Meloksikam - instructions for use, doses, side effects, contraindications

Excipients: starch pregelatinized (starch 1500) -30.0 / 60.0 mg, microcrystalline cellulose - 61.3 / 122.6 mg, sodium citrate dihydrate - 20.0 / 40.0 mg, silicon dioxide colloid (aerosil 380) - 0 , 6 / 1.2 mg, magnesium stearate - 0.6 / 1.2 mg.

Description:Tablets are light yellow with a greenish tint of color.For dosing 7.5 mg - planocylindrical with a bevel. For dosage of 15 mg - flat-cylindrical with chamfer and risk.

Pharmacotherapeutic group:Non-steroidal anti-inflammatory drug (NSAID)

ATX: & nbsp

M.01.A.C.06 Meloksikam

M.01.A.C Oksikamy

Pharmacodynamics:Meloksikam - a non-steroidal anti-inflammatory drug that has analgesic, anti-inflammatory and antipyretic effects. Anti-inflammatory effect is associated with inhibition of the enzymatic activity of cyclooxygenase-2 (COX-2), involved in the biosynthesis of prostaglandins in the inflammatory region. Less meloxicam acts on cyclooxygenase-1 (COX-1), involved in the synthesis of prostaglandin, which protects the mucous membrane of the gastrointestinal tract and takes part in the regulation of blood flow in the kidneys.

Pharmacokinetics:

Well absorbed from the digestive tract (gastrointestinal tract), the absolute bioavailability of meloxicam - 89%. Simultaneous food intake does not change the intake. When using the drug inside at doses of 7.5 mg and 15 mg of its concentration are proportional to the doses. Equilibrium concentrations are achieved within 3-5 days.With long-term use of the drug (more than 1 year), the concentrations are similar to those that are noted after the first reaching the equilibrium state. Binding to plasma proteins is more than 99%. The range of differences between the maximum and basal concentrations of the drug after its administration once a day is relatively small and amounts to using a dose of 7.5 mg 0.4-1.0 μg / ml, and when a dose of 15 mg is 0.8-2, 0 μg / ml, (the values of C_min and C_max). Meloksikam penetrates through the histohematological barriers, the concentration in the synovial fluid reaches 50% of the maximum concentration of the drug in the plasma.

Almost completely metabolized in the liver with the formation of four pharmacologically inactive derivatives. The main metabolite, 5'-carboxymeloxicam (60% of the dose value), is formed by oxidation of the intermediate metabolite, 5-hydroxymethylmeloxicam, which is also excreted, but to a lesser degree (9% of the dose value). In vitro studies have shown that CYP 2C9 plays an important role in this metabolic transformation, the CYP isoenzyme ZA4 is of additional importance.In the formation of the other two metabolites (which constitute, respectively, 16% and 4% of the dose), peroxidase takes part, the activity of which probably varies individually.

It is excreted equally through the intestines and kidneys, mainly in the form of metabolites. Through the intestine unchanged output of less than 5% of the daily dose in the urine as unchanged drug is detected only in trace amounts. The half-life (T_1/2) meloxicam is 15-20 hours. Plasma clearance is an average of 8 ml / min. In elderly people, the clearance of the drug is reduced. The volume of distribution is low, and averages 11 liters.

Hepatic or renal insufficiency of moderate severity of influence on the pharmacokinetics of meloxicam does not significantly affect the pharmacokinetics of meloxicam.

Indications:Symptomatic treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis (Bechterew's disease) and other inflammatory and degenerative joint diseases accompanied by pain syndrome.

Contraindications:

- Hypersensitivity to the active substance or ancillary components;

- contraindicated in the period after aortocoronary bypass surgery;

uncompensated heart failure;

- anamnestic data on an attack of bronchial obstruction, rhinitis, urticaria after taking acetylsalicylic acid or other NSAIDs (complete or incomplete acetylsalicylic acid intolerance syndrome - rhinosinusitis, urticaria, polyps of the nasal mucosa, asthma);

- erosive and ulcerative changes in the gastric mucosa or duodenum, active gastrointestinal bleeding;

- Inflammatory bowel disease (ulcerative colitis, Crohn's disease);

- cerebrovascular bleeding or other bleeding;

- severe hepatic impairment or active liver disease;

- marked renal failure in patients not undergoing dialysis (creatinine clearance less than 30 ml / min), progressive kidney disease, including confirmed hyperkalemia;

- pregnancy, the period of breastfeeding;

- Children under 15 years.

Carefully:

Ischemic heart disease, cerebrovascular disease, congestive heart failure, dyslipidemia / hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, creatinine clearance less than 60 ml / min.Anamnestic data on the development of gastrointestinal ulcerative lesions, the presence of Helicobacter pylori infection, advanced age, prolonged use of NSAIDs, frequent alcohol consumption, severe physical illness, concomitant therapy with the following drugs:

- anticoagulants (for example, warfarin);

- antiaggregants (for example, acetylsalicylic acid, clopidogrel);

- oral glucocorticosteroids (for example, prednisolone);

- selective serotonin reuptake inhibitors (eg, citalopram, fluoxetine, paroxetine, sertraline).

To reduce the risk of developing adverse events on the part of the gastrointestinal tract, a minimum effective dose should be used with the minimum possible short course.

Pregnancy and lactation:Contraindicated in pregnancy and lactation.

Dosing and Administration:

The drug is taken orally during meals once a day.

Recommended dosing regimen:

- Rheumatoid arthritis: 15 mg per day. Depending on the therapeutic effect, the dose can be reduced to 7.5 mg per day.

- Osteoarthritis: 7.5 mg per day. If the dose is ineffective, it can be increased to 15 mg per day.

- Ankylosing spondylitis: 15 mg per day.

