Why it's used

Piroxicam is a prescription medicine that is used to relieve the signs and symptoms of swollen, stiffed, warm or painful joints. It is also used to relieve the pain and stiffness affecting the spine. It works by obstructing the body's production of a substance which causes fever, pain, and inflammation.
Nonsteroidal Anti-inflammatory Drugs
Piroxicam belongs to the Nonsteroidal Anti-inflammatory Drugs class of medicines. Nonsteroidal anti-inflammatory drugs, also called as NSAIDs, help reduce fever, decrease pain, and prevent clotting of blood. NSAIDs also reduce inflammation in the body when used in higher doses.

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How to use

Read the medicine guide provided by your pharmacist, your doctor, or the medicine company. If you have any questions related to Piroxicam, ask your doctor or pharmacist. Use Piroxicam as per the instructions provided by your doctor.
Piroxicam is used with or without food. The capsules should be swallowed with water. Drink plenty of water while using this medicine to avoid dehydration.

Typical Dosage

The typical dose of Piroxicam for adults is 20 mg orally once a day. The maximum dose for adult patients of Piroxicam is 20 mg per day. Piroxicam is commonly used at the same time every day.
This medicine is to be used for longer periods of time.

Talk to Your Doctor

Discuss with your doctor if you develop new symptoms. Discuss with your doctor if unexplained weight gain, swelling due to fluid accumulation, nausea, fatigue, lack of energy, severe itching, jaundice, stomach pain, flu-like symptoms, difficulty breathing, shortness of breath, swelling of the face or throat, skin rash, chest pain, blisters, fever, black and tarry stools, heartburn, blood in the stool, constipation, slurred speech, hair loss, loss of appetite, headache, dizziness, and depression. If you have issues with the health of your liver, Patient with liver disease may require a low dose of this medicine.
Older patients may see an increase in the incidence of side-effects. As a result, a lower dose may be recommended for older patients.

Use in Children

The safety and effectiveness of using Piroxicam in children has not been established. The safety and effectiveness data of Piroxicam have not been studied in children under 12 years.

Avoid Alcohol

Avoid consuming alcohol together with Piroxicam.
Medicines may be recommended for uses other than those listed in the medicine guide. You should not use Piroxicam for conditions or symptoms for which it was not prescribed. Do not give Piroxicam to other people, even if they have the same conditions or symptoms that you have. The use of this medicine without the advice of a doctor may cause harm.

Storage

Follow storage instructions on the product package if available. Store Piroxicam below 30ºC (86º F), protect from moisture, and protect from light. Store this medicine away from children and pets.

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How to take Piroxicam

Your dose may depend on several personal factors. You should consult with your doctor to find out the dose that is best for you. The dose of Piroxicam depends on the following factors:
  • patient's age
  • patient's health
  • the health of the patient's kidneys
  • medicines recommended by your doctor
  • any other medicines in use
  • herbal supplements consumed
  • response to treatment

Piroxicam Dosage

Dosage for warm, swollen, or painful joints

Adult
  • Recommended: 20 mg once a day
  • Initial: 20 mg once daily
  • Maximum: 20 mg

Dosage for painful or stiffed joints (osteoarthritis)

Adult
  • Recommended: 20 mg once a day
  • Initial: 20 mg once daily
  • Maximum: 20 mg

Dosage for pain and stiffness affecting the spine

Adult
  • Recommended: 20 mg once a day
  • Initial: 20 mg once daily
  • Maximum: 20 mg

Minimum Age

12 years

Maximum Age

80 years

Forms

Capsules
Strength: 10 mg, 20 mg
Suppository
Strength: 10 mg, 20 mg
Tablet
Strength: 10 mg

Missed Dose

Take the missed dose as soon as you remember. Skip the missed dose if it is time for next dose. Avoid taking a double dose to make up for the missed dose.

