Instructions for Meloxicam-KV tablets 7.5 mg No. 20
Composition
active ingredient: meloxicam;
1 tablet contains meloxicam 7.5 mg or 15 mg;
Excipients: lactose monohydrate, sodium citrate, microcrystalline cellulose, colloidal anhydrous silica, croscarmellose sodium, povidone, magnesium stearate.
Dosage form
Pills.
Main physicochemical properties: flat-cylindrical tablets with a bevel, light yellow color (7.5 mg); flat-cylindrical tablets with a score and a bevel, light yellow color (15 mg).
Pharmacotherapeutic group
Nonsteroidal anti-inflammatory drugs and antirheumatic drugs. ATC code M01A C06.
Pharmacological properties
Pharmacodynamics.
Meloxicam-KV is a nonsteroidal anti-inflammatory drug (NSAID) of the enoleic acid class that has anti-inflammatory, analgesic, and antipyretic effects.
Meloxicam has shown high anti-inflammatory activity in all standard models of inflammation. As with other NSAIDs, its exact mechanism of action remains unknown. However, there is a common mechanism of development for all NSAIDs (including meloxicam): inhibition of the biosynthesis of prostaglandins, which are mediators of inflammation.
Pharmacokinetics.
Absorption.
Meloxicam is well absorbed from the gastrointestinal tract when administered orally, the absolute bioavailability of the drug is 90% (capsules). After a single dose of meloxicam, the maximum plasma concentration is reached within 5–6 hours for solid oral forms.
With multiple dosing, steady-state concentrations are reached within 3–5 days. With once-daily dosing, the mean plasma concentration with relatively small peak fluctuations is 0.4–1.0 μg/ml for 7.5 mg and 0.8–2.0 μg/ml for 15 mg, respectively (Cmin and Cmax at steady state, respectively). The mean plasma concentrations of meloxicam at steady state are reached within 5–6 hours.
Simultaneous food intake or the use of inorganic antacids does not affect the absorption of the drug.
Distribution. Meloxicam is highly bound to plasma proteins, mainly albumin (99%). Meloxicam penetrates into the synovial fluid, where the concentration is half that in plasma. The volume of distribution is low, averaging 11 l after intramuscular or intravenous administration, and shows individual variations in the range of 7–20%. The volume of distribution after multiple oral doses of meloxicam (7.5 to 15 mg) is 16 l with a coefficient of variation in the range of 11 to 32%.
Biotransformation.
Meloxicam undergoes extensive biotransformation in the liver.
Four different metabolites of meloxicam have been identified in urine, which are pharmacodynamically inactive. The main metabolite 5'-carboxymeloxicam (60% of the dose) is formed by oxidation of the intermediate metabolite 5'-hydroxymethylmeloxicam, which is also excreted to a lesser extent (9% of the dose). In vitro studies suggest that CYP 2C9 plays an important role in the metabolism process, while CYP 3A4 isoenzymes contribute to this to a lesser extent. Peroxidase activity in patients is probably responsible for the other two metabolites, which account for 16% and 4% of the administered dose, respectively.
Elimination.
Meloxicam is excreted mainly as metabolites in equal parts with urine and feces. Less than 5% of the daily dose is excreted unchanged in the feces, a small amount is excreted in the urine. The half-life varies from 13 to 25 hours after oral administration. Plasma clearance is about 7–12 ml/min after a single oral dose.
Dose linearity: Meloxicam exhibits linear pharmacokinetics in the therapeutic dose range of 7.5 mg to 15 mg after oral administration.
Special groups of patients.
Patients with hepatic/renal insufficiency.
Mild to moderate hepatic and renal impairment do not significantly affect the pharmacokinetics of meloxicam. In patients with moderate renal impairment, total clearance is significantly higher. Reduced plasma protein binding has been observed in patients with end-stage renal disease. In end-stage renal disease, an increase in the volume of distribution may lead to an increase in free meloxicam concentrations (see sections 4.3 and 4.4).
Elderly patients.
