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Piroxicam: Drug information

Piroxicam: Drug information
(For additional information see "Piroxicam: Patient drug information" and see "Piroxicam: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Cardiovascular thrombotic events:

NSAIDs cause an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI) and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.

Piroxicam is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.

Gastrointestinal bleeding, ulceration, and perforation:

NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

Brand Names: US
  • Feldene
Brand Names: Canada
  • APO-Piroxicam;
  • TEVA-Piroxicam
Pharmacologic Category
  • Analgesic, Nonopioid;
  • Nonsteroidal Anti-inflammatory Drug (NSAID), Oral
Dosing: Adult

Note: S afety: Use the lowest effective dose for the shortest duration of time. Avoid or use with caution in patients at risk for or with existing cardiovascular disease, GI disease, kidney impairment, chronic liver disease, or a bleeding diathesis due to greater risk for adverse events. Consider administering in combination with a proton pump inhibitor in patients at risk for GI bleeding (eg, taking dual antiplatelet therapy or an anticoagulant, ≥60 years of age, high doses) (Ref).

Ankylosing spondylitis

Ankylosing spondylitis (off-label use): Oral: 10 to 20 mg/day in 1 to 2 divided doses (Ref).

Osteoarthritis, rheumatoid arthritis

Osteoarthritis, rheumatoid arthritis: Oral: 20 mg once daily.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

Mild to moderate impairment: There are no dosage adjustments provided in the manufacturer’s labeling.

Severe impairment: Use is not recommended (has not been studied); if therapy must be initiated, close monitoring is recommended.

KDIGO 2012 guidelines provide the following recommendations for NSAIDs:

eGFR 30 to <60 mL/minute/1.73 m2: Temporarily discontinue in patients with intercurrent disease that increases risk of acute kidney injury.

eGFR <30 mL/minute/1.73 m2: Avoid use.

Dosing: Hepatic Impairment: Adult

Hepatic impairment prior to treatment initiation:

There are no specific dosage adjustments provided in the manufacturer’s labeling; however, a dosage reduction is recommended.

Hepatotoxicity during treatment:

Discontinue treatment if clinical signs and symptoms consistent with liver disease develop or if systemic manifestations occur.

Dosing: Older Adult

Note: Unless alternative agents are ineffective and a gastroprotective agent can be administered, avoid short-term scheduled use in combination with corticosteroids, anticoagulants, or antiplatelet agents or chronic use with or without medications that increase risk for bleeding (Ref).

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Piroxicam: Pediatric drug information")

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA): Limited data available: Children and Adolescents: Oral: 0.2 to 0.4 mg/kg/day once daily; maximum daily dose: 20 mg/day (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no pediatric-specific dosage adjustments provided in the manufacturer's labeling; some experts have suggested the following:

KDIGO 2012 guidelines provide the following recommendations for NSAIDs (KDIGO 2013): Children and Adolescents:

eGFR 30 to <60 mL/minute/1.73 m2: Temporarily discontinue in patients with intercurrent disease that increases risk of acute kidney injury

eGFR <30 mL/minute/1.73 m2: Avoid use

Dosing: Hepatic Impairment: Pediatric

There are no specific dosage adjustments provided in manufacturer's labeling; however, based on experience in adult patients, dosage adjustment suggested

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Cardiovascular: Edema

Dermatologic: Pruritus, skin rash

Gastrointestinal: Abdominal pain, anorexia, constipation, diarrhea, flatulence, nausea, vomiting

Nervous system: Dizziness, headache, vertigo

Otic: Tinnitus

<1%:

Cardiovascular: Palpitations

Gastrointestinal: Stomatitis

Nervous system: Drowsiness

Ophthalmic: Blurred vision

Frequency not defined:

Cardiovascular: Cerebrovascular accident, coronary thrombosis

Gastrointestinal: Gastrointestinal inflammation

Postmarketing:

Cardiovascular: Acute myocardial infarction, cardiac arrhythmia, cardiac failure, exacerbation of angina pectoris, hypertension, hypotension, syncope, tachycardia, vasculitis

Dermatologic: Alopecia, desquamation, diaphoresis, ecchymoses, erythema multiforme, erythema of skin, exfoliative dermatitis, onycholysis, skin photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, vesiculobullous reaction

Endocrine & metabolic: Fluid retention, hyperglycemia, hyperkalemia, hypoglycemia, weight changes

Gastrointestinal: Change in appetite, dyspepsia, eructation, esophagitis, gastritis, gastrointestinal hemorrhage, gastrointestinal perforation, gastrointestinal ulcer (including duodenal ulcer and gastric ulcer), glossitis, heartburn, hematemesis, melena, pancreatitis, xerostomia

Genitourinary: Cystitis, dysuria, female infertility, hematuria, nephrotic syndrome, oliguria, proteinuria

Hematologic & oncologic: Agranulocytosis, anemia, aplastic anemia, bruise, eosinophilia, hemolytic anemia, leukopenia, lymphadenopathy, pancytopenia, petechial rash, positive ANA titer, prolonged bleeding time, purpuric disease, rectal hemorrhage, thrombocytopenia

Hepatic: Hepatic failure, hepatitis, hepatotoxicity (idiosyncratic) (Chalasani 2014), increased liver enzymes, jaundice

