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UK, remember your settings and improve government services. Systemic piroxicam should be initiated only by specialists as a second-line treatment for arthritis, with patients who currently take piroxicam reassessed at a routine appointment. Revised warnings also highlight the need for caution when piroxicam is used with other drugs that may increase gastrointestinal risk eg, selective serotonin reuptake inhibitors class of antidepressants and low-dose aspirin. Patients should stop taking piroxicam and seek medical advice at the first occurrence of gastrointestinal symptoms. Patients who are receiving continuous long-term piroxicam treatment should be reassessed carefully in light of the increased risks of this treatment. If after full consideration of the risks and benefits there seems to be no alternative to piroxicam, specialist referral may be considered. Available epidemiological evidence suggests that systemic piroxicam poses a significantly greater risk of serious gastrointestinal toxicity than other NSAIDs, including gastrointestinal haemorrhage, ulceration, and perforation.
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