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Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) used to relieve the symptoms of arthritis (juvenile rheumatoid arthritis, osteoarthritis, and rheumatoid arthritis), such as inflammation, swelling, stiffness, and joint pain․ Meloxicam is sold under the brand name Mobic, among others․ Meloxicam belongs to the class of medications called oxicams․ It works by reducing hormones that cause inflammation and pain in the body․

Clinical Data

Pharmacokinetics

Meloxicam is well absorbed after oral administration, with peak plasma concentrations occurring within 5-6 hours․ The absolute bioavailability is approximately 89%․ Food does not affect the extent of absorption, but it may delay the time to reach peak plasma concentrations by 1-2 hours․

Meloxicam is extensively bound to plasma proteins (99%)․ The volume of distribution is approximately 0․4 L/kg․ Meloxicam is metabolized in the liver by cytochrome P450 enzymes, primarily CYP2C9 and CYP3A4․ The major metabolite is 5'-carboxymeloxicam, which is inactive․

Meloxicam is eliminated primarily in the urine, with approximately 50% excreted as unchanged drug and 50% as metabolites․ The elimination half-life is approximately 20 hours․

Pharmacodynamics

Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) with analgesic and antipyretic properties․ It works by inhibiting the enzyme cyclooxygenase (COX), which is responsible for the production of prostaglandins, thromboxanes, and prostacyclins․ Prostaglandins are involved in the inflammatory process, and their inhibition leads to a reduction in inflammation, pain, and fever․

Meloxicam is a selective COX-2 inhibitor, which means that it has a greater affinity for COX-2 than for COX-1․ COX-1 is responsible for the production of prostaglandins that protect the stomach lining, kidneys, and platelets․ Inhibition of COX-1 can lead to gastrointestinal ulcers, bleeding, and kidney problems․ Meloxicam's selectivity for COX-2 makes it less likely to cause these side effects․

Clinical Trials

Meloxicam has been shown to be effective in reducing pain and inflammation in patients with osteoarthritis and rheumatoid arthritis․ In clinical trials, meloxicam has been shown to be as effective as other NSAIDs, such as ibuprofen and naproxen, in reducing pain and inflammation․ Meloxicam has also been shown to be well-tolerated, with a low incidence of side effects․

One study compared the efficacy and safety of meloxicam to ibuprofen in patients with osteoarthritis of the knee․ The study found that meloxicam was as effective as ibuprofen in reducing pain and stiffness and improving function․ Meloxicam was also better tolerated than ibuprofen, with a lower incidence of gastrointestinal side effects․

Another study compared the efficacy and safety of meloxicam to naproxen in patients with rheumatoid arthritis․ The study found that meloxicam was as effective as naproxen in reducing pain and swelling and improving function․ Meloxicam was also better tolerated than naproxen, with a lower incidence of gastrointestinal and cardiovascular side effects․

Overall, the clinical data suggest that meloxicam is an effective and well-tolerated NSAID for the treatment of osteoarthritis and rheumatoid arthritis․

Dosage

Meloxicam is available as tablets, oral suspension, and injectable solution․ The recommended dosage of meloxicam varies depending on the condition being treated and the individual patient's response to the medication․

Osteoarthritis

The recommended starting dose of meloxicam for osteoarthritis is 7․5 mg once daily․ The dose may be increased to 15 mg once daily if needed․ The maximum recommended daily dose is 15 mg․

Rheumatoid Arthritis

The recommended starting dose of meloxicam for rheumatoid arthritis is 15 mg once daily․ The dose may be increased to 30 mg once daily if needed․ The maximum recommended daily dose is 30 mg․

Juvenile Rheumatoid Arthritis

The recommended starting dose of meloxicam for juvenile rheumatoid arthritis is 0․125 mg/kg once daily․ The dose may be increased to 0․25 mg/kg once daily if needed․ The maximum recommended daily dose is 0․25 mg/kg․

Injectable Meloxicam

Injectable meloxicam is indicated for the short-term treatment of acute pain․ The recommended dose is 15 mg once daily․ The maximum recommended daily dose is 15 mg․