Hypersensitivity: Anaphylaxis, angioedema, serum sickness

Immunologic: Drug reaction with eosinophilia and systemic symptoms (Bizid 2014)

Infection: Infection, sepsis

Nervous system: Abnormal dreams, akathisia, anxiety, colic, coma, confusion, depression, hallucination, insomnia, malaise, meningitis, mood changes, nervousness, paresthesia, seizure

Neuromuscular & skeletal: Asthenia, tremor

Ophthalmic: Conjunctivitis, swelling of eye

Otic: Auditory impairment

Renal: Glomerulonephritis, interstitial nephritis, polyuria, renal failure syndrome, renal function abnormality

Respiratory: Asthma, dyspnea, epistaxis, flu-like symptoms, pneumonia, respiratory depression

Miscellaneous: Fever

Contraindications

Hypersensitivity to piroxicam or to any component of the formulation; patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs; in the setting of coronary artery bypass graft (CABG) surgery.

Canadian labeling: Additional contraindications (not in US labeling): Active GI bleeding or recent or recurrent history of GI bleeding; active gastric/duodenal/peptic ulcer; active GI inflammatory disease; inflammatory bowel disease; cerebrovascular bleeding or other bleeding disorders; severe liver impairment or active liver disease; severe renal impairment (CrCl <30 mL/minute) or deteriorating renal disease; known hyperkalemia; children and adolescents <16 years of age; use in the third trimester of pregnancy; breast-feeding, severe uncontrolled heart failure

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactoid reactions: Even in patients without prior exposure anaphylactoid reactions may occur; patients with "aspirin triad" (bronchial asthma, aspirin intolerance, rhinitis) may be at increased risk. Contraindicated use in patients who experience bronchospasm, asthma, rhinitis, or urticaria with nonsteroidal anti-inflammatory drug (NSAID) or aspirin therapy.

• Cardiovascular events: Relative risk of serious adverse cardiovascular thrombotic events appears to be similar in those with and without known cardiovascular disease or risk factors for cardiovascular disease; however, absolute incidence of cardiovascular events (which may occur early during treatment) was higher in patients with known cardiovascular disease or risk factors. New-onset hypertension or exacerbation of hypertension may occur (NSAIDs may also impair response to angiotensin-converting enzyme [ACE] inhibitors, thiazide diuretics, or loop diuretics); may contribute to cardiovascular events; monitor BP; use with caution in patients with hypertension. May cause sodium and fluid retention, use with caution in patients with edema. Avoid use in patients with heart failure (FDA 2015). Avoid use in patients with recent myocardial infarction (MI) unless benefits outweigh risk of cardiovascular thrombotic events. Use the lowest effective dose for the shortest duration of time, consistent with individual patient goals, to reduce risk of cardiovascular events; alternate therapies should be considered for patients at high risk.

• CNS effects: May cause drowsiness, dizziness, blurred vision, and other neurologic effects that may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery, driving). Discontinue use with blurred or diminished vision and perform ophthalmologic exam. Periodically evaluate vision in all patients receiving long term therapy.

• Drug reaction with eosinophilia and systemic symptoms: Potentially serious, sometimes fatal, drug reaction with eosinophilia and systemic symptoms (DRESS), also known as multiorgan hypersensitivity reactions, has been reported with NSAIDs. Monitor for signs and symptoms (eg, fever, rash, lymphadenopathy, eosinophilia) in association with other organ system involvement (eg, hepatitis, nephritis, hematological abnormalities, myocarditis, myositis). Early symptoms of hypersensitivity reaction (eg, lymphadenopathy, fever) may occur without rash; discontinue therapy and further evaluate if DRESS is suspected.

• GI events: Avoid use in patients with active GI bleeding due to increased risk of serious GI events. In patients with a history of acute lower GI bleeding, avoid use of nonaspirin NSAIDs, especially if due to angioectasia or diverticulosis (Strate 2016). Use caution with a history of GI ulcers, concurrent therapy known to increase the risk of GI bleeding (eg, aspirin, anticoagulants and/or corticosteroids, selective serotonin reuptake inhibitors), smoking, use of alcohol, or in elderly or debilitated patients. Use the lowest effective dose for the shortest duration of time, consistent with individual patient goals, to reduce risk of GI adverse events; alternate therapies should be considered for patients at high risk. When used concomitantly with aspirin, a substantial increase in the risk of GI complications (eg, ulcer) occurs; concomitant gastroprotective therapy (eg, proton pump inhibitors) is recommended (Bhatt 2008).

• Hematologic effects: Platelet adhesion and aggregation may be decreased; may prolong bleeding time; patients with coagulation disorders or who are receiving anticoagulants should be monitored closely. Anemia may occur; patients on long-term NSAID therapy should be monitored for anemia. Rarely, NSAID use has been associated with potentially severe blood dyscrasias (eg, agranulocytosis, thrombocytopenia, aplastic anemia).

