May reduce effects of antihypertensives
Increased clearance with bile acid sequestrants eg. cholestyramine,

Increasd risk of renal failure with diuretics
May reduce natriuretic efects of furosemideand thiazides

May increase toxicity of methotrexate
May increase plasma conc.  and toxicity of lithium

Increased risk of severe GI  effects of aspirin, warfarin
 

Rheumatoid arthiritis
Ankylosing spondylitis
Osteoarthiritis
 

GI perforation, ulceration, bleeding or upset.
Monitor patient.

Muco-cutaneous reactions including pruritus, rash, urticaria,
Angloedema, photosensitivity,

Erythema, multiforme. Stevens Johnson syndrome.
Blood dyscrasias.

CNS or cardiovascular effects,
Transcient disturbances in liver tests.

 

Active peptic ulcer or history of peptic ulcer disease.
Asprin/ anti-inflammatory  induced allergy.  
Severe hepatic or renal failure.
 Pregnancy, lactation

Special Precaution:
History of gastro-intestinal disturbance, especially bleeding.
Congestive heart failure
 Liver cirrhosis,
Nephrotic syndrome.
Renal failure. Hypovolaemia.

 

Osteoarthiritis:
 7.5mg once daily at meal times, increase if necessary to a maximum of 15mg  once daily.

Rheumatoid arthiritis & ankylosing spondylitis:  15mg once daily.

Elderly: intially 7.5mg once daily.

Not recommended for children

 

List of entries

1. Rheumatoid Arthritis
2. Juvenile Rheumatoid Arthritis
3. Ankylosing spondylosis
4. Reiters Syndrome
5. Osteomyelitis
6. Cervical spondylosis
7. Gout

1. Rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic sytemic disease of unknown etiology, manifested primarily by inflammatory
arthritis of the peripheral joints,usally in a symetrical distribution. Systemic manifestations include hematologic,
pulmonary, neurological and cardiovascular abnormalities.

2. Juvenile Rheumatoid arthritis
Juvenile arthritis (JRA) consists of several distinct syndromes. Three main subgroups have been identified:
systemic-onset disease, polyarticular disease, and pauciarticular disease. In addition, ankylosing spondylosis and
rheumatoid arthritis  indistinguishable from adult onset disease may begin from childhood.

3. Ankylosing spondylosis
Ankylosing spondylosis, a disease that has been called by many names, including rheumatoid spondylosis and
Marie-Strumpell disease, is a chronic and usually progressive inflammatory disease invloving the articulations
of the spine and adjacent soft tissues. The sacroiliac joints are always affected. Involvement of the hip and shoulder
joints commonly occurs: peripheral joints are affected less frequently

The disease predominantly affects young men and begin most often in the third decade. A high association has
been found between this disorder and the histocompatibility antigen HLA-B27. The clinical features of this disease
are distinctly different from those of rheumatoid arthritis. The etiology is unknown.

4. Reiters Syndrome
Reiters syndrome is characterized by arthritis, urethritis, conjunctivitis, and mucocutaneous lesions. The complete
syndrome may not be present at any given time. The diagnosis should be entertained when arthritis is associated with
any of the other manifestations. The HLA-B27 is present in majority of the patients.  

5. Osteomyelitis
Osteomyelitis denotes infection of bone. While many types of microorganisms, including viruses and fungi may cause
ostyeomyelitis, it is usually bacterial in origin

6. Cervical spondylosis
The cervical intervertebral disks degenerate to some degree in the majority of individuals by the sixth and seventh
decades of life. This results in narrowing of the disks especially in the most mobile parts of the cervical spine
(fourth to fifth cervical, fifth to sixth cervical, sixth to seventh cervical and seventh cervical to first thoracic
segments) and spur formation on the margins of the adjacent vertebrae. There are anterior beaking and posterior
osteophytes which protude centrally with narrowing of the spinal canal or laterally so as to impinge on spinal roots in
the intervertebral canal. This condition is incorrectly called hypertrophic arthritis, but there is no consistent
association with arthritis of this type of joints. The more appropiate term cervical spondylosis refers to a wear and tear
(traumatic) phenomenon.

7. Gout
Gout is the term representing hetrogenous group of diseases found exclusively in humans which in their full
d evelopment are manifested by
a. an increase in serum urate cocentrations
b. recurrent attacks of characterstic type of acute arthritis in which crystals of monosodium urate are demonstrable
   in leukocytes of synovial fluid
c. aggregated deposits of monosodium urate monohydrate( tophi) chiefly in around the joints of the extremities and
    sometimes leading to severe crippling or deformity
d. renal disease involving intestinal tissues and blood vessels and
e. uric acid nephrolithiasis

These may occur singly or in combination
 


   















 

Pharmacology:
Meloxicam, unlike other NSAIDs  seem to inhibit the enzyme cyclo-oxygenase-2 (COX-2) to a greater extent than the enzyme cyclo-oxygenase -1 (COX-1). This has been shown in experiments on cellular enzymes where the concentration of meloxicam required to cause 50% inhibition of COX-2 was 15 to 70 times less than the concentration required to cause 50% inhibition of COX-1.
Meloxicam in effective anti-inflammatory doses is expected to cause fewer side effects such as gastric irritation and injury that are probably due to the inhibition of COX-1

Pharmacokinetics:
Meloxicam is absorbed slowly but completely. Its absorption is not diminished by food or by drugs such as cimetidine, aluminium hydroxide and aspirin. Following oral doses of 7.5 to 15mg, the peak plasma concentration of meloxicam is 0.88 to 1.92mcg/ml, about 99.5% of this is bound to proteins. The plasma concentration reaches  a plateau in 3 - 5 days and remains more or less steady.

The half-life of meloxicam is 20 hours, a given dose takes about 4 days for complete elimination. Impaired liver function does not seem to alter the metabolism of elimination of meloxicam.
However, in patients with impaired kidney function, its excretion may be delayed, and hence the lower dose of 7.5mg is recommended for such patients.  

 

Absorption is not diminished by food or drugs such as cimetidine, aluminiun hydroxide and aspirin.

Use during pregnancy and lactation not recommended.
Observe caution if required to be administered