1 What is Feldene?

Brand: Feldene

Generic: Piroxicam

Feldene is a long-acting potent non-steroidal anti-inflammatory drug (NSAID) with anti-inflammatory potency similar to indomethacin and good analgesic-antipyretic action.

Actually, it belongs to the oxicam group. It also inhibits platelet aggregation which may result in prolonged bleeding time.

In addition, it exerts an anti-inflammatory effect by lysosomal stabilization, kinin, and leukotriene production, alteration of chemotactic factors and neutrophil activation inhibition.

Moreover, it inhibits prostaglandin synthesis and reduces fever by acting on the heat-regulating center of the hypothalamus.

It is rapidly and almost completely absorbed and largely metabolized in the liver by hydroxylation and glucuronide conjugation.

This drug is excreted in urine and bile; enterohepatic cycling occurs. Plasma half-life of piroxicam is nearly 24 hours. Steady-state concentrations are achieved in a week.

The single daily administration is sufficient. Thus, this drug is widely used in acute gout, osteoarthritis, rheumatic disorders, postoperative pain, acute musculoskeletal conditions, juvenile idiopathic arthritis etc.

2 What to Know Before Using

Before using Feldene the risks and benefits ratio of taking the medicine should be considered. This is a decision that your doctor will make with your active participation.

For this medicine, certain factors that may alter the drug action should be considered. Present and past illness, drug interactions, hypersensitivity reactions, pregnancy, lactation and metabolic impairments should be considered cautiously.

Always try to answer each question appropriately asked by your physician. If you have had any allergic reaction to such medications or any other medicines, tell your doctor about that.

You should keep in mind that the use of piroxicam is contraindicated in hypersensitivity, active peptic ulceration, porphyria, pregnancy (3rd trimester) and lactation.

3 Proper Usage

To use Feldene correctly, you must follow all instructions given by your doctor. The dose of this medicine will vary according to patient’s condition or requirements.

You should follow the doctor's directions and advice. The amount of medicine that you take must not exceed the maximum therapeutic dose.

Also, the frequency of your daily drug administration and the duration of drug therapy depend on the particular medical problem for which you are taking the medicine.

Nowadays, piroxicam is preferably used in a wide variety of medical disorders like:

Due to slow onset of action piroxicam is suitable for use as a long-term anti-inflammatory drug in rheumatoid and osteo-arthritis, ankylosing spondylitis, etc, but is not the first choice of drug for any condition because of relatively higher toxicity.

It has also been used for acute gout, musculoskeletal injuries and in dentistry.

Gout is a metabolic disorder characterized by hyperuricaemia (normal plasma urate 2-6mg/dl). Uric acid, a product of purine metabolism, has low water solubility, especially at low pH.

When blood levels are high, it precipitates and deposits in joints, kidney, and subcutaneous tissue.

Acute gout manifests as sudden onset of severe inflammation in a small joint (commonest is metatarso-phalangeal joint of great toe) due to precipitation of urate crystals in joint space.

The joint becomes red, swollen, and extremely painful which requires immediate treatment.

Thus, piroxicam is given in relatively high and quickly repeated doses. Initially, 40mg is to be taken daily for 5-7 days.

Rheumatoid arthritis (RA) is an autoimmune disease in which there is joint inflammation, synovial proliferation, and destruction of articular cartilage.

RA is a chronic progressive, crippling disorder with a waxing and waning course. NSAIDs e.g. piroxicam are the first line drugs and afford symptomatic relief in pain, swelling, morning stiffness, immobility, but do not arrest the disease process.

In order to treat rheumatic disorders, adults are given 20 mg/day as a single dose at the initial stage. The maintenance dose is preferred to lie within 10-30 mg in single or divided doses.

In case of acute musculoskeletal conditions and postoperative pain, 40 mg is given daily for 2 days. Then, 20 mg/day for 1-2 weeks is given as a maintenance dose.

Juvenile idiopathic arthritis affected children of > 6 years or weighing < 15 kg require 5 mg once daily. If the body weight lies in between 16 to 25 kg then, 10 mg is given daily.

In case of 26-45 kg body weight, 15 mg is required daily. But when body weight exceeds 46 kg, 20 mg is given once daily.

Always try to take your medicine in time. If you miss any dose of this medicine, you should take it as soon as possible.

But when it is time for your next dose, then skip the missed dose and go back to your regular dosing schedule.

You should store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children.

Outdated medicine must be disposed of by an appropriate way.

4 Precautions to Take

In using Feldene, you must be careful and take some precautions as advised by your doctor.

In the case of such drug therapy, you may not need to discontinue the therapy as there are least chances of drug toxicity.

But you should not delay consulting with your physician in case of extreme unwanted effects suggesting renal or hepatic function impairment.

Moreover, elderly patients, children of below 12 years, patients with infections, asthma, allergic disorders, haematological disorders or hypertension should not be given such medications.

In addition, you should monitor the signs of liver, kidney, blood or eye disorders on a regular basis to avoid complications.

Animal studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

5 Potential Side Effects

There are some unwanted side-effects associated with Feldene that usually do not need medical attention.

These side-effects usually go away during the treatment episode as your body adjusts to the medicine.

Additionally, your health care professional may advise you about the ways how to prevent or reduce those unwanted side-effects.

Sometimes you may need to consult with the doctor if you feel any serious discomfort.

The following side effects may warrant medical care immediately: GI disturbances, peptic ulcer, GI bleeding, headache, dizziness, blurred vision, tinnitus, skin rashes, and pruritus, haematological changes, and photosensitivity.

Potentially fatal conditions such as toxic epidermal necrolysis and Stevens-Johnson syndrome may rarely occur. The GI side-effects are more than but it is better tolerated and less ulcerogenic.

Rashes and pruritus are seen in < 1% patients, but serious skin reactions are possible. Edema and reversible azotemia have been observed.