Meloxicam brands: Meloxicam (Oral Route) Description and Brand Names
Meloxicam (Oral Route) Description and Brand Names
Description and Brand Names
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US Brand Name
Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve the symptoms of arthritis (juvenile rheumatoid arthritis, osteoarthritis, and rheumatoid arthritis), such as inflammation, swelling, stiffness, and joint pain. However, this medicine does not cure arthritis and will only help you as long as you continue to take it.
This medicine is available only with your doctor’s prescription.
This product is available in the following dosage forms:
- Tablet, Disintegrating
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Portions of this document last updated: Oct. 01, 2021
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Differences, Similarities, and Which One is Better
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Meloxicam and Celebrex are nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat arthritis. Meloxicam is a generic version of Mobic while Celebrex is the brand name for celecoxib. Both drugs work by preventing the release of inflammatory substances called prostaglandins. By blocking their release in the body, meloxicam and Celebrex can alleviate pain, inflammation, and swelling in the joints.
While both NSAIDs treat pain, they have some differences in how they’re used and some side effects to watch out for. Other examples of NSAIDs include ibuprofen, naproxen, and diclofenac.
What are the main differences between Meloxicam vs. Celebrex?
Meloxicam (Meloxicam coupons | Meloxicam details) is a generic medication that is usually taken once daily for osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis. Meloxicam can reach peak levels in the blood up to 6 hours after taking a dose. It is absorbed over a longer period of time compared to Celebrex and other NSAIDs.
Celebrex (celecoxib) is a brand name drug that can be taken once or twice daily depending on the type of arthritis being treated. Celebrex (Celebrex coupons | Celebrex details) can also treat menstrual cramps. Peak concentrations of celecoxib are reached 3 hours after administration. Therefore, its effects are produced more quickly but last for a shorter time compared to meloxicam.
|Main differences between Meloxicam vs. Celebrex|
|Drug class||Nonsteroidal anti-inflammatory drugs (NSAID)||Nonsteroidal anti-inflammatory drugs (NSAID)|
|Brand/generic status||Generic version available||Generic version available|
|What is the generic name?
What is the brand name?
|Generic name: Meloxicam
Brand name: Mobic
|Generic name: Celecoxib
Brand name: Celebrex
|What form(s) does the drug come in?||Oral tablet
Orally disintegrating tablet
|What is the standard dosage?||7. 5 mg once daily||200 mg once daily or 100 mg twice daily|
|How long is the typical treatment?||Short-term or long-term use depending on your doctor’s instruction||Short-term or long-term use depending on your doctor’s instruction|
|Who typically uses the medication?||Adults and children over 2 years old and weigh 132 lbs (60 kg) or more||Adults and children over 2 years old and weigh 22 lbs (10 kg) or more|
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Conditions treated by Meloxicam and Celebrex
Meloxicam is an FDA-approved generic medication to treat osteoarthritis and rheumatoid arthritis. It can also treat juvenile rheumatoid arthritis, an autoimmune type of inflammation, in children 2 to 17 years old who weighs 132 lbs (60 kg) or more.
Celebrex (celecoxib) is a brand name drug FDA approved to treat osteoarthritis and rheumatoid arthritis. It also treats juvenile rheumatoid arthritis in children 2 to 17 years old who weighs 22 lbs (10 kg) or more. Celebrex can also treat arthritis of the spine (ankylosing spondylitis), menstrual cramp pain (primary dysmenorrhea), and general acute pain.
|Juvenile rheumatoid arthritis||Yes||Yes|
Is Meloxicam or Celebrex more effective?
Meloxicam and Celebrex are both effective at reducing inflammation, pain, and swelling if associated with arthritis. They are COX-2 inhibitor NSAIDs that decrease the production of prostaglandins by blocking the cyclooxygenase (COX-2) enzyme. Because everyone responds to medications differently, their differences in effectiveness vary between individuals.
In one review, COX-2 selective NSAIDs such as meloxicam and celecoxib were found to be equally effective as nonselective NSAIDs such as ibuprofen and naproxen for arthritis. However, some results showed that meloxicam may be less effective in some cases. COX-2 selective NSAIDs were found to have less gastrointestinal (GI) side effects such as stomach ulcers compared to other NSAIDs.
Another study showed that, while drugs like celecoxib and meloxicam have less risk of GI adverse events, they may have an increased risk of cardiovascular or heart side effects. However, all NSAIDs, in general, were found to have some cardiovascular risk and should only be taken with proper medical advice.
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Coverage and cost comparison of Meloxicam vs. Celebrex
Meloxicam is a generic medication that is covered by Medicare and most insurance plans. The average retail cost of meloxicam is around $35. By using a Single Care discount card, you can save more and pay around $13 for the same quantity.
Get the SingleCare discount card
Celebrex is a brand-name medication available in a generic version which is covered by Medicare and most insurance plans. The average retail cost of brand-name Celebrex is around $230. With a Single Care discount card, you can save on generic celecoxib and pay around $120 for the same quantity.
|Typically covered by insurance?||Yes||Yes|
|Typically covered by Medicare?||Yes||Yes|
|Standard dosage||7.5 mg tablets (quantity of 14)||50 mg capsules (quantity of 60)|
|Typical Medicare copay||Depends on your insurance plan||Depends on your insurance plan|
Common side effects of Meloxicam and Celebrex
Meloxicam and Celebrex share similar side effects. Both NSAIDs can cause side effects such as abdominal pain, diarrhea, nausea, indigestion, and flatulence (gas). Both medications can also cause headache, dizziness, back pain, and flu-like symptoms among others.