In elderly male patients, mean pharmacokinetic parameters were similar to those in young male volunteers. In elderly female patients, AUC values were higher and the half-life was longer compared to those in young volunteers of both sexes. Mean steady-state plasma clearance in elderly patients was slightly lower than in young volunteers.
Indication
Short-term symptomatic treatment of exacerbations of osteoarthritis.
Long-term symptomatic treatment of rheumatoid arthritis and ankylosing spondylitis.
Contraindication
III trimester of pregnancy (see section "Use during pregnancy or breastfeeding");
children under 16 years of age;
history of gastrointestinal bleeding or perforation associated with previous NSAID therapy;
history of active or recurrent peptic ulcer/bleeding (two or more separate confirmed episodes of ulceration or bleeding);
severe liver failure;
severe renal failure without dialysis;
gastrointestinal bleeding, history of cerebrovascular bleeding, or other blood clotting disorders;
severe heart failure;
treatment of perioperative pain in coronary artery bypass grafting.
Interaction with other medicinal products and other types of interactions
Interaction studies were conducted only in adults.
Risks associated with hyperkalemia.
Some medicinal products or therapeutic groups may contribute to hyperkalaemia: potassium salts, potassium-sparing diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, non-steroidal anti-inflammatory drugs, (low molecular weight or unfractionated) heparins, ciclosporin, tacrolimus and trimethoprim.
The onset of hyperkalemia may depend on whether there are associated factors. The risk of hyperkalemia is increased if the above-mentioned drugs are used concomitantly with meloxicam.
Pharmacodynamic interactions.
Other non-steroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid: Combination with other NSAIDs is not recommended (see section 4.4), including acetylsalicylic acid at doses ≥ 500 mg per dose or ≥ 3 g total daily dose.
Corticosteroids (e.g. glucocorticoids): Concomitant use with corticosteroids requires caution due to increased risk of gastrointestinal bleeding or ulceration.
Anticoagulants or heparin. The risk of bleeding is significantly increased due to inhibition of platelet function and damage to the gastroduodenal mucosa. NSAIDs may enhance the effects of anticoagulants such as warfarin (see section "Special precautions for use"). The concomitant use of NSAIDs and anticoagulants or heparin is not recommended in geriatric practice or at therapeutic doses (see section "Special precautions for use").
In other cases (e.g. at prophylactic doses) the use of heparin requires caution due to the increased risk of bleeding. Careful monitoring of the INR (international normalized ratio) is necessary if the combination is proven to be unavoidable.
Thrombolytic and antiplatelet agents: Increased risk of bleeding due to inhibition of platelet function and damage to the gastroduodenal mucosa.
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 (e.g. dehydrated patients or elderly patients with impaired renal function), the concomitant use of ACE inhibitors or angiotensin II antagonists and drugs that inhibit cyclooxygenase may lead to further deterioration of renal function, including possible acute renal failure, which is usually reversible. Therefore, the combination should be used with caution, especially in elderly patients. Patients should be adequately hydrated and renal function should be monitored after initiation of concomitant therapy and periodically thereafter (see section 4.4).
Other antihypertensive drugs (e.g. beta-blockers). As with the following drugs, the antihypertensive effect of beta-blockers may be reduced (due to inhibition of vasodilating prostaglandins).
Calcineurin inhibitors (e.g. cyclosporine, tacrolimus). Nephrotoxicity of calcineurin inhibitors may be potentiated by NSAIDs due to mediation of renal prostaglandin effects. Renal function should be monitored during treatment. Close monitoring of renal function is recommended, especially in elderly patients.
Deferasirox: Concomitant use of meloxicam and deferasirox may increase the risk of gastrointestinal adverse reactions. Caution should be exercised when combining these drugs.
Pharmacokinetic interaction: the effect of meloxicam on the pharmacokinetics of other drugs.
