Piroxicam

Brand Names: Feldene

Drug Class: Nonsteroidal Anti-inflammatory Drug (NSAID), Oxicam derivative

Overview

Piroxicam is a nonsteroidal anti-inflammatory drug (NSAID) used for the relief of signs and symptoms of osteoarthritis and rheumatoid arthritis. It works by inhibiting prostaglandin synthesis, providing analgesic and anti-inflammatory effects. Due to its long half-life, it offers once-daily dosing convenience.

Mechanism of Action

Piroxicam is a nonsteroidal anti-inflammatory drug (NSAID) that exerts its therapeutic effects through inhibition of cyclooxygenase (COX) enzymes, primarily COX-1 and COX-2. This inhibition reduces the synthesis of prostaglandins, which are mediators of inflammation, pain, and fever.

Indications

  • Osteoarthritis
  • Rheumatoid arthritis

Common Doses

  • 10 mg
  • 20 mg

Dosage

Typical adult dosage is 20 mg once daily. The dose may be divided (10 mg twice daily) if needed. Maximum recommended daily dose is 20 mg. Should be taken with food or milk to minimize gastrointestinal upset.

Contraindications

  • Known hypersensitivity to piroxicam or other NSAIDs
  • History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
  • In the setting of coronary artery bypass graft (CABG) surgery
  • Patients with active peptic ulcer disease or gastrointestinal bleeding

Side Effects

  • Dyspepsia, nausea, abdominal pain
  • Headache, dizziness
  • Edema, fluid retention
  • Elevated liver enzymes
  • Rash, photosensitivity
  • Serious reactions: Gastrointestinal bleeding/perforation, myocardial infarction, stroke, renal failure, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis

Interactions

  • Anticoagulants (warfarin): Increased risk of bleeding
  • Aspirin: May decrease piroxicam effectiveness and increase GI toxicity
  • ACE inhibitors/ARBs: May diminish antihypertensive effect and worsen renal function
  • Diuretics: Reduced diuretic and antihypertensive effects
  • Lithium: Increased lithium levels and toxicity
  • Methotrexate: Increased methotrexate toxicity

Counseling Points

  • Take with food or milk to reduce stomach upset
  • Report any signs of gastrointestinal bleeding (black/tarry stools, vomiting blood)
  • Avoid alcohol consumption while taking this medication
  • Use sun protection as piroxicam can cause photosensitivity
  • Report any chest pain, shortness of breath, weakness, or slurred speech immediately
  • Do not take other NSAIDs (including aspirin) without consulting healthcare provider