Piroxicam should be used with caution in: the elderly, patients with liver disease; patients with kidney disease; patients with high blood pressure, heart problems or stroke; patients with high cholesterol or hardening of the arteries; patients with asthma; patients with diabetes.
It should not be used in: patients with previous or current gastrointestinal ulcers, bleeding or perforation (hole in the lining of the gut); patients with previous or current gastrointestinal disorders that result in bleeding disorders such as ulcerative colitis (a type of inflammatory bowel disease that causes swelling, ulcers, and loss of function of the large intestine), Crohn's disease (a type of inflammatory bowel disease that causes the intestinal tract to swell and not work properly), gastrointestinal cancers or diverticulitis (inflamed or infected pouches/pockets in the large intestine); patients who are also taking other NSAIDs such as ibuprofen, celecoxib or aspirin at pain relief doses; patients taking anticoagulants; patients with a history of allergic drug reactions of any type or severity to piroxicam, other NSAIDs and other medications; patients in whom aspirin and other NSAIDs induce the symptoms of asthma, growths in the nose (nasal polyps), or red, itchy, raised areas of skin (angioedema or urticaria); patients with severe heart failure; patients in the last trimester of pregnancy.
Also see list of precautions and interactions.
Store below 25ºC- 30ºC (depending on brand).
What is it used for?
- Piroxicam is used to treat a number of painful conditions.
- It is a member of a class of pain killing drugs called non-steroidal anti-inflammatory drugs (NSAIDs).
- It is used to relieve the pain, stiffness and inflammation of conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, sprains, strains and other injuries.
- Benefits of being on this drug can include relieving the pain and reducing the swelling and stiffness in joints and muscles, thereby allowing you to do more of your normal daily activities.
Piroxicam is usually prescribed only when other NSAIDs have failed to provide adequate relief of symptoms.
Listed below are the typical uses of systemic piroxicam (capsules, tablets or melts):
- Relieve the symptoms of osteoarthritis (a disease of the joints), rheumatoid arthritis (a long term inflammatory disease of the joints) and ankylosing spondylitis (an inflammatory disease of the spine and large joints)
- In children over 6 years for juvenile idiopathic arthritis
Listed below are the typical uses of topical piroxicam (gel):
- Relieve the symptoms of mild osteoarthritis of the joints, reumatoid arthritis and ankylosing spondylitis
- Treatment of acute musculoskeletal injuries, such as: periarthritis (inflammation of the tissues surrounding a joint); epicondylitis (an inflammation of where bones attach to ligaments or tendons or of the tissues next to it); tendinitis (inflammation of a tendon); and tenosynovitis (inflammation of a tendon sheath)
- Relieve the symptoms of muscle sprains and muscle strains
On occasion your doctor may prescribe this medicine to treat a condition not on the above list.
HOW TO USE/TAKE
How often do I take it?
- The medication is available in the form of a capsule, tablet and melt ( a tablet which melts in the mouth). It is also available as a gel which can be applied directly to the skin.
- Take the capsule or tablet medication by mouth usually once a day with water, with food or soon after eating. Melts can be put on the tongue, where they will quickly dissolve or can be swallowed with water if preferable. The gel (about 3cms) should be rubbed into the affected site three to four times daily.
- Use this medication for the duration of the prescription in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told not to by your doctor.
- It may take up to a few hours before the full benefit of this drug takes effect.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- Piroxicam may make you feel dizzy, drowsy, tired or affect your vision. If you are affected, do not drive or operate machinery. Consult your doctor or pharmacist for more details.
When can I stop?
- Always complete the full course as prescribed by your doctor.
PIROXICAM SIDE EFFECTS
- Wind (flatulence)
- Feeling sick (nausea)
- Loss of appetite
- Sore mouth and/or lips
- Stomach ache
- Abdominal pain/discomfort
- Stomach (peptic) ulcers
- Stomatitis (inflammation of the mucous membrane of the mouth)
- Anorexia (loss of appetite)
- Epigastric distress (finding it difficult to swallow)
- Gastritis (inflammation of the lining of the stomach which may result in a feeling of fullness or burning in the upper abdomen)
- Mild to moderate local irritation, rash, erythema, pruritus and dermatitis
If any of these persist or you consider them severe then inform your doctor or pharmacist.
