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Tenoxicam (United States: Not available): Drug information

Tenoxicam (United States: Not available): Drug information
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For additional information see "Tenoxicam (United States: Not available): Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: Canada
  • ALTI-Tenoxicam
Pharmacologic Category
  • Analgesic, Nonopioid;
  • Nonsteroidal Anti-inflammatory Drug (NSAID), Oral
Dosing: Adult
Ankylosing spondylitis, rheumatoid arthritis, osteoarthritis, and/or extra-articular inflammation

Ankylosing spondylitis, rheumatoid arthritis, osteoarthritis, and/or extra-articular inflammation: Oral: 10 to 20 mg once daily (higher doses associated with increased risk of adverse effects and usually do not offer greater clinical benefit).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Alternatively, KDIGO 2012 guidelines provide the following recommendations for NSAIDs:

eGFR 30 to <60 mL/minute/1.73 m2: Temporarily discontinue in patients with intercurrent disease that increases risk of acute kidney injury.

eGFR <30 mL/minute/1.73 m2: Avoid use.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Dosing: Older Adult

Note: Unless alternative agents are ineffective and a gastroprotective agent can be administered, avoid short-term scheduled use in combination with corticosteroids, anticoagulants, or antiplatelet agents or chronic use with or without medications that increase risk for bleeding (Ref).

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Cardiovascular: Edema (≤1%)

Dermatologic: Pruritus (≤1%), skin rash (≤1%)

Gastrointestinal: Abdominal distress (1% to 2%), abdominal pain (≤3%), constipation (≤3%), diarrhea (≤2%), dyspepsia (≤10%), epigastric fullness (≤1%), epigastric pain (2% to 3%), flatulence (≤2%; including meteorism), heartburn (1% to 2%), nausea (2% to 7%), vomiting (≤1%)

Nervous system: Dizziness (≤3%), headache (≤4%)

<1%:

Cardiovascular: Flushing, hypertension, palpitations, tachycardia

Dermatologic: Diaphoresis, eczema, nail disease, seborrhea, skin photosensitivity, urticaria

Endocrine & metabolic: Albuminuria, increased gamma-glutamyl transferase

Gastrointestinal: Anorexia, aphthous stomatitis, dysphagia, epigastric discomfort, esophagitis, gastric hyperacidity, gastritis, gastrointestinal hemorrhage, glossitis, hematemesis, melena, peptic ulcer, reflux esophagitis, stomatitis, xerostomia

Genitourinary: Cystitis, dysuria, hematuria, urinary frequency

Hematologic & oncologic: Anemia, leukopenia, purpuric disease, thrombocytopenia

Hepatic: Abnormal liver function, hepatic coma, hepatic failure, hepatitis, increased serum alanine aminotransferase, increased serum aspartate aminotransferase, increased serum bilirubin, jaundice

Hypersensitivity: Angioedema

Nervous system: Confusion, depression, drowsiness, fatigue, insomnia, malaise, nervousness, paresis, paresthesia, vertigo

Neuromuscular & skeletal: Lower limb cramp

Ophthalmic: Abnormal lacrimation, conjunctivitis, diplopia, visual disturbance

Otic: Deafness, tinnitus

Renal: Increased blood urea nitrogen, increased serum creatinine, polyuria, renal failure syndrome, renal function abnormality

Respiratory: Bronchospasm, dyspnea, epistaxis

Miscellaneous: Fever

Frequency not defined: Endocrine & metabolic: Fluid retention

Postmarketing:

Dermatologic: Erythema multiforme, exfoliative dermatitis, Stevens Johnson syndrome, toxic epidermal necrolysis

Gastrointestinal: Gastrointestinal perforation

Genitourinary: Nephrotic syndrome, proteinuria

Immunologic: Drug reaction with eosinophilia systemic symptoms (Santiago 2010)

