Adult: 15 mg daily. May adjust dose depending on the response and severity of patient condition, may be reduced to 7.5 mg daily. Max: 15 mg daily. Elderly: 7.5 mg daily.
Oral Juvenile idiopathic arthritis
Child: ≥60 kg: 7.5 mg once daily.
Adult: As tab: 7.5 mg daily, may be increased to Max of 15 mg daily if necessary. As capsule: 5 mg daily. Max: 10 mg daily.
Osteoarthritis: Patient on dialysis: As tab: Max: 7.5 mg daily. As cap: Max: 5 mg daily.
Rheumatoid arthritis; Ankylosing spondylitis: Patient on dialysis: As tab: Max: 7.5 mg daily.
May be taken with or without food. May be taken w/ meals if GI discomfort occurs.
Hypersensitivity to meloxicam, aspirin or other NSAIDs. History of or active gastrointestinal bleeding, ulceration or perforation related to NSAID use. Active inflammatory bowel disease (e.g. Crohn’s disease of ulcerative colitis), severe heart failure. Treatment of perioperative pain in the setting of CABG surgery. Severe hepatic impairment. Pregnancy (3rd trimester) and lactation.
Patient with asthma, history of or recent ulcer disease or gastrointestinal bleeding, hypertension, recent MI, other CV risk factors (e.g. hyperlipidaemia, diabetes mellitus, smoking), fluid retention and oedema, hypovolaemia, coagulopathy. Dehydrated and debilitated patient. Renal and mild to moderate hepatic impairment. Children and elderly. Pregnancy (1st-2nd trimester). Concomitant use of other NSAIDs, corticosteroids, antiplatelets, anticoagulants.
Significant: Fluid retention, oedema, renal insufficiency, acute renal failure, renal papillary necrosis (prolonged use), hyperkalemia, blurred vision, anaemia, rarely, agranulocytosis, thrombocytopenia, leukopaenia. Blood and lymphatic system disorders: Anaemia, rarely, agranulocytosis, thrombocytopenia, leukopaenia. Cardiac disorders: Cardiac failure, rarely, palpitations. Gastrointestinal disorders: Dyspepsia, nausea, vomiting, abdominal pain, constipation, flatulence, diarrhoea, melaena, haematemesis, ulcerative stomatitis, rarely, gastritis. General disorders and admin site conditions: Malaise, fatigue. Immune system disorders: Angioedema. Investigations: Increased serum transaminase levels, increased serum bilirubin, increased serum creatinine and BUN, weight gain or loss. Metabolism and nutrition disorders: Hyperkalaemia, dehydration. Nervous system disorders: Headache, vertigo, paraesthesia. Psychiatric disorders: Anxiety, abnormal dreams, confusion, depression, nervousness. Renal and urinary disorders: Haematuria, albuminuria. Skin and subcutaneous tissue disorders: Pruritus, rash, photosensitivity, rarely, urticaria. Vascular disorders: Hypertension, hypotension, vasculitis, hot flushes, syncope. Potentially Fatal: Hypersensitivity reactions, CV thrombotic events including MI and stroke, gastrointestinal bleeding, ulceration or perforation; very rarely, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatitis, liver necrosis, hepatic failure, bronchospasm.
PO: C, D (Avoid during 3rd trimester or near delivery.), Z (NSAIDs use in >20 weeks gestation may cause oligohydramnios and fetal renal impairment. Fetal ductus arteriosus premature closure and persistent pulmonary hypertension may occur >30 weeks gestation. Avoid NSAIDs 30 weeks and later. If a NSAID is needed during 20-30 weeks, use lowest effective dose for shortest duration.)
Patient Counseling Information
This drug may cause minimal visual disturbances, vertigo or drowsiness, if affected, do not drive or operate machinery.
Monitor blood pressure during initial treatment and throughout therapy, CBC and chemistry profile periodically (prolonged use), occult blood loss, liver function tests and renal function (e.g. urine output, serum BUN and creatinine). Monitor for signs or symptoms of gastrointestinal bleeding and ototoxicity.
Symptoms: Lethargy, drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, rarely, hypertension, acute renal failure, hepatic dysfunction, respiratory depression, coma, convulsions, CV collapse, and cardiac arrest. Management: Initiate symptomatic and supportive treatment. Administration of activated charcoal and/or induction of emesis may be considered within 4 hours of ingestion. May administer 4 g oral colestyramine for accelerated clearance.
Increased risk of gastrointestinal ulceration or bleeding with anticoagulants (e.g. heparin, warfarin), antiplatelet agents, SSRIs, corticosteroids (e.g. glucocorticoids), salicylates, other NSAIDs (including aspirin). May decrease antihypertensive effects of diuretics, ACE inhibitors, angiotensin II antagonists and ß-blockers. May enhance nephrotoxicity of calcineurin inhibitors (e.g. ciclosporin, tacrolimus). Increased serum concentration of lithium, digoxin and methotrexate. Increased elimination with colestyramine.
May cause false-positive aldosterone/renin ratio (ARR).
Description: Meloxicam, an oxicam derivative, is NSAID that exhibits anti-inflammatory, analgesic and antipyretic activities. It reversibly inhibits cyclooxygenase-1 and -2 (COX-1 and -2), thereby inhibiting synthesis of prostaglandins. Pharmacokinetics: Absorption: Well absorbed from the gastrointestinal tract. Absolute bioavailability: 89% (cap). Time to peak plasma concentration: Within 2 hours (cap), 4-5 hours (tab). Distribution: Volume of distribution: Approx 10 L. Plasma protein binding: Approx 99.4%, mainly to albumin. Metabolism: Metabolised in the liver via oxidation by CYP2C9 and CYP3A4 to inactive metabolites. Excretion: Via urine (<1% as unchanged drug), faeces as inactive metabolites. Elimination half-life: Approx 15-22 hours.
M01AC06 - meloxicam ; Belongs to the class of non-steroidal antiinflammatory and antirheumatic products, oxicams.
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