piroxicam: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
piroxicam: clinical details
Prescribing considerations
- Reserve systemic piroxicam for second-line treatment of licensed arthritic conditions and ensure initiation by an appropriately experienced clinician.
- Assess gastrointestinal, cardiovascular, renal, hepatic, respiratory and serious skin-reaction risks before prescribing.
- Reassess benefit, tolerability and continued need frequently; avoid use in people older than 80 years.
Contraindications and cautions
- Previous or active gastrointestinal ulceration, bleeding or perforation, or a gastrointestinal disorder predisposing to bleeding
- Concomitant anticoagulants, other NSAIDs or analgesic-dose aspirin
- Previous serious allergic drug reaction, previous piroxicam-related skin reaction, or NSAID-triggered asthma, angioedema, nasal polyps or urticaria
- Severe heart failure
- Third trimester of pregnancy
Monitoring
- Consider baseline blood pressure, renal function and full blood count; assess liver function where clinically indicated.
- Individualise monitoring of renal function, blood pressure and blood counts according to risk.
- Monitor for gastrointestinal symptoms, skin or mucosal reactions, oedema, respiratory symptoms and visual complaints.
Clinical pharmacology
Piroxicam is an oxicam NSAID that reversibly inhibits cyclo-oxygenase and prostaglandin synthesis. It is well absorbed orally, highly protein-bound and has a long elimination half-life; reduced CYP2C9 metabolism can increase exposure.
Formulation and product differences
- Fast-dissolving tablets can disperse on the tongue or be swallowed with water; they contain aspartame, a phenylalanine source relevant to phenylketonuria.
- The selected hard capsule is swallowed orally and contains lactose, relevant to specified rare hereditary carbohydrate-intolerance disorders.
piroxicam preparations and strengths
Capsule
Route: Oral
Strengths: 10 mg, 20 mg
piroxicam interactions
Check prescribed, pharmacy and over-the-counter products before piroxicam is started.
Warfarin and other anticoagulants
Can enhance anticoagulant effects and substantially increase bleeding risk; concomitant use is contraindicated in the selected products.
Aspirin and other NSAIDs, including ibuprofen and naproxen
Combining them increases adverse-effect and bleeding risks and should be avoided.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.