Alcohol
Contraindicated
Textbook-cited
Increased risk of gastric bleeding
Concurrent use is contraindicated
Source: KDT 7e · p950
Drug reference
Piroxicam
NSAID (non-selective COX inhibitor, oxicam class) · Analgesic
Also known as Piroxicam betadex, Piroxicam cyclodextrin
START
20 mg OD with food; check baseline renal function, BP, and GI history; use PPI gastroprotection if GI risk factors
TYPICAL MAX
20 mg/day (40 mg x 2 days only for acute conditions)
STOP IF
GI bleeding, severe rash, jaundice, eGFR <30, signs of heart failure, CV event
WATCH
BP, renal function, LFTs, GI symptoms, signs of bleeding
CDSCO approvedSchedule HJan AushadhiATC M01AC01
KDIGO 2024 + manufacturer label
- ONSET
- 1.5h · Onset of analgesia
- PEAK
- 4h · Peak plasma concentration
- t½
- 2d · Very long half-life (45-50 hours)
- DURATION
- 1d · Once-daily dosing covers 24h
EXCRETION
Urine (metabolites)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid in third trimester; use only if clearly needed in first and second trimesters
FDA category + note
Top interactionssee all 12 →
- AlcoholContraindicatedTextbook-citedKDT 7e · p950
- MethylprednisoloneContraindicatedTextbook-citedKDT 7e · p950
- CiprofloxacinSevereTextbook-citedKDT 7e · p949
- DexamethasoneSevereTextbook-citedKDT 7e · p950
Available in India
313 branded formulations and 4 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Non-selective inhibition of cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2), reducing prostaglandin synthesis throughout the body. The enolic acid structure provides long half-life enabling once-daily dosing.
Indications
Rheumatoid arthritisOsteoarthritisAnkylosing spondylitisAcute musculoskeletal disordersAcute gout
Dosing
- Adult
- 20 mg once daily (usual dose); may use 10-20 mg daily. Acute conditions: 40 mg once daily x 2 days then 20 mg daily
- Pediatric
- Not recommended under 12 years; 12-17 years: limited data
- Renal adjustment
- Avoid if eGFR <30; use lowest effective dose if eGFR 30-60
- Hepatic adjustment
- Avoid in severe hepatic impairment; reduce dose in mild-moderate
- Geriatric
- Start at 10 mg/day; increased risk of GI bleeding and renal impairment
- Max dose
- 20 mg/day (40 mg/day for first 2 days of acute conditions only)
Pharmacokinetics
Onset
1-2 hours
Peak effect
3-5 hours (Tmax); steady-state by day 7-12
Duration
24-48 hours
Half-life
45-50 hours (long half-life enables once-daily dosing)
Bioavailability
100%
Protein binding
99%
Metabolism
Hepatic CYP2C9 (major) and CYP3A4 (minor); hydroxylation and glucuronidation
Excretion
Urine (major, as metabolites); fecal (minor)
Contraindications
- Active peptic ulcer disease or GI bleeding
- History of GI perforation/ulcer/bleeding with NSAIDs
- Severe heart failure
- Severe renal impairment (eGFR <30)
- Severe hepatic impairment
- Third trimester pregnancy
- Hypersensitivity to piroxicam or other NSAIDs
- Aspirin-induced asthma
Side effects
Common
DyspepsiaNauseaAbdominal painDiarrheaConstipationFlatulenceHeadacheDizzinessRashEdema
Serious
- GI bleeding, ulceration, perforation
- Cardiovascular thrombotic events (MI, stroke)
- Nephrotoxicity
- Hepatotoxicity
- Severe skin reactions (Stevens-Johnson, TEN)
- Agranulocytosis
- Anaphylaxis
Pregnancy & lactation
Pregnancy
Avoid in third trimester; use only if clearly needed in first and second trimesters
Lactation
Excreted in breast milk; use with caution during breastfeeding
Drug interactions
Methylprednisolone
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Ciprofloxacin
Severe
Textbook-cited
Enhanced CNS toxicity including seizures.
Avoid concurrent use
Source: KDT 7e · p949
Dexamethasone
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Glibenclamide
Severe
Textbook-cited
Hypoglycemia
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Gliclazide
Severe
Textbook-cited
Hypoglycemia
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Glimepiride
Severe
Textbook-cited
Hypoglycemia
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Glipizide
Severe
Textbook-cited
Hypoglycemia
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Heparin
Severe
Textbook-cited
Increased bleeding risk.
Avoid concurrent use
Source: KDT 7e · p949
Hydrocortisone
Severe
Textbook-cited
Significantly increased GI bleeding risk
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Levofloxacin
Severe
Textbook-cited
Enhanced CNS toxicity, seizure risk.
Avoid concurrent use
Source: KDT 7e · p949
Moxifloxacin
Severe
Textbook-cited
Enhanced CNS toxicity, seizure risk
Avoid concurrent use
Source: KDT 7e · p949
Related guidelines
Ask House about Piroxicam
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19