phl-Meloxicam – Uses, Side Effects, Interactions

Meloxicam belongs to the family of medications known as COX-2 inhibiting nonsteroidal anti-inflammatory drugs (NSAIDs). It is used to treat rheumatoid arthritis and painful osteoarthritis in adults. It helps with these conditions by relieving pain and reducing swelling and inflammation.

NSAIDs work by blocking a response to injury in the body that leads to inflammation and pain.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor.  Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

phl-Meloxicam is no longer being manufactured for sale in Canada. For brands that may still be available, search under meloxicam. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

Rheumatoid arthritis: The usual starting dose of meloxicam to treat the symptoms of rheumatoid arthritis is 15 mg once daily. For some people who may respond well to the medication, their doctor can reduce the dose to 7.5 mg once daily, according to need.

Osteoarthritis: The recommended dose to relieve osteoarthritis pain is 7.5 mg once daily. The doctor may increase this to 15 mg taken once daily if necessary.

For both conditions, the maximum dose of meloxicam is 15 mg taken once daily.

This medication may be taken with or without food.

The use of this medication should be limited to the lowest effective dose for the shortest period of time needed.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

are allergic to meloxicam or any ingredients of the medication

are about to have or have recently had coronary artery bypass graft (CABG) surgery

are pregnant or breast-feeding

are less than 18 years of age

have active or recent stomach or intestinal ulcers or bleeding

have bleeding of the brain or other bleeding disorders

have experienced asthma, hives, nasal polyps, or allergic reactions after taking ASA or other NSAIDs

have higher than normal levels of potassium in the blood

have inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

have severely reduced kidney function or worsening kidney function

have severely reduced liver function or active liver disease

have severe uncontrolled heart failure

What side effects are possible with this medication?

Many medications can cause side effects.  A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• constipation
• diarrhea
• dizziness or lightheadedness
• drowsiness
• flushing
• gas/flatulence
• headache
• indigestion
• mouth ulcers
• nausea
• sensitivity to sunlight
• sleepiness
• sore mouth
• uncomfortable feeling in the stomach
• weight changes

Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• confusion
• eye infection (e.g., swollen runny eyes, itching eyes, crusty eyelids)
• hearing problems
• high blood pressure
• pain while urinating or difficulty urinating
• pounding heart beat
• ringing in the ears
• signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• signs of kidney problems (e. g., increased urination at night, decreased urine production, blood in the urine, painful or difficult urination)
• signs of liver damage (e.g., yellow skin or eyes, abdominal pain, dark urine, clay-coloured stools, loss of appetite, nausea and vomiting, or itching)
• skin rash or itching
• small, red spots on skin
• swelling of the lower legs, ankles, or feet
• unexplained weight gain
• vision changes including blurred vision
• vomiting or persistent nausea, indigestion, stomach pain, or diarrhea

Stop taking the medication and seek immediate medical attention if any of the following occur:

• changes in the amount or colour of urine (such as red or brown urine)
• fainting
• rapid swelling of face, tongue, lips
• seizures
• severe stomach pain
• shortness of breath
• signs of bleeding in the stomach (e.g., bloody, black, or  tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)
• signs of breathing problems (e. g., shortness of breath, troubled breathing, wheezing, or tightness in chest, fast or irregular breathing)
• signs of meningitis not caused by infection (e.g., headache (severe), throbbing, or with stiff neck or back)
• signs of a severe allergic reaction (e.g., hives, difficulty breathing, swelling of the face, mouth, throat, or tongue)
• signs of a severe skin reaction (e.g., blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

HEALTH CANADA ADVISORY

June 8, 2021

Health Canada has issued new information concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs). To read the full Health Canada Advisory, visit Health Canada’s web site at www.hc-sc.gc.ca.

A previous advisory on non-steroidal anti-inflammatory drugs (NSAIDs) was issued on October 30, 2020.

Alcohol: People taking this medication should not drink alcohol, as this can increase the risk of stomach problems with the medication.

Allergic reactions: If you have had a reaction to acetylsalicylic acid (ASA) or other NSAIDs (e.g., ibuprofen, ketoprofen, diclofenac) that included a runny nose, itchy skin rash, nasal polyps, or shortness of breath and wheezing, you should not take this medication. If you experience symptoms of a severe allergic reaction (e.g., hives; difficulty breathing, wheezing; swelling of the face, tongue, or throat), get immediate medical attention.

Aseptic meningitis: This medication can rarely cause symptoms of aseptic meningitis (inflammation or swelling of the membranes around the brain and spinal cord that is not caused by bacteria). If you have an autoimmune condition (e.g., systemic lupus erythematosus, mixed connective tissue disease), you are more at risk for developing this. If you experience symptoms such as stiff neck, severe headache, nausea, vomiting, fever, or changes in consciousness, stop taking this medication and get immediate medical attention.

Bladder symptoms: This medication can cause bladder symptoms such as frequent or painful urination and blood in urine. If you develop these symptoms, stop taking this medication and contact your doctor immediately.

Blood counts: This medication can decrease the number of neutrophils (a type of white blood cell that helps fight infection), red blood cells (which carry oxygen), and platelets (which help your blood to clot). Your doctor will do blood tests to monitor this. Contact your doctor immediately if you notice an increased occurrence of signs of infection (e.g., fever, chills, or sore throat), feel unusually tired, lack energy, or experience unusual bleeding or bruising.

Blood pressure: Like other NSAIDs, meloxicam can cause increased blood pressure, which may contribute to other heart conditions. If you have high blood pressure, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Meloxicam may reduce mental or physical abilities required for performance of hazardous tasks such as operating machinery or driving a motor vehicle. Avoid these and other hazardous tasks until you are sure that this medication does not affect your ability to do these safely.

Fertility: Fertility may be decreased in people taking this medication. This medication is not recommended for women who are trying to get pregnant.

Galactose intolerance/glucose malabsorption: Meloxicam medications are prepared with lactose. If you have lactose or galactose intolerance you should not take these medications.

Heart attack and stroke: The use of COX-2 NSAIDs, including meloxicam, is associated with an increased risk of heart attack and stroke. This risk is increased with higher total daily doses and taking the medication over long periods of time. If you have a history of heart disease, including heart attack and stroke, discuss with your doctor the benefits and risks of taking this medication. Ask your doctor about all available treatment options that may be right for you.

Heart conditions: This medication can cause fluid retention which will make symptoms of certain heart conditions worse. If you have heart failure, high blood pressure, or other medical conditions that increase your risk of fluid retention (e. g., kidney problems), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Infection: This medication may mask signs of infection such as fever or muscle aches. If you notice other symptoms of infection (e.g., painful or frequent urination, sore throat, cough) contact your doctor.

Informing health professionals: Be sure to tell any health professionals (including your doctor, nurse, pharmacist, and dentist) involved in your care that you are taking this medication, particularly if you are scheduled for heart surgery.

Kidney function: This medication can affect kidney function. You have a higher risk of developing kidney problems if you are a senior, take diuretics (water pills; e.g., hydrochlorothiazide, furosemide), or already have kidney disease or heart failure. Your doctor may monitor your kidney function with blood tests when you are taking this medication. Meloxicam is not recommended for people with severely reduced kidney function if they are not receiving dialysis.

Liver function: This medication may affect your liver function or cause liver problems. If you experience symptoms of liver problems (e.g., nausea, vomiting, feeling tired, yellowing of the skin or eyes) contact your doctor immediately. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severely reduced liver function or have active liver disease should not take this medication.

Potassium levels: Meloxicam may cause high blood potassium levels. You are more at risk of high blood potassium if you are a senior, have diabetes or kidney failure, or are taking beta-blockers (e.g., metoprolol, atenolol), angiotensin converting enzyme (ACE) inhibitors (e. g., ramipril, enalapril), or some diuretics (e.g., triamterene, amiloride). Because extremely high blood potassium levels can contribute to other conditions, such as heart problems, your doctor will monitor your potassium level with blood tests while you are taking this medication.

Ulcers and bleeding in the stomach and intestines: This medication may cause stomach ulcers and bleeding from the stomach. These complications can occur at any time and are sometimes severe.

If you have had a stomach or intestinal ulcer, diverticulosis, Crohn’s disease or ulcerative colitis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you experience symptoms of an ulcer or other stomach problems (e.g., stomach or abdominal pain, black stools, blood or coffee grind-like vomit, weakness), contact your doctor immediately or get immediate medical attention.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. It must not be used during the last 3 months of pregnancy as it may cause heart and kidney problems for the developing baby and cause prolonged labour with excessive bleeding during delivery.

Breast-feeding: Many anti-inflammatory medications are known to pass into breast milk. If you are a breast-feeding mother and are taking meloxicam, it may affect your baby. Breast-feeding is not recommended while you are taking meloxicam.

Children: The safety and effectiveness of using this medication have not been established for children.

Seniors: Seniors may have a higher risk of side effects and should be closely monitored by their doctors while taking this medication.

What other drugs could interact with this medication?

There may be an interaction between meloxicam and any of the following:

• acetylsalicylic acid (ASA)
• alcohol
• aliskiren
• alteplase
• aminoglycoside antibiotics (e. g., amikacin, gentamicin, tobramycin)
• angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril, enalapril, captopril, quinapril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• apixaban
• “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
• bimatoprost
• bisphosphonates (e.g., alendronate, etidronate)
• bosentan
• carbamazepine
• celecoxib
• cholestyramine
• clopidogrel
• colestipol
• cyclosporine
• dabigatran
• dabrafenib
• dasatinib
• deferasirox
• desmopressin
• digoxin
• dipyridamole
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• edoxaban
• eplerenone
• glucosamine
• haloperidol
• heparin
• herbal products that affect blood clotting (e. g., cat’s claw, chamomile, evening primrose, feverfew, fenugreek, garlic, ginger, ginseng, turmeric)
• hydralazine
• ibrutinib
• latanoprost
• lithium
• low-molecular-weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
• mesalamine
• methotrexate
• mifepristone
• milk thistle
• multivitamins (with vitamins A, E) with or without minerals
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
• obinutuzumab
• omega-3 fatty acids
• oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
• pemetrexed
• pentoxifylline
• prasugrel
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
• rifampin
• rivaroxaban
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e. g., desvenlafaxine, duloxetine, venlafaxine)
• sodium phosphates
• sodium polystyrene sulfonate
• sulfasalazine
• tacrolimus
• tenofovir
• ticagrelor
• ticlopidine
• tipranavir
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• urokinase
• vancomycin
• vitamin E
• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/phl-Meloxicam

NSAIDs Appear to Increase Blood Pressure More Than Celecoxib

May 22, 2006 (New York) — The cyclooxygenase 2 (COX-2) inhibitor celecoxib (Celebrex) appears to slightly raise blood pressure, but the effect is not as large as that associated with the use of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, according to a meta-analysis of more than 44,000 patients.

“Hypertension was more prevalent in patients given celecoxib than those given placebo, which didn’t raise blood pressure at all,” said chief investigator William B. White, MD, from the University of Connecticut School of Medicine in Farmington.

But in studies that compared celecoxib to nonselective NSAIDs, “the other NSAIDS raised blood pressure more,” Dr. White told Medscape. He presented the findings here at the American Society of Hypertension 21st annual scientific meeting.

The COX-2 drugs have been a cause of concern since one such drug, rofecoxib (Vioxx), was voluntarily removed from the market in September 2004 due to an increased risk of heart attacks among people who took the drug daily for more than 18 months. Then another such agent, valdecoxib (Bextra), was pulled from the US market after the Food and Drug Administration (FDA) said risks for cardiac, stomach, and skin problems outweighed its benefits.

That left celecoxib as the only COX-2 drug on the market. But even it was forced by the FDA to carry strict new warnings alerting physicians and patients that it elevates the risk of myocardial infarction and strokes.

Meanwhile, other studies showed that nonselective NSAIDs may also increase the risk of myocardial infarction in people with arthritis. So physicians have been urging all involved to weigh their individual risks when choosing an analgesic.

Due to the controversy surrounding the use of the COX-2 agents and NSAIDs, Dr. White’s study, which was originally scheduled to be featured in a press conference here, was removed from its agenda. Reporters were, however, permitted to attend his general presentation to meeting attendees.

The meta-analysis included 41 trials comparing celecoxib either to other NSAIDs or placebo for disorders ranging from osteoarthritis to Alzheimer’s disease.

Of the total, 24,933 patients received celecoxib at doses ranging from 50 to 800 mg/day, 13,990 received the NSAIDs naproxen, diclofenac, ibuprofen, ketoprofen, or loxoprofen, and 4057 received placebo.

In the studies comparing celecoxib to placebo, 1.1% of people taking celecoxib developed hypertension or aggravated hypertension compared with 0.7% of patients receiving placebo (P = .023). Also, 0.2% of celecoxib-treated patients developed cardiac failure vs less than 0.1% of those receiving placebo (P = .046). Edema was also more prevalent in the celecoxib group: 2.0% vs 0.9% in the placebo group (P < .001).

But in the studies comparing celecoxib to the other NSAIDs, just 1.5% of those receiving celecoxib developed hypertension or aggravated hypertension compared with 2% of those receiving NSAIDs (P = .002). The risk of heart failure was 0.1% in the celecoxib group and 0.2% in the NSAID group, a nonsignificant difference (P = .056). More edema was also seen in the patients receiving NSAIDs: 3.0% vs 2.4% in the celecoxib group (P = .001).

Dr. White said that a subanalysis showed that the dose of celecoxib did not affect the results. “While celecoxib at all doses yielded a higher rate of high blood pressure than placebo, it was still very low,” he said.

As for how the drugs may increase blood pressure, Dr. White said, “When patients get a COX-2 inhibitor or an NSAID, there’s a blockage of salt and water excretion in the first 2 days or so. That can lead to a rise in blood pressure and the development of edema.”

The study received no funding from industry, Dr. White added.

Billy Arant Jr., MD, from the University of Tennessee College of Medicine in Chattanooga, said the study provides important new information for physicians to share with their patients when weighing the risks and benefits of using the popular painkillers. “It’s data that were not available on such a large scale until this point,” he told Medscape.

That said, there remains an important analysis that has yet to be performed, Dr. Arant added. “We need to look at how many of these patients were on antihypertensive medications and how the drugs fared in this group vs those not on medication.

“Patients who already had hypertension may have lost control of their blood pressure when on the drugs and people with normal blood pressure may have developed hypertension over time. Being on blood pressure medication could possibly be protective and affect the results. The fact that they now have this large data set will allow such an analysis,” Dr. White said.

ASH 21st Annual Scientific Meeting: Abstract 54. Presented May 18, 2006.

Reviewed by David Good

Common Adverse Reactions of Mobic

Meloxicam, known by the brand name Mobic, belongs to a class known as nonsteroidal anti-inflammatory drugs (NSAID) indicated in the treatment of osteoarthritis and rheumatoid arthritis symptoms, namely pain and inflammation. However, it finds common use as a potent analgesic for moderate pain.

It is strictly a prescription medication due to the risk of abuse and severe Mobic side effects. As a result, the drug should only be used when prescribed and in line with the prescribing information.

