Generic Name: Piroxicam
Class: Other Nonsteroidal Anti-inflammatory Agents
VA Class: MS120
Chemical Name: 4-Hydroxy-2-methyl-N2-pyridinyl-2H-1,2-benzothiazine-3-carboxamide 1,1-dioxide
Molecular Formula: C15H13N3O4S
CAS Number: 36322-90-4
- Cardiovascular Risk
Increased risk of serious (sometimes fatal) cardiovascular thrombotic events (e.g., MI, stroke).1 500 502 508 Risk may occur early in treatment and may increase with duration of use.500 502 505 506 508 (See Cardiovascular Thrombotic Effects under Cautions.)
Contraindicated in the setting of CABG surgery.508
- GI Risk
Increased risk of serious (sometimes fatal) GI events (e.g., bleeding, ulceration, perforation of the stomach or intestine).1 Serious GI events can occur at any time and may not be preceded by warning signs and symptoms.1 Geriatric individuals are at greater risk for serious GI events.1 (See GI Effects under Cautions.)
Prototypical NSAIA; an oxicam derivative.1 2 3 4
Uses for Feldene
Consider potential benefits and risks of piroxicam therapy as well as alternative therapies before initiating therapy with the drug.1 Use lowest possible effective dosage and shortest duration of therapy consistent with patient's treatment goals.1
Symptomatic treatment of rheumatoid arthritis and osteoarthritis.1
Has been used for the management of dysmenorrhea†.41
Feldene Dosage and Administration
Consider potential benefits and risks of piroxicam therapy as well as alternative therapies before initiating therapy with the drug.1
Administered orally, usually as a single daily dose.1 May be administered in divided doses daily.1
To minimize the potential risk of adverse cardiovascular and/or GI events, use lowest effective dosage and shortest duration of therapy consistent with patient's treatment goals.1 Adjust dosage based on individual requirements and response; attempt to titrate to lowest effective dosage.1
Osteoarthritis or Rheumatoid ArthritisOral
Initially, 20 mg daily.1 Adjust dosage based on response and tolerance; 30 or 40 mg daily may be required for maintenance therapy, 2 although 20 mg daily is usually adequate.1 2
Dosages >20 mg daily associated with increased frequency of adverse GI effects.1 2 3
Dosage reduction may be required.1
Cautions for Feldene
Known hypersensitivity to piroxicam or any ingredient in the formulation. 1
History of asthma, urticaria, or other sensitivity reaction precipitated by aspirin or other NSAIAs.1
In the setting of CABG surgery.508
Cardiovascular Thrombotic Effects
NSAIAs (selective COX-2 inhibitors, prototypical NSAIAs) increase the risk of serious adverse cardiovascular thrombotic events (e.g., MI, stroke) in patients with or without cardiovascular disease or risk factors for cardiovascular disease.500 502 508
Findings of FDA review of observational studies, meta-analysis of randomized controlled trials, and other published information500 501 502 indicate that NSAIAs may increase the risk of such events by 10–50% or more, depending on the drugs and dosages studied.500
Relative increase in risk appears to be similar in patients with or without known underlying cardiovascular disease or risk factors for cardiovascular disease, but the absolute incidence of serious NSAIA-associated cardiovascular thrombotic events is higher in those with cardiovascular disease or risk factors for cardiovascular disease because of their elevated baseline risk.500 502 506 508
Increased risk may occur early (within the first weeks) following initiation of therapy and may increase with higher dosages and longer durations of use.500 502 505 506 508
In controlled studies, increased risk of MI and stroke observed in patients receiving a selective COX-2 inhibitor for analgesia in first 10–14 days following CABG surgery.508
In patients receiving NSAIAs following MI, increased risk of reinfarction and death observed beginning in the first week of treatment.505 508
Increased 1-year mortality rate observed in patients receiving NSAIAs following MI;500 508 511 absolute mortality rate declined somewhat after the first post-MI year, but the increased relative risk of death persisted over at least the next 4 years.508 511
Some systematic reviews of controlled observational studies and meta-analyses of randomized studies suggest naproxen may be associated with lower risk of cardiovascular thrombotic events compared with other NSAIAs.115 116 117 119 500 501 502 503 506 FDA states that limitations of these studies and indirect comparisons preclude definitive conclusions regarding relative risks of NSAIAs.500
Use NSAIAs with caution and careful monitoring (e.g., monitor for development of cardiovascular events throughout therapy, even in those without prior cardiovascular symptoms) and at the lowest effective dose for the shortest duration necessary.1 500 508
Some clinicians suggest that it may be prudent to avoid NSAIA use, whenever possible, in patients with cardiovascular disease.505 511 512 516 Avoid use in patients with recent MI unless benefits of therapy are expected to outweigh risk of recurrent cardiovascular thrombotic events; if used, monitor for cardiac ischemia.508 Contraindicated in the setting of CABG surgery.508
No consistent evidence that concomitant use of low-dose aspirin mitigates the increased risk of serious adverse cardiovascular events associated with NSAIAs.1 502 508 (See Specific Drugs under Interactions.)