Hepatic Impairment

Patients with mild hepatic impairment (Child-Pugh score 5-6) should start with a dose of 7․5 mg once daily․ The dose may be increased to 15 mg once daily if needed․ Patients with moderate hepatic impairment (Child-Pugh score 7-9) should start with a dose of 7․5 mg every other day․ The dose may be increased to 7․5 mg once daily if needed․ Meloxicam is contraindicated in patients with severe hepatic impairment (Child-Pugh score 10-15)․

Renal Impairment

Patients with mild renal impairment (creatinine clearance 30-60 mL/min) do not require a dose adjustment․ Patients with moderate renal impairment (creatinine clearance 15-29 mL/min) should start with a dose of 7․5 mg every other day․ The dose may be increased to 7․5 mg once daily if needed․ Meloxicam is contraindicated in patients with severe renal impairment (creatinine clearance <15 mL/min)․

Elderly Patients

Elderly patients are more likely to experience adverse events from NSAIDs, including meloxicam․ Therefore, it is recommended to start with the lowest effective dose in elderly patients․

Administration

Meloxicam tablets and oral suspension can be taken with or without food․ Injectable meloxicam should be administered by deep intramuscular injection․

It is important to take meloxicam exactly as prescribed by your doctor․ Do not take more or less of the medication than prescribed, and do not take it more often than prescribed․ Taking too much meloxicam can increase your risk of side effects․

If you miss a dose of meloxicam, take it as soon as you remember․ However, if it is almost time for your next dose, skip the missed dose and take your next dose at the regular time․ Do not take two doses of meloxicam at the same time․

Side Effects

Meloxicam is generally well-tolerated, but it can cause side effects in some people․ The most common side effects of meloxicam include⁚

Gastrointestinal side effects, such as nausea, vomiting, diarrhea, constipation, and abdominal pain

Headache

Dizziness

Drowsiness

Fluid retention

Edema

Rash

Pruritus

Injection site reactions (if meloxicam is administered by injection)

Meloxicam can also cause serious side effects, although these are rare․ Serious side effects of meloxicam include⁚

Gastrointestinal bleeding

Peptic ulcer

Perforated ulcer

Heart attack

Stroke

Kidney failure

Liver failure

Stevens-Johnson syndrome

Toxic epidermal necrolysis

If you experience any serious side effects from meloxicam, stop taking the medication and seek medical attention immediately․

Gastrointestinal Side Effects

Meloxicam, like other NSAIDs, can cause gastrointestinal side effects, such as nausea, vomiting, diarrhea, constipation, and abdominal pain․ These side effects are more common in people who are taking high doses of meloxicam or who have a history of gastrointestinal problems․

To reduce the risk of gastrointestinal side effects, meloxicam should be taken with food․ It is also important to avoid taking meloxicam with alcohol or other medications that can irritate the stomach․

If you experience any gastrointestinal side effects from meloxicam, talk to your doctor․ Your doctor may recommend lowering your dose or switching to a different medication․

Cardiovascular Side Effects

Meloxicam, like other NSAIDs, can increase the risk of cardiovascular events, such as heart attack and stroke․ This risk is increased in people who are taking high doses of meloxicam or who have a history of cardiovascular disease․

To reduce the risk of cardiovascular side effects, it is important to take meloxicam at the lowest effective dose and for the shortest possible time․ It is also important to avoid taking meloxicam with other medications that can increase the risk of cardiovascular events, such as aspirin, clopidogrel, and warfarin․

If you have a history of cardiovascular disease, talk to your doctor before taking meloxicam․ Your doctor will weigh the risks and benefits of meloxicam and help you decide if it is right for you․

Renal Side Effects

Meloxicam, like other NSAIDs, can cause renal side effects, such as kidney failure․ This risk is increased in people who are taking high doses of meloxicam or who have a history of renal disease․

To reduce the risk of renal side effects, it is important to take meloxicam at the lowest effective dose and for the shortest possible time․ It is also important to avoid taking meloxicam with other medications that can damage the kidneys, such as ACE inhibitors, ARBs, and diuretics․

If you have a history of renal disease, talk to your doctor before taking meloxicam․ Your doctor will weigh the risks and benefits of meloxicam and help you decide if it is right for you․