Overdose

What to do if you overdose on Piroxicam?
There is no specific antidote for its overdose. The patient should be treated according to the symptoms. Use activated charcoal, also stomach emptying (gastric lavage) should be considered within one hour of lethal overdose. The urine output should be maintained. Kidney and liver function should be monitored. Also, the patient should be observed for at least four hours after the overdose. Seizures should be treated with diazepam injection in the veins. In addition, vomiting may be induced, and osmotic cathartic can be used which accelerates defecation.
Symptoms of an overdose of Piroxicam
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
If you think you have overdosed on Piroxicam, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Piroxicam

Before you use Piroxicam, tell your doctor of your medical and health history including the following:
  • inflammation in the digestive tract (ulcerative colitis)
  • inflammation of the lining of the digestive system (Crohn’s disease)
  • inflammation or infection in the digestive tract (diverticulitis)
  • severe heart failure
  • stomach bleeding
  • stomach or intestinal cancers
  • stomach or intestinal disorder
  • stomach ulcer
Before you use Piroxicam, discuss with your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Tell your doctor if you are allergic any of the following substances: aspirin, or other NSAIDs.
Before having surgery during the use of Piroxicam, discuss with your doctor and dentist about the medicinal products you use including prescription/non-prescription/herbal medicines.
The use of this medicine may change creatinine. This medicine may increase the level of waste products in the blood (creatinine).
The use of Piroxicam may change blood urea nitrogen (BUN). This medicine may increase the level of blood urea nitrogen.
The use of this medicine may change liver enzymes. This medicine may increase the level of liver enzyme (transaminase).

Seizures

Piroxicam can make you feel sleepy. Be careful when using any machinery, driving a vehicle, or doing any other activity that needs you to be fully alert. The consumption of alcohol with Piroxicam can worsen the sleepiness. Piroxicam may cause rarely seizures in some people. If you perform any activities where a loss of consciousness may cause harm to you (or others), you should discuss with your doctor.

Use in Pregnancy

Pregnant/breastfeeding women should not use this medicine. Piroxicam is not for use by women. NSAIDs should not be used in the first two trimesters of pregnancy except the possible benefits outweighs the potential risk to the baby. Piroxicam belongs to the NSAID class of medicines. NSAIDs should not be taken after 29 weeks of pregnancy as these medicines may cause serious harm to the unborn baby.

Use while Breastfeeding

Consult with your doctor on the use of Piroxicam during breastfeeding. Take necessary precautions while using Piroxicam during breastfeeding.

Use while Conceiving

Consult with your doctor on the use of Piroxicam, if you are trying to conceive. This medicine may cause problems in women to become pregnant.

Alcohol

Avoid consuming alcohol together with Piroxicam. Drinking alcohol may cause may increase risk of stomach ulcer or bleeding.

Increased Risks

This medicine may cause bleeding in the stomach. Regular use of tobacco or alcohol while using this medicine can increase your risk. Discuss with your doctor if you smoke and drink alcohol regularly. This medicine may increase your sensitivity to sunlight. If this happens, use a sunscreen and cover your skin when you are outdoors. Limit your time in the sun.

Side-effects in Older Patients

Piroxicam may cause increased incidence of side-effects in older patients. Elderly patients may see an increased risk of stomach and intestinal bleeding.

What precautions should be taken during Pregnancy and Nursing, and administering Piroxicam to Children or the Older Adults?

Pregnant Women

Contraindicated or Not Recommended
Warning: Piroxicam may cause blood vessel disease between heart and lungs (fetal ductus arteriosus) in newborn babies.

Breastfeeding

Precaution
Warning: NSAIDs may appear in very low amount in breast milk. Furthermore, if possible, avoid using this medicine when breastfeeding.

Younger Adults Population

Contraindicated or Not Recommended
Warning: Safety and effectiveness of Piroxicam have not been studied in children.

Older Adults Population

Precaution
Warning: Older adults are at increased risk of having the stomach and intestinal bleeding. The lowest effective dose of Piroxicam should be used to prevent this risk of bleeding.

