Pharmacology · Nonsteroidal anti-inflammatory drugs (NSAIDs)
Piroxicam !
An oxicam NSAID with a very long half-life, for osteoarthritis and rheumatoid arthritis. It takes days to stabilise and can cause serious skin reactions.
Updated 2026-11-01
Mechanism of action
Piroxicam, an oxicam, non-selectively inhibits COX-1 and COX-2 and lowers the prostaglandins of inflammation and pain. It may also inhibit neutrophil activation through COX-independent routes. Its very long half-life allows one daily dose but means adverse effects are slow to fade.
- Inhibits COX-1 and COX-2
- Lowers prostaglandin synthesis in the joint
- Less inflammation and pain
- Very long half-life: one daily dose and lingering effects
Pharmacokinetics
- Metabolism
- Liver, mainly by CYP2C9 to 5'-hydroxypiroxicam; CYP2C9 poor metabolisers have higher exposure.
- Half-life
- Very long, about 50 hours; steady state takes 7 to 12 days.
Indications
- Osteoarthritis Knee Osteoarthritis →
- Rheumatoid arthritis Rheumatoid arthritis →
Adverse effects
Common
- Diarrhoea, constipation and gas
- Headache and dizziness
- Ringing in the ears
Contraindications
- Hypersensitivity to piroxicam
- A previous serious skin reaction to an NSAID
- Aspirin-sensitive asthma
- The setting of coronary artery bypass graft (CABG) surgery
Key interactions
- Anticoagulants, antiplatelet agents, SSRIs and SNRIs
- Add to the risk of bleeding.
- ACE inhibitors, ARBs and diuretics
- Weaker blood pressure effect and risk of acute kidney injury.
- CYP2C9 inhibitors
- May increase exposure to piroxicam.
What is monitored
- Skin: any rash
- Signs of gastrointestinal bleeding
- Kidney function and blood pressure
Administration and safety
- Stopped at the first skin rash or other sign of hypersensitivity.
- It can mask the fever and inflammation of an infection.
Nursing care
- Teach the patient to stop it and seek care for any rash or blister.
- Watch for black stools and abdominal pain.
- In older adults, remember that its plasma levels run higher.
Pregnancy and breastfeeding
Like other NSAIDs, from about week 20 it can cause oligohydramnios, and from about week 30 premature closure of the ductus arteriosus.
Test yourself
Think of the answer, then tap the question to see it.
What practical consequence does piroxicam's half-life of about 50 hours have?
It allows one daily dose, but steady state takes 7 to 12 days and adverse effects are slow to fade after stopping.
Which skin history contraindicates piroxicam?
A previous serious skin reaction to an NSAID.
Which genetic variant increases exposure to piroxicam?
Being a CYP2C9 poor metaboliser.
Related drugs
Related conditions
← Back to the class: Nonsteroidal anti-inflammatory drugs (NSAIDs)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Piroxicam: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); PIROXICAM capsule (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 42 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.