ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -36 مورد

Piroxicam: Drug information

Piroxicam: Drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Piroxicam: Patient drug information" and "Piroxicam: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Cardiovascular thrombotic events:

NSAIDs cause an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI) and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.

Piroxicam is contraindicated during the perioperative setting of coronary artery bypass graft (CABG) surgery.

Gastrointestinal bleeding, ulceration, and perforation:

NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

Brand Names: US
  • Feldene [DSC]
Brand Names: Canada
  • APO-Piroxicam;
  • TEVA-Piroxicam
Pharmacologic Category
  • Analgesic, Nonopioid;
  • Nonsteroidal Anti-inflammatory Drug (NSAID), Oral
Dosing: Adult

Note: S afety: Use the lowest effective dose for the shortest duration of time. Avoid or use with caution in patients at risk for or with existing cardiovascular disease, GI disease, kidney impairment, chronic liver disease, or a bleeding diathesis due to greater risk for adverse events. Consider administering in combination with a proton pump inhibitor in patients at risk for GI bleeding (eg, taking dual antiplatelet therapy or an anticoagulant, ≥60 years of age, high doses) (Ref).

Ankylosing spondylitis

Ankylosing spondylitis (off-label use): Oral: 10 to 20 mg/day in 1 to 2 divided doses (Ref).

Osteoarthritis, rheumatoid arthritis

Osteoarthritis, rheumatoid arthritis: Oral: 20 mg once daily.

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

Mild to moderate impairment: There are no dosage adjustments provided in the manufacturer’s labeling.

Severe impairment: Use is not recommended (has not been studied); if therapy must be initiated, close monitoring is recommended.

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

Hepatic impairment prior to treatment initiation:

There are no specific dosage adjustments provided in the manufacturer’s labeling; however, a dosage reduction is recommended.

Hepatotoxicity during treatment:

Discontinue treatment if clinical signs and symptoms consistent with liver disease develop or if systemic manifestations occur.

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.

Dosing: Pediatric

(For additional information see "Piroxicam: Pediatric drug information")

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA): Limited data available: Children and Adolescents: Oral: 0.2 to 0.4 mg/kg/day once daily; maximum daily dose: 20 mg/day (Ref).

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: Pediatric

There are no pediatric-specific dosage adjustments provided in the manufacturer's labeling; some experts have suggested the following:

KDIGO 2012 guidelines provide the following recommendations for NSAIDs (KDIGO 2013): Children and Adolescents:

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: Pediatric

There are no specific dosage adjustments provided in manufacturer's labeling; however, based on experience in adult patients, dosage adjustment suggested

Adverse Reactions

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

1% to 10%:

Cardiovascular: Edema

Dermatologic: Pruritus, skin rash

Gastrointestinal: Abdominal pain, anorexia, constipation, diarrhea, flatulence, nausea, vomiting

Nervous system: Dizziness, headache, vertigo

Otic: Tinnitus

<1%:

Cardiovascular: Palpitations

Gastrointestinal: Stomatitis

Nervous system: Drowsiness

Ophthalmic: Blurred vision

Frequency not defined:

Cardiovascular: Coronary thrombosis

Gastrointestinal: Gastrointestinal inflammation

Nervous system: Cerebrovascular accident

Postmarketing:

Cardiovascular: Acute myocardial infarction, cardiac arrhythmia, exacerbation of angina pectoris, heart failure, hypertension, hypotension, syncope, tachycardia, vasculitis

Dermatologic: Alopecia, desquamation, diaphoresis, ecchymoses, erythema multiforme, erythema of skin, exfoliative dermatitis, fixed drug eruption, onycholysis, skin photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, vesiculobullous reaction

Endocrine & metabolic: Fluid retention, hyperglycemia, hyperkalemia, hypoglycemia, weight changes

Gastrointestinal: Change in appetite, dyspepsia, eructation, esophagitis, gastritis, gastrointestinal hemorrhage, gastrointestinal perforation, gastrointestinal ulcer (including duodenal ulcer, gastric ulcer), glossitis, heartburn, hematemesis, melena, pancreatitis, rectal hemorrhage, xerostomia

Genitourinary: Cystitis, dysuria, female infertility, hematuria, oliguria, polyuria, proteinuria

