Meloxicam
Mechanism :
Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, analgesic, and antipyretic activities. The mechanism of action of meloxicam, like that of other NSAIDs, may be related to prostaglandin synthetase (cyclo-oxygenase) inhibition.
Indication :
- Juvenile idiopathic arthritis pain
- Musculoskeletal pain disorders
Contraindications :
Contraindicated in patients with known hypersensitivity to meloxicam or the excipients, in patients with active peptic ulceration or gastro intestinal complaints, in patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic/anaphylactoid reactions to NSAIDs have been reported in such patients.
Use with caution in case of renal, hepatic or cardiac impairment.
Dosing :
>2 years:
0.125 mg/kg/day PO.
Max: 7.5 mg/day.
Adverse Effect :
Gastrointestinal discomfort, indigestion, nausea, diarrhea, occasionally bleeding and ulceration, headache, dizziness, vertigo, fluid retention, upper respiratory tract infections, hypersensitivity reactions like bronchospasm, rashes have been reported. Local discomfort, burning or itching and occasionally bleeding may occur with NSAID suppositories. Disturbances of blood count have been described in patients taking meloxicam.
Interaction :
ACE-inhibitors: NSAIDs may diminish the antihypertensive effect of ACE-inhibitors. This interaction should be given consideration in patients taking NSAIDs concomitantly with ACE-inhibitors.
Diuretics: Can reduce the natriuretic effect-of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis.
Lithium: When indomethacin and lithium are administered concurrently, subjects should be observed carefully for signs of lithium toxicity.
Methotrexate: Enhances the toxicity of methotrexate. Caution should be used when NSAIDs are administered concomitantly with methotrexate.
Warfarin: Effects of warfarin and NSAIDs on GI bleeding are synergistic, such that the users of both drugs together have a risk of serious GI bleeding higher than users of either drug alone.
Cidofovir: Contraindicated.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function, but avoid if possible |
| <10 | Dose as in normal renal function, but avoid if possible Only use if on dialysis |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Unlikely to be dialysed. Dose as in normal renal function |
| CAV/VVHD | Not dialysed. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
Mild to moderate hepatic impairment: No dosage adjustments are needed.
Severe hepatic impairment: Use is contraindicated.