MELOXICAM

INDICATIONMeloxicam 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.CONTRAINDICATIONAllergic Reactions : Meloxicam Tablets are contraindicated in patients with known hypersensitivity (e.g. anaphylactoid reactions and serious skin reactions) to Meloxicam. Meloxicam tablets should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients.Coronary Surgery: Meloxicam tablets are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery .SPECIAL PRECAUTIONCardiovascular Thrombotic Events : Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs, both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk factors for CV disease may be at greater risk. To minimize the potential risk for an adverse CV event in patients treated with an NSAID, the lowest effective dose should be used for the shortest duration possibleGastrointestinal Effects : NSAIDs, including Meloxicam, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine, which can be fatal. These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Only one in five patients who develop a serious upper GI adverse event on NSAID therapy is symptomatic. Upper GI ulcers, gross bleeding, or perforation caused by NSAIDs, occur in approximately 1% of patients treated for 3-6 months, and in about 2-4% of patients treated for one year. These trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy. Prescribe NSAIDs, including Meloxicam, with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding. Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients with neither of these risk factors. To minimize the potential risk for an adverse GI event in patients treated with an NSAID, use the lowest effective dose for the shortest possible duration. Patients and physicians should remain alert for signs and symptoms of GI ulceration and bleeding during Meloxicam therapy and promptly initiate additional evaluation and treatment if a serious GI adverse event is suspected. Hepatic Effects : Borderline elevations of one or more liver tests may occur in up to 15% of patients taking NSAIDs including Meloxicam. These laboratory abnormalities may progress, may remain unchanged, or may be transient with continuing therapy. Notable elevations of ALT or AST (approximately three or more times the upper limit of normal) have been reported in approximately 1% of patients in clinical trials with NSAIDs. In addition, rare cases of severe hepatic reactions, including jaundice and fatal fulminant hepatitis, liver necrosis and hepatic failure, some of them with fatal outcomes have been reported.A patient with symptoms and/or signs suggesting liver dysfunction, or in whom an abnormal liver test has occurred, should be evaluated for evidence of the development of a more severe hepatic reaction while on therapy with Meloxicam. If clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur.Hypertension : NSAIDs, including Meloxicam, can lead to onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events. NSAIDs, including Meloxicam, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.Patients taking ACE inhibitors, thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs.Renal Effects : Long-term administration of NSAIDs, including Meloxicam, can result in renal papillary necrosis, renal insufficiency, acute renal failure, and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a nonsteroidal anti-inflammatory drug may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics, ACE-inhibitors, and angiotensin II receptor antagonists, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state.Use caution when initiating treatment with Meloxicam in patients with considerable dehydration. It is advisable to rehydrate patients first and then start therapy with Meloxicam. Caution is also recommended in patients with pre-existing kidney disease.The extent to which metabolites may accumulate in patients with renal impairment has not been studied with Meloxicam. Because some Meloxicam metabolites are excreted by the kidney, monitor patients with significant renal impairment closely.Anaphylactoid Reactions : As with other NSAIDs, anaphylactoid reactions have occurred in patients without known prior exposure to Meloxicam. Meloxicam should not be given to patients with the aspirin triad. This symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs.Adverse Skin Reactions :NSAIDs, including Meloxicam, can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. Inform patients about the signs and symptoms of serious skin manifestations and discontinue use of the drug at the first appearance of skin rash or any other sign of hypersensitivity.Pregnancy : Starting at 30 weeks gestation, avoid the use of Meloxicam, because it may cause premature closure of the ductus arteriosusSIDE EFFECTThe most common side effects with NSAIDs are related to the gastrointestinal tract (GI) and include nausea, vomiting, abdominal pain, diarrhea, and gas. To prevent these common side effects, it is recommended that most NSAIDs be taken with food or milk. NSAIDs may cause ulcers in the stomach and/or small intestine. A few NSAIDs are designed to be less damaging to the stomach and small intestine, and, therefore, they may be taken with or without food. Meloxicam is an example of one of these NSAIDs, but, nevertheless, it should be taken cautiously without food. NSAIDs have been associated with an increased risk of blood clots that can cause strokes and heart attacks. NSAIDs also may interfere with the function of the kidneys or injure the kidneys.Other less common side effects of meloxicam are headache, fatigue related to anemia (low red blood cell count), joint pain, back pain, insomnia, itching, skin rash, bladder infection and upper respiratory tract infection.

PHARMACODYNAMICAfter intramuscular or subcutaneous administration, meloxicam is usually well absorbed. Species differences occur. In general, the volume of distribution is low for most NSAIDs in most species.This is probably caused by the extreme binding to plasma protein; meloxicam is no exception to this phenomenon.The proposed metabolic pathway of meloxicam in pigs is hepatic oxidation to its 5-hydroxymethyl and 5-carboxyl metabolites.Pharmacokinetics in neonatal animals can be different from that in adults. The metabolic pathways of hepatic oxidative reactions and glucuronide conjugation can be deficient in piglets for up to six weeks after birth.Such differences can usually be attributed to altered disposition processes during the neonatal period, which again can affect the plasma concentrations as well as the concentrations of drug attained at the receptor sites. The pharmacodynamic properties of NSAIDs can be recorded as inhibitory effects on COX enzymes. Meloxicam preferentially inhibits COX-2, which is induced by inflammatory stimuli in pathophysiological conditions. It has a high intrinsic activity combined with a low ulcerogenic potential.DOSAGEThe 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.