A long-acting NSAID with restricted use
Piroxicam
A long-acting NSAID for pain and inflammation that, because of higher risks, is now only started by a specialist for a limited range of conditions.
What is Piroxicam?
Piroxicam is a long-acting non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation, for example in arthritis. Because it carries a higher risk of serious stomach and skin reactions than some other NSAIDs, in the UK it is now only started by a specialist, after other treatments have been considered, and is reviewed regularly.
Education and reference only. This is a plain-language guide to Piroxicam — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling and stiffness, particularly in arthritis. It is one of the older NSAIDs and is unusual for lasting a long time in the body, so it is typically taken once daily. Because reviews found it carries a relatively high risk of serious stomach and skin reactions compared with other NSAIDs, its use in the UK is now restricted: it is started only by a specialist and is no longer a first-choice anti-inflammatory.
How it works
Piroxicam blocks enzymes called cyclo-oxygenase (COX-1 and COX-2), which the body uses to make prostaglandins — chemical messengers that drive pain, swelling and fever at sites of injury or inflammation. By reducing prostaglandins, piroxicam eases pain and inflammation. The same enzymes also protect the stomach lining and help the kidneys and platelets work, which is why blocking them brings the risk of stomach, kidney and bleeding side effects.
Company & origin
Originated / developed by: Pfizer (originally Pfizer, introduced around 1980).
Piroxicam is one of the older non-steroidal anti-inflammatory drugs (NSAIDs), introduced around 1980. It belongs to the oxicam group and is notable for its very long action in the body, meaning it is usually taken just once a day.
Practical use
How to take Piroxicam
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it with or just after food or a glass of milk to reduce the risk of stomach irritation.
- It is usually taken once a day because it lasts a long time in the body — follow the exact instructions your specialist gives.
- Use it for the shortest time that controls your symptoms; it is meant to be reviewed regularly rather than taken indefinitely without check-ups.
- Do not take other anti-inflammatory painkillers at the same time, including over-the-counter ibuprofen or aspirin taken for pain.
- Report any black or tarry stools, vomiting blood, severe stomach pain or any spreading skin rash or blistering straight away.
- Tell your prescriber if you develop swelling of the ankles, breathlessness or notice you are passing much less urine.
Weighing it up
Advantages & disadvantages of Piroxicam
Advantages
- Long-acting, so a simple once-daily routine is enough for most people.
- Effective at relieving the pain, swelling and stiffness of inflammatory joint conditions.
- Well-established medicine with decades of clinical experience behind it.
Disadvantages
- Carries a higher risk of serious stomach ulcers and bleeding, and of rare severe skin reactions, than many other NSAIDs — which is why its use is now restricted to specialist initiation.
- Its long action means that if a side effect occurs it can take longer to clear from the body.
- Like all NSAIDs it can harm the kidneys and slightly increase the risk of heart attack and stroke.
- Not suitable as a quick over-the-counter painkiller — it needs specialist oversight and regular review.
Practical use
Good to know
Piroxicam is no longer a routine painkiller in the UK. Because it has a higher risk of serious stomach ulcers and rare but severe skin reactions than other NSAIDs, it is only started by a specialist, used for the shortest time needed, and reviewed regularly. It should be taken with or after food to reduce stomach upset, and is not taken together with other NSAIDs (including over-the-counter ibuprofen or aspirin for pain). Like all NSAIDs it can affect the kidneys and slightly raise cardiovascular risk, so it is used cautiously in older people and those with heart, kidney or stomach problems.
Who should not take it / use with caution
- People with a current or past stomach or duodenal ulcer, or previous bleeding or perforation related to NSAIDs.
- People with severe heart failure, severe kidney or liver impairment, or a history of asthma, hives or swelling triggered by aspirin or other NSAIDs.
- Women from around the middle of pregnancy (about 20 weeks) onwards, and especially in the last three months (MHRA advice — NSAIDs can affect the baby's circulation/kidneys and fluid around the baby), and used very cautiously (or avoided) in older people and those with heart or circulation disease.
Monitoring
- Blood pressure and signs of fluid retention
- Kidney function, particularly in older people or those on blood-pressure medicines
- Any signs of stomach bleeding or skin reaction, with regular review of the need to continue
Side effects
- Indigestion, stomach pain, nausea and, more seriously, stomach ulcers or bleeding (which can occur without warning).
- Fluid retention with ankle swelling, raised blood pressure, and a small increase in the risk of heart attack and stroke.
- Effects on the kidneys, and rarely serious skin reactions — report any widespread rash, blistering or peeling immediately.
Key interactions
- Other NSAIDs and aspirin (for pain) — increases the risk of stomach bleeding; these should not be combined.
- Anticoagulants such as warfarin or DOACs, and antiplatelets, raise bleeding risk; SSRIs and steroids also add to this risk.
- Reduces the effect of, and adds kidney strain to, blood-pressure medicines and water tablets (especially ACE inhibitors, ARBs and diuretics); also raises levels of lithium and methotrexate.
Available as: Tablets and capsules taken by mouth; a dispersible (melt-in-the-mouth) form and a topical gel for use on the skin are also available.
Answers
Piroxicam: frequently asked questions
Why is piroxicam only started by a specialist now?
Safety reviews found that piroxicam carries a higher risk of serious stomach ulcers and bleeding, and of rare but severe skin reactions, than several other NSAIDs. Because of this it is no longer a first-choice anti-inflammatory and is started only by a specialist, used for the shortest time needed and reviewed regularly.
Can I take piroxicam with ibuprofen or aspirin?
No. Taking two NSAIDs together greatly increases the risk of stomach bleeding without adding benefit. Avoid over-the-counter ibuprofen or aspirin taken for pain while on piroxicam, and check with a pharmacist before buying any painkiller. Low-dose aspirin prescribed to protect the heart is a separate decision for your prescriber.
Why do I have to take it with food?
Piroxicam can irritate the stomach lining and, in some people, lead to ulcers or bleeding. Taking it with or just after food or milk helps reduce stomach upset. Report any black stools, vomiting blood or severe stomach pain straight away, as these can be signs of bleeding.
Is piroxicam safe for my heart and kidneys?
Like all NSAIDs, piroxicam can cause fluid retention, raise blood pressure, slightly increase the risk of heart attack and stroke, and reduce kidney function. It is used cautiously in older people and those with heart, circulation or kidney problems, at the lowest effective amount for the shortest time, with monitoring.
What should I do if I get a rash while taking it?
Stop the medicine and seek medical advice promptly. Piroxicam can rarely cause serious skin reactions, so any spreading rash, blistering, peeling or sores in the mouth or eyes should be treated as an emergency and reviewed urgently rather than waited on.
The wider class
About NSAIDs
Piroxicam belongs to the nsaids class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Piroxicam.
- NICE CKS: Anti-inflammatory painkillers (NSAIDs).
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