NSAIDs can cause a higher risk of serious heart/clotting events, including heart attack and stroke, which can cause death. The risk can occur immediately after starting it and increases the longer you take the medication. People who have heart disease or risk factors for heart disease are at higher risk.
NSAIDs should not be used before, during, or after coronary artery bypass graft (CABG) surgery.
NSAIDs can cause a higher risk of serious gastrointestinal (GI or stomach) problems. These may include bleeding, ulceration, and perforation of the stomach or intestines. This can happen at any time when taking an NSAID, without warning, and can cause death. Adults 65 and older are at higher risk for serious GI events.
NSAIDs like Feldene work by inhibiting cyclooxygenase (COX), an enzyme (protein) that contributes to inflammation in the body. COX helps produce prostaglandins (natural substances) involved in creating inflammation.
It is available as a capsule and taken by mouth.
What Is Feldene Used For?
The Food and Drug Administration (FDA) approved Feldene to treat the signs and symptoms of osteoarthritis and rheumatoid arthritis, including joint pain, tenderness, stiffness, and inflammation.
Brand Name(s): Feldene
Drug Availability: Prescription
Administration Route: Oral
Therapeutic Classification: Analgesic
Available Generically: Yes
Controlled Substance: N/A
Active Ingredient: Piroxicam
Dosage Form(s): Capsule
How to Take Feldene
If you are prescribed piroxicam, read the label and the information leaflet that comes with your prescription. Consult your healthcare provider if you have any questions.
Use piroxicam exactly as directed by your healthcare provider. Feldene should be prescribed at the lowest effective dose and for the shortest period of time possible.
While taking Feldene:
Avoid drinking alcohol. Avoid aspirin and other NSAIDs, like Celebrex (celecoxib), Advil or Motrin (ibuprofen), and Aleve (naproxen), among others. Consult your healthcare provider before taking other medications, especially for pain, fever, swelling, cold, or flu symptoms.
Storage
Store at room temperature (between 68 F and 77 F), away from heat, direct light, and moisture. Do not keep it in the bathroom. Store this medication in its original labeled container and out of the reach of children and pets. Keep the bottle tightly closed when not in use.
You can also ask your pharmacist or healthcare provider about the best ways to dispose of unused or expired medications. The FDA’s website is a potentially helpful resource for where and how to discard all unused and expired drugs. You can also find disposal boxes in your area.
Off-Label Uses
Piroxicam can be prescribed for uses that the FDA has not approved. This is known as off-label use. Because piroxicam is an NSAID, it may be used for other inflammatory conditions not explicitly stated on its label at the discretion of a healthcare provider.
Off-label uses of piroxicam may include:
Ankylosing spondylitis (a type of chronic arthritis typically affecting the spine) Headache pain
What Are the Side Effects of Feldene?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.
Common Side Effects
The most common side effects of Feldene are:
Stomach problems, such as stomach pain, indigestion, nausea, and constipation Headache Dizziness Sleepiness Rash Swelling/fluid retention Elevated liver enzymes Ringing in the ears Sensitivity to the sun Bruising Delayed ovulation Decreased fertility in women (you should not take Feldene if you are trying to become pregnant)
Severe Side Effects
All NSAIDs, including Feldene, have a boxed warning. This is the strongest warning required by the FDA. The warning states:
NSAIDs, such as Feldene, can cause a higher risk of serious heart or clotting events, including heart attack and stroke, which can cause death. The risk can occur immediately after starting Feldene use and increases the longer you are on this medication. People who have heart disease or risk factors for heart disease are at higher risk. NSAIDs should not be used before, during, or after CABG surgery. NSAIDs can cause a higher risk of serious stomach-related problems or GI events. These may include bleeding, ulceration, and perforation of the stomach or intestines. This can happen at any time when taking an NSAID, without warning, and can cause death. Adults 65 years and older are at higher risk for serious GI events.
In addition to the boxed warning, other serious side effects can occur. Call your healthcare provider immediately if you have serious side effects. Dial 911 if your symptoms feel life-threatening or you think you have a medical emergency.