The maximum daily dose should not exceed 15 mg.

In patients with an increased risk of side effects, as well as in patients with severe renal failure who are on hemodialysis, the dose should not exceed 7.5 mg per day.

Side effects:

From the digestive system: more than 1% - dyspepsia, incl. nausea, vomiting, abdominal pain, constipation, flatulence, diarrhea; 0.1-1% - a transient increase in the activity of "liver" transaminases, hyperbilirubinemia, belching, esophagitis, gastroduodenal ulcer, bleeding from the gastrointestinal tract (including latent), stomatitis; less than 0.1% - perforation of the gastrointestinal tract, colitis, hepatitis, gastritis.

On the part of the organs of hematopoiesis: more than 1% - anemia; 0.1-1% change in the blood formula, incl. leukopenia, thrombocytopenia.

From the skin: more than 1% - itching, skin rash; 0,1-1% - urticaria; less than 0.1% - photosensitivity, bullous eruptions, erythema multiforme, incl. Stevens-Johnson syndrome, toxic epidermal necrolysis.

From the respiratory system: less than 0.1% - bronchospasm.

From the nervous system: more than 1% - dizziness, headache; 0,1-1% - vertigo, tinnitus, drowsiness; less than 0.1% - confusion, disorientation, emotional lability.

From the side of the cardiovascular system: more than 1% - peripheral edema; 0.1-1% - increased blood pressure, palpitations, "tides" of blood to the skin of the face.

From the urinary system: 0.1-1% - hypercreatininaemia and / or elevated urea in the blood serum; less than 0.1% - acute renal failure; connection with the reception of meloxicam is not established - interstitial nephritis, albuminuria, hematuria.

From the sense organs: less than 0.1% - conjunctivitis, visual impairment, incl. blurred vision.

Allergic reactions: less than 0.1% - angioedema, anaphylactoid / anaphylactic reactions.

Overdose:

Symptoms: impaired consciousness, nausea, vomiting, epigastric pain, bleeding in the gastrointestinal tract, acute renal failure, hepatic insufficiency, respiratory arrest, asystole.

Treatment: there is no specific antidote; with an overdose of the drug should be washed stomach, taking activated charcoal (within the next hour), symptomatic therapy. Kolestyramine accelerates the removal of the drug from the body. Forced diuresis, alkalinization of urine, hemodialysis - ineffective because of the high connection of the drug with blood proteins.

Interaction:

When used simultaneously with other non-steroidal anti-inflammatory drugs (as well as with acetylsalicylic acid), the risk of erosive and ulcerative lesions and bleeding of the gastrointestinal tract increases.

With simultaneous use with antihypertensive drugs, it is possible to reduce the effectiveness of the latter.

When used simultaneously with lithium preparations, cumulation of lithium and an increase in its toxic effect are possible (control of the concentration of lithium in the blood is recommended).

With simultaneous use with methotrexate, the side effect of the latter on the hematopoietic system is increased (the risk of anemia and leukopenia, periodic monitoring of the general blood test is shown).

With simultaneous use with diuretics and with cyclosporine, the risk of developing kidney failure increases.

With simultaneous use with intrauterine contraceptives, the effectiveness of the latter may be reduced.

When used simultaneously with anticoagulants (heparin, ticlopidine, warfarin), as well as with thrombolytic drugs (streptokinase, fibrinolysin), the risk of bleeding increases (periodic monitoring of blood coagulability indices is necessary).

With simultaneous application with colestyramine, as a result of binding meloxicam, its excretion through the digestive tract increases.

When used simultaneously with selective serotonin reuptake inhibitors, the risk of developing gastrointestinal bleeding increases.

Special instructions:

Care should be taken when using the drug in patients who have a history of peptic ulcer and duodenal ulcer, as well as patients treated with anticoagulants. In such patients, the risk of erosive and ulcerative gastrointestinal diseases is increased.

Caution should be exercised and the indicators of renal function should be monitored when the drug is used in elderly patients, patients with chronic heart failure with circulatory insufficiency, in patients with cirrhosis, as well as in patients with hypovolemia as a result of surgical interventions.

In patients with renal insufficiency, if creatinine clearance is more than 25 ml / min, dosage adjustment is not required.

In patients on dialysis, the dosage of the drug should not exceed 7.5 mg / day.

Patients taking both diuretics and meloxicam, should take a sufficient amount of fluid.

If allergic reactions (itching, skin rash, urticaria, photosensitization) occur during treatment, you should contact your doctor to resolve the issue of stopping the drug.

Meloksikam, as well as other NSAIDs, can mask symptoms of infectious diseases.

The use of meloxicam, as well as other drugs that block the synthesis of prostaglandins, can affect fertility, so it is not recommended for women who want to become pregnant.

Effect on the ability to drive transp. cf. and fur:The use of the drug can cause the emergence of unwanted effects in the form of headaches and dizziness, drowsiness. It should abandon the management of vehicles and maintenance of machines and mechanisms that require concentration of attention.

Form release / dosage:Tablets of 7.5 mg and 15 mg.

Packaging:For 10 tablets in a planar cell package. 1, 2, 3, 4 or 5 contour mesh packages together with the instruction for use are placed in a pack of cardboard.

Storage conditions:

In a dry, protected from light place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use after the date shown on the package.

Terms of leave from pharmacies:On prescription

Registration number:LSR-004342/09

Date of registration:01.06.2009 / 08.11.2017

Expiration Date:Unlimited

The owner of the registration certificate:ALSI Pharma, ZAO ALSI Pharma, ZAO Russia

Representation: & nbspALSI Pharma CJSC ALSI Pharma CJSC Russia

Information update date: & nbsp22.04.2018

Illustrated instructions

Instructions

Meloksikam (Meloxicam)