PIROXICAM Drug Interactions
Also known as: Piroxicam
PIROXICAM (brand name: Piroxicam) is a NSAIDs. 1 INDICATIONS AND USAGE Piroxicam capsules are indicated: • For relief of the signs and symptoms of osteoarthritis. • For relief of the signs and symptoms of rheumatoid arthritis. Piroxicam capsules are a nonsteroidal anti-inflammatory drug indicated for •Relief of the signs and symptoms of…PIROXICAM has 16 documented drug interactions in our database, including 0 contraindicated, 16 major, 0 moderate, and 0 minor interactions.
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Combining piroxicam (an anti-inflammatory pain reliever) with aspirin 81mg (a blood thinner) significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Piroxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, leading to impaired platelet function and damage to the gastrointestinal mucosa. Aspirin 81mg, even at low doses, irreversibly inhibits platelet aggregation. The combined antiplatelet effects and gastrointestinal irritation from both drugs create an additive risk for bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding (e.g., stomach ulcers, melena, hematemesis). This combination can also increase the risk of other bleeding events such as epistaxis, bruising, or prolonged bleeding from cuts. The risk of serious GI bleeding can be 3 to 15 times higher than with either drug alone. This combination should generally be avoided due to the high bleeding risk. If both anti-inflammatory and antiplatelet effects are absolutely necessary, consider alternative NSAIDs with a lower GI risk (e.g., celecoxib, if appropriate, with a proton pump inhibitor) or alternative pain management strategies. Closely monitor for any signs of bleeding (e.g., black/tarry stools, vomiting blood, unusual bruising).
Combining piroxicam, an anti-inflammatory pain reliever, with apixaban, a blood thinner, significantly increases your risk of serious bleeding, including stomach bleeding.
Mechanism
Piroxicam inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation, which prolongs bleeding time. Apixaban directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use results in additive antiplatelet and anticoagulant effects.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, particularly gastrointestinal bleeding, which can be severe or even fatal. Studies show that combining NSAIDs with DOACs can increase the risk of major bleeding by approximately 2-3 fold compared to DOACs alone. Concurrent use of piroxicam and apixaban should generally be avoided due to the high bleeding risk. If pain management is necessary, consider alternative analgesics such as acetaminophen. If an NSAID is absolutely required, choose one with a shorter half-life and lower GI risk (e.g., ibuprofen for a short duration), and monitor closely for signs of bleeding. Proton pump inhibitor prophylaxis should be considered if an NSAID is unavoidable.
Combining piroxicam with rivaroxaban significantly increases your risk of bleeding, including serious internal bleeding. You should avoid taking these medications together unless specifically directed by your doctor.
Mechanism
Piroxicam, an NSAID, inhibits prostaglandin synthesis, which reduces platelet aggregation and impairs the gastroprotective lining of the stomach. Rivaroxaban is a direct oral anticoagulant that inhibits Factor Xa, preventing clot formation. The concurrent use of these drugs leads to an additive antiplatelet and anticoagulant effect, and increased gastrointestinal mucosal damage, synergistically elevating bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, which can range from minor bruising or nosebleeds to severe and life-threatening gastrointestinal hemorrhage, intracranial bleeding, or other internal bleeding. The risk of major bleeding can be several-fold higher compared to rivaroxaban alone. This combination should generally be avoided. If an NSAID is absolutely necessary, consider alternative pain management strategies or a different NSAID with a lower GI bleeding risk (e.g., COX-2 selective, if appropriate) for the shortest duration possible, with close monitoring for bleeding. Proton pump inhibitors (PPIs) should be co-prescribed to reduce GI bleeding risk. Patients must be educated on bleeding signs and symptoms.
Combining piroxicam with argatroban significantly increases your risk of serious bleeding, including stomach bleeding. Your doctor will likely avoid this combination.