Ophthalmic: Blurred vision

Renal: Acute interstitial nephritis

Contraindications

Hypersensitivity to tenoxicam or any component of the formulation; patients who have experienced asthma, urticaria, rhinitis or other allergic-type reactions after taking aspirin or other NSAIDs; active peptic ulcer or active GI inflammatory diseases; preoperative/preanesthesia use in the elderly or in patients at increased risk of renal failure or increased risk of bleeding; third trimester of pregnancy.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactoid reactions: Even in patients without prior exposure anaphylactoid reactions may occur; patients with "aspirin triad" (bronchial asthma, aspirin intolerance, rhinitis) may be at increased risk. Do not use in patients who experience bronchospasm, asthma, rhinitis, or urticaria with nonsteroidal anti-inflammatory drug (NSAID) or aspirin therapy.

• Cardiovascular events: NSAIDs cause an increased risk of serious (and potentially fatal) adverse cardiovascular thrombotic events, including myocardial infarction (MI) and stroke. Risk may occur early during treatment and may increase with duration of use. Relative risk appears to be similar in those with and without known cardiovascular disease or risk factors for cardiovascular disease; however, absolute incidence of serious cardiovascular thrombotic events (which may occur early during treatment) was higher in patients with known cardiovascular disease or risk factors and in those receiving higher doses. Use caution in patients with hypertension or conditions predisposing to fluid retention. Avoid use in heart failure (FDA 2015). Use the lowest effective dose for the shortest duration of time, consistent with individual patient goals, to reduce risk of cardiovascular events; alternate therapies should be considered for patients at high risk.

• CNS effects: NSAIDs may cause drowsiness, dizziness, blurred vision, and other neurologic effects that may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving).

• Drug reaction with eosinophilia and systemic symptoms: Potentially serious, sometimes fatal, drug reaction with eosinophilia and systemic symptoms (DRESS), also known as multiorgan hypersensitivity reactions, has been reported with NSAIDs. Monitor for signs and symptoms (eg, fever, rash, lymphadenopathy, eosinophilia) in association with other organ system involvement (eg, hepatitis, nephritis, hematological abnormalities, myocarditis, myositis). Early symptoms of hypersensitivity reaction (eg, lymphadenopathy, fever) may occur without rash; discontinue therapy and further evaluate if DRESS is suspected.

• GI events: [Canadian Boxed Warning]: NSAIDs cause an increased risk of serious GI inflammation, ulceration, bleeding, and perforation (may be fatal); instruct patients to contact health care provider if signs and symptoms of peptic ulceration or GI bleeding occur. These events may occur at any time during therapy and without warning. Use is contraindicated in patients with active peptic ulcer or active GI inflammatory disease. Use caution in patients with a history of GI disease (bleeding or ulcers, melena, ulcerative colitis, Crohn disease), concurrent therapy with aspirin, anticoagulants and/or corticosteroids, smoking, use of alcohol, the elderly or debilitated patients. Use the lowest effective dose for the shortest duration of time, consistent with individual patient goals, to reduce risk of GI adverse events; alternate therapies should be considered for patients at high risk. When used concomitantly with aspirin, a substantial increase in the risk of GI complications (eg, ulcer) occurs; concomitant gastroprotective therapy (eg, proton pump inhibitors) is recommended (Bhatt 2008).

• Hematologic effects: Platelet adhesion and aggregation may be decreased; may prolong bleeding time; patients with coagulation disorders or who are receiving anticoagulants should be monitored closely. Anemia may occur; patients on long-term NSAID therapy should be monitored for anemia. Rarely, NSAID use has been associated with potentially severe blood dyscrasias (eg, agranulocytosis, thrombocytopenia, aplastic anemia).

• Hepatic effects: Transaminase elevations have been reported with use; closely monitor patients with any abnormal liver function test. Rare (sometimes fatal) severe reactions (eg, hepatitis, jaundice, hepatic failure) have occurred with NSAID use. Discontinue immediately if signs or symptoms of hepatic disease develop or if systemic manifestations occur.

• Hyperkalemia: NSAID use may increase the risk of hyperkalemia, particularly in the elderly, diabetics, renal disease, and with concomitant use of other agents capable of inducing hyperkalemia (eg, angiotensin-converting enzyme inhibitors, beta-blockers, some diuretics). Monitor potassium closely.

