How does this medication work? What will it do for me?

Piroxicam belongs to the group of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). It is used to relieve the symptoms of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis (a condition associated with inflammation of the joints in the spine and between the spine and pelvis).

Piroxicam relieves pain and reduces swelling and inflammation by reducing a substance in the body that leads to inflammation and pain. Piroxicam will not cure your condition or prevent it from getting worse.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are using this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Capsule

10 mg
Each hard gelatin capsule with deep powder blue opaque body, imprinted with "PIROXICAM 10" and maroon opaque cap imprinted with the Pharmascience "P" logo, contains piroxicam 10 mg. Nonmedicinal ingredients: corn starch, D&C Red No. 28, FD&C Blue No. 1, FD&C Red No. 40, gelatin, lactose, magnesium stearate, sodium lauryl sulphate, and titanium dioxide.

20 mg
Each hard gelatin capsule with maroon opaque body, imprinted with "PIROXICAM 20" and maroon opaque cap imprinted with the Pharmascience "P" logo, contains piroxicam 20 mg. Nonmedicinal ingredients: corn starch, D&C Red No. 28, FD&C Blue No. 1, FD&C Red No. 40, gelatin, lactose, magnesium stearate, sodium lauryl sulphate, and titanium dioxide.

Suppository

10 mg
Each white-to-off-white cone-shaped suppository contains piroxicam 20 mg. Nonmedicinal ingredients: microcrystalline wax, propyl gallate, and suppocire.

20 mg
Each white-to-off-white cone-shaped suppository contains piroxicam 20 mg. Nonmedicinal ingredients: microcrystalline wax, propyl gallate, and suppocire.

How should I use this medication?

The recommended dose of piroxicam ranges from 10 mg to 20 mg daily, depending on needs and circumstances. A dose of 20 mg can be taken as either 20 mg once daily or 10 mg twice daily. Take this medication immediately after food, or with food or milk to avoid stomach upset. The usual maximum daily dose is 20 mg. Piroxicam suppositories are also an alternative. The lowest dose needed for the shortest possible duration of treatment should be used.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose and are taking piroxicam once a day, take it within 8 hours of your usual dose time and continue with your regular schedule. If you have missed your dose by more than 8 hours, skip the missed dose and continue with your regular dosing schedule. If you miss a dose and are taking piroxicam twice a day, take it within 2 hours of your usual dose time and continue with your regular schedule. If you have missed your dose by more than 2 hours, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you:

  • are or may be allergic to piroxicam or any ingredients of this medication
  • are allergic to ASA or other NSAIDs (e.g., ibuprofen, ketorolac, diclofenac) or have had allergic symptoms (e.g., runny nose; asthma; itchy skin rash; nasal polyps; swelling of the face, throat or tongue) caused by these medications
  • are breast-feeding
  • are in the third trimester (last 3 months) of pregnancy
  • have a bleeding disorder
  • have an inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease)
  • have an ulcer or bleeding in the stomach or intestines
  • have bleeding in the brain
  • have had recent or are going to have heart bypass surgery
  • have high blood potassium
  • have liver disease or severely reduced liver function
  • have severe uncontrolled heart failure
  • have severely reduced or worsening kidney function

Do not give this medication to children and adolescents under 16 years of age, or let them use it.

Do not use the suppository form of this medication if you have inflammation or recent bleeding from the anus or rectum.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal or stomach cramps, pain, or discomfort (mild to moderate)
  • drowsiness
  • fatigue
  • heartburn or indigestion
  • nausea
  • sun sensitivity

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • bleeding from rectum (with suppositories)
  • confusion
  • difficulty hearing
  • dizziness or lightheadedness
  • flu-like symptoms (e.g., achiness, chills, fever)
  • headache and stiff neck
  • heartburn (persistent)
  • increased sensitivity of skin to sunlight
  • rectal irritation (with suppositories)
  • signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • skin rash
  • sores or ulcers in mouth
  • swelling of feet, lower legs, arms, and hands
  • urinating problems (e.g., bladder pain, painful urination, frequent urination)
  • vomiting or persistent nausea, stomach pain, or diarrhea