Mechanism
Piroxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal defense and inhibit platelet aggregation. Argatroban is a direct thrombin inhibitor that prevents clot formation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, alongside increased gastrointestinal mucosal damage.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, which can be severe or even fatal. Other bleeding sites include intracranial, genitourinary, and soft tissue. The risk of major bleeding with NSAID plus anticoagulant therapy can be several-fold higher compared to anticoagulant monotherapy. This combination should generally be avoided due to the high risk of serious bleeding. If an NSAID is absolutely necessary, consider alternative pain management strategies or use a COX-2 selective NSAID with extreme caution and a proton pump inhibitor for gastroprotection, while closely monitoring for signs of bleeding. Frequent monitoring of bleeding parameters and clinical signs is crucial if co-administration cannot be avoided.
Combining piroxicam with bivalirudin significantly increases your risk of serious bleeding, including internal bleeding. This combination should generally be avoided.
Mechanism
Piroxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Bivalirudin is a direct thrombin inhibitor that prevents fibrin formation and platelet activation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, severely compromising hemostasis.
Clinical Management
The primary clinical effect is a substantially elevated risk of bleeding, which can manifest as gastrointestinal bleeding (e.g., ulcers, melena, hematemesis), intracranial hemorrhage, hematuria, or other serious hemorrhagic events. The risk of major bleeding can be several-fold higher compared to monotherapy, potentially leading to hospitalization, transfusions, or even death. This combination should be avoided due to the high risk of severe bleeding. If an NSAID is absolutely necessary, consider alternatives with lower systemic absorption (e.g., topical NSAIDs) or alternative pain management strategies. Close monitoring for signs of bleeding is essential if co-administration cannot be avoided, and bivalirudin dose adjustments may be necessary. Consider gastric protection with a proton pump inhibitor.
Combining piroxicam with warfarin significantly increases your risk of bleeding, including serious internal bleeding. Your doctor will likely avoid this combination due to the high risk.
Mechanism
Piroxicam, a non-selective NSAID, inhibits cyclooxygenase enzymes, reducing prostaglandin synthesis. This leads to decreased platelet aggregation and can cause gastrointestinal mucosal damage. Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors. The concurrent use results in an additive antiplatelet effect and impaired coagulation, exacerbated by potential GI irritation from the NSAID.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, which can be life-threatening. Studies show a 3- to 15-fold increase in GI bleeding risk when NSAIDs are combined with warfarin. Other bleeding manifestations include epistaxis, hematuria, and intracranial hemorrhage. This combination should generally be avoided. If an NSAID is absolutely necessary for a patient on warfarin, consider alternative analgesics or a short course of a COX-2 selective NSAID with extreme caution, close INR monitoring, and vigilant observation for bleeding signs. Proton pump inhibitors should be co-prescribed to reduce GI bleeding risk. Topical NSAIDs may be a safer alternative for localized pain.
Combining piroxicam with dabigatran significantly increases your risk of serious bleeding, including stomach bleeding. Your doctor will likely recommend avoiding this combination.
Mechanism
Piroxicam, an NSAID, inhibits prostaglandin synthesis, which impairs platelet aggregation and damages the gastrointestinal mucosa. Dabigatran directly inhibits thrombin, preventing clot formation. The combination leads to additive antiplatelet and anticoagulant effects, alongside increased GI mucosal vulnerability.
Clinical Management
This interaction substantially increases the risk of major bleeding events, particularly gastrointestinal bleeding, which can be life-threatening. Studies show a significantly elevated risk of GI bleeding (e.g., 2-4 fold increase) when NSAIDs are co-administered with DOACs compared to DOACs alone. This combination should generally be avoided due to the high risk of severe bleeding. If an NSAID is absolutely necessary, consider alternative pain management strategies or a short course of a COX-2 selective NSAID (like celecoxib) with extreme caution, proton pump inhibitor co-therapy, and close monitoring for bleeding. Discuss alternatives with your healthcare provider.
Combining piroxicam with edoxaban significantly increases your risk of serious bleeding, including stomach bleeding. You should avoid this combination unless specifically instructed by your doctor, who will weigh the risks carefully.
Mechanism
Piroxicam, a non-selective NSAID, inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Edoxaban is a direct oral anticoagulant (DOAC) that inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use of these agents results in an additive antiplatelet and anticoagulant effect, profoundly increasing the risk of hemorrhage.
