Meloxicam Interactions Checker – Drugs.com

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There are 379 drugs known to interact with
meloxicam, along with
12 disease interactions, and 3 alcohol/food interactions.

Of the total drug interactions,
95 are major, 278 are moderate, and 6 are minor.

Does meloxicam interact with my other drugs?

Enter other medications to view a detailed report.

• View all 379 medications that may interact with meloxicam
• View meloxicam alcohol/food interactions (3)
• View meloxicam disease interactions (12)

Most frequently checked interactions

View interaction reports for meloxicam and the medicines listed below.

• Major
• Moderate
• Minor
• Unknown

• Adderall (amphetamine / dextroamphetamine)
• Ambien (zolpidem)
• Aspir 81 (aspirin)
• Aspirin Low Strength (aspirin)
• Benadryl (diphenhydramine)
• CoQ10 (ubiquinone)
• Crestor (rosuvastatin)
• Cymbalta (duloxetine)
• Fish Oil (omega-3 polyunsaturated fatty acids)
• Flexeril (cyclobenzaprine)
• Flonase (fluticasone nasal)
• Lexapro (escitalopram)
• Lipitor (atorvastatin)
• Lyrica (pregabalin)
• Metoprolol Succinate ER (metoprolol)
• Metoprolol Tartrate (metoprolol)
• Nexium (esomeprazole)
• Norco (acetaminophen / hydrocodone)
• ProAir HFA (albuterol)
• Singulair (montelukast)
• Symbicort (budesonide / formoterol)
• Synthroid (levothyroxine)
• Tylenol (acetaminophen)
• Vitamin B12 (cyanocobalamin)
• Vitamin C (ascorbic acid)
• Vitamin D2 (ergocalciferol)
• Vitamin D3 (cholecalciferol)
• Xanax (alprazolam)
• Zoloft (sertraline)
• Zyrtec (cetirizine)

Meloxicam alcohol/food interactions

There are 3 alcohol/food interactions with meloxicam.

Meloxicam disease interactions

There are 12 disease interactions with meloxicam which include:

• asthma
• fluid retention
• GI toxicity
• rash
• renal toxicities
• thrombosis
• anemia
• heart failure
• hepatotoxicity
• hyperkalemia
• hypertension
• platelet aggregation inhibition

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Related treatment guides

• Osteoarthritis
• Inflammatory Conditions
• Fibromyalgia
• Juvenile Rheumatoid Arthritis

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

What is Meloxicam? | Is It Addictive? | Is Meloxicam Safe?

Table of Contents

What is Meloxicam?

Meloxicam, or Mobic, is a drug that is used extensively in the treatment of symptoms associated with arthritis. The symptoms it’s used to control or treat include pain and inflammation without the use of opioid painkillers, like hydrocodone or oxycodone.

Boehringer Ingelheim developed meloxicam, and it received a patent in 1977. However, it was only in the year 2000 that the drug received clearances for medical use.  It’s generally considered as a safe alternative to opioid medication, reducing the chances of needing addiction treatment.

Legally, it is available as prescription medicine. It is produced in three basic forms, all for oral consumption only – in tablet, disintegrating tablet, and capsule forms.

In tablet form, the medication is available in both generic as well as brand variants. However, the orally disintegrating tablet is only available as a branded medication. Generic variants of Mobic cost less than the branded versions.

Treats Inflammation and Pain

As an effective remedy for inflammation and pain, Mobic is used to treat arthritic health conditions such as osteoarthritis and rheumatoid arthritis. The medication is also used in treating an arthritic condition in young children aged two and above, known as juvenile idiopathic arthritis (JIA).

Meloxicam is safe when used following a doctor’s prescription. But its misuse or abuse can lead to potentially dangerous side effects. Many people also worry about this drug’s ability to cause addiction. Since meloxicam is used as a pain killer, many people believe it could be a gateway to opioids.  In some cases, meloxicam addiction may necessitate treatment in a rehab facility.

Statistics

In 2017, a total of 19,793,507 meloxicam prescriptions were issued in the U.S.A.¹

In 2016, meloxicam was the 36th most frequently prescribed drug in America. ¹

In 2006, a total of 48,928 meloxicam prescriptions were issued to active duty soldiers in the U.S. Army and in 2014, the number stood at 91,048.²

How Does Meloxicam Work?

