Last update July 18, 2022

4-Hydroxy-2-methyl-N-(2-pyridyl)-2H-1,2-benzothiazine-3-carboxamide 1,1-dioxide

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

It is a non-steroidal anti-inflammatory (NSAID), selective inhibitor of cyclooxygenase-2 (COX-2) that is used in the treatment of rheumatoid arthritis and other rheumatic diseases. Topical or oral administration once daily.

It is excreted in breast milk in clinically non-significant amount and no problems have been observed in infants whose mothers took this medication. (Ostensen 1988 y 1983)

Levels in plasma and urine of such infants were undetectable. (Ostensen 1988 y 1983)

Having published less quantity of studies than with other NSAIDs, safer alternatives may be preferable, especially in the neonatal period and in case of prematurity.

Expert authors consider the use of meloxicam to be probably safe during breastfeeding (Hale, Briggs 2015, Østensen 2007, Janssen 2000). The American Academy of Pediatrics rates it as usually compatible with breastfeeding. (AAP 2001)

Alternatives

  • Flurbiprofen ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Ibuprofen ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Indomethacin; Indometacin ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Paracetamol ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

4-Hydroxy-2-methyl-N-(2-pyridyl)-2H-1,2-benzothiazine-3-carboxamide 1,1-dioxide is Piroxicam in Chemical name.

Is written in other languages:

4-Hydroxy-2-methyl-N-(2-pyridyl)-2H-1,2-benzothiazine-3-carboxamide 1,1-dioxide is also known as

Tradenames

Main tradenames from several countries containing 4-Hydroxy-2-methyl-N-(2-pyridyl)-2H-1,2-benzothiazine-3-carboxamide 1,1-dioxide in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 %
Molecular weight 331 daltons
Protein Binding 99 %
VD 0.14 l/Kg
Tmax 3 - 5 hours
50 (30 - 86) hours
M/P ratio 0.01 -
Theoretical Dose 0.01 - 0.03 mg/Kg/d
Relative Dose 3.5 - 6.3 %
Ped.Relat.Dose 3.3 - 5 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on April 10, 2024 Full text (link to original source)
  2. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  3. Pfizer, S.L. Piroxicam. Ficha técnica. 2012 Full text (in our servers)
  4. FDA. Piroxicam. Drug Summary. 2012 Full text (in our servers)
  5. Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007 Abstract
  6. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  7. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med. 2000 Abstract Full text (link to original source) Full text (in our servers)
  8. Ostensen M, Matheson I, Laufen H. Piroxicam in breast milk after long-term treatment. Eur J Clin Pharmacol. 1988 Abstract
  9. Ostensen M. Piroxicam in human breast milk. Eur J Clin Pharmacol. 1983 Abstract

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