So, what severe reactions can it cause? Does Meloxicam cause weight gain? What are some warnings users should know? Find out here.

Common Mobic Side Effects

Mobic works by blocking the production of enzymes that cause joint inflammation and pain in arthritis and rheumatoid arthritis. It is available in tablets and oral suspension. But the mechanism of action is also associated with specific negative symptoms.

Meloxicam side effects include some mild and common ones, as well as severe reactions that need immediate attention from a doctor.

Some of the Common Meloxicam Side Effects Are Listed Below:

• Headaches
• Upset stomach
• Nausea
• Diarrhea
• Bloating
• Gas in the digestive tract
• Constipation
• Dizziness
• Nervousness
• Nasal or throat congestion

A multicenter study extending over twelve weeks found that anywhere between 5.5% to 8. 3% of patients on either 7.5 mg or 15 mg complained of a Meloxicam headache. It is one of the most common Meloxicam side effects that occur. However, a Meloxicam headache generally has no significant risk to the health.

Besides the common Mobic side effects, several severe adverse reactions can occur. Most of them occur very rarely and in less than 2% of patients, though their incidence is increased when the substance is abused. Severe GI effects were seen in just 1.7% of patients.

If any of these severe Mobic side effects occur, the drug should be stopped, and the individual should present at the hospital or contact their medical doctor immediately.

Some of the Other Serious Side Effects of Meloxicam Tablets Are:

• Bloody stools
• Chest pain or shortness of breath
• Fluid retention in the body resulting in swelling
• Dark vomit
• Decreased urination
• Skin rash or bruising

What Are the Adverse Reactions of Long-Term Use of Mobic?

Mobic is an NSAID, and with long-term use to manage chronic pain, such drugs are generally associated with a cluster of similar side effects. They include the risk of inducing ulcers, GI bleeding, kidney failure, and heart attacks. They can also worsen pre-existing heart failure and hypertension when used chronically. These are typically included among Meloxicam warnings on the prescribing information that comes with the medication.

Some studies have shown links between chronic NSAID use and the development of psychosis and cognitive impairment.

The Following Are Some of the Chronic Health Effects That Mobic Can Cause:

• Liver damage
• GI perforation
• Gastrointestinal bleeding
• Stroke
• Heart attack

Does Meloxicam Cause Weight Gain or Loss?

Many who use this medication may notice changes in their weight. Weight gain and weight loss are both seen with its use, though only rarely. It is a side effect documented in less than 2% of those who use Mobic. Weight loss is not a direct effect of the drug; instead, it results from the loss of appetite and nausea that may occur. There is, however, a direct link between weight gain and the use of this drug.

How Does Meloxicam Cause Weight Gain?

Unexpected weight gain while taking Mobic may be caused by the retention of fluid in the body. It results in swelling of the body and increased weight. If weight gain happens, it must be checked by a doctor immediately because Meloxicam warnings include unexpected weight gain as a severe adverse reaction of the drug.

Does Meloxicam Raise Blood Pressure?

Mobic and high blood pressure (hypertension) are associated with each other as another severe adverse reaction of Mobic 159 pill. When taking this drug, hypertension can increase the risk of stroke or cardiac arrest. These risks are increased when this pill is used for long durations or taken in high doses. Therefore, patients should monitor their intake of Meloxicam and check blood pressure regularly to ensure that it is not raised. In the case of hypertension, they should consult their doctor without any delay.

Meloxicam Side Effects in Pregnancy

FDA has put Mobic in the D pregnancy category. According to studies and trials, this medicine should not be used by pregnant women, especially in the last trimester. It should be removed from the system before the last three months of pregnancy. It is believed to cause damage to the fetus. Therefore, it is not advised to be used by breastfeeding women.

Meloxicam drug interactions to avoid, especially in pregnancy, include several blood-pressure reducing drugs, aminoglycosides, cyclosporine, and blood-thinning drugs.

Does Meloxicam Thin Blood?

Yes, it does to some extent. When used with other blood-thinning drugs, it can cause bleeding, which may even be fatal. Mobic interaction with tramadol should also be considered in such situations. There are no specific studies that show whether Mobic is passed on in breast milk or not. Therefore, the drug should be avoided by breastfeeding mothers.

Meloxicam Warnings

There are some significant effects that Mobic can have on the health, and these are included among Meloxicam warnings in the drug’s prescribing information. They are not absolute contraindications, but it is vital for those who use the medication to be aware of these adverse health effects, particularly in people who have certain pre-existing conditions.

These Warnings Include the Following:

• In the gastrointestinal system, the drug can result in gastrointestinal tract bleeding or the development or worsening of stomach ulcers.
• There can be an increase in the levels of liver enzymes, and in some cases, it can result in liver failure.
• Cardiovascular effects can include heart attacks, the formation of blood clots, and stroke. These can be fatal.
• Fluid retention, also known as edema, which manifests as swelling of the body, typically starting from the feet.
• It can cause kidney failure and damage.
• In the skin, Mobic use can cause severe conditions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and exfoliative dermatitis.

Patients with pre-existing conditions such as heart disease, peptic ulcer disease, hypertension, and liver failure, should avoid using Mobic. Alternatively, they should provide all previous health information to their medical doctor, who will then use that information to choose pain relief medication.

Don’t Take Mobic With Other NSAIDs

Can a patient take ibuprofen with Meloxicam? Since ibuprofen is also an NSAID, patients should not use it with Mobic without consultation from a doctor. Both of them act as blood thinners. When used together, they increase the chances of internal bleeding and renal toxicity.

Other NSAIDs like Celebrex may be used instead to avoid the severe adverse reactions of Mobic. However, when considering Mobic vs. Celebrex, Celebrex should not be used by patients with heart disease.

How to Minimize Meloxicam Adverse Effects?

Mobic is an NSAID drug used to treat pain, swelling, tenderness, and stiffness of joints caused by arthritis and other related conditions. Side effects of Meloxicam in humans span a wide range of problems that could arise while taking this medicine. Therefore, whenever a medical doctor prescribes the medication, Mobic adverse reactions are weighed to ensure that the benefits outnumber the negative reactions.

There are some steps that one might take to minimize the adverse effects of this drug.

These Steps Include the Following:

• Provide your doctor with all information on chronic health conditions, drugs currently being used, drug allergies, and medical history
• Any side effects, regardless of how mild, should be noted and discussed with your medical doctor
• The medication should only be used exactly as prescribed
• Taking this medicine after a meal also reduces the chances of a stomach ulcer or stomach irritation
• To reduce the less severe gastrointestinal symptoms like heartburn, gas, or bloating, patients should take the medication on a full stomach
• In the case of adverse reactions which are severe or that do not leave, discontinuing the drug should be considered

If adverse effects of Mobic become severe or abuse to this medication has been developed, professional addiction treatment is the right step to take. Meloxicam withdrawal symptoms are not common, and if present, are usually not severe. However, stopping the drug can cause the pain to come back. This will require looking for Meloxicam alternative medications that should be discussed with the doctor.

Frequently Asked Questions

Does Meloxicam Make You Sleepy?

Drowsiness is not among the common side effects (those that occur in more than 2% of patients) of this medication. On the contrary, the drug is more likely to cause insomnia than drowsiness, and it is seen in 3.6% of patients. It can cause dizziness, however.

What Are the Dangers of Meloxicam?

The dangers of Meloxicam include abuse of the drug, which predisposes to other dangers, such as GI bleeding, stomach ulcers, GI perforation, liver and kidney failure, skin conditions, and heart issues. It is important to make sure that your medical doctor is aware of any conditions you may have to reduce the risk of these dangers.

Can Meloxicam Cause Allergy?

Some individuals may be experiencing an allergic reaction to Meloxicam, but that is not a common adverse effect of this drug. Other Meloxicam allergy symptoms include skin irritation or skin rash.

However, more severe Mobic side effects related to allergies include asthma attacks, hives, shortness of breath, and other allergic reactions. Patients with a history of a similar allergic reaction to aspirin or other NSAIDs should not use Mobic. It will most certainly cause severe adverse effects in those individuals. Such symptoms can also be part of the side effects of Meloxicam.

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Page Sources

1. Martin, R. M., Biswas, P., & Mann, R. D. (2000). The incidence of adverse events and risk factors for upper gastrointestinal disorders associated with meloxicam use amongst 19,087 patients in general practice in England: cohort study. British journal of clinical pharmacology, 50(1), 35–42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014964/
2. C.S. Mott Children’s Hospital, meloxicam (oral/injection), 2020, https://www.mottchildren.org/health-library/d04532a1
3. Goldstein, J. L., & Cryer, B. (2015). Gastrointestinal injury associated with NSAID use: a case study and review of risk factors and preventative strategies. Drug, healthcare and patient safety, 7, 31–41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310346/
4. Eccleston, C., Cooper, T. E., Fisher, E., Anderson, B., & Wilkinson, N. M. (2017). Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents. The Cochrane database of systematic reviews, 8(8), CD012537. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460508/
5. Yocum, D., Fleischmann, R., Dalgin, P., Caldwell, J., Hall, D., & Roszko, P. (2000). Safety and efficacy of meloxicam in the treatment of osteoarthritis: a 12-week, double-blind, multiple-dose, placebo-controlled trial. The Meloxicam Osteoarthritis Investigators. Archives of internal medicine, 160(19), 2947–2954. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485487
6. Saag, K. G., Rubenstein, L. M., Chrischilles, E. A., & Wallace, R. B. (1995). Nonsteroidal antiinflammatory drugs and cognitive decline in the elderly. The Journal of rheumatology, 22(11), 2142–2147. https://pubmed.ncbi.nlm.nih.gov/8596158/
7. Marcum, Z. A., & Hanlon, J. T. (2010). Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults. The annals of long-term care : the official journal of the American Medical Directors Association, 18(9), 24–27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158445/
8. Distel, M., Mueller, C., Bluhmki, E., & Fries, J. (1996). Safety of meloxicam: a global analysis of clinical trials. British journal of rheumatology, 35 Suppl 1, 68–77. https://academic.oup.com/rheumatology/article-pdf/35/suppl_1/68/5043688/35-suppl_1-68. pdf
9. United States Food and Drug Administration, Mobic (meloxicam) tablets prescribing information, 2011, https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020938s022lbl.pdf

Published on: May 14th, 2019

Updated on: August 3rd, 2021

Olivier George is a medical writer and head manager of the rehab center in California. He spends a lot of time in collecting and analyzing the traditional approaches for substance abuse treatment and assessing their efficiency.

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.

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Drug-Induced Hypertension

US Pharm. 2008;33(9):HS11-HS20.

Pharmacists often receive
inquiries about the effects of medications on blood pressure. For example,
concerns about OTC cough and cold products still arise even though some
ingredients, such as phenylpropanolamine, have been removed from the U.S.
market. While only a few classes of drugs cause clinically significant
increases in arterial pressure, pharmacists should be aware of drugs that may
interfere with effective blood pressure control. A review of drug–drug
interactions with antihypertensive agents is beyond the scope of this article.
However, some of the more common examples of drug-induced hypertension will be
discussed (TABLE 1). Drug-induced blood pressure elevations represent
an important and modifiable cause of secondary hypertension; therefore, it is
imperative that pharmacists recognize this causal relationship.

Sympathomimetic Agents

It is well
established that sympathomimetic amines cause dose-related increases in blood
pressure. ^1-4 While sympathomimetic-induced hypertension may not be
clinically significant in healthy patients, it can become hazardous in others.^1-4
Sympathomimetic amines include amphetamines and similar compounds, such as
pseudoephedrine, phenylpropanolamine, and ephedrine. Historically, these
compounds were contained in some OTC cough and cold preparations. Because
phenylpropanolamine use was correlated with hypertension and stroke, the FDA
banned it from the market in November 2000.^3,4

Pseudoephedrine:
Pseudoephedrine is a bronchodilator and nasal vasoconstrictor that is
generally innocuous when used in recommended doses. However, due to its
potential for misuse, many retailers restrict its sale to behind the counter.
Pseudoephedrine is commonly used to treat symptoms of rhinitis and rhinorrhea,
but its effects on blood pressure and heart rate remain uncertain. Because of
its pharmacologic similarity to ephedrine and phenylpropanolamine, use of
pseudoephedrine has likewise been avoided in hypertensive patients.

Salerno et al assessed whether
pseudoephedrine causes clinically meaningful elevations in blood pressure and
heart rate.⁵ In this meta-analysis, the primary data extracted
included systolic and diastolic blood pressure and heart rate. Twenty-four
clinical trials had extractable vital sign information and included a total of
1,285 patients. This analysis demonstrated that pseudoephedrine causes a small^{mean increase in systolic blood pressure (approximately 1 mmHg), with nosignificant effect on diastolic blood pressure, and a slight increase in
heart rate (about 3 beats per minute). Immediate-release formulations had a
greater effect than sustained-releaseformulations, which would be expected
based on pharmacokinetics. Among immediate-release formulations, there wasa dose-related increase in all three cardiovascular variables. More
substantial increases in both systolic and diastolic blood pressure were noted
with increasing doses of pseudoephedrine. Women seemed to be slightly less
susceptible to the cardiovascular effectsthan men. Inpatients
whose hypertension was stable and controlled, pseudoephedrinetherapy
increased systolic blood pressure but had no effect on diastolic pressure.
There was no effect on heart rate in treated hypertensive patients, though
this may have been because many patients were receiving beta-blockers. There
was no documentation of any clinically significant adverseoutcomes,
such as hypertensive emergencies, stroke, or arrhythmia. Other investigators
have similarly concluded that when it is used at standard doses,
pseudoephedrine does not have a clinically significant effect on systolic or
diastolic blood pressure in patients with controlled hypertension.6}

Pharmacists should counsel
patients that pseudoephedrine may modestly increase blood pressure and heart
rate. These effects are greatest with immediate-release^{formulations,
higher doses, and short-term medicationadministration. Patients
with stable, controlled hypertensiondo not seem to be at higher
risk for blood pressure elevation compared to those without hypertension.
However, one cannot predict how any individual patient willreact.
The risk-benefit ratio should be evaluated carefullybefore using
any sympathomimetic agent in persons with hypertension. Pharmacists shouldinstruct
patients with cardiovascular disease to monitor theirblood
pressures carefully after starting pseudoephedrine-containing medications.
Sustained-release products would generally be preferred to avoid increases in
blood pressure. Alternatively, intranasal decongestants such as oxymetazoline
could be used, since they have not been shown to induce hypertension when used
at recommended doses.7}

Amphetamine Derivates:
A variety of drugs used for narcolepsy and attention-deficit/hyperactivity
disorder are chemically related to amphetamine. These central nervous system
(CNS) stimulants include dextroamphetamine, methamphetamine, and
methylphenidate. The FDA recently issued a warning for dextroamphetamine,
stating that using CNS-stimulant treatment at usual doses in children and
adolescents with serious heart problems and structural cardiac abnormalities
has been associated with sudden death.⁸ However, adverse
cardiovascular events induced by stimulants are not limited to children.
Adults with known cardiac disease have also shown increased risk of sudden
death with stimulant use at normal doses. As a general rule,
amphetamine-related compounds (i.e., CNS stimulants) should be avoided in
patients with known serious structural cardiac abnormalities, cardiomyopathy,
serious heart rhythm abnormalities, or other serious cardiac problems that
increase the risk of sudden death. Increases in both heart rate and blood
pressure have been observed in children receiving drugs in this class.⁹
Thus, this potential cardiovascular risk should be balanced against the
beneficial behavioral effects of these medications.

