Feldene

Feldene

 [fel´dēn]

trademark for preparations of piroxicam, a nonsteroidal antiinflammatory drug used in treatment of arthritis.

piroxicam

Apo-Piroxicam (CA), Brexidol (UK), Dom-Piroxicam (CA), Feldene, Gen-Piroxicam (CA), Novo-Pirocam (CA), Nu-Pirox (CA) PMS-Piroxicam (CA), PRO-Piroxicam (CA)

Pharmacologic class: Oxicam derivative, nonsteroidal anti-inflammatory drug (NSAID)

Therapeutic class: Analgesic, anti-inflammatory, antipyretic

Pregnancy risk category C (first and second trimesters), D (third trimester)

Pregnancy risk category C (first and second trimesters), D (third trimester)

FDA Box Warning

• Drug may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke (which can be fatal). Risk may increase with duration of use. Patients with cardiovascular disease or risk factors for it may be at greater risk.

• Drug increases risk of serious GI adverse events, including bleeding, ulcers, and stomach or intestinal perforation (which can be fatal). These events can occur at any time during use and without warning. Elderly patients are at greater risk.

• Drug is contraindicated for treatment of perioperative pain in setting of coronary artery bypass graft surgery.

Action

Inhibits cyclooxygenase (an enzyme needed for prostaglandin synthesis), stimulating anti-inflammatory response and blocking pain impulses

Availability

Capsules: 10 mg, 20 mg

⊘Indications and dosages

➣ Inflammatory disorders (such as arthritis)

Adults: 20 mg P.O. daily as a single dose or in two divided doses

Dosage adjustment

• Hepatic or renal impairment
• Elderly patients

Off-label uses

• Dysmenorrhea
• Ankylosing spondylitis
• Gout

Contraindications

• Hypersensitivity to drug or other NSAIDs (including aspirin)
• Active GI bleeding or ulcer disease
• Third trimester of pregnancy

Precautions

Use cautiously in:
• renal impairment, severe cardiovascular or hepatic disease
• history of ulcer disease
• pregnant patients in first or second trimester
• breastfeeding patients (not recommended)
• children (safety not established).

Administration

• Give with milk, antacids, or food to minimize GI upset.

Adverse reactions

CNS: headache, drowsiness, dizziness

CV: edema, hypertension, vasculitis, tachycardia, arrhythmias

EENT: blurred vision, tinnitus

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, dyspepsia, anorexia, severe GI bleeding

GU: proteinuria, renal failure

Hematologic: anemia, blood dyscrasias

Hepatic: jaundice, hepatitis

Skin: rash

Other: allergic reactions including anaphylaxis

Interactions

Drug-drug.Acetaminophen (chronic use), cyclosporine, gold compounds: increased risk of adverse renal reactions Anticoagulants, cefamandole, cefoperazone, cefotetan, clopidogrel, eptifibatide, heparin, plicamycin, thrombolytics, ticlopidine, tirofiban, valproic acid, vitamin A: increased risk of bleeding

Antineoplastics: increased risk of hematologic toxicity

Aspirin: decreased piroxicam blood level and efficacy

Corticosteroids, other NSAIDs: additive adverse GI reactions

Diuretics, other antihypertensives: decreased response to these drugs Insulin, oral hypoglycemics: increased risk of hypoglycemia

Lithium: increased lithium blood level and risk of toxicity

Probenecid: increased piroxicam blood level and risk of toxicity

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatinine, electrolytes, lactate dehydrogenase: increased levels

Bleeding time: prolonged Hematocrit, hemoglobin, platelets, white blood cells: decreased levels

Liver function tests: abnormal results

Drug-herbs.Alfalfa, anise, arnica, astragalus, bilberry, black currant seed oil, bladderwrack, bogbean, boldo, borage oil, buchu, capsaicin, cat's claw, celery, chaparral, cinchona bark, clove oil, coenzyme Q10, dandelion, danshen, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo, guggul, papaya extract, red clover, rhubarb, safflower oil, skullcap, St. John's wort: increased anticoagulant effect, greater bleeding risk

Patient monitoring

• Monitor vital signs and cardiovascular status. Stay alert for hypertension and arrhythmias.
• Monitor kidney and liver function tests, hearing, and CBC.

☞ Watch for signs and symptoms of drug-induced hepatitis and GI toxicity, including ulcers and bleeding.
• Monitor for signs and symptoms of infection, which drug may mask.

Patient teaching

• Advise patient to take with milk, antacids, or food to minimize GI upset.
• Tell patient drug may mask signs and symptoms of infection. Instruct him to contact prescriber if he suspects he has an infection.

☞ Teach patient to recognize and immediately report signs and symptoms of allergic reaction or GI bleeding.
• Inform patient that many herbs increase the risk of GI bleeding. Caution him not to use herbs without prescriber's approval.
• Instruct patient to drink plenty of fluids and to report decreased urination.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell female patient to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

Feldene

(fĕl′dēn′)

A trademark for the drug piroxicam.

Feldene

a trademark for an antiinflammatory agent (piroxicam).

Feldene

A brand name for PIROXICAM.