• Hepatic effects: Transaminase elevations have been reported with use. Rare (sometimes fatal), severe hepatic reactions (eg, fulminant hepatitis, hepatic necrosis, hepatic failure) have occurred with NSAID use; discontinue if signs or symptoms of liver disease develop, if systemic manifestations occur, or with persistent or worsening abnormal hepatic function tests

• Hyperkalemia: NSAID use may increase the risk of hyperkalemia, particularly in the elderly, diabetics, renal disease, and with concomitant use of other agents capable of inducing hyperkalemia (eg, ACE-inhibitors). Monitor potassium closely.

• Renal effects: NSAID use may compromise existing renal function; dose-dependent decreases in prostaglandin synthesis may result from NSAID use, reducing renal blood flow, which may cause renal decompensation. Patients with impaired renal function, dehydration, hypovolemia, heart failure, liver dysfunction, those taking diuretics, and ACE inhibitors, angiotensin II receptor blockers, and the elderly are at greater risk of renal toxicity. Rehydrate patient before starting therapy; monitor renal function closely. Long-term NSAID use may result in renal papillary necrosis

• Serum sickness: A serum sickness–like reaction can rarely occur; signs and symptoms include arthralgias, pruritus, fever, fatigue, and rash.

• Skin reactions: NSAIDs may cause serious skin adverse events including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis; discontinue use at first sign of skin rash or hypersensitivity.

Disease-related concerns:

• Asthma: Do not administer to patients with aspirin-sensitive asthma; severe bronchospasm may occur. Use caution in patients with other forms of asthma.

• Bariatric surgery: Gastric ulceration: Avoid chronic use of oral nonselective NSAIDs after bariatric surgery; development of anastomotic ulcerations/perforations may occur (Bhangu 2014; Mechanick 2020). Short-term use of celecoxib or IV ketorolac are recommended as part of a multimodal pain management strategy for postoperative pain (Chou 2016; Horsley 2019; Thorell 2016).

• Coronary artery bypass graft surgery: Risk of MI and stroke may be increased with use following coronary artery bypass graft surgery.

• Hepatic impairment: Use with caution in patients with decreased hepatic function.

• Hypertension: Use with caution; may cause new-onset hypertension or worsening of existing hypertension. Monitor BP closely with initiation and during piroxicam therapy.

• Renal impairment: Avoid use in patients with advanced renal disease; discontinue use with persistent or worsening abnormal renal function tests.

Special populations:

• Poor CYP2C9 metabolizers: Use with caution; hepatic metabolism may be reduced resulting in elevated serum concentrations.

Other warnings/precautions:

• Surgical/dental procedures: Withhold for at least 4 to 6 half-lives prior to surgical or dental procedures.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Feldene: 10 mg, 20 mg

Generic: 10 mg, 20 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsules (Feldene Oral)

10 mg (per each): $9.88

20 mg (per each): $16.91

Capsules (Piroxicam Oral)

10 mg (per each): $1.62 - $2.60

20 mg (per each): $2.59 - $4.49

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Generic: 10 mg, 20 mg

Administration: Adult

Oral: May administer in a single daily dose or divide twice daily. May take with food or milk to decrease GI upset.

Administration: Pediatric

Oral: May administer with food or milk to decrease GI upset

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/018147s050lbl.pdf#page=21, must be dispensed with this medication.

Use: Labeled Indications

Arthritis: Relief of signs and symptoms of osteoarthritis and rheumatoid arthritis.

Use: Off-Label: Adult

Ankylosing spondylitis

Medication Safety Issues
Sound-alike/look-alike issues:

Feldene may be confused with FLUoxetine

Piroxicam may be confused with PARoxetine

Older Adult: High-Risk Medication:

Beers Criteria: Piroxicam is identified in the Beers Criteria as a potentially inappropriate medication to be avoided for chronic use in patients 65 years and older (unless alternative agents ineffective and patient can receive concomitant gastroprotective agent) due to increased risk of GI bleeding and peptic ulcer disease in older adults in high-risk category (eg, older than 75 years of age or receiving concomitant oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents). In addition, avoid for short-term scheduled use in combination with oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents unless alternatives are ineffective and patient can receive concomitant gastroprotective agent (Beers Criteria [AGS 2023]).

International issues:

Flogene [Brazil] may be confused with Flogen brand name for naproxen [Mexico]; Florone brand name for diflorasone [Germany, Greece]; Flovent brand name for fluticasone [US, Canada]

Metabolism/Transport Effects

Substrate of CYP2C9 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of 5-Aminosalicylic Acid Derivatives. Risk C: Monitor therapy

Abrocitinib: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the antiplatelet effect of Abrocitinib. Risk X: Avoid combination

Acalabrutinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Acemetacin: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid combination

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): May enhance the antiplatelet effect of other Agents with Antiplatelet Properties. Risk C: Monitor therapy

Alcohol (Ethyl): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. Risk C: Monitor therapy

Aliskiren: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Risk C: Monitor therapy

Aminoglycosides: Nonsteroidal Anti-Inflammatory Agents may decrease the excretion of Aminoglycosides. Data only in premature infants. Risk C: Monitor therapy

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Anagrelide: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Angiotensin II Receptor Blockers: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Anticoagulants: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Risk C: Monitor therapy

