meloxicam

Absorption: Well absorbed following oral administration.

Distribution: Not widely distributed to tissues.

Protein Binding: 99.4%.

Metabolism/Excretion: Mostly metabolized to inactive metabolites by the liver via the CYP2C9 isoenzyme (and to a lesser extent by the CYP3A4 isoenzyme); the CYP2C9 isoenzyme exhibits genetic polymorphism (intermediate or poor metabolizers may have significantly ↑ meloxicam concentrations and an ↑ risk of adverse reactions). Metabolites are excreted in urine and feces.

Half-Life: 20.1 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	5–6 hr	24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Cross-sensitivity may occur with other NSAIDs, including aspirin;
Severe renal impairment (CCr ≤15 mL/min);
Concurrent use of aspirin (↑ risk of adverse reactions);
Coronary artery bypass graft surgery;
OB: Avoid use after 30 wk gestation.

Use Cautiously in:

Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, especially with prolonged use or use of higher doses); avoid use in patients with recent MI or HF
Dehydration (correct deficits before initiating therapy)
Renal impairment, HF, hepatic impairment, concurrent ACE inhibitor or diuretic therapy (↑ risk of renal impairment);
Hypertension;
Coagulation disorders or concurrent anticoagulant therapy (may ↑ risk of bleeding);
OB: Use at or after 20 wk gestation may cause fetal or neonatal renal impairment; if treatment is necessary between 20 wk and 30 wk gestation, limit use to the lowest effective dose and shortest duration possible;
Lactation: Safety not established in breastfeeding;
Pedi: Children 2 yr or 60 kg (safety and effectiveness of tablets not established); safety and effectiveness of capsules and injection not established in children;
Geri: Appears on Beers list. risk GI bleeding or peptic ulcer disease in older adults. Avoid chronic use unless other alternatives are not effective and the patient can take a gastroprotective agent; avoid short-term use in combination with oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents unless other alternatives are not effective and the patient can take a gastroprotective agent.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema, HF, hypertension, MI

Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), EXFOLIATIVE DERMATITIS, pruritus, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS (TEN)

F and E: hyperkalemia

GI: ↑liver enzymes, BLEEDING, diarrhea, dyspepsia, HEPATOTOXICITY, nausea

GU: delayed ovulation

Hemat: anemia, leukopenia, thrombocytopenia

Neuro: STROKE

Interactions ⬆ ⬇

Drug-drug:

May ↓ antihypertensive effects of ACE inhibitors.
May ↓ diuretic effects of furosemide or thiazide diuretics.
Concurrent use with aspirin↑ meloxicam blood levels and may ↑ risk of adverse reactions.
Concurrent use with cholestyramine↓ blood levels.
↑plasma lithium levels (close monitoring recommended when meloxicam is introduced or withdrawn).
↑risk of bleeding with anticoagulants, aspirin, clopidogrel, ticagrelor, prasugrel, corticosteroids, fibrinolytics, SNRIs, or SSRIs.
Concurrent use with sodium polystyrene sulfonate may ↑ risk of colonic necrosis; concurrent use should be avoided.

Route/Dosage ⬆ ⬇

PO (Adults ): Capsules: 5 mg once daily; may ↑ to 10 mg once daily, if needed; Tablets: 7.5 mg once daily; may ↑ to 15 mg once daily, if needed.
PO (Children 2–17 yr and ≥60 kg): Tablets: 7.5 mg once daily.

Availability ⬆ ⬇

(Generic available)

Tablets: 7.5 mg; 15 mg
Capsules: 5 mg; 10 mg
Oral suspensionraspberry flavor: 7.5 mg/5 mL
In combination with: bupivacaine (Zynrelef Kit). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria.
Analgesic effect is delayed. Assess pain and range of motion prior to and 2–3 hr following administration. Patient may not experience adequate analgesia for entire 24-hr dosing interval and may require administration of a short-acting, non-NSAID, immediate-release analgesic.
Assess for rash periodically during therapy. May cause SJS or TEN. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.
Monitor BP during initiation and periodically during therapy. May cause fluid retention and edema leading to new onset or worsening hypertension.
Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, facial swelling) periodically during therapy. Discontinue therapy if symptoms occur.

Lab Test Considerations:

Evaluate BUN, serum creatinine, CBC, and liver function periodically in patients receiving prolonged therapy. May cause anemia, thrombocytopenia, leukopenia, and abnormal liver or renal function tests.
- Bleeding time may be prolonged.

Implementation ⬆ ⬇

Administration in higher than recommended doses does not provide increased effectiveness but may cause increased side effects. Use lowest effective dose for shortest period of time to minimize risk of cardiovascular thrombotic events.
To reduce risk of renal toxicity, ensure patient is well hydrated prior to administration.
PO: May be administered without regard to food. Administer with food or milk to minimize GI irritation.
- Shake oral suspension gently before using.

Patient/Family Teaching ⬆ ⬇

Advise patient to take this medication with a full glass of water and to remain in an upright position for 15–30 min after administration.
Instruct patient to take medication as directed. Take missed doses as soon as remembered but not if almost time for the next dose. Do not double doses. Instruct parent/caregiver to read the Medication Guide prior to use and with each Rx refill in case of changes.
Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, or other OTC medications without consulting health care professional.
Inform patient that meloxicam may increase the risk for heart attack and stroke; risk increases with longer use or in patients with heart disease.
Advise patient to inform health care professional of medication regimen prior to treatment or surgery, especially right before or after coronary artery bypass graft surgery.
Advise patient to consult health care professional if rash, itching, visual disturbances, weight gain, edema, black stools, or signs of hepatotoxicity (nausea, fatigue, lethargy, jaundice, upper right quadrant tenderness, flu-like symptoms) occur.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise women to avoid meloxicam in the 3rd trimester of pregnancy (after 29 wks), may cause premature closure of the fetal ductus arteriosus. Use of meloxicam after 20 wks may cause fetal renal dysfunction leading to oligohydramnios. May cause reversible infertility in females and males attempting to conceive; may consider discontinuing meloxicam.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