Feldene (piroxicam) is a long-acting nonsteroidal anti-inflammatory drug (NSAID) used to relieve the pain, stiffness, and swelling of chronic arthritic conditions, primarily osteoarthritis (OA) and rheumatoid arthritis (RA). It belongs to the oxicam class of NSAIDs and is valued for its extended half-life, which allows once-daily dosing for most adults. By inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, Feldene reduces the formation of prostaglandins—chemical mediators that drive inflammation, joint swelling, and pain signaling. For many patients, consistent dosing over days to weeks can help reduce morning stiffness, improve range of motion, and support better day-to-day function.
Because Feldene is long-acting, it maintains steadier blood levels compared with shorter-acting NSAIDs. This can be helpful in chronic conditions where 24-hour symptom control matters, such as persistent arthralgia, synovitis, and tendon discomfort associated with degenerative and inflammatory joint disease. Clinicians typically recommend using the lowest effective dose for the shortest duration needed to control symptoms, revisiting the treatment plan periodically to balance benefits with known NSAID risks.
While Feldene is primarily indicated for OA and RA, some clinicians may consider it for other musculoskeletal complaints on a case-by-case basis when the benefit-risk profile is appropriate. It is not an opioid and does not treat neuropathic pain; its primary value lies in reducing inflammatory pain and improving mobility in arthritis.
The usual adult dose of Feldene for osteoarthritis or rheumatoid arthritis is 20 mg once daily. An alternative regimen is 10 mg twice daily if that suits tolerability or aligns better with symptom patterns. The maximum recommended daily dose is 20 mg. Doses above 20 mg per day increase the risk of adverse effects without proven additional benefit and are generally avoided.
Onset of pain relief can begin within several hours of the first dose, but optimal anti-inflammatory effect often develops over several days. Because piroxicam has a prolonged half-life (approximately 45–50 hours), it may take a week or more to reach steady-state levels; conversely, side effects may also take longer to resolve after discontinuation.
Special populations:
All NSAIDs, including Feldene, carry important safety considerations. Discuss your full medical history with a healthcare professional before starting therapy, especially if you have:
Cardiovascular risk: NSAIDs may increase the risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. Risk may rise with duration of use, higher doses, and in patients with preexisting cardiovascular disease or risk factors. Feldene is contraindicated in the perioperative setting of coronary artery bypass graft (CABG) surgery.
Gastrointestinal risk: NSAIDs can cause ulcers, GI bleeding, and perforation of the stomach or intestines at any time during use, often without warning symptoms. Older age, prior ulcer disease, high doses, prolonged therapy, concurrent corticosteroids, anticoagulants, antiplatelets, SSRIs/SNRIs, smoking, and alcohol use elevate risk. Piroxicam, in particular, has been associated with a comparatively higher risk of serious GI complications; some guidelines recommend reserving it for patients who have not responded adequately to other NSAIDs and using gastroprotection in higher-risk individuals.
Renal and fluid retention effects: NSAIDs may cause fluid retention, edema, hypertension, and kidney function decline—particularly in those with compromised renal perfusion (e.g., dehydration, heart failure, cirrhosis, diuretic therapy). Monitor blood pressure and renal function periodically, especially with long-term use.
Hepatic effects: Elevations in liver enzymes and rare cases of severe hepatic injury have been reported with NSAIDs. Discontinue if signs of liver dysfunction occur (e.g., persistent nausea, fatigue, jaundice, dark urine, right upper quadrant pain).
Serious skin reactions: Rare but severe skin reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), can occur. Stop piroxicam at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.
Fertility and pregnancy: NSAIDs may be associated with reversible delays in ovulation and are not recommended in those actively attempting to conceive. Avoid use after 20 weeks of gestation due to the risk of fetal renal dysfunction leading to oligohydramnios, and avoid entirely in the third trimester to prevent premature closure of the fetal ductus arteriosus. Discuss alternative therapies in pregnancy.
Lactation: Small amounts of NSAIDs may be excreted in breast milk. If piroxicam is deemed necessary while breastfeeding, use the lowest effective dose for the shortest duration and monitor the infant for GI symptoms.
Driving and alertness: Dizziness, drowsiness, and visual disturbances can occur. Use caution when driving or operating machinery until you know how the medication affects you.
Do not use Feldene if you:
Use only under specialist direction if you have a history of severe NSAID reactions or complex comorbidities. Pediatric and breastfeeding use should be guided by a clinician’s judgment and current safety data.
Like all NSAIDs, piroxicam can cause side effects. Many are mild and transient, but some can be serious. Seek urgent medical attention for severe symptoms.
Common side effects:
Serious adverse effects (stop the drug and get medical help):
If you experience bothersome but nonurgent symptoms (e.g., mild heartburn), discuss dose timing with food, antacid use, or gastroprotective strategies with your clinician rather than stopping abruptly, unless advised to do so.