Apixaban: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Apixaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of apixaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Bemiparin: Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin and nonsteroidal anti-inflammatory agents (NSAIDs) due to the increased risk of bleeding. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Bemiparin: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Beta-Blockers: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Beta-Blockers. Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Bisphosphonate Derivatives: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern. Risk C: Monitor therapy

Caplacizumab: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Caplacizumab. Specifically, the risk of bleeding may be increased. Management: Avoid coadministration of caplacizumab with antiplatelets if possible. If coadministration is required, monitor closely for signs and symptoms of bleeding. Interrupt use of caplacizumab if clinically significant bleeding occurs. Risk D: Consider therapy modification

Cephalothin: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased. Risk C: Monitor therapy

Collagenase (Systemic): Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and or bleeding may be increased. Risk C: Monitor therapy

Corticosteroids (Systemic): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor therapy

CycloSPORINE (Systemic): Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. Management: Consider alternatives to nonsteroidal anti-inflammatory agents (NSAIDs). Monitor for evidence of nephrotoxicity, as well as increased serum cyclosporine concentrations and systemic effects (eg, hypertension) during concomitant therapy with NSAIDs. Risk D: Consider therapy modification

Dabigatran Etexilate: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of dabigatran and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Dasatinib: May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Deferasirox: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy

Deoxycholic Acid: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased. Risk C: Monitor therapy

Desmopressin: Nonsteroidal Anti-Inflammatory Agents may enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

Digoxin: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Digoxin. Risk C: Monitor therapy

Drospirenone-Containing Products: May enhance the hyperkalemic effect of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Edoxaban: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of edoxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Enoxaparin: Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue nonsteroidal anti-inflammatory agents (NSAIDs) prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Enoxaparin: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Eplerenone: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone. Risk C: Monitor therapy

Heparin: Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or nonsteroidal anti-inflammatory agents (NSAIDs) if coadministration is required. Risk D: Consider therapy modification

Heparin: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required. Risk D: Consider therapy modification

Herbal Products with Anticoagulant/Antiplatelet Effects (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Risk C: Monitor therapy

Herbal Products with Anticoagulant/Antiplatelet Effects (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Bleeding may occur. Risk C: Monitor therapy

HydrALAZINE: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of HydrALAZINE. Risk C: Monitor therapy

Ibritumomab Tiuxetan: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding. Risk C: Monitor therapy

Ibrutinib: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Icosapent Ethyl: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Inotersen: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Ketorolac (Nasal): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid combination

Ketorolac (Systemic): Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Ketorolac (Systemic). Risk X: Avoid combination

Lecanemab: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of hemorrhage may be increased. Risk C: Monitor therapy

Limaprost: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Lipid Emulsion (Fish Oil Based): May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Lithium: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Lithium. Management: Consider reducing the lithium dose when initiating a NSAID. Monitor for increased lithium therapeutic/toxic effects if a NSAID is initiated/dose increased, or decreased effects if a NSAID is discontinued/dose decreased. Risk D: Consider therapy modification

Loop Diuretics: Nonsteroidal Anti-Inflammatory Agents may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. Risk D: Consider therapy modification

Macimorelin: Nonsteroidal Anti-Inflammatory Agents may diminish the diagnostic effect of Macimorelin. Risk X: Avoid combination

MetFORMIN: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of MetFORMIN. Risk C: Monitor therapy

Methotrexate: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Methotrexate. Management: Avoid coadministration of higher dose methotrexate (such as that used for the treatment of oncologic conditions) and NSAIDs. Use caution if coadministering lower dose methotrexate and NSAIDs. Risk D: Consider therapy modification

Methoxsalen (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Methoxsalen (Systemic). Risk C: Monitor therapy

Mifamurtide: Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Mifamurtide. Risk X: Avoid combination

Multivitamins/Fluoride (with ADE): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Multivitamins/Minerals (with AE, No Iron): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Naftazone: May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May enhance the adverse/toxic effect of other Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk for gastrointestinal toxicity is increased. Risk X: Avoid combination

Nonsteroidal Anti-Inflammatory Agents (Topical): May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of gastrointestinal (GI) toxicity is increased. Management: Coadministration of systemic nonsteroidal anti-inflammatory drugs (NSAIDs) and topical NSAIDs is not recommended. If systemic NSAIDs and topical NSAIDs, ensure the benefits outweigh the risks and monitor for increased NSAID toxicities. Risk D: Consider therapy modification

Obinutuzumab: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased. Risk C: Monitor therapy

Omacetaxine: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Risk C: Monitor therapy

Omega-3 Fatty Acids: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Pentosan Polysulfate Sodium: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents. Risk C: Monitor therapy

Pentoxifylline: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Phenylbutazone: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid combination

Pirtobrutinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Potassium Salts: Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy

Potassium-Sparing Diuretics: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

PRALAtrexate: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Avoid coadministration of pralatrexate with nonsteroidal anti-inflammatory drugs (NSAIDs). If coadministration cannot be avoided, closely monitor for increased pralatrexate serum levels or toxicity. Risk D: Consider therapy modification

Probenecid: May increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Prostaglandins (Ophthalmic): Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic). Risk C: Monitor therapy

Quinolones: Nonsteroidal Anti-Inflammatory Agents may enhance the neuroexcitatory and/or seizure-potentiating effect of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Quinolones. Risk C: Monitor therapy

