ピロキシカム

動物種別の用量

投与経路

禁忌

• 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)

有害事象

• 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)

薬物相互作用

• 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 · major
• 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 · major
• Diuretics · Increased risk of nephrotoxicity and renal papillary necrosis · moderate
• Aminoglycosides · Increased risk of nephrotoxicity · moderate

モニタリング

• Adverse Effects (particularly GI bleeding: melena, hematemesis, pale mucous membranes)
• Liver function tests (occasionally with chronic use)
• Renal function tests (occasionally with chronic use)
• Renal function (BUN, Creatinine, SDMA, Urinalysis)
• Liver enzymes
• Clinical signs of GI ulceration (vomiting, melena, anorexia)
• Hydration status
• Skin integrity (especially in cats)

過量投与

Overdosage can lead to severe **gastrointestinal (ulceration, perforation)** and **renal (papillary necrosis, failure)** effects. Dogs may be more sensitive to the ulcerative effects than humans. **Treatment:** * Decontamination with emetics and/or activated charcoal if recent. * Gastrointestinal protectants (e.g., misoprostol, omeprazole, sucralfate) are strongly warranted. * Fluid diuresis should be considered to protect renal function. * Monitor carefully and provide supportive care.