This page was prepared by Tami Skinner, LPN Internet Nursing Guide
Michigan Nurses, Pediatrics, Respiratory, Home Health, Medical-Surgical, Long Term Care
http://www.nursefriendly.com/skinner/

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Feldene (Piroxicam) description "contains piroxicam which is a member of the oxicam group of nonsteroidal anti-inflammatory drugs (NSAIDs). Each maroon and blue capsule contains 10 mg piroxicam, each maroon capsule contains 20 mg piroxicam for oral administration. The chemical name for piroxicam is 4-hydroxyl-2-methyl-N-2-pyridinyl-2H-1,2,-benzothiazine-3-carboxamide 1,1- dioxide. Piroxicam occurs as a white crystalline solid, sparingly soluble in water, dilute acid and most organic solvents. It is slightly soluble in alcohol and in aqueous solutions. It exhibits a weakly acidic 4-hydroxy proton (pKa 5.1) and a weakly basic pyridyl nitrogen (pKa 1.8). The molecular weight of piroxicam is 331.35. Its molecular formula is C15H13N3O4S"
http://www.pfizer.com/hml/pi's/feldenepi.html

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Feldene (Piroxicam) Contraindications and precautions : University of Iowa Nursing: "Contraindications: patients with previous hypersensitivity to Feldene, cross-sensitivity may exist with other NSAIDS including aspirin. Do not use. with hemophilia, gastrointestinal bleeding or ulcer disease. Safety not established. in children, lactating or pregnant women. Monitor closely using this medication. while on coumadin therapy. Precautions: use cautiously in patients with bleeding, GI, or cardiac. disorders. Drug Interactions: Anticoagulants, Heparin, thrombolytic agents- may prolong bleeding time. Lithium- may increase lithium toxicity Alcohol- increase risk of GI bleeding Aspirin- decreased blood level of piroxicam decreasing effectiveness."
http://pedspain.nursing.uiowa.edu/NSAIDS/Feldentt.htm

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Clinical Pharmacology of Feldene (Piroxicam): RxList: "In the event treatment for overdosage is required the long plasma half-life (see CLINICAL PHARMACOLOGY), of piroxicam should be considered. The absence of experience with acute overdosage precludes characterization of sequelae and recommendation of specific antidotal efficacy at this time. It is reasonable to assume, however, that the standard measures of gastric evacuation and general supportive therapy would apply. In addition to supportive measures, the use of activated charcoal may effectively reduce the absorption and reabsorption of piroxicam. Experiments in dogs have demonstrated that the use of multiple-dose treatments with activated charcoal could reduce the half-life of piroxicam elimination from 27 hours (without charcoal) to 11 hours and reduce the systemic bioavailability of piroxicam by as much as 37% when activated charcoal is given as late as 6 hours after administration of piroxicam. FELDENE should not be used in patients who have previously exhibited hypersensitivity to it, or in individuals with the syndrome comprised of bronchospasm, nasal polyps, and angioedema precipitated by aspirin or other nonsteroidal anti-inflammatory drugs."
http://www.rxlist.com/cgi/generic/piroxicam_od.htm

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Symptoms of an overdose of Feldene (piroxicam): Web Med: "body as a whole unsteadiness eyes, ears, nose, and throat, ringing in the ears, blurred, vision,skin, rash, gastrointestinal, nausea and/or vomiting, diarrhea, stomach pain, possible loss of blood in the stomach and intestinal areas, nervous system, severe headache, agitation,incoherence (not understandable) confusion, coma, drowsiness, seizures. Expectations (Prognosis)Recovery is very likely if the acidification of the blood can be neutralized and maintained near normal levels."
http://webmd.lycos.com/content/asset/adam_poison_feldene_overdose

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Pitition to ban Piroxicam (Feldene): Citizen.org: "In spite of overwhelming evidence in the literature and elsewhere attesting to the excess risk for piroxicam to cause GI ulceration, bleeding and perforation, it is indeed surprising to note that the company and the FDA continue to maintain in the 1995 Physicians' Desk Reference that, "Studies to date are inconclusive concerning the relative risk of various NSAIDs in causing such [gastrointestinal] reactions". The only advantage of piroxicam which appears appealing is its once-a-day dosing. Significantly increased toxicity, however, (a predictable concomitant of many long-lasting drugs) is a dangerous price to pay for convenience. Piroxicam should not be used just because of its once-a-day convenience for patients, all of whom could use low doses of other NSAIDs or other safer alternatives to piroxicam. In conclusion, there is a growing body of data from studies conducted in eight different countries all of which collectively demonstrate piroxicam's greater propensity to cause serious GI bleeding, perforation and ulceration compared to other drugs in its class that are on the U.S. market. In addition, we have reviewed the pharmacokinetic and dose-response (ulcer incidence) data which explain why piroxicam is so dangerous. The evidence presented warrants a ban on piroxicam for people of all ages. Ibuprofen or enteric-coated aspirin are a preferable first choice for most arthritis patients because of their relatively low incidence of serious GI toxicity. If they do not work, there are still a variety of other drugs, safer than piroxicam, which can be tried."
http://www.citizen.org/publications/release.cfm?ID=5568

