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Piroxicam, a nonsteroidal anti-inflammatory drug, carries important safety considerations that should be carefully reviewed by both patients and healthcare providers. Below are key warnings and precautions associated with its use:

• Heart Risks: Piroxicam may increase the likelihood of heart attacks, strokes, and blood clots, particularly when used long-term or at high doses. Individuals with existing heart conditions, or those at increased risk, should consult their healthcare provider before use. Avoid taking piroxicam if undergoing or having recently undergone heart bypass surgery. Seek immediate medical attention if experiencing symptoms like chest pain, difficulty breathing, or sudden weakness.

• Gastrointestinal Bleeding: This medication can cause serious gastrointestinal bleeding and ulcers, potentially without warning. Higher risks are present in older adults, those with a history of ulcers, and individuals using other NSAIDs, blood thinners, or consuming alcohol. Discontinue use and consult your healthcare provider if you notice symptoms such as persistent stomach pain, black stools, or vomit resembling coffee grounds.

• Blood Pressure and Heart Failure: Piroxicam may lead to fluid retention, raising blood pressure or increasing heart failure risk. Patients with existing heart issues or those on blood pressure medications should discuss their treatment plan with their provider to ensure safety. Report symptoms like unexplained fainting or irregular heartbeat promptly.

• Kidney and Liver Concerns: This medication may impair kidney function, especially in those with existing kidney or liver issues or those taking certain blood pressure drugs. It can also cause rare but serious liver damage. Regular monitoring may be necessary for long-term users. Alert your provider to any changes in urination or symptoms such as jaundice or dark urine.

• Severe Allergic Reactions: Allergic reactions, including anaphylaxis, though rare, can occur. Individuals with known allergies to aspirin or other NSAIDs should avoid piroxicam and seek medical help if severe symptoms like hives or difficulty breathing arise.

• Pregnancy and Breastfeeding: Piroxicam is not recommended during pregnancy, particularly in the second half, or while breastfeeding due to potential harm to the baby. Discuss risks and benefits with your healthcare provider.

• Contraindications: Do not use piroxicam if you have a known allergy to NSAIDs, a history of asthma or hives linked to aspirin or other NSAIDs, or if you've undergone coronary artery bypass graft surgery.

Always consult your healthcare provider to weigh the benefits and risks of piroxicam in your specific case.

When taking this medication, you may experience some common side effects, which are typically mild. These include upset stomach, nausea, vomiting, constipation, passing gas, diarrhea, headache, dizziness, drowsiness, and stomach pain. You may also notice swelling or fluid buildup, a rash, or ringing in the ears. If any of these effects persist or worsen, it's important to consult a healthcare provider.

In some cases, other side effects like a pounding heart, mouth sores, blurred vision, or more pronounced drowsiness have been reported. While these are less common, they should still be discussed with a healthcare professional if they occur.

It is crucial to be aware of serious side effects, although they are rare. Immediate medical attention is required if you experience symptoms of stomach bleeding, such as severe stomach pain, vomiting blood, or dark stools. Signs of a heart attack or stroke, including chest pain, pain radiating to the shoulder or jaw, slurred speech, or weakness on one side of the body, also necessitate urgent care. Heart failure may present as difficulty breathing, swelling, or a fast heartbeat.

Additionally, watch for signs of liver or kidney problems, such as yellowing skin, dark urine, reduced urination, or unusual fatigue. Allergic reactions, though rare, can manifest as hives, swelling of the lips or tongue, and breathing difficulties. Serious skin reactions, like reddening or blistering, also require prompt medical evaluation.

This is not an exhaustive list of side effects. If you notice any unusual or persistent symptoms, contact your healthcare provider for advice.

When taking piroxicam, it's important to be aware of potential drug interactions. This medication can interact with certain other drugs, which may require adjustments to your treatment plan.

1. Medications to Avoid:

   • Ketorolac should not be used with piroxicam.

2. Medications to Use with Caution:

   • Some medications may need to be used with caution or adjustments. These include:
     • Blood thinners and anti-platelet drugs such as clopidogrel, abciximab, apixaban, warfarin, and enoxaparin, as well as NSAIDs like ibuprofen, celecoxib, and aspirin.
     • ACE inhibitors (like captopril, lisinopril), angiotensin II receptor blockers (like losartan, valsartan), and diuretics (water pills) such as furosemide.
     • Corticosteroids (like prednisone) and lithium.

3. Risk of Increased Side Effects:

   • Using piroxicam with certain medications can heighten the risk of side effects. If both drugs are necessary, your doctor may adjust dosages. These medications include various blood pressure and heart medications such as beta-blockers (e.g., atenolol, metoprolol), and angiotensin II receptor blockers (e.g., azilsartan, irbesartan).

4. Bleeding Risk:

   • Piroxicam may increase the risk of bleeding, especially if taken with other medications that also pose this risk, such as anti-platelet drugs and anticoagulants.

Always inform your doctor and pharmacist about all the medications and supplements you are taking, whether prescription or over-the-counter, to ensure safe and effective use of piroxicam. If your doctor has prescribed low-dose aspirin for heart attack or stroke prevention, continue taking it unless advised otherwise by your healthcare provider.