Adult: As symptomatic treatment: Initially, 20 mg once daily given at the same time each day for 1-2 days via IV or IM inj, to be continued with the oral form when appropriate. Use the lowest effective dose for the shortest possible duration. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Use the lowest effective dose for the shortest possible duration.
Adult: For short-term treatment: Initially, 20 mg once daily given at the same time each day for 1-2 days via IV or IM inj, to be continued with the oral form when appropriate. Use the lowest effective dose for the shortest possible duration. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Use the lowest effective dose for the shortest possible duration.
Intramuscular, Intravenous Postoperative pain
Adult: 40 mg once daily for 5 days via IV or IM inj. Use the lowest effective dose for the shortest possible duration. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Use the lowest effective dose for the shortest possible duration.
Oral Acute musculoskeletal disorders
Adult: For short-term treatment: 20 mg once daily given at the same time each day. Usual treatment duration: Up to 7 days (Max: 14 days for severe cases). Use the lowest effective dose for the shortest possible duration. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Use the lowest effective dose for the shortest possible duration.
Adult: As symptomatic treatment: 20 mg once daily given at the same time each day. Use the lowest effective dose for the shortest possible duration. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Use the lowest effective dose for the shortest possible duration.
Special Patient Group
Pharmacogenomics:
CYP2C9 polymorphisms influence the metabolism and clearance of NSAIDs, thus affecting drug exposure and safety. Variations in allele frequencies have been observed across diverse racial, geographical, and ethnic populations. Individuals who are CYP2C9 intermediate or poor metabolisers may have reduced metabolic clearance of NSAIDs, leading to increased plasma levels and a prolonged elimination half-life. Tenoxicam is an NSAID with an extremely long half-life; hence, the risks associated with reduced CYP2C9 metabolism may be further increased. Genetic testing may be considered when prescribing NSAIDs.
Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline as of March 2020:
Phenotype and Genotype
Implications
Recommendations
CYP2C9 intermediate metaboliser
(activity score of 1.5)
Patients
carrying 1 normal function allele and 1 decreased function allele e.g. *1/*2
Mildly decreased metabolism
Initiate treatment with the recommended initial
dose. Use the lowest effective dose for the shortest possible duration.
CYP2C9 intermediate metaboliser
(activity score of 1)
Patients
carrying 1 normal function allele and 1 no function allele, or 2 decreased
function alleles e.g. *1/*3, *2/*2
Moderately decreased metabolism; higher plasma tenoxicam
levels may increase the risk of toxicities.
Select an alternative therapy that is not
primarily metabolised by CYP2C9 (e.g. ketorolac, naproxen, sulindac) or not
significantly affected by CYP2C9 genetic variants in
vivo or choose an NSAID that is metabolised by CYP2C9 but has a shorter
half-life. Selection of therapy will be based on individual treatment goals and
risks for toxicity.
CYP2C9 poor metaboliser (activity
score of 0-0.5)
Patients
carrying 1 no function allele and 1 decreased function allele, or 2 no function
alleles e.g. *2/*3, *3/*3
Significantly decreased metabolism
and prolonged half-life of tenoxicam; higher plasma tenoxicam levels may
increase the risk and/or severity of toxicities.
Select an alternative therapy that is not
primarily metabolised by CYP2C9 (e.g. ketorolac, naproxen, sulindac) or not
significantly affected by CYP2C9 genetic variants in
vivo or choose an NSAID that is metabolised by CYP2C9 but has a shorter
half-life. Selection of therapy will be based on individual treatment goals and
risks for toxicity.
Administration
Tenoxicam Should be taken with food.
Reconstitution
Intravenous/Intramuscular: Lyophilisate or powder for inj: Dissolve in 2 mL of sterile water for inj.
Contraindications
Hypersensitivity. History of asthma, angioedema, urticaria, rhinitis, or other hypersensitivity reactions to other NSAIDs (including aspirin and ibuprofen). Active or history of peptic ulcer/haemorrhage (2 or more distinct episodes); history of gastrointestinal perforation or bleeding (melaena, haematemesis) related to previous NSAIDs use, severe gastritis; severe heart failure. Severe hepatic and renal failure. Pregnancy (3rd trimester).
