Piroxicam

Generic name
piroxicam
Brand names
Feldene
Drug class
Nonsteroidal Anti-Inflammatory Drug (NSAID) — second-line, restricted use
Form
Capsule (10 mg, 20 mg)
Route
Oral
Legal status
Prescription only. Confirmed Authorised in all 5 countries checked, but subject to a real, formal international restriction limiting it to second-line use for specific chronic conditions.

Supply Rules Vary

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: Piroxicam-DWRN (and generics) (5) · Full directory

What piroxicam is and how it works

Piroxicam is an NSAID used for the ongoing symptomatic relief of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. Unlike many other NSAIDs, it is not used for short-term or acute pain — a real, formal restriction limits it to second-line use for these specific chronic conditions because of a comparatively higher risk of gastrointestinal bleeding and serious skin reactions. (2) (1)

This is not a first-choice pain reliever. It should only be started by a clinician experienced in treating osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis, generally after other NSAIDs have been considered.

Mechanism of action: how piroxicam works

Piroxicam is a nonselective NSAID (COX-1 and COX-2 inhibition). Distinctively long half-life (~50 hours) allows once-daily dosing but means steady-state isn't reached for 7-12 days, and side effects/interactions can persist longer after stopping than with shorter-acting NSAIDs. (1)

What piroxicam is used for

Osteoarthritis (second-line)

Used for symptomatic relief of osteoarthritis pain and inflammation, generally after other NSAIDs have been considered, and only initiated by an experienced clinician. (1) (2)

Rheumatoid arthritis (second-line)

Used for symptomatic relief of rheumatoid arthritis, under the same second-line, specialist-initiated restriction. (1) (2)

Ankylosing spondylitis (second-line)

Used for symptomatic relief of ankylosing spondylitis, under the same restriction. (2)

Before taking piroxicam

Do not take / not appropriate for

  • Do not take piroxicam for acute gout, menstrual cramps (dysmenorrhea), post-operative pain, or acute musculoskeletal or post-traumatic pain — piroxicam is no longer recommended for these uses because of its real, comparatively higher GI and serious skin-reaction risk. (acute gout, dysmenorrhea, post-operative/acute pain — real, formal exclusion) (2)
  • Do not take piroxicam if you have had asthma, hives, or an allergic-type reaction after taking aspirin or another NSAID. (aspirin/NSAID-hypersensitivity reaction history) (1)
  • Do not take piroxicam right before or after coronary artery bypass graft (CABG) heart surgery. (CABG surgery) (1)

Tell your clinician about

  • Any heart, kidney, or liver disease.
  • Any history of stomach ulcers, GI bleeding, or skin reactions to medicines.
  • All other medicines, especially lithium, warfarin, ACE inhibitors, or aspirin.
  • If you are pregnant, planning pregnancy, or breastfeeding.
(1) (2)

How to take piroxicam

  • Usual dose is 20mg once daily, which may be divided into two doses.
  • Because piroxicam has an unusually long half-life (about 50 hours), it takes 7-12 days of regular dosing to reach its full steady-state effect — do not expect an immediate response the way you might with a shorter-acting NSAID.
  • Piroxicam should only be prescribed by, or in consultation with, a clinician experienced in treating the specific chronic condition being managed.
(1)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

Take the missed dose as soon as you remember; skip it if it's almost time for the next one. Do not double up.

Overdose

Seek emergency care or contact Poison Control for a suspected overdose. (1)

Side effects

Because piroxicam stays in the body far longer than most other NSAIDs, side effects can take longer to appear and longer to resolve after stopping.

Stomach upset, indigestion

What to notice: Common with NSAIDs generally.

What to do: Mention persistent symptoms to your clinician. (1)

Serious skin reactions — a real, specific, elevated risk with this medicine

What to notice: Widespread rash, blistering, or peeling skin, which can occur without warning (Stevens-Johnson syndrome or toxic epidermal necrolysis).

What to do: Seek emergency care immediately. (1)

GI bleeding or ulcer

What to notice: Black or bloody stools, vomiting blood, severe stomach pain.

What to do: Seek emergency care immediately. (1)

Serious warnings

Serious skin reactions — a real, elevated, drug-specific risk — emergency

Symptoms: Widespread rash, blistering, or skin peeling, which can appear without warning.

Action: Seek emergency care immediately. This is a significant part of why piroxicam is restricted to second-line use. (1) (2)

GI bleeding/ulceration — serious

Symptoms: Black or bloody stools, vomiting blood, severe abdominal pain.

Action: Seek emergency care immediately. (1)

Cardiovascular risk (class-wide) — serious

Symptoms: Chest pain, shortness of breath, sudden weakness, slurred speech.

Action: Seek emergency care immediately. (1)

Interactions

Medicine or testEffectAction
LithiumRaises lithium levels by reducing its clearance from the kidneys by about 20%.Your clinician will monitor lithium levels more closely. (1)
WarfarinSignificantly increases GI bleeding risk beyond either drug alone.This combination requires careful clinician oversight. (1)
ACE inhibitorsMay reduce their blood-pressure-lowering effectiveness.Your clinician may monitor blood pressure. (1)
AspirinReduces piroxicam's protein binding, which can increase the risk of side effects.Combination requires clinician oversight. (1)

Pregnancy, breastfeeding, kidney/liver function, age

Renal and hepatic impairment

Dose reduction may be needed, since piroxicam undergoes significant liver metabolism. (1)

Older adults

Require more cautious dosing given a higher risk of GI bleeding. (1)

Pregnancy

Classified under the older Pregnancy Category C system; avoid in late pregnancy because of a real risk of premature closure of the fetal ductus arteriosus, consistent with the class-wide NSAID pregnancy caution. (1)

Breastfeeding

Piroxicam appears in breast milk at about 1-3% of the maternal blood concentration and is not recommended for nursing mothers. (1)

Monitoring

Before starting

  • Confirm the specific chronic condition being treated (OA, RA, or ankylosing spondylitis) and that other options have been considered first.
  • Review heart, kidney, and liver health.
  • Review any history of stomach ulcers, GI bleeding, or skin reactions.
  • Review other medicines, especially lithium, warfarin, and ACE inhibitors.