Rivaroxaban: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of rivaroxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

Salicylates: Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Salicylates. An increased risk of bleeding may be associated with use of this combination. Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the cardioprotective effect of Salicylates. Salicylates may decrease the serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Management: Nonselective NSAIDs may reduce aspirin's cardioprotective effects. Administer ibuprofen 30-120 minutes after immediate-release aspirin, 2 to 4 hours after extended-release aspirin, or 8 hours before aspirin. Risk D: Consider therapy modification

Selective Serotonin Reuptake Inhibitors: May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk. Risk D: Consider therapy modification

Selumetinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor therapy

Sincalide: Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider therapy modification

Sodium Phosphates: May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor therapy

Tacrolimus (Systemic): Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tacrolimus (Systemic). Risk C: Monitor therapy

Tenofovir Products: Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose due to a potential risk of acute renal failure. Diclofenac appears to confer the most risk. Risk D: Consider therapy modification

Tenoxicam: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Risk X: Avoid combination

Thiazide and Thiazide-Like Diuretics: May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Thrombolytic Agents: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents. Risk C: Monitor therapy

Tipranavir: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Tolperisone: Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may enhance the therapeutic effect of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Tricyclic Antidepressants: May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of major adverse cardiac events (MACE), hemorrhagic stroke, ischemic stroke, and heart failure may be increased. Tricyclic Antidepressants may enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Urokinase: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase. Risk X: Avoid combination

Vancomycin: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Vancomycin. Risk C: Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Vitamin E (Systemic): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the anticoagulant effect of Vitamin K Antagonists. Management: Consider alternatives to this combination when possible. If the combination must be used, monitor coagulation status closely and advise patients to promptly report any evidence of bleeding or bruising. Risk D: Consider therapy modification

Zanubrutinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Food Interactions

Onset of effect may be delayed if piroxicam is taken with food. Management: May administer with food or milk to decrease GI upset.

Reproductive Considerations

Nonsteroidal anti-inflammatory drugs (NSAIDs) may delay or prevent rupture of ovarian follicles. This may be associated with infertility that is reversible upon discontinuation of the medication. Consider discontinuing use in patients having difficulty conceiving or those undergoing investigation of fertility.

Based on available information, NSAIDs can be continued in males with rheumatic and musculoskeletal diseases who are planning to father a child (ACR [Sammaritano 2020]).

Pregnancy Considerations

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) close to conception may be associated with an increased risk of miscarriage due to cyclooxygenase-2 inhibition interfering with implantation (Bermas 2014; Bloor 2013).

Birth defects have been observed following in utero NSAID exposure in some studies; however, data are conflicting (Bloor 2013). Nonteratogenic effects, including prenatal constriction of the ductus arteriosus, persistent pulmonary hypertension of the newborn, oligohydramnios, necrotizing enterocolitis, renal dysfunction or failure, and intracranial hemorrhage have been observed in the fetus/neonate following in utero NSAID exposure (Bermas 2014; Bloor 2013). Maternal NSAID use may cause fetal renal dysfunction leading to oligohydramnios. Although rare, this may occur as early as 20 weeks' gestation and is more likely to occur with prolonged maternal use. Oligohydramnios may be reversible following discontinuation of the NSAID (Dathe 2019; FDA 2020). In addition, nonclosure of the ductus arteriosus postnatally may occur and be resistant to medical management (Bermas 2014; Bloor 2013).

Maternal use of NSAIDs should be avoided beginning 20 weeks' gestation. If NSAID use is necessary between 20 and 30 weeks' gestation, limit use to the lowest effective dose and shortest duration possible; consider ultrasound monitoring of amniotic fluid if treatment extends beyond 48 hours and discontinue the NSAID if oligohydramnios is found (FDA 2020). Because NSAIDs may cause premature closure of the ductus arteriosus, product labeling for piroxicam specifically states use should be avoided starting at 30 weeks' gestation.

Based on available information, NSAIDs can be continued during the first 2 trimesters of pregnancy in patients with rheumatic and musculoskeletal diseases; use in the third trimester is not recommended (ACR [Sammaritano 2020]).

Breastfeeding Considerations

Piroxicam is present in breast milk.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered compatible for the treatment of rheumatic and musculoskeletal diseases in lactating patients; agents with a short half-life and established safety data in infants may be preferred (ACR [Sammaritano 2020]).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother. Maternal use of NSAIDs should be avoided if the breastfeeding infant has platelet dysfunction, thrombocytopenia, or a ductal-dependent cardiac lesion (ABM [Martin 2018]; ABM [Reece-Stremtan 2017]; Bloor 2013).

Dietary Considerations

May be taken with food or milk to decrease GI adverse effect.

