Also known as Feldene, PXM, Piroxicamum, Pyroxycam
A nonsteroidal oxicam derivative with anti-inflammatory, antipyretic and analgesic properties. As a non-selective, nonsteroidal anti-inflammatory drug (NSAID), piroxicam binds and chelates both isoforms of cyclooxygenases (COX1 and COX2), thereby stalling phospholipase A2 activity and conversion of arachidonic acid into prostaglandin precursors at the rate limiting cyclooxygenase enzyme step. This results in inhibition of prostaglandin biosynthesis. As a second, independent effect, piroxicam inhibits the activation of neutrophils thereby contributing to its overall anti-inflammatory effects.
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Can I take Piroxicam while breastfeeding?
Low amounts of piroxicam in milk and failure to detect piroxicam or its metabolites in the urine of 2 older infants indicates that it would not be expected to cause adverse effects in older breastfed infants. Because there is no published experience with piroxicam during breastfeeding in the newborn period, shorter-acting agents may be preferred while nursing a newborn or preterm infant.
Drug levels
Maternal Levels. Peak milk levels of 170 and 220 mcg/L were found in the milk of 2 women who were taking piroxicam 20 and 40 mg daily, respectively. The time of the peak milk levels were 12 and 4 hours after the dose, respectively, in the 2 women.[1]
Maximum milk piroxicam levels averaging 40 mcg/L were found in 3 women during the first week of therapy with oral piroxicam 20 mg daily. After steady-state was attained in these 3 women plus one additional woman, milk levels averaged 102 mcg/L during the first 12 hours after the dose and 73 mcg/L during the period of 13 to 24 hours after the dose. A nursing infant would receive an estimated average 3.5% and maximum 6.3% of the weight-adjusted maternal dosage.[2]
Infant Levels. No piroxicam could be detected in the serum of an 13-month-old infant whose mother had been taking 20 mg daily of piroxicam for 4 months.[1]
Neither piroxicam nor its conjugates could be detected (<15 mcg/L) in the urine of one infant after 52 days of maternal therapy with 20 mg daily.[2]
Effects in breastfed infants
Maternal Levels. Peak milk levels of 170 and 220 mcg/L were found in the milk of 2 women who were taking piroxicam 20 and 40 mg daily, respectively. The time of the peak milk levels were 12 and 4 hours after the dose, respectively, in the 2 women.[1]
Maximum milk piroxicam levels averaging 40 mcg/L were found in 3 women during the first week of therapy with oral piroxicam 20 mg daily. After steady-state was attained in these 3 women plus one additional woman, milk levels averaged 102 mcg/L during the first 12 hours after the dose and 73 mcg/L during the period of 13 to 24 hours after the dose. A nursing infant would receive an estimated average 3.5% and maximum 6.3% of the weight-adjusted maternal dosage.[2]
Infant Levels. No piroxicam could be detected in the serum of an 13-month-old infant whose mother had been taking 20 mg daily of piroxicam for 4 months.[1]
Neither piroxicam nor its conjugates could be detected (<15 mcg/L) in the urine of one infant after 52 days of maternal therapy with 20 mg daily.[2]
Possible effects on lactation
Relevant published information was not found as of the revision date.
Alternate drugs to consider
Acetaminophen, Flurbiprofen, Ibuprofen, Indomethacin, Naproxen
References
1. Ostensen M. Piroxicam in human breast milk. Eur J Clin Pharmacol. 1983;25:829-30. PMID: 6662182
2. Ostensen M, Matheson I, Laufen H. Piroxicam in breast milk after long-term treatment. Eur J Clin Pharmacol. 1988;35:567-9. PMID: 3234465
Last Revision Date
20150310
Disclaimer:Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.
Source: LactMed – National Library of Medicine (NLM)