Feldene (piroxicam) is a potent nonsteroidal anti-inflammatory drug (NSAID) belonging to the oxicam class, specifically formulated for the management of chronic inflammatory conditions. Its primary mechanism of action involves the inhibition of cyclooxygenase (COX) enzymes, thereby reducing the synthesis of prostaglandins, which are key mediators of inflammation, pain, and fever. This prescription medication is indicated for the symptomatic treatment of osteoarthritis and rheumatoid arthritis, offering patients a sustained therapeutic option to improve mobility and quality of life. Clinical efficacy is supported by its long half-life, which allows for once-daily dosing, enhancing patient adherence and consistent inflammatory control.

Features

• Active Ingredient: Piroxicam (20 mg per capsule in standard formulation)
• Drug Class: Nonsteroidal anti-inflammatory drug (NSAID), oxicam derivative
• Pharmacokinetics: Long elimination half-life of approximately 50 hours
• Administration: Oral capsules; also available in gel form for topical application in some markets
• Bioavailability: High oral bioavailability (>90%) with peak plasma concentrations reached within 3–5 hours post-administration
• Protein Binding: Extensively bound to plasma proteins (>99%)
• Metabolism: Hepatic, primarily via cytochrome P450 2C9 (CYP2C9) and subsequent conjugation
• Excretion: Predominantly renal, with less than 5% excreted unchanged in urine

Benefits

• Provides potent anti-inflammatory, analgesic, and antipyretic effects for comprehensive symptom management in arthritic conditions.
• Enables once-daily dosing due to its prolonged half-life, simplifying treatment regimens and improving long-term adherence.
• Reduces joint stiffness, swelling, and pain, thereby enhancing functional capacity and mobility in patients with chronic arthritis.
• Demonstrates efficacy comparable to other NSAIDs with the convenience of single daily administration, supporting consistent therapeutic levels.
• Helps improve quality of life by enabling greater participation in daily activities and reducing disability associated with inflammatory joint diseases.
• Offers a non-opioid option for chronic pain management, minimizing risks associated with narcotic analgesics.

Common use

Feldene is primarily prescribed for the relief of signs and symptoms of osteoarthritis and rheumatoid arthritis. It is used to manage pain, reduce inflammation, decrease joint stiffness, and improve physical function in affected patients. Its use is generally reserved for chronic conditions requiring prolonged anti-inflammatory therapy, rather than acute pain episodes. In some clinical contexts, it may also be used off-label for other inflammatory musculoskeletal disorders, though such use should be carefully evaluated by a healthcare provider based on individual patient factors and supporting evidence.

Dosage and direction

The recommended initial dosage for most adults with osteoarthritis or rheumatoid arthritis is 20 mg administered orally once daily. Depending on therapeutic response and tolerability, the dose may be maintained or adjusted; however, doses exceeding 20 mg per day are not routinely recommended due to increased risk of adverse effects. Feldene should be taken with food or milk to minimize gastrointestinal irritation. Consistent timing of administration is advised to maintain stable plasma concentrations. For elderly patients or those with renal impairment, a lower initial dose (e.g., 10 mg daily) may be appropriate. Treatment should be initiated at the lowest effective dose for the shortest duration consistent with treatment goals.

Precautions

Patients should be advised to use the lowest effective dose for the shortest possible duration. Caution is required in patients with a history of gastrointestinal ulceration or bleeding, cardiovascular disease, hypertension, renal impairment, hepatic dysfunction, or asthma. Periodic monitoring of renal function, liver enzymes, and hemoglobin is recommended during prolonged therapy. Patients should avoid alcohol consumption during treatment, as it may increase the risk of gastrointestinal bleeding. Feldene may cause dizziness or drowsiness; patients should exercise caution when driving or operating machinery until they know how the medication affects them.

Contraindications

Feldene is contraindicated in patients with known hypersensitivity to piroxicam, aspirin, or other NSAIDs. It should not be used in individuals who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Use is contraindicated in the setting of peri-operative pain in the context of coronary artery bypass graft (CABG) surgery. It is also contraindicated in patients with active peptic ulcer disease or gastrointestinal bleeding, severe hepatic impairment, or severe untreated renal dysfunction.

Possible side effect

Common side effects may include gastrointestinal symptoms such as dyspepsia, nausea, abdominal pain, diarrhea, or constipation. Other frequently reported reactions include dizziness, headache, and peripheral edema. Serious side effects, though less common, can include gastrointestinal ulceration or bleeding, cardiovascular thrombotic events (e.g., myocardial infarction or stroke), renal impairment, hepatic toxicity, severe skin reactions, and hematological abnormalities such as anemia. Patients should seek immediate medical attention for signs of allergic reaction (e.g., rash, itching, swelling, severe dizziness, trouble breathing), chest pain, weakness on one side of the body, slurred speech, black stools, or persistent abdominal pain.

Drug interaction

Feldene may interact with several medication classes. Concurrent use with other NSAIDs or aspirin may increase the risk of gastrointestinal adverse effects. It may reduce the antihypertensive effect of ACE inhibitors, angiotensin II receptor blockers, and diuretics. Concomitant use with anticoagulants (e.g., warfarin) may increase the risk of bleeding. Piroxicam may enhance the nephrotoxic potential of cyclosporine and increase lithium plasma levels. Caution is advised when co-administering with methotrexate, SSRIs, or corticosteroids due to potential additive risks. Patients should inform their healthcare provider of all medications, including over-the-counter drugs and supplements, before starting Feldene.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended, as it may increase the risk of adverse effects.

Overdose

Symptoms of overdose may include lethargy, drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, coma, or acute renal failure. Respiratory depression and cardiovascular collapse are possible in severe cases. There is no specific antidote for piroxicam overdose. Management is supportive and symptomatic, including gastric lavage or activated charcoal (if presented early), and close monitoring of vital signs, renal function, and electrolyte balance. Hemodialysis is not likely to be effective due to high protein binding.

Storage

Store at room temperature (15–30°C or 59–86°F) in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not flush medications down the toilet or pour them into a drain unless instructed to do so.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read herein. The content does not cover all possible uses, directions, precautions, interactions, or adverse effects.

Reviews

Clinical studies and patient reports indicate that Feldene is effective in reducing pain and inflammation associated with arthritis, with many patients appreciating the convenience of once-daily dosing. However, reviews also highlight the importance of monitoring for gastrointestinal and cardiovascular side effects, particularly in long-term users. Patient experiences vary; some report significant improvement in mobility and pain relief, while others discontinue use due to adverse effects such as edema or dyspepsia. Physician reviews often emphasize its utility in managing chronic inflammation but caution against use in high-risk populations without rigorous monitoring.