Piroxicam

Piroxicam is a nonsteroidal anti-inflammatory drug (NSAID) indicated for the relief of the signs and symptoms of osteoarthritis and rheumatoid arthritis.

• Piroxicam is available under the following different brand names: Feldene.

Dosages of Piroxicam:

Dose Forms and Strengths

Capsule

• 10 mg
• 20 mg

Dosage Considerations – Should be Given as Follows:

Rheumatoid arthritis (including juvenile), osteoarthritis

• 20 mg orally once/day or divided twice daily; no more than 30-40 mg/day

Administration

• Take with food or 8-12 oz water to avoid gastrointestinal (GI) effects

Side effects of piroxicam include:

• Indigestion
• Upper respiratory infection
• Headache
• Diarrhea
• Nausea
• Abdominal pain
• Swelling (edema)
• Anemia
• Dizziness
• Constipation
• Vomiting
• Fever
• Chest pain (angina)
• Congestive heart failure
• High blood pressure (hypertension)

Heart attack (myocardial infarction)

• Gastrointestinal bleeding
• Gastrointestinal perforation
• Inflammatory disorder of digestive tract
• Decreased platelet aggregation, purpuric disorder
• Hepatitis
• Loss of appetite
• Stomach pain or upset
• Elevated liver enzymes
• Bloating
• Gas
• Heartburn
• Ulcers (gastric/duodenal)
• Nervousness
• Skin itching or rash
• Blurred vision

Less common side effects of piroxicam include:

• Erythema multiforme
• Skin redness
• Stevens-Johnson syndrome
• Toxic epidermal necrolysis
• Yellowing skin and eyes (jaundice)
• Liver failure
• Severe allergic reaction (anaphylaxis)
• Immune hypersensitivity reaction
• Cerebrovascular accident
• Interstitial nephritis
• Kidney failure
• Asthma
• Bronchospasm
• Skin swelling
• Ringing in the ears (tinnitus)
• Hearing loss

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Piroxicam has no known severe interactions with other drugs.
• Serious interactions of piroxicam include:
  • apixaban
  • benazepril
  • captopril
  • enalapril
  • fosinopril
  • ketorolac
  • ketorolac intranasal
  • lisinopril
  • methotrexate
  • moexipril
  • pemetrexed
  • perindopril
  • quinapril
  • ramipril
  • tacrolimus
  • trandolapril
• Piroxicam has moderate interactions with 237 different drugs.
• Piroxicam has mild interactions with at least 115 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.

Warnings

Cardiovascular Risk

• Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of serious cardiovascular thrombotic events, heart attack (myocardial infarction [MI]), and stroke, which can be fatal
• The risk may increase with the duration of use
• Patients with risk factors for or existing cardiovascular disease may be at greater risk
• NSAIDs are contraindicated for perioperative pain in the setting of coronary artery bypass graft (CABG) surgery (increased risk of MI and stroke)

Gastrointestinal Risk

• NSAIDs increase the risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal
• GI adverse events may occur at any time during use and without warning symptoms
• Elderly patients are at greater risk for serious GI events

This medication contains piroxicam. Do not take Feldene if you are allergic to piroxicam or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Absolute: acetylsalicylic acid (ASA)/aspirin allergy
• Relative: bleeding disorders, duodenal/gastric/peptic ulcer, stomatitis, systemic lupus erythematosus (SLE), ulcerative colitis, upper gastrointestinal (GI) disease, late pregnancy (may cause premature closure of the ductus arteriosus)

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Piroxicam?"

Long-Term Effects

• Long-term administration of nonsteroidal anti-inflammatory drugs (NSAIDs) may result in renal papillary necrosis and another renal injury; patients at greatest risk include the elderly, or those with impaired renal function, hypovolemia, heart failure, liver dysfunction, salt depletion, and individuals taking diuretics, ACE inhibitors, or ARBs.
• See "What Are Side Effects Associated with Using Piroxicam?"

Cautions

• May increase risk of asthma (bronchial), cardiac disease, congestive heart failure (CHF), hepatic impairment, high blood pressure (hypertension), renal impairment
• Long-term administration of nonsteroidal anti-inflammatory drugs (NSAIDs) may result in renal papillary necrosis and another renal injury; patients at greatest risk include the elderly, or those with impaired renal function, hypovolemia, heart failure, liver dysfunction, salt depletion, and individuals taking diuretics, ACE inhibitors, or ARBs
• May cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine when used long term and can be fatal; administer lowest effective dose for short periods; use caution
• NSAIDs including piroxicam can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal
• Not for administration to patients that have experienced aspirin anaphylactoid reactions
• Anemia reported in patients receiving NSAIDs, including piroxicam; may prolong bleeding time; monitor
• NSAIDs may cause adverse eye reactions; consult an ophthalmologist if symptoms occur
• Based on the mechanism of action, use of prostaglandin-mediated NSAIDs, including piroxicam, may delay or prevent rupture of ovarian follicles, which has been associated with reversible infertility in some women; women who have difficulties conceiving or who are undergoing investigation of infertility, withdrawal of NSAIDs, including piroxicam, should be considered
• Heart Failure (HF) risk:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
  • NSAIDs should be avoided or withdrawn whenever possible

Pregnancy and Lactation

• Use piroxicam with caution during the first and second trimesters of pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done. During the third trimester of pregnancy, use in piroxicam only LIFE-THREATENING emergencies when no safer drug is available. There is positive evidence of human fetal risk (may cause premature closure of the ductus arteriosus).