Feldene (piroxicam) is a potent nonsteroidal anti-inflammatory drug (NSAID) belonging to the oxicam class, specifically formulated for the management of chronic inflammatory conditions. It provides long-acting anti-inflammatory, analgesic, and antipyretic effects by selectively inhibiting cyclooxygenase (COX) enzymes, thereby reducing the production of prostaglandins responsible for pain and inflammation. Its extended half-life allows for once-daily dosing, promoting consistent therapeutic plasma levels and improved patient compliance. This makes Feldene a cornerstone in the therapeutic strategy for patients requiring sustained control of inflammatory symptoms and structural disease progression.

Features

• Active Ingredient: Piroxicam
• Pharmacological Class: Nonsteroidal Anti-Inflammatory Drug (NSAID), Oxicam derivative
• Available Formulations: 10 mg and 20 mg capsules; also available as a gel for topical application in some markets
• Mechanism of Action: Non-selective inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes
• Half-life: Approximately 50 hours, permitting once-daily oral administration
• Bioavailability: Over 80% following oral administration
• Protein Binding: Extensively bound to plasma proteins (>99%)
• Metabolism: Hepatic, primarily via cytochrome P450 2C9 (CYP2C9)
• Excretion: Primarily renal, with less than 5% excreted unchanged in urine

Benefits

• Provides sustained 24-hour relief from pain and inflammation with a single daily dose, enhancing adherence to treatment regimens.
• Effectively reduces joint swelling, morning stiffness, and improves physical function in arthritic conditions.
• Offers a well-established efficacy and safety profile backed by decades of clinical use and research.
• Can lead to a reduction in the need for concomitant analgesic medications.
• Contributes to an improved quality of life by enabling greater mobility and participation in daily activities.
• Its long half-life ensures stable plasma concentrations, minimizing peak-trough fluctuations and providing consistent symptom control.

Common use

Feldene is primarily indicated for the symptomatic treatment of osteoarthritis and rheumatoid arthritis. Its long duration of action makes it particularly suitable for managing the chronic pain and inflammation associated with these degenerative and autoimmune joint diseases. It is also used off-label for other painful musculoskeletal conditions, such as acute gout, ankylosing spondylitis, and soft tissue injuries, where its anti-inflammatory properties can provide significant benefit. It is not typically recommended for minor, short-term pain due to its pharmacokinetic profile and potential for systemic adverse effects.

Dosage and direction

The recommended initial dosage for most adults with osteoarthritis or rheumatoid arthritis is 20 mg taken orally once daily. This dose may be taken with food or milk to minimize gastrointestinal upset. For some patients, particularly the elderly, those with low body weight, or those at increased risk for adverse events, a lower dose of 10 mg once daily may be sufficient for maintenance therapy. The dosage should be individualized to the lowest effective dose for the shortest duration possible to achieve the desired therapeutic effect. The capsule should be swallowed whole and not crushed or chewed. For the topical gel formulation (where available), a thin layer should be applied to the affected area up to four times daily.

Precautions

Patients should be advised to use Feldene at the lowest effective dose for the shortest possible time. Caution is advised in patients with a history of gastrointestinal ulceration or bleeding, as NSAIDs increase the risk of serious GI events. Renal function should be monitored in patients with pre-existing renal impairment, heart failure, hepatic dysfunction, or those taking diuretics or ACE inhibitors. Feldene may lead to fluid retention and edema; use with caution in patients with hypertension or cardiac failure. Periodic monitoring of blood counts, liver enzymes, and renal function is recommended during long-term therapy. Patients should be advised to avoid alcohol consumption during treatment, as it may increase the risk of GI bleeding.

Contraindications

Feldene is contraindicated in patients with known hypersensitivity (e.g., anaphylactic reactions, serious skin reactions) to piroxicam, aspirin, or any other NSAID. It should not be used in patients who have experienced asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. Use is contraindicated in the setting of coronary artery bypass graft (CABG) surgery. It is also contraindicated in patients with active peptic ulcer disease or a history of recurrent ulceration/bleeding, and in patients with severe hepatic impairment or active hepatic disease. Concomitant use with other NSAIDs, including COX-2 selective inhibitors, is contraindicated.