Monitoring Parameters

Occult blood loss, hemoglobin, hematocrit, electrolytes, and periodic renal and hepatic function tests; periodic ophthalmologic exams with chronic use

Mechanism of Action

Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors; has antipyretic, analgesic, and anti-inflammatory properties

Other proposed mechanisms not fully elucidated (and possibly contributing to the anti-inflammatory effect to varying degrees), include inhibiting chemotaxis, altering lymphocyte activity, inhibiting neutrophil aggregation/activation, and decreasing proinflammatory cytokine levels.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Analgesia: Oral: Within 1 hour; Maximum effect: 3 to 5 hours

Absorption: Oral: Well absorbed

Distribution: Vd:

Children and Adolescents 7 to 16 years: 0.16 L/kg; Range: 0.12 to 0.25 L/kg (Mäkelä 1991)

Adults: 0.14 L/kg

Protein binding: 99%

Metabolism: Hepatic predominantly via CYP2C9; metabolites are inactive

Half-life elimination:

Children and Adolescents 7 to 16 years: 32.6 hours; Range: 22 to 40 hours (Mäkelä 1991)

Adults: 50 hours

Time to peak: 3 to 5 hours

Excretion: Primarily urine and feces (small amounts) as unchanged drug (5%) and metabolites

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: Effect not established; however, the drug is extensively metabolized in the liver and may require reduced doses.