• Ophthalmic events: Blurred/diminished vision has been reported; discontinue therapy and refer for ophthalmologic evaluation if symptoms occur.

• Renal effects: NSAID use may compromise existing renal function; dose-dependent decreases in prostaglandin synthesis may result from NSAID use, reducing renal blood flow, which may cause renal decompensation. Patients with impaired renal function, dehydration, hypovolemia, heart failure, hepatic impairment, those taking diuretics and ACE inhibitors, and patients ≥65 years of age are at greater risk of renal toxicity. Rehydrate patient before starting therapy. Long-term NSAID use may result in renal papillary necrosis and other renal injury.

• Skin reactions: NSAIDs may cause potentially fatal serious skin adverse events, including erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis; may occur without warning; discontinue use at first sign of skin rash (or any other hypersensitivity).

Disease-related concerns:

• Aseptic meningitis: NSAIDs may increase risk of aseptic meningitis; use caution in patients with hematopoietic disorders, systemic lupus erythematosus, or mixed connective tissue disease (Hoppmann 1991).

• Asthma: Contraindicated in patients with aspirin-sensitive asthma; severe bronchospasm may occur. Use caution in patients with other forms of asthma.

• Coronary artery bypass graft surgery: Risk of MI and stroke may be increased with NSAID use following CABG surgery.

• Hepatic impairment: Use with caution in patients with hepatic impairment; patients with advanced hepatic disease are at an increased risk of GI bleeding with NSAIDs.

• Renal impairment: Avoid NSAID use in patients with advanced renal disease; discontinue use with persistent or worsening abnormal renal function tests.

Special populations:

• Older adult/debilitated patients: Use with caution in older adult/debilitated patients.

Other warnings/precautions:

• Surgical/dental procedures: Some experts recommend withholding NSAID therapy for at least ~5 half-lives prior to surgical or dental procedures (Douketis 2008).

Product Availability

Not available in the United States.

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 20 mg

Administration: Adult

Oral: Administer with or after a meal, preferably at the same time each day.

Use: Labeled Indications

Note: Not approved in the United States.

Ankylosing spondylitis: Symptomatic treatment of ankylosing spondylitis

Extra-articular inflammation: Symptomatic treatment of extra-articular inflammation (eg tendinopathy, bursitis and periarthritis of the shoulders or hips)

Osteoarthritis: Symptomatic treatment of osteoarthritis (OA)

Rheumatoid arthritis: Symptomatic treatment of rheumatoid arthritis (RA)

Medication Safety Issues
Sound-alike/look-alike issues:

Tenoxicam may be confused with tamoxifen

Older Adult: High-Risk Medication:

Beers Criteria: Based on pharmacologic class concerns for Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in the Beers Criteria, tenoxicam may be a potentially inappropriate medication to be avoided in patients 65 years and older (unless alternative agents are ineffective and patient can receive concomitant gastroprotective agent) due to increased risk of GI bleeding and peptic ulcer disease in older adults in a high-risk category (eg, older than 75 years of age or receiving concomitant oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents). In addition, avoid for short-term scheduled use in combination with oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents unless alternatives are ineffective and patient can receive concomitant gastroprotective agent (Beers Criteria [AGS 2023]).

International issues:

Tenocam [BR, TH] brand name for Tenoxicam may be confused with Tenocor [TH] brand name for Atenolol; Tenoclor [BD] brand name for Atenolol and Chlorthalidone

Metabolism/Transport Effects

Substrate of CYP2C9 (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of 5-Aminosalicylic Acid Derivatives. Risk C: Monitor

Abciximab: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Abrocitinib: Agents with Antiplatelet Effects may increase antiplatelet effects of Abrocitinib. Risk X: Avoid

Acalabrutinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Acemetacin: May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid

Alcohol (Ethyl): May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. Risk C: Monitor

Aliskiren: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Aliskiren. Risk C: Monitor

