Silodol (Piroxicam) Dosage and Management for Arthritis
Recommended Dosage
The standard dose of piroxicam for both rheumatoid arthritis and osteoarthritis is 20 mg once daily, taken orally. 1
- The daily dose may be divided if desired, though once-daily dosing is preferred due to piroxicam's long half-life of approximately 40 hours 1, 2
- Initial dosing may range from 10-40 mg, but nearly all patients should be maintained on 20 mg once daily 3
- Steady-state blood levels are not reached for 7-12 days, so therapeutic response should not be fully assessed until at least 2 weeks of treatment 1
Pre-Treatment Risk Assessment
Before initiating piroxicam, you must evaluate gastrointestinal, renal, and cardiovascular risk factors. 4
- For patients over 60 years old or with history of GI bleeding, co-prescribe a proton pump inhibitor for gastroprotection 4
- Assess for active peptic ulcer disease, history of GI bleeding, severe heart failure, severe liver insufficiency, or severe renal insufficiency—all are contraindications 5
- Monitor blood pressure regularly as NSAIDs can cause hypertension and edema 5
Treatment Duration and Monitoring
Use piroxicam at the lowest effective dose for the shortest duration consistent with treatment goals. 1
- Piroxicam should serve as adjunctive therapy to disease-modifying treatments in inflammatory arthritis, not as monotherapy for long-term management 4
- Progressive therapeutic response occurs over several weeks, with effects evident early but continuing to improve 1
- Monitor renal function (BUN and creatinine) and liver function tests during treatment 5
Important Safety Restrictions
Never combine piroxicam with other NSAIDs, as this increases adverse events without additional benefit. 4
- Gastrointestinal complaints are the most frequently reported side effects and are dose-related 2
- In clinical studies, side effects were predominantly gastrointestinal, occurring in approximately 29% of patients, though most were mild to moderate 3
- Discontinuation due to adverse effects occurred in only 7.5% of patients in general practice studies 3
Comparative Efficacy
Piroxicam 20 mg daily demonstrates comparable efficacy to:
- Aspirin 3-6 g daily 2
- Indomethacin 75-150 mg daily 2
- Ibuprofen 1200-2400 mg daily 2, 6
- Naproxen 500 mg daily 2
Piroxicam is generally better tolerated than aspirin or indomethacin in arthritic diseases. 2
Role in Treatment Algorithm
For rheumatoid arthritis: NSAIDs like piroxicam are used primarily for symptom control alongside disease-modifying antirheumatic drugs (DMARDs) such as methotrexate 7
For osteoarthritis: Piroxicam should be considered after inadequate response to acetaminophen, using the lowest effective dose for the shortest duration 7
For ankylosing spondylitis: Piroxicam 20 mg daily shows comparable efficacy to indomethacin 75 mg 2
Common Pitfall to Avoid
Do not expect full therapeutic effect immediately—allow at least 2 weeks for proper assessment, as steady-state levels take 7-12 days to achieve and therapeutic response progressively increases over several weeks 1