Piroxicam and gastrointestinal bleeding.

A high number of spontaneous reports of gastrointestinal bleeding were associated with the use of piroxicam in Norwegian patients from 1982 to 1983. However, retrospective case studies at four Norwegian hospitals showed that the majority of these cases were actually associated with the use of aspirin. The remainder of the cases were divided evenly among the four other nonsteroidal anti-inflammatory drugs (NSAIDs), including piroxicam, then available in Norway. To further investigate the relationship between piroxicam and gastrointestinal bleeding, a 14-month prospective case study was undertaken of all patients hospitalized in Tromso, Norway, for hematemesis, melena, or perforation. Of the 43 patients admitted for gastrointestinal bleeding during the study period, 21 had used only aspirin or aspirin-like drugs. Of the 22 patients who had taken the other four NSAIDs the following were true: the cases of gastrointestinal adverse effects were equally distributed among all the NSAIDs; a significant number of patients had taken aspirin or steroids concomitantly with the NSAIDs; and a large number of the patients had previously documented ulcers or serious dyspeptic symptoms. On the basis of this experience, it can be concluded that side effects are associated with the use of all NSAIDs and that the number associated with piroxicam is not significantly different from that associated with other NSAIDs.