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Meloxicam

Medical and Pharmacy Editor:

Brand Name: Mobic, Vivlodex

Generic Name: Meloxicam

Drug Class: NSAIDs

What Is Meloxicam and How Does It Work?

Meloxicam is a prescription drug approved by the FDA as a treatment for symptoms associated with arthritis, including osteoarthritis, rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA).

Types of Arthritis

Arthritis is a condition that causes pain, swelling and stiffness in the joints of the body.

Osteoarthritis is a referred to as a degenerative joint disease because of the progressive decrease of cartilage surrounding the joints. Osteoarthritis is the most common chronic condition affecting the joints.

RA is a type of autoimmune arthritis that causes pain and swelling in the wrist and small joints of the hand and feet. Psoriatic arthritis is another arthritic condition that is cause by an autoimmune disease called psoriasis.

JIA is an arthritic disease that occurs in children.

About This Medication

This medication belongs to a class of drugs calls NSAIDs, or nonsteroidal anti-inflammatory drugs. These medications work by reducing the hormone in the body that cause inflammation responses. Inflammation plays a major role in all forms of arthritis. Drugs that reduce inflammation in the body help to manage arthritis symptoms including pain, swelling, and stiffness in your joints.

Read the health information leaflet that accompanies the prescription as well as every time the prescription is refilled. There may be new health or medical information.

This medication is available by prescription only. It is available for oral administration as tablets, capsules, and liquid suspension. Other treatments and medications are available, and may be used with this medication to manage pain.

Meloxicam is available under the following different brand names: Mobic and Vivlodex.

Dosages:

Adult and Pediatric doses:

Oral Tablet

  • 7.5 mg
  • 15 mg

Adult dosing only:

Oral Capsules

  • 5 mg
  • 10 mg

Dosage Considerations – Should be Given as Follows:

Osteoarthritis Pain

  • Mobic: Oral dose 7.5-15 mg each day. May increase dose as needed, not to exceed 15 mg per day
  • Vivlodex: Start with oral dose of 5 mg each day, if needed, may increase to 10 mg per day

Use the lowest effective amopunt for shortest duration consistent with individual treatment goals.

Rheumatoid Arthritis Pain

Oral dose of 7.5-15 mg each day. May increase as needed, not to exceed oral dose of 15 mg per day

Pediatric Dosing

Pauciarticular/Polyarticular Course Juvenile Idiopathic Arthritis

Under 2 years old: safety and efficacy not established.

Over 2 years and weight of 60 kg or more: Liver impairment: Oral dose of 0.125 mg/kg once per day. May increase as needed, not to exceed 7.5 mg per day.

Mild-to-moderate: no dosage adjustment or increase required

Severe: not studied

Kidney impairment:

Mild-to-moderate: no dosage adjustment or increase required

Severe: not studied

Hemodialysis:

  • Mobic: Hemodialysis did not lower the drug plasma concentration, therefore, additional doses are not necessary after hemodialysis
  • Vivlodex: Not to exceed 5 mg/day

Dosing Considerations:

Vivlodex capsules are not interchangeable with other formulations of oral meloxicam even if the mg strength is the same.

What Are Side Effects Associated with Using Meloxicam?

Common side effects include:

This document does not contain all possible side effects and others may occur. Check with your doctor or other medical professional for additional information about side effects or other concerns about conditions related to your health.

What Other Drugs Interact with Meloxicam?

If your doctor has directed you to use this NSAID, your medical doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first for more health information.

Severe Interactions include:

  • sodium polystyrene sulfonate

Serious Interactions of Meloxicam include:

Meloxicam has moderate interactions with at least 230 different drugs.

Meloxicam has mild interactions with at least 113 different drugs.

This information does not contain all possible interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the medications you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions, concerns, or more health information.

What Are Warnings and Precautions for Meloxicam?

Warnings

Cardiovascular risk

Gastrointestinal risk

  • This drug may increase potential of serious gastrointestinal adverse events, including bleeding, ulceration, and gastric or intestinal perforation, which can be fatal.
  • Gastrointestinal adverse events may occur at any time during use and without warning symptoms.
  • Elderly populations are at greater risk for serious gastrointestinal events.
This medication contains meloxicam. Do not take Mobic or Vivlodex if you are allergic to meloxicam or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Absolute:

  • salicylate allergy
  • perioperative pain in setting of coronary artery bypass graft surgery
  • History of asthma, urticarial, or other allergic-type reactions after taking aspirin or other NSAIDs

Relative:

Effects of Drug Abuse

None.