Tell your doctor immediately if you develop any of the following symptoms: any sign of bleeding in the stomach or intestines, such as passing black or blood-stained bowel movements or vomiting blood; a rash, blistering or peeling of the skin, mouth, eyes or genitals; yellowing of the skin and the whites of your eyes (jaundice) which may be a sign of hepatitis or other liver problems; stomach pain; swelling of the hands or feet; sudden or unexplained weight gain; vision changes; hearing changes (e.g. ringing in the ears); mental/mood changes; fast/pounding heartbeat; persistent/severe headache; fainting; difficult/painful swallowing; change in the amount of urine; easy bruising/bleeding; signs of infection (e.g., fever, persistent sore throat); unexplained stiff neck; seizures.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking Piroxicam, tell your doctor or pharmacist if you are allergic to it; or to other NSAIDs; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist in case of: current or previous gastrointestinal ulcer or perforation, gastrointestinal disorders that result in bleeding disorders such as ulcerative colitis, Crohn's disease, gastrointestinal cancers or diverticulitis, severe kidney disease, aspirin-sensitive asthma (a history of worsening breathing with runny/stuffy nose after taking aspirin or other NSAIDs), recent heart bypass surgery.
Before using this medication tell your doctor or pharmacist your medical history, especially any of the following: kidney problems; liver disease; poorly controlled diabetes; stomach/intestine/oesophagus problems (e.g. bleeding, ulcers, recurring heartburn); heart disease (e.g. congestive heart failure, history of heart attack); high blood pressure; stroke; swelling (oedema, fluid retention); dehydration; blood disorders (e.g. anaemia); bleeding or clotting problems; asthma; growths in the nose (nasal polyps).
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- You should limit the amount of alcohol you take whilst on this drug as it may increase the risk of stomach bleeding.
The elderly: piroxicam should be used with caution in the elderly as kidney, liver and heart function declines as you grow older and they therefore may be more sensitive to the side effects of this medication, especially gastrointestinal bleeding (bleeding in the gut) and perforation (holes in the lining of the gut) which may be fatal.
Pregnancy and breastfeeding - please ensure you read the detailed information below
Piroxicam is to be avoided in the last trimester of pregnancy, as the onset of labour may be delayed and the duration increased with an increased bleeding tendency in both mother and child. It should also not be used in the first two trimesters unless the potential benefit to the patients outweighs the potential risk to the foetus.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Piroxicam is not safe to take if you are breastfeeding, as it passes into the breast-milk.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Before using this medicine, tell your prescriber of all the medicines you are taking including prescription medicines and medicines you have bought over the counter without a prescription. Tell your prescriber if you are taking vitamins or complementary remedies such as herbal products, as these can also interact with medicines.
If you are taking more than one medicine, these may interact with each other. Your prescriber may decide to use medicines which interact with each other if the benefit outweighs the risks. In these cases, the dose of your medicines may need to be adjusted or you may be monitored more closely.
The following medicines may interact with piroxicam:
- Aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief, anticoagulants such as warfarin to prevent blood clots
- Corticosteroids, which are medicines given to treat a variety of conditions such as allergies and hormone imbalances
- Certain medicines used to treat heart conditions known as cardiac glycosides, such as digoxin
- Medicines used to treat depression
- Antihypertensives to treat high blood pressure
- Methotrexate, which can be given to treat various conditions such as cancers, psoriasis and rheumatoid arthritis
- Ciclosporin or tacrolimus, which are given to help prevent rejection of transplanted organs
- Quinolone antibiotics e.g. ciprofloxacin, which are used to treat various infections
- Mifepristone, a medicine used to terminate pregnancy
- Diuretics (water tablets) such as hydrochlorothiazide to treat high blood pressure or kidney problems
This information does not contain all possible interactions. Therefore, tell your prescriber of all the products you are using before taking this medicine.
If you have a question or want to discuss anything about your medicine, speak to your local pharmacist.
The effects of overdose with piroxicam are not known.
People who have taken too much piroxicam should tell a doctor or go to a hospital casualty department straight away.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of piroxicam or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.