Piroxicam has clinically relevant interactions. Always inform your healthcare provider about all prescription and over-the-counter medications, vitamins, and herbal supplements.
Protein binding displacement and pharmacokinetic interactions can vary by individual. Where possible, schedule medication reviews to minimize risks and consider alternate therapies if interaction risks are high.
If you miss a dose of Feldene, take it as soon as you remember unless it is close to the time for your next dose. If it is almost time for the next dose, skip the missed dose and resume your regular schedule. Do not double up to make up for a missed dose. Because piroxicam is long-acting, a single missed dose may cause only modest changes in symptom control; resume as directed.
Overdose symptoms may include severe nausea or vomiting, abdominal pain, drowsiness, confusion, dizziness, fainting, shortness of breath, GI bleeding, high blood pressure, acute kidney injury, or coma in extreme cases. If overdose is suspected, seek emergency medical care immediately.
Management is supportive:
Store Feldene at 68°F–77°F (20°C–25°C) in a dry place away from direct sunlight and moisture. Keep capsules in their original, tightly closed container. Do not store in the bathroom where humidity fluctuates.
Feldene (piroxicam) is an FDA-approved, prescription-only NSAID in the United States. Because of the potential for serious gastrointestinal and cardiovascular adverse events, as well as renal and hepatic effects, a licensed clinician must evaluate the patient’s medical history, risk factors, and current medications before initiating therapy. U.S. law requires dispensing through a pharmacy pursuant to a valid prescription order from an authorized prescriber.
Key points for consumers:
HealthSouth Walton Rehabilitation Hospital offers a legal and structured solution for acquiring Feldene without a traditional paper prescription by integrating clinician evaluation and compliant electronic prescribing or protocol-based dispensing in accordance with applicable federal and state laws. This process does not bypass prescription controls; instead, it ensures that patient assessment, documentation, and dispensing are performed under licensed medical oversight to protect patient safety and meet regulatory requirements.
The information provided here is intended for general educational purposes and does not replace individualized medical advice from a qualified healthcare professional. Always consult your clinician or pharmacist before starting, stopping, or changing any medication, including Feldene (piroxicam). Drug responses and risks vary based on your medical history, concurrent medications, and other factors. In case of a medical emergency or severe side effects, call emergency services immediately.
Feldene is the brand name for piroxicam, a prescription nonsteroidal anti-inflammatory drug (NSAID). It reduces pain, swelling, and stiffness by inhibiting cyclooxygenase (COX) enzymes that drive prostaglandin production, key mediators of inflammation.
Feldene is used for osteoarthritis and rheumatoid arthritis, and sometimes other musculoskeletal conditions where long-acting anti-inflammatory relief is needed. Your clinician may also use it off-label when its once-daily dosing and steady effect are advantageous.
Unlike many OTC NSAIDs, Feldene has a long half-life, allowing once-daily dosing with sustained effect. It is prescription-only because it carries important risks, including gastrointestinal bleeding and cardiovascular events, that require medical oversight.
Some pain relief can appear within several hours, but full anti-inflammatory benefit may build over several days. Its long half-life means effects persist about 24 hours or more after each dose, supporting once-daily use.
Avoid Feldene if you’ve had an allergic reaction to piroxicam, aspirin, or other NSAIDs; have active GI bleeding or ulcers; severe kidney or liver disease; or right before/after coronary artery bypass graft (CABG) surgery. It may be unsuitable in uncontrolled hypertension, heart failure, bleeding disorders, or late pregnancy—ask your clinician.
Common effects include stomach upset, heartburn, nausea, headache, dizziness, and edema (swelling). Taking it with food may ease stomach discomfort, but it does not eliminate the risk of ulcers or bleeding.
Seek urgent care for black/tarry stools, vomiting blood, severe stomach pain, chest pain, shortness of breath, sudden weakness or slurred speech, severe rash, facial or throat swelling, or little to no urine. These can signal GI bleeding, cardiovascular events, severe skin reactions, or kidney problems.
Yes. All NSAIDs can injure the stomach or intestines, sometimes without warning. Risk is higher with prior ulcers or bleeding, older age, heavy alcohol use, smoking, steroids, anticoagulants, SSRIs/SNRIs, or higher/longer dosing.
NSAIDs may raise blood pressure, worsen heart failure, and increase the risk of heart attack and stroke, particularly with long-term use or in people with cardiovascular disease. Monitor blood pressure and discuss your cardiac history with your prescriber.
Yes. It can reduce kidney blood flow, leading to injury, especially in dehydration, older adults, and those on diuretics, ACE inhibitors, or ARBs. It can also elevate liver enzymes or rarely cause serious liver injury—report jaundice, dark urine, or severe fatigue.
Notable interactions include blood thinners (warfarin, DOACs), antiplatelets (clopidogrel), other NSAIDs or aspirin, corticosteroids, SSRIs/SNRIs, lithium, methotrexate, cyclosporine, and “triple whammy” combos with ACEi/ARB plus diuretic. Always check interactions before starting or stopping medicines.