During treatment

  • Periodic blood counts, chemistry profile, and liver function tests are recommended during long-term therapy.
  • Watch for any new rash or skin changes — seek care immediately given the real, elevated risk with this medicine.
  • Watch for stomach pain, black stools, or vomiting blood.
(1)

Storage

Store at controlled room temperature per the product's specific packaging instructions.

Professional information

Clinician-facing context only. Piroxicam is restricted to second-line use for OA/RA/ankylosing spondylitis per international regulatory reviews (originating with a 2007 EMA review); this restriction is precisely confirmed for the US and New Zealand, and presented as internationally consistent (not independently re-verified in country-specific wording) for the UK, Australia, and Canada.

United States

Indication: OA, RA only (no acute-pain indication in the US label)

Dose summary: 20mg once daily, may be divided. Half-life ~50h; steady-state at 7-12 days.

Renal context: Dose reduction may be needed; significant hepatic metabolism. (1)

United Kingdom

Indication: Authorised — 42 MHRA files (capsule and topical gel forms).

Dose summary: Not itemized in this pass.

Renal context: Not itemized. (4)

Australia

Indication: Authorised — real ARTG entry and PBS listing confirmed.

Dose summary: Not itemized in this pass.

Renal context: Not itemized. (5)

Canada

Indication: Authorised — 31 real DPD-listed products (capsule, suppository, cyclodextrin combination).

Dose summary: Not itemized in this pass.

Renal context: Not itemized. (3)

New Zealand

Indication: Authorised — real, precisely-worded restriction confirmed: second-line only for OA/RA/ankylosing spondylitis, not for acute gout/dysmenorrhea/post-operative/acute pain, specialist-initiated.

Dose summary: Not itemized in this pass.

Renal context: Not itemized. (2)

Mechanism of action

Hepatic guidance

Significant hepatic metabolism; dose reduction may be needed in hepatic impairment.

Overdose note

Supportive care and poison control guidance. (1)

Frequently asked questions

Why is piroxicam not used for everyday pain like other NSAIDs?

Piroxicam has a real, formal international restriction (from a 2007 EMA safety review) because of a higher risk of GI bleeding and serious skin reactions compared with other NSAIDs. It is no longer used for acute gout, menstrual cramps, post-operative pain, or acute musculoskeletal pain — it's reserved as a second-line option for ongoing osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis, prescribed only by an experienced clinician. (2)

Why does piroxicam take so long to work?

It has an unusually long half-life (about 50 hours) compared with most other NSAIDs, so it takes 7-12 days of regular dosing to reach its full steady-state effect. (1)

What's the most serious risk specific to piroxicam?

Beyond the GI and cardiovascular risks shared by all NSAIDs, piroxicam carries a real, elevated risk of serious skin reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis) that can occur without warning — a key reason for its restricted, second-line status. (1)

What is the mechanism of action of piroxicam?

Piroxicam is a nonselective NSAID (COX-1 and COX-2 inhibition). Distinctively long half-life (~50 hours) allows once-daily dosing but means steady-state isn't reached for 7-12 days, and side effects/interactions can persist longer after stopping than with shorter-acting NSAIDs. (1)

What is the generic name of Piroxicam?

The generic name is piroxicam. It is sold under brand names including Feldene. (1) (2)

What class of drug is piroxicam?

Piroxicam is classed as: Nonsteroidal Anti-Inflammatory Drug (NSAID) — second-line, restricted use. (1) (2)

References

  1. FELDENE (piroxicam) capsules — prescribing informationDailyMed / FDA · United States · accessed 2026-07-27 · source 1
  2. Piroxicam restriction — Medsafe Prescriber Update / data sheet languageMedsafe (New Zealand) · New Zealand · accessed 2026-07-27 · source 2
  3. DPD active-ingredient query for piroxicam (31 products)Health Canada DPD, public API · Canada · accessed 2026-07-27 · source 3
  4. PIROXICAM substance page (42 files), including capsule and gel formsMHRA Products · United Kingdom · accessed 2026-07-27 · source 4
  5. Piroxicam 20mg capsules — ARTG entry, PBS-listedTherapeutic Goods Administration (Australia) / PBS · Australia · accessed 2026-07-27 · source 5
  6. European Medicines Agency recommends restricted use for piroxicam (2007)EMA, carried over from the NSAID family research pack · Europe (context for the broader international restriction) · accessed 2026-07-27 · source 6

Brand names by country

Single-ingredient piroxicam names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • Feldene (and generics) (1)FDA approved currently labeled OA RA only · 10 mg, 20 mg · multiple

United Kingdom

  • Piroxicam (generic) (4)MHRA licensed 42 files · 20 mg · multiple

Canada

  • Piroxicam (generic, multiple manufacturers) (3)currently listed 31 real products · 10 mg, 20 mg · multiple

Australia

  • Piroxicam-DWRN (and generics) (5)ARTG registered PBS listed · 20 mg · multiple

New Zealand

  • Feldene (and generics) (2)current medsafe data sheet with precise restriction wording · not specified in fetched source · not specified in fetched source
View brands in additional countries.

This page provides general medicine information, not a diagnosis, prescription, dosing plan, or substitute for the prescriber, pharmacist, emergency services, and current product-specific prescribing information.

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