Aminoglycosides: Nonsteroidal Anti-Inflammatory Agents may decrease excretion of Aminoglycosides. Data only in premature infants. Risk C: Monitor

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Anagrelide: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Angiotensin II Receptor Blockers: Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Angiotensin II Receptor Blockers may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Angiotensin-Converting Enzyme Inhibitors. Angiotensin-Converting Enzyme Inhibitors may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Risk C: Monitor

Anticoagulants (Miscellaneous Agents): Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Anticoagulants (Miscellaneous Agents). Risk C: Monitor

Antiplatelet Agents (P2Y12 Inhibitors): Agents with Antiplatelet Effects may increase antiplatelet effects of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor

Aspirin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may decrease therapeutic effects of Aspirin. Aspirin may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Specifically, the risk for bleeding may be increased. Aspirin may decrease serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Management: In general, avoid regular, frequent use of NSAIDs with aspirin whenever possible. If combined, monitor for increased bleeding and a reduced cardioprotective effect of aspirin. Risk D: Consider Therapy Modification

Bemiparin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Bemiparin. Management: Avoid this combination if possible, due to an increased risk of bleeding. If coadministration cannot be avoided, monitor patients closely for clinical and laboratory evidence of bleeding. Risk D: Consider Therapy Modification

Beta-Blockers: Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Beta-Blockers. Risk C: Monitor

Bile Acid Sequestrants: May decrease absorption of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Bisphosphonate Derivatives: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern. Risk C: Monitor

Caplacizumab: Agents with Antiplatelet Effects may increase adverse/toxic effects of Caplacizumab. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Cardiac Glycosides: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Cardiac Glycosides. Risk C: Monitor

Collagenase (Systemic): Agents with Antiplatelet Effects may increase adverse/toxic effects of Collagenase (Systemic). Specifically, the risk of injection site bruising and or bleeding may be increased. Risk C: Monitor

Corticosteroids (Systemic): May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor

CycloSPORINE (Systemic): Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of CycloSPORINE (Systemic). Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase serum concentration of Nonsteroidal Anti-Inflammatory Agents. Management: Consider alternatives to nonsteroidal anti-inflammatory agents (NSAIDs). Monitor for evidence of nephrotoxicity, as well as increased serum cyclosporine concentrations and systemic effects (eg, hypertension) during concomitant therapy with NSAIDs. Risk D: Consider Therapy Modification

Dasatinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Deferasirox: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor

Deoxycholic Acid: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Desirudin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Desirudin. Risk C: Monitor

Desmopressin: Nonsteroidal Anti-Inflammatory Agents may increase hyponatremic effects of Desmopressin. Risk C: Monitor

Direct Oral Anticoagulants (DOACs): Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Direct Oral Anticoagulants (DOACs). Risk C: Monitor

Drospirenone-Containing Products: May increase hyperkalemic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Enoxaparin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Enoxaparin. Management: Discontinue nonselective NSAIDs prior to initiation of enoxaparin whenever possible. If coadministration cannot be avoided, monitor patients closely for clinical and laboratory evidence of bleeding. Risk D: Consider Therapy Modification

Eplerenone: Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may increase hyperkalemic effects of Eplerenone. Risk C: Monitor

Fondaparinux: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Fondaparinux. Management: Discontinue nonselective nonsteroidal anti-inflammatory agents prior to the initiation of fondaparinux, if possible. If coadministration is required, monitor patients closely for signs and symptoms of bleeding. Risk D: Consider Therapy Modification

Glycoprotein IIb/IIIa Inhibitors: Agents with Antiplatelet Effects may increase antiplatelet effects of Glycoprotein IIb/IIIa Inhibitors. Risk C: Monitor

Heparin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Heparin. Risk C: Monitor

Heparins (Low Molecular Weight): Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Heparins (Low Molecular Weight). Risk C: Monitor

Herbal Products with Anticoagulant/Antiplatelet Effects: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

HydrALAZINE: Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of HydrALAZINE. Risk C: Monitor