More serious side effects may include altered blood pressure, heart arrhythmias, and impaired liver function. Although rare, allergic reactions are also possible and include trouble breathing, chest pain, swelling, and hives.
|Edema (fluid buildup in the limbs)||Yes||1.9%||Yes||2.1%|
|Upper respiratory tract infection||Yes||1.9%||Yes||8.1%|
Source: DailyMed (Meloxicam), DailyMed (Celebrex)
Drug interactions of Meloxicam vs. Celebrex
Both meloxicam and Celebrex can interact with blood thinners such as low dose aspirin, warfarin, and other drugs. Taking these medications together can increase the risk of bleeding and stomach ulcers.
Meloxicam and Celebrex can also interact with diuretics and certain blood pressure medications such as ACE inhibitors, angiotensin receptor blockers (ARBs), and beta blockers. Taking these drugs together may increase the risk of kidney problems.
Meloxicam and Celebrex also interact with lithium, methotrexate, and cyclosporine. Taking these drugs together can lead to increased toxicity.
It’s important to discuss all medications you may be taking with your doctor before taking an NSAID like meloxicam or Celebrex.
*This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.
Warnings of Meloxicam and Celebrex
Meloxicam and Celebrex both have warnings on their drug labels that indicate a greater risk of gastrointestinal (GI) and cardiovascular effects. These NSAIDs can increase the risk of GI events such as stomach ulcers or bleeding in the stomach or intestines. They can also increase the risk of heart attacks and stroke. If you have a history of high blood pressure, heart disease, or other conditions, you may be at a higher risk.
Both meloxicam and Celebrex are not recommended in those who have undergone coronary artery bypass graft (CABG) surgery.
Meloxicam and Celebrex should be monitored in those with kidney or liver problems as they can make these issues worse. These NSAIDs can also worsen asthma-related to aspirin sensitivity.
It is not recommended to use NSAIDs while pregnant.
Frequently asked questions about Meloxicam vs. Celebrex
What is Meloxicam?
Meloxicam is a generic NSAID medication that can treat inflammation, pain, and swelling from arthritis. It is usually taken once daily depending on your doctor’s prescription. As a relatively selective COX-2 inhibitor, it may have a lower risk of stomach ulcers compared to other NSAIDs.
What is Celebrex?
Celebrex is the brand name for celecoxib, an NSAID that treats arthritis. It can also treat arthritis of the spine as well as menstrual cramps. Celebrex is taken once or twice daily. It belongs to a class of NSAIDs called COX-2 selective NSAIDs.
Are Meloxicam and Celebrex the same?
Meloxicam and Celebrex belong to the same class of medications called NSAIDs. However, they are not the same. They have different uses and may be taken differently depending on the condition being treated.
Is Meloxicam or Celebrex better?
Meloxicam and Celebrex are both effective depending on their use. Meloxicam may be preferred for its once-daily dosing. Celebrex may be preferred for someone who has ankylosing spondylitis or menstrual cramps.
Can I use Meloxicam or Celebrex while pregnant?
Meloxicam and Celebrex should be avoided in women who are pregnant. Taking NSAIDs during the third trimester can increase the risk of heart problems in the baby.
Can I use Meloxicam or Celebrex with alcohol?
No. It is not recommended to use meloxicam or Celebrex with alcohol. Doing so can increase the risk of bleeding or stomach ulcers.
Does Celebrex cause weight gain?
Weight gain is a rare but possible side effect of Celebrex. It can occur in 0.1% to 1.9% of those who take Celebrex, according to the drug label.
Does Celebrex work immediately?
Celebrex starts working as the drug is absorbed in the body. Absorption can occur rather quickly although it may take a couple weeks of taking Celebrex consistently to receive the full benefits.
Meloxicam: Uses, Interactions, Mechanism of Action
Meloxicam is indicated for the symptomatic treatment of arthritis and osteoarthritis. In addition, it is indicated for the pauciarticular and polyarticular course of Juvenile Rheumatoid Arthritis (JRA) in patients aged 2 years old or above.10 Off-label uses include the treatment of dental or post-surgical pain. In addition to the above, meloxicam has also been studied in the treatment of neuropathic pain. 1
Meloxicam, together with the local anesthetic bupivacaine, is indicated for the production of postsurgical analgesia in adult patients for up to 72 hours following bunionectomy, open inguinal herniorrhaphy or total knee arthroplasty.13
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Meloxicam is an anti-inflammatory, analgesic analgesic with antipyretic effects in fever. 1 Prostaglandins are substances that contribute to inflammation.7 This drug also exerts preferential actions against COX-23, which may reduce the possible gastrointestinal effects of this drug.