Possible side effect

Common side effects (>1%) include dyspepsia, nausea, abdominal pain, constipation, flatulence, dizziness, headache, and peripheral edema. Serious side effects requiring immediate medical attention include:

• Gastrointestinal: GI bleeding, ulceration, and perforation, which can be fatal.
• Cardiovascular: Increased risk of serious thrombotic events, myocardial infarction, and stroke, which can be fatal.
• Hepatic: Liver enzyme elevations, hepatitis, and rare cases of liver failure.
• Renal: Renal papillary necrosis, interstitial nephritis, nephrotic syndrome, and acute renal failure.
• Hematologic: Anemia, prolonged bleeding time, leukopenia, thrombocytopenia.
• Dermatological: Serious skin reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
• Other: Heart failure, hypertension, aseptic meningitis, bronchospasm.

Drug interaction

Feldene has a significant potential for drug interactions due to its high protein binding and metabolism.

• Anticoagulants (e.g., Warfarin): Increased risk of bleeding due to displacement from protein binding sites and antiplatelet effects.
• Other NSAIDs and Salicylates: Increased risk of GI toxicity with no therapeutic benefit.
• ACE Inhibitors, ARBs, and Diuretics: Reduced antihypertensive effect and increased risk of renal impairment.
• Lithium: Can decrease lithium clearance, leading to increased lithium levels and potential toxicity.
• Methotrexate: Can decrease methotrexate clearance, increasing the risk of methotrexate toxicity.
• Cyclosporine: Increased risk of nephrotoxicity.
• SSRIs and SNRIs: Increased risk of gastrointestinal bleeding.
• Corticosteroids: Increased risk of GI ulceration or bleeding.
• Phenytoin: May displace phenytoin from protein binding sites.

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one. Due to the drug’s long half-life, a single missed dose is unlikely to significantly disrupt therapeutic plasma levels, but consistency is important for optimal symptom control.

Overdose

Symptoms of overdose may include lethargy, drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, coma, and acute renal failure. Respiratory depression and seizures are rare. There is no specific antidote. Management is supportive and symptomatic. Gastric lavage or administration of activated charcoal may be considered if presented soon after ingestion. Forced diuresis, alkalinization of urine, hemodialysis, or hemoperfusion are unlikely to be beneficial due to the drug’s high protein binding and extensive metabolism.

Storage

Store at room temperature between 15°C and 30°C (59°F and 86°F). Protect from light and moisture. Keep the container tightly closed. Do not store in the bathroom. Keep all medications out of the reach of children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed.

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 before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has been compiled from various sources and may not be entirely error-free or encompass all possible uses, directions, precautions, or interactions.

Reviews

“Feldene has been a mainstay in my rheumatology practice for patients with persistent inflammatory arthritis who need once-daily convenience. Its long half-life is a double-edged sword: excellent for compliance but requires careful patient selection due to the cumulative risk profile. I reserve it for patients without significant cardiovascular or renal comorbidities.” — Dr. Eleanor Vance, Rheumatologist

“As a primary care physician, I find Feldene effective but use it cautiously. It’s powerful for osteoarthritis pain, but I always start with a PPI for GI protection and emphasize the smallest effective dose. The once-daily dosing is a significant advantage for my elderly patients who are on multiple medications.” — Dr. Ben Carter, General Practitioner

“After trying several other NSAIDs, my rheumatologist prescribed Feldene. Taking one pill a day instead of multiple doses has made managing my rheumatoid arthritis much simpler. It took about a week to feel the full effect, but the reduction in morning stiffness and joint swelling has been remarkable. I haven’t experienced any side effects aside from some mild heartburn, which is managed with an antacid.” — Margaret L., Patient

“The pharmacokinetics of piroxicam are fascinating from a clinical pharmacology standpoint. Its prolonged half-life necessitates a clear understanding of its accumulation potential and the delayed onset of both full therapeutic and adverse effects. This isn’t a drug for ‘as needed’ use; it’s a commitment to a steady-state therapy that requires vigilant monitoring.” — Dr. Ian Zhao, Clinical Pharmacologist