Mobic belongs to the class of drugs that are known as non-steroidal anti-inflammatory drugs (NSAIDs). It received approval for use in April 2000.  The drug is primarily used in the treatment of conditions such as pain and inflammation that are associated with arthritis. These pains are caused by the inflammation induced by the presence of chemicals known as prostaglandins in the body.

By blocking the enzymes responsible for prostaglandin production and reducing their levels in the body, meloxicam reduces inflammation and associated symptoms of arthritis.

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Is Meloxicam Safe?

Mobic is viewed as a drug with the potential to replace opioid-class painkillers in the treatment of moderate- to severe-grades of physical pain. Compared to opioids, the risks of physical or psychological dependence is not severe in Mobic users. The fact that Mobic does not induce the kind of euphoria that opioids do is partly responsible for this. However, the risk of acquiring a Mobic dependence does exist and could occur when the drug continues to be taken even after it is no longer prescribed by a doctor.

Ironically, many instances of Mobic dependence and abuse occur on account of its reputation as a prescription painkiller. Some people mistakenly believe that because Mobic is a prescription pain killer, it must contain opioids, resulting in substance abuse.

USDA Guidance

The US Food and Drug Administration discourages medical practitioners from prescribing the drug, both – branded as well generic variants, for patients known to be at risk of acquiring psychological dependence through the use of psychoactive medications.

Although meloxicam is itself relatively harmless, it has the potential for misuse by being combined with substances such as alcohol. Its pain-alleviating properties mean that meloxicam is frequently used to treat hangovers after a binge-drinking session. Such practices could lead to long-term damage such as liver damage or heart disease.

How is Meloxicam Used?

Meloxicam is prescribed for patients who have arthritis, a medical condition wherein the joints experience pain and swelling. Mobic is primarily used in the treatment of symptoms related to osteoarthritis and rheumatoid arthritis — two of the common types of arthritis.

Medical practitioners also rely upon Mobic for use as an alternative to conventional opioid pain medications. To reduce the intensity of symptoms of opioid withdrawal, doctors often prescribe it before starting an opioid taper on their patients.

The method of Mobic use depends on the type of formulation a patient takes. Currently, three formulations are available in the market:

Oral tablets (immediate release action) available in 7.5mg and 15mg specifications. Brand name: Mobic tablets 7.5mg and 15mg.

Oral suspension in 7.5mg/5mL specifications.

Orally-disintegrating tablets in 7.5mg and 15mg specifications.

Although Mobic can be taken on an empty stomach, it is recommended to take it with food to reduce the chances of suffering an upset stomach.

The orally-disintegrating tablets must be placed on the tongue immediately after the pack is opened. Since the tablets are meant to dissolve on coming in touch with the tongue, water should not be consumed as long as the tablet is on the tongue. While in the mouth, care should be taken to see that the tablets are not crushed, broken, or chewed.

In the case of meloxicam in oral suspension form, the container has to be shaken well before use. The recommended dosage must be taken with the help of the measuring device included in the product packaging.

Effects of Meloxicam

Short-Term Effects

Some of the short-term side effects of meloxicam are:

Upset Stomach

An upset stomach is the most common side effect of meloxicam.   That is why taking it with food is recommended.

Allergic Reactions

Asthmatics are at a higher risk of experiencing serious allergic reactions to the drug. Similarly, people allergic to NSAIDS, are also susceptible to allergic reactions such as feeling shortness of breath.

Skin Reactions

Typical skin conditions arising from Mobic use include Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), and exfoliative dermatitis. 

Dizziness

Dizziness, drowsiness, and blurred vision are some of the side effects on the central nervous system.

Long-Term Effects

Ulcers

Long term use of meloxicam can cause bleeding or ulcers in the stomach, which can turn fatal if left untreated. The intestines also face similar risks from long-term usage of Mobic.  People who are older, especially those who regularly consume significant quantities of alcohol or suffer from poor health, face a higher risk of developing such problems. These issues could appear without any warning signs, or they may appear in the form of symptoms such as heartburn, stomachache, bloody vomit, bloody stools, or tarry stools.

