Drug interactions
Piroxicam + Tolbutamide
Severity: Moderate
Piroxicam and Tolbutamide: moderate 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
Piroxicam may enhance the glucose-lowering effect of tolbutamide, leading to hypoglycemia in some patients. Tolbutamide is cleared by CYP2C9, which piroxicam also uses, so competition is possible.
What this interaction means in plain words
Piroxicam and Tolbutamide can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Piroxicam belongs to Musculoskeletal; Tolbutamide belongs to Endocrine.
Why it happens
Possible competition for CYP2C9 metabolism and protein binding displacement; the mechanism is not firmly established.
What to do
Monitor blood glucose when piroxicam is started or stopped and reduce the tolbutamide dose if hypoglycemia occurs.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Tolbutamide
- Glyburide-metformin + Tolbutamide Major
- Insulin degludec-liraglutide + Tolbutamide Major
- Aceclofenac + Tolbutamide Moderate
- Acemetacin + Tolbutamide Moderate
- Acetylsalicylic acid + Tolbutamide Moderate
- Albiglutide + Tolbutamide Moderate
Frequently asked questions
Can I take Piroxicam with Tolbutamide?
MediHelp rates the interaction as moderate. Piroxicam and Tolbutamide can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Piroxicam may enhance the glucose-lowering effect of tolbutamide, leading to hypoglycemia in some patients. Tolbutamide is cleared by CYP2C9, which piroxicam also uses, so competition is possible.
How serious is the interaction between Piroxicam and Tolbutamide?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood glucose when piroxicam is started or stopped and reduce the tolbutamide dose if hypoglycemia occurs.
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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