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Piroxicam oral

Updated 2 Feb 2023 | NSAIDs


Oral formulations of piroxicam.

Drugs List

  • FELDENE 10mg capsules
  • FELDENE 20mg capsules
  • FELDENE MELT 20mg tablets
  • piroxicam 10mg capsules
  • piroxicam 20mg capsules
  • piroxicam 20mg orodispersible tablets sugar-free
  • Therapeutic Indications


    Ankylosing spondylitis
    Rheumatoid arthritis

    Unlicensed Uses

    Juvenile idiopathic arthritis



    Initial dose of 20mg once daily.
    Some patients may be maintained on 10mg daily.

    Maximum daily dose of 20 mg.


    Juvenile idiopathic arthritis (unlicensed)
    Children aged 6 to 18 years
    Bodyweight 46kg or greater: 20mg once daily.
    Bodyweight 26kg to 45kg: 15mg once daily.
    Bodyweight 15kg to 25kg: 10mg once daily.
    Bodyweight up to 15kg: 5mg once daily.


    Children under 6 years
    History of serious hypersensitivity reactions
    Recent anticoagulant therapy
    Crohn's disease
    Gastrointestinal haemorrhage
    Gastrointestinal perforation
    History of erythema multiforme
    History of gastrointestinal bleeding
    History of gastrointestinal perforation
    History of gastrointestinal ulceration
    History of Stevens-Johnson syndrome
    History of toxic epidermal necrolysis
    History of ulcerative colitis
    Nasal polyps, angioedema, and bronchospastic reactivity to NSAIDs
    Non-dialysed severe renal failure
    Peptic ulcer
    Severe cardiac failure
    Severe hepatic impairment
    Third trimester of pregnancy
    Ulcerative colitis

    Precautions and Warnings

    Children under 18 years
    Risk factors for cardiovascular disorder
    Cardiac impairment
    Cerebrovascular disorder
    Congestive cardiac failure
    First trimester of pregnancy
    Glucose-galactose malabsorption syndrome
    Hepatic impairment
    History of asthma
    Ischaemic heart disease
    Kidney transplantation
    Lactose intolerance
    Nephrotic syndrome
    Peripheral vascular disease
    Renal impairment
    Second trimester of pregnancy

    NSAIDs may provoke or exacerbate asthma
    Some formulations contain aspartame - caution in phenylketonuria
    Advise ability to drive/operate machinery may be affected by side effects
    Consider the need for combination therapy with gastroprotective agents
    Not all available brands are licensed for all age groups
    Treatment to be prescribed under the supervision of a specialist
    Some formulations contain lactose
    Advise patient to take with or after food
    If visual disturbances occur, perform ophthalmic evaluation
    May inhibit platelet aggregation - observe for signs of bleeding
    Monitor for gastrointestinal toxicity
    Monitor renal function in patients with cardiac impairment
    Monitor renal function in patients with hepatic impairment
    Monitor renal function in patients with renal impairment
    Monitor serum creatinine in patients with renal impairment
    Review treatment after 14 days, and frequently thereafter
    Risk of gastrointestinal haemorrhage
    Advise patients to report signs or symptoms of gastro-intestinal ulcer
    Avoid concomitant drugs which may increase risk of gastrotoxicity/bleeding
    Contact doctor immediately with any signs of hypersensitivity reactions
    Discontinue treatment if Stevens-Johnson Syndrome suspected
    Discontinue treatment if toxic epidermal necrolysis is suspected
    High dose/long term use may increase risk of arterial thrombotic events
    Risk of gastro-intestinal bleeding increased in the elderly
    Severe gastro-intestinal side effects may occur without warning
    Discontinue at first signs of skin erythema
    Discontinue if liver function deteriorates
    Maintain treatment at the lowest effective dose
    Start treatment at lowest recommended dose
    Maintain treatment for the shortest possible duration
    Advise patient to avoid excess of alcohol
    May cause impaired fertility

    Pregnancy and Lactation


    Piroxicam is contraindicated in the last trimester of pregnancy.

    Animal studies have not shown any teratogenic effects when using piroxicam during pregnancy (Briggs et al, 2015), however congenital abnormalities associated with NSAID use have been reported. Piroxicam inhibits prostaglandin synthesis which may expose the foetus to cardiopulmonary toxicity, renal dysfunction, possible prolongation of bleeding time and inhibition the contraction of the uterus if used in late pregnancy. Evidence indicates that NSAIDS use may lead to a higher risk of spontaneous abortions and impaired fertility (Briggs et al, 2015). The manufacturer suggests to avoid use of piroxicam in the first two trimesters of pregnancy and labour unless the potential benefit to the mother outweighs the potential risk to the foetus.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use piroxicam with caution in breastfeeding.

    Schaefer (2015) states that piroxicam is not the first NSAID of choice in breastfeeding due to its relatively long half-life. However, if necessary, it is compatible with breastfeeding as NSAIDs are known to be excreted into breast milk at low concentrations, therefore it is unlikely to cause harm to the infant. Hale (2015) and Briggs (2015) also support piroxicam to be considered safe to use in breastfeeding. The manufacturer suggests to avoid the use of piroxicam in breastfeeding as it appears in breast milk 1% to 3% of maternal plasma concentrations.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal discomfort
    Abdominal pain
    Aplastic anaemia
    Arterial thrombosis
    Blurred vision
    Cardiac failure
    Decrease in haemoglobin and haematocrit
    Dream abnormalities
    Drug rash with eosinophilia and systemic symptoms (DRESS)
    Elevated serum potassium
    Epigastric distress
    Exacerbation of colitis
    Exacerbation of Crohn's disease
    Exacerbation of pre-existing asthma
    Exfoliative dermatitis
    Eye irritation
    Fluid retention
    Gastro-intestinal perforation
    Gastro-intestinal ulceration
    Gastrointestinal bleeding
    Haemolytic anaemia
    Hearing disturbances
    Hypersensitivity reactions
    Increase in antinuclear antibodies (ANA)
    Increase in serum transaminases
    Interstitial nephritis
    Metabolic changes
    Mood changes
    Myocardial infarction
    Nephrotic syndrome
    Non-thrombocytopenic purpura
    Prolonged bleeding
    Renal failure
    Renal papillary necrosis
    Serum sickness
    Skin reactions
    Sodium retention
    Stevens-Johnson syndrome
    Swollen eyes
    Toxic epidermal necrolysis
    Vesiculo-bullous reactions
    Visual disturbances
    Weight changes


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: February 2017

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

    Summary of Product Characteristics: Feldene 10 mg capsules. Pfizer Ltd. Revised October 2020.

    Summary of Product Characteristics: Feldene 20 mg capsules. Pfizer Ltd. Revised October 2020.

    Summary of Product Characteristics: Feldene Melt 20 mg. Pfizer Ltd. Revised February 2020.

    Summary of Product Characteristics: Piroxicam 10 mg capsules. Actavis UK Ltd. Revised July 2016.

    Summary of Product Characteristics: Piroxicam 20 mg capsules. Actavis UK Ltd. Revised July 2016.

    The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

    NICE Evidence Services Available at: Last accessed: 11 September 2017

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