- Capsules 10 mg
- Capsules 20 mg
Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis.
Slight delay in the rate of absorption with food. Steady state is 7 to 12 days, up to 2 to 3 wk. T max is 3 to 5 h. Well absorbed. C max is 3 to 8 mcg/mL (multiple doses), 1.5 to 2 mcg/mL (single doses).
Vd is 0.14 L/kg. Protein binding is 99%. Excreted in breast milk.
In the liver by hydroxylation; no active metabolites.
The t 1/2 is approximately 50 h. Eliminated primarily in the urine, small amount in feces; 5% excreted unchanged.
Therapeutic effect is 3 to 5 h.
Special PopulationsHepatic Function Impairment
Effect not established; however, the drug is extensively metabolized in the liver and may require reduced doses.
Indications and Usage
Treatment of acute or long-term use of rheumatoid arthritis and osteoarthritis.
Symptomatic relief of primary dysmenorrhea, pain, sunburn, juvenile rheumatoid arthritis.
Known allergy or hypersensitivity to aspirin, iodides, or any NSAID, including piroxicam.
Dosage and AdministrationRheumatoid Arthritis, Osteoarthritis
PO Initiate and maintain at 20 mg/day in 1 to 2 divided doses.
Store at room temperature.
May augment risk of GI bleeding.Anticoagulants
May increase effect of anticoagulants because of decreased plasma protein binding and inhibition of platelet aggregation. May increase risk of gastric erosion and bleeding.Beta-blockers
Antihypertensive effect may be decreased.Cholestyramine
Effects of piroxicam may be decreased.Lithium
May decrease lithium Cl.Methotrexate
May increase methotrexate levels and toxicity.Ritonivir
May increase concentrations and possibly the toxicity of piroxicam by inhibiting its metabolism.
Laboratory Test Interactions
May prolong bleeding time. May reversibly increase BUN and serum creatinine.
Edema; weight gain; CHF; alterations in BP; vasodilation; palpitations; tachycardia.
Headache; malaise; dizziness; somnolence; vertigo; depression; insomnia; nervousness.
Pruritus; rash; sweating; erythema; bruising; desquamation; erythema multiforme; toxic epidermal necrolysis.
Tinnitus; swollen eyes; blurred vision; eye irritation; rhinitis; pharyngitis.
Epigastric distress; nausea; vomiting; anorexia; constipation; stomatitis; abdominal discomfort; diarrhea; flatulence; abdominal pain; indigestion; toxicity (bleeding, ulceration, perforation); heartburn; dyspepsia; anorexia.
Hematuria; proteinuria; increased BUN and serum creatinine; acute renal insufficiency and failure; papillary necrosis; interstitial nephritis; nephrotic syndrome; hyperkalemia; hyponatremia.
Increased bleeding time; decreased Hgb and Hct; anemia; leukopenia; eosinophilia, thrombocytopenia.
Increased LFTs; elevated liver enzymes.
Bronchospasm; laryngeal edema; dyspnea; hemoptysis; shortness of breath.
NSAIDs may cause an increased risk of serious CV thrombotic events, MI, and stroke, which can be fatal. This risk may increase with length of therapy. Patients with CV disease or risk factors for CV disease may be at greater risk. NSAIDs cause an increased risk of serious GI adverse reactions, including bleeding, inflammation, perforation of the stomach or intestines, and ulceration, which can be fatal. These events can occur any time during use and without warning symptoms. Elderly patients are at greater risk of serious GI events.
Category C .
Safety and efficacy not established.
Increased risk of adverse reactions. May require decreased dosage.
In certain patients (aspirin-allergic, nasal polyps) may precipitate asthma attacks.
May worsen CHF and hypertension.
Increases risk of bleeding.
Combination of dermatologic/allergic signs and symptoms (ie, arthralgias, pruritus, fever, fatigue, rash including vesiculobullous reactions, exfoliative dermatitis) suggestive of serum sickness have occurred.
Serious GI toxicity can occur at any time, with or without warning symptoms.
Drug may accumulate, increasing the risk of toxicity. In cases of advanced kidney disease, treatment with piroxicam is not recommended.
Drowsiness, dizziness, mental confusion, disorientation, lethargy, paresthesia, numbness, vomiting, GI irritation, headache, tinnitus, seizure, increased BUN.
- Explain that increased response may be seen after weeks of therapy.
- Caution patient to avoid exposure to sunlight, and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
- Identify signs and symptoms patient should report to health care provider, including changes in how food tastes, nausea, vomiting, constipation, diarrhea, cramping, black or red stool, discolored urine, changes in urination, fever, rash, unusual bruising or bleeding.
- Explain that taking medication with food will minimize GI distress.
- Inform patient to avoid aspirin and alcohol during therapy.
- Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness until the effects of the drug are known.
- Encourage patient to maintain adequate fluid intake.
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