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • blurred vision or any visual disturbance
  • change in the amount or colour of urine
  • signs of aseptic meningitis (e.g., stiff neck, severe headache, nausea, vomiting, fever, or changes in consciousness)
  • signs of bleeding in the stomach (e.g., bloody, black, or  tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)
  • signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
  • signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
  • signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
  • symptoms of a severe allergic reaction (e.g., hives; difficulty breathing; swelling of the face, mouth, throat or tongue)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergic reactions: If you have had a reaction to acetylsalicylic acid (ASA) or other NSAIDs (e.g., ibuprofen, ketoprofen, ketorolac) that included a runny nose, itchy skin rash, nasal polyps, or shortness of breath and wheezing, you should not take this medication. If you experience symptoms of a severe allergic reaction (e.g., hives; difficulty breathing; wheezing; swelling of the face, tongue, or throat), get immediate medical attention.

Aseptic meningitis: This medication can rarely cause symptoms of aseptic meningitis (inflammation or swelling of the membranes around the brain and spinal cord that is not caused by bacteria). If you have an autoimmune condition (e.g., systemic lupus erythematosus, mixed connective tissue disease), you are more at risk for developing this. If you experience symptoms such as stiff neck, severe headache, nausea, vomiting, fever, or changes in consciousness, stop taking this medication can get immediate medical attention.

Bladder problems: This medication may cause bladder pain, painful or difficult urination, or increased frequency of urination. If these symptoms occur without an explanation (e.g., infection), stop taking this medication and contact your doctor.

Blood clotting: This medication may reduce the ability of the blood to clot. If you are taking anticoagulants (e.g., warfarin, heparin) or have hemophilia or other blood disorders (e.g., low platelets), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you have a bleeding disorder, do not take this medication.

Blood counts: This medication can decrease the number of neutrophils (a type of white blood cell that helps fight infection), red blood cells (which carry oxygen), and platelets (which help your blood to clot). Your doctor will do blood tests to monitor this. If you notice any signs of anemia (e.g., unusual tiredness, difficulty breathing) or unusual bleeding or bruising, contact your doctor.

Drowsiness/reduced alertness: Piroxicam may cause drowsiness or dizziness, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.

Fluid and electrolyte balance: NSAIDs such as piroxicam can cause fluid retention and edema (swelling). This can lead to high blood pressure or worsening of heart failure. If you have heart failure or high blood pressure, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you have severe, uncontrolled heart failure, you should not take this medication.

Piroxicam may also cause high blood potassium levels. If you are a senior; have diabetes or kidney failure; or are taking beta-blockers (e.g., metoprolol, atenolol), angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril, enalapril), or some diuretics (e.g., triamterene, amiloride), you are more at risk of high blood potassium. If you have high blood potassium levels, you should not take this medication.

Heart attack and stroke: This medication may be associated with an increased risk of heart attack or stroke. The risk is higher with larger total daily doses and longer treatment periods. If you have a history of heart disease (e.g., heart attack, stroke, heart failure) or have risk factors for heart disease (e.g., high blood pressure, high cholesterol, diabetes, smoking, kidney disease) discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Long-term use of piroxicam may lead to a higher risk of reduced kidney function. If you have kidney disease, liver disease, or heart failure; take diuretics (water pills); or are a senior: you have an increased risk for kidney problems while taking this medication. .If you are taking medications such as diuretics (e.g., hydrochlorothiazide, triamterene, indapamide), ACE inhibitors (e.g., enalapril, ramipril), angiotensin receptor blockers (e.g., valsartan, candesartan), or cyclosporine, you are also at an increased risk.

If you have these conditions or are taking these medications, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you have severe kidney problems, you should not take this medication.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Rarely, this medication causes liver problems. If you experience unexplained tiredness, loss of appetite, itchy skin or yellowing of the skin or eyes while taking this medication, contact your doctor immediately. If you have liver disease or severely reduced liver function, you should not take this medication.

Skin reactions: This medication can cause skin reactions, some of which may be severe. If you experience a skin rash, especially where the skin is blistering or peeling, stop taking this medication and contact your doctor.

This medication may make your skin more sensitive to sunlight (including sunlamps) and may cause sunburn, skin blisters, and skin redness, itching or discolouration. If you have a reaction from the sun while taking this medication, contact your doctor.