Hematologic & oncologic: Agranulocytosis, anemia, aplastic anemia, bruise, eosinophilia, hemolytic anemia, leukopenia, lymphadenopathy, pancytopenia, petechial rash, positive ANA titer, prolonged bleeding time, purpuric disease, thrombocytopenia

Hepatic: Hepatic failure, hepatitis, hepatotoxicity (idiosyncratic) (Chalasani 2021), increased liver enzymes, jaundice

Hypersensitivity: Anaphylaxis, angioedema, drug reaction with eosinophilia and systemic symptoms (Bizid 2014), serum sickness

Infection: Infection, sepsis

Nervous system: Abnormal dreams, akathisia, anxiety, asthenia, colic, coma, confusion, depression, hallucination, insomnia, malaise, meningitis, mood changes, nervousness, paresthesia, seizure, tremor

Ophthalmic: Conjunctivitis, swelling of eye

Otic: Auditory impairment

Renal: Altered kidney function, glomerulonephritis, interstitial nephritis, kidney failure, nephrotic syndrome

Respiratory: Asthma, dyspnea, epistaxis, flu-like symptoms, pneumonia, respiratory depression

Miscellaneous: Fever

Contraindications

Hypersensitivity (eg, anaphylactic reactions, serious skin reactions) to piroxicam or to any component of the formulation; patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other nonsteroidal anti-inflammatory drugs; in the setting of coronary artery bypass graft (CABG) surgery.

Canadian labeling: Additional contraindications (not in US labeling): Active GI bleeding or recent or recurrent history of GI bleeding; active gastric/duodenal/peptic ulcer; active GI inflammatory disease; inflammatory bowel disease; cerebrovascular bleeding or other bleeding disorders; severe liver impairment or active liver disease; severe renal impairment (CrCl <30 mL/minute) or deteriorating renal disease; known hyperkalemia; children and adolescents <16 years of age; use in the third trimester of pregnancy; breast-feeding, severe uncontrolled heart failure

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. Contraindicated use in patients who experience bronchospasm, asthma, rhinitis, or urticaria with nonsteroidal anti-inflammatory drug (NSAID) or aspirin therapy.

• Cardiovascular events: Relative risk of serious adverse cardiovascular thrombotic events appears to be similar in those with and without known cardiovascular disease or risk factors for cardiovascular disease; however, absolute incidence of cardiovascular events (which may occur early during treatment) was higher in patients with known cardiovascular disease or risk factors. New-onset hypertension or exacerbation of hypertension may occur (NSAIDs may also impair response to angiotensin-converting enzyme [ACE] inhibitors, thiazide diuretics, or loop diuretics); may contribute to cardiovascular events; monitor BP; use with caution in patients with hypertension. May cause sodium and fluid retention, use with caution in patients with edema. Avoid use in patients with heart failure when possible (Heidenreich 2022). Avoid use in patients with recent myocardial infarction (MI) unless benefits outweigh risk of cardiovascular thrombotic events. 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: 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, driving). Discontinue use with blurred or diminished vision and perform ophthalmologic exam. Periodically evaluate vision in all patients receiving long term therapy.

• 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: Avoid use in patients with active GI bleeding due to increased risk of serious GI events. In patients with a history of acute lower GI bleeding, avoid use of nonaspirin NSAIDs, especially if due to angioectasia or diverticulosis (Strate 2016). Use caution with a history of GI ulcers, concurrent therapy known to increase the risk of GI bleeding (eg, aspirin, anticoagulants and/or corticosteroids, selective serotonin reuptake inhibitors), smoking, use of alcohol, or in 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. Rare (sometimes fatal), severe hepatic reactions (eg, fulminant hepatitis, hepatic necrosis, hepatic failure) have occurred with NSAID use; discontinue if signs or symptoms of liver disease develop, if systemic manifestations occur, or with persistent or worsening abnormal hepatic function tests

• 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, ACE-inhibitors). Monitor potassium closely.

• 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, liver dysfunction, those taking diuretics, and ACE inhibitors, angiotensin II receptor blockers, and the elderly are at greater risk of renal toxicity. Rehydrate patient before starting therapy; monitor renal function closely. Long-term NSAID use may result in renal papillary necrosis

• Serum sickness: A serum sickness–like reaction can rarely occur; signs and symptoms include arthralgias, pruritus, fever, fatigue, and rash.