In humans, meloxicam has demonstrated the ability to decrease erythrocyte sedimentation rate(ESR) in patients with rheumatoid arthritis, and to decrease ESR, C-reactive protein (CRP), as well as aquaporin-1 expression.1 As with other NSAIDS, prolonged use of meloxicum can result in renal or cardiovascular impairment or thrombotic cardiovascular events.10
A note on gastrointestinal effects
As meloxicam preferentially inhibits COX-2, it is thought to cause less gastrointestinal irritation compared to other NSAIDS. Despite this, it still carries a risk of gastric inflammation, bleeding and ulceration.5,10 In one study, patients on meloxicam suffered from gastrointestinal symptoms at a rate of 13% compared to 19% of those on diclofenac. GI events were found to be less severe in the meloxicam-treated patients.1
Meloxicam inhibits prostaglandin synthetase (cylooxygenase 1 and 2) enzymes leading to a decreased synthesis of prostaglandins, which normally mediate painful inflammatory symptoms.7 As prostaglandins sensitize neuronal pain receptors, inhibition of their synthesis leads to analgesic and inflammatory effects. Meloxicam preferentially inhibits COX-2, but also exerts some activity against COX-1, causing gastrointestinal irritation.1,10
The absolute bioavailability oral capsules after a dose was 89% in one pharmacokinetic study. Cmax was reached 5–6 hours after administration of a single dose given after the first meal of the day. The Cmax doubled when the drug was administered in the fasting state. Despite this, meloxicam can be taken without regard to food, unlike many other NSAIDS.1,10
Meloxicam formulated for instillation with bupivacaine produced varied systemic measures following a single dose of varying strength. In patients undergoing bunionectomy, 1.8 mg of meloxicam produced a Cmax of 26 ± 14 ng/mL, a median Tmax of 18 h, and an AUC∞ of 2079 ± 1631 ng*h/mL. For a 9 mg dose used in herniorrhaphy, the corresponding values were 225 ± 96 ng/mL, 54 h, and the AUC∞ was not reported. Lastly, a 12 mg dose used in total knee arthroplasty produced values of 275 ± 134 ng/mL, 36 h, and 25,673 ± 17,666 ng*h/mL.13
The volume of distribution of meloxicam is 10-15L. Because of its high binding to albumin, it is likely to be distributed in highly perfused tissues, such as the liver and kidney.1 Meloxicam concentrations in synovial fluid, measured after an oral dose, is estimated at 40% to 50% of the concentrations measured in the plasma.10 This drug is known to cross the placenta in humans.9
Meloxicam is about 99.4% protein bound, primarily to albumin. 1,3,10
Meloxicam is almost completely metabolized. CYP2C9 is the main enzyme responsible for the metabolism of meloxicam1,6 with minor contributions from CYP3A4.10 Meloxicam has 4 major metabolites with no activity determined. About 60% of the ingested dose is metabolized to 5′-carboxy meloxicam from hepatic cytochrome enzyme oxidation of an intermediate metabolite, 5’-hydroxymethylmeloxicam.6,8 Two other metabolites are likely produced via peroxidation.6,10
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Meloxicam is mainly eliminated through metabolism. Its metabolites are cleared through renal and fecal elimination.3 Less than 10 About 1.6% of the parent drug is excreted in the feces.1
The half-life of meloxicam is approximately 20 hours3, which is considerably longer than most other NSAIDS. It can therefore be dosed without the need for slow-release formulations.1
Meloxicam applied together with bupivacaine for postsurgical analgesia had a median half-life of 33-42 hours, depending on dose and application site.13
After an oral dose, the total clearance of meloxicam is 0.42–0.48 L/h.1,3 The FDA label indicates a plasma clearance from 7 to 9 mL/min. No dose changes are required in mild to moderate renal or hepatic impairment. The use of meloxicam in patients with severe renal or hepatic impairment has not been studied. FDA prescribing information advises against it.10
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The oral LD50 in rats is 98 mg/kg.11 Signs and symptoms of overdose with meloxicam may include shallow breathing, seizure, decreased urine output, gastrointestinal irritation, nausea, vomiting, gastrointestinal bleeding, and black tarry stools.12 In the case of an overdose, offer supportive treatment and attempt to remove gastrointestinal contents. Cholestyramine has been shown to enhance the elimination of meloxicam.11
Comparative Evaluation of the Analgesic Effect of Brand and Generics of Meloxicam tablets Available in markets
Meloxicam is one of non-steroidal anti-inflammatory drugs (NSAIDs) used for relief of pain and inflammation. It works by inhibition of cyclooxygenase enzymes which are responsible for Prostaglandins synthesis. The purpose of this study was to assess analgesic effects of brand (Mobic®) and three generics (Neoxicam®, Coxicam®, Oximal®) of meloxicam in rats. Fifty-four male albino rats were divided into nine groups equally and randomly allocated to receive oral Mobic, Neoxicam, Coxicam or Oximal at same doses (10 mg/kg) and one group received vehicle orally (positive control). Anti-nociception was evaluated using hot plate test at 30 minutes, 1st, 2nd, 4th and 8th hour after drug administration and formalin test at phase1 (within this time the first 5 minutes), phase 2A (from 10 to 39 min) and phase 2B (from 40 to 60 min). The result of this study in hot plate test shown that the analgesic effect of Oximal at 2nd and 4th hours was statistically significant (p<0.05) compared to Mobic; also Coxicam significantly increased the percentage of the maximum possible effect than the brand at 4th hour. However, there was no significant difference between the band and all generics at 30, 60 and 480 min. In formalin test, all treatment groups significantly reduced the frequency of flinching compared to positive control group, but there was no significant difference between the brand and generics at all time-points. Moreover, the reduction in the duration of licking was not significant between treatment groups and positive control group in phase1 and 2A. Nevertheless, the brand and generics significantly reduced the duration of licking in phase 2B compare to control group and there was no significant difference between the all treatment groups at the same phase. In conclusion, according to these results, the analgesic effect of the generics (Neoxicam, Coxicam, Oximal) proved to be as good as the brand (Mobic).
