Piroxicam

About Piroxicam

Piroxicam is a nonsteroidal anti-inflammatory drug (NSAID) that blocks the prostaglandins behind joint pain, stiffness and swelling. The label approves it for relief of the signs and symptoms of osteoarthritis and rheumatoid arthritis in adults; it has not been studied in children. The dose is 20 mg once a day, which may be split into two doses, using the lowest effective dose for the shortest time. Because piroxicam stays in the body a long time, steady levels take 7 to 12 days to build and the label says not to judge its effect for two weeks; MedlinePlus adds that the full benefit can take 8 to 12 weeks or longer.

The boxed warning covers heart attack and stroke, which can be fatal and can occur early in treatment, with the drug contraindicated around coronary artery bypass surgery, and bleeding, ulcers and perforation of the stomach or intestine, which can occur without warning and are more likely in older people and with past ulcers. Piroxicam must not be taken by anyone who has had asthma, hives or an allergic reaction to aspirin or another NSAID. Other warnings cover liver injury, raised blood pressure, heart failure and swelling, kidney injury and high potassium, anaphylaxis, severe skin reactions, a drug reaction with eosinophilia and systemic symptoms (DRESS), effects on blood counts, and the way NSAIDs can mask fever and inflammation. Nausea, constipation, gas, abdominal pain, diarrhea, headache, dizziness, swelling and rash were the most common side effects in trials.

What is distinctive is the long half-life, which makes piroxicam a once-daily arthritis drug but also means side effects can take time to clear. The label says to limit NSAID use between about 20 and 30 weeks of pregnancy and avoid it from about 30 weeks, because of effects on the baby’s kidneys and on a blood vessel in the baby’s heart. Piroxicam adds to the bleeding risk of warfarin, other anticoagulants, aspirin, SSRIs and SNRIs; blunts ACE inhibitors, ARBs, beta blockers and diuretics; raises digoxin, lithium, methotrexate and cyclosporine levels; and is not combined with other NSAIDs, salicylates or pemetrexed, while corticosteroids raise the stomach risk. It is not a controlled substance.

Taking Piroxicam

How to take it

Take it by mouth once a day, or as the prescriber directs, at about the same time each day, using the lowest dose for the shortest time that controls your symptoms. It can take weeks to feel the full benefit, so do not raise the dose on your own.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

In the original tightly closed container at room temperature, away from heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Warfarin and other anticoagulants, aspirin, SSRIs and SNRIs raise the bleeding risk; ACE inhibitors, ARBs, beta blockers and diuretics may work less well and the kidneys can suffer; digoxin, lithium, methotrexate and cyclosporine levels or toxicity can rise. Avoid other NSAIDs, salicylates and pemetrexed, and tell the pharmacist about corticosteroids and every other medicine you take.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Piroxicam differs from pharmacy to pharmacy

Piroxicam is an old generic, but a less common NSAID, so some pharmacies keep it on the shelf and others order it in; quotes depend on which maker the pharmacy buys from and whether the drug is on a flat-price generic list. A prescription for the Feldene brand without substitution is priced as a brand and costs far more than the generics.

The dose is one capsule a day, so a month is a small count and the dispensing fee is a large share of the quote; a ninety-day supply of a long-term arthritis prescription spreads that fee across fewer fills.

Ways to pay less for Piroxicam without insurance

• Ask the prescriber to write piroxicam generically and allow substitution.
• Once the dose is settled, ask the prescriber whether a ninety-day supply suits you, so you pay fewer dispensing fees.
• Ask whether piroxicam is on the pharmacy’s flat-price generic list, and compare more than one pharmacy, since stocking varies for a less common NSAID.
• If the quote is high, ask the prescriber whether a generic NSAID the pharmacy always stocks, such as naproxen or meloxicam, would suit you; do not switch on your own.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Piroxicam

1. 1.Can I take piroxicam with my blood pressure pills, my blood thinner or my antidepressant?
2. 2.How long should I wait before deciding whether piroxicam is working for my arthritis?
3. 3.Which symptoms, such as black stools, chest pain, swelling or a rash, mean I should stop it and get help?
4. 4.Should I avoid aspirin and other pain relievers while I take piroxicam?

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