Tolperisone |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may enhance the therapeutic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Tricyclic Antidepressants (Tertiary Amine) |
May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). |
|
Vancomycin |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Vancomycin. |
|
Verteporfin |
Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. |
|
Vitamin E (Systemic) |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Risk Factor D (Consider therapy modification) |
|
|
Apixaban |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Apixaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of apixaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. |
|
Bemiparin |
Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin and nonsteroidal anti-inflammatory agents (NSAIDs) due to the increased risk of bleeding. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Bemiparin |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Bile Acid Sequestrants |
May decrease the absorption of Nonsteroidal Anti-Inflammatory Agents. |
|
CycloSPORINE (Systemic) |
Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. Management: Consider alternatives to nonsteroidal anti-inflammatory agents (NSAIDs). Monitor for evidence of nephrotoxicity, as well as increased serum cyclosporine concentrations and systemic effects (eg, hypertension) during concomitant therapy with NSAIDs. |
|
Dabigatran Etexilate |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of dabigatran and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. |
|
Dabrafenib |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP2C9 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). |
|
Diclofenac (Systemic |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Seek alternatives to the combined use of diclofenac with other nonsteroidal anti-inflammatory agents (NSAIDs). Avoid the use of diclofenac/misoprostol with other NSAIDs. |
|
Edoxaban |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of edoxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. |
|
Enoxaparin |
Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue nonsteroidal anti-inflammatory agents (NSAIDs) prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Enoxaparin |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Enzalutamide |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP2C9 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C9 substrate should be performed with caution and close monitoring. |
|
Heparin |
Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or nonsteroidal anti-inflammatory agents (NSAIDs) if coadministration is required. |
|
Heparin |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required. |
|
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry) |
May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures. |
|
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Bleeding may occur. Management: Concomitant treatment with these agents should generally be avoided. If used concomitantly, increased diligence in monitoring for adverse effects (eg, bleeding, bruising, altered mental status due to CNS bleeds) must be employed. |
|
Lithium |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Lithium. |
|
Loop Diuretics |
Nonsteroidal Anti-Inflammatory Agents may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. |
|
Methotrexate |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Methotrexate. Management: Alternative anti-inflammatory therapy should be considered whenever possible, especially if the patient is receiving higher, antineoplastic doses of methotrexate. |
|
MiFEPRIStone |
May increase the serum concentration of CYP2C9 Substrates (High risk with Inhibitors). Management: Use CYP2C9 substrates at the lowest recommended dose, and monitor closely for adverse effects, during and in the 2 weeks following mifepristone treatment. |
|
Rivaroxaban |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of rivaroxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. |
|
Salicylates |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Salicylates. An increased risk of bleeding may be associated with use of this combination. Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the cardioprotective effect of Salicylates. Salicylates may decrease the serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Exceptions: Choline Magnesium Trisalicylate. |
|
Selective Serotonin Reuptake Inhibitors |
May enhance the antiplatelet effect of Nonsteroidal AntiInflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk. |
|
Sincalide |
Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. |
|
Sodium Phosphates |
May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with NSAIDs, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely. |
|
Tenofovir Products |
Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose. |
|
Vitamin K Antagonists (eg, warfarin) |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the anticoagulant effect of Vitamin K Antagonists. |
|
Risk Factor X (Avoid combination) |
|
|
Acemetacin |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Aminolevulinic Acid (Systemic) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). |
|
Dexibuprofen |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Dexibuprofen. |
|
Dexketoprofen |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Floctafenine |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Ketorolac (Nasal) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Ketorolac (Systemic |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Macimorelin |
Nonsteroidal Anti-Inflammatory Agents may diminish the diagnostic effect of Macimorelin. |
|
Mifamurtide |
Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Mifamurtide. |
|
Morniflumate |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). |
|
Omacetaxine |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Management: Avoid concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs) with omacetaxine in patients with a platelet count of less than 50,000/uL. |
|
Pelubiprofen |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Phenylbutazone |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Talniflumate |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Tenoxicam |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Urokinase |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase. |
|
Zaltoprofen |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
Monitoring parameters:
- Occult blood loss,
- hemoglobin,
- hematocrit,
- electrolytes,
- and periodic renal and hepatic function tests;
- periodic ophthalmologic exams with chronic use
How to administer Piroxicam (Feldene, Brexin)?