NSAIDs and COX-2 Inhibitors

Nonsteroidal
anti-inflammatory drugs (NSAIDs) have potentially adverse effects on blood
pressure.^10,11 NSAIDs block both cyclooxygenase-1 (COX-1) and COX-2
enzymes, which leads to a reduction in prostaglandin formation. These drugs
can have widespread beneficial and harmful effects, depending on the patient
context. Drug-induced hypertension associated with NSAIDs is due to the renal
effects of these drugs. Specifically, NSAIDs cause dose-related increases in
sodium and water retention. This effect is also seen with COX-2 selective
agents, such as celecoxib.¹¹

The COX-1 and COX-2 isoforms
are both expressed within the normal adult kidney, with COX-1 in the
glomerulus and afferent arteriole and COX-2 in the afferent arteriole, the
podocytes, and macula densa.¹² The specific location of each of
these isoenzymes in the kidney translates into notably different effects on
renal function. The prostaglandins produced by COX-1 primarily affect renal
homeostasis by promoting vasodilation in the renal vascular bed, reducing
renal vascular resistance, and consequently increasing renal perfusion.
Prostaglandins produced by the COX-2 isoenzyme have diuretic and natriuretic
effects.^12,13 In patients who are hemodynamically compromised, the
effects of the two isoenzymes are essential for the maintenance of renal
perfusion because of their vasodilatory effects. Because NSAIDs block the
production of the COX-1 and COX-2 prostaglandins, renal side effects are not
uncommon, occurring in approximately 1% to 5% of NSAID users.¹³

By inhibiting COX-2’s
natriuretic effect, thereby increasing sodium retention, all NSAIDs carry with
them the consequent risk of increased fluid retention.¹⁴
Additionally, the inhibition of vasodilating prostaglandins and the production
of vasoconstricting factors, namely endothelin-1, can contribute to the
induction of hypertension in a normotensive and/or controlled hypertensive
patient. ¹⁴

In a comparison of celecoxib
with diclofenac conducted in 287 patients with arthritis, cardiovascular and
renal side effects were seen in 79 patients (27.8%), with hypertension being
the most common (16.6%).¹⁴ There was no statistical difference in
the incidence of hypertension between the traditional NSAID and COX-2 groups.
This initiation of hypertension by NSAIDs is especially important in the
discussion of COX-2 safety in light of the fact that hypertensive status is a
key risk factor in the progression of virtually all cardiovascular diseases
including stroke, myocardial infarction, and congestive heart failure.¹⁵

A recent meta-analysis of
COX-2 inhibitors and their effects on blood pressure was published.¹⁶
Data were collected in 45,451 patients from 19 clinical trials. Interestingly,
there appeared to be a somewhat greater blood pressure elevation^{with
COX-2 inhibitors compared with placebo and nonselective NSAIDs (e. g.,
ibuprofen and diclofenac). Rofecoxibappeared to confer a greater
risk of developing clinically important elevations in both systolic and
diastolicpressures in comparison to celecoxib. However, rofecoxib
was voluntarily pulled from the market in 2004 due to concerns about increased
risk of heart attack and stroke.17}

Because of the widespread
availability of NSAIDs without a prescription, many patients with hypertension
may be at risk for aggravated blood pressure effects caused by these drugs.
Pharmacists should take a careful medication history and specifically inquire
about OTC use of NSAIDs. Patients with hypertension should be more closely
monitored for blood pressure elevations when using NSAIDs. Patients should be
counseled that this adverse effect tends to be dose related, but it is not
always predictable. The adverse effect of all NSAIDs and COX-2 inhibitors on
blood pressure may have the most^{clinical significance in the
elderly, in whom the prevalenceof arthritis, hypertension, and
NSAID use is high. 18}

Corticosteroids

All corticosteroid
drugs, including prednisone, can cause sodium retention, resulting in
dose-related fluid retention.¹⁹ Corticosteroids with strong
mineralocorticoid effects, such as fludrocortisone and hydrocortisone, produce
the greatest amount of fluid retention. However, some corticosteroids that
lack significant mineralocorticoid activity (e.g., dexamethasone,
triamcinolone, betamethasone) may produce minor fluid retention.²⁰
Corticosteroid-induced fluid retention can be severe enough to cause
hypertension, and patients with preexisting hypertension may develop a
worsening of blood pressure control when these drugs are initiated. The
principal mechanism of corticosteroid-induced hypertension is the
overstimulation of the mineralocorticoid receptor, resulting in sodium
retention in the kidney. This results in volume expansion and a subsequent
increase in blood pressure. Corticosteroid-induced hypertension may respond to
diuretic therapy. ²¹ The smallest effective dose and shortest
duration of steroid therapy should be used in order to decrease the
development of this adverse effect.

Fludrocortisone causes
significant blood pressure increases and, thus, is useful in treating patients
with postural hypotension. In a study of 64 elderly patients receiving an
average dose of 75 mcg of fludrocortisone for approximately five months, four
patients had to withdraw because of drug-induced hypertension.²²
The study investigators concluded that fludrocortisone therapy was poorly
tolerated in elderly patients, even at low doses.

Caffeine

The effects of caffeine on blood
pressure control are not well defined. A meta-analysis of randomized
controlled trials analyzing the effect of either coffee or caffeine alone on
blood pressure levels was recently published.²³ A total of 16
studies with randomized, controlled designs were selected for review,
representing 1,010 subjects. An increase of 2.04 mmHg in systolic blood
pressure and of 0.73 mmHg in dia­ stolic blood pressure was found after
pooling these trials. When the coffee and caffeine trials were analyzed
separately, the blood pressure elevations induced were larger with caffeine
(410 mg/day) than with coffee (725 mL/day). The effects of coffee and caffeine
on heart rate were not significant.

Estrogens and Progestins

Chronic use of oral contraceptives
may slightly raise blood pressure in certain women and may have other adverse
effects on cardiovascular risk. Early epidemiologic studies using high-dose
estrogen found mean elevations in blood pressure of 3 to 6 mmHg systolic and 2
to 5 mmHg diastolic, with approximately 5% of women developing new
hypertension.²⁴ This was more likely to occur in patients who had
previously developed hypertension during a pregnancy or in those with a family
history of hypertension. Although the rise in blood pressure is usually mild,
malignant hypertension can occur. ²⁵ The main concern with an oral
contraceptive–induced rise in blood pressure is the development of persistent
hypertension and subsequent premature cardiovascular disease, especially in
women who smoke. Cessation of therapy typically leads to a return to baseline
blood pressure within two to 12 months, but proteinuria may persist.^25,26

The mechanisms responsible for
the hypertensive effect of oral contraceptives are poorly understood. The
renin-angiotensin system may be involved, since estrogen stimulates the
hepatic production of the renin substrate angiotensinogen.²⁷ Both
estrogen and progesterone appear to contribute in a dose-dependent fashion.
The often-quoted 5% incidence of hypertension associated with estrogen is
derived from studies of high-dose therapy in which the estrogen dose was at
least 50 mcg and the progestin dose was 1 to 4 mg.²⁴ However,
current preparations contain as little as 20% of the amount of estrogen and
progestin used in previous preparations. A report from the Nurses’ Health
Study prospectively evaluated almost 70,000 female nurses, aged 25 to 42 years.²⁸
After adjustment for age, weight, smoking, family history, and other risk
factors, the relative risk of hypertension in the nurses compared to women who
never used oral contraceptives was 1.8 for current users and 1.2 for previous
users. Overall, only 41.5 cases of hypertension per 10,000 person-years could
be attributed to oral contraceptive use, and this number rapidly declined with
cessation of therapy. In a meta-analysis of 14 studies published between 1980
and 2003, the relative risk of stroke and heart attack increased two-fold in
current users of oral contraceptives (<50 mcg of ethinyl estradiol daily).²⁹

Postmenopausal estrogen
replacement therapy (ERT), or hormone replacement therapy (HRT) when combined
with progestin, consists of much lower estrogen doses than those in oral
contraceptives. ERT and HRT appear to have a neutral effect on blood pressure
as illustrated by the following observations from two large randomized trials.
The Women’s Health Initiative (WHI) is the largest (N = 16,000) randomized,
placebo-controlled trial that has evaluated the effect of estrogen-progestin
replacement on outcomes in postmenopausal women.³⁰ At 5.2 years,
HRT produced only a small increase (1.5 mmHg) in systolic pressure compared to
placebo. Similar findings were noted in the PEPI trial in which ERT, with or
without progestins, did not affect blood pressure at three years.³¹

Additional studies involving
fewer women have found a reduction of ambulatory blood pressure and a greater
decline of nocturnal pressure in ERT users.^32,33 It is possible
that HRT may slow the rise in systolic pressure over a longer period of
treatment.³⁴ However, because of the significant increases in
coronary, stroke, and venous thromboembolic risk demonstrated in the WHI, HRT
is no longer recommended for cardiovascular protection.³⁵

Dietary Supplements

Ginseng is
generally recognized as safe and has been associated with few serious side
effects. Because it can have a mild stimulant effect, use with other
stimulants in patients with cardiovascular disease should be cautioned. A type
of ginseng abuse syndrome, characterized by diarrhea, hypertension,
nervousness, dermatologic eruptions, and insomnia, has been described.³⁶
This syndrome may be exhibited after single high doses or prolonged periods of
use. Other supplements that may increase arterial pressure include natural
licorice and yohimbine.³⁷ Generally, all patients with hypertension
should discuss use of dietary supplements with their pharmacist or physician
beforehand. The effects of most supplements on blood pressure have not been
adequately characterized.

Serotonin-Norepinephrine
Reuptake Inhibitors

Venlafaxine:
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) used in
the treatment of depression and anxiety disorders. The likely mechanism of
venlafaxine-induced hypertension is the increase in levels of norepinephrine
and the subsequent potentiation of noradrenergic neurotransmission. ³⁸
The extended-release formulation of venlafaxine increases blood pressure in
approximately 3% of patients when normal doses (75-150 mg) are used.³⁸
The majority of these blood pressure elevations, however, were considered
minor. Doses >=300 mg of extended-release venlafaxine demonstrated
clinically significant elevations in 13% of patients, with the majority of
blood pressure increases between 10 and 15 mmHg.³⁹ However, it is
important to note that dosing 300 mg or more is not common, and the risk of
venlafaxine-induced hypertension will usually not warrant the discontinuation
of this drug.⁴⁰

Sibutramine:
The clinical significance
of sibutramine-induced hypertension is not well defined. Sibutramine is an
SNRI and is chemically similar to amphetamine. Sibutramine’s likely mechanism
of blood pressure elevation in both normotensive and hypertensive patients is
the elevated amount of norepinephrine present in the body. ⁴¹ A
clinical trial evaluating the adverse reactions induced by sibutramine
demonstrated a mean elevation of systolic and diastolic blood pressures of 2
mmHg in previously normotensive patients receiving 10 to 15 mg sibutramine
daily. Interestingly, an elevation of 7 mmHg was demonstrated in hypertensive
patients receiving similar doses.⁴² Other trials have demonstrated
similar findings.^43,44 Patients with established hypertension
receiving sibutramine experienced significantly higher elevations in blood
pressure than patients who had normal blood pressure before medication
initiation. Sibutramine treatment should probably be limited to patients who
do not have cardiovascular disease, including hypertension, functional
abnormalities, and coronary artery disease.

Immunosuppressants

Cyclosporine:
The adverse effect of
cyclosporine on blood pressure is well known.⁴⁵ The exact mechanism
of cyclosporine-induced hypertension is uncertain, but several hypotheses have
been proposed, including increased prostaglandin synthesis and decreased
water, sodium, and potassium excretion. ^46,47 Up to 50% of renal
transplant patients receiving cyclosporine treatment have reported elevated
blood pressure, and most of these cases required treatment for hypertension.⁴⁸
Because of the adverse effects of cyclosporine withdrawal in transplant
patients and in patients with autoimmune disease, cyclosporine is rarely
discontinued for elevated hypertension. Treatment of cyclosporine-induced
hypertension may be pharmacologic, consisting possibly of calcium channel
blockers, diuretics, beta-blockers, or ACE inhibitors, or nonpharmacologic,
consisting of reduced sodium intake.⁴⁵ In 1999, a consensus
statement was released, stating that if systolic blood pressure rose above 140
mmHg or diastolic pressure rose above 90 mmHg on two consecutive occasions,
then the cyclosporine dose should be decreased by 25%.⁴⁸ Blood
pressure should be monitored every two weeks for the first three months of
cyclosporine therapy in order to monitor for any changes.

Tacrolimus:
In patients with severe, treatment-refractory cyclosporine-induced
hypertension, switching to tacrolimus may be an option. Tacrolimus, like
cyclosporine, has been shown to have a significant effect on blood pressure.
However, the incidence of tacrolimus-induced hypertension (35%) is less than
that of cyclosporine (50%).⁴⁹ The mechanism of tacrolimus-induced
hypertension is postulated to be similar to cyclosporine’s, as previously
discussed.⁵⁰ Modifications similar to those listed for
cyclosporine-induced hypertension, whether pharmacologic or nonpharmacologic,
may be required to treat the blood pressure elevations associated with
tacrolimus therapy.⁵¹ Careful blood pressure monitoring is
warranted during therapy with either tacrolimus or cyclosporine.

Summary

Pharmacists should
maintain an awareness of the major drug classes that may increase blood
pressure and/or interfere with effective blood pressure control. Examples
include sympathomimetics, NSAIDs, estrogens, corticosteroids, cyclosporine,
and some natural products (e.g., ginseng). Pharmacists should screen for
medications that raise blood pressure and should provide feedback to patients
and medical providers to decrease this potential cause of secondary
hypertension. Generally, all patients with hypertension should be monitored
more closely anytime additional medications are prescribed, especially when
drugs known to raise blood pressure are added.

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prescription-event monitoring studies in England. Obesity. 2007;15:2712-2722.

45. Vercauteren SB,
Bosmans JL, Elseviers MM, et al. A meta-analysis and morphological review of
cyclosporine-induced nephrotoxicity in auto-immune diseases. Kidney Int.
1998;54:536-545.

46. Kutkuhn B,
Hollenbeck M, Heering P, et al. Development of insulin resistance and elevated
blood pressure during therapy with cyclosporine A. Blood Press.
1997;6:13-17.

47. Charnick SB,
Nedelman JR, Chang CT, et al. Description of blood pressure changes in
patients beginning cyclosporin A therapy. Ther Drug Monit.
1997;19:17-24.

48. Cush JJ, Tugwell P,
Weinblatt M, Yocum D. US consensus guidelines for use of cyclosporin A in
rheumatoid arthritis. J Rheumatol. 1999;26:1176-1186.