Serious GI toxicity (e.g., bleeding, ulceration, perforation) can occur with or without warning symptoms; increased risk in those with a history of GI bleeding or ulceration, geriatric patients, smokers, those with alcohol dependence, and those in poor general health.1 94 102 109
For patients at high risk for complications from NSAIA-induced GI ulceration (e.g., bleeding, perforation), consider concomitant use of misoprostol;16 47 68 94 102 alternatively, consider concomitant use of a proton-pump inhibitor (e.g., omeprazole)16 68 94 or use of an NSAIA that is a selective inhibitor of COX-2 (e.g., celecoxib).16
Hypertension and worsening of preexisting hypertension reported; either event may contribute to the increased incidence of cardiovascular events.1 Use with caution in patients with hypertension; monitor BP.1
Impaired response to ACE inhibitors, angiotensin II receptor antagonists, β-blockers, and certain diuretics may occur.1 508 (See Specific Drugs under Interactions.)
Heart Failure and Edema
Fluid retention and edema reported.1 508
NSAIAs (selective COX-2 inhibitors, prototypical NSAIAs) may increase morbidity and mortality in patients with heart failure.500 501 504 507 508
NSAIAs may diminish cardiovascular effects of diuretics, ACE inhibitors, or angiotensin II receptor antagonists used to treat heart failure or edema.508 (See Specific Drugs under Interactions.)
Manufacturer recommends avoiding use in patients with severe heart failure unless benefits of therapy are expected to outweigh risk of worsening heart failure; if used, monitor for worsening heart failure.508
Some experts recommend avoiding use, whenever possible, in patients with reduced left ventricular ejection fraction and current or prior symptoms of heart failure.507
Direct renal injury, including renal papillary necrosis, reported in patients receiving long-term NSAIA therapy.1
Potential for overt renal decompensation.1 31 48 49 50 65 Increased risk of renal toxicity in patients with renal or hepatic impairment or heart failure, in geriatric patients, in patients with volume depletion, and in those receiving a diuretic, ACE inhibitor, or angiotensin II receptor antagonist.1 31 48 65 114 (See Renal Impairment under Cautions.)
Anaphylactoid reactions reported. 1
Immediate medical intervention and discontinuance for anaphylaxis.1
Avoid in patients with aspirin triad (aspirin sensitivity, asthma, nasal polyps); caution in patients with asthma.1
Serious skin reactions (e.g., exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis) reported; can occur without warning.1 Discontinue at first appearance of rash or any other sign of hypersensitivity (e.g., blisters, fever, pruritus).1
Severe reactions including jaundice, fatal fulminant hepatitis, liver necrosis, and hepatic failure (sometimes fatal) reported rarely with NSAIAs. 1
Elevations of serum ALT or AST reported.1
Monitor for symptoms and/or signs suggesting liver dysfunction; monitor abnormal liver function test results.1 Discontinue if signs or symptoms of liver disease or systemic manifestations (e.g., eosinophilia, rash) occur or if liver function test abnormalities persist or worsen.1
Anemia reported rarely.1 Determine hemoglobin concentration or hematocrit in patients receiving long-term therapy if signs or symptoms of anemia occur.1
May inhibit platelet aggregation and prolong bleeding time. 1
Visual disturbances reported; ophthalmic evaluation recommended if visual changes occur. 1
Not a substitute for corticosteroid therapy; not effective in the management of adrenal insufficiency.1
May mask certain signs of infection.1
Obtain CBC and chemistry profile periodically during long-term use.1
Category C.1 Avoid use in third trimester because of possible premature closure of the ductus arteriosus.1
Distributed into milk in humans; use not recommended.1
Safety and efficacy not established.1
Caution advised.1 Geriatric adults appear to tolerate NSAIA-induced adverse effects less well than younger individuals.96 Fatal adverse GI effects reported more frequently in geriatric patients than younger adults.96
Consider lowest effective dosage for the shortest possible duration.1
Monitor closely.1 (See Hepatic Impairment under Dosage and Administration.)