What Veterinarians Should Tell Clients About Pain Control and Their Pets
by Michele Sharkey, DVM, MS, Office of New Animal Drug Evaluation; Margarita Brown, DVM MS, Retired, Office of Surveillance and Compliance; and Linda Wilmot, DVM, Retired, Office of New Animal Drug Evaluation
Non-steroidal anti-inflammatory drugs (NSAID) are commonly prescribed and are effective pain control drugs for pets. Like most drugs, they do cause side effects, some serious. Veterinarians are in the best position to inform their clients about these side effects, so the clients can take better care of their pets. And, pet owners expect veterinarians to explain all potential risks of medications.
Dogs are living longer and healthier lives thanks to advances in veterinary medicine and pharmaceuticals. With active lifestyles that extend into advanced ages, dogs are often diagnosed with osteoarthritis or undergo surgical procedures and are treated for postoperative pain. NSAIDs are among the most common analgesics prescribed in these cases.
NSAIDs are used to control signs of arthritis, including inflammation, swelling, stiffness, and joint pain. Inflammation—the body’s response to irritation or injury—is characterized by redness, warmth, swelling, and pain. NSAIDs mediate the production or function of prostaglandins (enzymes) involved in inflammation.
In the United States, NSAIDs approved for use in dogs include:
Table 1: Some FDA-Approved Nonsteroidal Anti-Inflammatory Drugs for Dogs
|Carprofen||Marketed under multiple trade names|
|Meloxicam||Marketed under multiple trade names|
|Robenacoxib||ONSIOR (for a maximum of 3 days)|
*Indicates an FDA-approved generic animal drug.
In the United States, there is one NSAID approved for up to 3 days use in cats: ONSIOR (robenacoxib) tablets or ONSIOR (robenacoxib) injection. Meloxicam injection is approved for a single injection to control pain associated with surgery in cats.
You can get more information about NSAIDs approved for use in animals in the US by going to Animal Drugs at FDA, and then the “NSAID Labels” navigational button under Supporting Documents, where you can look up the drugs by their brand names or active ingredient.
Other NSAIDs are available in the United States for human uses but have not been approved for use in dogs or cats. Sometimes there may not be an approved animal drug available for a specific indication or dosage form. However, the Animal Medicinal Drug Use Clarification Act of 1994 gives veterinarians the same kind of discretionary authority available to physicians, allowing veterinarians, under certain conditions, to prescribe drugs for “extralabel” uses, which are uses not listed on the label.
As with any medication, veterinarians should discuss the benefits as well as the risks of the drugs with their clients when prescribing an NSAID. Every year millions of doses of medications are prescribed for dogs with good reason—but many adverse reactions occur. Most adverse reactions are mild, but some result in permanent impairment or even death. If the client can recognize a possible reaction and stop the medication while seeking veterinary attention for the dog, quick action may make the difference between a good outcome and a disaster.
The most common side effects from NSAIDs include vomiting, loss of appetite, depression/lethargy, and diarrhea. Some side effects can be serious, especially if the drug is not used according to labeled directions, resulting in the need for medical care. Serious adverse reactions include gastric ulcers and perforations, kidney and liver problems. Death may result in some instances.
All NSAIDs approved for oral use in dogs and cats come with a Client Information Sheet (also known as the Information for Dog (Cat) Owner Sheet) that describes the drug’s side effects. Dog and cat owners should ask veterinarians for the Client Information Sheet when an NSAID is prescribed. These Client Information Sheets provide the pet owner with important information in a user-friendly manner regarding what can be expected from use of the drug, potential side effects, and the need to seek veterinary attention if problems occur. By accompanying each NSAID prescription with the Information for Dog (Cat) Owner Sheet, a handy reference of valuable safety information and drug company contact information is readily available to the owner.
Not all side effects can be predicted
All approved medications indicated for pets are subject to extensive evaluation by a drug company using stringent standards set by the CVM before they are marketed. Every effort is made to ensure safe and effective treatments. However, every drug has the potential for side effects. Pre-testing by the animal drug manufacturer and review of the data from those tests by the government ensure that the animal drug is safe and effective. Because of the relatively low frequency of some adverse events, some adverse effects are recognized only after the marketing of the product in a large population of animals.
NSAID therapy can also unmask hidden disease, previously undiagnosed due to the absence of apparent clinical signs. Dogs with underlying kidney disease, for example, may experience worsening of that disease while on NSAIDs. Dogs at greatest risk for kidney problems are those that are dehydrated, on concomitant diuretic therapy, or have kidney, heart, and/or liver dysfunction.
Unexpected reactions to a drug are reported to the drug manufacturer, and every reaction reported to a pharmaceutical manufacturer must by law be reported to the FDA.
Advice given to owners
We recommend that pet owners work with their veterinarians to make medication decisions including the use of over-the-counter drugs, vitamins, herbal supplements, flea control products, and other medications. Giving certain medications and other over-the-counter products at the same time could be detrimental to a dog’s health.
Many reactions due to NSAIDs may be lessened if owners are aware of potential side effects, and with appropriate use many can be minimized or avoided. First and foremost, if an owner suspects a reaction to an NSAID, the owner should stop administering the drug immediately and should contact a veterinarian. Some reactions are mild and go away after stopping the drug.