Hypertension

Meloxicam use can lead to the worsening of hypertension in patients with a history of hypertension. While, in others, Mobic could cause the onset of high blood pressure. That’s why it is important to monitor blood pressure when meloxicam is prescribed.

Fluid Retention

Fluid retention or edema (swelling) is another likely side effect of meloxicam usage, and therefore people with heart conditions are generally not prescribed the drug.

Stroke

Even people with no history of heart disease are in danger of suffering a stroke when prescribed the drug. Therefore, NSAIDs are not to be prescribed nor used for the treatment of pains arising due to coronary artery bypass graft (CABG) surgery.

Insomnia

Insomnia is another potential adverse effect of meloxicam use over the long-term. ¹ Insomnia is a health condition where the person is unable to fall asleep and thus feels sleepy during the daytime, and a corresponding lack of energy.  Insomnia can also lead to feelings of depression, anxiety, or irritability, difficulty in focusing, learning, and remembering things.

Kidney Damage

While long-term usage can damage the kidneys, often, ending use results in reversal of such damage.

Liver Damage

Liver damage is among the major effects that long-term usage of meloxicam can cause. 

Can You Overdose on Meloxicam?

While meloxicam is considered a safe drug, it is possible to overdose, if more than the maximum recommended dosage is taken. 

The factors influencing the Mobic dosage that your doctor prescribes include the type, severity, and condition for which the medication is being used, the age of the patient, the form of meloxicam being taken, health, and medical conditions involved.

Meloxicam is available in tablet and orally disintegrating tablet form, both of which are produced in 7.5 grams specifications. Initial dosage usually begins at 7.5 g and could reach a maximum dosage of 15 g for adults. So, technically speaking, anything above 15 g is considered an overdose.

The symptoms of meloxicam overdose include drowsiness, nausea, lack of energy, vomiting, stomachache, bloody or tarry stool, breathlessness, seizures, and coma.

What is Withdrawal From Meloxicam Like?

Withdrawal from this medication is generally not difficult, and may be safely stopped without any tapering. However, there may be some symptoms that are unmasked by stopping the medication, and it may be wise for people to take precautions to avoid any discomfort. An awareness of meloxicam helps people anticipate any potential problems.  You should always discuss your medications with a healthcare provider before discontinuing any drug.

Detox Recommended

However, discontinuing the drug, all of a sudden, could cause uncomfortable symptoms to emerge.   It is advisable to consult a healthcare provider for necessary advice on keeping such problems at bay while undergoing detox.

Pain and Inflammation May Return

Typically, the withdrawal from meloxicam usage would lead to a return of the symptoms for which the medication was prescribed for in the first place – pain and inflammation. After discontinuing Mobic it’s possible to suffer from withdrawal symptoms such as stiffness, redness, swelling, and heat.

In actual terms, there are no withdrawal symptoms associated with meloxicam. But it takes the body between 15 and 20 hours to metabolize and expel half the drug out of the system. This is also the time frame for Mobic withdrawal. Since it is not an opioid class drug, meloxicam withdrawal does not result in the worsening of symptoms after stopping the drug intake. But the symptoms treated initially by the drug could resurface once use is discontinued.

Is Treatment for Meloxicam Dependence Needed?

Meloxicam withdrawal management usually does not require any kind of medical intervention or alternate drug therapy. This is because, unlike the case of alcohol or substance dependence, meloxicam withdrawal has no specific safety concerns associated with it.

The only medical intervention may be in terms of drugs, prescribed by the health provider, to address the problems that meloxicam was prescribed in the first place. In this case, alternative such medicines would be medicines prescribed for suppressing pains and inflammations related to arthritis. The alternatives include pain treatments involving physical therapy, acupuncture, ice-application, heat-application, and adequate rest.