• Skin reactions: NSAIDs may cause serious skin adverse events (sometimes fatal), including exfoliative dermatitis, fixed drug eruption (including generalized bullous fixed drug eruption), 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:

• Asthma: Do not administer to patients with aspirin-sensitive asthma; severe bronchospasm may occur. Use caution in patients with other forms of asthma.

• Bariatric surgery: Gastric ulceration: Avoid chronic use of oral nonselective NSAIDs after bariatric surgery; development of anastomotic ulcerations/perforations may occur (Bhangu 2014; Mechanick 2020). Short-term use of celecoxib or IV ketorolac are recommended as part of a multimodal pain management strategy for postoperative pain (Chou 2016; Horsley 2019; Thorell 2016).

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

• Hepatic impairment: Use with caution in patients with decreased hepatic function.

• Hypertension: Use with caution; may cause new-onset hypertension or worsening of existing hypertension. Monitor BP closely with initiation and during piroxicam therapy.

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

Special populations:

• Poor CYP2C9 metabolizers: Use with caution; hepatic metabolism may be reduced resulting in elevated serum concentrations.

Other warnings/precautions:

• Surgical/dental procedures: Withhold for at least 4 to 6 half-lives prior to surgical or dental procedures.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Feldene: 10 mg [DSC], 20 mg [DSC]

Generic: 10 mg, 20 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsules (Piroxicam Oral)

10 mg (per each): $1.62 - $2.60

20 mg (per each): $2.59 - $4.49

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

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

Capsule, Oral:

Generic: 10 mg, 20 mg

Administration: Adult

Oral: May administer in a single daily dose or divide twice daily. May take with food or milk to decrease GI upset.

Administration: Pediatric

Oral: May administer with food or milk to decrease GI upset

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/018147s050lbl.pdf#page=21, must be dispensed with this medication.

Use: Labeled Indications

Arthritis: Relief of signs and symptoms of osteoarthritis and rheumatoid arthritis.

Use: Off-Label: Adult

Ankylosing spondylitis

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

Feldene may be confused with FLUoxetine

Piroxicam may be confused with PARoxetine

Older Adult: High-Risk Medication:

Beers Criteria: Piroxicam is identified in the Beers Criteria as a potentially inappropriate medication to be avoided for chronic use in patients 65 years and older (unless alternative agents ineffective and patient can receive concomitant gastroprotective agent) due to increased risk of GI bleeding and peptic ulcer disease in older adults in 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:

Flogene [Brazil] may be confused with Flogen brand name for naproxen [Mexico]; Florone brand name for diflorasone [Germany, Greece]; Flovent brand name for fluticasone [US, Canada]

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

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: May increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk for gastrointestinal toxicity is increased. 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

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

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

Food Interactions

Onset of effect may be delayed if piroxicam is taken with food. Management: May administer with food or milk to decrease GI upset.

Reproductive Considerations

Nonsteroidal anti-inflammatory drugs (NSAIDs) may delay or prevent rupture of ovarian follicles. This may be associated with infertility that is reversible upon discontinuation of the medication. Consider discontinuing use in patients having difficulty conceiving or those undergoing investigation of fertility.

Based on available information, NSAIDs can be continued in males with rheumatic and musculoskeletal diseases who are planning to father a child (ACR [Sammaritano 2020]).

Pregnancy Considerations

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) close to conception may 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; FDA 2020). In addition, nonclosure of the ductus arteriosus postnatally may occur and be resistant to medical management (Bermas 2014; Bloor 2013).

Maternal use of NSAIDs should be avoided beginning 20 weeks' gestation. 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). Because NSAIDs may cause premature closure of the ductus arteriosus, product labeling for piroxicam specifically states use should be avoided starting at 30 weeks' gestation.

Based on available information, NSAIDs can be continued during the first 2 trimesters of pregnancy in patients with rheumatic and musculoskeletal diseases; use in the third trimester is not recommended (ACR [Sammaritano 2020]).

Breastfeeding Considerations

Piroxicam is present in breast milk.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered compatible for the treatment of rheumatic and musculoskeletal diseases in lactating patients; agents with a short half-life and established safety data in infants may be preferred (ACR [Sammaritano 2020]).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother. Maternal use of NSAIDs should be avoided if the breastfeeding infant has platelet dysfunction, thrombocytopenia, or a ductal-dependent cardiac lesion (ABM [Martin 2018]; ABM [Reece-Stremtan 2017]; Bloor 2013).

