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--> pain medication management --> meloxicam



MELOXICAM (MOBIC)

Meloxicam is a unique once a day dosage peripheral non-specific prostaglandin synthesis inhibitor with anti-inflammatory, anti-pyretic (fever reducing) and analgesic properties for patients age 18 and older. An oral dose is 89% equivalent to an IV bolus (one time amount) injection. The oral absorption is not affected by food or antacids. It achieves significant synovial joint fluid concentrations after a single oral dosage, making it a good choice for joint inflammatory disorders.

Meloxicam is excreted in both urine and feces in equal amounts. No dosage reduction is necessary in patients with mild to moderate liver (hepatic) or kidney (renal) insufficiency diseases.

INDICATIONS



Meloxicam is indicated for relief of osteoarthritis symptoms reducing pain, stiffness and increased joint function- range of motion- studied in patients with hip and knee pathology.

The drug should be avoided in those patients who have demonstrated allergic reactions or sensitivities to other non-steroidal anti-inflammatory medications, have a history of asthma or known significant gastrointestinal disorders or on warfarin –type anticoagulation prescriptions.

SIDE EFFECTS



Adverse reactions to Meloxicam can include ulceration or perforation of the bowel, dyspepsia, nausea, vomiting, or diarrhea. Approximately 1% of patients taking this medication for 3-6 months or 2% for one year may develop GI ulcers, bleeding, or perforation. Other co-morbid conditions such as smoking, alcoholism, being elderly and those in a compromised medical state will have an increased risk for the incidence of these reactions. Severe anaphylactic reactions may occur in those patients with significant respiratory diseases including asthma, have nasal polyps, or history of bronchospasms. Meloxicam should be avoided in patients with severe renal diseases with reduced kidney function. It is contraindicated in late pregnancy due to cardiovascular risks and should be avoided in nursing mothers. Meloxicam can cause transient increases in liver enzymes which is reversibly on discontinuation and should be used cautiously in patients with diagnosed abnormal liver function.

Anemia may result to due to its potential to cause fluid retention, blood loss via the gastrointestinal system, or its effect on erythropoiesis (formation of erythrocytes), and platelet function through its prostaglandin synthesis effect. The drug should be used cautiously in patients in heart failure, or have hypertension or fluid retention problems. Patients on Meloxicam can experience nausea, fatigue, pruritis (itching), lethargy, and “flu-like “symptoms and should consult their physician.

INTERACTION WITH OTHER MEDICATIONS



Drug interactions may occur with the concomitant use of aspirin and should be avoided as both drugs compete for the protein binding sites and render each less effective, if not also increasing the potential for each medication’s side effects. Meloxicam IS NOT a substitute for aspirin in the indication for platelet aggregation for cardiovascular prophylaxis. Patients on Cimetidine (Tagamet) for gastrointestinal disturbances may not be administered Meloxicam; however there is no potential drug interaction. Cardiac patients on digoxin do not experience any untoward interaction with Meloxicam with respect to altering either’s therapeutic efficiency. Furosemide, a loop diuretic, and the thiazide diuretics may have reduced effects in some patients. Lithium carbonate may have elevated plasma levels as much as 21% which may have serious consequences and must be monitored closely and have a reduction in Meloxicam dosages prescribed. Rheumatoid patients on Methotrexate did not have any significant untoward reactions, nor produce effects on serum levels. The drug may produce increased bleeding in patients on warfarin and INR should be monitored closely or the Meloxicam replaced by alternative medication.

Meloxicam should be avoided in patients under age 18 and monitored closely in those patients over 65 especially those patients with existing co-morbidities affecting the cardiovascular, renal, or hepatic systems. Overdoses are generally easily reversed with supportive medical emergency techniques through administration of activated charcoal, gastric lavage, respiratory support and forced diuresis.

DOSAGE



The drug in available in both 7.5 and 15mg tablets either with twice daily or once daily dosing up to 15mg daily without regard to meals, though patients with “sensitive" digestive systems, it is generally recommend within the first half hours after meals

REFERENCES

PDR, Physicians’ Desk Reference 59th edition, 2005

Drugs.com, Meloxicam (Mobic)

COMMENTS

I have found Meloxicam (Mobic) a valuable medication for the treatment of joint pain in my practice; it is generally well tolerated and is a good choice for active patients with busy life styles in the once daily dose of 15mg administered after dinner.



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