Ibritumomab Tiuxetan: Agents with Antiplatelet Effects may increase antiplatelet effects of Ibritumomab Tiuxetan. Risk C: Monitor

Ibrutinib: Agents with Antiplatelet Effects may increase adverse/toxic effects of Ibrutinib. Specifically, the risk of bleeding and hemorrhage may be increased. Risk C: Monitor

Inotersen: Agents with Antiplatelet Effects may increase adverse/toxic effects of Inotersen. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Ketorolac (Nasal): May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid

Ketorolac (Systemic): Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Ketorolac (Systemic). Risk X: Avoid

Limaprost: May increase adverse/toxic effects of Agents with Antiplatelet Effects. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Lithium: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Lithium. Management: Consider reducing the lithium dose when initiating a NSAID. Monitor for increased lithium therapeutic/toxic effects if a NSAID is initiated/dose increased, or decreased effects if a NSAID is discontinued/dose decreased. Risk D: Consider Therapy Modification

Loop Diuretics: Nonsteroidal Anti-Inflammatory Agents may decrease diuretic effects of Loop Diuretics. Loop Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. Risk D: Consider Therapy Modification

Macimorelin: Coadministration of Nonsteroidal Anti-Inflammatory Agents and Macimorelin may alter diagnostic results. Risk X: Avoid

MetFORMIN: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of MetFORMIN. Risk C: Monitor

Methotrexate: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Methotrexate. Management: Avoid coadministration of higher dose methotrexate (such as that used for the treatment of oncologic conditions) and NSAIDs. Use caution if coadministering lower dose methotrexate and NSAIDs. Risk D: Consider Therapy Modification

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methoxyflurane: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Methoxyflurane. Risk X: Avoid

Mifamurtide: Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Mifamurtide. Risk X: Avoid

MiFEPRIStone: Tenoxicam may decrease therapeutic effects of MiFEPRIStone. Risk C: Monitor

Miscellaneous Antiplatelets: Agents with Antiplatelet Effects may increase antiplatelet effects of Miscellaneous Antiplatelets. Risk C: Monitor

Nadroparin: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Nadroparin. Management: Coadministration of NSAIDs and nadroparin is not recommended due to an increased risk of bleeding. If coadministration is required, monitor patients closely for clinical and laboratory signs of bleeding. Risk D: Consider Therapy Modification

Naftazone: May increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): Nonsteroidal Anti-Inflammatory Agents (Topical) may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of gastrointestinal (GI) toxicity is increased. Management: Coadministration of systemic nonsteroidal anti-inflammatory drugs (NSAIDs) and topical NSAIDs is not recommended. If systemic NSAIDs and topical NSAIDs, ensure the benefits outweigh the risks and monitor for increased NSAID toxicities. Risk D: Consider Therapy Modification

Nonsteroidal Anti-Inflammatory Agents: Tenoxicam may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid

Obinutuzumab: Agents with Antiplatelet Effects may increase adverse/toxic effects of Obinutuzumab. Specifically, the risk of bleeding may be increased. Management: Consider avoiding coadministration of obinutuzumab and agents with antiplatelet effects, especially during the first cycle of obinutuzumab therapy. Risk D: Consider Therapy Modification

Omacetaxine: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Risk C: Monitor

Pentosan Polysulfate Sodium: Agents with Antiplatelet Effects may increase adverse/toxic effects of Pentosan Polysulfate Sodium. Specifically, the risk of hemorrhage may be increased. Risk C: Monitor

Phenylbutazone: May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid

Pirtobrutinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Potassium Salts: Nonsteroidal Anti-Inflammatory Agents may increase hyperkalemic effects of Potassium Salts. Risk C: Monitor

Potassium-Sparing Diuretics: Nonsteroidal Anti-Inflammatory Agents may increase hyperkalemic effects of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Potassium-Sparing Diuretics. Risk C: Monitor

PRALAtrexate: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Avoid coadministration of pralatrexate with nonsteroidal anti-inflammatory drugs (NSAIDs). If coadministration cannot be avoided, closely monitor for increased pralatrexate serum levels or toxicity. Risk D: Consider Therapy Modification