Dietary Considerations

May be taken with food or milk to decrease GI adverse effect.

Monitoring Parameters

Occult blood loss, hemoglobin, hematocrit, electrolytes, and periodic renal and hepatic function tests; periodic ophthalmologic exams with chronic use

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 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)

Onset of action: Analgesia: Oral: Within 1 hour; Maximum effect: 3 to 5 hours

Absorption: Oral: Well absorbed

Distribution: Vd:

Children and Adolescents 7 to 16 years: 0.16 L/kg; Range: 0.12 to 0.25 L/kg (Mäkelä 1991)

Adults: 0.14 L/kg

Protein binding: 99%

Metabolism: Hepatic predominantly via CYP2C9; metabolites are inactive

Half-life elimination:

Children and Adolescents 7 to 16 years: 32.6 hours; Range: 22 to 40 hours (Mäkelä 1991)

Adults: 50 hours

Time to peak: 3 to 5 hours

Excretion: Primarily urine and feces (small amounts) as unchanged drug (5%) and metabolites

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: Effect not established; however, the drug is extensively metabolized in the liver and may require reduced doses.

CYP2C9 polymorphisms: Higher systemic exposure has been noted.

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

  • (AE) United Arab Emirates: Apo piroxicam | Feldene | Riacen | Unicam;
  • (AR) Argentina: Axis | Brionot | Fada piroxicam | Feldene | Osteocalmine | Roxicam;
  • (AT) Austria: Felden | Piroxicam arcana;
  • (AU) Australia: Candyl | Cm piroxicam | Dbl piroxicam | Feldene | Genrx piroxicam | Mobilis | Rosig | Tw piroxicam;
  • (BD) Bangladesh: Flexicam | Rheudene;
  • (BE) Belgium: Feldene | Piroxicam eurogenerics | Piroxicam merck-generics | Solicam;
  • (BF) Burkina Faso: Feldene | Vitaxicam;
  • (BG) Bulgaria: Feldene | Hotemin | Piroxicam alkaloid | Remoxicam | Sotilen;
  • (BR) Brazil: Anartrit | Anflene | Farmoxicam | Feldanax | Feldene | Feldox | Feldran | Flamadene | Flamostat | Flogene | Floxicam | Inflamene | Inflanan | Inflanox | Inflax | Lisedema | Pirfel | Piroflam | Pirogreen | Piroxan | Piroxene | Piroxiflam | Piroxil | Piroxin | Piroxinid | Piroxiplus | Reumaxican;
  • (CH) Switzerland: Felden | Piroxicam merck;
  • (CI) Côte d'Ivoire: Adco-piroxicam | Feldene | Zildam;
  • (CL) Chile: Dapase | Fabudol | Feldene | Pricam;
  • (CN) China: Ou hua ji wei;
  • (CO) Colombia: Arantil | Astroxican | Bursicam | Centrol | Dolpirox | Feldene | Fex | Flexicam | Kydoflam | Lumbaxen | Monidem | Movilil | Orfakan | Osteosan | Oxifar | Oxivate | Piroxedol | Piroxicam mk | Piroxim | Piroxinil | Proxigel | Rokso | Sindexan | Stopen | Veran D | Zyray;
  • (CZ) Czech Republic: Apo piroxicam | Arthremin | Hotemin;
  • (DE) Germany: Durapirox | Felden | Feldene | Piroflam | Piroxicam M8v | Piroxicam Stada | Piroximerck;
  • (DO) Dominican Republic: Antiflog | Bruxicam | Facicam | Feldene | Fradene | Gelprox | Icalex | Improntal | Inoxicam | Novoxicam | Piroxed | Piroxicam mk | Proxicam | Trixicam | Vitaxicam;
  • (EC) Ecuador: Artronil | Feldene | Italpyd | Piroxicam Genfar | Piroxicam mk | Piroxim | Proxigel;
  • (EE) Estonia: Erazon | Feldene | Piroxicam alpharma;
  • (EG) Egypt: Feldene | Feldoral | Inflacam | Peroxiden | Piroxam | Piroxiden | Vendocid;
