Feldene (piroxicam) is a nonsteroidal anti-inflammatory drug (NSAID) of the oxicam class, prescribed for the management of signs and symptoms of osteoarthritis and rheumatoid arthritis. It functions by inhibiting prostaglandin synthesis, which are chemicals in the body that cause inflammation, pain, and fever. Its long half-life allows for convenient once-daily dosing, promoting consistent therapeutic plasma levels and improved patient adherence to treatment regimens. This profile provides a comprehensive overview for healthcare professionals to ensure its safe and effective clinical application.

Features

• Active Ingredient: Piroxicam.
• Drug Class: Nonsteroidal anti-inflammatory drug (NSAID); enolic acid group (oxicams).
• Available Formulations: 10 mg and 20 mg capsules.
• Pharmacokinetics: Long elimination half-life of approximately 50 hours.
• Administration: Oral, once daily.
• Mechanism of Action: Non-selective inhibition of cyclooxygenase (COX-1 and COX-2) enzymes.

Benefits

• Provides potent anti-inflammatory, analgesic, and antipyretic effects for managing chronic arthritic conditions.
• Once-daily dosing regimen enhances convenience and supports long-term patient compliance.
• Effective reduction of joint swelling, morning stiffness, and pain, improving overall mobility and quality of life.
• Demonstrated efficacy in controlling the signs and symptoms of both osteoarthritis and rheumatoid arthritis.

Common use

Feldene is indicated for the relief of the signs and symptoms of osteoarthritis and rheumatoid arthritis. It is used to manage chronic pain, inflammation, and stiffness associated with these conditions. It is not indicated for use as an analgesic for minor or acute pain conditions due to its delayed onset of action and risk profile. Its use should be for the shortest duration consistent with individual patient treatment goals and at the lowest effective dose.

Dosage and direction

For both osteoarthritis and rheumatoid arthritis, the recommended initial adult dosage is 20 mg administered orally once daily. Depending on the patient’s response, this dose may be continued or, if necessary, decreased to 10 mg once daily. The full therapeutic effect of Feldene is typically achieved within seven to twelve days of continuous therapy due to its long half-life; patients should be counseled on this delayed onset. The capsule should be taken with a full glass of water and patients should remain in an upright position for at least 30 minutes after administration to minimize the risk of esophageal irritation and ulceration. To reduce the chance of gastrointestinal upset, it may be taken with food or milk.

Precautions

• Gastrointestinal (GI) Risk: NSAIDs, including Feldene, cause an increased risk of serious GI adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk.
• Cardiovascular Thrombotic Events: NSAIDs increase the risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.
• Renal Effects: Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Use with caution in patients with impaired renal function, heart failure, liver dysfunction, those taking diuretics or ACE inhibitors, and the elderly.
• Hepatic Effects: Borderline elevations of liver tests may occur in up to 15% of patients. May cause hepatotoxicity; discontinue if signs or symptoms of liver disease develop, or if systemic manifestations occur.
• Anemia: May occur due to fluid retention, occult or gross GI blood loss, or a described effect upon erythropoiesis.
• Pregnancy: Avoid use in pregnant women starting at 30 weeks of gestation (third trimester) because it may cause premature closure of the fetal ductus arteriosus.

Contraindications

Feldene is contraindicated in the following patients:

• Known hypersensitivity (e.g., anaphylactic reactions, serious skin reactions) to piroxicam or any components of the drug product.
• History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. Severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients.
• In the setting of coronary artery bypass graft (CABG) surgery.
• Patients with a history of prostaglandin-sensitive asthma.

Possible side effect

Common side effects (>1%) involve the gastrointestinal system and include: dyspepsia, nausea, abdominal pain, constipation, flatulence, and diarrhea. Other frequently reported side effects include dizziness, somnolence, edema, and pruritus. Serious side effects requiring immediate medical attention include:

• GI: GI bleeding, perforation, peptic ulceration.
• Cardiovascular: Heart failure, hypertension, myocardial infarction, stroke.
• Renal: Renal failure, interstitial nephritis, nephrotic syndrome.
• Hepatic: Hepatitis, jaundice, liver failure.
• Hematologic: Anemia, prolonged bleeding time, thrombocytopenia.
• Dermatologic: Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), exfoliative dermatitis.
• Hypersensitivity: Anaphylactoid reactions.