Use not recommended in patients with advanced renal disease; close monitoring of renal function advised if used.1
Common Adverse Effects
Dyspepsia, nausea, diarrhea, constipation, rash, dizziness, headache, edema, tinnitus.1
Interactions for Feldene
Pharmacokinetic interaction possible with other highly protein-bound drugs; monitor patient; dosage adjustment may be needed.1
Reduced BP response to ACE inhibitor1
Angiotensin II receptor antagonists
Reduced BP response to angiotensin II receptor antagonist118
Antacids (magnesium- or aluminum-containing)
Pharmacokinetic interaction unlikely1 13
Possible bleeding complications1
Use with caution;1 37 97 monitor PT; adjust anticoagulant dosage as needed1 97
Diuretics (furosemide, thiazides)
Reduced natriuretic effects1 98
Monitor for diuretic efficacy and renal failure1
Increased plasma lithium concentrations1 72 73 74 75 76 77 78 79
Monitor plasma lithium concentrations when initiating or discontinuing piroxicam;1 72 73 76 77 79 monitor for lithium toxicity29 72 73 76
Increased plasma methotrexate concentrations,1 100 particularly with high methotrexate dosage99 100
Use with caution1
NSAIAs including aspirin: Increased risk of GI ulceration and other complications 1
Aspirin: No consistent evidence that use of low-dose aspirin mitigates the increased risk of serious cardiovascular events associated with NSAIAs112 502 508
Decreased plasma piroxicam concentrations with concomitant use of 20 mg piroxicam and 3.9 g aspirin daily 1
Concomitant use not recommended1
Thrombolytic agents (streptokinase)
Possible bleeding complications26
Use with caution26
Well absorbed following oral administration;1 3 peak plasma concentrations usually attained within 3 to 5 hours.1
Decreases rate but not extent of absorption.2 12 28
Distributed into synovial fluid.3
Distributed into human milk.1 43 95
May accumulate slowly in cartilage.2 5
Plasma Protein Binding
Extensively metabolized,2 principally by hydroxylation and glucuronide conjugation of the hydroxy metabolite.1 28
Excreted principally in urine and feces, 1 with urinary excretion approximately twice the fecal excretion.1 Excreted principally as metabolites; <5% excreted unchanged.1 28
50 hours1 (range: 14–158 hours).2 13
Tight, light-resistant containers34 35 at <30°C.34 36
Inhibits cyclooxygenase-1 (COX-1) and COX-2.88 89 90 91 92 93
Pharmacologic actions similar to those of other prototypical NSAIAs;2 4 exhibits anti-inflammatory, analgesic, and antipyretic activity.1 2 4
Advice to Patients
Importance of reading the medication guide for NSAIAs that is provided to the patient each time the drug is dispensed.1
Risk of serious cardiovascular events (e.g., MI, stroke).1 500 508
Risk of GI bleeding and ulceration.1
Risk of serious skin reactions.1 Risk of anaphylactoid and other sensitivity reactions.1
Risk of hepatotoxicity.1
Importance of seeking immediate medical attention if signs and symptoms of a cardiovascular event (chest pain, dyspnea, weakness, slurred speech) occur.1 500 508
Importance of notifying clinician if signs and symptoms of GI ulceration or bleeding, unexplained weight gain, or edema develops.1
Importance of discontinuing piroxicam and contacting clinician if rash or other signs of hypersensitivity (blisters, fever, pruritus) develop.1 Importance of seeking immediate medical attention if an anaphylactic reaction occurs.1
Importance of discontinuing therapy and contacting clinician immediately if signs and symptoms of hepatotoxicity (nausea, fatigue, lethargy, pruritus, jaundice, upper right quadrant tenderness, flu-like symptoms) occur.1
Risk of heart failure or edema; importance of reporting dyspnea, unexplained weight gain, or edema.508
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 Importance of avoiding piroxicam in late pregnancy (third trimester).1
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant diseases.1
Importance of informing patients of other important precautionary information.1 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
AHFS DI Essentials. © Copyright 2017, Selected Revisions November 21, 2016. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
1. Pfizer Laboratories. Feldene (piroxicam) capsules prescribing information. New York, NY; 2006 Mar.
2. Dahl SL, Ward JR. Pharmacology, clinical efficacy, and adverse effects of piroxicam, a new nonsteroidal anti-inflammatory agent. Pharmacotherapy. 1982; 2:80-9. [PubMed 6765393]
3. Brogden RN, Heel RC, Speight TM et al. Piroxicam: a review of its pharmacological properties and therapeutic efficacy. Drugs. 1981; 22:165-87. [PubMed 7021122]
4. Wiseman EH. Pharmacologic studies with a new class of nonsteroidal anti-inflammatory agents–the oxicams–with special reference to piroxicam (Feldene). Am J Med. 1982; 72(2A):2-8.
