Differences Between Naproxen and Piroxicam
| Feature | Naproxen | Piroxicam |
|---|---|---|
| 1. Drug Class | NSAID (Propionic acid derivative) | NSAID (Oxicam class) |
| 2. Brand Names | Aleve, Naprosyn | Feldene |
| 3. Onset of Action | 1–2 hours | 3–5 hours |
| 4. Duration of Action | 8–12 hours | Up to 24–48 hours |
| 5. Half-life | ~12–17 hours | ~50 hours |
| 6. Dosing Frequency | Twice daily | Once daily |
| 7. Indication for Acute Pain | Preferred | Less preferred due to slower onset |
| 8. Use in Arthritis | Effective | Very effective (especially for chronic OA/RA) |
| 9. Gastrointestinal Risk | Moderate | Higher than naproxen |
| 10. Cardiovascular Risk | Slightly higher | Lower CV risk |
| 11. Renal Risk | Moderate | Moderate to high with long use |
| 12. Risk of Photosensitivity | Rare | More frequent |
| 13. Suitable for Short-Term Use | Yes | Less suitable due to long half-life |
| 14. Pediatric Use | Approved in certain ages | Not recommended |
| 15. Elderly Use | Use with caution | Use with more caution |
| 16. Hepatotoxicity Risk | Low | Moderate |
| 17. Drug Interactions | Moderate (anticoagulants, SSRIs) | Higher (due to long half-life) |
| 18. Pregnancy Category | Category C/D (3rd trimester) | Category C/D (3rd trimester) |
| 19. Cost & Availability | Widely available & affordable | Available, slightly costlier |
| 20. Risk of Accumulation | Low | High (due to long half-life) |
Indications
| Naproxen | Piroxicam |
|---|---|
| – Osteoarthritis (OA) | – Osteoarthritis (OA) |
| – Rheumatoid arthritis (RA) | – Rheumatoid arthritis (RA) |
| – Ankylosing spondylitis | – Ankylosing spondylitis |
| – Acute musculoskeletal pain | – Chronic musculoskeletal pain |
| – Dysmenorrhea | – Not commonly used |
| – Gout (acute flares) | – Less effective for acute gout |
Contraindications
| Naproxen | Piroxicam |
|---|---|
| – Active peptic ulcer or GI bleeding | – Same as naproxen |
| – NSAID hypersensitivity | – NSAID hypersensitivity |
| – Severe renal or hepatic impairment | – Same |
| – History of asthma triggered by NSAIDs | – Same |
| – Late pregnancy (3rd trimester) | – Same |
Usual Adult Dosage
| Naproxen | Piroxicam |
|---|---|
| Initial: 250–500 mg twice daily | Standard: 20 mg once daily |
| Max daily: 1000 mg | Max daily: 20 mg |
| Titration: Based on pain/inflammation | Not commonly titrated due to long half-life |
| Pediatric: Yes (age/weight dependent) | Not recommended in children |
Warning Signs (for both drugs)
| Common to Both |
|---|
| – Stomach pain, heartburn, GI bleeding (black or bloody stool) |
| – Shortness of breath or chest pain (CV risks) |
| – Swelling of face, lips, or throat (allergy) |
| – Decreased urine output (renal damage) |
| – Severe skin reactions (rash, peeling, blisters) |
| – Headache, dizziness, vision changes (CNS effects) |
| – Elevated liver enzymes (jaundice, dark urine) |
Which Is Best and Safer?
| Context | Best Choice |
|---|---|
| Short-term pain or inflammation | Naproxen – Faster onset, safer for short-term use |
| Chronic arthritis (RA/OA) | Piroxicam – Once-daily dosing, strong efficacy |
| GI Risk Concern | Naproxen – Lower risk than Piroxicam |
| Elderly patients | Naproxen preferred (cautiously) due to shorter half-life |
| Cardiovascular risk | Piroxicam has a slightly better CV profile, but still requires caution |
Conclusion:
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Naproxen is safer and more suitable for general, short-term use, especially in younger adults and for acute pain.
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Piroxicam may be better for long-term arthritis treatment in select patients but carries higher GI and renal risks due to its long half-life.
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Always consider individual patient risk factors, comorbidities, and duration of therapy when choosing between the two.