Short-Term Effects

May cause drowsiness, blurred vision, dizziness, and other central nervous system effects.

See "What Are Side Effects Associated with Using Meloxicam?”

Long-Term Effects

Increased risk of GI ulcers with prolonged use.

Long-term administration of NSAIDs may result in renal papillary necrosis and other renal injury; patients at greatest risk include elderly individuals; those with impaired renal function, hypovolemia, liver dysfunction, or salt depletion; and those taking diuretics, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers.

See "What Are Side Effects Associated with Using Meloxicam?”

Cautions

  • Use caution in asthma (bronchial), congestive heart failure, high blood pressure, fluid retention, renal impairment, stomatitis, history of gastrointestinal ulcers.
  • Fluid retention and edema observed in some treated with NSAIDs; use of this drug may blunt cardiovascular effects of several therapeutic agents used to treat these medical conditions (e.g., diuretics, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers).
  • Avoid use in those with severe heart failure unless benefits expected to outweigh risk of worsening heart failure; if this medication is used in patients with severe heart failure, monitor patients for signs of worsening heart failure.
  • Increased risk of potentially fatal thrombotic events (myocardial infraction and stroke); further increased with longer duration of drug use and presence of preexisting cardiovascular disease; to minimize potential risk for adverse cardiovascular event in NSAID-treated patients, use lowest effective dose for shortest duration possible; physicians and patients should remain alert for of such events, throughout entire treatment course, even in absence of previous cardiovascular symptoms; patients should be informed about symptoms of serious cardiovascular events and steps to take if they occur.
  • Risk of high levels of potassium increases with use.
  • Increased risk of gastrointestinal ulcers with prolonged use.
  • Nonsteroidal anti-inflammatory drug use may compromise existing renal function; rehydrate patient before initiating therapy; monitor renal function closely; long-term administration of nonsteroidal anti-inflammatory drugs may result in renal papillary necrosis and other renal injury; those at greatest risk include elderly individuals; those with impaired renal function, hypovolemia, heart failure, liver dysfunction, or salt depletion; and those taking diuretics, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers.
  • Risk of new-onset hypertension or exacerbation of preexisting hypertension.
  • May cause severe skin reactions including exfoliative dermatitis, Steven-Johnson syndrome, and toxic epidermal necrolysis; discontinue at first sign of skin reactions.
  • Simultaneous use of aspirin may not mitigate thrombotic risk but increases gastrointestinal ulcer risk.
  • May cause drowsiness, blurred vision, dizziness, and other central nervous system effects.
  • May decrease platelet adhesion and aggregation.
  • Avoid use of meloxicam in those with recent myocardial infarction unless benefits outweigh risk of recurrent cardiovascular thrombotic events; if used in patients with recent myocardial infarction, monitor patients for signs of cardiac ischemia.
  • Systemic allergic reactions may occur in people who have never been exposed to the drug; not for use in patients who experience cough, asthma, nasal drip, or hives with nonsteroidal anti-inflammatory or aspirin treatment; seek emergency help if an anaphylactic reaction occurs.
  • Use with caution with hepatic impairment; closely monitor any abnormal LFT; discontinue therapy if signs or symptoms of liver disease develop or if systemic manifestations occur.
  • Monitor hemoglobin or hematocrit with any signs or symptoms of anemia.
  • Heart Failure risk.

Pregnancy and Lactation

  • Use with caution for short-term use, if the benefits outweigh risks. Animal studies show risk and human studies are not yet available or neither animal nor human studies are done. Do not use for prolonged periods or after 31-32 weeks of gestation. Only use meloxicam in LIFE-THREATING emergencies when no safer drug is available. There is positive evidence of human fetal risk.
  • Quebec Pregnancy Registry identified 4705 women who had spontaneous abortions by 20 weeks' gestation; each case was matched to 10 control subjects (n=47,050) who had not had spontaneous abortions; exposure to non-aspirin NSAID treatment during pregnancy was documented in approximately 7.5% of cases of spontaneous abortions and approximately 2.6% of controls.
  • It is unknown whether meloxicam is excreted in breast milk and effects on infants are unknown. This drug is not recommended when breastfeeding.
Reviewed on 4/14/2017


SOURCE:
Medscape. Meloxicam.
https://reference.medscape.com/drug/mobic-vivlodex-meloxicam-343299#0

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