Piroxicam Side-effects

The following side-effects may commonly occur when using Piroxicam. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
The following side-effects may commonly occur in older patients on the use of Piroxicam. Discuss with your doctor if any of these side-effects last for a long time or are severe:
Rarely, the use of Piroxicam may cause the following side-effects:
  • abnormal sensation in the body
  • anxiety
  • appetite changes
  • bluish or purple-colored patches on the skin
  • change in weight
  • decreased female fertility
  • dream abnormalities
  • drowsiness
  • dry mouth
  • fainting
  • feeling of discomfort
  • fluid retention
  • hair loss
  • hearing abnormality
  • hives
  • insomnia
  • nervousness
  • sweat
  • swollen eyes
  • tremors
  • weakness
The following severe side-effects may also occur when using Piroxicam:
  • heart disorders (possibly fatal)
    Symptoms: irregular heartbeat, worsening of chest pain (exacerbation of angina), low blood pressure, heart attack, heart failure, high blood pressure, increased heartbeat fainting
    Blood pressure should be monitored accurately during the start of Piroxicam treatment and throughout the course of treatment.
  • nervous system disorders
    Symptoms: convulsions, state of unconsciousness (coma), the perception of a nonexistent object or event inflammation of the membrane of the brain and spinal cord
  • urinary system disorders
    Symptoms: blood in the urine (hematuria) high level of potassium
  • Symptoms: high blood sugar levels low blood sugar
  • eye disorders
    Symptoms: blurred vision
  • digestive system disorders
    Symptoms: abnormally low body weight, constipation, diarrhea, vomiting, inflammation of the esophagus, inflammation of the stomach, inflammation of the liver, yellow discoloration of the skin, rectal bleeding, inflammation of the lining of the digestive system (Crohn's disease), stomach and intestinal bleeding vomiting of blood
    Use of Piroxicam should be discontinued in such conditions.
  • Symptoms: deficiency of red blood cells (anemia), increased bleeding time, collection of blood under the tissue, increased number of eosinophils, nosebleed, decrease in the number of leukocytes, red or purple discolored spots on the skin, tiny purple, red, or brown spots on the skin, abnormally low levels of thrombocytes, lowered white blood cell, premature destruction of erythrocytes, body stops producing enough red blood cells, disease of the lymph nodes, decreased number of red blood cells, white blood cells and platelets
    Discontinue the use of Piroxicam in such conditions.
  • skin disorders (possibly fatal)
    Symptoms: swelling of the lower layer of skin, allergic skin disorder, sun allergy rash
  • Symptoms: narrowing of airways of the lungs (asthma), shortness of breath (dyspnea), slow and ineffective breathing lung inflammation
  • kidney disorders
    Symptoms: inflammation of the kidney (glomerulonephritis), swelling in between the kidney tubules (interstitial nephritis), inflammation of the internal kidney structures (nephritic syndrome) kidney failure
Your doctor has prescribed Piroxicam because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious side-effects. This page does not list all possible side-effects of Piroxicam.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Side-effects and Allergic Reactions of Piroxicam by Severity and Frequency

Common Side-effects

Following are the common side-effects of this medicine:

Infrequent and Rare Side-effects

Following are the infrequent and rare side-effects of this medicine:

Severe Side-effects

Following are the severe side-effects of this medicine:

Side-effects in Older Adults

Following are the side-effects of this medicine in elderly patients:

Mild Allergic Reactions

Following are the symptoms of mild allergic reactions to this medicine:

Serious Allergic Reactions

Following are the symptoms of serious allergic reactions to this medicine:
Patients should be notified about the symptoms of severe skin reactions, and drug use should be discontinued at the first sign of skin rash or any other sign of allergy.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Heart-Related Effects

Patients with the known condition of heart disease or who are more prone to risk factors for heart disease are at an increased risk while using this medicine. The combined use of aspirin and other NSAIDs such as Piroxicam does increase the risk of serious stomach and intestinal events, the incidence of heart attack, and stroke. The lowest effective dose for the shortest duration should be given to the patients suffering from the risk of heart diseases. Patients should remain alert for the development of heart-related events.

High Blood Pressure

Patients taking thiazides and having the condition of high blood pressure are at increased risk when using this medicine. The use of NSAIDs such as Piroxicam can cause worsening of existing high blood pressure, even increased possibility of heart-related events and abnormalities in other therapies. Proper monitoring of blood pressure is required from the start of the medicine and throughout the treatment course.

Heart Failure and Fluid Retention

Patients with fluid retention or heart failure are at an increased risk while using this medicine. Take necessary precautions while using Piroxicam in patients with fluid retention or heart failure.

Stomach and Intestinal Disorders

Patients with the stomach and intestinal related disease, combined use of oral corticosteroids, use of alcohol, long-term use of NSAID therapy, older age, smoking, and poor health status are at greater risk when using this medicine. Use of NSAIDs including Piroxicam may lead to the severe condition of the stomach and intestinal events including bleeding, ulceration, and perforation of the stomach, small intestine or large intestine. Such patients should use the lowest dose for the shortest duration or there should be discontinuation of the use of the NSAIDs. Patients and doctors should be alert for signs of the stomach and intestinal bleeding and ulcerations during NSAID treatment and immediately start further evaluation and therapy if any serious stomach and the intestinal event is suspected.