49. Pham S, Kormos R,
Hattler B, et al. A prospective trial of tacrolimus in clinical heart
transplantation: intermediate-term results. J Thorac Cardiovasc Surg.
1996;111:764-772.

50. Fung JJ, Todo S,
Jain A, et al. Conversion from cyclosporine to FK 506 in liver allograft
recipients with cyclosporine-related complications. Transplant Proc.
1990;22:6-12.

51. Jain A, Reyes J,
Kashyap R, et al. Liver transplantation under tacrolimus in infants, children,
adults, and seniors: long-term results, survival, and adverse events in 1000
consecutive patients. Transplant Proc.1998;30:1403-1404.

To comment on this article, contact

[email protected].

Diclofenac (Voltaren) and risk of cardiovascular events (heart attack and stroke)

Published: 8 July 2013

Trans-Tasman Early Warning System – Alert Communication

Diclofenac (Voltaren) and risk of cardiovascular events (heart attack
and stroke)

Products affected
Information for consumers and caregivers
Information for healthcare professionals
Data summary
What action is Medsafe taking?
How to report
Further information

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used for
the relief of moderate pain and inflammation. Diclofenac provides symptomatic
relief but has not been shown to halt or reverse the underlying disease
process.

Recent publications have suggested an increased risk of cardiovascular
events such as heart attack and stroke with the use of diclofenac. Medsafe
and the Medicines Adverse Reactions Committee (MARC) have concluded there
is a very small increased risk of these effects with diclofenac, when used
at high doses and for long-term therapy.

However, study limitations make it impossible for Medsafe to determine
whether there is a higher risk of cardiovascular events with diclofenac
treatment compared to treatment with other NSAIDs.

Diclofenac is available under different brand names (refer to product
list at the end of this alert). This alert applies to diclofenac tablets,
suppositories and injections. It does not apply to diclofenac-containing
products applied to the skin or used in the eye.

Products affected

A list of products containing diclofenac available
in New Zealand can be found below (Further infomation).

Information for consumers and caregivers

• Non-steroidal anti-inflammatory drugs, including diclofenac,
  are effective at relieving pain and inflammation for many conditions.
• For most people, taking diclofenac is safe. However, if you
  have high blood pressure, high cholesterol, diabetes, your kidneys
  do not work very well or you smoke, you should check with your healthcare
  professional that this medicine is appropriate.
• Use the lowest dose that works for you and stop as soon as you
  can.
• Medsafe cannot give advice about an individual’s medical condition.
  If you have any concerns about a medicine you are taking Medsafe
  encourages you to talk to your healthcare professional.

 

Information for healthcare professionals

• The overall benefit to risk of harm balance of diclofenac remains
  positive.
• It is not possible to clearly differentiate cardiovascular risk
  between different non-steroidal anti-inflammatory drugs (NSAIDs).
• Use the lowest effective dose for the shortest possible duration.
• Patients who have had a recent myocardial infarction (within
  the last 6 to 12 months) should not use diclofenac.
• The effectiveness of diclofenac (and other NSAIDs) may vary
  between individual patients.
• Patients receiving long-term diclofenac should be periodically
  reviewed for effectiveness, adverse effects and development of cardiovascular
  risk factors. Consideration should be given to monitoring blood
  pressure, haemoglobin levels and renal function.
• Relevant risk factors for cardiovascular events associated with
  diclofenac (and other NSAIDs) include hypertension, hyperlipidaemia,
  diabetes, ischaemic heart disease and smoking.
• Discuss the risks and benefits of NSAID treatment with patients
  before commencing therapy.
• Don’t forget the other important harms associated with NSAID
  treatment, such as gastrointestinal bleeding, impaired renal function
  and severe skin reactions.
• Report any adverse reactions to the Centre of Adverse Reactions
  Monitoring (CARM).

Data summary

The Medicines Adverse Reactions Committee (MARC) reviewed the latest
data in June 2013. The MARC concluded that there was a small increase in
the risk of cardiovascular events with the use of diclofenac.

Many studies had a low number of overall events. This limits risk estimation,
with subsequent risk values only marginally statistically significant. However,
diclofenac is widely used and it is important to highlight the small increase
in risk.

The risk values varied between the different studies. Examples of data
reviewed are shown below:

Table 1: Odds ratios estimated by case-crossover analysis for specific
causes of death associated with exposure to NSAIDs stratified according
to daily dosage¹.

Figure 1: Estimate of rate ratio (with 95% confidence interval) for non-steroidal
anti-inflammatory drugs compared with placebo or non-use, for primary outcome
of myocardial infarction².

Table 2: Estimated relative risk of cardiovascular events according to
risk of underlying cardiovascular disease, compared with non-use³*

*In general, high risk = experienced prior vascular ischaemic events,
low risk = no such history

The limitations of the studies included in the review included a lack
of information on the efficacy of the different medicines in individual
patients, the inability to adjust for some important confounders (eg, smoking
status, alcohol use, body mass index or obesity, over-the-counter non-steroidal
anti-inflammatory drug [NSAID] use and use of other medications), the observational
nature of most studies, and a lack of information in many instances of dosage,
regimen and indication for use.

The MARC noted that other NSAID adverse reactions are also important,
including the risk of gastrointestinal events, renal injury and severe skin
reactions. The MARC also noted that other types of pain relievers also have
undesirable effects.

A previous MARC review (2006/2007) of the risk of cardiovascular events
with the use of NSAIDs determined that all NSAIDs are associated with an
increased risk of serious cardiovascular events. The MARC recommended that
no distinction should be made between individual NSAIDs or dosages, or between
prescription-only and over-the-counter NSAIDs, in terms of the risk management
advice given. Medsafe was unable to determine from the new data a clear
difference in risk between different NSAIDs. Other risks and benefits associated
with NSAIDs and other types of pain relievers also need to be taken into
account.

References

• Fosbol, E.L. et al. (2010) Cause-Specific Cardiovascular Risk Associated
  with Nonsteroidal Anti-Inflammatory Drugs among Healthy Individuals.
  Circulation: Cardiovascular Quality and Outcomes, 3 (4): 395-405
• Trelle, S et al. (2011). Cardiovascular safety of non-steroidal
  anti-inflammatory drugs: network meta-analysis. BMJ, 342: c7086
• McGettigan P and Henry, D (2011). Cardiovascular Risk with Non-Steroidal
  Anti-Inflammatory Drugs: Systematic Review of Population- Based Controlled
  Observational Studies. PLoS Medicine, Vol. 8 Issue 9 e1001098

What action is Medsafe taking?

Medsafe is working with the sponsors of these products to ensure data
sheets, Consumer Medicine Information and package inserts appropriately
outline the safety of diclofenac.

How to report

Phone	+64 3 479 7247 to speak to a Medical Advisor at CARM.
Online	Submit an online report Prescribers can submit using the online reporting tool available in patient management software.
Yellow Card	A completed Yellow card can be submitted to CARM via email, fax or mail (address is on the card).
Email	[email protected]
Fax	+64 3 479 7150

Further information

European Medicines Agency decision

Product name	Sponsor
Apo-Diclo Enteric coated tablet	Apotex NZ Ltd
Diclax SR Modified release tablet	Douglas Pharmaceuticals Ltd
Diclofenac 25 Film Coated tablet	Dr Reddy’s New Zealand Ltd
Diclofenac Sandoz Enteric coated tablet	Novartis New Zealand Ltd
Voltaren D Dispersible tablet	Novartis New Zealand Ltd
Voltaren Enteric coated tablet	Novartis New Zealand Ltd
Voltaren Osteo Enteric coated tablet	Novartis Consumer Health Australasia Pty Ltd
Voltaren Rapid 25 tablet	Novartis Consumer Health Australasia Pty Ltd
Voltaren Solution for injection	Novartis New Zealand Ltd
Voltaren SR Modified release tablet	Novartis New Zealand Ltd
Voltaren Suppository	Novartis New Zealand Ltd

Meta-analysis of Cyclooxygenase-2 Inhibitors and Their Effects on Blood Pressure | Hypertension | JAMA Internal Medicine

Background 
Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed and are associated with blood pressure (BP) elevation. The development of selective cyclooxygenase-2 inhibitors (coxibs) raises the issue of the magnitude of BP response compared with nonselective NSAIDs. We therefore performed a meta-analysis comparing the effects of coxibs with placebo, nonselective NSAIDs, and each other on BP elevation and hypertension.

Methods 
Nineteen randomized controlled trials involving coxibs were published before May 2004, with a total of 45 451 participants in which BP data were available. The Cohen method statistically combined weighted mean difference (WMD). The Der Simonian and Laird method pooled results concerning the relative risk (RR) of developing hypertension and the RR of clinically important BP elevations.

Results 
Among the trials analyzed, coxibs caused a WMD point estimate increase in systolic and diastolic BP compared with placebo (3.85/1.06 mm Hg) and nonselective NSAIDs (2.83/1.34 mm Hg). Cyclooxygenase-2 inhibitors were associated with a nonsignificantly higher RR of causing hypertension compared with placebo (RR, 1.61; 95% confidence interval [CI], 0.91-2.84; P = .10) and nonselective NSAIDs (RR, 1.25; 95% CI, 0.87-1.78; P = .23). Rofecoxib induced a WMD point estimate increase in systolic BP (2.83 mm Hg) and a nonsignificantly higher risk of developing clinically important systolic BP elevation (RR, 1.50; 95% CI, 1.00-2.26; P = .05) compared with celecoxib.

Conclusions 
Cyclooxygenase-2 inhibitors were associated with a point-estimate BP elevation compared with placebo and nonselective NSAIDs. There was a nonsignificantly higher incidence of developing hypertension compared with nonselective NSAIDs, as was observed with rofecoxib compared with celecoxib. These BP elevations may be clinically significant in relation to increased cardiovascular risk.Published online February 14, 2005 (doi:10.1001/archinte.165.5.ioi50013).

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely prescribed pharmacological agents.¹ However, major limitations to their use have been associated with gastrointestinal toxic effects. This has resulted in a significant preference to prescribe cyclooxygenase-2 inhibitors (coxibs) over conventional NSAIDs because of their apparent lower toxicity profile,^2,3 despite most patients not meeting specified criteria for treatment.^4,5

Additional toxic effects extending beyond the gastrointestinal tract have been identified. For example, rofecoxib has been associated with an increased risk of cardiovascular events.² Furthermore, coxibs may be associated with systemic hypertension,^6-10 as are nonselective NSAIDs.^11,12 However, it is unknown how the coxibs compare with nonselective NSAIDs with respect to blood pressure (BP) effects and hypertension risk.

Available data on the potential association of coxibs with hypertension are conflicting because they are drawn from heterogeneous studies not specifically designed to address this issue.^10,13 Safety data from trials involving coxibs have alluded to an increased risk of BP elevation or development of hypertension.^2,6,10,14-18 However, the study population involved in previous trials was widely heterogeneous, the comorbidity of hypertension among participants remained elusive in trials involving arthritis patients, and the studies themselves varied in trial design. As such, it remains uncertain what magnitude of effect coxibs actually have on BP. To our knowledge, no long-term prospective study has attempted to specifically address this question to date.

Elevated systolic BP is closely associated with increased cardiovascular events including heart failure, myocardial infarction, and death.^19,20 The BP effects of coxibs are a question of major clinical and public health significance owing to widespread and increasing use of these agents. In the United States, at least 20 million people are affected by osteoarthritis,²¹ many with comorbid hypertension.^22,23

To determine if coxibs are associated with higher hypertension risk compared with nonselective NSAIDs, we performed a meta-analysis of available published data as of May 2004. We compared the effects of coxibs and nonselective NSAIDs on BP elevation and the risk of hypertension.

Outcome measures and applied definitions

The outcome measures analyzed were (1) weighted mean difference (WMD) for systolic and diastolic BP, (2) relative risk (RR) of patients developing hypertension (for trials comparing coxibs and placebo and those comparing coxibs and nonselective NSAIDs), and (3) RR of patients developing a clinically important elevation in systolic or diastolic BP (for trials comparing rofecoxib and celecoxib).

For trials comparing coxibs with placebo or nonselective NSAIDs, hypertension was not directly defined and only assessed as part of the safety data obtained during trial observations.^{2,3,6,14,15,17,18,24-31}

For the 3 trials comparing rofecoxib and celecoxib, a clinically important elevation in systolic BP was defined as an increase of 20 mm Hg with an absolute value higher than 140 mm Hg at any time during the trial, while a clinically important elevation in diastolic BP was defined as an increase of 15 mm Hg with an absolute value higher than 90 mm Hg at any time during the trial.^8,9,32

Criteria for inclusion and exclusion of studies for meta-analysis

Prospective randomized controlled trials of parallel design, published in English, were considered for inclusion in this meta-analysis. Studies were included if the BP effects of coxibs and comparator groups were described (available data were classified into appropriate treatment groups where necessary).

Studies with fewer than 50 patients or involving treatment of less than 4 weeks’ duration were excluded. Trial participants with osteoarthritis and/or rheumatoid arthritis, with no restriction to age or sex, were considered for analysis. Studies with healthy volunteers were excluded. A flowchart detailing the reasons for exclusion of studies from consideration in this meta-analysis is provided, in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement³³ (Figure 1).

Search strategy for studies meeting inclusion criteria

We searched MEDLINE and the Cochrane Database of Systematic Reviews from date of inception through May 2004. Each search strategy included keywords related to trial design (meta-analysis, double blind, random allocation, randomized, clinical trial, placebo controlled) which were cross-linked with names of individual coxibs (celecoxib, rofecoxib, meloxicam, etoricoxib, and valdecoxib) and search terms of interest including NSAIDs, hypertension, blood pressure, and safety. Abstracts of major rheumatology, cardiology, and gastroenterology conferences from Europe and North America were reviewed, and bibliographies of all retrieved articles were consulted for additional publications. The Food and Drug Administration (FDA) Web site of currently licensed coxibs was reviewed for data concerning BP effects of coxibs.^34,35 Data extraction was undertaken independently by one investigator (T.-J.A.). Formal quantitative data synthesis was undertaken in a blinded manner by another investigator (S.J.H.), in accordance with the QUOROM statement.³³

Trials meeting inclusion criteria for analysis

Nineteen articles described random allocation of 1 or more coxibs and reported BP measurements.^{2,3,6,8-10,14,15,17,18,24-32} Ten studies were randomized but not placebo-controlled, in which 2 or more NSAIDs were compared.^{2,3,8,9,17,18,24,25,28,32}

Most studies did not have BP measurements as the primary outcome, since these were mainly gastrointestinal safety or arthritis efficacy studies. Twelve articles provided data concerning quantitative change in systolic BP,^{2,8-10,14,15,17,24,25,28,31,32} while 8 articles provided similar data regarding diastolic BP.^{2,10,14,17,24,25,31,32} Only 1 article provided uncertainty data (in the form of SE of the mean) for BP measurements.¹⁰ Sixteen articles provided actual numbers of patients who developed hypertension or experienced worsening of hypertension during the study.^{2,3,6,8-10,14,18,25-32}

All trials were categorized into 3 groups: (1) trials comparing coxibs with placebo (10 trials),^{6,10,14,15,26,27,29-32} (2) trials comparing coxibs with conventional NSAIDs (13 trials),^{2,3,6,14,17,18,24-29,31} and (3) trials comparing coxibs with another coxib (3 trials).^8,9,32 Five studies involved arthritic patients with comorbid diabetes or hypertension.^8-10,17,28 Because there were no apparent systematic differences between trials, we considered it clinically appropriate to pool their results.