5. Conner CS. Piroxicam. Drugdex. 1983; (Mar):1-36.
6. Simon LS, Mills JA. Nonsteroidal anti-inflammatory drugs. N Engl J Med. 1980; 302:1179-85. [PubMed 6988717]
7. Flower RJ, Moncada S, Vane JR. Drug therapy of inflammation: analgesic-antipyretics and antiinflammatory agents; drugs employed in the treatment of gout. In: Gilman AG, Goodman L, Gilman A, eds. Goodman and Gilman’s the pharmacological basis of therapeutics. 6th ed. New York: Macmillan Publishing Company; 1980:682-93.
8. Wiseman EH. Review of preclinical studies with piroxicam: pharmacology, pharmacokinetics, and toxicology. In: O’Brien WM, Wiseman EH, eds. Royal Society of Medicine International Congress and Symposium Series. Number 1. New York: Grune & Stratton; 1978:11-23.
9. Ferreira SH, Lorenzetti BB, Correa FMA. Central and peripheral antianalgesic action of aspirin-like drugs. Eur J Pharmacol. 1978; 53:39-48. [PubMed 310771]
10. Atkinson DC, Collier HOJ. Salicylates: molecular mechanism of therapeutic action. Adv Pharmacol Chemother. 1980; 17:233-88. [PubMed 7004141]
11. Bernheim HA, Block LH, Atkins E. Fever: pathogenesis, pathophysiology, and purpose. Ann Intern Med. 1979; 91:261-70. [PubMed 223485]
12. Ishizaki T, Nomura T, Abe T. Pharmacokinetics of piroxicam, a new nonsteroidal anti-inflammatory agent, under fasting and postprandial states in man. J Pharmacokinet Biopharm. 1979; 7:369-81. [PubMed 512843]
13. Hobbs DC, Twomey TM. Piroxicam pharmacokinetics in man: aspirin and antacid interaction studies. J Clin Pharmacol. 1979; 19:270-81. [PubMed 89124]
14. Pitts NE. Efficacy and safety of piroxicam. Am J Med. 1982; 72(2A):77-87.
15. Abruzzo JL, Gordon GV, Meyers AR. Double-blind study comparing piroxicam and aspirin in the treatment of osteoarthritis. Am J Med. 1982; 72(2A):45-9.
16. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis; 2002 update. Arthritis Rheum. 2002; 46:328-46. [PubMed 11840435]
17. Willkens RF. The use of nonsteroidal anti-inflammatory agents. JAMA. 1978; 240:1632-5. [PubMed 691156]
18. Willkens RF, Ward JR, Louie JS et al. Double-blind study comparing piroxicam and aspirin in the treatment of rheumatoid arthritis. Am J Med. 1982; 72(2A):23-6.
19. Turner R, April PA, Robbins DL. Double-blind multicenter study comparing piroxicam and ibuprofen in the treatment of rheumatoid arthritis. Am J Med. 1982; 72(2A):34-8.
20. Davies J, Dixon AS. Efficacy and safety of piroxicam compared with indomethacin in the management of rheumatoid arthritis. Am J Med. 1982; 72(2A):27-30.
21. Sydnes OA. Double-blind comparison of piroxicam and naproxen in the management of rheumatoid arthritis. Am J Med. 1982; 72(2A):31-3.
22. Hart FD. Rheumatic disorders. In: Avery GS, ed. Drug treatment: principles and practice of clinical pharmacology and therapeutics. 2nd ed. New York: ADIS Press; 1980:861-2.
23. Huskisson EC. European experience with piroxicam. Am J Med. 1982; 72(2A):70-6.
24. Pitts NE, Proctor RR. Summary: efficacy and safety of piroxicam. In O’Brien WM, Wiseman EH, eds. Royal Society of Medicine International Congress and Symposium Series. Number 1. New York: Grune & Stratton; 1978:97-108.
25. Mitnick PD, Klein WJ. Piroxicam-induced renal disease. Arch Intern Med. 1984; 144:63-4. [PubMed 6691775]
26. Hoechst-Roussel. Streptase prescribing information. Somerville, NJ; 1980 Aug.
27. Pfizer. Feldene (piroxicam): the first one-a-day agent for rheumatoid arthritis and osteoarthritis. New York. 1983 Mar.
