Who Should Not Use Piroxicam? An Essential Medication Guide

October 11, 2025 •

4 min read

According to the FDA, piroxicam and other NSAIDs carry a black box warning for serious cardiovascular and gastrointestinal risks, which can be fatal. Therefore, it is crucial to understand who should not use piroxicam before starting this medication.

Quick Summary

Piroxicam should be avoided by individuals with certain heart conditions, severe allergies to NSAIDs, active gastrointestinal bleeding or ulcers, and severe kidney or liver disease. It is also contraindicated during late pregnancy and should be used with extreme caution in the elderly.

Key Points

Serious Cardiovascular Risks: Piroxicam can increase the risk of heart attack and stroke, especially with long-term use, and is contraindicated following CABG surgery.
High Gastrointestinal Bleeding Risk: The medication carries a black box warning for serious GI bleeding, ulceration, and perforation, with a higher risk for older adults and those with a history of ulcers.
Contraindicated in Late Pregnancy: Piroxicam is not recommended for use during the last trimester of pregnancy due to potential harm to the fetus.
Allergy to Aspirin or Other NSAIDs: Avoid piroxicam if you have a known allergy to aspirin or other NSAIDs, especially if you have aspirin-sensitive asthma.
Avoid in Severe Organ Dysfunction: Piroxicam is contraindicated in individuals with severe kidney, liver, or heart failure.
Elderly Population is High-Risk: Older adults are at greater risk for serious side effects and should use the lowest possible dose for the shortest duration.
Drug Interactions are Common: Piroxicam interacts with blood thinners, blood pressure medications, and other NSAIDs, increasing the risk of adverse events.

What is Piroxicam?

Piroxicam is a potent nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, swelling, and stiffness caused by conditions such as rheumatoid arthritis and osteoarthritis. Its effectiveness in treating chronic inflammation is accompanied by significant risks, leading regulatory bodies like the FDA to issue serious warnings. Its extended presence in the body due to a long half-life increases the potential for adverse effects. Consequently, healthcare providers must carefully evaluate the benefits against the risks for each patient.

Who Should Avoid Piroxicam?

Certain individuals should completely avoid piroxicam due to a high risk of severe complications. These contraindications are vital and require consultation with a medical professional.

Cardiovascular Risks

Piroxicam, like other NSAIDs, elevates the risk of serious and potentially fatal cardiovascular events such as heart attack and stroke.

Coronary Artery Bypass Graft (CABG) Surgery: Piroxicam is strictly contraindicated immediately before or after CABG surgery as it significantly increases the risk of heart attack and stroke.
Recent Heart Attack or Stroke: Unless directed by a doctor, patients who have recently had a heart attack or stroke should not take piroxicam.
Severe Heart Failure: Piroxicam should be avoided in patients with severe heart failure as it can cause fluid retention and worsen the condition.

Gastrointestinal Risks

Serious and potentially fatal gastrointestinal adverse events are a significant risk associated with piroxicam.

Active GI Ulcers or Bleeding: Piroxicam should not be used by patients with current or recent peptic ulcer disease or GI bleeding.
Previous Serious GI Events: Individuals with a history of GI inflammation, ulceration, or perforation face a substantially higher risk of serious GI complications.

Hypersensitivity and Allergy Concerns

Individuals with specific allergies should not use piroxicam due to the risk of severe reactions.

Aspirin-Sensitive Asthma: Piroxicam is contraindicated in patients with aspirin-sensitive asthma, as it can trigger severe and potentially fatal bronchospasm.
Known NSAID Allergy: Anyone with a history of an allergic reaction (e.g., hives, angioedema) to piroxicam or other NSAIDs should not take this medication.
Serious Skin Reactions: Piroxicam has been linked to severe skin reactions like Stevens-Johnson syndrome and toxic epidermal necrolysis, so those who have experienced these should avoid it.

Severe Kidney or Liver Disease

Piroxicam can potentially harm the kidneys and liver, particularly in individuals with pre-existing conditions.

Severe Kidney Failure: The medication is contraindicated in patients with severe kidney disease.
Severe Liver Failure: Piroxicam should not be taken by patients with severe liver impairment.

Pregnancy and Fertility

Piroxicam poses risks to both fertility and developing fetuses.

Last Trimester of Pregnancy: Piroxicam must be avoided after 20 weeks of gestation as it can cause serious heart and kidney problems in the unborn baby.
Infertility: NSAIDs, including piroxicam, may temporarily impact ovulation in women trying to conceive.
Breastfeeding: Piroxicam passes into breast milk and is not advised for nursing mothers.

