Formulary
Piroxicam: Indications, Dosing, Side Effects and Interactions
Piroxicam clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Piroxicam: Indications, Dosing, Side Effects and Interactions
Piroxicam clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Rheumatoid arthritis (initiated by a specialist),Osteoarthritis (initiated by a specialist),Ankylosing spondylitis (initiated by a specialist)**
- **Adult** (By Mouth): Up to 20 mg once daily.
**Pain relief in musculoskeletal conditions,Treatment in knee or hand osteoarthritis (adjunct)**
- **Adult** (To The Skin): Apply 3-4 times a day, 0.5% gel to be applied; review treatment after 4 weeks.
**Relief of pain and inflammation in juvenile idiopathic arthritis for piroxicam**
- **Child 6-17 years (body-weight up to 15 kg)** (By mouth): 5 mg daily.
- **Child 6-17 years (body-weight 15-25 kg)** (By mouth): 10 mg daily.
- **Child 6-17 years (body-weight 26-45 kg)** (By mouth): 15 mg daily.
- **Child 6-17 years (body-weight 46 kg and above)** (By mouth): 20 mg daily.
Cautions
With systemic use Allergic disorders; cardiac impairment (NSAIDs may impair renal function); cerebrovascular disease; coagulation defects; connective-tissue disorders; dehydration (risk of renal impairment); elderly (risk of serious side-effects and fatalities); heart failure; history of gastro-intestinal disorders; ischaemic heart disease; may mask symptoms of infection; peripheral arterial disease; risk factors for cardiovascular events; uncontrolled hypertension With topical use Avoid contact with eyes; avoid contact with inflamed or broken skin; avoid contact with mucous membranes; not for use with occlusive dressings; topical application of large amounts can result in systemic effects, including hypersensitivity and asthma (renal disease has also been reported)
Contraindications
With systemic use Active gastro-intestinal bleeding; active gastro-intestinal ulceration; history of gastro-intestinal bleeding; history of gastro-intestinal perforation; history of gastro-intestinal ulceration; inflammatory bowel disease; severe heart failure
Side effects
General side-effects: Common or very common Gastrointestinal discomfort; gastrointestinal disorders; nausea; skin reactions Rare or very rare Severe cutaneous adverse reactions (SCARs) Frequency not known Bronchospasm; dyspnoea; photosensitivity reaction Specific side-effects: Common or very common With oral use Anaemia; appetite decreased; constipation; diarrhoea; dizziness; drowsiness; eosinophilia; headache; hyperglycaemia; leucopenia; oedema; rash (discontinue); thrombocytopenia; tinnitus; vertigo; vomiting; weight changes Uncommon With oral use Hypoglycaemia; palpitations; stomatitis; vision blurred Rare or very rare With oral use Nephritis tubulointerstitial; nephrotic syndrome; renal failure; renal papillary necrosis Frequency not known With oral use Alopecia; angioedema; aplastic anaemia; confusion; depression; embolism and thrombosis; eye irritation; eye swelling; fertility decreased female; fluid retention; haemolytic anaemia; haemorrhage; hallucination; hearing impairment; heart failure; hepatic disorders; hypersensitivity; hypertension; malaise; mood altered; nervousness; onycholysis; pancreatitis; paraesthesia; sleep disorders; vasculitis Side-effects, further information For information about cardiovascular and gastrointestinal side-effects, and a possible exacerbation of symptoms in asthma, see Non-steroidal anti-inflammatory drugs Topical application of large amounts can result in systemic effects.
Interactions
**Severe interactions:**
- Cimetidine: Results of two separate studies indicate a slight but significant increase in absorption of piroxicam following cimetidine administration but no significant changes in elimination rate...
**Other interactions (16):**
- Antacids: Concomitant administration of antacids had no effect on piroxicam plasma levels.
- Anticoagulants: NSAIDs, including piroxicam, may enhance the effects of anticoagulants, such as warfarin.
- Therefore the use of piroxicam with concomitant anticoagulant such as warfarin should be avoided (see section 4.3).
- Aspirin and other Non-Steroidal Anti-Inflammatory Drugs: Feldene, like other non-steroidal anti-inflammatory drugs decreases platelet aggregation and prolongs bleeding time.
- As with other NSAIDs, the use of piroxicam together with acetylsalicylic acid or concomitant use with other NSAIDs, including other piroxicam formulations, must be avoided, since data are inadequate...
- Human studies have shown that concomitant use of piroxicam and acetylsalicylic acid reduces the plasma piroxicam concentration to about 80% of the usual value.
Pregnancy
Important safety information For piroxicam CHMP advice-Piroxicam (June 2007) With systemic use: The CHMP has recommended restrictions on the use of piroxicam because of the increased risk of gastro-intestinal side-effects and serious skin reactions. The CHMP has advised that: piroxicam should be initiated only by physicians experienced in treating inflammatory or degenerative rheumatic diseases piroxicam should not be used as first-line treatment in adults, use of piroxicam should be limited to the symptomatic relief of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis piroxicam dose should not exceed 20 mg daily piroxicam should no longer be used for the treatment of acute painful and inflammatory conditions treatment should be reviewed 2 weeks after initiating piroxicam, and periodically thereafter concomitant administration of a gastro-protective agent should be considered. Topical preparations containing piroxicam are not affected by these restrictions. MHRA/CHM advice: NSAIDs: potential risks following prolonged use after 20 weeks of pregnancy (June 2023) With systemic use: See Non-steroidal anti-inflammatory drugs .
Breast feeding
With systemic use: Use with caution during breast-feeding. Amount too small to be harmful. With topical use: Patient packs for topical preparations carry a warning to avoid during breast-feeding.
Hepatic impairment
With oral use: Manufacturer advises caution.
Renal impairment
With systemic use: In general, for NSAIDs the MHRA advises to avoid where possible; if necessary, use with caution (risk of fluid retention and further renal impairment, including renal failure). With topical use: Caution (deterioration in renal function has also been reported after topical use). M
Medicinal forms
Tablet,Capsule,Gel
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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