Piroxicam/Feldene...is it OK?

[aussigal]

I have done the search thingy and not had much sucess...
Eventually I found it on Als site and he says he doesnt recommend this combo of drugs (piroxicam & warfarin)...AAAARRRGGGHHHH!!!!

I used to take this for my Arthritis before warfarin. Now my GP/PCP just re-prescribed it for me because I need something more for the Arthritis. I am not so sure if I should be taking it (I havent yet) and would appreciate some advice . OR some suggestions of alternatives...I already take Tramadol slow-release 150mg, but need to add an anti-inflammatory of some sort to the mix.

Thanks guys and gals...

 

[jeffp]

I've seen more than just a few GI bleed events with Feldene over the years, so with warfarin I'd expect even more of a chance. The problem with many GI bleeds is that you don't know about it 'til something else brings it to light.
Do they have Arthrotec (diclofenac and misoprostol) available there? (I haven't checked for any med reactions with warfarin on it - I'm sure Al will chime in if he gets a chance to use the net - He's travelling this week doing the lecture circuit.) It's probably in the same anti-inflammatory league as ibuprophen (maybe a bit stronger) but the misoprostol helps to decrease the incidence of GI bleeds. I'm sure you'll find a reasonable risk product that will not cause too much problem with warfarin. Just takes some trial and error to find what works the best.

 

[jeffp]

I was just reading a journal article by Jack Ansell ( I gotta get a life! ) and noticed that he has piroxicam in the "high potentiation" category for warfarin. (Has an additive effect on the anticoagulant action.) So I guess that that means that you wouldn't likely want to take it with warfarin unless you monitor the INR and adjust the dose accordingly. I'd still worry about the GI bleed risk though.

 

[Guest]

I would say that naproxen is safer.

 

[aussigal]

Thankyou Jeff and Al...

My Doc said I would need to adjust my warfarin 'cos this stuff will cause my inr to go up...and this weeks inr came in low at 1.8 this is before I took any Feldene,....

...I havent heard of Arthrotec but I do know of diclofenac so I will check that one out, its available in Aus. and doesnt look to have the same restrictions as the regular NSAIDS...Thanks Jeff.

...I found some references that talked about proteins and these 2 drugs. It said something along the lines of them both wanting to bind to the same protein and therefore it causes your inr to go up. I am getting more confused because all of the NSAIDS seem to have the same restrictions on them.

My back was really driving me crazy so I caved-in and took some of the Feldene and it gave me huge relief. I hope it hasnt/doesnt give me anything-else. All I want is some relief from the pinching and crushing feelings coming from my arthritic back. I think I better get back into my Doc and switch pills before we have a bleeding-event....

thanks guys

 

[Natanni]

Hey Ton

Keep us posted on what you find that works for you! Good to know these things.

Nathan had his first real migrane since having his surgery. He has been given the okay for Ibuprofen for his migranes, but has not really needed it until now, and he didn't have any on him so it just blew up into a horrid migrane. He had a back injury from work years ago, and had to take Flexaril for about a week and we were wondering if he could ever take that again in the event he needs it as he does have permanent damage, but it will only flare if he reinjures the area. We found his newly added Crestor drove his rock solid INR of 2.6 to a now consistant 3.2.

Nice to see you Ton

Ann

 

[Guest]

ibuprofen is never OK with warfarin. It has too much risk of causing a GI bleed. The doc is saying OK without looking it up.

Diclofenac is not very good either for the same reason.

 

[Natanni]

OH oh....this was his heart surgeon from the Mayo....what would be a good alternative Al? Tylenol doesn't not work, only ibuprofen has ever worked for him if taken at the onset of his migrane aura. His surgeon gave the okay for (2) Ibuprofen on a prn-migrane basis. Gosh, I wish anticogulated people could take some sort of medication to protect the lining of their stomachs and ward off GI Bleeds...

Sorry Ton, didn't mean to hyjack thread...

 

[Guest]

I'm sorry, I must have missed the part about it being just for migraine prevention. One occasional dose (even a large one) is not likely to produce bleeding.

I do have one of my patients in the hospital right now because her doctor prescribed indomethacin for gout and it caused a GI bleed.

 

[aussigal]

Thats OK Ann...I needed to know that answer as well...I have taken Codalgin Forte (paracetamol 500mg with codeine 30mg) for migraine but its terribly constipating .

What I am seeking is an Anti-inflammatory that I can take daily to relieve the Arthritis... I am not really happy with the idea of piroxicam after what AL says...and even though I took it for 4 days and the relief was great, I am getting scared and want to swap this drug for something less likely to cause a bleed...It must be time for me to go back and have a conference with my Doc and see what is a better choice.