When you're dealing with chronic joint pain, arthritis, or stubborn inflammation, finding the right medication can feel like a constant trial and error. Feldene, the brand name for piroxicam, has been around for decades as a potent NSAID - but it’s not the only option. And for many people, it’s not even the best one. If you’re wondering whether to stick with Feldene or switch to something else, you’re not alone. Let’s break down how piroxicam stacks up against the most common alternatives, what the real-world trade-offs are, and which options actually deliver better results with fewer risks.

What is Feldene (Piroxicam) and how does it work?

Feldene contains piroxicam, a nonsteroidal anti-inflammatory drug (NSAID) that reduces pain and swelling by blocking enzymes called COX-1 and COX-2. These enzymes trigger inflammation, so when you take piroxicam, you’re essentially putting a brake on your body’s pain signals. It’s often prescribed for osteoarthritis, rheumatoid arthritis, and acute gout attacks. One of its main selling points is its long half-life - you only need to take it once a day. That’s convenient, especially if you’re juggling work, family, or a busy schedule.

But convenience doesn’t mean safety. Piroxicam is one of the stronger NSAIDs on the market, and that strength comes with a cost. Studies show it carries a higher risk of gastrointestinal bleeding compared to other NSAIDs like ibuprofen or naproxen. The UK’s National Institute for Health and Care Excellence (NICE) has flagged piroxicam as a drug that should be used with caution, especially in people over 65 or those with a history of stomach ulcers.

Alternative 1: Naproxen (Aleve, Naprosyn)

Naproxen is probably the most common alternative to piroxicam. Like piroxicam, it’s a traditional NSAID, but it’s gentler on the stomach and has a better safety profile in long-term use. You typically take it twice a day, which is less convenient than Feldene’s once-daily dose - but many patients prefer it because the side effects are noticeably milder.

A 2023 analysis in the British Journal of Clinical Pharmacology found that naproxen had a 30% lower risk of serious gastrointestinal events compared to piroxicam over a 12-month period. It’s also considered safer for the heart than some other NSAIDs, making it a go-to for patients with mild cardiovascular risk factors. If you’ve been on Feldene and noticed heartburn, nausea, or dark stools, switching to naproxen could be a simple fix.

Alternative 2: Ibuprofen (Advil, Nurofen)

Ibuprofen is the go-to painkiller for most people - it’s cheap, available over the counter, and works well for mild to moderate pain. But it’s not a direct replacement for piroxicam in chronic conditions. Ibuprofen has a short half-life, meaning you need to take it every 4 to 6 hours. That’s fine for a headache or a sprained ankle, but for all-day arthritis pain, it’s a hassle.

Still, if your inflammation is mild or intermittent, ibuprofen might be all you need. It’s also less likely to cause kidney issues than piroxicam. A large observational study in Scotland tracked over 120,000 NSAID users and found that those on high-dose ibuprofen had a 25% lower risk of acute kidney injury than those on piroxicam. If you’re younger, active, and don’t need round-the-clock relief, ibuprofen is a smart, low-risk option.

Alternative 3: Celecoxib (Celebrex)

Celecoxib is a COX-2 inhibitor, which means it targets only the inflammation-causing enzyme without affecting the stomach-protecting one. That’s why it’s often called a “stomach-friendly” NSAID. For people with a history of ulcers or those on blood thinners, celecoxib can be a game-changer.

But it’s not perfect. Celecoxib carries a slightly higher risk of heart problems than naproxen, which is why the FDA added a black box warning in 2005. It’s also more expensive - a 30-day supply can cost over £50 in the UK without a prescription. Still, if your main concern is protecting your gut and you’re otherwise healthy, celecoxib offers a solid middle ground between effectiveness and safety. Many rheumatologists now prescribe it as a first-line option for patients who can’t tolerate traditional NSAIDs.

Alternative 4: Diclofenac (Voltaren, Cambia)

Diclofenac is another strong NSAID, often used in gel form for localized joint pain. The oral version is just as potent as piroxicam, but it’s more likely to cause liver enzyme elevations. In fact, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has restricted diclofenac’s use in patients with liver disease.

What makes diclofenac stand out is its topical form. If your pain is focused on one knee or shoulder, applying Voltaren gel twice a day can give you the same relief as a pill - without the stomach or kidney risks. For many older adults, this is the preferred route. One study found that 78% of patients with knee osteoarthritis got adequate pain relief from diclofenac gel alone, without needing oral NSAIDs at all.

