BMA Concise Guide to Medicine & Drugs

Piroxicam

Brand names Brexidol, Feldene

Used in the following combined preparations None

QUICK REFERENCE

Drug group Non-steroidal anti-inflammatory drug and drug for gout

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) that, like others in this group, reduces pain, stiffness, and inflammation. Blood levels of the drug remain high for many hours after a dose, so it needs to be taken only once daily. Piroxicam is used for osteoarthritis, rheumatoid arthritis, acute attacks of gout, and ankylosing spondylitis. It gives relief of the symptoms of arthritis, although it does not cure the disease. It is sometimes prescribed in conjunction with slow-acting drugs in rheumatoid arthritis to relieve pain and inflammation while these drugs take effect. The drug may also be given for pain relief after sports injuries, for conditions such as tendinitis and bursitis, and following minor surgery.

Piroxicam carries the highest risk of any of the NSAIDs of causing gastrointestinal side effects.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, capsules, melts, injection, gel.

Frequency and timing of doses 1–3 x daily with food or plenty of water.

Adult dosage range 10–20mg daily.

Onset of effect 3–4 hours (pain relief); full effect develops over 2–4 weeks (arthritis) or 4–5 days (gout).

Duration of action Up to 2 days. Some effect may last for 7–10 days after treatment has been stopped.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 4 hours, take a single dose now and skip the next.

Stopping the drug When taken for short-term pain relief, the drug can be safely stopped as soon as you no longer need it. If prescribed for the long-term treatment of arthritis, however, you should seek medical advice before stopping the drug.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. Large overdoses may cause nausea and vomiting. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

The most common adverse effects are gastrointestinal: heartburn, indigestion, nausea, and vomiting. Less commonly, the drug may cause headache, dizziness, drowsiness, swelling of the legs or feet, and weight gain. Discuss with your doctor if any of these are severe. If you develop a rash or itching, you should stop taking the drug and contact your doctor. If you experience wheezing or breathlessness, or have black or bloodstained faeces, stop taking the drug and consult your doctor immediately. There is also an increased risk of certain disorders with long-term use of piroxicam (see Prolonged use).

INTERACTIONS

General note Piroxicam interacts with a wide range of drugs, including other NSAIDs, corticosteroids, and oral anticoagulant drugs, to increase the risk of bleeding and/or peptic ulcers.

Lithium and methotrexate Piroxicam may raise blood levels of these drugs.

Antihypertensive drugs and diuretics The beneficial effects of these drugs may be reduced by piroxicam.

Ciprofloxacin, norfloxacin, and ofloxacin Piroxicam may increase the risk of seizures when taken with these drugs.

Ritonavir This drug increases blood levels of piroxicam.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have liver or kidney problems.

· You have heart problems or high blood pressure.

· You have had a peptic ulcer, oesophagitis, or acid indigestion.

· You have porphyria.

· You have asthma.

· You are allergic to aspirin or other NSAIDs.

· You are taking other medicines.

Pregnancy The drug may increase the risks of adverse effects on the baby’s heart and may prolong labour if taken in the third trimester. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk but at normal doses adverse effects are unlikely. Discuss with your doctor.

Infants and children Not recommended under 6 years. Reduced dose necessary.

Over 60 Increased likelihood of adverse effects. Reduced dose may therefore be necessary.

Driving and hazardous work Avoid such activities until you have learned how piroxicam affects you; the drug can cause dizziness.

Alcohol Avoid. Alcohol may increase the risk of stomach disorders with piroxicam.

Surgery and general anaesthetics Piroxicam may prolong bleeding. Discuss with your doctor or dentist before any surgery.

PROLONGED USE

There is an increased risk of bleeding from peptic ulcers and in the bowel with prolonged use of piroxicam. There is also a small risk of a heart attack or stroke. To minimize these risks, the lowest effective dose is given for the shortest duration.