Contraindications

Meloxicam is contraindicated in the following patients⁚

Patients who are allergic to meloxicam or any other NSAID

Patients who have a history of asthma, urticaria, or other allergic reactions to aspirin or other NSAIDs

Patients who have a history of gastrointestinal bleeding or perforation

Patients who have severe hepatic impairment (Child-Pugh score 10-15)

Patients who have severe renal impairment (creatinine clearance <15 mL/min)

Patients who are pregnant or breastfeeding

Meloxicam should be used with caution in the following patients⁚

Patients who have a history of gastrointestinal ulcers or bleeding

Patients who have a history of cardiovascular disease

Patients who have a history of renal disease

Patients who are taking anticoagulants

Patients who are taking corticosteroids

Patients who are elderly

Allergic Reactions

Meloxicam is contraindicated in patients who are allergic to meloxicam or any other NSAID․ Allergic reactions to NSAIDs can range from mild (e․g․, skin rash, hives) to severe (e․g․, anaphylaxis)․

If you experience any signs of an allergic reaction to meloxicam, stop taking the medication and seek medical attention immediately․

Gastrointestinal Bleeding

Meloxicam is contraindicated in patients who have a history of gastrointestinal bleeding or perforation․ NSAIDs can increase the risk of gastrointestinal bleeding, especially in people who are taking high doses of the medication or who have a history of gastrointestinal problems․

If you have a history of gastrointestinal bleeding or perforation, talk to your doctor before taking meloxicam․ Your doctor will weigh the risks and benefits of meloxicam and help you decide if it is right for you․

Hepatic Impairment

Meloxicam is contraindicated in patients with severe hepatic impairment (Child-Pugh score 10-15)․ NSAIDs can cause liver damage, especially in people who are taking high doses of the medication or who have a history of liver disease․

If you have a history of liver disease, talk to your doctor before taking meloxicam․ Your doctor will weigh the risks and benefits of meloxicam and help you decide if it is right for you․

Renal Impairment

Meloxicam is contraindicated in patients with severe renal impairment (creatinine clearance <15 mL/min)․ NSAIDs can cause kidney damage, especially in people who are taking high doses of the medication or who have a history of renal disease․

If you have a history of renal disease, talk to your doctor before taking meloxicam․ Your doctor will weigh the risks and benefits of meloxicam and help you decide if it is right for you․

Pregnancy and Breastfeeding

Meloxicam is contraindicated in women who are pregnant or breastfeeding․ NSAIDs can cause birth defects and other problems in unborn babies․ They can also pass into breast milk and harm nursing infants․

If you are pregnant or breastfeeding, talk to your doctor before taking meloxicam․ Your doctor will weigh the risks and benefits of meloxicam and help you decide if it is right for you․

Precautions

Meloxicam should be used with caution in the following patients⁚

Patients who have a history of gastrointestinal ulcers or bleeding

Patients who have a history of cardiovascular disease

Patients who have a history of renal disease

Patients who are taking anticoagulants

Patients who are taking corticosteroids

Patients who are elderly

Gastrointestinal Ulcers and Bleeding

Meloxicam, like other NSAIDs, can cause gastrointestinal ulcers and bleeding․ This risk is increased in people who are taking high doses of meloxicam or who have a history of gastrointestinal problems․

To reduce the risk of gastrointestinal ulcers and bleeding, meloxicam should be taken with food․ It is also important to avoid taking meloxicam with alcohol or other medications that can irritate the stomach․

If you have a history of gastrointestinal ulcers or bleeding, talk to your doctor before taking meloxicam․ Your doctor will weigh the risks and benefits of meloxicam and help you decide if it is right for you․

Cardiovascular Disease

To reduce the risk of cardiovascular events, it is important to take meloxicam at the lowest effective dose and for the shortest possible time․ It is also important to avoid taking meloxicam with other medications that can increase the risk of cardiovascular events, such as aspirin, clopidogrel, and warfarin․

Renal Disease

Meloxicam, like other NSAIDs, can cause renal side effects, such as kidney failure․ This risk is increased in people who are taking high doses of meloxicam or who have a history of renal disease․

If you have a history of renal disease, talk to your doctor before taking meloxicam․ Your doctor will weigh the risks and benefits of meloxicam and help you decide if it is right for you․