- Oral: May administer in a single daily dose or divide twice a day.
- It can be administered with food or milk to reduce GI side effects.
Mechanism of action of Piroxicam (Feldene, Brexin):
- Reversible inhibition of COX-1 and COX-2 enzymes which causes less formation protaglandin precursors.
- Other proposed mechanisms not fully explained (and possibly contributing to the anti-inflammatory effect to varying degrees), include inhibiting chemotaxis, altering the activity of lymphocyte, inhibiting neutrophil aggregation/activation, and decreasing proinflammatory cytokine levels.
The onset of action:
- Analgesia: Oral: Within 1 hour;
- Maximum effect: 3 to 5 hours
Absorption:
- Oral: Well absorbed
Protein binding:
- 99%
Metabolism:
- Hepatic predominantly via CYP2C9; metabolites are inactive
Half-life elimination:
- Children and Adolescents 7 to 16 years: 32.6 hours; Range: 22 to 40 hours.
- Adults: 50 hours
Time to peak:
- 3 to 5 hours
Excretion:
- Primarily urine and feces (small amounts) as unchanged drug (5%) and metabolites
International Brands of Piroxicam:
- Feldene
- APO-Piroxicam
- DOM-Piroxicam
- PMS-Piroxicam
- TEVA-Piroxicam
- Ameroxicam
- Anflene
- Anmatic
- Antiflog
- Arotika Cool
- Artronil
- Atidem
- Baxo
- Benisan
- Brexic
- Brexidol
- Brexin
- Brexine
- Brucam
- Bruxicam
- Butacinon
- Campain
- Candyl-D
- Citoken T
- Dispercam
- Dolonex
- Edecam
- Erazon
- Exipan
- Facicam
- Felcam
- Feldegel
- Felden
- Felden Gel
- Feldene
- Feldene Gel
- Feldoral
- Fines
- Flamexin
- Flamic Gel
- Flexar
- Flexicam
- Flodol Gel
- Focus
- Gelprox
- Genoldene
- Hotemin
- Improntal
- Infeld
- Inflamene
- Kapirox
- Konshien
- Kydoflam
- Leal
- Lubor
- Macroxam
- Maxidene
- Mobilis
- Mobilus
- Movon Gel
- Movon-20
- Murupe Patch 48
- Nac
- Nysa
- PC-20
- Pemar
- Pillozen
- Pirac
- Piram
- Piram-D
- Pirax
- Pirocam
- Pirocutan
- Pirocutan Gel
- Pirogel
- Pirom
- Piromed
- Pirosol
- Pirox
- Pirox IM
- Piroxam
- Piroxedol
- Piroxene
- Piroxicam
- Piroxim
- Piroxin
- Pixicam
- Pleroxi
- Proxalyoc
- Proximax
- Pyridam
- Pyrolox
- Pyroxy
- Rheo-Ma Inj
- Rheudene
- Rheugesic
- Rosiden
- Roxicam
- Roxican
- Roxifen
- Roxitan
- Roxium
- Ruvamed
- Salvacam
- Sefdene
- Sinalgico
- Solocalm
- Sotilen
- Stopen
- Toricam Gel
- Tropidene
- Unicam
- Vendocid
- Xicalom
- Xicam
- Xycam
- Zincun
- Zitumex
- Zofora
- Zuparex
Piroxicam Brand Names in Pakistan:
Piroxicam Injection 20 mg/ml |
|
| Aksocam | Akson Pharmaceuticals (Pvt) Ltd. |
| Betadex | Ray Pharma (Pvt) Ltd |
| Bropox | Wellborne Pharmachem And Biologicals |
| Camitle | Myrtle Pharma Kar. |
| Epharox | Epharm Laboratories |
| Fasicamx | Fassgen Pharmaceuticals |
| Frogen | Zinta Pharmaceuticals Industries |
| Heldene | Hygeia Pharmaceuticals |
| Mobicam | Global Pharmaceuticals |
| Modivid | Caraway Pharmaceuticals |
| Muvon | Neutro Pharma (Pvt) Ltd. |
