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18 Feb 2020 | 05:26 PM (IST)
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Overview

Introduction

4-Steps Gel is a pain relieving medicine. It is applied topically to treat moderate to severe pain. It helps relieve pain and swelling or various joints and muscles.

4-Steps Gel is only meant for external use and should be used strictly as advised by your doctor. A thin layer of the medicine should be massaged into the affected areas with clean and dry hands. Avoid getting in contact with your eyes, nose, or mouth. In case of accidental contact, you should rinse it thoroughly with plenty of water.

It is usually safe with little or no side effects. However, it may cause burning sensation and skin irritation at the site of application. They are usually temporary and resolve with time. If they do not get better with time or worsen, you should let your doctor know. Your doctor may be able to suggest ways of preventing or reducing the symptoms.

Before using the medicine, it is important to tell your doctor if you are using or have recently used any other medicines for the same disease or other diseases. To make sure the medicine is safe, pregnant and breastfeeding women should consult their doctor before using the medicine.

Uses of 4-Steps Gel

Side effects of 4-Steps Gel

Most side effects do not require any medical attention and disappear as your body adjusts to the medicine. Consult your doctor if they persist or if you’re worried about them

Common side effects of 4-Steps

  • No common side effects seen

How to use 4-Steps Gel

This medicine is for external use only. Use it in the dose and duration as advised by your doctor. Check the label for directions before use. Clean and dry the affected area and apply the gel. Wash your hands after applying, unless hands are the affected area.

How 4-Steps Gel works

4-Steps Gel is a non-steroidal anti-inflammatory drug (NSAID). It works by blocking the release of certain chemical messengers that are responsible for inflammation (pain and swelling).

Safety Advice

Alcohol
No interaction found/established
Pregnancy
CONSULT YOUR DOCTOR
4-Steps Gel may be unsafe to use during pregnancy. Although there are limited studies in humans, animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing it to you. Please consult your doctor.
Breastfeeding
SAFE IF PRESCRIBED
4-Steps Gel is probably safe to use during breastfeeding. Limited human data suggests that the drug does not represent any significant risk to the baby.
The baby's skin should not come into direct contact with the treated area of skin. Water-miscible cream/gel is preferred as ointments may expose the baby to harmful effects of 4-Steps Gel via licking.
Driving
No interaction found/established
Kidney
No interaction found/established
Liver
No interaction found/established

What if you forget to take 4-Steps Gel?

If you miss a dose of 4-Steps Gel, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Alternate Brands

For informational purposes only. Consult a doctor before taking any medicines.
4-Steps Gel
₹0.95/gm of Gel
Piricam Gel
Zydus Cadila
₹0.9/gm of Gel
save 5%
Minicam Gel
Blue Cross Laboratories Ltd
₹0.96/gm of Gel
1% costlier
Felcam Gel
Sun Pharmaceutical Industries Ltd
₹1.49/gm of Gel
56% costlier
Pirox Gel
Cipla Ltd
₹2.25/gm of Gel
136% costlier
Dolonex Gel
Pfizer Ltd
₹5.32/gm of Gel
458% costlier

Quick Tips

  • 4-Steps Gel helps relieve pain and swelling of various joints and muscles.
  • Rub it gently over the affected area, until it is absorbed.
  • Do not apply to broken, diseased, infected or irritated skin, or to open wounds.
  • Do not cover the area being treated with airtight dressings such as bandages, as these may increase the risk of side effects.
  • Avoid contact with your eyes, nose or mouth. Rinse it off with water if you accidentally get the gel in these areas.
  • Stop using 4-Steps Gel and immediately inform your doctor if you notice skin rashes, sores, blisters or ulcers in the mouth, nose, throat or genitals.
  • Do not use it for longer than four weeks without talking to to your doctor first.

Interaction with Drugs

Taking 4-Steps with any of the following medicines can modify the effect of either of them and cause some undesirable side effects
Brand(s): Nimsun, Abinim, Nimulis
LIFE-THREATENING
Brand(s): Oxy Triactin, Sioril
LIFE-THREATENING
Brand(s): Pyregin, Alpagin, Novalgin RC
LIFE-THREATENING

Patient Concerns

arrow
Heart pain slowly pls suggest next steps
Dr. Nabajit Talukdar
Cardiology
Get a tmt done
Knee pain,walking &climbing steps very painful.
Dr. Akshat Goel
Orthopaedics
Get an Xray done of both knees (AP and Lateral views) in standing positionTake Tab Altraday and Tab Flotrip-plus twice daily
arrow
Do you have any questions related to 4-Steps Gel ?