Probenecid: May increase serum concentration of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Prostaglandins (Ophthalmic): Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic). Risk C: Monitor

Quinolones: Nonsteroidal Anti-Inflammatory Agents may increase neuroexcitatory and/or seizure-potentiating effects of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Quinolones. Risk C: Monitor

Salicylates: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase adverse/toxic effects of Salicylates. An increased risk of bleeding may be associated with use of this combination. Risk X: Avoid

Selective Serotonin Reuptake Inhibitor: May increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may decrease therapeutic effects of Selective Serotonin Reuptake Inhibitor. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk. Risk D: Consider Therapy Modification

Selumetinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Serotonin/Norepinephrine Reuptake Inhibitor: May increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor

Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider Therapy Modification

Sodium Phosphates: May increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Sulprostone: Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Sulprostone. Risk X: Avoid

Tacrolimus (Systemic): Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Tacrolimus (Systemic). Risk C: Monitor

Tenofovir Products: Nonsteroidal Anti-Inflammatory Agents may increase nephrotoxic effects of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose due to a potential risk of acute renal failure. Diclofenac appears to confer the most risk. Risk D: Consider Therapy Modification

Thiazide and Thiazide-Like Diuretics: Nonsteroidal Anti-Inflammatory Agents may decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Thrombolytic Agents: Agents with Antiplatelet Effects may increase adverse/toxic effects of Thrombolytic Agents. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Tipranavir: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Tolperisone: Nonsteroidal Anti-Inflammatory Agents may increase adverse/toxic effects of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may increase therapeutic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Tricyclic Antidepressants: May increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents. Tricyclic Antidepressants may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of major adverse cardiac events (MACE), hemorrhagic stroke, ischemic stroke, and heart failure may be increased. Risk C: Monitor

Vancomycin: Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Vancomycin. Risk C: Monitor

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Vitamin E (Systemic): May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Vitamin K Antagonists: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may increase anticoagulant effects of Vitamin K Antagonists. Management: Consider alternatives to this combination when possible. If the combination must be used, monitor coagulation status closely and advise patients to promptly report any evidence of bleeding or bruising. Risk D: Consider Therapy Modification

Volanesorsen: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Zanubrutinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Zidovudine: Tenoxicam may increase adverse/toxic effects of Zidovudine. Risk C: Monitor

Reproductive Considerations

The chronic use of NSAIDs in patients who can become pregnant may be associated with infertility that is reversible upon discontinuation of the medication (Micu 2011).

Pregnancy Considerations

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) close to conception may possibly be associated with an increased risk of miscarriage due to cyclooxygenase-2 inhibition interfering with implantation (Bermas 2014; Bloor 2013).

Birth defects have been observed following in utero NSAID exposure in some studies; however, data are conflicting (Bloor 2013). Nonteratogenic effects, including prenatal constriction of the ductus arteriosus, persistent pulmonary hypertension of the newborn, oligohydramnios, necrotizing enterocolitis, renal dysfunction or failure, and intracranial hemorrhage, have been observed in the fetus/neonate following in utero NSAID exposure (Bermas 2014; Bloor 2013). Maternal NSAID use may cause fetal renal dysfunction leading to oligohydramnios. Although rare, this may occur as early as 20 weeks' gestation and is more likely to occur with prolonged maternal use. Oligohydramnios may be reversible following discontinuation of the NSAID (Dathe 2019). In addition, nonclosure of the ductus arteriosus postnatally may occur and be resistant to medical management (Bermas 2014; Bloor 2013).

[Canadian Boxed Warning]: Caution should be exercised in prescribing tenoxicam during the first and second trimesters of pregnancy. Use of NSAIDs at ~20 weeks' gestation or later may cause fetal renal dysfunction leading to oligohydramnios and neonatal renal impairment or failure. Tenoxicam is contraindicated for use during the third trimester because of risk of premature closure of the ductus arteriosus and uterine inertia (prolonged parturition ).