Precautions for High-Risk Individuals

Some groups require extra caution and monitoring when using piroxicam due to an increased risk of side effects.

The Elderly: Patients aged 65 or older have a higher risk of serious GI and kidney problems. The lowest effective dose for the shortest duration is recommended.
Patients with Hypertension: Piroxicam can cause fluid retention, potentially increasing blood pressure. Blood pressure should be monitored closely.
Smokers and Alcohol Users: Combining smoking or alcohol consumption with piroxicam significantly raises the risk of GI bleeding.

Significant Drug Interactions

Inform your doctor about all other medications you are taking before starting piroxicam, as dangerous interactions can occur.

Other NSAIDs and Aspirin: Combining piroxicam with other NSAIDs (e.g., ibuprofen, naproxen) or analgesic doses of aspirin is not recommended due to increased side effect risk, especially GI bleeding.
Anticoagulants: Concomitant use with blood thinners like warfarin significantly increases the risk of serious bleeding.
ACE Inhibitors and Diuretics: Piroxicam can decrease the effectiveness of blood pressure medications and 'water pills', potentially leading to declining kidney function, particularly in the elderly.
Lithium and Methotrexate: Piroxicam can increase blood levels of lithium and methotrexate, potentially causing toxicity.
SSRIs: Taking piroxicam with selective serotonin reuptake inhibitors (SSRIs) can increase the risk of bleeding.

Comparison of Piroxicam with Ibuprofen (Another NSAID)


Feature	Piroxicam (e.g., Feldene)	Ibuprofen (e.g., Advil, Motrin)
Drug Class	Prescription NSAID	Over-the-counter and prescription NSAID
Primary Use	Chronic arthritis (osteoarthritis, rheumatoid arthritis)	General pain, inflammation, fever
Half-Life	Long (steady-state not reached for 7-12 days)	Short (requires more frequent dosing)
Cardiovascular Risk	Black Box Warning, increased risk of heart attack/stroke, especially with long-term use	Black Box Warning, similar risks to other NSAIDs
GI Bleeding Risk	Black Box Warning, higher risk, especially in the elderly	Black Box Warning, risk increases with higher doses or long-term use
Use in Elderly	Higher risk of GI bleeding and renal problems; caution advised	Dose adjustments may be necessary due to age-related organ function decline

Conclusion

Piroxicam is a powerful anti-inflammatory medication, but its use is not appropriate for everyone. The FDA has issued strong warnings regarding its cardiovascular and gastrointestinal side effects. Patients with a history of heart attack, stroke, or GI bleeding are at a significantly higher risk for serious complications. Furthermore, piroxicam is contraindicated for late-term pregnant women, patients with severe heart, kidney, or liver disease, and those with a known allergy to aspirin or other NSAIDs. Elderly individuals and those taking certain other medications also require special care and monitoring. Always have a detailed conversation with a healthcare provider to ensure that piroxicam is the safest and most appropriate treatment option for your specific health profile.

Visit the MedlinePlus Piroxicam information page for more details.

Frequently Asked Questions

No, you should not take piroxicam if you have a history of stomach or intestinal ulcers or bleeding. It significantly increases the risk of serious and potentially fatal GI adverse events.

Piroxicam is not safe for use during the later stages of pregnancy (20 weeks or later) as it can harm the unborn baby. It is not recommended for breastfeeding mothers, and women trying to conceive should discuss potential effects on ovulation with a doctor.

Elderly patients (65 and older) are at a higher risk of serious GI bleeding and kidney problems with piroxicam. Use with caution is required, and the lowest effective dose for the shortest time should be used.

Yes, piroxicam can increase your risk of a heart attack or stroke, especially if you already have heart disease. It should be avoided, particularly before or after heart bypass surgery.

No, you should not take piroxicam with other NSAIDs like ibuprofen or naproxen. Combining them increases the risk of serious side effects, such as stomach bleeding.

If you have signs of an allergic reaction, such as swelling, hives, or trouble breathing, stop taking the medication immediately and seek emergency medical help. Patients with aspirin-sensitive asthma should not use piroxicam.

Piroxicam should be avoided by people with severe kidney disease, as it can cause kidney damage. It can also reduce blood flow to the kidneys, potentially worsening pre-existing kidney dysfunction.

Yes, consuming alcohol while taking piroxicam can significantly increase your risk of stomach bleeding and ulcers.