MELOXICAM
(mel-ox'-i-cam)
Mobic
Classifications: CENTRAL NERVOUS SYSTEM AGENT (CNS); ANALGESIC; NONSTEROIDAL
ANTI-INFLAMMATORY DRUG (NSAID)
Prototype: Ibuprofen
Pregnancy Category: C (first and second trimesters); D (third trimester)
Availability
7.5 mg tablets
Actions
Is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory,
analgesic, and antipyretic activities. The mechanism of action, like other NSAIDs, may
be related to prostaglandin synthetase (cyclooxygenase) inhibition.
Therapeutic Effects
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, severe renal or
hepatic disease; salicylate hypersensitivity, pregnancy [(category C) first and second
trimester, (category D) third trimester)], 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, 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 may increase
risk of GI bleed; may increase lithium levels and toxicity; warfarin may increase risk of
bleeding. 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: Metabolized in liver by CYP2C9. Elimination:
Equally eliminated 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.
● Do not breast feed while taking this drug.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold;
classifications in SMALL CAPS;
Canadian drug name;
Prototype drug