Drug Information

Piroxicam is used to treat rheumatoid arthritis and osteoarthritis. It is in a class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs).

Common brand names:

Feldene

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Iron

    NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss.1 Iron supplements can cause GI irritation.2 However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency. If both iron and nabumetone are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

Reduce Side Effects

  • Licorice

    The flavonoids found in the extract of licorice (Glycyrrhiza glabra) known as DGL (deglycyrrhizinated licorice) are helpful for avoiding the irritating actions NSAIDs have on the stomach and intestines. One study found that 350 mg of chewable DGL taken together with each dose of aspirin reduced gastrointestinal bleeding caused by the aspirin.3 DGL has been shown in controlled human research to be as effective as drug therapy (cimetidine) in healing stomach ulcers.4

Support Medicine

  • Stinging Nettle

    In a controlled human study, people who took stinging nettle with diclofenac obtained similar pain relief compared to people taking twice as much diclofenac with no stinging nettle.5 More research is needed to determine whether people taking diclofenac might benefit from also taking stinging nettle.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • Potassium

    An 85-year-old man developed higher than normal blood levels of potassium following several months of treatment with piroxicam.6 Until more is known, people taking piroxicam for long periods should have their blood checked regularly for high potassium levels and may need to avoid high potassium intake with the guidance of a health practitioner.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • White Willow

    Willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. Taking aspirin significantly lowers blood levels of piroxicam and increases the potential for adverse side effects.7 Though no studies have investigated interactions between willow bark and piroxicam, people taking the drug should avoid the herb until more information is available.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

1. Bjarnason I, Macpherson AJ. Intestinal toxicity of non-steroidal anti-inflammatory drugs. Pharmacol Ther 1994;62:145-57.

2. Threlkeld DS, ed. Blood Modifiers, Iron-Containing Products. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jun 1998, 62-9a.

3. Rees WDW, Rhodes J, Wright JE, et al. Effect of deglycyrrhizinated liquorice on gastric mucosal damage by aspirin. Scand J Gastroenterol 1979;14:605-7.

4. Morgan AG, McAdam WAF, Pacsoo C, Darnborough A. Comparison between cimetidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance therapy. Gut 1982;23:545-51.

5. Chrubasik S, Enderlein W, Bauer R, Grabner W. Evidence for antirheumatic effectiveness of Herba Urticae dioicae in acute arthritis: a pilot study. Phytomedicine 1997;4:105-8.

6. Miller KP, Lazar EJ, Fotino S. Severe hyperkalemia during piroxicam therapy. Arch Int Med 1984;144:2414-5.

7. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2342-4.