Clinical Management
This combination carries a substantially elevated risk of major bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other site-specific bleeding. The risk of gastrointestinal bleeding can be 3-15 times higher compared to anticoagulant monotherapy, potentially leading to anemia, hospitalization, or even death. This combination should generally be avoided due to the high bleeding risk. If an NSAID is absolutely necessary, consider alternative pain management strategies or a short course of a less potent analgesic. If concurrent use is unavoidable, monitor closely for signs of bleeding (e.g., melena, hematemesis, bruising) and consider gastroprotective agents. Discuss with the prescribing physician to assess the risk-benefit and explore alternatives.
Combining piroxicam (an NSAID) with heparin (a blood thinner) significantly increases your risk of serious bleeding. This combination should generally be avoided.
Mechanism
Piroxicam inhibits cyclooxygenase (COX-1 and COX-2) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Heparin directly inhibits clotting factors, preventing clot formation. The concurrent use results in additive antiplatelet and anticoagulant effects, severely compromising the body's ability to form clots and stop bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other serious bleeding events. The risk of major gastrointestinal bleeding can be several-fold higher compared to either drug alone. This combination should be avoided whenever possible. If an NSAID is absolutely necessary, consider alternative analgesics or non-pharmacological pain management. If concurrent use is unavoidable, closely monitor for signs of bleeding (e.g., black stools, easy bruising, nosebleeds) and consider lower doses of both agents with frequent coagulation monitoring. Proton pump inhibitor prophylaxis may be considered for GI protection.
Combining piroxicam (an NSAID) with enoxaparin (a blood thinner) significantly increases your risk of serious bleeding, including stomach bleeding, which can be life-threatening.
Mechanism
Piroxicam inhibits prostaglandin synthesis, reducing platelet aggregation and damaging the gastrointestinal mucosa. Enoxaparin directly inhibits Factor Xa, preventing clot formation. The additive antiplatelet and anticoagulant effects, along with GI mucosal damage from piroxicam, synergistically increase bleeding risk.
Clinical Management
This combination substantially increases the risk of major bleeding, particularly gastrointestinal bleeding, intracranial hemorrhage, and other site-specific bleeding. The risk of serious GI bleeding can be increased by 3 to 15 times compared to enoxaparin alone. Symptoms may include black, tarry stools; vomiting blood; severe abdominal pain; or unusual bruising. This combination should generally be avoided due to the high bleeding risk. If concurrent use is absolutely necessary, it should be done with extreme caution, close monitoring for signs of bleeding, and consideration of gastroprotective agents (e.g., proton pump inhibitors). Alternative pain management strategies or alternative anticoagulants with lower bleeding risk (if appropriate) should be explored.
Combining piroxicam with fondaparinux significantly increases your risk of serious bleeding, including internal bleeding. This combination should generally be avoided.
Mechanism
Piroxicam, a non-selective NSAID, inhibits cyclooxygenase enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Fondaparinux is a selective factor Xa inhibitor that prevents thrombin generation and clot formation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, leading to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, which can range from minor ecchymoses to severe and life-threatening hemorrhage, including gastrointestinal bleeding, intracranial hemorrhage, and hematuria. The risk of serious gastrointestinal bleeding can be several-fold higher compared to either drug alone. This combination should be avoided if possible. If concomitant use is absolutely necessary, the patient's bleeding risk must be carefully assessed, and they should be closely monitored for signs of bleeding. Consider alternative pain management strategies that do not increase bleeding risk, or use a COX-2 selective NSAID with caution and for the shortest duration possible, along with gastroprotective agents.
Combining piroxicam with dipyridamole significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided.
Mechanism
Piroxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and platelet aggregation. Dipyridamole is an antiplatelet agent that inhibits phosphodiesterase, leading to increased cyclic AMP and reduced platelet aggregation. The concurrent use of these agents results in additive antiplatelet effects, significantly impairing hemostasis.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other serious bleeding events. The risk of serious GI bleeding with NSAID plus antiplatelet therapy can be several-fold higher compared to either drug alone. This combination is generally not recommended due to the high bleeding risk. If concurrent use is unavoidable, patients must be closely monitored for signs of bleeding, and a proton pump inhibitor (PPI) should be co-prescribed to reduce GI bleeding risk. Consider alternative pain management strategies or alternative antiplatelet agents if possible.
Combining piroxicam with ticagrelor significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided unless absolutely necessary and under strict medical supervision.