Anticoagulants

Meloxicam can increase the risk of bleeding in patients who are taking anticoagulants, such as warfarin․ This is because meloxicam can inhibit the action of anticoagulants․

If you are taking an anticoagulant, talk to your doctor before taking meloxicam․ Your doctor will monitor your INR (international normalized ratio) closely and adjust your dose of anticoagulant as needed․

Corticosteroids

Meloxicam can increase the risk of gastrointestinal ulcers and bleeding in patients who are taking corticosteroids, such as prednisone․ This is because corticosteroids can weaken the stomach lining․

If you are taking a corticosteroid, talk to your doctor before taking meloxicam․ Your doctor will monitor you closely for signs of gastrointestinal bleeding․

Elderly Patients

Elderly patients are more likely to experience adverse events from NSAIDs, including meloxicam․ This is because elderly patients are more likely to have underlying health conditions, such as cardiovascular disease, renal disease, and gastrointestinal problems․

Therefore, it is important to start with the lowest effective dose of meloxicam in elderly patients and to monitor them closely for adverse events․

Drug Interactions

Meloxicam can interact with a number of other medications, including⁚

Anticoagulants (e․g․, warfarin, heparin)

Corticosteroids (e․g․, prednisone, dexamethasone)

Lithium

Methotrexate

Diuretics (e․g․, furosemide, hydrochlorothiazide)

ACE inhibitors (e․g․, captopril, enalapril)

ARBs (e․g․, losartan, valsartan)

Other NSAIDs (e․g․, ibuprofen, naproxen)

Anticoagulants

Meloxicam can increase the risk of bleeding in patients who are taking anticoagulants, such as warfarin․ This is because meloxicam can inhibit the action of anticoagulants․

Corticosteroids

If you are taking a corticosteroid, talk to your doctor before taking meloxicam․ Your doctor will monitor you closely for signs of gastrointestinal bleeding․

Lithium

Meloxicam can increase the levels of lithium in the blood․ This can lead to lithium toxicity, which can cause serious side effects, such as nausea, vomiting, diarrhea, confusion, and seizures․

If you are taking lithium, talk to your doctor before taking meloxicam․ Your doctor will monitor your lithium levels closely and adjust your dose of lithium as needed․

Methotrexate

Meloxicam can increase the levels of methotrexate in the blood․ This can lead to methotrexate toxicity, which can cause serious side effects, such as bone marrow suppression, anemia, and kidney damage․

If you are taking methotrexate, talk to your doctor before taking meloxicam․ Your doctor will monitor your methotrexate levels closely and adjust your dose of methotrexate as needed․

Diuretics

Meloxicam can reduce the effectiveness of diuretics․ This can lead to fluid retention and swelling․

If you are taking a diuretic, talk to your doctor before taking meloxicam․ Your doctor will monitor your fluid status closely and adjust your dose of diuretic as needed․

ACE Inhibitors and ARBs

Meloxicam can reduce the effectiveness of ACE inhibitors and ARBs․ This can lead to high blood pressure․

If you are taking an ACE inhibitor or ARB, talk to your doctor before taking meloxicam․ Your doctor will monitor your blood pressure closely and adjust your dose of ACE inhibitor or ARB as needed․

Other NSAIDs

Meloxicam can increase the risk of side effects, such as gastrointestinal bleeding, when taken with other NSAIDs․

If you are taking another NSAID, talk to your doctor before taking meloxicam․ Your doctor will weigh the risks and benefits of taking two NSAIDs together and help you decide if it is right for you․

Overdosage

Meloxicam overdose can cause a range of symptoms, including⁚

Gastrointestinal symptoms, such as nausea, vomiting, diarrhea, and abdominal pain

Headache

Dizziness

Drowsiness

Confusion

Seizures

Coma

Kidney failure

Liver failure

Cardiac arrest

The treatment of meloxicam overdose is supportive and includes⁚

Gastric lavage

Activated charcoal

Intravenous fluids

Monitoring of vital signs

Treatment of specific symptoms as they arise

There is no specific antidote for meloxicam overdose․

Gastric Lavage

Gastric lavage is the removal of stomach contents by lavage tube․ It is most effective if performed within 1 hour of ingestion․