Available data were pooled using meta-analytical methods available in the STATA software program (version 7.0; Stata Corp, College Station, Tex). Weighted mean difference of both systolic and diastolic BP change was presented as a point estimate with no confidence interval of uncertainty (because uncertainty was not mentioned in most of the trials analyzed) using the Cohen method. Risk ratio estimates for the development of hypertension (the development of a clinically important elevation in either systolic or diastolic BP in the case of the rofecoxib vs celecoxib comparison) were presented as a point estimate, with 95% confidence intervals, using the Der Simonian and Laird (random effects) method.

STATA assigns relative weights to each individual study according to the contribution of each study to each meta-analysis performed.^36,37 In the case of the Cohen method for continuous data, this is based on a function concerning the treatment group size. For the Der Simonian and Laird method concerning dichotomous data, this is based on a function concerning the treatment group size and the number of events observed.

Statistical significance was set at the α = .05 level on the basis of 2-way z tests implicitly related to the Der Simonian and Laird method only. Statistical significance could not be calculated for WMD calculated via the Cohen method because these results are point estimates only.

The meta-analysis included 45 451 patients from 19 trials (Table). In the trials providing sex stratification, there were overall more women studied, with a ratio of 2.5:1. Most patients had arthritis, of which 29 824 had osteoarthritis and 15 627 had rheumatoid arthritis. The number of patients in each category was (1) coxib vs placebo (n = 5786), (2) coxib vs NSAID (n = 40 888), and (3) rofecoxib vs celecoxib (n = 2833). The coxibs used in the trials were celecoxib, rofecoxib, and etoricoxib. Placebo was a comparator in 10 trials,^{6,10,14,15,26,27,29-32} and the most commonly used nonselective NSAID comparator was naproxen, which was used in 9 trials.^{2,6,14,17,18,26-29}

The WMD increases for systolic BP comparing coxibs with placebo, coxibs with a nonselective NSAID, and rofecoxib with celecoxib were 3.85 mm Hg, 2.83 mm Hg, and 2.83 mm Hg, respectively (Figure 2). The WMD increases for systolic BP comparing rofecoxib with placebo, rofecoxib with a nonselective NSAID, celecoxib with placebo, and celecoxib with a nonselective NSAID were 5.66 mm Hg, 3.32 mm Hg, 2.60 mm Hg, and 0.14 mm Hg, respectively (Figure 2).

The WMD increases for diastolic BP comparing coxibs with placebo and coxibs with a nonselective NSAID were 1.06 mm Hg and 1.34 mm Hg, respectively (Figure 2). The WMD increases for diastolic BP comparing rofecoxib with a nonselective NSAID, celecoxib with a nonselective NSAID, and celecoxib with placebo were 1.59 mm Hg, 0.15 mm Hg, and 0.99 mm Hg, respectively (Figure 2). The WMD for diastolic BP comparing rofecoxib vs celecoxib was not calculated because differences between the 2 agents have not been reported.^8,9

The RR of developing hypertension for coxibs vs placebo (Figure 3) and coxibs vs nonselective NSAIDs (Figure 4) were 1.61 (95% confidence interval [CI], 0.91-2.84; P = .10) and 1.25 (95% CI, 0.87-1.78; P = .23), respectively. A breakdown of contribution for each individual coxib with respect to both of these RR calculations has also been provided (Figure 5 and Figure 6). In the trials comparing rofecoxib vs celecoxib, the RR of developing a clinically important elevation in systolic BP was 1.50 (95% CI, 1.00-2.26; P = .05), and the RR of developing a clinically important elevation in diastolic BP was 1.55 (95% CI, 0.91-2.63, P = .11).

The development of coxibs, with their putative improved gastrointestinal safety profile, has led them to gain significant popularity as an alternative to nonselective NSAIDs for various musculoskeletal ailments.^4,5,38 Our results demonstrate that coxibs cause both systolic and diastolic BP elevation compared with placebo and nonselective NSAIDs. Whether this elevation is clinically significant remains uncertain.

We note a disproportionate rise in systolic BP compared with diastolic BP, on average, with coxib use. This potential widened pulse pressure could have significant cardiovascular risk implications, as demonstrated in the Framingham study,³⁹ which observed a very steep relationship between systolic BP and cardiovascular risk. Interestingly, for each defined level of systolic BP, the lower the diastolic BP, the greater the cardiovascular risk.^39,40 The increase in systolic BP with a lesser change in diastolic BP observed, on average, among patients within these coxib studies over a relative short time may therefore be clinically significant in terms of potential cardiovascular risk.

Our analysis demonstrated a nonsignificantly increased risk of developing hypertension with coxib use compared with both placebo and nonselective NSAIDs. This risk was more pronounced when coxibs were compared with placebo (a 61% increase in RR) compared with nonselective NSAIDs (a 25% increase in RR). This is consistent with both coxibs and nonselective NSAIDs causing prostaglandin inhibition and possessing antinatriuretic and vasoconstrictor properties.^12,41

The question that arises is whether these demonstrated changes are of clinical significance. Cyclooxygenase-2 inhibitors are increasingly used^4,5,38 for musculoskeletal ailments, most commonly arthritis.⁴² The subgroup of patients most commonly afflicted are the elderly, often with cardiovascular comorbidities.²³ These agents can potentially cause or exacerbate hypertension in this patient group. Although the incremental change in BP is small, the potential widening of pulse pressure³⁹ and widespread use of these agents may have significant public health implications.

The other major observation of this investigation was that of a consistent increase in systolic and diastolic BP with rofecoxib in head-to-head trials vs celecoxib.^8,9 There also appears to be a differential effect when reviewing the individual contributions of each coxib with respect to the development of hypertension (Figure 5 and Figure 6). These differential effects on BP by seemingly similar agents may relate to differences in pharmacokinetic and pharmacodynamic properties. Celecoxib has a shorter half-life than rofecoxib, with differential effects on BP still evident during 24-hour ambulatory BP monitoring.^10,35,43 Rofecoxib is metabolized by cytosol reductase, which may (particularly at high doses) competitively inhibit the metabolism of aldosterone. This may further exacerbate fluid and sodium retention as well as vascular remodelling.⁴⁴ Alternatively, celecoxib may also inhibit carbonic anhydrase, leading to a diuretic action that would offset some of the BP-elevating effect of cyclooxygenase-2 inhibition within the kidney.⁴⁵

Analyses of this nature are subject to a variety of limitations. First, a number of studies have used a parallel study design, comparing 2 different NSAIDs (or doses) with a comparator. When combining the results, it was necessary to split the data into several classifications. For example, the study by Sower et al¹⁷ investigated 3 patient groups treated with different NSAIDs (rofecoxib, celecoxib, and naproxen). To conform to meta-analytical methods, the data were split into the following 2 comparisons: rofecoxib (25 mg/d) vs naproxen (1000 mg/d) and celecoxib (200 mg/d) vs naproxen (1000 mg/d). This has resulted in “double counting” of comparator group patients (in this example, naproxen, 1000 mg/d). Considering that the relative weights attributed to both comparisons within the context of the analysis were low (eg, a total of 4.6% of the total weight for the above example), this limitation is unlikely to impact greatly on interpretation of the results.

Inconsistencies in reporting styles among the studies analyzed necessitated some assumptions to be imputed regarding the data. For example, the study by Collantes et al¹⁴ reported a diastolic BP increase among their patients of <1.1 mm Hg, while the study by Emery et al²⁵ reported a BP increase of 1-2 mm Hg. For the purposes of the present analysis, we used 1.1 mm Hg (worst case scenario) and 1.5 mm Hg (midpoint of the range), respectively, as the input data points for these particular studies.

The fact that BP was not a predetermined end point in the trials is another limitation of this analysis. Indeed, most outcomes concerning BP were ancillary considerations as part of the safety assessment for each compound and not part of the primary outcome measures. Most trials did not clearly define the term hypertension.^{2,3,6,8-10,14,15,17,18,24,25,28,30-32} As such, it was difficult to determine if the definitions used in this meta-analysis were universally applied throughout the trials analyzed, which has potential impact on the accuracy of the data available.

Apart from the trials that looked at BP effects as an outcome measure, there was no clear description of techniques (or calibration of instruments) used to measure BP, particularly among the multicenter trials. Two trials used 24-hour ambulatory BP,^10,34 whereas others presumably used clinic or office readings. There are limitations in regard to interpreting the analysis of such different methods of measuring BP.⁴⁶

Similarly, some trials pooled for the analysis mention hypertension as an adverse event. Elevated BP could occur anywhere within each study and might not be related to NSAID effect. For example, a patient experiencing excessive pain during a study visit may have elevated BP and subsequently have been recorded as hypertensive. Given the generally similar analgesic efficacy of the active therapies, this would not be expected to make a significant difference to head-to-head comparisons.

Heterogeneity of the recruited study populations is another area of potential bias among the trials analyzed with respect to preexisting hypertension and use of antihypertensive medication. For instance, the proportion of patients in each study with hypertension at baseline was only noted in 5 of the studies analyzed.^8-10,17,28 It is therefore difficult to determine whether these BP effects occurred in trial participants with preexisting hypertension or in those without (or in both categories). There was also a lack of information about whether the proportion of patients using different antihypertensive medications was evenly distributed. Normotensive patients usually have no significant BP increase when using anti-inflammatory agents,¹ which may lead to an underestimate in our findings. Irrespective of the fact that these trials were randomized, the potential differences between hypertensive and normotensive patients increase the difficulty of establishing BP differences between treatment groups.

A further potential confounder to the individual trial data relates to the varying study designs used among trials, especially in regard to “wash-out” periods of previous NSAID therapy. Only 4 studies reported a “wash-out” period (mandatory in 3 studies^9,14,30 and not specifically required in another²⁵). It is possible that baseline BP and early subsequent measurements could be influenced by prior NSAID use, thereby affecting the relative BP changes during the study.

The possibility of sponsorship bias exists among the data available. Among the Pfizer/Pharmacia-sponsored trials,^3,8-10,18 celecoxib was less likely to cause hypertension than rofecoxib, whereas in Merck Sharp Dohme–sponsored trials,^{2,6,15,24,28,30,32} the BP effects of the 2 agents appeared to be similar.

Finally, a meta-analysis is no substitute for a double-blind, randomized, placebo-controlled clinical trial that is adequately powered. However, it is difficult to design a trial that considers the copious number of different combinations and permutations of commercially available NSAIDs. Because such data are not yet available, we are reliant on retrospective analysis to guide us.

Despite the aforementioned caveats, this meta-analysis conforms to recommendations regarding size and careful searching to reduce publication bias.^36,47 This enables these results to be, what we believe, the best possible summation of available information concerning the research question at hand.

The results of this meta-analysis demonstrate that, among the trials analyzed, there appears to be a somewhat greater BP elevation with coxibs compared with placebo and nonselective NSAIDs. Rofecoxib appears to confer a greater risk of developing hypertension and clinically important elevations in both systolic and diastolic BP compared with celecoxib. The effects observed may have most clinical significance in the elderly, in whom the prevalence of arthritis and hypertension is high.

Cyclooxygenase-2 inhibitors are a welcome addition to the therapeutic options in the treatment of arthritis, which remains a chronic, debilitating, and painful condition. However, their potential (and differential) effect on BP elevation requires caution in their use and warrants further investigation. Clinicians need to weigh the risks of improved gastrointestinal safety vs potential hazards of developing elevated BP when considering the use of these agents, especially in the elderly population.

Correspondence: Henry Krum, MBBS, PhD, FRACP, NHMRC Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine and Department of Medicine, Monash University, Alfred Hospital, Melbourne, Victoria 3004, Australia ([email protected]).

Accepted for Publication: December 21, 2004; published online, February 14, 2005.

Financial Disclosure: Dr Liew has been a consultant to Pfizer, and Dr Krum has been a consultant to Pfizer, Merck, and Novartis regarding cyclooxygenase-2 inhibitors.

Funding/Support: Mr Haas currently receives assistance via a NHMRC Public Health Postgraduate Research Scholarship (scholarship application ID No. 237059). Dr Liew currently receives assistance via a Royal Australasian College of Physicians Postdoctoral Fellowship.

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Meloxicam tablets

What is this medicine?

MELOXICAM (mel OX i cam) is a non-steroidal anti-inflammatory drug (NSAID). It is used to reduce swelling and to treat pain. It may be used for osteoarthritis, rheumatoid arthritis, or juvenile rheumatoid arthritis.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Mobic

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• bleeding disorders
• cigarette smoker
• coronary artery bypass graft (CABG) surgery within the past 2 weeks
• drink more than 3 alcohol-containing drinks per day
• heart disease
• high blood pressure
• history of stomach bleeding
• kidney disease
• liver disease
• lung or breathing disease, like asthma
• stomach or intestine problems
• an unusual or allergic reaction to meloxicam, aspirin, other NSAIDs, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

Take this medicine by mouth with a full glass of water. Follow the directions on the prescription label. You can take it with or without food. If it upsets your stomach, take it with food. Take your medicine at regular intervals. Do not take it more often than directed. Do not stop taking except on your doctor’s advice.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for selected conditions, precautions do apply.

Patients over 65 years old may have a stronger reaction and need a smaller dose.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following medications:

This medicine may also interact with the following medications:

• aspirin and aspirin-like medicines
• certain medicines for blood pressure, heart disease, irregular heart beat
• certain medicines for depression, anxiety, or psychotic disturbances
• certain medicines that treat or prevent blood clots like warfarin, enoxaparin, dalteparin, apixaban, dabigatran, rivaroxaban
• cyclosporine
• diuretics
• fluconazole
• lithium
• methotrexate
• other NSAIDs, medicines for pain and inflammation, like ibuprofen and naproxen
• pemetrexed

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Tell your doctor or healthcare provider if your symptoms do not start to get better or if they get worse.

This medicine may cause serious skin reactions. They can happen weeks to months after starting the medicine. Contact your healthcare provider right away if you notice fevers or flu-like symptoms with a rash. The rash may be red or purple and then turn into blisters or peeling of the skin. Or, you might notice a red rash with swelling of the face, lips or lymph nodes in your neck or under your arms.

Do not take other medicines that contain aspirin, ibuprofen, or naproxen with this medicine. Side effects such as stomach upset, nausea, or ulcers may be more likely to occur. Many medicines available without a prescription should not be taken with this medicine.

This medicine can cause ulcers and bleeding in the stomach and intestines at any time during treatment. This can happen with no warning and may cause death. There is increased risk with taking this medicine for a long time. Smoking, drinking alcohol, older age, and poor health can also increase risks. Call your doctor right away if you have stomach pain or blood in your vomit or stool.