28. Wiseman EH, Hobbs DC. Review of pharmacokinetic studies with piroxicam. Am J Med. 1982; 72(2A):9-17. [PubMed 6800256]
29. Reimann IW, Frolich JC. Effects of diclofenac on lithium kinetics. Clin Pharmacol Ther. 1981; 30:348-52. [PubMed 7273598]
30. Rae SA, Williams IA, English J et al. Alteration of plasma prednisolone levels by indomethacin and naproxen. Br J Clin Pharmacol. 1982; 14:459-61. [PubMed 7126420]
31. Merck, Sharp & Dohme. Indocin, Indocin SR prescribing information. West Point, PA. 1985 Oct.
32. Syntex. Naprosyn prescribing information. Palo Alto, CA. 1983 Apr.
33. Gosselin RE, Hodge HC, Smith RP et al. Clinical toxicology of commercial products. Acute poisoning. 5th ed. Baltimore: The Williams & Wilkins Co; 1984:I-10.
34. USP DI. Vol. 1: 1984 Drug information for the health care provider. Rockville, MD: The United States Pharmacopeial Convention, Inc; 1983:896-7.
35. The United States Pharmacopeial Convention, Inc. Piroxicam. Pharmacopeial Forum. 1984; 10:4058-9.
36. D’Ambrosio GG (Pfizer Laboratories, New York): Personal communication; 1984 Mar 29, Apr 11.
37. Jacotot B. Interaction of piroxicam with oral anticoagulants. Proceedings of the IXth European Congress of Rheumatology; 1979 September 4; Wiesbaden. New York: Academy Professional Information Services; 1980:46-8.
38. Widmark PH. Piroxicam: its safety and efficacy in the treatment of acute gout. Am J Med. 1982; 72(2A):63-5. [PubMed 7058825]
39. Weintraub M, Case K, Kroening B et al. Effects of piroxicam on platelet aggregation. Clin Pharmacol Ther. 1978; 23:134-5.
40. Pomberg O. Comparison of piroxicam with indomethacin in ankylosing spondylitis: a double-blind crossover trial. Am J Med. 1982; 72(2A):58-62. [PubMed 7058824]
41. Cash HC, Humpston D, Kasap HS. Feldene in the symptomatic treatment of primary dysmenorrhoea. Practitioner. 1982; 226:1338-41. [PubMed 7050953]
42. Abramson S, Edelson H, Kaplan H et al. The neutrophil in rheumatoid arthritis: its role and the inhibition of its activation by nonsteroidal antiinflammatory drugs. Semin Arthritis Rheum. 1983; 13(Suppl 1):148-52. [PubMed 6312608]
43. Ostensen M. Piroxicam in human breast milk. Eur J Clin Pharmacol. 1983; 25:829-30. [PubMed 6662182]
44. Stefanini M, Claustro LZ, Mulkey P. Bleeding tendency possibly related to increased plasma antithrombin III activity in patient treated with piroxicam. South Med J. 1984; 77:633-4. [PubMed 6609435]
45. Martin RL, McSweeney GW, Schneider J. Fatal pemphigus vulgaris in a patient taking piroxicam. N Engl J Med. 1983; 309:795-6. [PubMed 6888461]
46. MacDougall LG, Taylor-Smith A, Rothberg AD et al. Piroxicam poisoning in a 2-year-old child. South Afr Med J. 1984; 66:31-3.
47. Lanza Fl, and the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. A guideline for the treatment and prevention of NSAID-induced ulcers. Am J Gastroenterol. 1998; 93:2037-46. [PubMed 9820370]