Methotrexate. NSAIDs may reduce the tubular secretion of methotrexate, thereby increasing its plasma concentration. For this reason, concomitant use of NSAIDs is not recommended in patients receiving high doses of methotrexate (more than 15 mg/week) (see section "Special warnings and precautions for use"). The risk of interaction between NSAIDs and methotrexate should also be considered when using low doses of methotrexate, in particular in patients with impaired renal function. If combined treatment is necessary, blood tests and renal function should be monitored. Caution should be exercised when NSAIDs and methotrexate are taken for 3 consecutive days, as plasma levels of methotrexate may increase and toxicity may increase. Although the pharmacokinetics of methotrexate (15 mg/week) were not affected by concomitant treatment with meloxicam, it should be considered that the haematological toxicity of methotrexate may be increased by treatment with NSAIDs (see information above) (see section "Adverse reactions").
Pemetrexed. When meloxicam is co-administered with pemetrexed in patients with creatinine clearance between 45 and 79 ml/min, meloxicam should be discontinued 5 days before, on the day of, and for 2 days after pemetrexed administration. If the combination of meloxicam and pemetrexed is necessary, patients should be closely monitored, especially for myelosuppression and gastrointestinal adverse reactions. In patients with severe renal impairment (creatinine clearance below 45 ml/min), the co-administration of meloxicam and pemetrexed is not recommended.
In patients with normal renal function (creatinine clearance ≥ 80 ml/min), a dose of 15 mg meloxicam may reduce the elimination of pemetrexed and therefore increase the incidence of adverse reactions associated with pemetrexed. Therefore, caution should be exercised when prescribing 15 mg meloxicam concomitantly with pemetrexed in patients with normal renal function (creatinine clearance ≥ 80 ml/min).
Pharmacokinetic interaction: the effect of other drugs on the pharmacokinetics of meloxicam.
Cholestyramine: Cholestyramine accelerates the elimination of meloxicam due to impaired intrahepatic circulation, so the clearance of meloxicam increases by 50% and the half-life decreases to 13 ± 3 hours. This interaction is clinically significant.
Pharmacokinetic interaction: effect of the combination of meloxicam and other drugs on pharmacokinetics.
Oral antidiabetic agents (sulfonylureas, nateglinide). Meloxicam is almost completely eliminated by hepatic metabolism, approximately two-thirds of which is mediated by cytochrome (CYP) P450 enzymes (major pathway: CYP 2C9 and minor pathway: CYP 3A4) and one-third by other pathways, such as peroxidase oxidation. The possibility of pharmacokinetic interactions should be considered when meloxicam is co-administered with medicinal products that are known to inhibit or are metabolised by CYP 2C9 and/or CYP 3A4. Interactions mediated by CYP 2C9 can be expected when used in combination with medicinal products such as oral antidiabetic agents (sulfonylureas, nateglinide); this interaction may lead to increased plasma levels of these agents and meloxicam. Patients taking meloxicam and sulfonylureas or nateglinide should be closely monitored for the development of hypoglycemia.
No clinically significant pharmacokinetic interaction was found when co-administered with antacids, cimetidine, and digoxin.
Application features
Adverse reactions can be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms (see section “Dosage and Administration” and information on gastrointestinal and cardiovascular risks below).
The recommended maximum daily dose should not be exceeded in case of insufficient therapeutic effect, nor should additional NSAIDs be used, as this may increase toxicity while the therapeutic benefit has not been proven. The concomitant use of meloxicam with NSAIDs, including selective cyclooxygenase-2 inhibitors, should be avoided.
Meloxicam is not suitable for the treatment of patients requiring acute pain relief.
If there is no improvement after several days, the clinical benefit of treatment should be reassessed.
Attention should be paid to a history of esophagitis, gastritis and/or peptic ulcer in order to ensure that they are completely cured before starting therapy with meloxicam. Patients treated with meloxicam and patients with a history of such cases should be regularly monitored for possible recurrence.
Gastrointestinal disorders.
The risk of gastrointestinal bleeding, ulceration or perforation is higher with increasing NSAID doses in patients with a history of ulcer, particularly complicated by bleeding or perforation (see section 4.3), and in the elderly. In such patients, treatment should be initiated at the lowest effective dose. Combination therapy with protective agents (such as misoprostol or proton pump inhibitors) should be considered for such patients, as well as for patients who require concomitant use of low-dose aspirin or other agents that increase gastrointestinal risks (see information below and section 4.5).