This medicine does not prevent heart attack or stroke. In fact, this medicine may increase the chance of a heart attack or stroke. The chance may increase with longer use of this medicine and in people who have heart disease. If you take aspirin to prevent heart attack or stroke, talk with your doctor or healthcare provider.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• nausea, vomiting
• redness, blistering, peeling, or loosening of the skin, including inside the mouth
• signs and symptoms of a blood clot such as breathing problems; changes in vision; chest pain; severe, sudden headache; pain, swelling, warmth in the leg; trouble speaking; sudden numbness or weakness of the face, arm, or leg
• signs and symptoms of bleeding such as bloody or black, tarry stools; red or dark-brown urine; spitting up blood or brown material that looks like coffee grounds; red spots on the skin; unusual bruising or bleeding from the eye, gums, or nose
• signs and symptoms of liver injury like dark yellow or brown urine; general ill feeling or flu-like symptoms; light-colored stools; loss of appetite; nausea; right upper belly pain; unusually weak or tired; yellowing of the eyes or skin
• signs and symptoms of stroke like changes in vision; confusion; trouble speaking or understanding; severe headaches; sudden numbness or weakness of the face, arm, or leg; trouble walking; dizziness; loss of balance or coordination

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• constipation
• diarrhea
• gas

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

90,000 Diclofenac can be dangerous for the heart – scientists

May 31, 2013

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The decision about whether to take painkillers should be made by patients themselves, scientists say

Two popular pain relievers, ibuprofen and diclofenac, can slightly increase the risk of heart problems if taken in large doses for a long time, the researchers say.

Often, these drugs, which help fight inflammation, are taken by people with severe arthritis to help them experience less discomfort in their daily lives.

According to the researchers, some patients consider this risk to be acceptable.

Research published in the medical journal Lancet suggests that the risk of taking these drugs is increased for smokers and overweight people.

This risk has been previously reported, but researchers at the University of Oxford have analyzed the issue with unprecedented care to provide patients with more information to make informed choices.

A team of scientists examined over 353,000 medical histories from 639 separate clinical studies to determine the effects of NSAIDs on the body.

They focused only on cases where patients were given prescriptions for large doses of pain relievers – 150 mg of diclofenac or 2,400 mg of ibuprofen per day.

Researchers found that for every 1000 people taking the medication, the number of heart attacks increased by three annually, heart failure by four, and deaths increased by one, all due to the use of pain relievers.

In absolute terms, the number of heart attacks per 1000 people per year increased from eight (the usual rate) to 11 for people taking these drugs.

“Three cases per thousand per year seems like a low risk, but the conclusion should be made by the patients themselves,” said the head of the researchers, Professor Colin Baigent.

He added: “So if you are a patient, then go to the doctor, sit down and talk to him about it.” It is the patient, according to Professor Baignet, who must decide whether such a risk is acceptable to him.

People taking these drugs temporarily, for example for headaches, do not need to worry, the scientist adds.

At the same time, he added that those who are already at risk of heart problems, taking large doses of these drugs, further increase their risk of getting sick.

High blood pressure, cholesterol and smoking are among the main contributors to heart problems.

Movalis at pressure: indications for use, contraindications

How does Movalis affect pressure: increases or decreases it? This drug belongs to the group of non-steroidal anti-inflammatory drugs, and, in fact, it has nothing to do with blood pressure.However, patients who used “Movalis” noted jumps in blood pressure, to which doctors respond that this is nothing more than a manifestation of side symptoms.

What kind of drug?

“Movalis” medicine is widely used in the treatment of various disorders of the musculoskeletal system. The medication is sold in the following dosage forms:

Indicate your pressure

• solution for intramuscular injection;
• oral tablets;
• rectal suppositories.

The active ingredient in Movalis is meloxicam, which helps relieve painful sensations and prevents the development of inflammatory processes in the body. When taken orally, the medication is perfectly absorbed in the small intestine, and regardless of the meal. Its components are excreted along with feces and urine. With regular use, the maximum concentration is observed on the 3rd day of treatment.

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Indications for use

It is recommended to use the medical preparation “Movalis” for the treatment of the following pathologies:

• The drug is effective in the treatment of osteoarthritis.

  osteoarthritis;

• chronic systemic connective tissue disease of an autoimmune nature;
• ankylosing spondylitis;
• Pain syndromes in arthrosis, osteochondrosis and degenerative changes in the joints.

Back to the table of contents

Contraindications and side effects

ulcerative colitis Increased blood pressure

84

Restrictions on admission	Negative effects
Peptic ulcer	Headaches and dizziness
Bronchial asthma	Tinnitus
Stomatitis
Severe liver and kidney dysfunction	Rash, urticaria and itching on the skin
Bleeding from the gastrointestinal tract	Abdominal pain
Children under 12 years old	Decrease in leukocytes in the blood
Individual intolerance to the components of the drug	Drowsiness
Pregnancy	Anemia
Diabetes mellitus	Decrease in the number of platelets in the blood
Lactats ionic period	Stool problems
Elderly	Nausea and vomiting
Smoking	Inflammation of the colon mucosa
Alcohol abuse	Gastritis and esophagitis
	Visual impairment
	Bronchial asthma
	Heart palpitations
	Painful bloating
	Conjunctivitis

“Movalis”

Hypertensive patients are not recommended to take medication because of its ability to increase blood pressure.

The official annotation to the drug “Movalis” indicates that the drug can increase blood pressure. That is why people diagnosed with hypertension should stop taking this medication. Observing pressure surges, you should stop treatment with “Movalis” and inform your doctor about it in order to find a similar remedy. If necessary, symptomatic therapy can be carried out aimed at normalizing blood pressure indicators.

Back to the table of contents

Drug and alcohol interaction

It is categorically contraindicated to combine Movalis with alcohol-containing beverages. Otherwise, such a combination can provoke the development or exacerbation of inflammatory liver diseases and peptic ulcer disease. If you neglect this recommendation, then when a nonsteroidal anti-inflammatory drug is taken together with alcohol, severe pain in the epigastric region may occur.Before starting a therapeutic course with the drug “Movalis”, you should study the features of its use with other drugs.

When taking Movalis in combination with diuretic drugs, you need to drink as much liquid as possible, as well as periodically monitor the functional parameters of the kidneys. It should be borne in mind that “Movalis” reduces the effectiveness of medications, the action of which is aimed at normalizing blood pressure. The described medication can significantly reduce the contraceptive effect of the intrauterine device.

Specify your pressure

Instructions for use Concor tablets 10 mg 30 pcs

Active ingredients

Form of issue

Tablets

Composition

Active ingredient: Bisoprolol fumarate. Concentration of active substance (mg): 10

Pharmacological effect

Selective beta-blocker, without its own sympathomimetic activity, does not have a membrane stabilizing effect.It has only a slight affinity for the beta-adrenergic receptors of the smooth muscles of the bronchi and blood vessels, as well as for the beta-adrenergic receptors involved in the regulation of metabolism. Consequently, bisoprolol does not generally affect airway resistance and metabolic processes in which beta-adrenergic receptors are involved. The selective effect of the drug on betagadrenergic receptors persists beyond the therapeutic range. Bisoprolol does not have a pronounced negative inotropic effect.The maximum effect of the drug is achieved 3-4 hours after ingestion. Even with the appointment of bisoprolol once a day, its therapeutic effect lasts for 24 hours due to the 10-12 hour half-life from blood plasma. As a rule, the maximum reduction in blood pressure (BP) is achieved 2 weeks after the start of treatment. Bisoprolol reduces the activity of the sympathoadrenal system (SAS) by blocking the beta-adrenergic receptors of the heart. With a single oral administration in patients with ischemic heart disease (IHD) without signs of chronic heart failure (CHF), bisoprolol lowers the heart rate (HR), reduces the stroke volume of the heart and, as a result, reduces the ejection fraction and myocardial oxygen demand.With long-term therapy, the initially increased total peripheral vascular resistance (OPSR) decreases. A decrease in renin activity in blood plasma is considered as one of the components of the hypotensive action of beta-blockers.

Pharmacokinetics

Suction. Bisoprolol is almost completely (more than 90%) absorbed from the gastrointestinal tract. Its bioavailability due to insignificant metabolism “at the first pass” through the liver (at the level of about 10%) is about 90% after oral administration.Food intake does not affect bioavailability. Bisoprolol demonstrates linear kinetics, and its plasma concentrations are proportional to the dose taken in the range from 5 to 20 mg. The maximum concentration in blood plasma is reached after 2-3 hours. Distribution. Bisoprolol is widely distributed. The volume of distribution is 3.5 l / kg. The connection with blood plasma proteins reaches approximately 30%. Metabolism. It is metabolized by the oxidative pathway without subsequent conjugation. All metabolites are polar (water-soluble) and are excreted by the kidneys.The main metabolites found in blood plasma and urine do not show pharmacological activity. The data obtained as a result of experiments with human liver microsomes in vitro show that bisoprolol is metabolized primarily by the CYP3A4 isoenzyme (about 95%), and the CYP2D6 isoenzyme plays only a minor role. Excretion. The clearance of bisoprolol is determined by the balance between excretion by the kidneys unchanged (about 50%) and metabolism in the liver (about 50%) to metabolites, which are also excreted by the kidneys.The total ground clearance is 15 l / h. The half-life is 10-12 hours. There is no information on the pharmacokinetics of bisoprolol in patients with CHF and simultaneous impaired liver or kidney function.

Readings

Arterial hypertension, ischemic heart disease (angina pectoris), chronic heart failure.

Contraindications

Shock.AV block II and III degree. SSSU. Severe sinoatrial blockade, a tendency to bronchospasm (bronchial asthma, obstructive airway diseases), late stages of peripheral circulatory disorders, concomitant use of MAO inhibitors (with the exception of MAO type B inhibitors), if a history indicates that the patient or his relatives have psoriasis (use beta-blockers, including Concor Cor, should be performed only after a careful assessment of the benefit-risk ratio, pheochromocytoma (the appointment of Concor Cor to patients with pheochromocytoma is allowed only after taking alpha-blockers).In patients with chronic heart failure, Concor Cor should not be used in case of exacerbation of heart failure or during episodes of decompensation of heart failure, which require intravenous administration of drugs that affect myocardial contractility. in addition, for patients with chronic heart failure, the use of Concor Cor is contraindicated for bradycardia, if the pulse rate is less than 50-60 minutes, and for arterial hypotension, if systolic blood pressure is less than 90-100 mm Hg. Art.

Use during pregnancy and lactation

During the period of bearing a child, the expectant mother should be especially careful about taking medications. What was safe before pregnancy can have irreversible consequences during pregnancy. Therefore, both the attending physician and you yourself are obliged to own all the information about the pills recommended for the treatment of diseases. Today we will talk about the drug Concor and its compatibility with carrying babies.The drug Concor is prescribed for patients with chronic heart failure, arterial hypertension, ischemic heart disease. The active ingredient of this drug is bisoprolol. It reduces myocardial oxygen demand by lowering blood pressure and heart rate. Sometimes the drug can affect glucose metabolism and the smooth muscles of the arteries and bronchi. A single use of this medication can provide short-term relief within 24 hours. For adult patients, Concor is prescribed according to the scheme.If the patient is just starting treatment with the drug, then the recommended dose is half a tablet per day, then you can take 1 tablet (5 mg of bisoprolol fumarate) per day. Doses of Concor are selected for each patient individually, taking into account the propensity to allergies, the tolerability of the drug and the presence of chronic diseases. Usually, the course of treatment with this drug is long. You should know that 98% of it is excreted by the kidneys, 2% of the dose – through the intestines: The period of excretion from the body lasts up to 12 hours.

Method of administration and dosage

The drug is taken orally once a day.The tablets should be taken with a small amount of liquid in the morning before, during or after breakfast. The tablets should not be chewed or powdered. Arterial hypertension and angina pectoris. The dose is selected individually, primarily taking into account the heart rate and the patient’s condition. Typically, the starting dose is 5 mg once a day. If necessary, the dose can be increased to 10 mg once a day. In the treatment of arterial hypertension and angina pectoris, the maximum recommended dose is 20 mg once a day.Chronic heart failure The standard treatment regimen for chronic heart failure includes the use of ACE inhibitors or angiotensin II receptor antagonists (in case of intolerance to ACE inhibitors), beta-blockers, diuretics and, optionally, cardiac glycosides. At the beginning of the treatment of chronic heart failure with Concor, a special titration phase is required under regular medical supervision. A precondition for treatment with Concor is stable chronic heart failure without signs of exacerbation.Treatment with Concor begins in accordance with the following titration schedule. In this case, individual adaptation may be required depending on how well the patient tolerates the prescribed dose, i.e., the dose can be increased only if the previous dose was well tolerated. To ensure an appropriate titration process at the initial stages of treatment, it is recommended to use bisoprolol in a tablet dosage form of 2.5 mg. The recommended starting dose is 1.25 mg once a day. Depending on individual tolerance, the dose should be gradually increased to 2.5 mg, 3. 75 mg, 5 mg, 7.5 mg and 10 mg 1 time per day. Each subsequent dose increase should be carried out at least 2 weeks later. If an increase in the dose of the drug is poorly tolerated by the patient, then a decrease in the dose is possible. The maximum recommended dose for the treatment of chronic heart failure is 10 mg once a day. During titration, regular monitoring of blood pressure, heart rate and the severity of symptoms of chronic heart failure is recommended.Aggravation of the symptoms of chronic heart failure is possible from the first day of using the drug. If the patient does not tolerate the maximum recommended dose of the drug, then a gradual dose reduction should be considered. During the titration phase or after it, a temporary worsening of the course of chronic heart failure, arterial hypotension or bradycardia is possible. In this case, it is recommended, first of all, to adjust the doses of concomitant therapy drugs.You may also need to temporarily reduce the dose of the drug Concor or cancel it. After stabilization of the patient’s condition, titration of the dose should be repeated, or treatment should be continued. Duration of treatment for all indications. Treatment with Concor is usually long-term. Special patient groups: Patients with mild or moderate hepatic or renal impairment, as well as elderly patients, do not usually need to adjust the dosage regimen. In severe renal impairment (CC less than 20 mlmin) and in patients with severe liver disease, the maximum daily dose is 10 mg.Increasing the dose in these patients should be done with extreme caution. Elderly patients do not need dose adjustment. Since there is not enough data on the use of the drug Concor in children, it is not recommended to prescribe the drug to children under 18 years of age. To date, there is insufficient data on the use of Concor in patients with chronic heart failure in combination with type 1 diabetes mellitus, severe renal or liver dysfunction, restrictive cardiomyopathy, congenital heart defects or heart valve disease with severe hemodynamic disorders.Also, until now, there have been no sufficient data on patients with chronic heart failure with myocardial infarction in the last 3 months.