The veterinarian is in the best position to advise the dog owner on using an NSAID. Before administering an NSAID to a dog, the veterinarian often recommends blood tests. The knowledge gained from these tests could be critical in deciding if the drug is safe to use in a dog. If a dog is prescribed an NSAID for the control of pain associated with osteoarthritis, regular veterinarian check-ups and blood tests are recommended to evaluate the continued use of the drug.
When treating a dog with an NSAID, the owner should never increase the dose or frequency of administration without consulting their veterinarian.
The owners should follow their veterinarians’ instructions.
A pet owner should never give an NSAID to a dog (or cat) unless under the direction of a veterinarian.
Pain control in response to the use of an NSAID varies between dogs (just as it does in people). Because the response to pain medication is individualized, no one NSAID is considered more effective than another, and because every NSAID can cause adverse reactions, including stomach/intestinal ulcers and death, none is considered safer than others.
But selecting the best NSAID is important. With advances in the recognition and definition of animal pain and the many NSAID choices available, much benefit can be gained from the appropriate and careful use of these drugs.
Sometimes, the process of finding the best NSAID for a specific patient can mean changing the prescription. Only one brand of NSAID should be administered to a dog at any given time. If at some time the owner and the veterinarian decide to try a different NSAID, a wash-out period is recommended. A wash-out period is a period of time recommended by the veterinarian during which the dog does not receive any NSAID. This allows one NSAID to be cleared from the body before starting another NSAID. Then the dog can be switched to another NSAID. NSAIDs should not be combined with the use of a corticosteroid, either.
The pain associated with osteoarthritis may wax and wane. The lowest effective dose should be used for the shortest duration depending on the dog’s response. If the dog seems to improve to the point of not needing the drug, the owner should discuss continued use of the NSAID with a veterinarian.
The key to making any transition or change work well is good veterinarian-client communications.
An informed dog owner is the best defense against serious side effects from NSAIDs. The veterinarian is the most qualified source for information regarding NSAID use and a dog’s care. Owners should not hesitate to ask questions and inquire about possible side effects or signs to watch for when treating a dog. A Client Information Sheet, which a veterinarian should give the pet owner whenever an NSAID is prescribed, serves as a reminder of this information for use at home.
What starts out as a minor problem can readily progress to an emergency. An owner should be encouraged to call his or her veterinarian with any concerns about the NSAID the dog is receiving. The veterinarian and/or owner may even call the drug manufacturer (a toll free number appears on each label and the Client Information Sheet). Pharmaceutical companies offer customer service and technical support for product information and quality control. When possible problems are experienced with a product, the manufacturer may have specific recommendations for the treating veterinarian regarding tests and treatments.
Package inserts and Client Information Sheets for many of the NSAIDs used in dogs, cats, and horses may be found at the NSAID Labels page of Animal Drugs @FDA.
Meloxicam – an overview | ScienceDirect Topics
Ketorolac, until recently, was the only parenteral NSAID available in the United States and was therefore used quite extensively in the perioperative period. Pharmacologically, it is a member of the pyrrolo-pyrrole group and is avidly protein bound, resulting in a low volume of distribution. Ketorolac is extensively conjugated in the liver and then excreted in the urine. Time to measurable effect is about 30 minutes, with a peak effect noted at 1 to 2 hours and a duration of action of 4 to 6 hours.
In the management of postoperative pain, ketorolac has proven very useful, with an opioid-sparing effect and efficacy similar to morphine in the treatment of moderate pain.39,40 Concerns exist regarding the renal safety profile of ketorolac in the perioperative setting that have necessitated modifications of dosing guidelines. Previously, the drug was administered at a 60-mg initial dose followed by 30 mg every 4 hours, and cases of acute tubular necrosis were reported. Gastrointestinal bleeding and operative site bleeding have also been reported and are mostly associated with advanced patient age, duration of therapy beyond 5 days, and higher dosing regimens. 41 Subsequently, dosing recommendations were decreased by more than 50%. The ketorolac product labeling now advises the following intravenous dosing protocol: for a single dose, 30 mg intravenously or 15 mg if patient age is greater than 65 year or body weight less than 50 kg; for multiple dosing, patients should be commenced on 30 mg every 6 hours, not to exceed 120 mg in a 24-hour period; in those older than 65 years or weighing less than 50 kg, the dosing should be 15 mg every 6 hours, not to exceed 60 mg in 24 hours.42 In no circumstance should dosing go beyond 5 days of therapy, and ketorolac is best avoided in patients with a history of peptic ulcer disease or renal impairment.
Acetaminophen, while strictly speaking is not an NSAID, is generally grouped in this therapeutic class and plays a major role in analgesic therapy. Acetaminophen is a para-aminophenol derivative with analgesic and antipyretic properties similar to aspirin. The very useful antipyretic effect is thought to be a direct effect on the hypothalamic heat-regulating centers via inhibiting action of endogenous pyrogens. Recent reports suggest that acetaminophen acts via serotonergic pathways, COX-3 inhibition, and/or endogenous cannabinoid potentiation to provide analgesia, but its mechanism of action remains poorly understood.43–45 Although equipotent to aspirin in inhibiting central prostaglandin synthesis, acetaminophen has no significant peripheral prostaglandin synthetase inhibition and is therefore less useful than NSAIDs for painful inflammatory disorders.
