Drug interactions
Piroxicam + Rivaroxaban
Severity: Major
Piroxicam and Rivaroxaban: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Combining an NSAID with rivaroxaban raises the risk of clinically significant bleeding, particularly gastrointestinal bleeding. Piroxicam has a long half-life and notable GI toxicity, which adds to the concern.
What this interaction means in plain words
Piroxicam and Rivaroxaban can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Piroxicam belongs to Musculoskeletal; Rivaroxaban belongs to Cardiovascular.
Why it happens
Additive effects of anticoagulation, NSAID-induced platelet dysfunction and gastric mucosal injury.
What to do
Avoid the combination where possible and use paracetamol or another non-NSAID analgesic. If unavoidable, use the shortest course with gastroprotection and monitor for bleeding and anemia.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Piroxicam
- Ketorolac intranasal + Piroxicam Contraindicated
- Ketorolac + Piroxicam Contraindicated
- Aceclofenac + Piroxicam Major
- Acemetacin + Piroxicam Major
- Acetylsalicylic acid + Piroxicam Major
- Alteplase + Piroxicam Major
Other interactions of Rivaroxaban
- Defibrotide + Rivaroxaban Contraindicated
- Ketoconazole + Rivaroxaban Contraindicated
- Ketorolac + Rivaroxaban Contraindicated
- Abciximab + Rivaroxaban Major
- Acalabrutinib + Rivaroxaban Major
- Acetylsalicylic acid + Rivaroxaban Major
Frequently asked questions
Can I take Piroxicam with Rivaroxaban?
MediHelp rates the interaction as major. Piroxicam and Rivaroxaban can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Combining an NSAID with rivaroxaban raises the risk of clinically significant bleeding, particularly gastrointestinal bleeding. Piroxicam has a long half-life and notable GI toxicity, which adds to the concern.
How serious is the interaction between Piroxicam and Rivaroxaban?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and use paracetamol or another non-NSAID analgesic. If unavoidable, use the shortest course with gastroprotection and monitor for bleeding and anemia.
What other medicines interact with Piroxicam?
MediHelp also lists interactions of Piroxicam with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Piroxicam page.
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