How meloxicam works
The active ingredient meloxicam inhibits the enzyme cyclooxigenase (COX), which is important for the formation of prostaglandins. Prostaglandins are tissue hormones that perform a variety of functions in the body. The COX enzyme exists in two subtypes, COX-1 and COX-2.
COX-1 is found in many tissues of the human body. It is involved in the formation of prostaglandins, which primarily control endogenous processes such as the formation of gastric acid or blood flow to the kidneys.
COX-2, on the other hand, is specifically formed in inflamed and injured tissues so that increased prostaglandins are produced there as inflammatory messengers. In other words, the prostaglandins promote inflammation here so that the injured tissue is well supplied with blood and the immune system can reach any invading pathogens at an early stage.
Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit both COX variants, with the actual target being COX-2. Inhibition of COX-1 is thought to be responsible for side effects, particularly those in the gastrointestinal tract.
Meloxicam inhibits primarily COX-2 at low doses, similar to diclofenac, but at higher doses this preference is lost. The drug therefore has fewer side effects than less selective NSAIDs.
Absorption, degradation and excretion
After the active substance has been broken down in the liver, it is excreted in approximately equal amounts in the stool and urine. About 13 to 25 hours after taking meloxicam, half of its breakdown products have been excreted.
When is meloxicam used?
Meloxicam is approved for:
- Short-term symptomatic treatment of osteoarthritis pain.
- Long-term symptomatic treatment of rheumatoid arthritis or ankylosing spondylitis (ankylosing spondylitis).
How meloxicam is used
The pain reliever and inflammatory drug meloxicam is taken once daily as a tablet. It should always be taken at approximately the same time of day so that blood levels remain constant.
Depending on the severity of the condition and the pain, 7.5 to 15 milligrams of meloxicam is taken with a glass of water at a meal. The maximum dosage of 15 milligrams per day should not be exceeded.
Meloxicam may also be injected to initiate therapy.
What are the side effects of meloxicam?
Typical side effects of meloxicam include indigestion, nausea, vomiting, abdominal pain, constipation, flatulence, and diarrhea in more than ten percent of those treated. Rarely, headaches also occur.
What should be considered when taking meloxicam?
Contraindications
Meloxicam must not be taken by:
- Hypersensitivity to meloxicam or other NSAIDs.
- gastrointestinal bleeding in the past under NSAID therapy
- recurrent ulcers or bleeding
- severe liver or kidney dysfunction
- severe heart failure (congestive heart failure)
Drug Interactions
Meloxicam should not be taken with other NSAIDs because the side effects on the digestive tract and kidneys typical of NSAIDs may increase and no further increase in effect is to be expected.
Simultaneous use of cortisone and anticoagulants (such as phenprocoumon, warfarin) may also increase the side effects of meloxicam and lead to bleeding in the gastrointestinal tract.
Simultaneous use of meloxicam with blood pressure medications such as ACE inhibitors, dehydrating agents (diuretics), and sartans may lead to worsening of kidney function. Patients are therefore monitored by a physician at the start of therapy.
Examples of such agents include:
- ACE inhibitors: captopril, ramipril, enalapril, etc.
- Diuretics: Hydrochlorothiazide, indapamide, furosemide, torasemide, etc.
- Sartans: candesartan, eprosartan, valsartan, etc.
As a result, active ingredients can accumulate in the body and reach toxic blood levels. This is true, for example, of lithium – used for mental illnesses – and methotrexate (MTX), which is used for cancer and autoimmune diseases.
Age restriction
Meloxicam tablets are approved for use from age 16, and injections from age 18.
Pregnancy and lactation
In the first two trimesters of pregnancy, meloxicam should be taken only if urgently needed. Better studied agents are ibuprofen and acetaminophen. In the last trimester of pregnancy, meloxicam is contraindicated.
The active ingredient passes into breast milk. Long-term use in breastfeeding women is therefore not recommended.
How to obtain medicines containing meloxicam
Meloxicam is available by prescription in Germany and Austria in any dosage and package size. In Switzerland, the approval has expired and distribution has been discontinued.
How long has meloxicam been known?
Meloxicam belongs to the class of oxicams. Unlike other oxicams, which are only slightly selective in their action, meloxicam is COX-2 selective, especially at low doses.
Since its approval in Germany in 1996, it was under patent protection until 2005. Since then, various generics containing the active ingredient meloxicam have come onto the market.
