Piroxicam Dosage and Administration for Arthritis
For rheumatoid arthritis and osteoarthritis, piroxicam should be administered at 20 mg orally once daily, which is the FDA-approved standard dose that provides 24-hour symptom control. 1
Standard Dosing Regimen
- The recommended dose is 20 mg given orally once per day for both rheumatoid arthritis and osteoarthritis. 1
- If desired, the daily dose may be divided, though single daily dosing is preferred due to piroxicam's long half-life of approximately 40 hours. 1, 2
- The single 20 mg daily dose produces 24-hour control of symptoms, making it highly convenient for patient compliance. 3
Time to Therapeutic Effect
- Steady-state blood levels are not reached for 7 to 12 days due to piroxicam's extended half-life. 1
- Although therapeutic effects are evident early in treatment, there is a progressive increase in response over several weeks. 1
- The effect of therapy should not be fully assessed until at least two weeks of treatment have elapsed. 1
Special Dosing Considerations
Acute Gout
- For acute gouty arthritis, a higher dose of 40 mg once daily for 5 days has been shown effective, with analgesic effects demonstrated within 3 hours of first dose administration. 4
Dose Adjustment
- After observing the response to initial therapy, the dose and frequency should be adjusted to suit individual patient needs. 1
- Use the lowest effective dose for the shortest duration consistent with patient treatment goals to minimize cardiovascular, gastrointestinal, and renal risks. 1
Comparative Efficacy
- Piroxicam 20 mg daily is comparable in efficacy to aspirin 3-6 g, indomethacin 75-150 mg, naproxen 500 mg, ibuprofen 1200-2400 mg, and diclofenac 75 mg in rheumatoid arthritis. 2
- In osteoarthritis, piroxicam 20 mg daily is comparable to aspirin 2.6-3.9 g, indomethacin 75 mg, naproxen 500 mg, and fenbufen 600 mg, but is generally better tolerated than aspirin or indomethacin. 2
- Piroxicam 20 mg was at least as effective as indomethacin 75 mg in ankylosing spondylitis. 2
Safety and Risk Mitigation
- Prior to initiating therapy, evaluate gastrointestinal, renal, and cardiovascular risk factors. 5
- Consider co-prescribing a proton pump inhibitor for gastroprotection in high-risk patients (age >60, history of GI bleeding, concurrent aspirin use). 6
- Gastrointestinal complaints are the most frequently reported side effects, and their frequency and severity appear to be dose-related. 2
- Piroxicam should not be used in combination with other NSAIDs, as this increases adverse event risk without additional benefit. 6
Important Caveats
- Piroxicam should be considered as adjunctive therapy to disease-modifying treatments in inflammatory arthritis conditions, not as monotherapy for long-term management. 6
- Regular assessment of efficacy and adverse effects is recommended during treatment. 6
- The increase in daily dose is not accompanied by more frequent development or aggravation of adverse effects, though the lowest effective dose principle still applies. 7
- Patient preference and compliance has consistently been higher for patients on piroxicam therapy compared to other NSAIDs, likely due to once-daily dosing. 3