Piroxicam
FELDENE
Pronunciation: peer-OX-i-kam
“Pirate rocks a cam (and it) Fell down”
“The N said... NSAID”
What it isLong-acting non-selective NSAID; arthritis.
Why this oneA half-life long enough for once-daily dosing.
What limits itThe highest GI bleeding risk of the common NSAIDs, and the long half-life prolongs any toxicity. It raises serum lithium.
FDA-approved for
- arthritis (1982)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Osteoarthritis and rheumatoid arthritis | Adult | 20 mg QD | 20 mg QD (may divide) | 20 mg QD |
Renal Avoid in advanced renal disease unless benefit outweighs risk; monitor renal function in renal/hepatic impairment, HF, dehydration, or hypovolemia
Hepatic Monitor; discontinue if abnormal liver tests persist or worsen or signs of liver disease develop
Instructions
- Use lowest effective dose for shortest duration
- Steady-state not reached for 7-12 days; do not assess effect for 2 weeks
- Avoid at ≈30 weeks gestation and later; limit use 20-30 weeks gestation
Available strengths
- cap 10, 20 mg
Contraindications
- History of asthma, urticaria, or other allergic-type reactions after aspirin or other NSAIDs
- In the setting of CABG surgery
Cautions
- CV thrombotic events
- GI bleeding, ulceration, and perforation
- Hepatotoxicity
- Hypertension
- Heart failure and edema
- Renal toxicity and hyperkalemia
- Anaphylactic reactions
- Aspirin-sensitive asthma
- Serious skin reactions and DRESS
- Fetal toxicity (oligohydramnios, premature ductus closure)
- Hematologic toxicity/anemia
Adverse reactions
- Nausea
- Constipation
- Flatulence
- Abdominal pain
- Diarrhea
- Headache
- Dizziness
- Edema
- Rash
Pregnancy Avoid at ≈30 wk gestation and later (premature ductus arteriosus closure); limit 20-30 wk (oligohydramnios/fetal renal dysfunction).
Lactation Piroxicam is excreted in human milk at ~1-3% of maternal concentration.
Cost
Generic entry1992
⚠ BOXED WARNINGS
- Cardiovascular thrombotic events
- Gastrointestinal bleeding, ulceration and perforation
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityGI bleeding, kidney injury, hypertension and fluid retention; many agents increase lithium concentrations.
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