Acetaminophen has few side effects in the usual dosage range; unlike NSAIDs, no significant gastrointestinal toxicity or platelet function inhibition occur. Acetaminophen has, however, been associated with the development of hypertension but has not yet been associated with increased cardiovascular risk.46 Nephrotoxicity also can occur with acetaminophen but less frequently than it occurs with NSAIDs.47
Acetaminophen is completely and rapidly absorbed following oral administration, and peak serum concentrations are achieved within 2 hours. About 90% of acetaminophen is hepatically metabolized to sulfate and glucuronide conjugates for renal excretion with a small amount secreted unchanged in the urine. Minor metabolites are responsible for the hepatotoxicity seen in overdose.48 CYP 450 enzyme system induction in the liver by any agent, including ethanol, increases the formation of toxic free radial metabolites and thereby increases hepatotoxicity. In the healthy individual, daily doses of 2.6 to 3.2 g are generally considered safe, but acetaminophen dosing should not exceed 4 g/day.49,50 In patients with a history of ethanol abuse or liver disease, acetaminophen should generally be avoided.
The bioavailability of rectal acetaminophen is variable and is approximately 80% of that following oral administration. The rate of rectal absorption is slower, with maximum plasma concentration occurring 2 to 3 hours after administration. Doses of 40 to 60 mg/kg of rectal acetaminophen have been shown to have an opioid-sparing effect in the management of postoperative pain. 51 In Europe, an intravenous prodrug form of acetaminophen, propacetamol, and intravenous acetaminophen are available for clinical use and have been shown to reduce postoperative opioid consumption.52,53 In 2011, an intravenous form of acetaminophen was introduced in the United States for the parenteral management of pain and fever.54 Intravenous acetaminophen (1 g every 4 hours for 24 hours) was well tolerated, improved pain reporting, and decreased morphine consumption after orthopedic surgery.55
Microsoft Word – Medication information sheets.doc
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Patients with gastrointestinal diseases require regular monitoring. If ulcerative lesions of the gastrointestinal tract or gastrointestinal bleeding occur, meloxicam should be canceled.
Gastrointestinal ulcers, perforation, or bleeding can occur with NSAIDs at any time, with or without a history of alarming symptoms or a history of serious gastrointestinal complications.The consequences of these complications are generally more serious for the elderly.
When using meloxicam, such serious skin reactions 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. In the event of the first signs of a skin rash, changes in mucous membranes or other signs of hypersensitivity, consideration should be given to discontinuing the use of meloxicam.
There are cases when taking NSAIDs to increase the risk of developing serious cardiovascular thrombosis, myocardial infarction, angina pectoris attack, possibly fatal. 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 kidney, 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, liver cirrhosis, 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 kidney function is necessary.In the case of combination therapy, renal function should also be monitored.
When using meloxicam (as well as most other NSAIDs), an episodic increase in serum transaminase activity or other indicators of liver function is possible. In most cases, this increase was small and transient. If the identified changes are significant or do not decrease over time, meloxicam should be canceled, and the identified laboratory changes should be monitored.
Weakened or emaciated patients may be less tolerant of adverse events, and therefore, such patients should be carefully monitored.Like other NSAIDs, meloxicam can mask the symptoms of an underlying infectious disease.
As an inhibitor of COX / prostaglandin synthesis, meloxicam may interfere with fertility and is therefore not recommended for women who have difficulty conceiving. In women undergoing examination for this reason, it is recommended to discontinue meloxicam.
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 mechanisms
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. During the period of treatment, patients need to be careful when driving and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.
Metakam, 50 ml.HorseVet Veterinary Pharmacy.
Trade name of the medicinal product: Metacam®.
International non-proprietary name: meloxicam.
Dosage form: injection solution.
1 ml of Metakam injection solution contains 20 mg of meloxicam as an active ingredient, and as auxiliary substances: ethanol, poloxamer-188, macrogol 300 (polyethylene glycol 300), glycine, sodium edetate, sodium hydroxide, hydrochloric acid, meglumine and water for injection.
In appearance, the preparation is a clear yellow liquid.
The shelf life of the drug Metakam, subject to storage conditions, is 3 years from the date of production, after opening the bottle – no more than 28 days. The medicinal product must not be used after the expiration date.
Metakam is stored in closed manufacturer’s packaging separately from food and feed; in a dark place at a temperature of 10 ° C to 25 ° C out of the reach of children.
Pharmacotherapeutic group: non-steroidal anti-inflammatory drugs.
Meloxicam, which is part of the drug, has a pronounced anti-inflammatory and analgesic activity.
The mechanism of action of meloxicam is the selective suppression of the production of cyclooxygenase (COX) in the arachidonic acid cycle, while the production of COX-2 is suppressed, under the action of which the synthesis of inflammatory prostaglandins (PGE1 and PGE2), causing inflammation, edema and pain, occurs.
Pharmacodynamics and pharmacokinetics
Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) that inhibits the synthesis of prostaglandins, and thus has anti-inflammatory, anti-exudative, analgesic and anti-inflammatory effects. It reduces the infiltration of leukocytes at the site of inflammation, inhibits platelet aggregation, and also blocks the production of thromboxane B2 in animals caused by E. coli endotoxin.
After a single subcutaneous injection to cows at a dose of 0.5 mg of meloxicam / kg, Cmax reaches values of 2.7 μg / ml and 2.1 μg / ml after 4 and 7.7 hours, respectively.After two intramuscular injections to pigs at a dose of 0.4 mg meloxicam / kg, the Cmax value is reached 1.9 μg / ml 1 hour after application. More than 98% of meloxicam is bound to plasma proteins. The highest concentrations are found in the liver and kidneys. Lower concentrations are found in skeletal muscle and adipose tissue.