Resources

1. https://clincalc.com/DrugStats/Drugs/Meloxicam
2. https://academic.oup.com/milmed/article/182/3-4/e1709/4099494

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Catalog :: Medicines :: Musculoskeletal system :: Anti-inflammatory drugs :: Meloxicam-Teva 15mg №20 tab. 5

One tablet contains

active substance – meloxicam 7.5 and 15 mg

excipients : sodium citrate, lactose monohydrate, microcrystalline cellulose (Avicel PH 102), povidone (PVP K-30), crospovidone, silicon kol loid anhydrous ( Aerosil 200), magnesium stearate.

Description

Round, flat, marbled, yellow, bevelled tablets, scored on one side and engraved with “MLX 7.5” on the other side (for a dosage of 7.5 mg).

Yellow marbled oval tablets, scored on one side and engraved with “MLX 15” on the other side (for 15 mg dosage).

Pharmacotherapeutic group

Musculoskeletal system. Anti-inflammatory and antirheumatic drugs. Anti-inflammatory and antirheumatic drugs, non-steroidal. Oxycams. Meloxicam.

ATC code M01AC06

Pharmacological properties

Pharmacokinetics

The bioavailability of meloxicam after oral administration is about 89%. The maximum plasma concentration is reached approximately 5-6 hours after oral administration. Eating does not affect the rate and extent of absorption of meloxicam. Meloxicam binds to plasma proteins (99%). Meloxicam is excreted from the body mainly by hepatic metabolism. About 2/3 of the amount of the drug that is metabolized in the liver is destroyed by enzymes of the cytochrome P450 system (the main metabolic pathway is cytochrome 2C9, additional – cytochrome 3A4), about 1/3 is metabolized by other systems, for example, by peroxidation. When used in conjunction with meloxicam, drugs that have a known ability to inhibit CYP 2C9 and / or CYP 3A4 or are metabolized with the participation of these enzymes, the possibility of pharmacokinetic interaction should be taken into account. The mean half-life is about 20 hours. The total clearance in blood plasma is 8 ml / min.

Pharmacodynamics

Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) from the oxicam group of substances with anti-inflammatory, analgesic and antipyretic properties. The mechanism of action is associated with a decrease in the biosynthesis of prostaglandins as a result of inhibition of the enzymatic activity of cyclooxygenase (COX-2).

Indications for use

• Short-term symptomatic treatment of exacerbations of osteoarthritis
• long-term symptomatic treatment of rheumatoid arthritis or ankylosing spondylitis.

Method of administration and dosage

Tablets should be taken with food, drinking water or other liquid.

Osteoarthritis: the dose is 7.5 mg per day. If sufficient improvement does not occur, the dose may be increased to 15 mg per day.

Rheumatoid arthritis, ankylosing spondylitis: The dose is 15 mg per day. Depending on the success of therapy, the dose may be reduced to 7.5 mg per day. In elderly patients, the recommended dose is 7.5 mg daily

With a slight or moderate decrease in kidney function (creatinine clearance is reduced by no more than 25 ml / min from the norm), a dose reduction is not required. It is contraindicated in patients with severely impaired renal function who are not on hemodialysis. In patients on dialysis with severe renal insufficiency, the dose should not exceed 7.5 mg per day

Adolescents (from 16 years): The maximum daily dose is 0.25 mg/kg, should not exceed 15 mg.

The duration of the drug is individual and determined by the attending physician.

Side effects

Common

– headache

Very common

– nausea, vomiting, abdominal pain, diarrhea , constipation, flatulence, dyspepsia

Uncommon

– anemia

– allergic reactions, itching, rash, angioedema, anaphylactic shock

– dizziness, drowsiness, vertigo

– dyspepsia, gastritis, erosive and ulcerative lesions of the gastrointestinal

tract, colitis, perforation of the gastrointestinal tract, hidden or overt

gastrointestinal bleeding (gastrointestinal bleeding, ulcer and perforation can potentially lead to death) bilirubin)

– sodium and water retention

– hyperkalemia

– changes in renal function (increased creatinine and/or urea levels)

Rarely

– emotional lability

– leukopenia, thrombocytopenia

– conjunctivitis, visual disturbances, including blurred vision

– tinnitus

90 002 – palpitations

– acute development of bronchial asthma (in patients with allergies to acetylsalicylic acid or other NSAIDs), urticaria, severe skin adverse reactions (SCNR): Stevens-Johnson syndrome and toxic

epidermal necrolysis

– ulcerative stomatitis, esophagitis

Very rare

– hepatitis

– bullous dermatitis, erythema multiforme insufficiency, in particular in patients with risk factors