Kidney Related Disease

Patients who are using NSAIDs for a long time, with abnormal functioning of kidney, liver dysfunction, heart failure, taking diuretics or ACE-inhibitors, and the elderly are at increased risk when using this medicine. Patients taking NSAIDs such as Piroxicam for a long time has resulted in kidney injuries and further damaging to the kidney cells. Discontinuation of NSAID therapy is recommended.

Long-Term Kidney Related Disease

Patients with long-term kidney related disease are at increased risk when using this medicine. Proper and close monitoring of the functioning of the kidneys in the patient is required if Piroxicam therapy is started.

Life-Threatening Allergic Reactions

Asthmatic patients who experience irritation and swelling in the nose with or without non-cancerous growth inside the nose or those who exhibit severe, potentially fatal constriction of bronchial muscles after taking aspirin or other NSAIDs are at an increased risk. These patients may suffer from life-threatening allergic reactions. Take immediate emergency procedures if any life-threatening allergic reactions occur.

Serious Skin Adverse Effects

Patients using NSAIDs including Piroxicam can cause serious skin adverse events which may lead to fatal conditions. Patients should be notified about the symptoms of severe skin signs, and the drug use should be discontinued at the first look of skin rash or any another sign of allergic reaction.

Other Allergic Reactions

Patients taking NSAIDs including Piroxicam can cause joint pain, severe itching, fever, fatigue, and rash including blisters in the mouth and redness or peeling of the skin.

Pregnancy

Patients who are in their late pregnancy are at higher risk when using this medicine. Patients taking NSAIDs including Piroxicam can cause premature closure of the blood vessel of the fetus. Use of Piroxicam should be avoided in late pregnancy.

Interactions with Piroxicam

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
This page does not contain all the possible interactions of Piroxicam. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Highly Protein Bound Drugs

Piroxicam may interact with Highly Protein Bound Drugs. Piroxicam is highly protein-bound, therefore, might be supposed to replace other protein-bound drugs. Doctors should carefully monitor patients for a dose change requirements when Piroxicam is used in patients who are on therapy with other highly protein-bound drugs.

Nonsteroidal Anti-Inflammatory Drugs

There may be an interaction of Piroxicam with NSAIDs (aspirin), which is used to reduce pain, fever, inflammation and prevents the blood clot formation. Use of aspirin may lead to reduced protein binding capacity of Piroxicam. Further, the levels of Piroxicam get reduced to their average values when Piroxicam is taken with aspirin. The combined use of Piroxicam and aspirin is not advisable because of the possibility for increased side effects.

Antimetabolites

Piroxicam interacts with antimetabolites (methotrexate), which is used to treat cancer. Use of Piroxicam may lead to decreased removal of methotrexate from the body. It is advised to remain cautious when using Piroxicam with methotrexate.

ACE-Inhibitors

Special instructions need to be followed while taking this medicine along with ACE-Inhibitors, which are used for the treatment of high blood pressure. NSAIDs may diminish the blood pressure lowering effect of ACE inhibitors. Patients who are elderly, on diuretic therapy, or with improper functioning of the kidney which does not filter or remove wastes properly take combine use of NSAIDs including selective COX-2 inhibitors, with ACE inhibitors, may result in degeneration of functioning of the kidney, including possible acute kidney failure. Patients should consult with their doctor before taking NSAIDs in combination with ACE-inhibitors.

Diuretics

Your doctor's guidelines may need to be followed while taking this medicine along with diuretics, which increases the production of urine. Piroxicam can reduce the levels of sodium in the blood (natriuretic effect) of furosemide and thiazides in some of the patients. This is related to the inhibition of kidney prostaglandin synthesis. During combined therapy with NSAIDs, the patient should be examined carefully for symptoms of kidney failure, as well as to confirm diuretic efficacy.

Lithium

Piroxicam may interact with lithium, which is used for the treatment of major depressive disorder. NSAIDs have produced a rise in blood lithium levels and a decrease in clearance of lithium in the blood. These effects have been associated with interference of kidney prostaglandin synthesis by the NSAID. When NSAIDs and lithium are used in combination, patients should be examined for symptoms of harmful effects of lithium.

Oral Anticoagulants

There may be an interaction of Piroxicam with oral anticoagulants (warfarin), which is used to prevent blood clot formation. When warfarin and NSAIDs are used together, they produce a risk of serious stomach and intestinal bleeding.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Piroxicam interacts with nucleoside reverse transcriptase inhibitors (zidovudine), which is used to treat HIV/AIDS. The combined use of NSAIDs with zidovudine may increase the risk of harmful conditions of blood-related disorders.

