Pirox

Indications

Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling and stiffness in long-term joint conditions such as osteoarthritis, rheumatoid arthritis and ankylosing spondylitis (a type of arthritis affecting the spine). Because of its risk of stomach and skin side effects, it is usually not the first choice and is used when other NSAIDs are not suitable. Gel forms are used for local muscle and joint pain.

How It Works

Piroxicam blocks cyclo-oxygenase (COX) enzymes, which the body uses to make prostaglandins. Prostaglandins are chemicals that cause pain, swelling and fever. Lowering them reduces inflammation and pain. Piroxicam stays in the body a long time, so one dose a day is enough.

Dosage and Administration

Usual adult dose: 20 mg once daily by mouth, taken with or after food and a full glass of water. Some people need only 10 mg daily. The dose should not exceed 20 mg a day. Treatment should be reviewed by a doctor within 14 days. For gel, apply a thin layer to the painful area 3 to 4 times daily or as directed on the label. Use the lowest effective dose for the shortest time.

Interactions

Do not combine with other NSAIDs or Aspirin (except low-dose Aspirin if your doctor advises). Risk of bleeding rises with Warfarin, Clopidogrel, Corticosteroids and SSRI antidepressants. Piroxicam may reduce the effect of blood pressure medicines and diuretics, and may raise levels of Lithium and Methotrexate. Kidney risk is higher with ACE inhibitors, Diuretics and Ciclosporin.

Contraindications

Do not use if you have an active or past stomach ulcer or bleeding, severe heart, liver or kidney failure, asthma or allergy triggered by Aspirin or other NSAIDs, a history of serious skin reactions to any medicine, or in the last 3 months of pregnancy. Not for children.

Side Effects

Common side effects include indigestion, stomach pain, nausea, heartburn, diarrhoea or constipation, headache, dizziness and fluid retention. Piroxicam can cause stomach ulcers and bleeding, raised blood pressure, kidney problems and, rarely, serious skin reactions. Gel may cause local skin redness or sensitivity to sunlight.

Get urgent medical help if you vomit blood, pass black or bloody stools, have chest pain, sudden weakness on one side, shortness of breath, blistering or peeling skin, or swelling of the face and throat.

Pregnancy and Lactation

Avoid in pregnancy unless your doctor advises it, and do not use in the last 3 months, as it can harm the baby's heart and kidneys and delay labour. Small amounts pass into breast milk; ask your doctor before using while breastfeeding.

Precautions and Warnings

Older people are at higher risk of stomach bleeding. Tell your doctor if you have heart disease, high blood pressure, kidney or liver problems, asthma or a bleeding disorder. Your doctor may add a stomach-protecting medicine. Stop and seek advice at the first sign of skin rash. Avoid alcohol and smoking, which increase stomach risk.

Overdose

Overdose can cause nausea, vomiting, stomach pain, drowsiness and, in severe cases, stomach bleeding, kidney failure or seizures. Seek medical help immediately.

Therapeutic Class

Non-steroidal anti-inflammatory drug (NSAID), oxicam group.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.