MELOXICAM

MELOXICAM
(mel-ox'-i-cam)
Mobic
Classifications: analgesic, nonsteroidal antiinflammatory drug (nsaid); antipyretic;
Therapeutic: nsaid, analgesic; antipyretic
Prototype: Ibuprofen
Pregnancy Category: C

Availability

7.5 mg tablets

Action

Is a nonsteroidal antiinflammatory drug (NSAID) that is less selective in inhibiting only COX-2 enzyme than celecoxib; meloxicam inhibits both COX-1 and COX-2 enzymes that are necessary for synthesis.

Therapeutic Effect

Exhibits antiinflammatory, analgesic, and antipyretic actions.

Uses

Relief of the signs and symptoms of osteoarthritis, rheumatoid arthritis.

Contraindications

Hypersensitivity to meloxicam; rhinitis, urticaria/angioedema, asthma; allergic reactions to aspirin or other antiinflammatory agents; NSAID hypersensitivity; GI bleeding; peptic ulcer disease; severe renal or hepatic disease; salicylate hypersensitivity; perioperative pain with CABG surgery; pregnancy (category C), lactation; bleeding.

Cautious Use

Helicobacter pylori infections; history of coagulation defects, liver dysfunction, gastrointestinal disease or ulceration, anemia, anticoagulant therapy; asthma; bone marrow suppression; corticosteroid therapy, dehydration, edema, older adults; females of childbearing age; GI bleeding, GI diseases, GI perforation; heart failure; hepatic disease, renal impairment; hypertension, hypovolemia, immunosuppression; jaundice, lactase deficiency, advanced renal dysfunction; hypertension or cardiac conditions aggravated by fluid retention and edema.

Route & Dosage

Osteoarthritis
Adult: PO 7.5–15 mg once daily

Rheumatoid Arthritis
Adult: PO 15 mg once daily

Administration

Oral

Do not exceed the maximum recommended daily dose of 15 mg.
Use the lowest effective dose for the shortest duration to minimize risk of serious adverse effects.
Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Edema, fall, flu-like syndrome, pain. GI: Abdominal pain, diarrhea, dyspepsia, flatulence, nausea, constipation, ulceration, GI bleed. Hematologic: Anemia. Musculoskeletal: Arthralgia. CNS: Dizziness, headache, insomnia. Respiratory: Pharyngitis, upper respiratory tract infection, cough. Skin: Rash, pruritus. Urogenital: Micturition frequency, urinary tract infection.

Interactions

Drug: May decrease effectiveness of ace inhibitors, diuretics; aspirin, warfarin may increase risk of bleed; may increase lithium levels and toxicity. Herbal: Feverfew, garlic, ginger, ginkgo may increase bleeding potential.

Pharmacokinetics

Absorption: 89% bioavailable. Peak: 4–5 h. Distribution: >99% protein bound, distributes into synovial fluid. Metabolism: In liver (CYP2C9). Elimination: Equally in urine and feces. Half-Life: 15–20 h.

Nursing Implications

Assessment & Drug Effects

Monitor for and immediately report S&S of GI ulceration or bleeding, including black, tarry stool, abdominal or stomach pain; hepatotoxicity, including fatigue, lethargy, pruritus, jaundice, flu-like symptoms; skin rash; weight gain and edema.
Withhold drug and notify physician if hepatotoxicity or GI bleeding is suspected.
Monitor carefully patients with a history of CHF, HTN, or edema for fluid retention.
Monitor diabetics using sulfonylureas for hypoglycemia.
Lab tests: Hgb & Hct, CBC with differential, liver function tests, serum electrolytes, BUN, and creatinine within 3 mo of initiating therapy and every 6–12 mo thereafter; with high-risk patients (e.g., >60 y, history of peptic ulcer disease, prolonged or high-dose NSAID therapy, concurrent use of corticosteroids or anticoagulants) monitor within first 3–4 wk and every 3–6 mo thereafter.
Coadministered drugs: With warfarin, closely monitor INR when meloxicam is initiated or dose changed; monitor for lithium toxicity, especially during addition, withdrawal, or change in dose of meloxicam.

Patient & Family Education

Report any of the following to the physician immediately: nausea, black tarry stool, abdominal or stomach pain, unexplained fatigue or lethargy, itching, jaundice, flu-like symptoms, skin rash, weight gain, or edema.
Minimize alcohol intake and use of tobacco. Discontinue drug if hepatotoxicity or GI bleeding is suspected. Note that GI bleeding may occur without forewarning and is more likely in older adults, in those with a history of ulcers or GI bleeding, and with alcohol consumption and cigarette smoking.
Do not take aspirin or other NSAIDs while on this medication.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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