Immunosuppressants

Special instructions need to be followed while taking this medicine along with immunosuppressants (tacrolimus, ciclosporin), which are used to lower the risk of organ rejection. There is a possible increased risk of kidney damage when NSAIDs are given with tacrolimus and ciclosporin.

Antiarrhythmics

Your doctor's guidelines may need to be followed while taking this medicine along with antiarrhythmics (quinidine antibiotics), which are used to treat heart disorders. Patients taking quinolones and NSAIDs including Piroxicam may have an increased risk of repeatedly contraction and relaxation of body muscles.

Cardiac Glycosides

Piroxicam may interact with cardiac glycosides, which are used to treat conditions of heart failure and certain irregular heartbeats. Use of NSAIDs may lead to heart failure and increase the levels of cardiac glycosides in the blood.

Corticosteroids

There may be an interaction of Piroxicam with corticosteroids, which are used to provide relief from allergic conditions. There is an increased risk of stomach and intestinal ulceration or bleeding.

Chelating Agents

Piroxicam interacts with chelating agents (penicillamine), which are used in the treatment of accumulation of excessive amount of copper into the body organs (Wilson's disease). Use of Piroxicam may lead to the condition of kidney damage while using penicillamine.

Xanthine Derivatives

Special instructions need to be followed while taking this medicine along with xanthine derivatives (pentoxifylline), which is used to treat muscle pain in people with abnormal narrowing of arteries of legs, arms, and stomach. There is an increased risk of bleeding when NSAIDs such as Piroxicam is given in combination with Pentoxifylline.

Histamine H2 Receptor Antagonist

Your doctor's guidelines may need to be followed while taking this medicine along with Histamine H(2)-receptor antagonists such as cimetidine, which is used to treat heartburn and stomach ulcers. As Piroxicam is highly protein-bound drug therefore it may be supposed to replace other protein-bound drugs. Patients receiving Piroxicam and cimetidine should be monitored closely for dose change requirements.

Antiprogestogen

Piroxicam may interact with Antiprogestogen or Antiglucocorticoid such as mifepristone, which is used for the termination of early pregnancy. NSAIDs such as Piroxicam should not be used for 8-12 days after mifepristone use as NSAIDs can decrease the effect of mifepristone.

Interactions of Piroxicam by Severity

Severe

The following medicines are usually not to be taken together without consulting with your doctor or pharmacist.

Serious

The following medicines may interact when taken together and can cause harmful effects in the body. Please consult with your doctor or pharmacist before taking these medicines together.

Moderate

The following medicines may interact when taken together and can increase your risk of harmful effects. Please consult with your doctor or pharmacist before taking these medicines together.

When should Piroxicam be not used?

Allergy

Piroxicam should not be used in patients with known allergy to Piroxicam, other NSAIDs and other medicines. Patients may see an increased risk of severe skin allergies, a painless detachment of the nail, sun allergy, and hair loss. These patients may have the following symptoms if they use this medicine:

Treatment of Peri-Operative Pain

Piroxicam should not be used for the treatment of pain at the time of surgery (perioperative pain) in coronary artery bypass graft surgery.

Existing Allergic-Type Reactions

Piroxicam should not be given to patients who have difficulty in breathing, hives, or allergic-type reactions after receiving aspirin or other NSAIDs. Serious, rarely fatal, allergic-like reactions to NSAIDs including Piroxicam have been reported in such patients.

Stomach and Intestinal Disorders

Patients with an active stomach ulcer, inflammatory stomach, and intestinal disorder or stomach and intestinal bleeding should not use Piroxicam.

Existing Stomach and Intestinal Disorders

Patients with the history of stomach and intestinal ulceration, bleeding or hole should not use Piroxicam.

Combined Use With Anticoagulants

Piroxicam should not be used in combination with medicines that help prevent blood clotting.

Aspirin and Other NSAIDs

The combined use of Piroxicam with other NSAIDs, including COX-2 selective NSAIDs and aspirin should not be used. These patients may have the following symptoms if they use this medicine:
  • swelling of the lower layer of the skin and tissue
  • difficulty in breathing
  • stuffy nose
  • painless soft growths inside your nose
  • hives

Severe Heart Failure

Patients with severe heart failure should not take Piroxicam.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Piroxicam is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.
This page provides information for Piroxicam .
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