Meloxicam


Generic Medicine Info
Administration
May be taken with or without food. May be taken w/ meals if GI discomfort occurs.
Contraindications
Hypersensitivity; history of asthma, urticaria, or allergic-type reactions after aspirin or other NSAID use. Active or history of recurrent peptic ulceration or bleeding (≥2 distinct episodes of proven ulceration or bleeding), history of cerebrovascular bleeding or other bleeding disorders; history of gastrointestinal bleeding or perforation associated with previous NSAID therapy; severe heart failure; active intestinal inflammatory disease (e.g. Crohn's disease, ulcerative colitis). Phenylketonuria (orally disintegrating tab). Moderate to severe renally impaired patient who are at risk for renal failure due to volume depletion (IV). Use in the setting of CABG surgery. Severe hepatic and renal (non-dialysed) impairment. Pregnancy (3rd trimester).
Special Precautions
Patient with a history of ulcerative colitis or Crohn's disease; oedema, hypovolaemia, other forms of asthma, hypertension, CHF, established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, gastrointestinal disease, diabetes, coagulopathy, recent MI. Meloxicam is available in multiple formulations, certain products or formulations may only be used for certain indications and some may not be bioequivalent; refer to specific product guidelines prior to administration and do not switch between brands or formulations. Avoid chronic use after bariatric surgery; defer use for at least 4-6 half-lives before surgical or dental procedures. Not indicated for use in patients requiring relief from acute pain or when rapid onset of analgesia is required. CYP2C9 genetic polymorphism; available product information may not reference pharmacogenomic information, refer to specific country guidelines for their respective recommendations. Use may mask the usual signs and symptoms of infection. Avoid concomitant use with other NSAIDs (including cyclooxygenase-2 inhibitors). Not recommended in women undergoing investigation of infertility or having difficulty conceiving. Smokers. Dehydrated and debilitated patient. Children and elderly. Mild to moderate renal and hepatic impairment. Pregnancy (1st and 2nd trimester) and lactation. Patient Counselling This drug may cause drowsiness, dizziness, and blurred vision; if affected, do not drive or operate machinery. Monitoring Parameters Assess cardiac risk and potential for gastrointestinal bleeding prior to initiation of therapy. Monitor blood pressure, gastrointestinal effects, and ototoxicity at the start of therapy and periodically throughout use; CBC, chemistry profile, occult blood loss, periodic LFTs, renal function (e.g. urine output, serum BUN and creatinine), K level. Perform ophthalmic evaluations periodically during prolonged use. Assess for signs and symptoms of gastrointestinal bleeding. Monitor analgesic response after treatment initiation (IV).
Adverse Reactions
Significant: Anaphylactoid reactions, new-onset or exacerbation of hypertension, oedema, Na and fluid retention, cardiac failure; decreased platelet adhesion and aggregation, prolonged bleeding time, increased risk of haemorrhage; anaemia (particularly with long term use); transaminase elevations (mild and transient), hyperkalaemia; blurred or decreased vision; interstitial nephritis (with or without nephrotic syndrome), impaired renal function, renal papillary necrosis; anastomotic ulcerations/perforations (if used after bariatric surgery). Rarely, severe blood dyscrasias (e.g. agranulocytosis, thrombocytopenia, aplastic anaemia). Ear and labyrinth disorders: Vertigo. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, constipation, flatulence, stomatitis, gastritis, eructation, exacerbation of colitis and Crohn's disease. Investigations: Abnormal renal function test (e.g. increased serum creatinine and/or serum urea). Nervous system disorders: Headache, dizziness, somnolence. Skin and subcutaneous tissue disorders: Rash, pruritus, angioedema. Vascular disorders: Flushing.
Potentially Fatal: CV thrombotic events including MI and stroke (increased risk with higher doses and prolonged use); gastrointestinal bleeding, ulceration, and perforation; drug reaction with eosinophilia and systemic symptoms (DRESS)/multiorgan hypersensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis. Rarely, severe hepatic reactions (e.g. fulminant hepatitis, hepatic necrosis, hepatic failure).
Drug Interactions
Increased risk of gastrointestinal ulcers and bleeding with other NSAIDs, aspirin (at anti-inflammatory doses), other salicylates (e.g. diflunisal, salsalate), or corticosteroids. Increased risk of gastrointestinal bleeding with SSRIs. Increased risk of bleeding with anticoagulants (e.g. warfarin, heparin), thrombolytics, and antiplatelet drugs. May reduce the therapeutic effect of diuretics, β-blockers, ACE inhibitors, angiotensin receptor blockers, and intrauterine devices. Increased nephrotoxic effect of calcineurin inhibitors (e.g. ciclosporin, tacrolimus). May decrease renal excretion and increase the risk of lithium toxicity. Increased plasma concentration of methotrexate. Colestyramine increases the clearance and decreases the half-life of meloxicam. May increase the risk of myelotoxicity, nephrotoxicity, and gastrointestinal toxicity with pemetrexed. May increase the serum concentration and prolong the half-life of digoxin.
CIMS Class
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
ATC Classification
M01AC06 - meloxicam ; Belongs to the class of non-steroidal antiinflammatory and antirheumatic products, oxicams.
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