Alternative 5: Paracetamol (Acetaminophen)

Paracetamol isn’t an NSAID - it doesn’t reduce inflammation. But it’s still a first-choice painkiller for many people with arthritis, especially if they can’t take NSAIDs at all. It’s safe for the stomach, doesn’t interfere with blood pressure meds, and is safe during pregnancy.

But here’s the catch: it doesn’t touch swelling. If your joints are hot, swollen, and stiff, paracetamol won’t fix that. It only dulls the pain. That’s why many doctors recommend combining it with a topical NSAID or a low-dose oral NSAID, rather than using it alone. If you’ve tried Feldene and stopped because of side effects, paracetamol might be your starting point - but don’t expect it to be a full replacement.

Alternative 6: Non-drug options - Physical therapy, weight loss, and heat/cold

Medication isn’t the only path to relief. A 2024 Cochrane review found that structured physical therapy was just as effective as NSAIDs for knee osteoarthritis over six months - and had zero side effects. Strengthening the muscles around your joints, improving flexibility, and learning how to move without aggravating pain can make a huge difference.

Weight loss also matters. For every pound lost, you reduce 4 pounds of pressure on your knees. Losing just 10 pounds can cut arthritis pain by up to 50%. Heat packs, cold compresses, and even acupuncture have shown measurable benefits in clinical trials. These aren’t “alternative” therapies - they’re core parts of pain management that should be used alongside, not instead of, medication.

Which alternative is right for you?

There’s no single best drug. The right choice depends on your age, medical history, lifestyle, and what kind of pain you’re dealing with.

• If you need long-lasting relief and have no stomach issues: Piroxicam (Feldene) still works - but monitor for side effects.
• If you want balance between effectiveness and safety: Naproxen is the most reliable all-rounder.
• If you have a history of ulcers: Celecoxib or topical Diclofenac gel are safer bets.
• If your pain is mild or occasional: Ibuprofen or Paracetamol are low-risk starters.
• If you want to reduce medication use: Combine physical therapy and weight management with low-dose painkillers.

Many patients don’t realize they can mix approaches. For example: take naproxen twice a day for flare-ups, use diclofenac gel on the sore knee, do 20 minutes of daily exercises, and keep paracetamol on hand for breakthrough pain. This layered strategy often means you can use lower doses of each drug - reducing side effects while keeping pain under control.

What to watch out for

No NSAID is risk-free. Even the safest ones can cause problems if used long-term or in high doses. Here’s what to monitor:

• Stomach pain, nausea, black stools - signs of bleeding
• Swelling in ankles or sudden weight gain - possible kidney or heart issues
• High blood pressure - NSAIDs can interfere with blood pressure meds
• Dark urine or yellowing skin - signs of liver stress

If you’re on any of these drugs for more than three months, ask your doctor for a blood test to check kidney and liver function. Regular monitoring isn’t optional - it’s essential.

Final thoughts

Feldene (piroxicam) isn’t outdated, but it’s no longer the first choice for most patients. Modern guidelines from the European League Against Rheumatism (EULAR) and NICE now recommend starting with naproxen or topical NSAIDs before moving to stronger oral options. The goal isn’t just to relieve pain - it’s to do it safely, sustainably, and with as few side effects as possible.

If you’ve been on Feldene for years without issues, you might not need to change. But if you’ve had stomach upset, high blood pressure, or just feel like you’re on too many pills, it’s worth having a conversation with your doctor about alternatives. There’s a better fit out there - and you don’t have to live with side effects just because a drug worked once.

Next steps if you're considering a switch

Don’t stop Feldene on your own. Talk to your GP or pharmacist. Bring a list of your symptoms, what side effects you’ve had, and what you hope to achieve - less pain, fewer pills, better sleep. Ask if you can try naproxen or diclofenac gel for 4 weeks. Most insurance plans in the UK cover these alternatives at low cost.

If you’re already on multiple medications, ask about drug interactions. Piroxicam can interfere with blood pressure drugs, antidepressants, and even some supplements. Your pharmacist can run a quick check - it takes five minutes and could prevent a serious problem.

Finally, consider a referral to a physiotherapist. Many NHS clinics offer free or low-cost arthritis programs that teach you how to move better, reduce pain naturally, and cut down on medication use. You don’t have to choose between pills and pain - there’s a smarter way to manage it.