Unknown

– confusion, disorientation, photosensitivity reaction

– pancreatitis

Contraindications

– hypersensitivity to meloxicam or to any component of the drug

– hypersensitivity to acetylsalicylic acid and other NSAIDs

– history of gastrointestinal bleeding or perforation associated with previous NSAID therapy, gastrointestinal bleeding, history of cerebrovascular bleeding or other bleeding cauldron persons with hereditary intolerance to fructose, Lapp-lactose, malabsorption of glucose-galactose

– recurrent peptic ulcer

– severe liver failure

• severe renal failure without dialysis
• severe heart failure
• children under 16 years of age
• pregnancy and lactation

90 002 Drug interactions

Other non-steroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid > 3 g / day:

Co-administration with other non-steroidal anti-inflammatory drugs, including acetylsalicylic acid in anti-inflammatory doses (≥ 1 g as a single dose or ≥ 3 g as a total daily dose) is not recommended.

Corticosteroids (eg glucocorticoids):

Caution should be exercised when co-administered with corticosteroids due to an increased risk of bleeding or gastrointestinal ulceration.

Oral anticoagulants, heparin, thrombolytics: increased risk of bleeding due to delayed platelet function and damage to the gastric and intestinal mucosa. NSAIDs may enhance the effects of anticoagulants such as warfarin. The simultaneous use of NSAIDs and anticoagulants or heparin is not recommended. In other cases, when using heparin, care must be taken due to the increased risk of bleeding. If this combination cannot be avoided, careful monitoring of the INR is recommended.

Selective serotonin reuptake inhibitors (SSRIs):

Increased risk of gastrointestinal bleeding.

Diuretics, ACE inhibitors and angiotensin II antagonists:

NSAIDs may reduce the effect of diuretics and other antihypertensive drugs. In some patients with impaired renal function (for example, patients with dehydration or elderly patients with impaired renal function), the co-administration of an ACE inhibitor or angiotensin II antagonists and agents that inhibit cyclooxygenase may lead to further deterioration of renal function, including possible acute renal failure, which is usually reversible. This combination should be used with caution, especially in elderly patients. The patient needs to drink enough liquid, it is advisable to check the kidney function before starting treatment

Other antihypertensive drugs (eg beta-blockers):

Reduces the antihypertensive effect of beta-blockers (by inhibiting the synthesis of prostaglandins with a vasodilating effect).

Calcineurin inhibitors (eg cyclosporine, tacrolimus): NSAIDs may increase the nephrotoxicity of cyclosporins indirectly via renal prostaglandins. During the co-administration of these drugs, it is necessary to monitor kidney function

Contraception:

There are reports that NSAIDs reduce the effectiveness of intrauterine devices.

Lithium:

NSAIDs increase the concentration of lithium in the blood (through a decrease in renal excretion of lithium), which can reach toxic values. The simultaneous use of lithium and NSAIDs is not recommended. If co-administration cannot be avoided, it is necessary to determine the level of lithium in plasma at the beginning and end of treatment, as well as after changing the dose of meloxicam.

Methotrexate:

NSAIDs reduce tubular secretion of methotrexate, thereby increasing plasma concentrations of methotrexate. For this reason, for patients taking high doses of methotrexate (more than 15 mg/week), the concomitant use of NSAIDs is not recommended. The risk of interaction between NSAIDs and methotrexate must be considered in patients receiving low doses of methotrexate, especially in patients with impaired renal function. In the case of combined treatment, blood tests and kidney function should be monitored. Be careful if NSAIDs and methotrexate are received within 3 days, because in these cases, the plasma level of methotrexate may increase and lead to increased toxicity. Concomitant treatment with meloxicam does not affect the pharmacokinetics of methotrexate (15 mg/week), but the haematological toxicity of methotrexate should be considered to be aggravated by NSAIDs.

Cholestyramine:

Cholestyramine accelerates the elimination of meloxicam by interrupting the enterohepatic circulation so that the clearance of meloxicam is increased by 50% and the half-life is reduced to 13 ± 3 hours. This interaction is of clinical importance.