Ulcers or bleeding in the stomach or intestines: Piroxicam can cause stomach ulcers, perforation (holes), and bleeding from the stomach. These complications can occur at any time without warning, and are sometimes severe enough to require immediate medical attention. The risk of ulcers and bleeding increase if you are taking higher doses of piroxicam for longer periods of time.

Other factors that increase the risk of these complications include drinking excessive amounts of alcohol, increased age, smoking, poor health, H pylori infection, and taking certain medications (e.g., warfarin, ASA, clopidogrel, prednisone, citalopram, fluoxetine, paroxetine, sertraline).

If you currently have ulcers in the stomach or intestines that are bleeding, or have an inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis), you should not take this medication. If you have a history of these conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stop taking the medication and get immediate medical attention if you experience symptoms or signs of stomach ulcers or bleeding in the stomach (black, tarry stools, blood in stools, stomach pain, vomiting blood or coffee-grind material). These reactions can occur at any time during treatment without warning.

Pregnancy: This medication should not be used during pregnancy, especially during the third trimester. If you become pregnant while taking this medication, contact your doctor immediately.

This medication may reduce fertility. If you are trying to get pregnant or are having difficulty getting pregnant, you should not use this medication.

Breast-feeding: Piroxicam passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of this medication have not been established for children less than 16 years of age.

Seniors: If you are a senior, you may have a higher risk of experiencing side effects from this medication. You should use the lowest effective dose under close medical supervision.

What other drugs could interact with this medication?

There may be an interaction between piroxicam and any of the following:

  • acetylsalicylic acid (ASA)
  • amiodarone
  • alcohol
  • aliskiren
  • aminoglycoside antibiotics (e.g., amikacin, gentamicin, tobramycin)
  • angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril, enalapril)
  • angiotensin receptor blockers (e.g., candesartan, losartan, telmisartan)
  • beta-blockers (e.g., metoprolol, atenolol)
  • apixaban
  • aprepitant
  • "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
  • bisphosphonates (e.g., alendronate, etidronate)
  • bosentan
  • capecitabine
  • carbamazepine
  • celecoxib
  • certain kinase inhibitors (e.g., ceritinib, dabrafenib, nilotinib)
  • cholestyramine
  • cimetidine
  • clopidogrel
  • corticosteroids (e.g., prednisone, cortisone)
  • cyclosporine
  • dabigatran
  • deferasirox
  • desmopressin
  • digoxin
  • dipyridamole
  • diuretics (water pills; e.g., spironolactone, furosemide, hydrochlorothiazide, triamterene)
  • drospirenone
  • eplerenone
  • fenofibric acid
  • 5-ASA derivatives (e.g., mesalamine, sulfasalazine)
  • fluorouracil
  • fluvastatin
  • gemfibrozil
  • glucosamine
  • haloperidol
  • heparin
  • herbal products that affect blood clotting (e.g., cat's claw, chamomile, fenugreek, evening primrose, feverfew, garlic, ginger, ginseng, turmeric)
  • HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delaviridine, efavirenz, etravirine)
  • hydralazine
  • leflunomide
  • lithium
  • low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
  • methotrexate
  • mifepristone
  • multivitamins and multivitamins with minerals
  • nicardipine
  • other NSAIDs (e.g., naproxen, diclofenac)
  • omega-3 fatty acids
  • omeprazole
  • pemetrexed
  • pentoxifylline
  • phenobarbital
  • phenytoin
  • porfimer
  • potassium supplements
  • primidone
  • probenecid
  • prostaglandin eye drops (e.g., latanoprost, bimatoprost)
  • pyrimethamine
  • quinine
  • quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
  • rifampin
  • rivaroxaban
  • secobarbital
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, sertraline)
  • serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
  • sitaxentan
  • sodium phosphates
  • some oral antidiabetes medications (e.g., glyburide, gliclazide)
  • sulfonamides ("sulfas"; e.g., sulfisoxazole, sulfamethoxazole)
  • tacrolimus
  • tenofovir
  • ticagrelor
  • ticlopidine
  • tolbutamide
  • tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
  • trimethoprim
  • urokinase
  • vancomycin
  • vitamin E
  • warfarin
  • zafirlukast

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.