If NSAID use is necessary between 20 and 30 weeks' gestation, limit use to the lowest effective dose and shortest duration possible; consider ultrasound monitoring of amniotic fluid if treatment extends beyond 48 hours, and discontinue the NSAID if oligohydramnios is found (FDA 2020).

Breastfeeding Considerations

Breastfeeding is not recommended by manufacturer.

Monitoring Parameters

CBC, serum electrolytes, kidney and liver function tests (periodically); occult blood loss; BP; ophthalmic exams with prolonged therapy; observe for bleeding, bruising; evaluate GI effects (abdominal pain, bleeding, dyspepsia).

Mechanism of Action

Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors; has antipyretic, analgesic, and anti-inflammatory properties

Other proposed mechanisms for NSAIDs not fully elucidated (and possibly contributing to the anti-inflammatory effect to varying degrees), include inhibiting chemotaxis, altering lymphocyte activity, inhibiting neutrophil aggregation/activation, and decreasing proinflammatory cytokine levels.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Oral: Rapid and complete; delayed with food

Distribution: ~9.7 L (Francis 1987)

Protein binding: 98% to 99%

Metabolism: Hepatic

Bioavailability: Oral: ~100%

Half-life elimination: 72 hours (± 28 hours)

Time to peak, serum: 0.5 to 6 hours (median: 1.25 hours)

