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Pharmacologic class: Nonopioid analgesic, nonsteroidal anti-inflammatory drug (NSAID)
Therapeutic class: Analgesic, anti-inflammatory drug
Pregnancy risk category C
FDA Box Warning
• Drug may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), and stroke. Risk may increase with duration of use. Patients with cardiovascular disease or risk factors for it may be at greater risk.
• Drug increases risk of serious GI adverse events, including bleeding, ulcers, and stomach or intestinal perforation. These events can occur at any time during use and without warning. Elderly patients are at greater risk.
• Drug is contraindicated for treatment of perioperative pain in setting of coronary artery bypass graft surgery.
Unknown. Thought to reduce inflammation and pain by inhibiting prostaglandin synthesis of the enzyme cyclooxygenase.
Oral suspension: 7.5 mg/5 ml
Tablets: 7.5 mg, 15 mg
Indications and dosages
➣ Osteoarthritis; rheumatoid arthritis
Adults: 7.5 mg P.O. once daily; may increase to 15 mg/day
➣ Juvenile arthritis
Children ages 2 and older: 0.125 mg/kg P.O. once daily, up to a maximum of 7.5 mg
• Hypersensitivity to drug, its components, or other NSAIDs
Use cautiously in:
• bleeding disorders, GI or cardiac disorders, severe renal impairment, severe hepatic disease, asthma, peptic ulcer disease
• concurrent aspirin, oral anticoagulant, or corticosteroid therapy
• elderly or debilitated patients
• pregnant or breastfeeding patients.
• Before starting therapy, ask patient about aspirin sensitivity and allergies to other NSAIDs. If patient is dehydrated, provide adequate fluids.
CNS: headache, dizziness, syncope, malaise, fatigue, asthenia, depression, confusion, nervousness, drowsiness, insomnia, vertigo, tremor, paresthesia, anxiety, seizures
CV: hypertension, hypotension, palpitations, angina, vasculitis, heart failure, arrhythmias, MI
EENT: abnormal vision, conjunctivitis, hearing loss, tinnitus, pharyngitis
GI: nausea, vomiting, diarrhea, constipation, colitis, GI ulcers with perforation, abdominal pain, dyspepsia, gastroesophageal reflux, esophagitis, flatulence, ulcerative stomatitis, dry mouth, pancreatitis, GI hemorrhage
GU: urinary frequency, urinary tract infection, albuminuria, hematuria, renal failure
Hematologic: anemia, purpura, leukopenia, thrombocytopenia
Musculoskeletal: joint pain, back pain
Respiratory: upper respiratory infection, dyspnea, coughing, asthma, bronchospasm
Skin: rash, urticaria, pruritus, bullous eruption, sweating, alopecia, photosensitivity, angioedema
Other: altered taste, increased appetite, weight gain or loss, hot flashes, fluid retention and edema, masking of infection symptoms, hypersensitivity reactions including anaphylaxis
Drug-drug. Angiotensin-converting enzyme inhibitors: decreased antihypertensive effect
Anticoagulants: increased risk of bleeding
Aspirin: increased meloxicam blood level, increased risk of toxicity
Cholestyramine: decreased meloxicam blood level
Furosemide, thiazides: decreased diuretic effect
Lithium: increased lithium blood level
Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, gamma-glutamyl transferase: increased levels
Hemoglobin, platelets, white blood cells: decreased values
Drug-behaviors. Alcohol use, smoking: increased risk of GI irritation and bleeding
☞ Closely monitor patient with aspirin-sensitivity asthma, because of risk of severe bronchospasm.
• In prolonged therapy, monitor CBC and kidney and liver function tests.
☞ Assess for cardiovascular disorders and hepatotoxicity.
• Monitor patient for fluid retention and weight gain.
☞ Instruct patient to immediately report signs and symptoms of hepatotoxicity, including right upper quadrant pain, nausea, fatigue, lethargy, pruritus, and jaundice.
• Tell patient to report abdominal pain, blood in stool or emesis, or black tarry stools.
• Instruct patient to avoid alcohol and smoking.
• Caution pregnant patient to avoid drug, especially during third trimester.
• Tell patient to consult prescriber before taking over-the-counter preparations.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.