48. The Upjohn Company. Motrin prescribing information. Kalamazoo, MI; 1985 Jul.
49. Clive DM, Stoff JS. Renal syndromes associated with nonsteroidal anti-inflammatory agents. N Engl J Med. 1984; 310:563-72. [PubMed 6363936]
50. Adams DH, Michael J, Bacon PA et al. Non-steroidal anti-inflammatory drugs and renal failure. Lancet. 1986; 1:57-9. [PubMed 2867313]
51. Fok KH, George PJM, Vicary FR. Peptic ulcers induced by piroxicam. BMJ. 1985; 290:117. [PubMed 3917708]
52. Morgan AG. Peptic ulcers induced by piroxicam. BMJ. 1985; 290:564. [PubMed 3918675]
53. Emery P, Grahame R. Peptic ulcers induced by piroxicam. BMJ. 1985; 290:564. [PubMed 3918675]
54. Emery P, Grahame R. Gastrointestinal blood loss and piroxicam. Lancet. 1982; 1:1302-3. [PubMed 6123039]
55. Laake K, Kjeldaas L, Borchgrevink CF. Side-effects of piroxicam (Feldene): a one-year material of 103 reports from Norway. Acta Med Scand. 1984; 215:81-3. [PubMed 6695566]
56. Paulus HE. FDA Arthritis Advisory Committee Meeting: postmarketing surveillance of nonsteroidal antiinflammatory drugs. Arthritis Rheum. 1985; 28:1168-9. [PubMed 4052129]
57. Settipane GA. Adverse reactions to aspirin and other drugs. Arch Intern Med. 1981; 141:328-32. [PubMed 7008734]
58. Weinberger M. Analgesic sensitivity in children with asthma. Pediatrics. 1978; 62(Suppl):910-5. [PubMed 103067]
59. Settipane GA. Aspirin and allergic diseases: a review. Am J Med. 1983; 74(Suppl):102-9. [PubMed 6344621]
60. VanArsdel PP Jr. Aspirin idiosyncracy and tolerance. J Allergy Clin Immunol. 1984; 73:431-3. [PubMed 6423718]
61. Stevenson DD. Diagnosis, prevention, and treatment of adverse reactions to aspirin and nonsteroidal anti-inflammatory drugs. J Allergy Clin Immunol. 1984; 74(4 Part 2):617-22. [PubMed 6436354]
62. Stevenson DD, Mathison DA. Aspirin sensitivity in asthmatics: when may this drug be safe? Postgrad Med. 1985; 78:111-3,116-9. (IDIS 205854)
63. Pleskow WW, Stevenson DD, Mathison DA et al. Aspirin desensitization in aspirin-sensitive asthmatic patients: clinical manifestations and characterization of the refractory period. J Allergy Clin Immunol. 1982; 69(1 Part 1):11-9. [PubMed 7054250]
64. Rossi AC, Hsu JP, Faich GA. Ulcerogenicity of piroxicam: an analysis of spontaneously reported data. BMJ. 1987; 294:147-50. [PubMed 3109543]
65. Palmer JF. Letter sent to Wolleben J, of Pfizer Pharmaceutical regarding labeling revisions about gastrointestinal adverse reactions to Feldene (piroxicam). Rockville, MD: Food and Drug Administration, Division of Oncology and Radiopharmaceutical Drug Products. 1988 Sep.
66. Anon. Labeling revisions for NSAIDs. FDA Drug Bull. 1989; 19:3-4.
67. Searle. Cytotec (misoprostol) prescribing information. Skokie, IL; 1989 Jan.
68. Anon. Drugs for rheumatoid arthritis. Med Lett Drugs Ther. 2000; 42:57-64. [PubMed 10887424]
69. Saw KC, Quick CRG, Higgins AF. Ileocaecal perforation and bleeding are non-steroidal anti-inflammatory drugs (NSAIDs) responsible? J R Soc Med. 1990; 83:114-5.
70. Stubb S, Reitamo S. Fixed drug eruption caused by piroxicam. J Am Acad Dermatol. 1990; 22:1111-2. [PubMed 2142495]
71. Soll AH, Weinstein WM, Kurata J et al. Nonsteroidal anti-inflammatory drugs and peptic ulcer disease. Ann Intern Med. 1991; 114:307-19. [PubMed 1987878]
72. Nonsteroidal anti-inflammatory drug interactions: Lithium. In: Hansten PD, Horn JR. Drug interactions and updates. Vancouver, WA: Applied Therapeutics, Inc; 1993:609-10.
73. Lithium/NSAIDs. In: Tatro DS, Olin BR, Hebel SK eds. Drug interaction facts. St. Louis: JB Lippincott Co; 1993(April):463.
74. Miller LG, Bowman RC, Bakht F. Sparing effect of sulindac on lithium levels. J Fam Prac. 1989; 28:592-3.
75. Stein G, Robertson M, Nadarajah J. Toxic interactions between lithium and non-steroidal anti-inflammatory drugs. Psych Med. 1988; 18:535-43.
76. Khan IH. Lithium and non-steroidal anti-inflammatory drugs. BMJ. 1991; 302:1537-8. [PubMed 1855032]
77. Kerry RJ, Owen G, Michaelson S. Possible toxic interaction between lithium and piroxicam. Lancet. 1983; 1:418-9. [PubMed 6130411]
78. Harrison TM, Davies DW, Norris CM. Lithium carbonate and piroxicam. Br J Psychiatry. 1986; 149:124-5. [PubMed 3096415]
79. Nadarajah J, Stein GS. Piroxicam induced lithium toxicity. Ann Rheum Dis. 1985; 44:502. [PubMed 4026412]
80. Ciba Geigy, Ardsley, NY: Personal communication on diclofenac 28:08.04.
81. Reviewers’ comments (personal observations) on diclofenac 28:08.04.
82. Corticosteroid interactions: nonsteroidal anti-inflammatory drugs (NSAIDs). In: Hansten PD, Horn JR. Drug interactions and updates. Vancouver, WA: Applied Therapeutics, Inc; 1993:562.
