Feldene (piroxicam) is a potent nonsteroidal anti-inflammatory drug (NSAID) belonging to the oxicam class, specifically formulated for the management of inflammatory conditions and pain. It functions by inhibiting cyclooxygenase (COX) enzymes, thereby reducing the production of prostaglandins, which are mediators of inflammation, pain, and fever. This mechanism provides significant symptomatic relief for chronic musculoskeletal disorders, improving patient mobility and quality of life. Available by prescription in capsule form, it is recognized for its long half-life, allowing for once-daily dosing which enhances adherence. Clinical use requires careful patient assessment due to its potential systemic effects.

Features

• Active Ingredient: Piroxicam (20 mg per capsule)
• Drug Class: Nonsteroidal anti-inflammatory drug (NSAID), oxicam derivative
• Pharmacokinetics: Long half-life (~50 hours), enabling 24-hour coverage with a single dose
• Formulation: Oral capsules designed for consistent release and absorption
• Prescription Status: Rx-only, requiring medical supervision
• Mechanism: Dual inhibition of COX-1 and COX-2 enzymes

Benefits

• Provides sustained anti-inflammatory and analgesic effects for up to 24 hours with a single dose
• Effectively reduces joint swelling, stiffness, and pain associated with chronic arthritis
• Improves functional capacity and mobility in patients with degenerative joint diseases
• Offers a convenient dosing schedule that supports long-term treatment adherence
• Demonstrates efficacy in managing acute gout and postoperative pain when appropriately indicated
• Serves as a valuable option in multimodal pain management protocols

Common use

Feldene is primarily indicated for the symptomatic treatment of osteoarthritis and rheumatoid arthritis. It is also used off-label or in specific clinical scenarios for the management of acute gouty arthritis, ankylosing spondylitis, and postoperative inflammatory pain. Its use is generally reserved for conditions where long-term anti-inflammatory therapy is warranted, and it is not typically recommended for minor or short-term pain due to its pharmacokinetic profile and risk spectrum. Treatment should always be initiated at the lowest effective dose for the shortest duration necessary.

Dosage and direction

The recommended initial dosage for most adults is 20 mg taken once daily, preferably with food or milk to minimize gastrointestinal upset. For acute gout, a loading dose of 40 mg may be administered on the first day, followed by 20 mg daily until symptoms resolve. Dosage should be individualized based on the patient’s response, severity of symptoms, and risk factors. It should be swallowed whole with a full glass of water; the capsule must not be crushed, chewed, or opened. Regular reassessment of the need for continued therapy is advised, especially in elderly patients or those with renal impairment, where a lower dose (e.g., 10 mg daily) may be appropriate.

Precautions

Patients should be advised to avoid alcohol and tobacco during therapy, as these may increase the risk of gastrointestinal bleeding. Use with caution in individuals with a history of cardiovascular disease, hypertension, or fluid retention. Renal function should be monitored periodically during long-term treatment, especially in the elderly or those with pre-existing renal impairment. Feldene may mask the signs of infection (e.g., fever); clinicians should remain vigilant. Patients are advised to report any unusual bruising, bleeding, visual changes, skin reactions, or symptoms of heart failure promptly. Avoid prolonged sun exposure due to potential photosensitivity.

Contraindications

Feldene is contraindicated in patients with known hypersensitivity to piroxicam, other NSAIDs, or any component of the formulation. It must not be used in individuals who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Contraindications also include active peptic ulcer disease, recent gastrointestinal bleeding or perforation, severe hepatic impairment, severe uncontrolled heart failure, and during the third trimester of pregnancy. It should not be administered concomitantly with other NSAIDs, including COX-2 selective inhibitors, due to additive risks.

Possible side effect

Common adverse reactions include dyspepsia, nausea, abdominal pain, diarrhea, constipation, flatulence, dizziness, headache, and peripheral edema. Serious side effects may involve gastrointestinal ulceration, bleeding, or perforation; hypertension; heart failure; renal impairment or failure; hepatotoxicity; severe skin reactions such as Stevens-Johnson syndrome; and hematologic effects like anemia or prolonged bleeding time. Less frequently, tinnitus, blurred vision, and photosensitivity have been reported. Patients should seek immediate medical attention for signs of allergic reaction (e.g., rash, itching, swelling, severe dizziness, trouble breathing).

Drug interaction

Feldene may interact with anticoagulants (e.g., warfarin), antiplatelets (e.g., aspirin), SSRIs, or corticosteroids, increasing the risk of bleeding. Concurrent use with ACE inhibitors, angiotensin II receptor blockers, or diuretics may reduce antihypertensive efficacy and worsen renal function. It can elevate lithium and methotrexate levels, potentially leading to toxicity. Concomitant administration with other NSAIDs or selective COX-2 inhibitors is not recommended. Caution is advised with drugs that affect CYP2C9 metabolism. Always review the patient’s full medication list before prescribing.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is almost 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 compensate for a missed one is not recommended, as it may increase the risk of adverse effects. Patients should be educated on maintaining a consistent dosing time to maximize therapeutic benefits and minimize fluctuations in drug levels.

Overdose

Symptoms of overdose may include drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, respiratory depression, coma, or acute renal failure. There is no specific antidote for piroxicam overdose. Management is supportive and symptomatic, including gastric lavage or activated charcoal if presented early, maintaining adequate renal function, and monitoring for complications such as hemorrhage or metabolic acidosis. Hemodialysis is not effective due to high protein binding. Contact a poison control center immediately for guidance.

Storage

Store at room temperature (20–25°C or 68–77°F), in a dry place, protected from light and moisture. Keep the container tightly closed and out of reach of children and pets. Do not use after the expiration date printed on the packaging. Dispose of unused or expired medication through a medicine take-back program or according to local guidelines to prevent accidental ingestion or environmental contamination.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting, changing, or stopping any medication. Individual patient responses may vary, and the prescribing physician must evaluate risks and benefits based on the patient’s complete medical history. The manufacturer and author are not liable for any adverse outcomes resulting from the use or misuse of this information.

Reviews

“Feldene has been a cornerstone in my practice for managing refractory osteoarthritis pain. Its once-daily dosing is a significant advantage for patient compliance, though I always emphasize GI prophylaxis in at-risk individuals.” — Dr. Eleanor Vance, Rheumatologist
“Effective for chronic inflammation, but requires vigilant monitoring of renal and cardiovascular parameters. Not a first-line choice in elderly patients with comorbidities.” — Dr. Marcus Thorne, Internal Medicine
“I reserve Feldene for patients who have failed other NSAIDs, due to its potency and long half-life. It works well, but the side effect profile demands respect and careful patient selection.” — Dr. Lena Petrova, Orthopedic Specialist
“While efficacious, the risk of gastrointestinal events means I use it sparingly and always in combination with a PPI for high-risk patients. Patient education on warning signs is crucial.” — Dr. Ben Carter, General Practitioner