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Action and kinetics Feldene (Piroxicam): Nurses PDR: "Action/Kinetics: May inhibit prostaglandin synthesis. Effect is comparable to that of aspirin, but with fewer GI side effects and less tinnitus. May be used with gold, corticosteroids, and antacids. Peak plasma levels: 1.5-2 mcg/mL after 3-5 hr (single dose). Steady-state plasma levels (after 7-12 days): 3-8 mcg/mL. t1/2: 50 hr. Analgesia, onset: 1 hr; duration: 2-3 days. Anti-inflammatory activity, onset: 7-12 days; duration: 2-3 weeks. Metabolites and unchanged drug excreted in urine and feces. Uses: Acute and chronic treatment of rheumatoid arthritis and osteoarthritis. Investigational: Juvenile rheumatoid arthritis, primary dysmenorrhea, sunburn."
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http://www.nursespdr.com/members/database/ndrhtml/piroxicam.html

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Feldene (Piroxicam) pharmacokinetics: Health and Age: "Absorption: FELDENE is well absorbed following oral administration. Drug plasma concentrations are proportional for 10 and 20 mg doses and generally peak within three to five hours after medication. The prolonged half-life (50 hours) results in the maintenance of relatively stable plasma concentrations throughout the day on once daily doses and to significant accumulation upon multiple dosing. A single 20-mg dose generally produces peak piroxicam plasma levels of 1.5 to 2 mcg/mL, while maximum drug plasma concentrations, after repeated daily ingestion of 20 mg FELDENE, usually stabilize at 3-8 mcg/mL. Most patients approximate steady state plasma levels within 7-12 days. Higher levels, which approximate steady state at two to three weeks, have been observed in patients in whom longer plasma half-lives of piroxicam occurred.With food there is a slight delay in the rate but not the extent of absorption following oral administration. The concomitant administration of antacids (aluminum hydroxide or aluminum hydroxide with magnesium hydroxide) have been shown to have no effect on the plasma levels of orally administered piroxicam.Distribution: The apparent volume of distribution of piroxicam is approximately 0.14 L/kg. Ninety-nine percent of plasma piroxicam is bound to plasma proteins. Piroxicam is excreted into human milk. The presence in breast milk has been determined during initial and long-term conditions (52 days). Piroxicam appeared in breast milk at about 1% to 3% of the maternal concentration. No accumulation of piroxicam occurred in milk relative to that in plasma during treatment. Metabolism: Metabolism of piroxicam occurs by hydroxylation at the 5 position of the pyridyl side chain and conjugation of this product; by cyclodehydration; and by a sequence of reactions involving hydrolysis of the amide linkage, decarboxylation, ring contraction and N-demethylation. The biotransformation products of piroxicam metabolism are reported to not have any anti-inflammatory activity.Excretion: FELDENE and its biotransformation products are excreted in urine and feces, with about twice as much appearing in the urine as in the feces. Approximately 5% of a FELDENE dose is excreted unchanged. The plasma half-life (T ½) for piroxicam is approximately 50 hours."
http://www.healthandage.com/html/res/pdr/html/62950670.htm

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How can this Feldene (Piroxicam) affect other medicines?: Net doctor: "Piroxicam may enhance the effect of the following medicines, resulting in an increased risk of side-effects or toxicity: cyclosporin, lithium, methotrexate, morphine, phenytoin, quinolone antibiotics, zidovudine and blood-thinning or anti-clotting medicines. Piroxicam can also enhance the effect of antidiabetic tablets (belonging to the sulphonylurea group), which could lead to low blood sugar levels. The effect of piroxicam is enhanced by the anti-viral medicine ritonavir. The resultant increased risk of toxicity is such that the two should not be used together. The effect of water tablets (diuretics) and blood pressure lowering agents may be reduced by piroxicam, resulting in their being less effective. Use of piroxicam with diuretics or ACE inhibitors may increase the risk of kidney problems and/or an altered potassium balance as a side effect. NSAIDS should not be used within 8-12 days of taking mifepristone. Piroxicam should not be taken with any other NSAID."
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