83. Garcia Rodriguez LA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994; 343:769-72. [PubMed 7907735]
84. Hollander D. Gastrointestinal complications of nonsteroidal anti-inflammatory drugs: prophylactic and therapeutic strategies. Am J Med. 1994; 96:274-81. [PubMed 8154516]
85. Schubert TT, Bologna SD, Yawer N et al. Ulcer risk factors: interaction between Helicobacter pylori infection, nonsteroidal use, and age. Am J Med. 1993; 94:413-7. [PubMed 8475935]
86. Piper JM, Ray WA, Daugherty JR et al. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991; 114:735-40. [PubMed 2012355]
87. Bateman DN, Kennedy JG. Non-steroidal anti-inflammatory drugs and elderly patients: the medicine may be worse than the disease. BMJ. 1995; 310:817-8. [PubMed 7711609]
88. Hawkey CJ. COX-2 inhibitors. Lancet. 1999; 353:307-14. [PubMed 9929039]
89. Kurumbail RG, Stevens AM, Gierse JK et al. Structural basis for selective inhibition of cyclooxygenase-2 by anti-inflammatory agents. Nature. 1996; 384:644-8. [PubMed 8967954]
90. Riendeau D, Charleson S, Cromlish W et al. Comparison of the cyclooxygenase-1 inhibitory properties of nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors, using sensitive microsomal and platelet assays. Can J Physiol Pharmacol. 1997; 75:1088-95. [PubMed 9365818]
91. DeWitt DL, Bhattacharyya D, Lecomte M et al. The differential susceptibility of prostaglandin endoperoxide H synthases-1 and -2 to nonsteroidal anti-inflammatory drugs: aspirin derivatives as selective inhibitors. Med Chem Res. 1995; 5:325-43.
92. Cryer B, Dubois A. The advent of highly selective inhibitors of syclooxygenase—a review. Prostaglandins Other Lipid Mediators. 1998; 56:341-61. [PubMed 9990677]
93. Simon LS. Role and regulation of cyclooxygenase-2 during inflammation. Am J Med. 1999; 106(Suppl 5B):37-42S.
94. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med. 1999; 340:1888-99. [PubMed 10369853]
95. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and lactation. 5th ed. Baltimore, MD: Williams & Wilkins; 1998:875-6.
96. Mylan. Meclofenamate sodium capsules prescribing information. Morgantown, WV; 1998 Jun.
97. Piroxicam (Feldene) interactions: warfarin (Coumadin). In: Hansten PD, Horn JR. Drug interactions and updates. Vancouver, WA: Applied Therapeutics, Inc; 1997:440-1.
98. Furosemide (Lasix) interactions: Indomethacin (Indocin). In: Hansten PD, Horn JR. Drug interactions and updates. Vancouver, WA: Applied Therapeutics, Inc; 1997:308-9.
99. Tracy TS, Worster T, Bradley JD et al. Methotrexate disposition following concomitant administration of ketoprofen, piroxicam, and flurbiprofen in patients with rheumatoid arthritis. Br J Clin Pharmac. 1994; 37:453-6.
100. Kremer JM and Hamilton RA. The effects of nonsteroidal antiinflammatory drugs on methotrexate (MTX) pharmacokinetics: impairment of renal clearance of MTX at weekly maintenance doses but not at 7.5 mg. J Rheumatol. 1995; 22:2072-7. [PubMed 8596147]
101. Aspirin interactions: Captopril (Capoten). In: Hansten PD, Horn JR. Drug interactions and updates. Vancouver, WA: Applied Therapeutics, Inc; 1997:62-3.
102. Singh G, Triadafilopoulos G. Epidemiology of NSAID induced gastrointestinal complications. J Rheumatol. 1999; 26(suppl 56):18-24.
103. in’t Veld BA, Ruitenberg A, Hofman A et al. Nonsteroidal antiinflammatory drugs and the risk of Alzheimer’s disease. N Engl J Med. 2001; 345:1515-21. [PubMed 11794217]
104. Breitner JCS, Zandi PP. Do nonsteroidal antiinflammatory drugs reduce the risk of Alzheimer’s disease? N Engl J Med. 2001; 345:1567-8. Editorial.
