[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/) › Piroxicam

[Pharmacology](https://durgical.com/en/pharmacology/) · [Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/)

# 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

- Class: [Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/)
- Enzyme: Cyclooxygenase 1 and 2 (COX-1/COX-2)
- ATC code: M01AC01

## 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 →](https://durgical.com/en/conditions/knee-osteoarthritis/)
- Rheumatoid arthritis [Rheumatoid arthritis →](https://durgical.com/en/conditions/rheumatoid-arthritis/)

## Adverse effects

### Common

- Diarrhoea, constipation and gas
- Headache and dizziness
- Ringing in the ears

### Serious (rare, important)

- Gastrointestinal ulcer, bleeding and perforation
- Cardiovascular thrombotic events
- Serious skin reactions: exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis
- Kidney injury and hyperkalaemia

## 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.

## Memory aid

PIROXICAM = a «PYRE» that burns slowly: a half-life of about 50 hours. What is slow to arrive is slow to leave, a skin reaction included.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/piroxicam/)

## Related drugs

- [Meloxicam](https://durgical.com/en/pharmacology/meloxicam/)
- [Naproxen](https://durgical.com/en/pharmacology/naproxen/)

## Related conditions

- [Knee Osteoarthritis](https://durgical.com/en/conditions/knee-osteoarthritis/)
- [Rheumatoid arthritis](https://durgical.com/en/conditions/rheumatoid-arthritis/)

[← Back to the class: Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/)

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](https://medlineplus.gov/druginfo/meds/a684045.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [PIROXICAM capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f1123fe1-b79c-430b-8548-08cd6e518482) (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](https://atcddd.fhi.no/atc_ddd_index/?code=M01AC01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/piroxicam/