Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation caused by rheumatoid arthritis and osteoarthritis. It has a long half-life, allowing once-daily dosing.
Also known as: feldene
Long half-life NSAID + anticoagulant: increased bleeding risk. Prolonged accumulation.
The long half-life of piroxicam (50 h) prolongs exposure to the antiplatelet effect. Bleeding risk is higher than with short half-life NSAIDs.
INR, signs of bleeding.
Major bleeding.
Avoid combination. If necessary, monitor INR weekly. Consider short half-life NSAID (ibuprofen) as alternative.
DailyMed/FDA — approved Piroxicam label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=923a81d7-78e7-48e9-901d-e3ce3539aba3
H2 blocker + NSAID: cimetidina may reduce piroxicam absorption but minimal clinical effect.
Cimetidine may slightly reduce oral absorption of piroxicam, but the clinical effect is minimal. Both are CYP-metabolised — theoretical competition.
No specific monitoring required.
No dose adjustment required. Monitor piroxicam efficacy.
DailyMed/FDA — approved Piroxicam label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=923a81d7-78e7-48e9-901d-e3ce3539aba3
Food delays absorption but does not affect extent. Peak delayed by 1-2 h.
May be taken with food to reduce GI discomfort.
Long half-life prolongs exposure in renal impairment. Risk of accumulation and toxicity.
eGFR 30-50: reduced dose. eGFR <30: avoid. Prefer short half-life NSAID.
DailyMed/FDA — approved Piroxicam label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=923a81d7-78e7-48e9-901d-e3ce3539aba3
CONTRAINDICATED in 3rd trimester. Long half-life increases fetal exposure.
3rd trimester: CONTRAINDICATED. 1st-2nd trimester: avoid (prefer paracetamol).
Excreted in breast milk. Avoid during breastfeeding.
May inhibit ovulation. Use reliable contraception.
DailyMed/FDA — approved Piroxicam label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=923a81d7-78e7-48e9-901d-e3ce3539aba3
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Non-selective inhibition of COX-1 and COX-2. Prolonged anti-inflammatory and analgesic activity due to long half-life. High risk of gastrointestinal effects.
Competitive inhibition of COX-1 and COX-2. High plasma protein binding (99%). Acts primarily by peripheral inhibition of prostaglandin synthesis.
Slow but complete oral absorption. Bioavailability: 90%. Food does not significantly affect absorption. Peak: 3-5 h.
Metabolised in the liver by CYP2C9 and CYP3A4. Inactive metabolites. Little or no CYP2C19 metabolism.
50 h (mean). May reach 100 h in the elderly. Significant accumulation.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
