Nonsteroidal Anti-Inflammatory Agent (NSAID)

Relief of signs and symptoms of osteoarthritis

C (D in third trimester)

May cause premature closure of the ductus arteriosus in the third trimester of pregnancy. It is not known whether meloxicam is excreted in human milk. Due to a potential for serious adverse reactions, the manufacturer recommends that a decision be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Hypersensitivity to meloxicam or any component, aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs).

Gastrointestinal irritation, ulceration, bleeding, and perforation may occur with NSAIDs. Serious complications may occur without prior symptoms of gastrointestinal distress. Use with caution in patients with a history of GI disease (bleeding or ulcers), decreased renal function, hepatic disease, congestive heart failure, dehydration, hypertension, or asthma. Use with caution in elderly patients. Anaphylactoid reactions may occur, even with no prior exposure to meloxicam. Use in advanced renal disease is not recommended. May alter platelet function; use with caution in patients receiving anticoagulants or with hemostatic disorders. Safety and efficacy in pediatric patients have not been established.

1% to 10%:

Cardiovascular: Edema (2% to 5%)

Central nervous system: Headache and dizziness occurred in 2% to 8% of patients, but occurred less frequently than placebo in controlled trials

Dermatologic: Rash (1% to 3%)

Gastrointestinal: Diarrhea (3% to 8%), dyspepsia (5%), nausea (4%), flatulence (3%), abdominal pain (2% to 3%)

Respiratory: Upper respiratory infection (2% to 3%), pharyngitis (1% to 3%)

Miscellaneous: Flu-like symptoms (4% to 5%), falls (3%)

<2%: Allergic reaction, anaphylactic reaction, shock, fatigue, hot flashes, malaise, syncope, weight changes, angina, cardiac failure, hypertension, hypotension, myocardial infarction, vasculitis, seizures, paresthesia, tremor, vertigo, colitis, xerostomia, duodenal ulcer, gastric ulcer, gastritis, gastroesophageal reflux, gastrointestinal hemorrhage, hematemesis, intestinal perforation, melena, pancreatitis, duodenal perforation, gastric perforation, ulcerative stomatitis, arrhythmia, palpitations, tachycardia, agranulocytosis, leukopenia, purpura, thrombocytopenia, increased ALT, increased AST, hyperbilirubinemia, increased GGT, hepatitis, jaundice, hepatic failure, dehydration, abnormal dreams, anxiety, confusion, depression, nervousness, somnolence, asthma, bronchospasm, dyspnea, alopecia, angioedema, bullous eruption, erythema multiforme, photosensitivity reaction, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, abnormal vision, conjunctivitis, taste perversion, tinnitus, albuminuria, increased BUN, increased creatinine, hematuria, interstitial nephritis, renal failure

Symptoms of overdose include lethargy, drowsiness, nausea, vomiting, and epigastric pain. Rarely, severe symptoms have been associated with NSAID overdose including apnea, metabolic acidosis, coma, nystagmus, seizures, leukocytosis, and renal failure. Management of nonsteroidal anti-inflammatory (NSAID) intoxication is supportive and symptomatic. Since meloxicam undergoes enterohepatic cycling, multiple doses of charcoal may be needed to reduce the potential for delayed toxicities. Cholestyramine has been shown to increase meloxicam clearance.

Ace inhibitors: Antihypertensive effects of ACE inhibitors may be diminished by NSAID administration.

Anticoagulants (warfarin, heparin, LHWHs) in combination with NSAIDs can cause increased risk of bleeding.

Antiplatelet drugs (ticlopidine, clopidogrel, aspirin, abciximab, dipyridamole, eptifibatide, tirofiban) can cause an increased risk of bleeding.

Aspirin increases serum concentrations (AUC) of meloxicam (in addition to potential for additive adverse effects); concurrent use is not recommended.

Cholestyramine (and possibly colestipol) increases the clearance of meloxicam.

Corticosteroids may increase the risk of GI ulceration; avoid concurrent use.

Cyclosporine: NSAIDs may increase serum creatinine, potassium, blood pressure, and cyclosporine levels; monitor cyclosporine levels and renal function carefully.

Hydralazine's antihypertensive effect is decreased; avoid concurrent use.

Lithium levels can be increased; avoid concurrent use if possible or monitor lithium levels and adjust dose. When NSAID is stopped, lithium will need adjustment again.

Loop diuretic's efficacy (diuretic and antihypertensive effect) may be reduced by NSAIDs.

Antihypertensive effects of thiazide diuretics are decreased; avoid concurrent use.

Warfarin INRs may be increased by meloxicam. Monitor INR closely, particularly during initiation or change in dose. May increase risk of bleeding. Use lowest possible dose for shortest duration possible.

Store at 25°C (77°F)

Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclo-oxygenase, which results in decreased formation of prostaglandin precursors

Distribution: 10 L

Protein binding: 99.4%

Metabolism: Hepatic, including metabolism by CYP2C9 and CYP3A4 (minor)

Bioavailability: 89%

Half-life: 15-20 hours

Time to peak: 5-10 hours

Elimination: As inactive metabolites, in urine and feces (bile or enteral secretion)

Adult: Oral: Initial: 7.5 mg once daily; some patients may receive additional benefit from an increased dose of 15 mg once daily

Dosage adjustment in hepatic impairment: No specific adjustment is recommended in hepatic impairment; patients with severe hepatic impairment have not been adequately studied

Elderly: Increased concentrations may occur in elderly patients (particularly in females); however, no specific dosage adjustment is recommended

Should be taken with food or milk to minimize gastrointestinal irritation

CBC, periodic liver function, renal function (serum BUN, and creatinine)

If self-administered, use exactly as directed (do not increase dose or frequency); adverse reactions can occur with overuse. Take with food or milk. While using this medication, do not use alcohol, excessive amounts of vitamin C, or salicylate-containing foods (curry powder, prunes, raisins, tea, or licorice), other prescription or OTC medications containing aspirin or salicylate, or other NSAIDs without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience nausea, vomiting, gastric discomfort (frequent mouth care, small frequent meals, chewing gum, sucking lozenges may help). GI bleeding, ulceration, or perforation can occur with or without pain. Stop taking medication and report ringing in ears; persistent cramping or pain in stomach; unresolved nausea or vomiting; difficulty breathing or shortness of breath; unusual bruising or bleeding (mouth, urine, stool); skin rash; unusual swelling of extremities; chest pain; or palpitations.

Tablet: 7.5 mg