Yes, taking with food or milk can reduce stomach upset. Antacids don’t prevent ulcers or bleeding but may ease dyspepsia; talk to your clinician about protective therapy (such as a PPI) if you’re at higher GI risk.
If it’s been only a short time, take it when you remember; if it’s near the next dose, skip the missed one and resume your usual schedule. Do not double up.
No. Piroxicam is not an opioid, is not habit-forming, and does not cause withdrawal, though it carries other important risks typical of NSAIDs.
Store at room temperature, away from moisture and heat, and out of reach of children and pets. Dispose of unused medication via a take-back program or follow local guidance; don’t flush unless instructed.
It’s best to avoid or minimize alcohol while using Feldene. Alcohol increases the risk of stomach irritation and bleeding and may compound dizziness or drowsiness.
NSAIDs, including Feldene, are generally avoided in the third trimester due to risks such as premature closure of the fetal ductus arteriosus and kidney problems. Use in earlier pregnancy or while trying to conceive should be discussed with your obstetric provider to weigh risks and alternatives.
Small amounts may pass into breast milk; risk to infants is not fully defined. If an NSAID is needed during breastfeeding, some agents with more lactation data may be preferred—consult your clinician to individualize the choice.
NSAIDs can, in some cases, interfere with ovulation and may transiently affect fertility. If you’re trying to conceive, talk with your clinician about timing, alternatives, and the shortest effective use.
Yes, NSAIDs can increase bleeding. Your surgeon or dentist will advise when to stop—often several days beforehand—based on the procedure and your health status.
Older adults are at higher risk of GI bleeding, kidney injury, fluid retention, and cardiovascular events with NSAIDs. If needed, the lowest effective dose for the shortest duration and protective strategies (such as GI prophylaxis) are often recommended under medical supervision.
Feldene can cause dizziness, drowsiness, or visual disturbances in some people. Use caution until you know how it affects you.
Discuss risk-reduction strategies with your clinician, such as a proton pump inhibitor, H. pylori testing and treatment if indicated, and avoiding alcohol and smoking. Alternative therapies or non-NSAID options may be safer, depending on your history.
Feldene (piroxicam) offers once-daily dosing and steady anti-inflammatory effects, which some patients find convenient for chronic arthritis. Ibuprofen often requires multiple daily doses and may be gentler for short-term use; the best choice depends on your risk profile and treatment goals.
Both are longer-acting than many NSAIDs, but piroxicam has an especially long half-life that supports once-daily dosing. Naproxen’s duration is substantial as well and may have a more favorable cardiovascular profile in some analyses; consult your clinician about risks and convenience.
Diclofenac can provide potent pain relief and is available in topical and oral forms. Piroxicam offers sustained systemic relief; comparative “strength” varies by condition and patient tolerance, with GI and cardiovascular risks guiding selection.
Meloxicam is relatively COX-2–preferential at lower doses, which may translate to somewhat less GI irritation versus nonselective NSAIDs like piroxicam. Individual risk factors and dosing still drive GI safety, so protection strategies may be needed with either.
Celecoxib, a COX-2–selective NSAID, generally carries a lower risk of gastric ulcers and bleeding than nonselective agents like piroxicam, particularly when not combined with aspirin. Cardiovascular risk, cost, and patient history influence the decision.
Indomethacin has long been used for acute gout flares due to rapid onset and potency, though other NSAIDs and colchicine are also options. Piroxicam can relieve inflammatory pain but is less commonly chosen for acute gout because of its long half-life and safety considerations.
They should not be combined. Ketorolac is a potent NSAID intended for short-term use; using it with another NSAID like piroxicam greatly increases the risk of GI and kidney toxicity without added benefit.
Avoid routine combination, as dual NSAID therapy raises bleeding and ulcer risk. If you’re on low-dose aspirin for cardiovascular protection, your clinician can help time dosing and consider GI protection.
Nabumetone is a prodrug that may be somewhat easier on the stomach for some patients and is typically dosed once or twice daily. Piroxicam’s very long half-life supports once-daily dosing; tolerability varies, and GI/cardiovascular risks guide choice.
Etodolac has relative COX-2 preference at some doses, potentially offering improved GI tolerability compared with nonselective NSAIDs. Piroxicam offers convenience of steady plasma levels; patient-specific risks and responses determine the better option.
Topical NSAIDs (like diclofenac gel) can be preferred for localized osteoarthritis pain (e.g., knee, hand) to limit systemic exposure and GI risk. Oral piroxicam is considered when pain is more diffuse or deep, but carries higher systemic risks.
Acetaminophen is not an NSAID and can often be combined with piroxicam for additional analgesia, provided you don’t exceed acetaminophen’s daily limit and have no liver contraindications. Always review your regimen with your clinician to avoid hidden combination products.