Activated Charcoal

Activated charcoal is a fine, black powder that absorbs toxins and drugs from the gastrointestinal tract․ It is most effective if given within 2 hours of ingestion․

Intravenous Fluids

Intravenous fluids are given to maintain hydration and blood pressure․

Monitoring of Vital Signs

Vital signs, such as blood pressure, heart rate, and respiratory rate, should be monitored closely․

Treatment of Specific Symptoms

Specific symptoms of meloxicam overdose should be treated as they arise․ For example, seizures can be treated with anticonvulsants, and kidney failure can be treated with dialysis․

Prognosis

The prognosis for meloxicam overdose depends on the severity of the overdose and the timeliness of treatment․ With early and aggressive treatment, most patients recover fully․ However, severe overdose can be fatal․

Special Populations

Pregnancy

Meloxicam is contraindicated in women who are pregnant․ NSAIDs can cause birth defects and other problems in unborn babies․

If you are pregnant or planning to become pregnant, talk to your doctor before taking meloxicam․ Your doctor will discuss the risks and benefits of meloxicam and help you decide if it is right for you․

Breastfeeding

Meloxicam is contraindicated in women who are breastfeeding․ NSAIDs can pass into breast milk and harm nursing infants․

If you are breastfeeding, talk to your doctor before taking meloxicam․ Your doctor will discuss the risks and benefits of meloxicam and help you decide if it is right for you․

Children

Meloxicam is not approved for use in children under the age of 12․ The safety and efficacy of meloxicam in children have not been established․

Elderly Patients

Therefore, it is important to start with the lowest effective dose of meloxicam in elderly patients and to monitor them closely for adverse events․

Patients with Hepatic Impairment

Meloxicam should be used with caution in patients with hepatic impairment․ NSAIDs can cause liver damage, especially in people who are taking high doses of the medication or who have a history of liver disease․

The starting dose of meloxicam in patients with mild hepatic impairment (Child-Pugh score 5-6) is 7․5 mg once daily․ The dose may be increased to 15 mg once daily if needed․ Patients with moderate hepatic impairment (Child-Pugh score 7-9) should start with a dose of 7․5 mg every other day․ The dose may be increased to 7․5 mg once daily if needed․ Meloxicam is contraindicated in patients with severe hepatic impairment (Child-Pugh score 10-15)․

Patients with Renal Impairment

Meloxicam should be used with caution in patients with renal impairment․ NSAIDs can cause kidney damage, especially in people who are taking high doses of the medication or who have a history of renal disease․

The starting dose of meloxicam in patients with mild renal impairment (creatinine clearance 30-60 mL/min) is 7․5 mg once daily․ The dose may be increased to 15 mg once daily if needed․ Patients with moderate renal impairment (creatinine clearance 15-29 mL/min) should start with a dose of 7․5 mg every other day․ The dose may be increased to 7․5 mg once daily if needed․ Meloxicam is contraindicated in patients with severe renal impairment (creatinine clearance <15 mL/min)․

Generic Availability

Meloxicam is available as a generic medication․ The generic form of meloxicam is just as effective as the brand-name medication, but it is typically much cheaper․

The following generic manufacturers offer meloxicam⁚

Aurobindo Pharma

Dr․ Reddy's Laboratories

Glenmark Pharmaceuticals

Lupin Pharmaceuticals

Mylan Pharmaceuticals

Sandoz

Sun Pharmaceutical Industries

Teva Pharmaceuticals

When choosing a generic medication, it is important to choose a manufacturer that you trust․ You can ask your doctor or pharmacist for recommendations․

Brand Names

Meloxicam is also available under the following brand names⁚

Mobic

Vivlodex

Meloxicam Orion

Patient Education

If you are taking meloxicam, it is important to follow your doctor's instructions carefully․ You should take meloxicam exactly as prescribed, and you should not take more or less of the medication than prescribed․

Meloxicam can cause side effects, such as gastrointestinal upset, headache, dizziness, and drowsiness․ If you experience any side effects from meloxicam, talk to your doctor․

