Pronunciation:

(mel OKS i kam)

U.S. Brand Names:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Pregnancy Implications:

Lactation:

Contraindications:

Warnings/Precautions:

Use of NSAIDs can compromise existing renal function especially when Clcr<30 mL/minute. CNS adverse effects such as confusion, agitation, and hallucination are generally seen in overdose or high-dose situations; however, elderly may demonstrate these adverse effects at lower doses than younger adults. Do not exceed 15 mg/day. Withhold for at least 4-6 half-lives prior to surgical or dental procedures.

Adverse Reactions:

2% to 10%:

Cardiovascular: Edema (2% to 3%)

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

Dermatologic: Pruritus (<1% to 2%), rash (1% to 3%)

Gastrointestinal: Diarrhea (3% to 6%), dyspepsia (4% to 9%), nausea (3% to 7%), flatulence (3%), abdominal pain (2% to 5%)

Respiratory: Cough (<1% to 2%), pharyngitis (1% to 3%), upper respiratory infection (2% to 3%)

Miscellaneous: Flu-like symptoms (5% to 6%), falls (3%)

<2%: Agranulocytosis, allergic reaction, alopecia, anaphylactic reaction, angina, angioedema, anxiety, arrhythmia, bronchospasm, bullous eruption, cardiac failure, colitis, confusion, depression, duodenal perforation, duodenal ulcer, dyspnea, erythema multiforme, gastric perforation, gastric ulcer, gastritis, gastroesophageal reflux, gastrointestinal hemorrhage, hematemesis, hematuria, hepatic failure, hepatitis, hyper-/hypotension, interstitial nephritis, intestinal perforation, jaundice, leukopenia, melena, MI, pancreatitis, paresthesia, photosensitivity reaction, pruritus, purpura, renal failure, seizure, shock, somnolence, Stevens-Johnson syndrome, syncope, thrombocytopenia, tinnitus, toxic epidermal necrolysis, tremor, ulcerative stomatitis, urticaria, vasculitis, vertigo

Overdosage/Toxicology:

Drug Interactions:

ACE inhibitors: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure

Angiotensin II antagonists: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure

Anticoagulants (warfarin, heparin, LMWHs) 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.

Methotrexate: Severe bone marrow suppression, aplastic anemia, and GI toxicity have been reported with concomitant NSAID therapy. Avoid use during moderate or high-dose methotrexate (increased and prolonged methotrexate levels). NSAID use during low-dose treatment of rheumatoid arthritis has not been fully evaluated; extreme caution is warranted.

Thiazide diuretics: 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.

Ethanol/Nutrition/Herb Interactions:

Stability:

Mechanism of Action:

Pharmacodynamics/Kinetics:

Distribution: 10 L

Protein binding: 99.4%

Metabolism: Hepatic via CYP2C9 and CYP3A4 (minor)

Bioavailability: 89%

Half-life elimination: 15-20 hours

Time to peak: 5-10 hours

Excretion: Urine and feces (as inactive metabolites)

Dosage:

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

Dosage adjustment in renal impairment:

Mild to moderate impairment: No specific dosage recommendations

Significant impairment (Clcr 15 mL/minute): Avoid use

Dosage adjustment in hepatic impairment:

Mild (Child-Pugh class A) to moderate (Child-Pugh class B) hepatic dysfunction: No dosage adjustment is necessary

Severe hepatic impairment: Patients with severe hepatic impairment have not been adequately studied

Monitoring Parameters:

Dietary Considerations:

Patient Education:

Anesthesia and Critical Care Concerns/Other Considerations:

In short-term use, NSAIDs vary considerably in their effect on blood pressure. When NSAIDs are used in patients with hypertension, appropriate monitoring of blood pressure responses should be completed and the duration of therapy, when possible, kept short. The use of NSAIDs in the treatment of patients with congestive heart failure may be associated with an increased risk for fluid accumulation and edema; may precipitate renal failure in dehydrated patients.

Cardiovascular Considerations:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Suspension: 7.5 mg/5 mL (100 mL) [contains sodium benzoate; raspberry flavor]

Tablet: 7.5 mg, 15 mg

International Brand Names: