Meloxicam

Chemical name: 4-Hydroxy-2-methyl N (5-methyl-2-thiazolyl) 2H1,2-benzothiazine-3-carboxamide 1,1 dioxide

Large doses of other NSAIDs, including salicylates, and the simultaneous use of more than one NSAID may increase the likelihood of gastrointestinal ulcers and bleeding through synergistic effects. Oral anticoagulants, ampicillin, systemic heparin, and thrombolytics may increase the likelihood of bleeding. If the above combination medications are unavoidable, the effects of anticoagulants must be closely monitored. Lithium: NSAIDs have been reported to increase plasma lithium concentrations, so it is recommended to monitor plasma lithium levels when starting, adjusting, and stopping meloxicam. Methotrexate: Similar to other NSAIDs, meloxicam can increase the hematotoxicity of methotrexate. In this case, strict monitoring of blood cell counts is recommended. Contraception: NSAIDs have been reported to reduce the effectiveness of intrauterine contraceptive devices. Diuretics: When using NSAIDs, patients with diuretic dehydration may develop acute renal insufficiency, so patients using meloxicam and diuretics should ensure adequate blood volume and monitor renal function before starting treatment. Antihypertensive drugs (e.g., beta-receptor blockers, ACE inhibitors, vasodilators, diuretics) have been reported to reduce the effect of antihypertensive drugs during NSAID treatment by inhibiting prostaglandins that cause vasodilation. Cholestyramine combined with meloxicam in the gastrointestinal tract can accelerate the elimination of meloxicam. NSAIDs may increase the renal toxicity of cyclosporine, which is mediated by renal prostaglandins. Renal function should be measured during combined treatment. No pharmacokinetic drug interactions were observed when antacids, cimetidine, digoxin, and furosemide were used simultaneously. Interactions with oral hypoglycemic drugs cannot be ruled out.

The main ingredient of this product is meloxicam.

Pharmacodynamic interactions: Other nonsteroidal anti-inflammatory drugs including salicylates (acetylsalicylic acid ge; 3g/day): The simultaneous use of several nonsteroidal anti-inflammatory drugs may increase the possibility of gastrointestinal ulcers and bleeding through synergistic effects. The combination of meloxicam and other nonsteroidal anti-inflammatory drugs is not recommended. Diuretics: Treatment with nonsteroidal anti-inflammatory drugs has the potential to cause acute renal failure in dehydrated patients. Patients using this product and diuretics should be supplemented with adequate water, and renal function should be monitored before starting treatment. Oral anticoagulants: Because of the inhibition of platelet function and damage to the gastroduodenal mucosa, the risk of bleeding is increased. The combination of nonsteroidal anti-inflammatory drugs and oral anticoagulants is not recommended. If combined use cannot be avoided, the INR should be carefully monitored. Thrombolytics and antiplatelet drugs: Because of the inhibition of platelet function and damage to the gastroduodenal mucosa, the risk of bleeding is increased. ACE inhibitors and angiotensin II receptor antagonists: NSAIDs and angiotensin II receptor antagonists have a synergistic inhibitory effect on glomerular filtration, and symptoms may be aggravated when renal function is affected. In elderly patients and/or dehydrated patients, the combination of the two may cause acute renal failure due to direct effects on glomerular filtration. Renal function should be monitored at the beginning of treatment and patients should be rehydrated regularly. In addition, co-administration may reduce the antihypertensive effect of ACE inhibitors and angiotensin II receptor antagonists, resulting in partial loss of efficacy (due to inhibition of the vasodilatory effect of prostaglandins). Other antihypertensive drugs (such as beta-blockers); beta-blockers may have a reduced antihypertensive effect (due to inhibition of the vasodilatory effect of prostaglandins). Cyclosporine: NSAIDs may increase the nephrotoxicity of cyclosporine through their effects mediated by renal prostaglandins. Renal function should be measured during co-administration. Careful monitoring of renal function is particularly necessary in elderly patients. Intrauterine contraceptive devices: NSAIDs have been reported to reduce the efficacy of intrauterine contraceptive devices. There has been one case report of NSAIDs reducing the efficacy of intrauterine contraceptive devices, but further confirmation is needed. Pharmacokinetic interactions (effects of meloxicam on the pharmacokinetics of other drugs) Lithium: NSAIDs have been reported to increase plasma concentrations of lithium (by inhibiting renal excretion of lithium), potentially to toxic concentrations. Therefore, it is recommended that NSAIDs not be used with lithium. If coadministration is necessary, it is recommended that plasma lithium levels be monitored during initiation, adjustment, and discontinuation of meloxicam. Methotrexate: NSAIDs decrease renal tubular secretion of methotrexate and thus increase plasma concentrations of methotrexate. Therefore, it is recommended that patients receiving higher doses of methotrexate (greater than 15 mg/week) not use NSAIDs together. The potential for interaction between NSAIDs and methotrexate should also be considered in patients receiving lower doses of methotrexate, especially in patients with renal impairment. If coadministration is necessary, blood cell counts and renal function should be monitored. Special attention should be paid to the co-administration of NSAIDs and methotrexate within 3 days, as plasma methotrexate concentrations may increase and cause increased toxicity. Although the pharmacokinetics of methotrexate (15 mg/week) are not proportionally affected by the co-administration of meloxicam, it should be considered that the hematotoxicity of methotrexate may be amplified by the co-administration of NSAIDs (see above). Pharmacokinetic interactions (effects of other drugs on the pharmacokinetics of meloxicam) Cholestyramine: By affecting the enterohepatic circulation, cholestyramine accelerates the elimination of meloxicam, accelerating the clearance of meloxicam by 50% and reducing the half-life to 13 plus min; 3 hours. This interaction is clinically significant. No clinically relevant pharmacokinetic drug interactions have been observed with the concomitant use of antacids, cimetidine and digoxin.