| Nicep | Medisave Pharmaceuticals |
| Oxicam | Ipram International |
| Pcam | Merck Private Ltd. |
| Piroflam | Polyfine Chempharma (Pvt) Ltd. |
| Pirowan | Swan Pharmaceuticals(Pvt) Ltd |
| Piroxilite | Elite Pharma |
| Pulsecam | Pulse Pharmaceuticals |
| Rheupain | Mediate Pharmaceuticals (Pvt) Ltd |
| Rosiden | Medisure Laboratories Pakistan (Pvt.) Ltd. |
| Rumolon Inj | Tabros Pharma |
| Weldene | Wilshire Laboratories (Pvt) Ltd. |
| Xycam | Mediceena Pharma (Pvt) Ltd. |
| Zicam | Goodman Laboratories |
Piroxicam Injection-IM 20 mg/ml |
|
| Feldene | Pfizer Laboratories Ltd. |
Piroxicam Syrup 2 mg/5ml |
|
| Broven | Chas. A. Mendoza |
Piroxicam Cream 1 % W/W |
|
| Riacen | Lahore Chemical & Pharmaceutical Works (Pvt) Ltd |
Piroxicam Cream 0.5 % W/W |
|
| Riacen | Chiesi Pharmaceuticals (Pvt) Ltd. |
Piroxicam Gel 0.5 % W/W |
|
| Alicam | Webros Pharmaceuticals |
| Camgen | Biogen Pharma |
| Comatic | Neutro Pharma (Pvt) Ltd. |
| Diodex | Pearl Pharmaceuticals |
| Ericam | Zephyr Pharmatec (Pvt) Ltd. |
| Feldene | Pfizer Laboratories Ltd. |
| Fenoxim | Medisearch Pharmacal(Pvt) Ltd |
| Hyalgan Gel | Nimrall Laboratories |
| Mobicam | Global Pharmaceuticals |
| Mod | Caraway Pharmaceuticals |
| Modivid | Caraway Pharmaceuticals |
| Orthosap | Sapient Pharma |
| Oxipro | Shrooq Pharmaceuticals |
| Pcam | Merck Private Ltd. |
| Pharox | Valor Pharmaceuticals |
| Piram | Navegal Laboratories |
| Poxicam | Bio Labs (Pvt) Ltd. |
| Proxim | Novartis Pharma (Pak) Ltd |
| Rheupain | Mediate Pharmaceuticals (Pvt) Ltd |
| Rosiden | Medisure Laboratories Pakistan (Pvt.) Ltd. |
| Rosiden | Medisure Laboratories Pakistan (Pvt.) Ltd. |
| Roxicam | Wilsons Pharmaceuticals |
| Roxim | Spl Pharmaceuticals (Pvt) Ltd |
| Sonicam | Syntex Pharmaceuticals |
| Xorip | Reliance Pharma |
| Zecam | Zeb Laboratories |
Piroxicam 2 mg Tablets |
|
| Broven | Chas. A. Mendoza |
Piroxicam 10 mg Tablets |
|
| Abxicam | Innvotek Pharmaceuticals |
| Allicam | Webros Pharmaceuticals |
| Anarom | Caylex Pharmaceuticals (Pvt) Ltd. |
| Davirox | Davis Pharmaceutical Laboratories |
| Discam | Davis Pharmaceutical Laboratories |
| Exican B | Nova Med Pharmaceuticals |
| Feldene | Pfizer Laboratories Ltd. |
| Feldicam | Rex Pharmaceuticals Pakistan |
| Limbar | Siza International (Pvt) Ltd. |
| O-Zole | Nova Med Pharmaceuticals |
| Oram | Bryon Pharmaceuticals (Pvt) Ltd. |
| Osteocam | Mega Pharmaceuticals (Pvt) Ltd |
| Pcam | Merck Private Ltd. |
| Pharox | Valor Pharmaceuticals |
| Rheucam | Epoch Pharmaceutical |
| Rheucam | Epoch Pharmaceutical |
Piroxicam 20 mg Tablets |
|
| Abxicam | Innvotek Pharmaceuticals |
| Allicam | Webros Pharmaceuticals |
| Anarom | Caylex Pharmaceuticals (Pvt) Ltd. |
| Arcam | Saydon Pharmaceutical Industries (Pvt) Ltd. |
| Bcd-20 | Gillman Pharmaceuticals |
| Beka | Glitz Pharma |