Special Precautions
Patient with active or history of bronchial asthma; uncontrolled hypertension, CHF, established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, risk factors for CV disease (e.g. hyperlipidaemia, diabetes mellitus, smoking); history of gastrointestinal disease (ulcerative colitis, Crohn's disease); haematopoietic disorders, SLE and mixed connective tissue disorders; fluid retention. Patients undergoing major surgery. Debilitated patients. CYP2C9 intermediate and poor metabolisers. Concomitant use with agents that may increase the risk of gastrointestinal bleeding or ulceration, such as antiplatelets (e.g. low-dose aspirin), anticoagulants, corticosteroids, and SSRIs. Mild to moderate renal and hepatic impairment. Elderly. Pregnancy (1st and 2nd trimester) and lactation.
Adverse Reactions
Significant: Hypersensitivity reactions (e.g. dyspnoea, asthma, anaphylactoid reactions); reduced platelet aggregation, prolonged bleeding time; fluid retention, oedema; new onset or worsening of hypertension; precipitation of renal failure; transaminase elevations; blurred or diminished vision; impairment of female fertility; mask the usual signs of infection; increased risk of aseptic meningitis (in patients with haematopoietic disorders, SLE, and mixed connective tissue disorders). Rarely, interstitial nephritis, glomerulonephritis, papillary necrosis, and nephrotic syndrome. Blood and lymphatic system disorders: Anaemia, aplastic anaemia, haemolytic anaemia, thrombocytopenia, non-thrombocytopenic purpura, leucopenia, neutropenia, eosinophilia. Ear and labyrinth disorders: Tinnitus. Gastrointestinal disorders: Dyspepsia, nausea, vomiting, abdominal pain, constipation, diarrhoea, flatulence, heartburn, indigestion. General disorders and administration site conditions: Malaise, fever. Nervous system disorders: Headache, dizziness, somnolence, paraesthesia. Psychiatric disorders: Confusional state, hallucinations. Respiratory, thoracic and mediastinal disorders: Bronchospasm. Potentially Fatal: Gastrointestinal ulceration, perforation or bleeding; increased risk of CV thrombotic events (including MI, stroke). Rarely, severe skin reactions, including exfoliative dermatitis, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN).
Parenteral/PO: Z (NSAIDs caused foetal ductus arteriosus premature closure, foetal renal impairment and persistent pulmonary hypertension. Avoid near term, else use lowest dose for shortest time.)
Patient Counseling Information
This drug may cause drowsiness, dizziness and visual disturbances, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor blood pressure, CBC, serum electrolytes; kidney and liver function tests (periodically); occult blood loss. Perform ophthalmic exams with prolonged treatment. Assess for signs and symptoms of skin reactions, bleeding, or severe gastrointestinal effects.
Management: Symptomatic and supportive treatment. Consider administering activated charcoal or performing gastric lavage within 1 hour of ingestion. Maintain adequate hydration and ensure good urine output. Administration of antacids, H2 antagonists and proton-pump inhibitors may be indicated. Treat frequent or prolonged convulsions with IV diazepam. Closely monitor the liver and kidney function.
Drug Interactions
Increased risk of gastrointestinal bleeding or ulceration, such as antiplatelets (e.g. low-dose aspirin), anticoagulants, corticosteroids, and SSRIs. Enhanced nephrotoxic effects with ciclosporin and tacrolimus. Increased risk of convulsion with quinolones. May enhance the anticoagulant effect of warfarin and other anticoagulants. May reduce the antihypertensive effect of α-adrenergic blockers, β-adrenergic blockers, and ACE inhibitors. May decrease the elimination and increase the serum levels of lithium and methotrexate. May interfere with the natriuretic action of diuretics, which may enhance the risk of nephrotoxicity. May reduce the therapeutic effects of mifepristone.
Food Interaction
Food may delay the rate of absorption.
Action
Description: Overview: Tenoxicam is an NSAID that exhibits anti-inflammatory, analgesic, and antipyretic properties. Mechanism of Action: Tenoxicam reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2), thereby reducing prostaglandin precursors formation. Pharmacokinetics: Absorption: Rapidly and completely absorbed from the gastrointestinal tract (oral). Rapidly absorbed after IM inj. Food may delay the rate of absorption. Bioavailability: Approx 100% (oral). Time to peak plasma concentration: Oral: Approx 2 hours (fasted). Distribution: Penetrates synovial fluid. Plasma protein binding: Approx 99%. Metabolism: Completely metabolised to inactive metabolites. Excretion: Mainly via urine (primarily as metabolites); faeces. Plasma elimination half-life: 72 hours (± 28 hours).
Chemical Structure
Tenoxicam Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 54677971, Tenoxicam. https://pubchem.ncbi.nlm.nih.gov/compound/Tenoxicam. Accessed Feb. 24, 2026.
Sign Out
Continue with Google