oxaprozin

Absorption: Well absorbed following oral administration (80%); 35% is rapidly converted to an active metabolite.

Distribution: Unknown.

Protein Binding: 99.9%.

Metabolism/Excretion: The active metabolite is metabolized by the liver to inactive compounds.

Half-Life: 42–50 hr.

Time/Action Profile ⬆ ⬇

(antirheumatic action)

ROUTE	ONSET	PEAK	DURATION
PO	within 7 days	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Cross-sensitivity may exist with other NSAIDs, including aspirin;
Active GI bleeding or ulcer disease;
Coronary artery bypass graft surgery;
OB: Avoid use after 30 wk gestation;
Lactation: Lactation.

Use Cautiously in:

Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, MI, and stroke, especially with prolonged use or use of higher doses); avoid use in patients with recent MI or HF;
History of peptic ulcer disease and/or GI bleed, smoking, alcohol use, severe hepatic impairment, coagulopathy, and poor general health status (↑ risk of GI bleeding);
Renal impairment (↓ initial dose may be necessary);
OB: Use at or after 20 wk gestation may cause fetal or neonatal renal impairment; if treatment is necessary between 20 wk and 30 wk gestation, limit use to the lowest effective dose and shortest duration possible;
Pedi: Children 6 yr (safety and effectiveness not established);
Geri: Appears on Beers list. risk GI bleeding or peptic ulcer disease in older adults. Avoid chronic use unless other alternatives are not effective and the patient can take a gastroprotective agent; avoid short-term use in combination with oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents unless other alternatives are not effective and the patient can take a gastroprotective agent.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema, HF, hypertension, MI, vasculitis

Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), EXFOLIATIVE DERMATITIS, ↑sweating, photosensitivity, pruritus, rash, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS

EENT: abnormal vision, tinnitus

F and E: hyperkalemia

GI: abdominal pain, diarrhea, dyspepsia, ↑liver enzymes, anorexia, cholestatic jaundice, constipation, dry mouth, duodenal ulcer, flatulence, gastritis, GI BLEEDING, ↑appetite, nausea, stomatitis, vomiting

GU: albuminuria, azotemia, interstitial nephritis

Hemat: prolonged bleeding time

Metab: weight gain

Neuro: agitation, anxiety, confusion, depression, dizziness, drowsiness, fatigue, headache, insomnia, malaise, paresthesia, STROKE, tremor, weakness

Resp: dyspnea, hypersensitivity pneumonitis

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)

Interactions ⬆ ⬇

Drug-drug:

↑adverse GI effects and toxicity with aspirin, other NSAIDs, potassium supplements, corticosteroids, or alcohol.
Chronic use with acetaminophen may ↑ risk of adverse renal reactions.
May ↓ effectiveness of diuretics or antihypertensive therapy.
May ↑ hypoglycemic effects of insulin or oral hypoglycemic agents.
↑risk of toxicity from methotrexate.
↑risk of bleeding with anticoagulants, aspirin, clopidogrel, ticagrelor, prasugrel, corticosteroids, fibrinolytics, SNRIs, or SSRIs.
↑risk of adverse hematologic reactions with antineoplastics or radiation therapy.

Drug-Natural Products:

↑anticoagulant effect and bleeding risk with arnica, chamomile, clove, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others.

Route/Dosage ⬆ ⬇

Osteoarthritis or Rheumatoid Arthritis

PO (Adults ): 1200 mg once daily; onset may be more rapid with an initial 1800-mg dose. Patients with low body weight, mild disease, or renal impairment may be started at 600 mg/day (not to exceed 1800 mg/day or 26 mg/kg/day). Daily doses >1200 mg should be given in 2–3 divided doses. Consideration should be given to ↓ dose to lowest effective amount.

Juvenile Rheumatoid Arthritis

PO (Children 6–16 yr and ≥55 kg): 1200 mg once daily.
PO (Children 6–16 yr and 32–54 kg): 900 mg once daily.
PO (Children 6–16 yr and 22–31 kg): 600 mg once daily.

Availability ⬆ ⬇

(Generic available)

Capsules (Oxanto): 300 mg
Tablets (Daypro): 600 mg

Assessment ⬆ ⬇

Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Monitor for rhinitis, asthma, and urticaria.
Assess pain and range of motion prior to and periodically during therapy.
Monitor BP during initiation and periodically during therapy. May cause fluid retention and edema leading to new onset or worsening hypertension.
Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, facial swelling) periodically during therapy. Discontinue therapy if symptoms occur.

Lab Test Considerations:

May cause prolonged bleeding time, which may persist for up to 2 wk following discontinuation of therapy.
- Evaluate BUN, serum creatinine, CBC, and liver function tests periodically in patients receiving prolonged therapy. Serum potassium, BUN, serum creatinine, alkaline phosphatase, LDH, AST, and ALT tests may show ↑ levels. Blood glucose, hemoglobin, and hematocrit concentrations; leukocyte and platelet counts; and CCr may be ↓.

Implementation ⬆ ⬇

Do not confuse oxaprozin with oxcarbazepine.
Administration in higher than recommended doses does not provide increased effectiveness but may cause increased side effects. Use lowest effective dose for shortest period of time to minimize risk of cardiovascular thrombotic events.
PO: Administer with food or antacids to decrease GI irritation.

Patient/Family Teaching ⬆ ⬇

Advise patient to take oxaprozin with a full glass of water and to remain in an upright position for 15–30 min after administration.
Instruct patient to take medication as directed. Take missed doses as soon as remembered but not if almost time for the next dose. Do not double doses.
May cause drowsiness and dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, and other OTC or herbal products without consulting health care professional.
Advise patient to notify health care professional of medication regimen prior to treatment or surgery. Oxaprozin should be discontinued 2 wk prior to surgery.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions (especially in children with juvenile rheumatoid arthritis).
Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise women to avoid oxaprozin in the 3rd trimester of pregnancy (after 29 wk); may cause premature closure of the fetal ductus arteriosus. Use of oxaprozin after 20 wk may cause fetal renal dysfunction leading to oligohydramnios. May cause reversible infertility in women attempting to conceive; may consider discontinuing oxaprozin.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