  • (ES) Spain: Doblexan | Feldene | Improntal | Piroxicam pharmagenus | Piroxicam Ratiopharm | Piroxicam tamarang | Piroxicam ur | Piroxican reig | Salvacam | Sasulen | Vitaxicam;
  • (FI) Finland: Dacam | Felden | Pirom;
  • (FR) France: Feldene | Flexirox | Inflaced | Olcam | Piroxicam biogaran | Piroxicam Cristers | Piroxicam gnr | Piroxicam irex | Piroxicam ivax | Piroxicam Jumer | Piroxicam merck | Piroxicam pfizer | Piroxicam Ratiopharm | Piroxicam rpg | Piroxicam sandoz | Piroxicam Teva | Piroxicam zydus | Zofora;
  • (GB) United Kingdom: Feldene | Flamatrol | Larapam | Piroflam | Piroxicam arrow | Piroxicam berk | Piroxicam cox | Piroxicam kent | Piroxicam sandoz | Pirozip;
  • (GH) Ghana: Letacam;
  • (GR) Greece: Bleduran | Calmopyrol | Feldene | Flodeneu | Grecotens | Neo axedil | Pedifan | Proponol | Pyrcost | Ruvamed | Valopon | Zerospasm | Zitumex;
  • (HK) Hong Kong: Apo piroxicam | Axcel Piroxicam | Cp Pirox | Fedcovit | Feldene | Felticam | Felxicam | Flamic | Foldcam | Goodgen | Hotemin | Karoxicam | Mobilis | Pericam | Pirocam | Pirux | Pyrocam | Sefdene | Sotilen | Synoxicam;
  • (HR) Croatia: Erazon | Lubor;
  • (HU) Hungary: Feldene | Hotemin | Huma-pirocam | Piroxicam-b | Piroxicam-jenapharm;
  • (ID) Indonesia: Arpyrox | Benoxicam | Bitrafarm | Campain | Dains | Denicam | Emelden | Felcam | Feldco | Feldene | Indene | Infeld | Lanareuma | Licofel | Maxicam | Mepirox | Miradene | Omeretic | Pirocam | Pirodene | Pirofel | Rexicam | Rexil | Rheumaden | Rosic | Roxidene | Scandene | Sofden | Tropidene | Wiros | Xicalom;
  • (IE) Ireland: Feldene | Geroxicam | Pericam;
  • (IL) Israel: Feldene;
  • (IN) India: Amida | Brexic | Dolonex | Doloswift | Ecwin | Flexar | Mobidin | Modact | Movon | Piricam | Pirox | Prostaloc | Ranset | Roxicam | Zeepain;
  • (IQ) Iraq: Safaxicam;
  • (IT) Italy: Antiflog | Artroxicam | Bruxicam | Dexicam | Euroxi | Feldene | Flodol | Flogobene | Lampoflex | Oxicam | Piroxicam doc | Piroxicam eg | Piroxicam jet | Polipirox | Reucam | Reumagil | Riacen | Roxene | Roxenil | Roxiden | Zacam;
  • (JO) Jordan: Feldene | Orthocam | Pirox | Reucam | Roxam | Sotilen | Unicam;
  • (JP) Japan: Alvilack | Alvilack sato | Alvilack taiyo | Alvilack wakamoto | Amtenen | Arudein | Arudein choseido | Baxo | Boues isei | Boues merck hoei | Boues teisan | Feldene | Kimetagin | Kyowacalm | Lumeleem mikasa | Lumeleem takeshima | Palpasin | Piatec | Pilipo | Pilipo ohta | Pilipo teiyaku | Pioparu | Pipethanen | Pirokiparl | Pyrocarmin | Ravisulin;
  • (KE) Kenya: Caroxicam | Cupirox | Feldene | Feldoral | Pirocam | Piromed | Piroxy | Pyromax | Redene | Roxicam;
  • (KR) Korea, Republic of: Comcam | Daehwa piroxicam | Felcam | Felcicam | Feldene | Fulden | Konycam | Nalcicam | Paldon | Paxiden | Pilactam | Pilcam | Pillozen | Pirocam | Piroctam | Polten | Riopan | Rocam | Rosiden | Rotan | Talocam | Tauros | Unicam | Vicam | Yucam;
  • (KW) Kuwait: Feldene | Orthocam;
  • (LB) Lebanon: Apo piroxicam | Feldene | Piroxicalm | Riacen | Vitaxicam;
  • (LT) Lithuania: Apo piroxicam | Arthremin | Calmopyrol | Erazon | Feldene | Hotemin | Pirox;
  • (LU) Luxembourg: Feldene | Solicam;
  • (LV) Latvia: Apo piroxicam | Arthremin | Calmopyrol | Erazon | Feldene | Pirox | Piroxicam Teva;
  • (MA) Morocco: Apo-pirocam | Feldene | Oxiden | Remox | Reumoxican | Riacen | Roxam | Solicam | Zildam;
