DAYPRO ALTA
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DAYPRO ALTA (DAYPRO ALTA).
Oxaprozin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2), thereby reducing prostaglandin synthesis, which mediates inflammation, pain, and fever.
| Metabolism | Primarily hepatic via cytochrome P450 (CYP) 2C9 and CYP2C8; minor metabolism via glucuronidation. Metabolites are inactive. |
| Excretion | Renal: 85% (60-90% as oxaprozin glucuronide and 5-10% as unchanged oxaprozin); Fecal: <5%; Biliary: negligible. |
| Half-life | 50-65 hours (mean 57 hours); clinically significant accumulation occurs with multiple dosing, requiring dose adjustment in elderly and renal impairment. |
| Protein binding | >99.5% bound to albumin. |
| Volume of Distribution | 0.15-0.25 L/kg; low Vd indicates extensive plasma protein binding and limited tissue distribution. |
| Bioavailability | Oral: approximately 100% (well absorbed with no significant first-pass metabolism). |
| Onset of Action | Oral: analgesic effect within 1 hour; anti-inflammatory effect within 3-5 days. |
| Duration of Action | 24-48 hours for analgesic effect; anti-inflammatory effect persists for several days after drug cessation due to long half-life. |
| Molecular Weight | 312.36 |
Oxaprozin is administered orally. The usual adult dose is 1200 mg once daily. For osteoarthritis and rheumatoid arthritis, dosing can range from 600 to 1200 mg once daily. A starting dose of 600 mg once daily may be considered for patients with low body weight or milder disease.
| Dosage form | TABLET |
| Renal impairment | For patients with creatinine clearance (CrCl) of 50-79 mL/min: no dose adjustment is generally required, but monitor for adverse effects. For CrCl 30-49 mL/min: reduce dose by 50% or use 600 mg once daily. For CrCl <30 mL/min: use is contraindicated. End-stage renal disease (ESRD): avoid use. |
| Liver impairment | Child-Pugh Class A (mild impairment): no dose adjustment needed. Child-Pugh Class B (moderate impairment): reduce dose by 50% or use 600 mg once daily; monitor closely. Child-Pugh Class C (severe impairment): use is contraindicated. No specific studies; caution advised. |
| Pediatric use | Not approved for pediatric use. Safety and efficacy have not been established in patients under 18 years. Avoid use in children and adolescents unless under expert guidance and with caution. |
| Geriatric use | Elderly patients (≥65 years) are at increased risk for NSAID-related adverse effects, including GI bleeding, renal impairment, and cardiovascular events. Initiate therapy at the lowest effective dose (e.g., 600 mg once daily) and monitor renal function, blood pressure, and for signs of GI toxicity. Avoid use if possible in patients with high cardiovascular risk or history of GI ulceration. |
| 1st trimester | Avoid; associated with risk of miscarriage and congenital malformations (cardiovascular, gastrointestinal). |
| 2nd trimester | Avoid; may cause oligohydramnios and premature ductus arteriosus constriction. |
| 3rd trimester | Contraindicated; risks of premature closure of ductus arteriosus, oligohydramnios, and neonatal renal impairment. |
Clinical note
Comprehensive clinical and safety monograph for DAYPRO ALTA (DAYPRO ALTA).
| Placental transfer | Crosses placenta; detected in cord blood and fetal tissues. Transfer increases with gestational age. |
| Breastfeeding | Excreted in breast milk in low amounts; potential for serious adverse effects in infants (e.g., renal toxicity, gastrointestinal bleeding). Use is not recommended. |
| Lactation Rating |
■ FDA Black Box Warning
Cardiovascular risk: NSAIDs may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use and in patients with cardiovascular risk factors. Gastrointestinal risk: NSAIDs increase risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of stomach or intestines, which can be fatal. These events can occur at any time without warning.
| Serious Effects |
History of aspirin or NSAID-induced asthma/urticariaActive peptic ulcer disease or GI bleedingSevere heart failure (NYHA III-IV)Perioperative pain in CABG surgeryThird trimester of pregnancySignificant renal impairment (CrCl <30 mL/min)Hypersensitivity to oxaprozin
| Precautions | Cardiovascular thrombotic events (MI, stroke), Gastrointestinal bleeding, ulceration, perforation, Renal toxicity (elevated creatinine, nephrotoxicity), Hepatic effects (transaminase elevations, rare severe hepatotoxicity), Hypertension exacerbation, Fluid retention and edema, Anaphylactoid reactions, Serious skin reactions (e.g., exfoliative dermatitis, Stevens-Johnson syndrome), Premature closure of ductus arteriosus in pregnancy, Hematologic effects (anemia, bleeding) |
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| L4 |
| Teratogenic Risk | First trimester: NSAIDs are not associated with a major teratogenic risk, but avoid due to potential risk of miscarriage. Second trimester: Use only if clearly needed. Third trimester: Avoid after 30 weeks due to premature closure of ductus arteriosus and oligohydramnios. DAYPRO ALTA (oxaprozin) is contraindicated in third trimester. |
| Fetal Monitoring | Monitor for signs of premature ductus arteriosus closure, oligohydramnios, fetal renal impairment via ultrasound. Maternal monitoring for GI bleeding, renal function, blood pressure, and signs of fluid retention. |
| Fertility Effects | NSAIDs may impair female fertility through reversible inhibition of prostaglandin synthesis affecting ovulation. Discontinuation may lead to restoration of fertility. No known effect on male fertility. |
| Food/Dietary |
| May be taken with food or milk to minimize gastrointestinal irritation. Avoid alcohol due to increased risk of GI bleeding. No specific food restrictions otherwise. |
| Clinical Pearls | Daypro Alta (oxaprozin) is a nonsteroidal anti-inflammatory drug (NSAID) with a long half-life (~40-50 hours) allowing once-daily dosing. Monitor for GI bleeding, renal impairment, and cardiovascular events. Use with caution in elderly and those with renal insufficiency. Avoid in patients with aspirin-sensitive asthma or NSAID allergy. |
| Patient Advice | Take with food or milk to reduce stomach upset. · Do not take other NSAIDs or aspirin while on this medication. · Report any signs of stomach bleeding (black stools, coffee-ground vomit), chest pain, or swelling. · Avoid alcohol as it increases GI bleeding risk. · Tell your doctor about all medications, especially blood thinners and diuretics. |