Side effects

From the side of the central nervous system and peripheral nervous system: possible (especially at the beginning of the course of treatment) feeling of fatigue, dizziness, headache, sleep disturbance, depression. rarely hallucinations. Usually these phenomena are mild and usually disappear within 1-2 weeks.From the side of the organ of vision: rarely – visual impairment, decreased tearing (should be considered when wearing contact lenses), conjunctivitis. From the side of the cardiovascular system: in some cases – orthostatic hypotension, bradycardia, impaired AV conduction, decompensation of heart failure with the development of peripheral edema. paresthesias and a feeling of coldness in the extremities are possible. At the beginning of treatment, the condition may worsen in patients with intermittent claudication or Raynaud’s syndrome.From the respiratory system: rarely – shortness of breath (in patients with a tendency to bronchospasm, including with bronchitis with broncho-obstructive syndrome). From the digestive system: in some cases – diarrhea, constipation, nausea, abdominal pain, increased activity of liver enzymes in the blood plasma (AST, ALT), hepatitis. From the musculoskeletal system: in some cases – muscle weakness, muscle cramps, arthropathy with damage to one or more joints (mono- or polyarthritis). From the endocrine system: decreased glucose tolerance (with latent diabetes mellitus) and masked signs of hypoglycemia.in some cases – an increase in the level of triglycerides in the blood. From the reproductive system: in some cases – a violation of potency. Dermatological reactions: itching is possible. rarely – skin redness, increased sweating, rash.

Overdose

Symptoms: The most common symptoms of overdose: AV block, severe bradycardia, marked decrease in blood pressure, bronchospasm, acute heart failure and hypoglycemia.The sensitivity to a single dose of a high dose of bisoprolol varies greatly among individual patients and, probably, patients with CHF are highly sensitive. Treatment: If an overdose occurs, first of all, it is necessary to stop taking the drug and begin supportive symptomatic therapy. With severe bradycardia: intravenous administration of atropine. If the effect is insufficient, a remedy with a positive chronotropic effect can be administered with caution. Temporary pacemaker placement may sometimes be required.With a pronounced decrease in blood pressure: intravenous administration of plasma-substituting solutions and vasopressor drugs. For AV block: patients should be monitored continuously and treated with beta-agonists such as epinephrine. If necessary – setting of an artificial pacemaker. With exacerbation of CHF: intravenous administration of diuretics, drugs with a positive inotropic effect, as well as vasodilators. With bronchospasm: the appointment of bronchodilators, including beta-agonists and / or aminophylline.For hypoglycemia: intravenous dextrose (glucose).

Interaction with other drugs

The efficacy and tolerability of bisoprolol may be affected by the simultaneous administration of other drugs. This interaction can also occur when two drugs are taken over a short period of time. The doctor must be informed about taking other medicines, even if they are taken without a doctor’s prescription (i.e.i.e., over-the-counter drugs). Combinations not recommended. Treatment of chronic heart failure: Class I antiarrhythmics (for example, quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and cardiac contractility. All indications for the use of the drug Concor Blockers of “slow” calcium channels (BMCC) such as verapamil and, to a lesser extent, diltiazem, when used simultaneously with bisoprolol, can lead to a decrease in myocardial contractility and impairment of AV conduction.In particular, intravenous administration of verapamil to patients taking beta-blockers can lead to severe arterial hypotension and AV block. Centrally acting antihypertensives (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to a decrease in heart rate and a decrease in cardiac output, as well as vasodilation due to a decrease in central sympathetic tone. Abrupt withdrawal, especially before the withdrawal of beta-blockers can increase the risk of developing “rebound” arterial hypertension.Combinations requiring special care Treatment of arterial hypertension and angina pectoris Class I antiarrhythmics (for example, quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conductivity and myocardial contractility. All indications for the use of the drug Concor BMCC dihydropyridine derivatives (for example, nifedipine, felodipine, amlodipine), when used simultaneously with bisoprolol, may increase the risk of arterial hypotension.In patients with CHF, the risk of subsequent deterioration of the contractile function of the heart cannot be excluded. Class III antiarrhythmics (eg, amiodarone) may exacerbate AY conduction disturbances. The action of beta-blockers for topical use (for example, eye drops for the treatment of glaucoma) can enhance the systemic effects of bisoprolol (lowering blood pressure, lowering heart rate). Parasympathomimetics, when used concomitantly with bisoprolol, can increase the violation of AV conduction and increase the risk of developing bradycardia.The hypoglycemic effect of insulin or oral hypoglycemic agents may be enhanced. Signs of hypoglycemia – in particular tachycardia – can be masked or suppressed. Such interactions are more likely with the use of non-selective beta-blockers. Agents for general anesthesia can increase the risk of cardiodepressive action, leading to arterial hypotension (see section “Special instructions”). Cardiac glycosides, when used simultaneously with bisoprolol, can lead to an increase in the duration of the impulse, and thus to the development of bradycardia.Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce the hypotensive effect of bisoprolol. The simultaneous use of the drug Concor with beta-adrenergic agonists (for example, isoprenaline, dobutamine) can lead to a decrease in the effect of both drugs. The combination of bisoprolol with adrenergic agonists that affect beta and alpha-adrenergic receptors (for example, norepinephrine, epinephrine) can enhance the vasoconstrictor effects of these drugs, which occur with the participation of alpha-adrenergic receptors, leading to an increase in blood pressure.Such interactions are more likely with the use of non-selective beta-blockers. Antihypertensive drugs, as well as other drugs with a possible antihypertensive effect (for example, tricyclic antidepressants, barbiturates, phenothiazines) can enhance the hypotensive effect of bisoprolol. Mefloquine, when used simultaneously with bisoprolol, may increase the risk of developing bradycardia. MAO inhibitors (with the exception of MAO B inhibitors) can enhance the hypotensive effect of beta-blockers.Simultaneous use can also lead to the development of a hypertensive crisis.

Special instructions

Do not interrupt treatment with Concor abruptly and do not change the recommended dose without first consulting your doctor, as this may lead to a temporary deterioration in heart activity. Treatment should not be interrupted suddenly, especially in patients with coronary artery disease. If discontinuation of treatment is necessary, the dose should be reduced gradually.At the initial stages of treatment with Concor, patients need constant monitoring. The drug should be used with caution in the following cases: Diabetes mellitus with significant fluctuations in the concentration of glucose in the blood: symptoms of a pronounced decrease in glucose concentration (hypoglycemia) such as tachycardia, palpitations or excessive sweating can be masked, Strict diet, Conducting desensitizing therapy, AV blockade of the 1st degree, Prinzmetal angina pectoris, Disturbances of peripheral arterial circulation of mild to moderate degree (at the beginning of therapy, an increase in symptoms may occur), Psoriasis (incl.hours in history). Respiratory system: with bronchial asthma or COPD, the simultaneous use of bronchodilating agents is indicated. In patients with bronchial asthma, an increase in airway resistance is possible, which requires a higher dose of beta-adrenergic agonists. Allergic reactions: beta-blockers, including the drug Concor, can increase the sensitivity to allergens and the severity of anaphylactic reactions due to the weakening of adrenergic compensatory regulation under the action of beta-blockers.Epinephrine (adrenaline) therapy does not always give the expected therapeutic effect. General anesthesia: when carrying out general anesthesia, the risk of beta-adrenergic blockade should be considered. If it is necessary to discontinue therapy with Concor before surgery, this should be done gradually, and completed 48 hours before general anesthesia. You should warn the anesthesiologist that you are taking Concor. Pheochromocytoma: in patients with adrenal tumor (pheochromocytoma), Concor can be prescribed only against the background of the use of alpha-blockers.Hyperthyroidism: when treated with Concor, the symptoms of hyperthyroidism (hyperthyroidism) may be masked. Impact on the ability to drive vehicles and complex mechanisms Concor does not affect the ability to drive vehicles according to the results of a study in patients with coronary artery disease. However, due to individual reactions, the ability to drive vehicles or work with technically complex mechanisms may be impaired. This should be paid special attention to at the beginning of treatment, after changing the dose, as well as with the simultaneous use of alcohol.

Prescription

Yes

90,000 What they are treating us with: Nise. From osteochondrosis and gout

The above-mentioned opinion of the European Medicines Agency recommends patients with chronic diseases that cause pain (for example, chronic osteoarthritis) to stop taking nimesulide in tablets and granules on a regular basis. This medicine can be toxic to the liver with long-term use.Patients with liver or kidney disease, ulcerative lesions of the mucous membrane of the stomach and intestines, impaired blood clotting will have to give up this medication. Like aspirin, nimesulide prevents platelets from sticking together, and if your blood already clots poorly and bleeds frequently, medications with these ingredients are not your option.

But as a second-choice drug for a one-time fight against pain symptoms (for example, pain during menstruation, acute pain after surgery, exacerbation in chronic pain), it can help, and it can cope with the task no worse than the popular pain relievers diclofenac and naproxen.But you can drink tablets or solution no more than several days in a row.

The gel for external use is less dangerous. With its help, little of the active substance enters the body, and it will act more locally. It may be less effective than when taken orally, but at least less of a threat to your health. Therefore, in case of severe hepatic or renal failure, exacerbation of ulcerative lesions of the gastrointestinal tract, hypersensitivity and skin lesions, of course, it is better for you to refrain from applying this gel, but the restrictions, as you may have noticed, are less strict than for tablets.

In this case, children under 12 years old, pregnant and breastfeeding mothers should not take the drug. Its safety in these cases has not been proven, therefore, if it is worth taking a risk, it is only under the close supervision of a doctor.

Our advice cannot be equated with a doctor’s prescription. Before you start taking this or that drug, be sure to consult with a specialist.

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117 reviews, instructions for use

Application during pregnancy and breastfeeding

The use of the drug Movalis ^® is contraindicated during pregnancy.

It is known that NSAIDs are excreted in breast milk, therefore, the use of the drug Movalis ^® during breastfeeding is contraindicated.

As a drug that inhibits the synthesis of COX / prostaglandin, Movalis ^® may affect fertility and is therefore not recommended for women planning pregnancy.Meloxicam may delay ovulation. In this regard, for women who have problems with conception and are undergoing examination for such problems, it is recommended to cancel the use of the drug Movalis ^® .

Application for violations of liver function

The drug is contraindicated in severe liver failure.

No dose adjustment is required in patients with (compensated) cirrhosis of the liver.

Application for impaired renal function

The drug is contraindicated in severe renal failure (if hemodialysis is not performed, CC <30 ml / min, as well as with confirmed hyperkalemia), progressive kidney disease.

The drug should be prescribed with caution in case of renal failure (CC 30-60 ml / min).

In patients with severe renal failure on hemodialysis, the dose should not exceed 7.5 mg / day.

In patients with mild to moderate renal insufficiency (CC> 25 ml / min), dose adjustment is not required.

Use in children

The use of the drug in children under 12 years of age is contraindicated.

Special instructions

Patients with gastrointestinal diseases should be monitored regularly.If ulcerative lesions of the gastrointestinal tract or gastrointestinal bleeding occur, Movalis ^® must be canceled.

Gastrointestinal bleeding, ulcers and perforations can occur during the use of NSAIDs at any time, both in the presence of alarming symptoms or a history of serious gastrointestinal complications, or in the absence of these signs. The consequences of these complications are generally more serious in the elderly.

When using the drug Movalis ^® , serious skin reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis can develop.Therefore, special attention should be paid to patients reporting the development of adverse events from the skin and mucous membranes, as well as hypersensitivity reactions to the drug, especially if such reactions were observed during previous courses of treatment. The development of such reactions is observed, as a rule, during the first month of treatment. If the first signs of a skin rash, changes in mucous membranes or other signs of hypersensitivity appear, the question of discontinuing the use of Movalis ^® should be considered.

Cases of increased risk of developing serious cardiovascular thrombosis, myocardial infarction, angina attack, possibly fatal, when taking NSAIDs have been described. This risk increases with prolonged use of the drug, as well as in patients with a history of the above diseases and those predisposed to such diseases.

NSAIDs inhibit the synthesis of prostaglandins in the kidneys, which are involved in maintaining renal perfusion. The use of NSAIDs in patients with reduced renal blood flow or reduced BCC can lead to decompensation of latent renal failure.After the withdrawal of NSAIDs, renal function is usually restored to its original level. The most at risk of developing this reaction are elderly patients, patients with dehydration, congestive heart failure, cirrhosis of the liver, nephrotic syndrome or acute renal dysfunction, patients taking diuretics, ACE inhibitors, angiotensin II receptor antagonists, and also patients who have undergone major surgical interventions that lead to hypovolemia.In such patients, diuresis and renal function should be carefully monitored at the beginning of therapy.

The use of NSAIDs in conjunction with diuretics can lead to sodium, potassium and water retention, as well as to a decrease in the natriuretic effect of diuretics. As a result, predisposed patients may experience increased signs of heart failure or arterial hypertension. Therefore, careful monitoring of the condition of such patients is necessary, as well as the maintenance of adequate hydration.Before starting treatment, a study of renal function is necessary.

In the case of combination therapy, renal function should also be monitored.

When using the drug Movalis ^® (as well as most other NSAIDs), an episodic increase in the activity of transaminases or other indicators of liver function in the blood serum was reported. In most cases, this increase was small and transient. If the identified changes are significant or do not decrease over time, Movalis ^® should be canceled and the laboratory changes identified should be monitored.

Weakened or malnourished patients may be less likely to tolerate adverse events, therefore, such patients require careful monitoring.

Like other NSAIDs, Movalis ^® can mask the symptoms of an infectious disease.

As a drug that inhibits the synthesis of COX / prostaglandin, Movalis ^® may affect fertility and is therefore not recommended for women who have difficulty conceiving. In women undergoing examination for this reason, it is recommended to cancel the use of the drug Movalis ^® .

In patients with mild to moderate renal insufficiency (CC> 25 ml / min), dose adjustment is not required.

No dose adjustment is required in patients with (compensated) cirrhosis of the liver.

Influence on the ability to drive vehicles and use mechanisms

Special clinical studies of the effect of the drug on the ability to drive and use mechanisms have not been conducted. However, when driving and working with mechanisms, the possibility of dizziness, drowsiness, visual impairment or other disorders of the central nervous system should be taken into account.Patients should be careful when driving and operating machinery.