User Feedback


FAQs

Q. What is the difference between 4-Steps and diclofenac?

Both 4-Steps and diclofenac are pain killers. However, piroxicam is a non-selective COX (cyclooxygenase - an enzyme responsible for inflammation and pain) inhibitor whereas diclofenac has a bit more selectivity to a COX-2 enzyme. This selectivity of diclofenac is supposed to decrease the side effects as compared to 4-Steps.

Q. What is the difference between 4-Steps and naproxen?

Both 4-Steps and naproxen are pain killers. Both are non-selective COX (cyclooxygenase - an enzyme responsible for inflammation and pain). Research studies have shown both are equally effective. However, gastric side effects are lesser with naproxen as compared to 4-Steps.

Q. What is the difference between 4-Steps and meloxicam?

Both 4-Steps and meloxicam are pain killers. Both are non-selective COX (cyclooxygenase - an enzyme responsible for inflammation and pain). Research studies have shown both are equally effective. However, acute gastric side effects are lesser with meloxicam as compared to 4-Steps.

Q. What is the difference between 4-Steps and ketoprofen?

Both 4-Steps and ketoprofen are pain killers. Both are non-selective COX (cyclooxygenase -an enzyme responsible for inflammation and pain). Research studies have shown ketoprofen topical gel is better and effective as compared to 4-Steps. Ketoprofen gel also showed excellent tolerability.

Q. What is the difference between 4-Steps and tramadol?

4-Steps is a COX (cyclooxygenase -an enzyme responsible for inflammation and pain) whereas Tramadol is a narcotic-like painkiller. Tramadol is a habit forming medicine.

Q. What is the difference between 4-Steps and nimesulide?

Both 4-Steps and nimesulide are pain killers. However, 4-Steps is a non-selective COX (cyclooxygenase -an enzyme responsible for inflammation and pain) inhibitor whereas nimesulide is selective to the COX-2 enzyme. This selectivity of nimesulide is supposed to decrease the side effects as compared to piroxicam. It should not be used in children below 12 years of age.

Q. Can 4-Steps be used in the treatment of chikungunya?

Usually, the platelet count does not dip in cases of chikungunya and painkillers like piroxicam can lead to the risk of increased bleeding tendency. So refrain from taking 4-Steps or any painkiller in the case of any fever with joint pain. Consult your doctor before starting 4-Steps.

Q. Are 4-Steps and aspirin same?

No. 4-Steps and aspirin are not same. They belong to the same class of drugs known as COX (cyclooxygenase) inhibitors. They both are anti-inflammatory and analgesic.

Q. Can 4-Steps be used along with dexamethasone?

No. 4-Steps should not be used with dexamethasone. They both increase each other's toxicity. There is an increased risk of GI ulceration.

Q. Can 4-Steps be used with methocarbamol?

Yes. Methocarbamol can be used with 4-Steps as no serious side effects are known. Inform your doctor before starting any of the medication.

Q. Can 4-Steps be used along with paracetamol?

Yes. Paracetamol can be used with 4-Steps as no serious side effects are known. Inform your doctor before starting any of the medication.

Q. Is 4-Steps a NSAID?

Yes. 4-Steps is a non-steroidal anti-inflammatory drug (NSAID).

Q. Is 4-Steps a sulfa drug?

4-Steps is a sulphur containing compound. 4-Steps can cause serious adverse events in sensitive individuals. It can cause severe skin reactions like Steven Johnson Syndrome. Do inform your doctor if you have any kind of allergies.

Q. Is 4-Steps a blood thinner?

No. 4-Steps is not a blood thinner. It is a pain killer. It should be avoided in a patient with a bleeding disorder.

Q. Is 4-Steps a muscle relaxant?

No. 4-Steps is not a muscle relaxant. It is a pain killer which acts on COX (cyclooxygenase -an enzyme responsible for inflammation and pain) enzyme.

Q. Is 4-Steps a narcotic?

No. 4-Steps is not a narcotic. It is a pain killer which acts on COX (cyclooxygenase -an enzyme responsible for inflammation and pain) enzyme to decrease the pain and inflammation.

