meloxicam

Meloxicam is in a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs) that are used to treat pain and/or inflammation. Other members of this class include ibuprofen (Motrin), indomethacin (Indocin), nabumetone (Relafen) and several others. Prostaglandins are chemicals that contribute to inflammation especially within joints, and it is the inflammation that leads to the common symptoms of pain, tenderness, and swelling associated with arthritis. Meloxicam blocks the enzymes that make prostaglandins (cyclooxygenase 1 and 2) and reduces the levels of prostaglandins. As a result, inflammation and its accompanying symptoms are reduced. Meloxicam was approved for use in April 2000.

Meloxicam is used to treat tenderness, swelling, and pain caused by the inflammation of osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis in patients 2 years of age or older.

WARNING

• Individuals who are allergic to NSAIDs may experience shortness of breath when given an NSAID. People with asthma also are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.
• New onset or worsening of high blood pressure (hypertension) may occur. Blood pressure should be monitored closely during treatment.
• Meloxicam may cause fluid retention and swelling (edema). It should be used cautiously in people with heart failure.
• Meloxicam may reduce kidney function. Therefore, it should not be used in people with severe kidney failure. It should be used cautiously in the elderly, people with heart failure, liver dysfunction, and those taking diuretics, ACE-inhibitors, or angiotensin II antagonists.
• Serious skin reactions such as exfoliative dermatitis, Stevens- Johnson syndrome, and toxic epidermal necrolysis (TEN) may occur without warning.
• NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions in people with or without heart disease or risk factors for heart disease. The increased risk of heart attack or stroke may occur as early as the first week of use and the risk may increase with longer use and is higher in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.
• Central nervous system effects including drowsiness, dizziness, and blurred vision may occur in patients who are taking an NSAIDs.

The lowest effective dose should be used for each patient. Meloxicam therapy usually is started at 7.5 mg daily. Some patients require a dose of 15 mg daily, but this larger dose should be taken only under the direction of a physician. Juvenile rheumatoid arthritis is treated with 0.125 mg/kg daily up to 7.5 mg per day. Meloxicam may be taken with or without food.

Meloxicam may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.

Meloxicam may reduce the blood pressure-lowering effects of drugs given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure.

When meloxicam is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.

Meloxicam increases the negative effect of cyclosporine on kidney function and reduces the effect of furosemide (Lasix) and thiazide diuretics because of prostaglandin inhibition.

Individuals taking oral blood thinners, for example, warfarin (Coumadin), should avoid meloxicam because meloxicam also thins the blood, and excessive blood thinning may lead to bleeding.

Meloxicam should be avoided by patients with a history of asthma attacks, hives, or other allergic reactions to aspirin or other NSAIDs. If aspirin is taken with meloxicam there may be an increased risk for developing a gastrointestinal ulcer.

Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking meloxicam or other NSAIDs.

Cholestyramine (Questran), colestipol (Colestid), and colesevelam (Welchol) may decrease the effectiveness of meloxicam by preventing its absorption from the intestine.

Meloxicam oral suspension contains sorbitol. Combining sodium polystyrene sulfonate (Kayexalate) with sorbitol may cause fatal intestinal necrosis. Therefore, meloxicam oral solution should not be combined with Kayexalate.

There have been no studies of meloxicam therapy in pregnant women.. Meloxicam generally should be avoided during the first and second trimester of pregnancy. Because meloxicam may cause a fetal birth defect called ductus arteriosus (early closure of two major blood vessels of the heart and lung) in the third trimester of pregnancy, meloxicam also should be avoided during this last part of pregnancy.

There have been no studies in humans to determine if meloxicam is excreted in breast milk.

What preparations of meloxicam are available?

Tablets: 7.5, 15 mg. Oral Suspension: 7.5 mg/ml

How should I keep meloxicam stored?

Meloxicam should be stored in a dry place at room temperature, 15 C to 30 C (59 F to 86 F).