Clinically significant pharmacokinetic interactions have not been identified when co-administered with antacids, cimetidine and digoxin.

Special instructions:

The lowest effective dose should be used for the minimum period necessary to control symptoms.

The maximum daily dose should not be exceeded if there is insufficient therapeutic effect, and NSAIDs should not be added as this may increase toxicity. Meloxicam-Teva is not suitable for the treatment of acute pain.

Meloxicam-Teva should not be prescribed to patients who have a history of asthma symptoms, nasal mucosal polyps, angioedema, urticaria after the appointment of acetylsalicylic acid or other NSAIDs.

Use with caution in elderly patients.

As with other NSAIDs, Meloxicam should be used with caution in patients with a history of upper gastrointestinal disease and in patients receiving anticoagulant therapy. In the event of a peptic ulcer or gastrointestinal bleeding, Meloxicam-Teva should be discontinued.

Serious skin reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, and even death have been reported rarely with the use of NSAIDs. Adverse events from the skin and mucous membranes in patients at risk of developing these reactions are observed during the first month of treatment. If a skin rash or mucosal damage occurs, you should immediately stop taking Meloxicam-Teva.

NSAIDs inhibit the synthesis of renal prostaglandins, which are involved in maintaining a sufficient level of renal blood flow. The administration of NSAIDs to patients with reduced renal blood flow and circulating blood volume may accelerate renal decompensation, however, after discontinuation of NSAID therapy, renal function is usually restored to its previous level. The risk of developing such reactions is especially high in patients with symptoms of dehydration, patients with congestive heart failure, cirrhosis of the liver, nephrotic syndrome and severe kidney disease, in patients receiving diuretics, as well as in those who have undergone significant surgery that led to hypovolemia. In such patients, diuresis and renal function should be carefully monitored from the very beginning of treatment.

In rare cases, NSAIDs can cause interstitial nephritis, glomerulonephritis, renal medulla necrosis or nephrotic syndrome.

In patients with end-stage renal disease and on hemodialysis, Meloxicam-Teva should not be administered at a dose of more than 7.5 mg / day. Dose reduction is not required in patients with mild or moderately severe renal insufficiency (creatinine clearance more than 25 ml / min).

As with most NSAIDs, an increase in serum transaminases or changes in other parameters characterizing liver function have been reported in rare cases. In most cases, deviations from the norm were minor and transient.

If deviations from the norm are expressed or are of a permanent nature, Meloxicam-Teva should be discontinued and control laboratory tests should be carried out.

Dose reduction is not required in patients with clinically non-progressive cirrhosis.

Debilitated and debilitated patients may tolerate side effects more severely and should be closely monitored. Like other NSAIDs, Meloxicam should be used with caution in elderly patients who are more likely to have impaired renal, hepatic, or cardiac function.

Meloxicam, like any other NSAID, may mask the symptoms of an infectious disease.

Meloxicam-Teva 7.5 mg and 15 mg tablets contain lactose and therefore should not be taken by patients with congenital galactose intolerance (eg, galactosemia), lactase deficiency, or glucose-galactose malabsorption syndrome.

Fertility

The use of Meloxicam-Teva, as well as any other drug that inhibits COX or prostaglandin synthesis, may impair fertility and is not recommended for women who intend to become pregnant. Meloxicam may delay ovulation. In this regard, in women with impaired fertility or who are being examined for these disorders, meloxicam should be discontinued.

Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous machinery other potentially dangerous mechanisms.

Overdose

Symptoms: drowsiness, nausea, vomiting, stomach pain, bleeding in the gastrointestinal tract, increased blood pressure, renal failure, impaired liver function, respiratory depression, coma convulsions, cardiovascular collapse, anaphylactoid reactions.

Treatment: symptomatic therapy, taking cholestyramine 4 g 3 times a day accelerates the elimination of meloxicam.

Release form and packaging

10 tablets in a blister pack made of PVC/PE/PVDC film and aluminum foil.

2 blister packs, together with instructions for medical use in the state and Russian languages, are put into a cardboard box.