Q. Can 4-Steps be used in hypertension?

No. 4-Steps is not a medication to control hypertension. It is important to note that 4-Steps decreases the effectiveness of the antihypertensive medication when given together. Inform your doctor if you are taking antihypertensive medications before starting 4-Steps.

Q. Can 4-Steps be used along with Losartan?

No. 4-Steps should not be combined with Losartan. It is important to note that 4-Steps decreases the effectiveness of the antihypertensive medication like losartan when given together leading to failure of antihypertensive therapy. Inform your doctor if you are taking antihypertensive medications before starting 4-Steps.

Q. Can 4-Steps be used with Lisinopril?

No. 4-Steps should be avoided with lisinopril. It is important to note that piroxicam decreases the effectiveness of the antihypertensive medication like lisinopril when given together leading to failure of antihypertensive therapy. Inform your doctor if you are taking antihypertensive medications before starting 4-Steps.

Q. Can 4-Steps be used with calcium channel blocker?

Yes. 4-Steps can be taken with calcium channel blocker. NSAIDs have been observed to reduce the effectiveness of all antihypertensive drugs except calcium channel blockers (ref: White 2007)

Q. Can 4-Steps be used with Tizanidine?

Yes, 4-Steps can be combined with tizanidine. Piroxicam is a pain killer and tizanidine is a skeletal muscle relaxant. It is used in the condition like a backache.

Q. Why is beta cyclodextrin added to 4-Steps?

Yes. 4-Steps can be combined with beta-cyclodextrin. Research has shown that combining 4-Steps with beta-cyclodextrin leads to faster onset of action of piroxicam and reduced gastric side effects.

Q. Are there any alternatives of 4-Steps?

Yes. There are alternatives to 4-Steps. Pain killers are prescribed according to the disease condition. Consult your doctor before starting piroxicam or changing it to other medication.

Q. What are the contraindications for 4-Steps?

Contraindications to piroxicam are an allergy, bleeding tendency, duodenal/gastric/peptic ulcer, stomatitis, Systemic Lupus Erythematosus (SLE), ulcerative colitis, upper GI disease, late pregnancy, cardiac disease, hepatic impairment, renal impairment.

Q. Can 4-Steps be used in the treatment of allergy?

No. 4-Steps is not a drug to treat allergy. It is a pain killer.

Q. How long does 4-Steps work?

4-Steps is a long acting drug. Once the daily dose is enough for the relief of pain but it depends from person to person as the effectiveness of piroxicam increases when given for few weeks.

Q. Can you get high by using 4-Steps?

No. 4-Steps is not known to cause high. It is a non-narcotic painkiller.

Q. Can 4-Steps be used to treat menstrual cramp?

4-Steps is not approved for the treatment of menstrual cramps. Research studies have shown that piroxicam is quite effective in significantly decreasing the menstrual cramps.

Q. Can I use 4-Steps for a migraine?

4-Steps is not approved for the treatment of migraine. Research studies have shown that 4-Steps is effective in significantly decreasing the pain associated with migraine without aura.

Q. Is 4-Steps effective in back pain management?

Yes. It can be given for decreasing the back pain. However, you should consult your doctor for the exact cause of your back pain and then start the treatment. Do not self-medicate yourself with 4-Steps as the cause of back pain can be different for different person.

Q. Is 4-Steps affective in gout management?

Yes. 4-Steps can be given for the treatment of acute gout. Research studies have shown 4-Steps to be highly effective in the treatment of acute gout.

Q. Can you donate blood when on the medication with 4-Steps?

Yes. You can donate blood when on 4-Steps. Do inform your doctor before donating blood.

Q. Can I use 4-Steps if I am a diabetic?

4-Steps in a diabetic patient can only be taken only by consulting a doctor because these medicines have the propensity to cause renal failure when taken for a long period. Diabetes itself causes renal 4-Steps so taking piroxicam can lead to increased risk of renal failure by many folds.

Q. Can I use 4-Steps if I have a deranged renal function?

No. 4-Steps should not be taken if you have a abnormal renal function because long-term administration of NSAIDs has resulted in renal papillary necrosis and another renal injury.

Q. Can 4-Steps lead to skin reactions?

Yes. 4-Steps is known to cause skin reactions which can be very severe such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. You should inform your doctor if you feel you have a mild rash and immediately discontinue the drug.

Q. Can I use 4-Steps if I am pregnant?

No. 4-Steps should not be taken in pregnancy. It causes premature closure of the ductus arteriosus which can lead to fetal heart failure and death of the baby.