  • (MX) Mexico: Ainek | Apopiran | Arbest | Artricam | Artyflam | Asabon | Bapixied | Brexodin | Citoken | Dolzycam | Eucam | Facicam | Feldene | Flogosan | Genoldene | Laspiro | Oxicanol | Pirodax | Pirox | Piroxicam gi merck | Piroxicam gi serra | Reutricam | Ripox | Serpicam | Zuparex;
  • (MY) Malaysia: Apo piroxicam | Axcel Piroxicam | Feldene | Felxicam | Meldene | Pirodene | Pirox | Piroxica | Piroxicap | Piroxy | Rosiden | Roxicam | Roxim | Uphaxicam;
  • (NG) Nigeria: Archy arixica | Auscel piroxicam | Brawn lab piroxicam | Edm piroxicam | Educam | Emxicam | Fedigyn | Felcur | Felgin | Felmicam | Felmor | Feloxin | Felrox | Felvcard | Felxicam | Ferex | Fizycam | Gevicam | Gimbacam | Grexicam | Ibu piroxicam | Inflacam | Jessecam | Jozocam | Juroxicam | Krishat piroxicam | Kucam | Liricon piroxicam | Machdech | Mckenzie piroxicam | Mf 20 | Nelb piroxicam | Neroxicam | Nolyxicam | Odivin | Pemaxicam | Phomcam | Pirofit | Piromax | Pironet | Piroxbase | Rccam | Ricam | Samjones | Shree piroxicam | Softhealth piroxicam | Softland piroxicam | Spevin | Stacam | Ulticam | Unicure piroxicam | Vadis piroxicam | Vaxicam | Zonason piroxicam;
  • (NO) Norway: Felden;
  • (PE) Peru: Apo-piroxican | Atidem | Feldene | Ginoxicam | Movilil | Piraldene | Piroxiden;
  • (PH) Philippines: Feldene | Flaxine | Kapirox | Neperlan | Palpasin | Parixam | Piroxikin | Proximax | Troxiflam;
  • (PK) Pakistan: Aksocam | Alxicam | Axicam | Bepirox | Brexidol | Brozicam | Bruxicam | Camcard | Campro | Camtrin | Capirox | Dolonex | Ericam | Fedracam | Felaxicam | Felcam | Feldene | Feldetrol | Fesmocom | Figlex | Foster | Fycam | Gelcam | Gloxi | Jucam | Leecam | M-piro | M-Quin | Magcam | Maricam | Mcam | Medrox | Mobicam | Oram | Oricam | Oxyclod | Painflex | Paldon | Panaxy | Pcam | Phelodene | Picam | Piram | Piroc | Piropain | Piroxil | Piroxim | Piroxinor | Pixicam | Poxicam | Propain | Proxim | Pyoxil | Pyricam | Rheumaden | Riacen | Rosiden | Roxicam | Roxidin | Rumolon | Rupirox | Safoxicam | Salden | Traumalax | Tripirox;
  • (PL) Poland: Apo piroxicam | Feldene;
  • (PR) Puerto Rico: Feldene;
  • (PT) Portugal: Feldene | Flexar | Flogocan | Reumoxican | Roxazin;
  • (QA) Qatar: Apo-Piroxicam | Feldene | Feldoral;
  • (RO) Romania: Bleduran | Calmopyrol | Erazon | Feldene | Hotemin;
  • (RU) Russian Federation: Erazon | Feldene | Feldoral sedico | Hotemin | Piroxicam Akri | Piroxicam OBL | Piroxum | Unicam;
  • (SA) Saudi Arabia: Feldene | Orthocam | Unicam;
  • (SE) Sweden: Felden | Piroxicam Mylan;
  • (SG) Singapore: Apo piroxicam | Erazon | Feldene | Rosiden | Sotilen;
  • (SI) Slovenia: Erazon;
  • (SK) Slovakia: Arthremin | Hotemin | Lubor | Sotilen;
  • (SL) Sierra Leone: Relaxicam;
  • (SR) Suriname: Feldene | Felxicam;
  • (TH) Thailand: Aleesun-f | Ammidene | Anmatic | Bicam | Butacinon | Butazodin | Canpirox | Capirox | Caroxine | Cerox | Denox 101 | Dexalin | Felcam | Felcap | Feldene | Felgesic | Felicam | Felrox | Felstar | Feltadone | Felxicam | Flamic | Fulldine | Goose Solon | Heropedd | Hirox | Hita | Joint | Maczy | Manoxicam | Maswin | Maswin Forte | Maxidene | Metacap | Morox | Moxicam | Neopod | Neorox | Nitropin | Nutarzol | Nutaxol | Paxam | Pc-20 | Phardene | Pidoxam | Pidoxone | Piram | Pirax | Piraxil | Pircam | Pirock | Pirogin | Pirox | Pirox Man | Piroxal | Piroxam | Piroxan | Piroxcin | Piroxen | Piroxhim | Piroxicam forte | Piroxicam Frx | Piroxicam Stada | Piroxidon | Piroxidon F | Pox 109 | Predene | Puta Pee Dee | Pycam | Pyradxy | Pyroxy | Roxam | Roxicam | Roxican | Roxifen | Roxson | Roxycam | Roxycan t.m. | Rumaxicam | Sinocam | Sotilen | Topxicam | Verox | Xicam;
