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Feldene is a reversible inhibitor of COX. Feldene lowers prostaglandin concentration in synovial fluid and inhibit platelet aggregation. Feldene decreases the production of IgM rheumatoid factor.

The common side effects reported with Feldene are edema, anorexia, abdominal pain, constipation, diarrhea, dyspepsia, elevated liver enzymes, flatulence, gross bleeding/perforation, heartburn, nausea, ulcers (gastric/duodenal), vomiting, anemia, increased bleeding time, dizziness, headache, pruritus, rash, tinnitus and abnormal renal function.

When Feldene is co administered with highly protein bound drugs, there should be careful monitoring for dose adjustments. Feldene decreases antihypertensive effect of Angiotensin Converting Enzyme (ACE) inhibitors and diuetics. The use of Piroxicam causes an increased risk of cardiovascular thrombotic events, myocardial infarction, and stroke. Piroxicam can cause serious gastrointestinal events including bleeding, ulceration, and perforation of the stomach, small intestine or large intestine. Feldene should be avoided in late pregnancy as it causes premature closure of the ductus arteriosus. Patients should be informed of the warning signs and symptoms of hepatotoxicity, which can occur during Feldene treatment. Piroxicam is not recommended during lactation. Piroxicam should not be used as an alternative to corticosteroids or to treat corticosteroid insufficiency. Piroxicam can cause anemia due to fluid retention and GI blood loss.

The recommended starting dosage of Feldene for the relief of rheumatoid arthritis and osteoarthritis is 20mg once daily.