Adult Dosing
Osteoarthritis
- Recommended dose: 20 mg PO qd
- Daily dose may be divided if required
Rheumatoid arthritis
- Recommended dose: 20 mg PO qd
- Daily dose may be divided if required
Note: Use the lowest effective dose for the shortest duration to achieve response
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- COX-2 selective and nonselective NSAIDs have been shown to increase the risk of serious and potentially fatal cardiovascular thrombotic events, MI and stroke. Risk increases with duration of use, presence of cardiovascular disease or risk factors for cardiovascular disease [US Black Box Warning]
- Use lowest effective dose of NSAID to minimize the potential risk for an adverse CV event
- Use with caution in hypertensive patients because piroxicam can lead to new hypertension or worsening of pre-existing hypertension, which may contribute to increased incidence of CV events. Monitor BP closely before starting the therapy and throughout the course of therapy.
- Use with caution in patients with fluid retention, hypertension, or heart failure
- NSAIDs can cause an increased risk of GI adverse events such as bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. This occurs mostly with concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status [US Black Box Warning]
- Use cautiously in patients with a prior history of ulcer disease or gastrointestinal bleeding
- Patients and physicians should remain alert for signs and symptoms of GI ulceration and bleeding during therapy
- Renal papillary necrosis, renal insufficiency, acute renal failure, and other renal injuries have been associated with the use of piroxicam. It is contraindicated in severe renal impairment
- Piroxicam is not recommended in patients with advanced renal disease. If administered, closely monitor the patient
- Anaphylactoid reactions may occur in patients receiving piroxicam. Avoid using therapy in patients with aspirin triad
- Piroxicam should not be administered to asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm with aspirin or other NSAIDs
- Patients should be aware of the symptoms of serious skin manifestations such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN). Discontinue the drug at the first appearance of skin rash or any other sign of hypersensitivity
- Avoid use of drug in late pregnancy, as it may cause premature closure of the ductus arteriosus
- Elevation ALT or AST have occurred during therapy
- Anemia may occur due to fluid retention or due to occult or gross GI blood loss. Patients having coagulation disorders or receiving anticoagulants should be carefully monitored
- Ophthalmic evaluations are necessary in patients who develop visual complaints during treatment with piroxicam
- Check CBC and chemistry profile in cases of long-term therapy. Monitor blood pressure throughout the treatment period. Check serum creatinine and CrCl in severe renal disease
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- History of gastrointestinal bleeding or ulceration
- Hypertension
- Fluid retention
- Heart failure
- Cardiovascular disease
- Risk of cardiovascular diseases
- Congestive heart failure
- Peptic Ulcer Disease
- Pre-existing asthma
- Coagulation disorder
- Concomitant anticoagulant use
- Concomitant diuretic use
- Concomitant corticosteroid use
- Alcohol use
- Smokers
- Elderly patients
- Dehydration
- Prolonged use
Pregnancy Category:C
Breastfeeding: No published experience with piroxicam during breastfeeding in the newborn period, shorter-acting agents may be preferred while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 19 April 2011). According to manufacturer's data, piroxicam is excreted in breast milk at about 1% to 3% of the maternal concentration. Not recommended for use in nursing mothers.
US Trade Name(s)
US Availability
piroxicam (generic)
Feldene
Canadian Trade Name(s)
Canadian Availability
piroxicam (generic)
Pirox
UK Trade Name(s)
UK Availability
piroxicam (generic)
Brexidol
Australian Trade Name(s)
- Feldene
- Feldene-D
- Mobilis
- Mobilis-D
Australian Availability
piroxicam (generic)
- CAPS: 10, 20 mg
- ODT: 10, 20 mg
Feldene, Mobilis, Mobilis-D
Feldene-D
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Piroxicam 10 MG CAPS [Bottle] (NOSTRUM LABORATORIES)
30 mg = $77.68
60 mg = $135 - Piroxicam 20 MG CAPS [Bottle] (NOSTRUM LABORATORIES)
30 mg = $134.28
60 mg = $254.94 - Feldene 20 MG CAPS [Bottle] (PFIZER U.S.)
30 mg = $175.98
90 mg = $519.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