  • (TN) Tunisia: Arthrosyl | Feldene | Inflaced | Roxam;
  • (TR) Turkey: Feldoks | Inflamex | Oksikam | Piralden | Piroksan;
  • (TW) Taiwan: Apo piroxicam | Arudein | Carnet | Felcam | Feldemine | Feldene | Feldine | Felon | Felten | Feren | Focus | Foldcam | Furokan | Goodgen | Ketolin | Konshien | Lirocam | Pesugen | Picam | Pioparu | Pirocam | Pirocan | Pirocon | Pirodene | Pirogene | Pirox | Piroxim | Pitocam | Piton | Poudercam | Poudercone | Pyrocam | Reucam | Rheucam | Riacen | Semincon | Sotilen | Tecon | Toricam | Tosifen | Vitaxicam;
  • (UA) Ukraine: Erazon | Fedine | Feldene | Movon | Piricam | Pirox;
  • (UG) Uganda: Agomove | Aspyrox | Penacam | Piricam | Piro | Proxyren | Ro pericem;
  • (UY) Uruguay: Leal | Roxican;
  • (VE) Venezuela, Bolivarian Republic of: Feldene | Flamalit | Maxipiro | Pirocam | Pixorid;
  • (VN) Viet Nam: Piropharm;
  • (ZA) South Africa: Adco-piroxicam | Cpl alliance piroxicam | Merck-piroxicam | Pyrocaps | Rolab-piroxicam | Roxifen | Xycam;
  • (ZM) Zambia: Felcine | Feldene | Feloxicam | P Cam | Piricam | Pirofen | Roxitan;
  • (ZW) Zimbabwe: Adco-piroxicam | Roxicam | Roxitan
  1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
  2. Abraham NS, Hlatky MA, Antman EM, et al; ACCF/ACG/AHA. ACCF/ACG/AHA 2010 Expert Consensus Document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010;122(24):2619-2633. doi:10.1161/CIR.0b013e318202f701 [PubMed 21060077]
  3. Bermas BL. Non-steroidal anti inflammatory drugs, glucocorticoids and disease modifying anti-rheumatic drugs for the management of rheumatoid arthritis before and during pregnancy. Curr Opin Rheumatol. 2014;26(3):334-340. doi:10.1097/BOR.0000000000000054 [PubMed 24663106]
  4. Bhangu A, Singh P, Fitzgerald JE, Slesser A, Tekkis P. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg. 2014;38(9):2247-2257. doi: 10.1007/s00268-014-2531-1. [PubMed 24682313]
  5. Bhatt DL, Scheiman J, Abraham NS, et al, “ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risk of Antiplatelet Therapy and NSAID Use. A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents,” J Am Coll Cardiol, 2008, 52(18):1502-17. [PubMed 19017521]
  6. Bizid S, Haddad W, Ben Abdallah H, Ghanem M, Bouali R, Abdelli N. Severe acute hepatitis induced by a DRESS syndrome to piroxicam. Tunis Med. 2014;92(6):417. [PubMed 25741844]
  7. Bloor M, Paech M. Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation. Anesth Analg. 2013;116(5):1063-1075. doi:10.1213/ANE.0b013e31828a4b54 [PubMed 23558845]
  8. Brooks PM and Day RO, “Nonsteroidal Anti-inflammatory Drugs - Differences and Similarities,” N Engl J Med, 1991, 324(24):1716-25. [PubMed 2034249]
  9. Chalasani NP, Hayashi PH, Bonkovsky HL, et al. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109(7):950-966. [PubMed 24935270]
  10. Chalasani NP, Maddur H, Russo MW, Wong RJ, Reddy KR; Practice Parameters Committee of the American College of Gastroenterology. ACG Clinical Guideline: diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2021;116(5):878-898. doi:10.14309/ajg.0000000000001259 [PubMed 33929376]