The main ingredient of this product is meloxicam, whose chemical name is 4-hydroxy-2-methyl-N-(5-methyl-2-thiazolyl)-2H-1,2-benzothiazine-3-carboxamide-1,1,-dioxide.

(1) Large doses of other NSAIDs including salicylates: The use of more than one NSAID at the same time may increase the possibility of gastrointestinal ulcers and bleeding through synergistic effects. (2) Oral anticoagulants, ampicillin, systemic heparin, and thrombolytics may increase the possibility of bleeding. If the above-mentioned combined use is unavoidable, the effects of anticoagulants must be closely monitored. (3) Lithium: NASIDs have been reported to increase plasma lithium concentrations. Therefore, it is recommended to monitor plasma lithium levels when starting, adjusting, and stopping this product. (4) Methotrexate: Similar to other NASIDs, this product can increase the blood toxicity of methotrexate. In this case, it is recommended to strictly monitor blood cell counts. (5) Contraception: NASIDs have been reported to reduce the effectiveness of intrauterine contraceptive devices. (6) Diuretics: When using NASIDs, patients who are dehydrated by diuresis may develop acute renal insufficiency. Therefore, patients using this product and diuretics should supplement with enough water, and renal function should be monitored before starting treatment. (7) Antihypertensive drugs (e.g., beta-blockers, ACE inhibitors, vasodilators, diuretics): There are reports that during NSAID treatment, the effect of antihypertensive drugs is reduced by inhibiting prostaglandins that cause vasodilation. (8) Cholestyramine binds to this product in the gastrointestinal tract and can accelerate the elimination of this product. (9) NSAIDs can increase the renal toxicity of cyclosporine through the indirect effect of renal prostaglandins. Renal function should be measured during combined treatment. (10) No pharmacokinetic drug interactions were observed when antacids, cimetidine, digoxin and furosemide were used simultaneously. (11) Interactions with oral hypoglycemic drugs cannot be ruled out.