Meloxicam is degraded to alcohol, an acid derivative and several polar metabolites, pharmacologically inactive.
Meloxicam is excreted with a half-life of 26 hours and 17.5 hours after subcutaneous injection in heifers and lactating cows, respectively.
In pigs after intramuscular injection, the average elimination half-life is about 2.5 hours, and in horses after intravenous injection, 8.5 hours. Approximately 50% of the administered dose is eliminated through urine and the remainder through feces.
Order of application
Metakam is used as an anti-inflammatory and analgesic drug in cattle for diarrhea in combination with rehydration therapy, for acute respiratory infections, purulent catarrhal mastitis in combination with appropriate antibacterial therapy, as well as for inflammatory processes of the musculoskeletal system …Pigs with dysfunction of the musculoskeletal system associated with inflammatory processes of non-infectious etiology, in the treatment of postpartum sepsis and mastitis-metritis-agalactia syndrome in combination with appropriate antibacterial drugs. Horses with chronic and acute diseases of the musculoskeletal system and colic as an anti-inflammatory and analgesic agent.
Contraindication to the use of Metacam is the increased individual sensitivity of the animal to the components of the drug.It is forbidden to administer the drug to calves under one week of age, foals under 6 weeks of age, foal or lactating mares, animals with liver and cardiovascular lesions, impaired renal function, manifestation of hemorrhagic syndrome.
Metakam is used in cattle once subcutaneously or intravenously at a dose of 2.5 ml per 100 kg of animal weight, which corresponds to 0.5 mg of meloxicam per 1 kg of animal weight; for pigs, a single intramuscular injection at a dose of 2.0 ml per 100 kg of animal weight, which corresponds to 0.4 mg of meloxicam per 1 kg of animal weight.
According to indications, it is possible to re-administer the drug to pigs after 24 hours. Horses are administered the drug once intravenously at a dose of 3.0 ml per 100 kg of animal weight, which corresponds to 0.6 mg of meloxicam per 1 kg of animal weight.
Symptoms of overdose when using the drug were not identified.
No peculiarities of the action at the beginning of taking Metakam and at its cancellation have been identified.
The use of the drug in foals and lactating mares is prohibited.The drug is used for pregnant and lactating sows, as well as for pregnant and lactating cows.
If the term for repeated use of Metacam is missed, pigs should enter it in the prescribed dose as soon as possible.
When using the drug in accordance with this instruction, side effects and complications, as a rule, are not observed. In some vaccinated animals, a swelling may form at the injection site, which spontaneously disappears.If, in isolated cases, anaphylactic reactions occur, symptomatic treatment of animals with antihistamines, adreno- and sympathomimetics is recommended.
The simultaneous use of the drug with glucocorticosteroids, other non-steroidal anti-inflammatory drugs, and anticoagulants is prohibited.
Slaughter of cattle for meat is allowed no earlier than 15 days, pigs and horses – 5 days after the last use of the drug Metakam.
Milk can be used for food 5 days after the last use of the drug.
Milk obtained earlier than the established period can be used after boiling for feeding fur-bearing animals.
Meat of animals, forcedly killed before the expiration of the specified period, can be used as feed for fur animals.
Manufacturer: Boehringer Ingelheim (Germany)
Meloxicam-Prana 7.5mg tablets 20 pcs.
Analgesic, anti-inflammatory, antipyretic.Inside, with food 1 time per day. Rheumatoid arthritis, ankylosing spondylitis – 15 mg / day. Osteoarthritis – 7.5 mg / day. If ineffective, the dose can be increased to 15 mg / day. The maximum daily dose is 15 mg / m deep, for adults, 7.5-15 mg 1 r per day.
Composition: Each tablet contains: As an active ingredient: Meloxicam 7.5 mg and 15 mg; In auxiliary substances: Lactose monohydrate, microcrystalline cellulose, magnesium stearate, corn starch, colloidal silicon dioxide, sodium croscarmellose.
NSAID, selective COX-2 inhibitor. Belongs to the class of oxicams, is a derivative of enolic acid. It has anti-inflammatory, analgesic and antipyretic effects. The mechanism of action is associated with a decrease in the biosynthesis of prostaglandins as a result of inhibition of the enzymatic activity of COX. At the same time, meloxicam more actively affects COX-2, which is involved in the synthesis of prostaglandins in the inflammation focus, which reduces the risk of side effects on the upper gastrointestinal tract and slightly affects COX-1.At the same time, meloxicam does not affect the synthesis of proteoglycan by chondrocytes of the articular cartilage, does not affect the development of spontaneous arthrosis in rats and mice, which indicates its chondroneutrality.
Inflammatory and degenerative diseases of the joints (arthrosis, osteoarthritis), rheumatoid arthritis, ankylosing spondylitis (ankylosing spondylitis).
application and dosage
Inside 7.5-15 mg 1 time / day. The maximum daily dose of is 15 mg.Topically applied 2 times / day. Apply in a thin layer on clean, dry skin over the lesion and rub lightly for 2-3 minutes.
From the digestive system: dyspepsia, nausea, vomiting, abdominal pain, constipation, intestinal colic, diarrhea, esophagitis, stomatitis; rarely – erosive and ulcerative lesions of the gastrointestinal tract.
From the side of the central nervous system: dizziness, headache, tinnitus.