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dropped blood pressure medication How does Aspirin affect blood pressure readings? Why is it recommended for many pathologies of the cardiovascular system? When should you take it?When faced with arterial hypertension, a person has to take many medications, most of which are expensive. But neither blocking thromboxane nor inhibiting COX have anything to do with blood pressure. Therefore, for many years it was believed that acetylsalicylic acid does not affect it. However, weak links have emerged in this entrenched theory today. Confusion in the head. It turned out that taking aspirin in the morning led to an increase of 2.6 mm Hg. Art. systolic and 1.6 mm Hg.Art. diastolic pressure. Aspirin for blood thinning. Reduces or increases blood pressure Aspirin. Overdose. Drug interactions. Terms of sale, storage. Shelf life. Aspirin composition. Aspirin prevents platelets from sticking together, therefore, the risk of blood clots is reduced. Reduces or increases blood pressure Aspirin. If the cause of the headache is an increase in intracranial pressure, taking the medication will relieve you of the pain. In the presence of hypertension, aspirin should be taken only when adequate blood pressure control has been achieved.- If you suspect a stroke. The doctor will prescribe the necessary tests, an electrocardiogram and other necessary examinations, measure your blood pressure, and find out if you have any. Indications for the use of aspirin. Aspirin is an NSAID (non-steroidal anti-inflammatory drug). Effect on blood pressure. Scientists from Spain have conducted studies to find out whether Aspirin increases or decreases blood pressure. To obtain data, they prescribed to take the drug to one group of patients with pressure before bedtime for three months.Read the instructions for using the drug Aspirin Cardio tablets 100 mg 28 pcs on the website of the Gorzdrav online pharmacy: composition, side effects, indications, contraindications. Free shipping. Description. Round biconvex tablets of white color; on a cross-section, a homogeneous mass of white, surrounded by a white shell. Active ingredients. Acetylsalicylic acid. Aspirin, or acetylsalicylic acid, is a drug that belongs to the group of so-called non-steroidal anti-inflammatory drugs.It includes such familiar drugs as ibuprofen (Nurofen, Faspik, Advil), nimesulide (Nimesil, Nise), meloxicam (Movalis, Artrozan) and some others, but only aspirin has a unique effect on platelets. Aspirin does not thin the blood. The use of ASA in patients with arterial hypertension requires an adequate correction of the blood pressure level. There is no data on the negative effect of ASA on the action of antihypertensive drugs, and therefore the very presence of arterial hypertension is by no means a contraindication to taking ASA.There are several approaches that can significantly reduce the incidence of side effects and ensure long-term use of ASA. How can aspirin prevent a heart attack? Aspirin prevents blood clotting. When bleeding occurs, a special blood cell called platelets seals the opening in the blood vessel and stops the bleeding. Similar processes involving platelets can occur in the vessels that supply the heart with blood. Such drugs are used when it is necessary to lower blood pressure, as well as to prevent heart failure.The funds affect the lumen of blood vessels, reducing them, while slowing down the breakdown of a natural vasodilator in the body (bradykinin). Compatible with the diagnosis of diabetes mellitus, well tolerated by patients due to the minimum number of side effects. low pressure how to increase tablets tablets from pressure 50 mg water vapor pressure in the air

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The biogenic complex helps people who have persistent or periodic high blood pressure.It can be expressed in the appearance of headaches, flies before the eyes, tinnitus, general malaise. Cardilite is a modern drug based on natural herbal ingredients to combat hypertension and high blood pressure. Has a complex effect on the cardiovascular system and the patient’s body as a whole. Differs in high efficiency, affordable price and absence of any side reactions. In 2016, under the guidance of Russian scientists, clinical trials were carried out during which this drug was tested (the results of the experiments are described in detail on the manufacturer’s website).It has shown a positive effect in 99% of cases. It should be noted that no side reactions of the agent were identified. Blood pressure is the force with which blood presses against the walls of blood vessels and the heart. With hypertension, blood pressure on the arteries and heart becomes unnecessarily high, which leads to premature wear of these organs and increases the risk of other diseases, for example, impaired kidney or brain function. Blood pressure is measured in millimeters of mercury (mmHg) and is recorded in two dimensions: systolic pressure: blood pressure.What are the reasons for high blood pressure? How do other diseases affect the onset of hypertension? Why is dissatisfaction with life bad for cardiovascular health? Blood pressure problems predominantly begin after age 50. When measured with a tonometer, readings above 140/90 mm Hg are obtained. Art. Registration of proportionally increased systolic and diastolic pressure is characteristic. In the absence of treatment, blood pressure rises to very high rates, visual impairment and vomiting join the symptoms.A second cause of high blood pressure may be high cholesterol levels in the blood. In order not to disrupt circulation, the heart needs to start the mechanisms with the greatest strength: to squeeze the vessels and contract more strongly. Kidney problems are common and can cause high blood pressure. Kidneys are filters that cleanse the blood of dirt. Blood pressure (BP) is the pressure that blood exerts on the walls of blood vessels. This is one of the vital signs of health.It is measured in millimeters of mercury (mmHg) and interpreted on the basis of two values: an indicator of systolic pressure (upper): blood pressure at the moment when your heart contracts and pushes blood into the artery The main criterion for arterial hypertension (or arterial hypertension) as a whole group of diseases – stable, that is, an increase in blood pressure (BP) revealed during repeated measurements on different days. Blood pressure (blood pressure) is the main indicator of the work of the heart, as the driving force of blood in the body.The pressure with which blood flows through the vessels is called blood pressure or arterial pressure. It is measured in millimeters of mercury (mmHg). The highest pressure is recorded when blood leaves the left ventricle of the heart. Getting into the vessels, the pressure gradually decreases, and in the veins it becomes minimal. When measuring blood pressure, 3 indicators are taken into account. Speaking about blood pressure, we use the concept of the so-called upper (more correctly – systolic) and lower (diastolic) pressure. High blood pressure is a situation where the systolic pressure is 140 mm.Hg and above, and diastolic – 90 mm Hg. and higher. – Does high blood pressure respond well to therapy? Is this problem curable? Increased blood pressure is considered if the systolic at rest averages 140 mm Hg. Art. or more, diastolic at rest on average – 90 mm Hg. Art. or more, or there is an increase in both values. With high blood pressure, both systolic and diastolic are usually increased. Memory or comprehension problems. Uncontrolled high blood pressure can interfere with your ability to think, remember, and heal.

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The doctor may recommend taking medicines, drugs for hypertension already at the first examination, if he finds you have a high risk of complications of hypertension. For example, an increase in blood pressure to high numbers, or a large number of associated risk factors. If at the first meeting with a doctor you received only non-drug recommendations (changes in diet, physical activity, etc.)the prescription of medications is carried out when the doctor, based on the results of the examination (ECG, echocardiography, 24-hour blood pressure monitoring, blood test data, etc.), sees the insufficient effectiveness of these methods. For hypertension, hearing loss is characteristic almost to the same extent in both ears. In hypertension, as in arteriosclerosis, sometimes there is an acute lesion of the inner ear, leading to complete or partial loss of auditory and vestibular functions.The latter happens with thrombosis or embolism of the internal auditory artery. Currently, arterial hypertension (AH) is considered in the history of mankind as a non-infectious pandemic, affecting almost half of the population, as well as as the main cause of vascular hearing impairment. Unfortunately, we rarely notice tinnitus or dizziness that persists after an episode of high blood pressure, although this is an important symptom of hearing problems. The blood flow in the cochlea is directly related to the general indicators of blood pressure and blood circulation in the brain.With each increase in pressure, hearing deteriorates by about 10 – 20 dB. With timely treatment, such violations are reversible. Hearing impairment symptoms. After 50 years for people with a diagnosis of arterial hypertension, you should visit a specialist: 1 time per year or more often when a hearing disorder is diagnosed Tinnitus at normal pressure indicates the presence of other diseases. For example, meteorological people may have a buzzing sound. With hypertension, it is important to keep the pressure level not higher than 140/90 mm.Hg For this, antihypertensive drugs are used: diuretics, beta-blockers, ACE inhibitors, sartans or calcium channel blockers. Arterial hypertension is practically the most common complaint of patients with dizziness. Moreover, both before the start of antihypertensive therapy, and in its process. Including, with the formal stabilization of blood pressure, when we reach the target figures. It improves regional blood flow in the inner ear area. Normalizes the excitation of peripheral receptors.Normalizes the process of excitation in the region of the vestibular nuclei of the brain stem. Tinnitus in neurological diseases. Tinnitus due to arterial hypertension and hypertensive crisis. Cerebral circulation disorder. Effect of increased intracranial pressure on noise in the head and ears. To quickly reduce high blood pressure, you need to take several breaths and contrast baths. Long-term pressure reduction will require dietary and lifestyle adjustments. How to reduce blood pressure at home.First of all, you need to measure the pressure to make sure that the symptoms caused (weakness, nausea, drowsiness, dizziness) are associated with it. Hypertension – causes and mechanism of development. Hypertension is a chronic disease in which there is a frequent rise in blood pressure. If normal, it is 120/80 mm. rt. Art., then at 140/90 mm. rt. Art. are already diagnosing the initial stage of the disease. In some patients, only the systolic (upper) pressure rises, but with it the lower (diastolic) value may also increase. aspirin blood pressure . tablets for pressure 50 mg. Reviews, instructions for use, composition and properties. The device is designed to correct blood pressure using a series of electrical impulses, by normalizing vascular tone and enhancing the body’s own defenses. It can be used at home and in medical institutions both as monotherapy and as part of complex treatment. PERCUTANEOUS ELECTRIC STIMULATOR FOR CORRECTION OF BLOOD PRESSURE AVR-051 – the name of the device – arterial blood pressure corrector AVR-051 (read as ABP from arterial blood pressure).A wearable medical device for correcting blood pressure using a series of electrical impulses. Correction of blood pressure occurs due to the normalization of vascular tone, i.e., removal of constant tension or relaxation. ABP-051 has two automatic programs: Program 1 Designed to correct high blood pressure in arterial hypertension. 2. The apparatus works by means of electrical stimulation. The device has two electrodes that are placed on the wrist and apply a low frequency electric current to it.In response to this effect, the vasomotor center, which is located in the medulla oblongata, changes the tone of the smooth muscles of the small arteries. Medical diagnostic devices for measuring blood pressure allow you to get blood pressure and heart rate readings at home. It is especially important to keep them always at hand for people with pathologies of the cardiovascular system. How to choose a wrist tonometer? Medical diagnostic devices for measuring blood pressure allow you to get blood pressure and heart rate at home.It is especially important to keep them always at hand for people with pathologies of the cardiovascular system. The best wrist blood pressure monitors for the elderly are compact and easy to use. Correction of blood pressure. Sorting: By price. Home blood pressure corrector AVR-051. More details. Reviews. Category: Correction of blood pressure. Manufacturer: Shvabe. Description: ABP-051 is a joint development of Shvabe and INFERUM, has two automatic programs. Indications The device is designed to correct blood pressure using a series of electrical impulses, by normalizing vascular tone and enhancing the body’s own defenses.It can be used at home and in medical institutions both as monotherapy and as part of complex treatment. Shvabe device for normalization of pressure ABP-051. Delivery from Moscow. 94% out of 18 for the year. Blood pressure corrector AVR-051. Delivery from Moscow. 90% out of 80 for the year. EcoMed + CARDIOLOGY LLC. Medical equipment and supplies, services. Blood pressure corrector AVR-051. Delivery from Moscow. 90% out of 80 for the year. What is a blood pressure corrector.Blood pressure correctors are small wrist bracelets. According to the manufacturers, they treat high blood pressure, or hypertension, and low blood pressure, or hypotension, with an electric current. The principle of operation of the device. The pressure corrector applies a low-frequency electric shock to the skin of the left wrist. To lower the pressure, the device is applied to the inside of the wrist, to increase it to the outside. The procedure lasts 5-6 minutes, during the day they need from 1 to 3. The course of treatment usually lasts 14 days, after which you need a break for 10-15 days.This is what a pressure corrector on the arm looks like. Photo source. Transcutaneous electrostimulator AVR-051. for the correction of blood pressure, cardboard pack No. 1. Inferum LLC, Russia. All forms of release () Analogs (). A wearable medical device for correcting blood pressure using a series of electrical impulses. Electrical stimulation by the device helps to normalize the tone of the walls of blood vessels, has a positive general regulating effect on the physiological systems of the body. Areas of influence: Built-in electrodes of electrical stimulation act on biologically active areas of the wrist.Recommended for people with high or low blood pressure. Tonometer is a medical diagnostic device, a special apparatus for measuring pressure. Its use is relevant for people who suffer from arterial hypertension or hypotension, diabetes mellitus, regularly perform hard physical work. Also, the elderly, pregnant women should periodically monitor the level of blood pressure. It is necessary to measure pressure if disturbed by: dizziness; nausea

90,000 Announcements of thesis defense, Dissertation Council

08.09.2021

Kosova Nina Vasilievna
Dissertation “Mechanochemically stimulated synthesis of nanostructured cathode materials for metal-ion batteries”
for an academic degree
doctors of chemical sciences

Dissertation defense: 22.12.2021

26.07.2021

Shindrov Alexander Alexandrovich
Dissertation “Mixed-anionic iron-sodium-containing compounds as matrices for reversible intercalation of alkali metal ions”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 06.10.2021

09/21/2020

Maslennikov Daniel Vladimirovich
Dissertation “Study of the factors determining the morphology and microstructure of the reaction products of thermal decomposition (Ce _1-x Gd _x ) ₂ (C ₂ O ₄ ) ₃ • 10H ₂ O (x = 0, 0.1) ”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 02.12.2020

08.06.2020

Bychkov Alexey Leonidovich
Dissertation “Mechanochemical processing of natural polymers and its technological application”
for an academic degree
doctors of chemical sciences

Dissertation defense: 09/23/2020

08.06.2020

Mishchenko Ksenia Vladimirovna
Dissertation “Synthesis and thermal transformations of bismuth formates and oxocarbonate to obtain metallic bismuth and its oxides”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 09/16/2020

04.10.2019

Ukhina Arina Viktorovna
Dissertation “Structural and morphological features of the formation of metal-diamond compositions”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 12/18/2019

19.08.2019

Semykina Daria Olegovna
Dissertation “Structural-morphological and electrochemical properties of sodium / lithium-vanadium-containing electrode materials for sodium / lithium-ion batteries”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 27.11.2019

15.10.2018

Tyapkin Pavel Yurievich
Dissertation “Nanocomposites based on iron oxides synthesized in the pores of mesoporous silicon dioxide”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 21.12.2018

08.10.2018

Skripkina Tatiana Sergeevna
Dissertation “Mechanochemical modification of the structure of humic acids to obtain complex sorbents”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 19.12.2018 at 10:00

08.10.2018

Podgorbunskikh Ekaterina Mikhailovna
Dissertation “Research of mechano-enzymatic transformations of polymers of difficult-to-process plant raw materials”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 12/19/2018 at 12:00

03.10.2018

Shubnikova Elena Viktorovna
Dissertation “Structure and oxygen permeability of oxides with mixed conductivity
Sr _1-y Ba _y Co _0.8-x Fe _0.2 M _x O _3-δ (M = W, Mo) ”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 05.12.2018

26.09.2018

Lozanov Viktor Vasilievich
Dissertation “Synthesis and physicochemical study of refractory compounds formed in systems based on hafnium, tantalum and iridium”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 12.12.2018

03.05.2017

Prokip Vladislav Edvardovich
Dissertation “Physical and chemical research of hafnium germanates”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 07/05/2017 at 10:00

01.02.2017

Pestereva Natalya Nikolaevna
Dissertation “Transport processes along the phase boundary MeWO ₄ | WO ₃ and physicochemical properties of composites MeWO ₄ -WO ₃ (Me = Ca, Sr, Ba)”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 04/05/2017 at 10:00

27.12.2016

Popov Mikhail Petrovich
Dissertation “Study of the effect of modification with tungsten on the functional properties of perovskite composition Ba _0.5 Sr _0.5 Co _0.8 Fe _0.2 O _3-δ ”
for an academic degree
candidate of chemical sciences.

Dissertation defense: 03/01/2017 at 10:00

10.