Serious side effects and their symptoms can include the following:
Stomach bleeding, perforation, or ulcers: Bloody stools, coughing up blood, vomit that looks like coffee grounds Heart attack: Chest pain (angina), shortness of breath, pain, stiffness, or numbness in the upper body, cold sweat, nausea or vomiting, light-headedness, dizziness, or fainting Stroke: Facial drooping, arm weakness, and speech difficulties Thromboembolism (clotting): Pain or cramping, hardened veins, or redness or darkened skin in one leg (for blood clots in the leg); sudden shortness of breath, chest pain, coughing up blood (for blood clots in the lung); heart attack or stroke (for blood clots in the arteries) High blood pressure: Many people experience no symptoms of high blood pressure. If present, symptoms can include dizziness, headaches, nosebleeds, and shortness of breath. Heart failure: Swelling, fast weight gain, and shortness of breath Kidney problems: Less or no urination, swelling of the feet and ankles, tiredness, and shortness of breath Liver problems: Appetite loss, stomach pain, tiredness, itching, dark urine, clay-colored stools, and yellowing of the skin or whites of the eyes (jaundice) Hypersensitivity reaction or anaphylaxis: Rash, hives, swelling around the lips, tongue, and face, and difficulty breathing Stevens-Johnson syndrome/toxic epidermal necrolysis: Rash, blistering and peeling skin, burning throat and eyes, and fever High levels of potassium in the blood (hyperkalemia): Tingling sensation, decreased reflexes, paralysis, muscle weakness, gas and bloating, and nausea Low red blood cell levels: Pale skin, tiredness, light-headedness, shortness of breath, and cold hands and feet Drug reaction with eosinophilia and systemic symptoms (DRESS): A severe reaction that causes skin rash and problems with internal organs Blood disorders, such as anemia Increased bleeding time
Long-Term Side Effects
While many people tolerate piroxicam well, long-term or delayed side effects are possible. Some long-term side effects can be mild, such as:
Appetite and weight changesNosebleeds Ringing in the earsSeparation of the nail from the skinBruising Small spots due to bleeding under the skinWeakness Anxiety Numbness and tinglingInfection Hair lossSun sensitivity
Moderate, long-term side effects may include:
Constipation Increased liver enzymes/liver problemsLow red blood cellsSwelling/fluid retention/swollen lymph nodesHigh blood sugarPink eye Muscle quiveringDark stoolsStomach problems Mouth soresInflamed esophagus (the tube that passes food to the stomach)Difficulty swallowing Low blood platelet levelsLow sodium levelsUrinary tract infectionBlood in the urineDepression Infertility
Severe, long-term side effects may include:
Stomach perforations, ulcers, or bleedingLiver or heart failureBlood cell problems Seizures Hearing lossHeart attack Blood vessel inflammationLife-threatening skin reactions (Stevens-Johnson syndrome/toxic epidermal necrolysis)Vomiting blood Painful swallowing Kidney problems or failureHigh potassium levelsClotting Serum sickness (the immune system reacts to medication, causing fever, rash, and painful and swollen joints)
Dosage: How Much Feldene Should I Take?
Modifications
You may need to use caution when taking Feldene if you are 65 years or older, especially if you have a history of ulcers or other health conditions. The lowest effective dose of Feldene should be used for the shortest time possible.
If you experience a serious side effect, you or your healthcare provider may send a report to the FDA’s MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (capsules): For osteoarthritis and rheumatoid arthritis: Adults—20 milligrams (mg) once a day or 10 mg 2 times a day. Children—Use and dose must be determined by your doctor.
Kidney problems may also occur with NSAIDs. Therefore, people with kidney problems should consult their healthcare provider about using Feldene.
Feldene is not recommended for people who are pregnant or breastfeeding. If you are taking Feldene and find out you are pregnant, contact your healthcare provider immediately for medical advice.