From the side of the cardiovascular system: increased blood pressure, palpitations, edema, hot flashes. From the urinary system: changes in laboratory parameters of renal function.
From the side of the hematopoietic system: anemia, leukopenia, thrombocytopenia.
Allergic reactions: bronchospasm, photosensitivity, pruritus, rash, urticaria.
Peptic ulcer of the stomach and duodenum in the acute phase, severe liver dysfunction, renal failure (without hemodialysis), pregnancy, children and adolescence up to 15 years, hypersensitivity to meloxicam and other NSAIDs (incl.including salicylates).
Used with caution in patients with a history of gastrointestinal diseases.
Interaction with other drugs
With simultaneous use, it is possible to reduce the effectiveness of antihypertensive drugs (beta-blockers, ACE inhibitors, vasodilators).
With simultaneous use with anticoagulants, the risk of bleeding increases.
With simultaneous use with diuretics, the risk of developing renal failure in patients in a state of dehydration increases.With simultaneous use with NSAIDs, the risk of developing ulcerative lesions of the gastrointestinal tract and gastrointestinal bleeding increases.
With simultaneous use with lithium preparations, the concentration of lithium in the blood plasma increases.
With simultaneous use, cholestyramine accelerates the elimination of meloxicam.
With simultaneous use with methotrexate, it is possible to increase the myelodepressant effect; with cyclosporine – it is possible to enhance the nephrotoxic effect of cyclosporine.
90,000 50 brands with the most effective advertising
Coca-Cola, according to the analytical marketing platform Warc, was recognized as the best brand of 2015 based on the analysis of the effectiveness of advertising activities.Also in the top five were McDonald’s, IKEA and Always.
The Warc Best Brands ranking is based on an analysis of the customer’s business performance after the launch of advertising campaigns recognized as the best at various festivals. Warc analysts studied more than 2,000 winners in 79 different festivals, where they evaluated the effectiveness of advertising campaigns. The prestige of the award was determined using the results of a survey of more than 100 senior strategists. The methodology was developed in consultation with King’s College London.
Warc100 is an analytical platform that studies advertising activities and creative ideas of the world’s leading brands. Since 1985, the service has been determining the most effective advertising campaigns and presents an annual rating, as well as ratings of advertisers and agencies. Warc has offices in the UK, USA and Singapore.
Coca-Cola and McDonald’s have not changed their leading positions in the ranking of the best brands of Warc 2016. Brands occupy the first and second places in the ranking for the third year in a row, while the first-emerging brand of the Australian chain optician OPSM has displaced Mercedes-Benz from the third line …
Three companies helped to top the Warc Coca-Cola rankings: Share a Coke (just three months after the launch of the campaign, brand sales increased by 0.4%, and profits increased to 2.5%), #colouryoursummer (the campaign increased Coca sales -Cola by 7% at the end of 2015) and local advertising of mini kiosks in Germany intended for the sale of miniature cans of the drink (sales of cola in new kiosks increased by 278%).
McDonald’s took second place in the Warc rankings thanks to two apps: “Surprise Alarm” (the app that took the leading position in app stores in 2015 motivates consumers to wake up by reminding them of what can be bought at chain restaurants in the morning) and the campaign “I see fries” (a consumer could get free fries if he photographed something resembling fries in his environment; in just two weeks after launching the campaign, its page has collected more than 3 million.clicks).
Australian optician network OPSM breaks through to rank # 3 in Warc’s Best Brands with the Penny the Pirate campaign. The advertising campaign, which was developed by the agency Saatchi and Saatchi, included the development of a special book and a mobile application that allows children with visual impairments to freely read and view pictures. As a result of this campaign, OPSM sales grew by 22.4%, and the number of eye examinations in the chain’s stores grew by 22.6%.The “Penny the Pirate” campaign was ultimately rated by Warc analysts as the most effective in 2015.
Recall that Procter & Gamble became the most effective global advertiser in 2015, according to Warc 100. The Warc 100 ranked nine ad campaigns for the brand, including Leo Burnett’s #LikeAGirl for Always, BBDO’s Touch the Pickle for Whisper, and Smellcome to manhood for Old Spice by Wieden + Kennedy.Warc 100 analysts note that “Procter & Gamble’s strong position in the current Warc 100 ranking reflects the company’s ability to create influential ads that make people talk about it.”
Top 50 brands with the most effective advertising in 2015
|Rank||Brand||Advertiser||Points 1||The Coca-Cola Company||310.2|
|3||OPSM||Luxottica 9017 9017 9017 9017||IKEA||IKEA||138|
|5||Always||Procter & Gamble||133.6|
|8||Volvo 90 172||Volvo Group||103.9|
|10||Pantene||Procter & Gamble||87.3||US Department of Defense||81.2|
|16||Hindustan Unilever||Unilever||Ford||The Ford Motor Company||71.8|
|18||British Airways||International Airlines Group||71.6|
|23||Deutsche Telekom||9016 9016 Telekom 68.3172 9017||Nissan||Nissan||66.7|
|25||Newcastle Brown Ale||Heineken||66.4|
|26||New Zealand Transport Agency||90 New Zealand Transport Agency 65.72|
|27||Nike||Nike||64.9 90 172|
|30 62172 90||BMW|
|31||Honey Maid||Mondelez International||59.9|
|32||Gillette||Procter & Gamble||57.7|
|17 , 7|
|Idea Cellular||Aditya Birla Group||52|