| Beladex | Sapient Pharma |
| Betamark | Welmark Pharmaceuticals |
| Betane | Genera Pharmaceuticals |
| Biodextrin | Biorex Pharmaceuticals |
| Bless | Medizan Labs (Pvt) Ltd |
| Brysk | Dyson Research Laboratories |
| Cam | Hisun Pharmaceuticals |
| Camgen | Biogen Pharma |
| Cirer | Nawan Laboratories (Pvt) Ltd. |
| Comfam | Pulse Pharmaceuticals |
| Cyclobex | Roryan Pharmaceutical Industries (Pvt) Ltd |
| Cyclocam Plus | Crest Pharmaceuticals |
| Cyclodex | Platinum Pharmaceuticals (Pvt.) Ltd. |
| Cyclodor | Shaheen Agencies |
| Cydex | Alfalah Pharma (Pvt) Ltd. |
| Dexin | Qintar Pharmacuticals |
| Diodex | Pearl Pharmaceuticals |
| Discam | Davis Pharmaceutical Laboratories |
| Epharox | Epharm Laboratories |
| Ever-Pir | Everest Pharmaceuticals |
| Exican | Nova Med Pharmaceuticals |
| Fai-Cam | Unison Chemical Works |
| Feldene | Pfizer Laboratories Ltd. |
| Feldene Ffd | Pfizer Laboratories Ltd. |
| Feldicam | Rex Pharmaceuticals Pakistan |
| Hocam | Honig Pharmaceuticals Laboratories |
| Limbar | Siza International (Pvt) Ltd. |
| Locam | Paramount Pharmaceuticals |
| Mcdex | English Pharmaceuticals Industries |
| Mquin | Macquins International |
| Mrexin | Medifine Laboratories |
| Nagid | Csh Pharmaceuticals-North (Pvt) Ltd |
| Naldene | Pharmawise Labs. (Pvt) Ltd. |
| Novagesic | Envoy Pharma |
| O-Zole | Nova Med Pharmaceuticals |
| Oram | Bryon Pharmaceuticals (Pvt) Ltd. |
| Orthosap | Sapient Pharma |
| Orthram | Davis Pharmaceutical Laboratories |
| Osteocam | Mega Pharmaceuticals (Pvt) Ltd |
| Oxibet | Silver Oak Corporation. |
| Oxicam | Ipram International |
| Oxipro | Shrooq Pharmaceuticals |
| Paladon | Venture Chemical & Pharmaceuticals (Pvt) Ltd. |
| Pancare | Regent Laboratories Ltd. |
| Parqin | Qintar Pharmacuticals |
| Paxam | Dr. Raza Pharma (Private) Limited |
| Paxil 20 | Shaigan Pharmaceuticals (Pvt) Ltd |
| Paxyl | Harmann Pharmaceutical Laboratories (Pvt) Ltd. |
| Payaram | Medicraft Pharmaceuticals (Pvt) Ltd. |
| Payram | Medicraft Pharmaceuticals (Pvt) Ltd. |
| Pcam | Merck Private Ltd. |
| Peerox-B | Goodman Laboratories |
| Perdin | Genome Pharmaceuticals (Pvt) Ltd |
| Pericam | Don Valley Pharmaceuticals (Pvt) Ltd. |
| Pharox-B | Valor Pharmaceuticals |
| Piraxin | Tabros Pharma |
| Piricam | Lowitt Pharmaceuticals (Pvt) Ltd |
| Piro-D | Pakheim Internanational Pharma |
| Pirodex | Schazoo Zaka |
| Pirolive | Olive Pharmaceuticals |
| Pirosil | Cirin Pharmaceuticals (Pvt) Ltd. |
| Pirotek | W & Ali Sons Pharmaceuticals |
| Pirotel | Ideal Pharmaceutical Industries |
| Pirotel | Ideal Pharmaceutical Industries |
| Piroxibet | Lawari International |
| Piroxibron | Wellborne Pharmachem And Biologicals |
| Piroxirown-B | Crown Pharmaceuticals |
| Preksin | Universal Pharmaceuticals (Pvt) Ltd |
| Proxilib | Stalwart Pharmaceuticals (Pvt) Ltd |