Meloxicam is contraindicated in certain people, such as people who are allergic to NSAIDs, people who have a history of gastrointestinal bleeding or ulcers, and people who have severe liver or kidney disease․ If you have any of these conditions, talk to your doctor before taking meloxicam․

Meloxicam can interact with other medications, such as anticoagulants, corticosteroids, lithium, and methotrexate․ If you are taking any other medications, talk to your doctor before taking meloxicam․

Meloxicam is available as a generic medication․ The generic form of meloxicam is just as effective as the brand-name medication, but it is typically much cheaper․

Brand Names

Meloxicam is available under the following brand names⁚

Mobic

Vivlodex

Meloxicam Orion

Mobic

Mobic is the most common brand name for meloxicam․ It is available in both tablet and injectable forms․ Mobic is used to treat osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis․

Vivlodex

Vivlodex is a brand name for meloxicam that is available in tablet form․ Vivlodex is used to treat osteoarthritis and rheumatoid arthritis․

Meloxicam Orion

Meloxicam Orion is a brand name for meloxicam that is available in tablet form․ Meloxicam Orion is used to treat osteoarthritis and rheumatoid arthritis․

Generic Meloxicam

Meloxicam is also available as a generic medication․ The generic form of meloxicam is just as effective as the brand-name medication, but it is typically much cheaper․

When choosing a brand of meloxicam, it is important to choose a manufacturer that you trust․ You can ask your doctor or pharmacist for recommendations․

Patient Education

Meloxicam can cause side effects, such as gastrointestinal upset, headache, dizziness, and drowsiness․ If you experience any side effects from meloxicam, talk to your doctor․

Meloxicam is available as a generic medication․ The generic form of meloxicam is just as effective as the brand-name medication, but it is typically much cheaper․

Patient Education

How to Take Meloxicam

Meloxicam can be taken with or without food․ It is important to take meloxicam exactly as prescribed by your doctor․ Do not take more or less of the medication than prescribed, and do not take it more often than prescribed․ Taking too much meloxicam can increase your risk of side effects;

Side Effects of Meloxicam

Meloxicam can cause side effects, such as⁚

Gastrointestinal side effects, such as nausea, vomiting, diarrhea, constipation, and abdominal pain

Headache

Dizziness

Drowsiness

Fluid retention

Edema

Rash

Pruritus

Injection site reactions (if meloxicam is administered by injection)

Serious Side Effects of Meloxicam

Meloxicam can also cause serious side effects, although these are rare․ Serious side effects of meloxicam include⁚

Gastrointestinal bleeding

Peptic ulcer

Perforated ulcer

Heart attack

Stroke

Kidney failure

Liver failure

Stevens-Johnson syndrome

Toxic epidermal necrolysis

If you experience any serious side effects from meloxicam, stop taking the medication and seek medical attention immediately․

Precautions

Meloxicam should be used with caution in the following patients⁚

Patients who have a history of gastrointestinal ulcers or bleeding

Patients who have a history of cardiovascular disease

Patients who have a history of renal disease

Patients who are taking anticoagulants

Patients who are taking corticosteroids

Patients who are elderly

Contraindications

Meloxicam is contraindicated in the following patients⁚

Patients who are allergic to meloxicam or any other NSAID

Patients who have a history of asthma, urticaria, or other allergic reactions to aspirin or other NSAIDs

Patients who have a history of gastrointestinal bleeding or perforation

Patients who have severe hepatic impairment (Child-Pugh score 10-15)

Patients who have severe renal impairment (creatinine clearance <15 mL/min)

Patients who are pregnant or breastfeeding

Drug Interactions

Meloxicam can interact with a number of other medications, including⁚

Anticoagulants (e․g․, warfarin, heparin)

Corticosteroids (e․g․, prednisone, dexamethasone)

Lithium

Methotrexate

Diuretics (e․g․, furosemide, hydrochlorothiazide)

ACE inhibitors (e․g․, captopril, enalapril)

ARBs (e․g․, losartan, valsartan)

Other NSAIDs (e․g․, ibuprofen, naproxen)

Overdosage

Meloxicam overdose can cause a range of symptoms, including⁚

Gastrointestinal symptoms, such as nausea, vomiting, diarrhea, and abdominal pain

Headache