Meloxicam
Administration
- Type: NSAID
- Dosage Forms: 7.5, 15mg
- Routes of Administration: PO
- Common Trade Names: Mobic, Vivlodex
Adult Dosing
Osteoarthritis
- 7.5-15mg PO QD
- Max 15mg/day
Rheumatoid arthritis
- 7.5-15mg PO QD
- Max 15mg/day
Pediatric Dosing
Juvenile idiopathic arthritis(>60kg)
- 7.5mg PO QD
- Max 7.5mg/day
Special Populations
- Pregnancy Rating: C, category D if >30wk gestation
- Lactation risk: safety unknown, inadequate literature available to assess risk
Renal Dosing
- Adult:
- mild-mod impairment: no adjustment
- CrCl <15: avoid use
- HD: max 7.5mg/day
- Pediatric: see Adult dosing
Hepatic Dosing
- Adult:
- Child-Pugh Class A or B: no adjustment
- Child-Pugh Class: not defined
- Pediatric: see Adult Dosing
Contraindications
- Allergy to class/drug
- ASA or NSAID-induced asthma or urticaria
- caution if:
- renal impairment, dehydration, elderly or debilitated
- history of GI bleed or ulcers, alcohol use, or coagulopathy
- hepatic impairment
- asthma
- cardiovascular disease (or high risk of), including CABG surgery periop use, recent MI, CHF, HTN, smoker
- fluid retention
- PKU
- prolonged use
Adverse Reactions
Serious
- GI bleed, ulcer, perforation
- blood dyscrasias, prolonged bleeding time, anemia
- nephrotoxicity, renal papillary necrosis
- MI, stroke, thromboembolism, HTN, CHF
- hepatotoxicity, hepatic necrosis, pancreatitis
- bronchospasm
- exfoliative dermatitis, SJS/TEN
Common
- dyspepsia, nausea/vomiting, abdominal pain, diarrhea, constipation, flatulence
- headache, dizziness, drowsiness, tinnitus
- dizziness
- rash, pruritus, urticaria, photosensitivity
- fluid retention, peripheral edema
- ecchymosis
- elevated creatinine, ALT/AST
- sinusitis
- vomiting (peds)
- headache (peds)
- fever (peds)
- delayed ovulation
Pharmacology
- Half-life: 15-20 hours
- Metabolism: liver extensively; CYP450 (2C9, 3A4 substrate)
- Excretion: urine (0.2% unchanged); feces (1.6% unchanged)
- Mechanism of Action: exact MOA unknown; inhibits cyclooxygenase, reducing prostaglandin and thromboxane synthesis