| Proxim | Novartis Pharma (Pak) Ltd |
| Pyroxi | Lotus Pharmaceuticals (Pvt) Ltd |
| Qitar | Ambrosia Pharmaceuticals |
| Qluz | Wilshire Laboratories (Pvt) Ltd. |
| Rheucam | Epoch Pharmaceutical |
| Rheucam | Epoch Pharmaceutical |
| Rheumonil | Batala Pharmaceuticals. |
| Ripocam | Syntex Pharmaceuticals |
| Rocicain | Aries Pharmaceuticals (Pvt) Ltd |
| Rocicain | Aries Pharmaceuticals (Pvt) Ltd |
| Rocician | Aries Pharmaceuticals (Pvt) Ltd |
| Rosiden | Medisure Laboratories Pakistan (Pvt.) Ltd. |
| Roxbex | Rakaposhi Pharmaceutical (Pvt) Ltd. |
| Roxic | Everest Pharmaceuticals |
| Roxic | Robins Pharmaceutical Industries |
| Roxidin | Rakaposhi Pharmaceutical (Pvt) Ltd. |
| Sandan Dispersible | Bloom Pharmaceuticals (Pvt) Ltd. |
| Sandan Dispersible | Bloom Pharmaceuticals (Pvt) Ltd. |
| Simroxy | Usawa Pharmaceuticals |
| Socalm | Zesion Pharmaceutical (Pvt) Ltd |
| Stapirox | Standard Drug Co. |
| Syntec | Orta Labs. (Pvt) Ltd. |
| Tactic | Tagma Pharma (Pvt) Ltd. |
| Tasocam | F.M. Pharmaceuticals International |
| Tasocam-B | Tas Pharmaceutical |
| Textrin | Tagma Pharma (Pvt) Ltd. |
| Traumalax | Nenza Pharmaceuticals (Pvt) Limited |
| Utrahit | Unipharma (Pvt) Ltd. |
| Viepram | Tagma Pharma (Pvt) Ltd. |
| Volika | Varioline International (Pvt) Ltd. |
| Welcame | Cherwel Pharmaceuticals (Pvt) Ltd |
| Weldene | Wilshire Laboratories (Pvt) Ltd. |
| Xycam | Mediceena Pharma (Pvt) Ltd. |
| Zerax | Raazee Theraputics (Pvt) Ltd. |
| Zicam | Goodman Laboratories |
Piroxicam 10 mg Capsules |
|
| Biocam | Biorex Pharmaceuticals |
| Brozicam | Pliva Pakistan (Pvt) Limited |
| Caliment | Evron (Pvt) Ltd. |
| Caliment | Evron (Pvt) Ltd. |
| Exican | Nova Med Pharmaceuticals |
| Felcam | Cibex (Private) Limited |
| Feldene | Pfizer Laboratories Ltd. |
| Fycam | Fynk Pharmaceuticals |
| Oram | Bryon Pharmaceuticals (Pvt) Ltd. |
| Oxicam | Ipram International |
| Pcam | Merck Private Ltd. |
| Pirofel | Well & Well Pharma (Pvt) Ltd |
| Piroxicam | Jinnah Pharmaceuticals |
| Poxicam | Bio Labs (Pvt) Ltd. |
| Rheumatus | Lotus Pharmaceuticals (Pvt) Ltd |
| Roxicam | Wilsons Pharmaceuticals |
| Trost | Hamaz Pharmaceutical (Pvt) Ltd. |
Piroxicam 20 mg Capsules |
|
| Aksocam | Akson Pharmaceuticals (Pvt) Ltd. |
| Aloxin | Alson Pharmaceuticals |
| Amolive | Olive Pharmaceuticals |
| Arsicam | Linear Pharma |
| Axicam | Mass Pharma (Private) Limited |
| Biocam | Biorex Pharmaceuticals |
| Brexa | Aries Pharmaceuticals (Pvt) Ltd |
| Broksin | Universal Pharmaceuticals (Pvt) Ltd |
| Brozicam | Pliva Pakistan (Pvt) Limited |
| Bruxicam | Drugs Inn Pakistan |
| Caliment | Evron (Pvt) Ltd. |
| Caliment | Evron (Pvt) Ltd. |
| Cam | Hisun Pharmaceuticals |
| Cap-20 | Flow Pharmaceuticals (Pvt) Ltd. |
| Delpirox | Rehman Medicine Co. |
| Delprox | Delta Pharma (Pvt) Ltd. |
