piroxicam

Piroxicam is a nonsteroidal anti-inflammatory drug (NSAID) that is used to treat fever, pain, and inflammation in the body.

As a group, NSAIDs are non-narcotic relievers of mild to moderate pain of many causes, including injury, menstrual cramps, arthritis, and other musculoskeletal conditions. Other members of this class include ibuprofen (Motrin), naproxen (Aleve), indomethacin (Indocin), nabumetone (Relafen) and several others. They work by reducing the levels of prostaglandins, chemicals that are responsible for pain, fever, and inflammation.

Piroxicam blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower concentrations of prostaglandins. As a consequence, inflammation, pain and fever are reduced. The FDA approved piroxicam in 1982.

The most common side effects of piroxicam are:

• rash,
• headaches,
• dizziness,
• drowsiness,
• abdominal pain,
• nausea,
• constipation,
• fluid retention,
• ringing in the ears, and
• photosensitivity.

NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury.

Piroxicam also may cause stomach and intestinal bleeding and ulcers. Sometimes, stomach ulceration and intestinal bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of the bleeding. People who are allergic to other NSAIDs should not use piroxicam.

NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients with preexisting impairment of kidney function or congestive heart failure, and use of NSAIDs in these patients should be done cautiously.

Individuals with asthma are more likely to experience allergic reactions to prioxicam and other NSAIDs. Fluid retention, blood clots, heart attacks, hypertension, and heart failure have also been associated with the use of NSAIDs.

The recommended dose is 20 mg once daily or 10 mg twice daily. Piroxicam should be taken with food.

Piroxicam may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.

Piroxicam may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins play a role in the regulation (reduction) of blood pressure.

Combining NSAIDs such as piroxicam with angiotensin receptor blockers (for example, valsartan [Diovan], losartan [Cozaar], irbesartan [Avapro]) or angiotensin converting enzyme ACE) inhibitors (for example, enalapril [Vasotec], captopril [Capoten]) in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.

When piroxicam is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycoside antibiotics (for example, gentamicin) the blood levels of methotrexate or aminoglycoside may increase, presumably because the elimination of methotrexate or aminoglycosides from the body is reduced. This may lead to more methotrexate- or aminoglycoside-related side effects.

Individuals taking oral blood thinners or anticoagulants, for example, warfarin, should avoid piroxicam because piroxicam also thins the blood, and excessive blood thinning may lead to bleeding.

Alcohol consumption may increase the risk of developing stomach ulcers when taking piroxicam or other NSAIDs.

Safety during pregnancy has not been established. Use in late pregnancy may cause premature closing of the ductus arteriosus in the fetus.

Piroxicam is excreted into human breast milk. Use by nursing mothers is not recommended.

What preparations of piroxicam are available?

Capsules: 10 and 20 mg

How should I store piroxicam?

Piroxicam should be stored at room temperature in a sealed container that excludes moisture.