CYP2C9 polymorphisms: Higher systemic exposure has been noted.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Apo piroxicam | Feldene | Riacen | Unicam;
  • (AR) Argentina: Axis | Brionot | Fada piroxicam | Feldene | Osteocalmine | Roxicam;
  • (AT) Austria: Felden | Piroxicam arcana;
  • (AU) Australia: Candyl | Cm piroxicam | Dbl piroxicam | Feldene | Genrx piroxicam | Mobilis | Rosig | Tw piroxicam;
  • (BD) Bangladesh: Flexicam | Rheudene;
  • (BE) Belgium: Feldene | Piroxicam eurogenerics | Piroxicam merck-generics | Solicam;
  • (BF) Burkina Faso: Feldene | Vitaxicam;
  • (BG) Bulgaria: Feldene | Hotemin | Piroxicam alkaloid | Remoxicam | Sotilen;
  • (BR) Brazil: Anartrit | Anflene | Farmoxicam | Feldanax | Feldene | Feldox | Feldran | Flamadene | Flamostat | Flogene | Floxicam | Inflamene | Inflanan | Inflanox | Inflax | Lisedema | Pirfel | Piroflam | Pirogreen | Piroxan | Piroxene | Piroxiflam | Piroxil | Piroxin | Piroxinid | Piroxiplus | Reumaxican;
  • (CH) Switzerland: Felden | Piroxicam merck;
  • (CI) Côte d'Ivoire: Adco-piroxicam | Feldene | Zildam;
  • (CL) Chile: Dapase | Fabudol | Feldene | Pricam;
  • (CN) China: Ou hua ji wei;
  • (CO) Colombia: Arantil | Astroxican | Bursicam | Centrol | Dolpirox | Feldene | Fex | Flexicam | Kydoflam | Lumbaxen | Monidem | Movilil | Orfakan | Osteosan | Oxifar | Oxivate | Piroxedol | Piroxicam mk | Piroxim | Piroxinil | Proxigel | Rokso | Sindexan | Stopen | Veran D | Zyray;
  • (CZ) Czech Republic: Apo piroxicam | Arthremin | Hotemin;
  • (DE) Germany: Durapirox | Felden | Feldene | Piroflam | Piroxicam M8v | Piroxicam Stada | Piroximerck;
  • (DO) Dominican Republic: Antiflog | Bruxicam | Facicam | Feldene | Fradene | Gelprox | Icalex | Improntal | Inoxicam | Novoxicam | Piroxed | Piroxicam mk | Proxicam | Trixicam | Vitaxicam;
  • (EC) Ecuador: Artronil | Feldene | Italpyd | Piroxicam Genfar | Piroxicam mk | Piroxim;
  • (EE) Estonia: Erazon | Feldene | Piroxicam alpharma;
  • (EG) Egypt: Feldene | Feldoral | Inflacam | Peroxiden | Piroxam | Piroxiden | Vendocid;
  • (ES) Spain: Doblexan | Feldene | Improntal | Piroxicam pharmagenus | Piroxicam Ratiopharm | Piroxicam tamarang | Piroxicam ur | Piroxican reig | Salvacam | Sasulen | Vitaxicam;
  • (FI) Finland: Dacam | Felden | Pirom;
  • (FR) France: Feldene | Flexirox | Inflaced | Olcam | Piroxicam biogaran | Piroxicam Cristers | Piroxicam gnr | Piroxicam irex | Piroxicam ivax | Piroxicam Jumer | Piroxicam merck | Piroxicam pfizer | Piroxicam Ratiopharm | Piroxicam rpg | Piroxicam sandoz | Piroxicam Teva | Piroxicam zydus | Zofora;
  • (GB) United Kingdom: Feldene | Flamatrol | Larapam | Piroflam | Piroxicam arrow | Piroxicam berk | Piroxicam cox | Piroxicam kent | Piroxicam sandoz | Pirozip;
  • (GH) Ghana: Letacam;
  • (GR) Greece: Bleduran | Calmopyrol | Feldene | Flodeneu | Grecotens | Neo axedil | Pedifan | Proponol | Pyrcost | Ruvamed | Valopon | Zerospasm | Zitumex;
  • (HK) Hong Kong: Apo piroxicam | Axcel Piroxicam | Cp Pirox | Fedcovit | Feldene | Felticam | Felxicam | Flamic | Foldcam | Goodgen | Hotemin | Karoxicam | Mobilis | Pericam | Pirocam | Pirux | Sefdene | Sotilen | Synoxicam;
  • (HR) Croatia: Erazon | Lubor;
  • (HU) Hungary: Feldene | Hotemin | Huma-pirocam | Piroxicam-b | Piroxicam-jenapharm;
  • (ID) Indonesia: Arpyrox | Benoxicam | Bitrafarm | Campain | Dains | Denicam | Emelden | Felcam | Feldco | Feldene | Indene | Infeld | Lanareuma | Licofel | Maxicam | Mepirox | Miradene | Omeretic | Pirocam | Pirodene | Pirofel | Rexicam | Rexil | Rheumaden | Rosic | Roxidene | Scandene | Sofden | Tropidene | Wiros | Xicalom;
  • (IE) Ireland: Feldene | Geroxicam | Pericam;
  • (IL) Israel: Feldene;
  • (IN) India: Amida | Brexic | Dolonex | Doloswift | Ecwin | Flexar | Mobidin | Modact | Movon | Piricam | Pirox | Prostaloc | Ranset | Roxicam | Zeepain;
  • (IQ) Iraq: Safaxicam;
  • (IT) Italy: Antiflog | Artroxicam | Bruxicam | Dexicam | Euroxi | Feldene | Flodol | Flogobene | Lampoflex | Oxicam | Piroxicam doc | Piroxicam eg | Piroxicam jet | Polipirox | Reucam | Reumagil | Riacen | Roxene | Roxenil | Roxiden | Zacam;
  • (JO) Jordan: Feldene | Orthocam | Pirox | Reucam | Roxam | Sotilen | Unicam;
  • (JP) Japan: Alvilack | Alvilack sato | Alvilack taiyo | Alvilack wakamoto | Amtenen | Arudein | Arudein choseido | Baxo | Boues isei | Boues merck hoei | Boues teisan | Feldene | Kimetagin | Kyowacalm | Lumeleem mikasa | Lumeleem takeshima | Palpasin | Piatec | Pilipo | Pilipo ohta | Pilipo teiyaku | Pioparu | Pipethanen | Pirokiparl | Pyrocarmin | Ravisulin;
  • (KE) Kenya: Caroxicam | Cupirox | Feldene | Feldoral | Pirocam | Piromed | Piroxy | Pyromax | Redene | Roxicam;
  • (KR) Korea, Republic of: Comcam | Daehwa piroxicam | Felcam | Felcicam | Feldene | Fulden | Konycam | Nalcicam | Paldon | Paxiden | Pilactam | Pilcam | Pillozen | Pirocam | Piroctam | Polten | Riopan | Rocam | Rosiden | Rotan | Talocam | Tauros | Unicam | Vicam | Yucam;
  • (KW) Kuwait: Feldene | Orthocam;
  • (LB) Lebanon: Apo piroxicam | Feldene | Piroxicalm | Riacen | Vitaxicam;