| Diodex | Pearl Pharmaceuticals |
| Ericam | Zephyr Pharmatec (Pvt) Ltd. |
| Exican | Nova Med Pharmaceuticals |
| Fapro | Farm Aid Group Pak Ltd. |
| Fedracam | Fedro Pharmaceutical |
| Fedracam | Fedro Pharmaceutical |
| Fedracam | Fedro Pharmaceutical |
| Felaxicam | Medera Pharmaceuticals (Pvt) Ltd. |
| Felcam | Cibex (Private) Limited |
| Feldene | Pfizer Laboratories Ltd. |
| Feloxicam | Medera Pharmaceuticals (Pvt) Ltd. |
| Foster | Ferroza International Pharmaceuticals (Pvt) Ltd. |
| Foster | Ferroza International Pharmaceuticals (Pvt) Ltd. |
| Fycam | Fynk Pharmaceuticals |
| Gel-Cam | Imco Pharmaceuticals Laboratories |
| Gloxi | Goodman Laboratories |
| Indene | Shafaz Pharma International (Pvt) Ltd. |
| Infarel | Mercy Pharmaceutical Ltd |
| Inflacid | Gray`S Pharmaceuticals |
| Inflarox | Polyfine Chempharma (Pvt) Ltd. |
| Jaldin | Irza Pharma (Pvt) Ltd. |
| Maricam | Miracle Pharmaceuticals(Pvt) Ltd |
| Medrox | Chas. A. Mendoza |
| Mobicam | Global Pharmaceuticals |
| Nicep | Medisave Pharmaceuticals |
| Oram | Bryon Pharmaceuticals (Pvt) Ltd. |
| Oxicam | Ipram International |
| Oxyclod | Glitz Pharma |
| Pain-R | Rogen Pharmaceuticals |
| Painles | Panacea Pharmaceuticals |
| Pcam | Merck Private Ltd. |
| Pelcam | Z-Jans Pharmaceutical (Pvt) Ltd. |
| Pharox | Valor Pharmaceuticals |
| Phelodene | Unexo Labs (Pvt) Ltd. |
| Piram | Navegal Laboratories |
| Pirobet | Highnoon Laboratories Ltd. |
| Piroc | Bloom Pharmaceuticals (Pvt) Ltd. |
| Pirofel | Well & Well Pharma (Pvt) Ltd |
| Pirojoint | Sayyed Pharmaceuticals |
| Piromin | Medifine Laboratories |
| Piroxicam | Jinnah Pharmaceuticals |
| Pixicam | City Pharma |
| Poxicam | Bio Labs (Pvt) Ltd. |
| Precam | Genome Pharmaceuticals (Pvt) Ltd |
| Precam-20 | Prix Pharmaceutica |
| Propain | Royal Consumer Manufacturing Company |
| Proxim | Novartis Pharma (Pak) Ltd |
| Pulsecam | Pulse Pharmaceuticals |
| Pyricam | Amson Vaccines & Pharma (Pvt) Ltd. |
| Pyrocam | Lowitt Pharmaceuticals (Pvt) Ltd |
| Rapicam | Hygeia Pharmaceuticals |
| Rheumatus | Lotus Pharmaceuticals (Pvt) Ltd |
| Riacen | Chiesi Pharmaceuticals (Pvt) Ltd. |
| Rosiden | Medisure Laboratories Pakistan (Pvt.) Ltd. |
| Roxicam | Wilsons Pharmaceuticals |
| Roxidin | Rakaposhi Pharmaceutical (Pvt) Ltd. |
| Roxidin | Rakaposhi Pharmaceutical (Pvt) Ltd. |
| Roxsy | Winilton Pharmaceuticals (Pvt) Ltd |
| Rupirox | Hizat Pharmaceutical Industries (Pvt) Ltd. |
| Salden | Danas Pharmaceuticals (Pvt) Ltd |
| Sicam | Siam Pharmaceuticals |
| Sponac | Rock Pharmaceuticals |
| Swatch | Tagma Pharma (Pvt) Ltd. |
| Traumalax | Nenza Pharmaceuticals (Pvt) Limited |
| Trix | Trison Research Laboratories (Pvt) Ltd |
| Trost | Hamaz Pharmaceutical (Pvt) Ltd. |
| Vascam | Rasco Pharma |
| Vincam | Obsons Pharmaceuticals |
| Xegen | Shawan Pharmaceuticals |
 Injection.webp)