105. McGeer PL, Schulzer M, McGeer EG. Arthritis and anti-inflammatory agents as possible protective factors for Alzheimer’s disease: a review of 17 epidemiologic studies. Neurology. 1996; 47:425-32. [PubMed 8757015]
106. Beard CM, Waring SC, O’sBrien PC et al. Nonsteroidal anti-inflammatory drug use and Alzheimer’s disease: a case-control study in Rochester, Minnesota, 1980 through 1984. Mayo Clin Proc. 1998; 73:951-5. [PubMed 9787743]
107. in’t Veld BA, Launer LJ, Hoes AW et al. NSAIDs and incident Alzheimer’s disease: the Rotterdam Study. Neurobiol Aging. 1998; 19:607-11. [PubMed 10192221]
108. Stewart WF, Kawas C, Corrada M et al. Risk of Alzheimer’s disease and duration of NSAID use. Neurology. 1997; 48:626-32. [PubMed 9065537]
109. Pharmacia. Daypro (oxaprozin) caplets prescribing information. Chicago, IL; 2002 May.
110. Chan FKL, Hung LCT, Suen BY et al. Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med. 2002; 347:2104-10. [PubMed 12501222]
111. Graham DY. NSAIDs, Helicobacter pylori, and Pandora’s box. N Engl J Med. 2002; 347:2162-4. [PubMed 12501230]
112. Food and Drug Administration. Analysis and recommendations for agency action regarding non-steroidal anti-inflammatory drugs and cardiovascular risk. 2005 Apr 6.
113. Cush JJ. The safety of COX-2 inhibitors: deliberations from the February 16-18, 2005, FDA meeting. From the American College of Rheumatology website (). Accessed 2005 Oct 12.
114. Novartis Pharmaceuticals. Diovan (valsartan) capsules prescribing information (dated 1997 Apr). In: Physicians’ desk reference. 53rd ed. Montvale, NJ: Medical Economics Company Inc; 1999:2013-5.
115. McGettigan P, Henry D. Cardiovascular risk and inhibition of cyclooxygenase: a systematic review of observational studies of selective and nonselective inhibitors of cyclooxygenase 2. JAMA. 2006; 296: 1633-44. [PubMed 16968831]
116. Kearney PM, Baigent C, Godwin J et al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006; 332: 1302-5. [PubMed 16740558]
117. Graham DJ. COX-2 inhibitors, other NSAIDs, and cardiovascular risk; the seduction of common sense. JAMA. 2006; 296:1653-6. [PubMed 16968830]
118. Merck & Co. Clinoril (sulindac) tablets prescribing information. Whitehouse Station, NJ; 2006 Feb.
119. Chou R, Helfand M, Peterson K et al. Comparative effectiveness and safety of analgesics for osteoarthritis. Comparative effectiveness review no. 4. (Prepared by the Oregon evidence-based practice center under contract no. 290-02-0024.) . Rockville, MD: Agency for Healthcare Research and Quality. 2006 Sep. Available at: .
500. Food and Drug Administration. Drug safety communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. Silver Spring, MD; 2015 Jul 9. From the FDA web site. Accessed 2016 Mar 22.
501. Coxib and traditional NSAID Trialists' (CNT) Collaboration, Bhala N, Emberson J et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013; 382:769-79. [PubMed 23726390]
502. Food and Drug Administration. FDA briefing document: Joint meeting of the arthritis advisory committee and the drug safety and risk management advisory committee, February 10-11, 2014. From FDA web site
503. Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011; 342:c7086. [PubMed 21224324]
504. Gislason GH, Rasmussen JN, Abildstrom SZ et al. Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure. Arch Intern Med. 2009; 169:141-9. [PubMed 19171810]
505. Schjerning Olsen AM, Fosbøl EL, Lindhardsen J et al. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation. 2011; 123:2226-35. [PubMed 21555710]
506. McGettigan P, Henry D. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med. 2011; 8:e1001098. [PubMed 21980265]
507. Yancy CW, Jessup M, Bozkurt B et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 62:e147-239. [PubMed 23747642]
508. Pfizer. Feldene (piroxicam) capsules prescribing information. New York, NY; 2016 May.
511. Olsen AM, Fosbøl EL, Lindhardsen J et al. Long-term cardiovascular risk of nonsteroidal anti-inflammatory drug use according to time passed after first-time myocardial infarction: a nationwide cohort study. Circulation. 2012; 126:1955-63. [PubMed 22965337]
512. Olsen AM, Fosbøl EL, Lindhardsen J et al. Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among myocardial infarction patients--a nationwide study. PLoS One. 2013; 8:e54309.
516. Bavry AA, Khaliq A, Gong Y et al. Harmful effects of NSAIDs among patients with hypertension and coronary artery disease. Am J Med. 2011; 124:614-20. [PubMed 21596367]
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