II. Indications

  1. See NSAID
  2. FDA approved indications in Adults
    1. Rheumatoid Arthritis
    2. Osteoarthritis

III. Contraindications

  1. See NSAID

IV. Mechanism

  1. See NSAID
  2. NSAID in the Oxicam Class
  3. Piroxicam has a long half life and may be dosed daily
  4. Additional mechanisms beyond inhibition of Prostaglandin synthesis
    1. Inhibits Neutrophil aggregation
    2. Inhibits Lysosome enzyme release

V. Medications

  1. Piroxicam capsules 10 mg, 20 mg

VI. Dosing: Adults

  1. Arthritis (OA, RA): 20 mg orally daily (or divided twice daily)

VII. Adverse Effects

  1. See NSAID

VIII. Safety

  1. See NSAID
  2. Considered safe in Lactation
  3. Avoid NSAIDs in pregnancy outside the first part of the second trimester (13 to 20 weeks)
    1. Teratogenic in first trimester
    2. Risk of premature ductus arteriosus closure in the fetus in third trimester
    3. Most NSAIDs carry a legacy system Pregnancy Category B or C designation (aside from third trimester)
      1. However, many obstetricians avoid NSAIDs entirely in pregnancy (even in second trimester)

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Related Studies

Cost: Medications

piroxicam (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PIROXICAM 10 MG CAPSULE Generic $0.15 each
PIROXICAM 20 MG CAPSULE Generic $0.39 each

Ontology: Piroxicam (C0031990)

Definition (NCI) A nonsteroidal oxicam derivative with anti-inflammatory, antipyretic and analgesic properties. As a non-selective, nonsteroidal anti-inflammatory drug (NSAID), piroxicam binds and chelates both isoforms of cyclooxygenases (COX1 and COX2), thereby stalling phospholipase A2 activity and conversion of arachidonic acid into prostaglandin precursors at the rate limiting cyclooxygenase enzyme step. This results in inhibition of prostaglandin biosynthesis. As a second, independent effect, piroxicam inhibits the activation of neutrophils thereby contributing to its overall anti-inflammatory effects.
Definition (MSH) A cyclooxygenase inhibiting, non-steroidal anti-inflammatory agent (NSAID) that is well established in treating rheumatoid arthritis and osteoarthritis and used for musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily.
Definition (CSP) 4-hydroxy-2-methyl-N-2-pyridyl-2H-1,2- benzothiazine-3-carboxamide- 1,1-dioxide; nonsteroidal antiinflammatory drug (NSAID) which functions by inhibiting prostaglandin synthesis; effective against colon cancer.
Definition (PDQ) A nonsteroidal oxicam derivative with anti-inflammatory, antipyretic and analgesic properties. As a non-selective, nonsteroidal anti-inflammatory drug (NSAID), piroxicam binds and chelates both isoforms of cyclooxygenases (COX1 and COX2), thereby stalling phospholipase A2 activity and conversion of arachidonic acid into prostaglandin precursors at the rate limiting cyclooxygenase enzyme step. This results in inhibition of prostaglandin biosynthesis. As a second, independent effect, piroxicam inhibits the activation of neutrophils thereby contributing to its overall anti-inflammatory effects. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39761&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39761&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C751" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D010894
SnomedCT 363618008, 27754002, 387153005
LNC LP15181-8, MTHU001848
English Piroxicam, 2H-1,2-Benzothiazine-3-carboxamide, 4-hydroxy-2-methyl-N-2-pyridinyl-, 1,1-dioxide, 4-Hydroxy-2-methyl-N-2-pyridinyl-2H-1,2-benzothiazine-3-carboximide-1,1-dioxide, piroxicam, PXM, piroxicam (medication), PIROXICAM, Piroxicam [Chemical/Ingredient], Piroxicam product (substance), Piroxicam product, Piroxicam (product), Piroxicam (substance)
Swedish Piroxikam
Czech piroxikam
Finnish Piroksikaami
Russian PIROKSIKAM, ПИРОКСИКАМ
Japanese ピオパール, フェルデン, バキソ, ピロキシカム
Croatian PIROKSIKAM
Polish Piroksykam
Spanish piroxicam (producto), piroxicam (sustancia), piroxicam, Piroxicam
French Piroxicam
German Piroxicam
Italian Piroxicam
Portuguese Piroxicam