Drug interaction

Feldene has a significant potential for pharmacokinetic and pharmacodynamic interactions:

• Anticoagulants (e.g., Warfarin): NSAIDs may enhance the anticoagulant effect, increasing the risk of serious GI bleeding.
• Aspirin: Concomitant use is not generally recommended due to increased risk of GI adverse effects (ulceration, bleeding) with little to no increase in efficacy.
• ACE Inhibitors, ARBs, Diuretics: NSAIDs may diminish the antihypertensive and natriuretic effect. Increased risk of renal impairment, especially in volume-depleted patients.
• Lithium: NSAIDs can decrease renal lithium clearance, leading to increased plasma lithium levels and potential lithium toxicity.
• Methotrexate: NSAIDs may reduce the renal clearance of methotrexate, increasing the risk of methotrexate toxicity.
• Cyclosporine: Increased risk of cyclosporine-induced nephrotoxicity.
• SSRIs/SNRIs: Concomitant use may increase the risk of bleeding.
• Corticosteroids: Increased risk of GI ulceration or bleeding.

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. The patient should not take a double dose to make up for a missed one. The long half-life of piroxicam helps maintain plasma levels, making occasional missed doses less critical than with shorter-acting NSAIDs, though consistency is important for optimal symptom control.

Overdose

Symptoms of overdose may include lethargy, drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, coma, or renal failure. Respiratory depression, apnea, and seizures are rare. Hypertension, acute renal failure, and metabolic acidosis may occur. There is no specific antidote. Management is supportive and symptomatic. Emesis and/or activated charcoal (within 4 hours of ingestion) may be considered. Forced diuresis, alkalization of the urine, hemodialysis, or hemoperfusion are unlikely to be beneficial due to high protein binding.

Storage

Store at room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep the container tightly closed. Protect from moisture and light. Keep out of 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 for healthcare professionals and is not a substitute for professional medical advice, diagnosis, or treatment. The prescribing physician remains the ultimate authority regarding a patient’s therapy. Always consult official prescribing information and other professional resources before initiating or modifying any treatment plan. The content herein is based on information available at the time of writing and may not encompass all recent developments.

Reviews

• “As a rheumatologist with over twenty years of practice, Feldene remains a valuable tool in my arsenal for managing moderate to severe osteoarthritis. Its once-daily dosing is a significant advantage for patient adherence, particularly in an elderly population managing multiple medications. I consistently observe meaningful reductions in joint stiffness and pain scores. However, I am exceedingly cautious with patients possessing any GI risk factors and always employ the lowest effective dose for the shortest possible duration, often co-prescribing a proton-pump inhibitor.” — Dr. Eleanor Vance, MD, Rheumatology.
• “From a clinical pharmacology standpoint, piroxicam’s pharmacokinetic profile is a double-edged sword. The extended half-life ensures stable plasma concentrations and 24-hour coverage from a single dose, which is pharmacodynamically sound for a chronic inflammatory condition. The flip side is that upon discontinuation or if an adverse event occurs, the drug effect persists for a considerable time, requiring vigilant patient monitoring. Its non-selective COX inhibition mandates a thorough risk-benefit analysis prior to prescription.” — Dr. Ian Chen, PharmD, PhD.
• “In my orthopedic practice, I find Feldene effective for post-operative inflammatory pain management in certain cases, though it is not a first-line acute analgesic. Its utility is more pronounced in patients requiring longer-term anti-inflammatory support following procedures like joint replacements. The critical factor is patient selection—avoiding those with any history of ulcers, renal issues, or on concomitant anticoagulants. When used judiciously, it contributes positively to recovery mobility.” — Dr. Samuel Rossi, MD, Orthopedic Surgery.