Excretion: Urine (primary route; mainly as metabolite); feces

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Tilcotil;
  • (AR) Argentina: Mefenix;
  • (AT) Austria: Tilcotil;
  • (AU) Australia: Tilcotil;
  • (BD) Bangladesh: Enocam | Inoten | Mobicam | Oxiflam | Raditil | Tenoflex | Tenopain | Tenorix | Tenoxim | Texicam | Tilcotil | Tilkotil | Xicotil | Xten;
  • (BE) Belgium: Tilcotil;
  • (BG) Bulgaria: Tilcotil;
  • (BR) Brazil: Infexican | Inflagel | Reumotec | Teflan | Tenobio | Tenocam | Tenotec | Tenoxen | Tenoxican | Tenoxil | Tilatil | Tilonax | Tiloxican | Tiloxineo | Titenil;
  • (CH) Switzerland: Tilcotil;
  • (CL) Chile: Bioflam | Desinflam | Efexicam | Felis | Mitrotil | Tilcotil | Zolimin;
  • (CO) Colombia: Artricam | Dialit | Glofen | Movilil | Movinox | Rodix | Strofen | Tenoxicam mk | Texocam | Tilcotil | Zolimin;
  • (CZ) Czech Republic: Dolmen | Tilcotil;
  • (DE) Germany: Liman | Tilcotil;
  • (DO) Dominican Republic: Bioflan | Tenoxil | Texocam | Tilcotil;
  • (EC) Ecuador: Modutrol | Tefarel | Tenoxican | Tilcotil;
  • (EG) Egypt: Anoxicam | Epicotil | Soral | Tenoxil;
  • (ES) Spain: Artriunic | Reutenox | Tilcotil;
  • (FI) Finland: Tilcotil;
  • (FR) France: Tilcotil;
  • (GB) United Kingdom: Tenoxicam kent | Tenoxicam sandoz;
  • (GR) Greece: Algin vek | Amcinafal | Artroxicam | Docticam | Dranat | Hobaticam | Indobros | Istotosal | Neo adlibamin | Neo antiperstam | Neo endusix | Oxytel | Portonal | Redac | Tentepanil | Tilcitin | Toscacalm | Voir | Zibelant;
  • (HK) Hong Kong: Tilcotil | Xotilon;
  • (HU) Hungary: Tilcotil | Tilcotil roche;
  • (ID) Indonesia: Artricom | Meditil | Notritis | Oxaflam | Pilopil | Thenil | Tilcotil | Tilflam | Xotilon;
  • (IN) India: Novotil | Tobitil;
  • (IT) Italy: Bart | Dolmen | Rexalgan | Tilcotil;
  • (JO) Jordan: Tilcotil;
  • (JP) Japan: Cobacotil | Gescolilu | Ruconart Choseido | Rucornart | Rucornart choseido | Tilcotil | Tiltria | Tipuracon;
  • (KR) Korea, Republic of: Gesicam | Ildong tenoxicam | Mobilex | Paumin | Saipen | Telcamin | Tenocam | Tenoxicam i.d | Tilcam | Tilcotil;
  • (KW) Kuwait: Epicotil | Tilcotil;
  • (LB) Lebanon: Reutenox | Soral | Tilcotil;
  • (LT) Lithuania: Tilcotil;
  • (LU) Luxembourg: Tilcotil;
  • (MA) Morocco: Tilcotil;
  • (MX) Mexico: Tilcotil;
  • (MY) Malaysia: Analcam | Nadamen | Seftil | Sinoral | Tilcotil | Tilnoxcam;
  • (NL) Netherlands: Tilcotil;
  • (NZ) New Zealand: Reutenox | Tilcotil;
  • (PE) Peru: Artrilase | Tenoxicam genfar | Tilcotil;
  • (PH) Philippines: Rheuflex | Tilcotil | Tobiflex;
  • (PK) Pakistan: Fenkil | Neo endusix | Orthocam | Paumin | Senoxi | Sinoral | Teflan | Tenoxam | Tilcotil | Tobitil;
  • (PT) Portugal: Bioreucam | Calibral | Doxican | Tenalgin | Tilcotil;
  • (QA) Qatar: Apo-Tenoxicam | Epicotil | Mobiflex | Tenocam | Tenox JPM | Tilko;
  • (RU) Russian Federation: Artoxan | Teksamen | Texared;
  • (SA) Saudi Arabia: Apo-tenoxicam | Tilcotil;
  • (SE) Sweden: Alganex;
  • (SG) Singapore: Tilcotil;
  • (TH) Thailand: Memzotil | Nadamen | Seftil | Sinoral | Tenax | Tenogesic | Tenosic | Tenox | Tenoxcam | Tenoxil | Tenoxstar | Tensocam | Tenxanac | Tenxil | Tilcotil | Tilnoxcam | Tonox;
  • (TN) Tunisia: Tilcotil;
  • (TR) Turkey: Arcotil | Oksamen | Oksamen l | Ticoten | Tilcotil | Trocmetam | Vienoks;
  • (TW) Taiwan: Sutondin | Tencam | Tilcotil;
  • (UA) Ukraine: Artoxan | Oxiliten | Tenoliof | Tilcotil;
  • (UG) Uganda: Epicotil;
  • (UY) Uruguay: Rapicalm | Tenoxene | Tilcotil;
  • (VE) Venezuela, Bolivarian Republic of: Rodix | Tecam | Tenoxin | Tilcotil;
  • (VN) Viet Nam: Katecid | Tenotil;
  • (ZA) South Africa: Tilcotil | Tobitil
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  9. Kidney Disease: Improving global outcomes (KDIGO) CKD work group, KDIGO 2012 clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney Inter, Suppl, 2013, 3:1-150.
  10. Micu MC, Micu R, Ostensen M. Luteinized unruptured follicle syndrome increased by inactive disease and selective cyclooxygenase 2 inhibitors in women with inflammatory arthropathies. Arthritis Care Res (Hoboken). 2011;63(9):1334-1338. [PubMed 21618455]
  11. Santiago F, Gonçalo M, Vieira R, Coelho S, Figueiredo A. Epicutaneous patch testing in drug hypersensitivity syndrome (DRESS). Contact Dermatitis. 2010;62(1):47-53. doi:10.1111/j.1600-0536.2009.01659.x [PubMed 20136879]
  12. Tenoxicam tablet [product monograph]. Toronto, Ontario, Canada: Apotex Inc; September 2021.
  13. US Food and Drug Administration (FDA) Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory.
  14. US Food and Drug Administration (FDA). FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid. https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic. Published October 15, 2020. Accessed December 1, 2021
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