Q. Can I use 4-Steps if I have peptic ulcer disease?

No. 4-Steps is contraindicated in cases of active peptic ulcer disease. 4-Steps is known to cause gastric ulceration and bleeding.

Q. Can I use 4-Steps if I have asthma?

Some patients with asthma are hypersensitive to non-steroidal anti-inflammatory (NSAID) drugs like aspirin which can lead to acute attacks of asthma. Consult your doctor before starting this medication.

Q. Can 4-Steps lead to difficulty in conception?

Yes. 4-Steps can sometimes cause reversible infertility. Piroxicam by its mechanism of action may delay or prevent rupture of ovarian follicles, which has been associated with reversible infertility in some women. Consult your doctor before starting this medication.

Q. Can 4-Steps be used with diuretics?

No. 4-Steps should not be used with diuretics. 4-Steps reduces the natriuretic effect of furosemide and thiazides diuretics in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis.

Q. Can 4-Steps be used with lithium?

No. 4-Steps should not be used with lithium. 4-Steps leads to an elevation of plasma lithium levels and a reduction in renal lithium clearance. This is because of inhibition of renal prostaglandin synthesis by the NSAID. Consult and inform your doctor before starting this medication.

Q. Can 4-Steps be used with warfarin?

No. 4-Steps should be avoided with warfarin as they both lead to increase in bleeding tendencies. Inform your doctor if you are taking any of the medications. If given together then the therapy should be monitored closely.

Q. What increases the chances of getting a gastric ulcer when I am already taking 4-Steps?

The chances of gastric ulceration increases if you take medicines like corticosteroids and anticoagulants. Long term use, alcohol, smoking and old age are few other factors which can increase the chances of ulceration.

Q. Who should not take a Non-Steroidal Anti-Inflammatory Drug (NSAID)/ 4-Steps?

Patients who had an asthma attack, hives, or other allergic reaction with aspirin or any other NSAID medicine or for pain right before or after heart bypass surgery.

Q. What are the serious side effects of 4-Steps?

GI discomfort and, rarely, serious GI side effects, such as ulcers and bleeding, serious skin side effects such as exfoliative, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis, liver failure, renal damage.

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Disclaimer:

1mg's sole intention is to ensure that its consumers get information that is expert-reviewed, accurate and trustworthy. However, the information contained herein should NOT be used as a substitute for the advice of a qualified physician. The information provided here is for informational purposes only. This may not cover all possible side effects, drug interactions or warnings or alerts. Please consult your doctor and discuss all your queries related to any disease or medicine. We intend to support, not replace, the doctor-patient relationship.

References

  1. Furst DE, Ulrich RW, Varkey-Altamirano C. Nonsteroidal Anti-Inflammatory Drugs, Disease Modifying Antirheumatic Drugs, Nonopioids Analgesics, & Drugs Used in Gout. In: Katzung BG, Masters SB, Trevor AJ, editors. Basic and Clinical Pharmacology. 11th ed. New Delhi, India: Tata McGraw Hill Education Private Limited; 2009. p. 628.
  2. Grosser T, Smyth E, FitzGerald GA. Anti-Inflammatory, Antipyretic, and Analgesic Agents; Pharmacotherapy of Gout. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics. 12th ed. New York, New York: McGraw-Hill Medical; 2011. p. 989-90.
  3. Briggs GG, Freeman RK, editors. A Reference Guide to Fetal and Neonatal Risk: Drugs in Pregnancy and Lactation. 10th ed. Philadelphia, PA: Wolters Kluwer Health; 2015. pp. 1127-28.
  4. PubChem. Piroxicam. [Accessed 02 Apr. 2019] (online) Available from:External Link
  5. ScienceDirect. Piroxicam. [Accessed 02 Apr. 2019] (online) Available from:External Link
  6. Central Drugs Standard Control Organisation (CDSCO). [Accessed 02 Apr. 2019] (online) Available from:External Link

Manufacturer/Marketer Address

Prathmesh Ashish, A wing,1st Floor, Kanakia Road,Mira Road(E), Thane(Mumbai), Pin :- 401104, Maharashtra, India.
A licensed vendor partner from your nearest location will deliver 4-Steps Gel. Once the pharmacy accepts your order, the details of the pharmacy will be shared with you. Acceptance of your order is based on the validity of your doctor's ℞ and the availability of this medicine.
MRP
95.23
100 gm in 1 tube
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