  • (LT) Lithuania: Apo piroxicam | Arthremin | Calmopyrol | Erazon | Feldene | Hotemin | Pirox;
  • (LU) Luxembourg: Feldene | Solicam;
  • (LV) Latvia: Apo piroxicam | Arthremin | Calmopyrol | Erazon | Feldene | Pirox | Piroxicam Teva;
  • (MA) Morocco: Apo-pirocam | Feldene | Oxiden | Remox | Reumoxican | Riacen | Roxam | Solicam | Zildam;
  • (MX) Mexico: Ainek | Apopiran | Arbest | Artricam | Artyflam | Asabon | Bapixied | Brexodin | Citoken | Dolzycam | Eucam | Facicam | Feldene | Flogosan | Genoldene | Laspiro | Oxicanol | Pirodax | Pirox | Piroxicam gi merck | Piroxicam gi serra | Reutricam | Ripox | Rocugen | Serpicam | Zuparex;
  • (MY) Malaysia: Apo piroxicam | Axcel Piroxicam | Feldene | Felxicam | Meldene | Pirodene | Pirox | Piroxica | Piroxicap | Piroxy | Rosiden | Roxicam | Roxim | Uphaxicam;
  • (NG) Nigeria: Archy arixica | Auscel piroxicam | Brawn lab piroxicam | Edm piroxicam | Educam | Emxicam | Fedigyn | Felcur | Felgin | Felmicam | Felmor | Feloxin | Felrox | Felvcard | Felxicam | Ferex | Fizycam | Gevicam | Gimbacam | Grexicam | Ibu piroxicam | Inflacam | Jessecam | Jozocam | Juroxicam | Krishat piroxicam | Kucam | Liricon piroxicam | Machdech | Mckenzie piroxicam | Mf 20 | Nelb piroxicam | Neroxicam | Nolyxicam | Odivin | Pemaxicam | Phomcam | Pirofit | Piromax | Pironet | Piroxbase | Rccam | Ricam | Samjones | Shree piroxicam | Softhealth piroxicam | Softland piroxicam | Spevin | Stacam | Ulticam | Unicure piroxicam | Vadis piroxicam | Vaxicam | Zonason piroxicam;
  • (NO) Norway: Felden;
  • (PE) Peru: Apo-piroxican | Atidem | Feldene | Ginoxicam | Movilil | Piraldene | Piroxiden;
  • (PH) Philippines: Feldene | Flaxine | Kapirox | Neperlan | Palpasin | Parixam | Piroxikin | Proximax | Troxiflam;
  • (PK) Pakistan: Aksocam | Alxicam | Axicam | Bepirox | Brexidol | Brozicam | Bruxicam | Camcard | Campro | Camtrin | Capirox | Dolonex | Ericam | Fedracam | Felaxicam | Felcam | Feldene | Feldetrol | Fesmocom | Figlex | Foster | Fycam | Gelcam | Gloxi | Jucam | Leecam | M-piro | M-Quin | Magcam | Maricam | Mcam | Medrox | Mobicam | Oram | Oricam | Oxyclod | Painflex | Paldon | Panaxy | Pcam | Phelodene | Picam | Piram | Piroc | Piropain | Piroxil | Piroxim | Piroxinor | Pixicam | Poxicam | Propain | Proxim | Pyoxil | Pyricam | Rheumaden | Riacen | Rosiden | Roxicam | Roxidin | Rumolon | Rupirox | Safoxicam | Salden | Traumalax | Tripirox;
  • (PL) Poland: Apo piroxicam | Feldene;
  • (PR) Puerto Rico: Feldene;
  • (PT) Portugal: Feldene | Flexar | Flogocan | Reumoxican | Roxazin;
  • (QA) Qatar: Apo-Piroxicam | Feldene | Feldoral;
  • (RO) Romania: Bleduran | Calmopyrol | Erazon | Feldene | Hotemin;
  • (RU) Russian Federation: Erazon | Feldene | Feldoral sedico | Hotemin | Piroxicam Akri | Piroxicam OBL | Piroxum | Unicam;
  • (SA) Saudi Arabia: Feldene | Orthocam | Unicam;
  • (SE) Sweden: Felden | Piroxicam Mylan;
  • (SG) Singapore: Apo piroxicam | Erazon | Feldene | Rosiden | Sotilen;
  • (SI) Slovenia: Erazon;
  • (SK) Slovakia: Arthremin | Hotemin | Lubor | Sotilen;
  • (SL) Sierra Leone: Relaxicam;
  • (TH) Thailand: Aleesun-f | Ammidene | Anmatic | Bicam | Butacinon | Butazodin | Canpirox | Capirox | Caroxine | Cerox | Denox 101 | Dexalin | Felcam | Felcap | Feldene | Felgesic | Felicam | Felrox | Felstar | Feltadone | Felxicam | Flamic | Fulldine | Goose Solon | Heropedd | Hirox | Hita | Joint | Maczy | Manoxicam | Maswin | Maswin Forte | Maxidene | Metacap | Morox | Moxicam | Neopod | Neorox | Nitropin | Nutarzol | Nutaxol | Paxam | Pc-20 | Phardene | Pidoxam | Pidoxone | Piram | Pirax | Piraxil | Pircam | Pirock | Pirogin | Pirox | Pirox Man | Piroxal | Piroxam | Piroxan | Piroxcin | Piroxen | Piroxhim | Piroxicam forte | Piroxicam Frx | Piroxicam Stada | Piroxidon | Piroxidon F | Predene | Puta Pee Dee | Pycam | Pyradxy | Pyroxy | Roxam | Roxicam | Roxican | Roxifen | Roxson | Roxycam | Roxycan t.m. | Rumaxicam | Sinocam | Sotilen | Topxicam | Verox | Xicam;
  • (TN) Tunisia: Arthrosyl | Feldene | Inflaced | Roxam;
  • (TR) Turkey: Feldoks | Inflamex | Oksikam | Piralden | Piroksan;
  • (TW) Taiwan: Apo piroxicam | Arudein | Carnet | Felcam | Feldemine | Feldene | Feldine | Felon | Felten | Feren | Focus | Foldcam | Furokan | Goodgen | Ketolin | Konshien | Lirocam | Pesugen | Picam | Pioparu | Pirocam | Pirocan | Pirocon | Pirodene | Pirogene | Pirox | Piroxim | Pitocam | Piton | Poudercam | Poudercone | Pyrocam | Reucam | Rheucam | Riacen | Semincon | Sotilen | Tecon | Toricam | Tosifen | Vitaxicam;
  • (UA) Ukraine: Erazon | Fedine | Feldene | Movon | Piricam | Pirox;
  • (UG) Uganda: Agomove | Aspyrox | Piricam | Proxyren;
  • (UY) Uruguay: Leal | Roxican;
  • (VE) Venezuela, Bolivarian Republic of: Feldene | Flamalit | Maxipiro | Pirocam | Pixorid;
  • (ZA) South Africa: Adco-piroxicam | Cpl alliance piroxicam | Merck-piroxicam | Pyrocaps | Rolab-piroxicam | Roxifen | Xycam;
  • (ZM) Zambia: Felcine | Feldene | Feloxicam | P Cam | Piricam | Pirofen | Roxitan;
  • (ZW) Zimbabwe: Adco-piroxicam | Roxicam | Roxitan
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