  11. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council [published correction appears in J Pain. 2016;17(4):508-510]. J Pain. 2016;17(2):131-157. doi: 10.1016/j.jpain.2015.12.008. [PubMed 26827847]
  12. Dathe K, Hultzsch S, Pritchard LW, Schaefer C. Risk estimation of fetal adverse effects after short-term second trimester exposure to non-steroidal anti-inflammatory drugs: a literature review. Eur J Clin Pharmacol. 2019;75(10):1347-1353. doi:10.1007/s00228-019-02712-2 [PubMed 31273431]
  13. Feldene (piroxicam) [prescribing information]. New York, NY: Pfizer Labs; November 2024.
  14. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi: 10.1210/jc.2015-4061. [PubMed 26934393]
  15. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063 [PubMed 35363499]
  16. Horsley RD, Vogels ED, McField DAP, et al. Multimodal postoperative pain control is effective and reduces opioid use after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2019;29(2):394-400. doi: 10.1007/s11695-018-3526-z. [PubMed 30317488]
  17. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Inter Suppl. 2013;3:1-150.
  18. Kroon FP, van der Burg LR, Ramiro S, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis). Cochrane Database Syst Rev. 2015;(7):CD010952. doi: 10.1002/14651858.CD010952.pub2. [PubMed 26186173]
  19. Mäkelä AL, Olkkola KT, and Mattila MJ, "Steady State Pharmacokinetics of Piroxicam in Children With Rheumatic Diseases," Eur J Clin Pharmacol, 1991, 41(1):79-81. [PubMed 1782984]
  20. Martin E, Vickers B, Landau R, Reece-Stremtan S. ABM clinical protocol #28, peripartum analgesia and anesthesia for the breastfeeding mother. Breastfeed Med. 2018;13(3):164-171. doi:10.1089/bfm.2018.29087.ejm [PubMed 29595994]
  21. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16(2):175-247. doi:10.1016/j.soard.2019.10.025 [PubMed 31917200]
  22. Page J and Henry D, “Consumption of NSAIDs and the Development of Congestive Heart Failure in Elderly Patients: An Underrecognized Public Health Problem,” Arch Intern Med, 2000, 160(6):777-84. [PubMed 10737277]
  23. Piroxicam [product monograph]. Toronto, Ontario, Canada: Teva Canada Limited; July 2015.
  24. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 7th ed. Glenview, IL: American Pain Society; 2016.
  25. Reece-Stremtan S, Campos M, Kokajko L; Academy of Breastfeeding Medicine. ABM clinical protocol #15: analgesia and anesthesia for the breastfeeding other, revised 2017. Breastfeed Med. 2017;12(9):500-506. doi:10.1089/bfm.2017.29054.srt [PubMed 29624435]
  26. Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol. 2020;72(4):529‐556. doi:10.1002/art.41191 [PubMed 32090480]
  27. Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(4):459-474. doi: 10.1038/ajg.2016.41. [PubMed 26925883]
  28. Teva-Piroxicam (piroxicam) [product monograph]. Toronto, Ontario, Canada: Teva Canada Limited; August 2022.
  29. Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016;40(9):2065-2083. doi: 10.1007/s00268-016-3492-3. [PubMed 26943657]
  30. 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 October 20, 2020.
  31. Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Care Res (Hoboken). 2016;68(2):151-166. doi: 10.1002/acr.22708. [PubMed 26401907]
Topic 9781 Version 865.0