Mechanism
Piroxicam, a non-selective NSAID, inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Ticagrelor is an antiplatelet agent that directly inhibits the P2Y12 receptor, preventing ADP-mediated platelet activation and aggregation. The concurrent use of these agents leads to an additive antiplatelet effect, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other serious bleeding events. The risk of major gastrointestinal bleeding can be several-fold higher compared to either drug alone, potentially leading to anemia, hospitalization, and in severe cases, life-threatening complications. This combination should be avoided if possible. If concomitant use is unavoidable, it should be for the shortest duration and at the lowest effective dose, with close monitoring for signs of bleeding (e.g., black stools, easy bruising, nosebleeds). Consider alternative pain management strategies that do not increase bleeding risk, such as acetaminophen. Proton pump inhibitors (PPIs) may be co-prescribed to reduce GI bleeding risk if NSAID use is essential.
Combining piroxicam with clopidogrel significantly increases your risk of bleeding, particularly in the stomach or intestines. This combination should generally be avoided due to severe potential harm.
Mechanism
Piroxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Clopidogrel is an antiplatelet agent that irreversibly inhibits the P2Y12 ADP receptor on platelets, preventing platelet activation. The concurrent use of these agents results in a synergistic inhibition of platelet function and disruption of gastrointestinal mucosal defense, leading to a substantially heightened risk of bleeding.
Clinical Management
The primary clinical effect is a significantly increased risk of serious bleeding, including gastrointestinal hemorrhage (e.g., ulcers, melena, hematemesis), intracranial hemorrhage, and other major bleeding events. The risk of major gastrointestinal bleeding can be increased by 3 to 15 times compared to either drug alone, with a particularly high risk in the elderly or those with a history of GI issues. This combination is generally contraindicated. If concurrent use is unavoidable, it should be for the shortest duration possible, with close monitoring for signs of bleeding (e.g., black stools, easy bruising, unusual fatigue). Consider alternative pain management strategies that do not involve NSAIDs, or alternative antiplatelet agents if appropriate. Proton pump inhibitor (PPI) co-therapy should be considered if the combination is absolutely necessary to reduce GI bleeding risk.
Combining piroxicam with prasugrel significantly increases your risk of serious bleeding, including stomach bleeding. This combination should generally be avoided.
Mechanism
Piroxicam, a non-selective NSAID, inhibits cyclooxygenase-1 (COX-1), reducing platelet aggregation and impairing the integrity of the gastrointestinal mucosa. Prasugrel is a potent P2Y12 platelet inhibitor, irreversibly blocking ADP-induced platelet aggregation. The combined antiplatelet effects and GI mucosal damage lead to a synergistic increase in bleeding risk.
Clinical Management
Patients are at a substantially increased risk of serious bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other major bleeding. The risk of major GI bleeding can be several-fold higher compared to either drug alone, potentially leading to hospitalization, transfusions, or even death. This combination should generally be avoided due to the high risk of serious bleeding. If an NSAID is absolutely necessary, consider a COX-2 selective NSAID (e.g., celecoxib) at the lowest effective dose for the shortest duration, along with a proton pump inhibitor (PPI) for gastroprotection. Closely monitor for any signs of bleeding (e.g., black stools, easy bruising, nosebleeds).
Combining piroxicam with cilostazol significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided.
Mechanism
Piroxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal protection and inhibit platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that directly inhibits platelet aggregation and causes vasodilation. The concurrent use of these agents results in additive antiplatelet effects and increased gastrointestinal toxicity, leading to a substantially elevated bleeding risk.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other systemic bleeding events. Patients may experience symptoms such as black, tarry stools, blood in vomit, easy bruising, or prolonged bleeding from minor cuts. The risk of serious GI bleeding can be several-fold higher compared to either drug alone. This combination should generally be avoided due to the high risk of bleeding. If concurrent use is deemed absolutely necessary, closely monitor for signs and symptoms of bleeding, and consider gastroprotective agents (e.g., proton pump inhibitors). Evaluate alternative pain management strategies that do not involve NSAIDs, or consider alternative antiplatelet agents if appropriate. Discuss with the prescribing physician to weigh risks versus benefits.
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