Missed Dose
If you miss a dose of Feldene, take it as soon as possible. If it is almost time for the next dose, skip the missed dose. Do not take two doses together.
Overdose: What Happens If I Take Too Much Feldene?
Taking too much piroxicam can cause:
Tiredness or drowsinessNausea or vomitingStomach pain or bleeding
In rare cases, high blood pressure, kidney problems, slowed breathing, and coma may occur.
Precautions
What Are Reasons I Shouldn’t Take Feldene?
Feldene is not appropriate for everyone. You should not take this medication if allergic to piroxicam or any inactive ingredients in Feldene.
If someone collapses or isn’t breathing after taking Feldene, call 911 immediately.
This medicine may raise your risk of having a heart attack or stroke. This is more likely in people who already have heart disease. People who use this medicine for a long time might also have a higher risk. Check with your doctor right away if you are having chest pain or discomfort, nausea or vomiting, pain or discomfort in the arms, jaw, back, or neck, trouble breathing, slurred speech, or weakness.
This medicine may cause bleeding in your stomach or intestines. These problems can happen without warning signs. This is more likely if you have had a stomach ulcer in the past, if you smoke or drink alcohol regularly, are over 60 years of age, are in poor health, or using certain other medicines (eg, steroid medicine, blood thinner).
Check with your doctor right away if you have any symptoms of liver problems including dark-colored urine or pale stools, nausea, vomiting, loss of appetite, pain in your upper stomach, or yellow skin or eyes.
Some possible warning signs of serious side effects that can occur during treatment with this medicine may include black, tarry stools, decreased urination, severe stomach pain, skin rash, swelling of the face, fingers, feet, or lower legs, unusual bleeding or bruising, unusual weight gain, vomiting of blood or material that looks like coffee grounds, or yellow skin or eyes. Also, signs of serious heart problems could occur such as chest pain or tightness, fast or irregular heartbeat, unusual flushing or warmth of the skin, weakness, or slurring of speech. Check with your doctor immediately if you notice any of these warning signs.
Check with your doctor right away if you have bloody urine, a decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.
Hyperkalemia (high potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you have stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, or weakness or heaviness of the legs.
This medicine may also cause serious allergic reaction called anaphylaxis, which can be life-threatening and requires medical attention. Although this is rare, it may occur more often in patients who are allergic to aspirin or to any of the nonsteroidal anti-inflammatory drugs (NSAIDs). Tell your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after using this medicine.
Serious skin reactions, including exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) can occur with this medicine. Check with your doctor right away if you have black, tarry stools, blistering, peeling, or loosening of the skin, chest pain, chills, cough, diarrhea, fever, itching, joint or muscle pain, painful or difficult urination, red irritated eyes, red skin lesions, sore throat, sores, ulcers, or white spots in the mouth or on the lips, swollen glands, unusual bleeding or bruising, or unusual tiredness or weakness.
Using this medicine during the later part of a pregnancy can harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.
This medicine may cause a delay in ovulation for women and may affect their ability to have children. If you plan to have children, talk with your doctor before using this medicine.
Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after your treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
Before having any kind of surgery or medical tests, tell your doctor that you are using this medicine. It may be necessary for you to stop treatment for a while, or to change to a different nonsteroidal anti-inflammatory drug before your procedure.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Other people who should not take Feldene include:
People with asthma or hives due to aspirin or other NSAIDs People with aspirin triad (people who have all three of these conditions: aspirin or NSAID sensitivity, asthma, and sinus disease with polyps) People having CABG surgery People with kidney problems Pregnant people, especially at 30 weeks and beyond
Feldene may be prescribed cautiously for some people, only if your healthcare provider determines it is safe. This includes for:
People aged 65 years and older Kidney or liver problems Asthma Heart disease, a recent heart attack, or at risk for heart disease High blood pressure, heart failure, or fluid retention Conditions that affect blood clotting Dehydration (water loss) or hypovolemia (any fluid loss, such as water and salt loss) Stomach bleeding or a history of stomach ulcers Cigarette or alcohol use Women who are trying to become pregnant People who are poor CYP2C9 metabolizers (an enzyme responsible for breaking down several types of drugs)
What Other Medications Interact With Feldene?
