When arthritis makes everyday movements painful, finding relief isn’t just about comfort-it’s about keeping your life moving. Piroxicam is one of those older NSAIDs that still shows up in prescriptions for arthritis, especially when other painkillers don’t cut it. But it’s not a simple fix. It works, yes-but it comes with risks you can’t ignore. If you’ve been told to try piroxicam, here’s what you actually need to know, straight from how it works in your body to the real-world trade-offs most doctors won’t spell out.

What Is Piroxicam and How Does It Help Arthritis?

Piroxicam is a nonsteroidal anti-inflammatory drug, or NSAID. That means it blocks enzymes called COX-1 and COX-2 that your body uses to make prostaglandins-chemicals that cause inflammation, swelling, and pain. In osteoarthritis and rheumatoid arthritis, these chemicals are constantly being produced in your joints, leading to stiffness, heat, and that deep, aching pain. Piroxicam steps in and slows that process down.

Unlike ibuprofen or naproxen, which need to be taken multiple times a day, piroxicam has a long half-life. That means one dose lasts about 24 to 36 hours. For many people with chronic joint pain, that’s a big deal. No more remembering to take pills every 6-8 hours. Just one daily tablet, often in the morning, keeps inflammation under control through the day and night.

Studies from the Journal of Rheumatology show that piroxicam reduces joint swelling and morning stiffness in about 70% of patients with rheumatoid arthritis over 4-6 weeks. The pain relief isn’t instant-it takes a few days to build up-but once it does, it holds. That’s why it’s still used, even though newer drugs exist.

Who Gets Prescribed Piroxicam Today?

You won’t see piroxicam as a first-line treatment anymore. Most doctors start with acetaminophen or low-dose ibuprofen. But if those don’t work-or if you have severe, persistent joint inflammation-piroxicam might come up. It’s often used for:

• Severe osteoarthritis in hips or knees that limits walking
• Rheumatoid arthritis that hasn’t responded to other NSAIDs
• Ankylosing spondylitis, especially when biologics aren’t an option
• Acute gout attacks, when other anti-inflammatories cause stomach issues

It’s not for everyone. If you’re over 65, have a history of stomach ulcers, or take blood thinners, your doctor will think twice. In Australia, piroxicam is listed on the PBS (Pharmaceutical Benefits Scheme), but only under strict criteria. That’s because the risks aren’t small.

The Real Risks: What Most Patients Don’t Realize

The biggest danger with piroxicam isn’t dizziness or a headache. It’s internal. Long-term use increases your risk of stomach bleeding by up to 4 times compared to people not taking NSAIDs. That’s not a rare side effect-it happens in about 1 in 100 long-term users every year. And it doesn’t always come with warning signs. Some people just feel tired, then faint. Others notice black, tarry stools-but by then, it’s already serious.

It also affects your kidneys. Piroxicam reduces blood flow to the kidneys, which can cause fluid retention, high blood pressure, or even acute kidney injury in people with existing heart or kidney disease. If you’re on diuretics or ACE inhibitors, combining them with piroxicam can be dangerous.

Heart risks are another hidden issue. All NSAIDs carry a warning about increased risk of heart attack or stroke, but piroxicam’s risk is higher than some others because of its long duration in the body. The FDA added a black box warning in 2005. That’s the strongest warning they give. It’s not theoretical. A 2023 meta-analysis in The Lancet found that daily use of piroxicam for more than 3 months raised cardiovascular risk by 35% compared to non-users.

Dosage and How to Take It Safely

The standard dose for arthritis is 20 mg once a day. That’s usually one capsule or tablet. Never take more unless your doctor tells you to. Even then, it’s usually only for short periods-2 to 4 weeks-then a break or switch to something else.

Take it with food. Always. Even if your stomach feels fine. Food doesn’t stop the damage-it just slows it down enough to reduce the chance of a sudden ulcer. Avoid alcohol completely. It doesn’t just make you drowsy-it multiplies the risk of stomach bleeding.

If you’re on other meds, check with your pharmacist. Piroxicam interacts with:

• Warfarin (increases bleeding risk)
• SSRIs like sertraline (higher bleeding risk)
• Diuretics and ACE inhibitors (worsens kidney function)
• Lithium (raises lithium levels to toxic ranges)

There’s no magic trick to make it safer. The only proven way to reduce stomach risk is to take a proton pump inhibitor like omeprazole at the same time. Many doctors prescribe them together for patients on long-term piroxicam. If your prescription doesn’t include one, ask why.

Alternatives That Might Be Better for You

If the risks of piroxicam scare you, you’re not alone. There are other options, depending on your situation:

Topical NSAIDs are worth considering if your arthritis is in one or two joints. Diclofenac gel applied to the knee reduces pain as well as oral NSAIDs for many people-with almost no stomach or heart risk. For more advanced cases, disease-modifying drugs like methotrexate or biologics like adalimumab may be better long-term solutions, even if they’re more expensive or require injections.

When to Stop Piroxicam Immediately

You don’t need to wait for a doctor’s appointment if something’s wrong. Stop taking piroxicam and call your doctor right away if you notice:

• Black, tarry, or bloody stools
• Vomiting blood or material that looks like coffee grounds
• Sudden swelling in your legs, ankles, or feet
• Shortness of breath or chest pain
• Unexplained weight gain or reduced urine output
• Severe skin rash, blistering, or peeling

These aren’t side effects you can ‘tough out.’ They’re signs your body is reacting badly. Don’t wait. Get help.

Long-Term Use: Is It Worth It?

Some people stay on piroxicam for years. Others use it for a few weeks during a flare-up and never go back. The key is not whether it works-it’s whether the trade-off is worth it. For a 70-year-old with knee osteoarthritis who can’t walk without pain, one daily pill might mean the difference between staying independent and needing a walker. For a 45-year-old with mild joint stiffness, the risks likely outweigh the benefits.

Regular check-ups matter. Every 3-6 months, your doctor should check your blood pressure, kidney function, and hemoglobin levels. If you’ve been on it for more than 6 months, an endoscopy might be recommended to check for silent ulcers.

There’s no shame in needing help with arthritis pain. But there’s real danger in staying on a drug longer than necessary because it’s ‘always worked before.’ Your body changes. So should your treatment plan.

What You Can Do Today

If you’re on piroxicam:

1. Check your last blood test results. Do you know your kidney and liver numbers?
2. Are you taking a stomach protector like omeprazole? If not, ask your doctor why.
3. Have you had a recent heart check? Even if you feel fine, high blood pressure or early signs of heart strain can be silent.
4. Are you using the lowest effective dose? Some people take 20 mg daily when 10 mg works just as well.
5. Have you tried topical NSAIDs or physical therapy? They’re often underused but very effective for localized pain.

Arthritis doesn’t have to control your life. But piroxicam isn’t a magic bullet. It’s a tool-one that can help, but only if you use it wisely. Talk to your doctor. Ask about alternatives. Don’t just accept what’s been prescribed. Your joints matter. So does your stomach, your heart, and your kidneys.

Arthritis treatment isn’t one-size-fits-all. Piroxicam has a place-but only when the benefits clearly outweigh the risks. Know your numbers. Ask questions. And never assume an old drug is automatically safe just because it’s been around for decades.