Relatively contraindicated in liver dysfunction. Use of tenoxicam with concomitant NSAIDs, including COX-2 selective inhibitors, should be avoided. Non-selective NSAIDs may be associated with increased risk of serious cardiovascular events, including MI and stroke, which may increase with dose or duration of use. Patients with uncontrolled hypertension, congestive heart failure, established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease should only be treated with tenoxicam after careful consideration. NSAIDs may lead to onset of new hypertension or worsening of pre-existing hypertension, and patients taking anti-hypertensives with NSAIDs may have impaired anti-hypertensive response. Fluid retention and edema observed in some patients taking NSAIDs. All NSAIDs can cause GI discomfort and rarely serious, potentially fatal GI effects such as ulcers, bleeding and perforation which may increase with dose or duration of use, but can occur at any time without warning. The elderly have increased frequency of adverse reactions to NSAIDs, especially GI bleeding and perforation which may be fatal. Debilitated patients do not seem to tolerate ulceration or bleeding as well as others. Combination therapy with protective agents should be considered for these patients, also for patients requiring concomitant low dose aspirin or other drugs likely to increase GI toxicity. NSAIDs may very rarely cause serious cutaneous adverse events such as exfoliative dermatitis, toxic epidermal necrolysis and Stevens-Johnson syndrome, which can be fatal and occur without warning. These serious adverse effects are idiosyncratic and independent of dose or duration of use, the onset of the reaction occurring in the majority of cases within 1^st^ month of treatment. If severe skin reactions occur, tenoxicam should be discontinued immediately. Tenoxicam inhibits platelet aggregation and may affect hemostasis. Adverse eye findings reported with NSAIDs including tenoxicam (ophthalmic evaluation recommended for patients who develop visual disturbances). As known for other anti-inflammatory medicines, tenoxicam may mask usual signs of infection. Use of tenoxicam, as with any agent known to inhibit COX/prostaglandin synthesis, may impair fertility and is not recommended in women attempting to conceive. Due to the high plasma protein binding of tenoxicam, caution is required when plasma albumin levels are markedly reduced.