Tell your healthcare provider about all medicines you take, including prescription and over-the-counter (OTC) medicines, vitamins, or supplements.
Feldene should not be mixed with other NSAIDs. Examples of NSAIDs include:
Advil or Motrin (ibuprofen) Aleve or Naprosyn (naproxen) Aspirin Celebrex (celecoxib) Mobic (meloxicam) Relafen (nabumetone)
Drugs that interfere with blood clotting can increase the risk of bleeding when taken with Feldene. Examples include:
Aspirin Jantoven (warfarin) Plavix (clopidogrel) Serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants, such as Cymbalta (duloxetine), Effexor XR (venlafaxine), and Pristiq (desvenlafaxine) Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline)
Certain blood pressure medications can interact with Feldene, resulting in less effective blood pressure medicine. Examples include:
Angiotensin-converting enzyme (ACE) inhibitor drugs, like Altace (ramipril), Vasotec (enalapril), and Zestril (lisinopril) Angiotensin receptor blockers (ARBs), such as Benicar (olmesartan), Cozaar (losartan), and Diovan (valsartan) Beta-blockers, such as Lopressor or Toprol XL (metoprolol) and Tenormin (atenolol)
ACE inhibitors or ARBs combined with Feldene can also affect kidney function in older adults or dehydrated people.
A few other examples of drugs that Feldene also interacts with include:
Corticosteroids, such as Rayos (prednisone) Diuretics or “water pills,” such as Microzide (hydrochlorothiazide) and Lasix (furosemide) Lanoxin (digoxin) Lithium Methotrexate
Other drug interactions may occur with Feldene. Consult your healthcare provider for a complete list of drug interactions.
What Medications Are Similar?
Feldene is a prescription NSAID. Examples of other NSAIDs include:
IbuprofenNaproxenCelecoxibClinoril (sulindac)Indocin (indomethacin)MeloxicamKetoprofenNabumetoneKetorolacDiclofenac sodium oralVoltaren gel (diclofenac sodium topical)
Some NSAIDs are available OTC, some are available by prescription only, and some are available both OTC and prescription, but in different dosages.
People with osteoarthritis or rheumatoid arthritis are often treated with an NSAID but may benefit from other measures, such as other medications, physical therapy, acupuncture, or surgery.
Often, people with rheumatoid arthritis take other medications in combination with an NSAID, such as Tylenol (acetaminophen) and disease-modifying anti-rheumatic drugs (DMARDs).
DMARDs include oral drugs such as:
Arava (leflunomide) Plaquenil (hydroxychloroquine) Methotrexate Xeljanz (tofacitinib)
Other DMARDs are biologic response modifiers, including injectable drugs, such as Humira (adalimumab) and Remicade (infliximab).
This is a list of drugs also prescribed or used for rheumatoid arthritis or osteoporosis. It is NOT a list of drugs recommended to take with Feldene. Talk to your pharmacist or a healthcare provider if you have questions.
How Can I Stay Healthy While Taking Feldene?
Before taking Feldene, discuss your medical history and all medications you take with your healthcare provider.
Rare but serious side effects can also occur. If you have hives, difficulty breathing, or swelling around the face, get emergency medical help immediately. Medical assistance is also required for skin reactions. Before taking Feldene, talk to your healthcare provider about potential side effects.
Many people who take Feldene do not have any serious side effects. However, there are some serious side effects associated with all NSAIDs. Before taking Feldene, discuss the side effects with your healthcare provider. Some things to look out for include the following:
Heart and clotting problemsHeart failure and swelling (edema)GI bleeding, ulcer, or perforationLiver problemsSevere allergic reactionsSkin reactions
If any of these symptoms occur, get medical help immediately. Also, avoid alcohol while taking Feldene. Talk to your healthcare provider about what other measures you can take for osteoarthritis or rheumatoid arthritis.