Patients with a history of gastrointestinal toxicity, especially elderly patients, should be informed of any unusual abdominal symptoms (especially gastrointestinal bleeding), especially during the initial stages of treatment.
The use of meloxicam is not recommended in patients receiving concomitant medications that may increase the risk of ulceration or bleeding, including heparin as a radical therapy or in geriatric practice, anticoagulants such as warfarin, or other non-steroidal anti-inflammatory drugs, including acetylsalicylic acid at doses ≥ 500 mg per dose or ≥ 3 g total daily dose (see section "Interaction with other medicinal products and other forms of interaction").
If gastrointestinal bleeding or ulceration occurs in patients taking meloxicam, treatment should be discontinued.
NSAIDs should be used with caution in patients with a history of gastrointestinal diseases (ulcerative colitis, Crohn's disease), as these conditions may be exacerbated (see section "Adverse reactions").
Liver disorders.
Up to 15% of patients taking NSAIDs (including meloxicam) may have elevations in one or more liver function tests. These laboratory abnormalities may progress, may remain unchanged, or may be transient with continued treatment. Marked elevations in ALT or AST (approximately three times or more times the upper limit of normal) have been observed in 1% of patients in clinical trials with NSAIDs. In addition, rare cases of severe hepatic reactions, including jaundice and fulminant hepatitis, hepatic necrosis, and hepatic failure, some of which were fatal, have been reported.
Patients with symptoms of hepatic dysfunction or suspected hepatic dysfunction, or those with abnormal liver function tests, should be monitored for the development of more severe hepatic impairment during therapy with the drug. If clinical signs and symptoms consistent with liver disease develop or if systemic manifestations of the disease (e.g. eosinophilia, rash, etc.) occur, Meloxicam should be discontinued.
Cardiovascular disorders.
Close monitoring is recommended in patients with hypertension and/or a history of mild to moderate congestive heart failure, as fluid retention and edema have been reported with NSAID therapy.
Clinical monitoring of blood pressure is recommended for patients with risk factors at the beginning of therapy, especially at the beginning of treatment with meloxicam.
Clinical and epidemiological data suggest that the use of some NSAIDs (especially at high doses and in long-term treatment) may be associated with a small increased risk of vascular thrombotic events (e.g. myocardial infarction or stroke). There are insufficient data to exclude such a risk with meloxicam.
Patients with uncontrolled hypertension, congestive heart failure, established ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease should be treated with meloxicam only after careful consideration. Such consideration is necessary before initiating long-term treatment in patients with risk factors for cardiovascular disease (such as hypertension, hyperlipidemia, diabetes mellitus, smoking).
NSAIDs may increase the risk of serious cardiovascular thrombotic events, myocardial infarction and stroke, which may be fatal. The increased risk is related to the duration of use. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease.
There have been reports of life-threatening severe skin reactions: Stevens-Johnson syndrome and toxic epidermal necrolysis - with the use of meloxicam. Patients should be informed of the signs and symptoms of severe lesions and closely monitored for skin reactions. The greatest risk of developing Stevens-Johnson syndrome or toxic epidermal necrolysis occurs during the first weeks of treatment. If a patient develops symptoms or signs of Stevens-Johnson syndrome or toxic epidermal necrolysis (e.g. skin rash, often progressing with blisters or mucosal lesions), meloxicam treatment should be discontinued. It is important to diagnose and discontinue any drugs that may cause severe skin reactions: Stevens-Johnson syndrome or toxic epidermal necrolysis as soon as possible. This is associated with a better prognosis in severe skin lesions. If a patient has developed Stevens-Johnson syndrome or toxic epidermal necrolysis while receiving meloxicam, the drug should never be restarted in the future.
Anaphylactic reactions.
As with other NSAIDs, anaphylactic reactions may occur in patients with no known history of reaction to meloxicam. Meloxicam should not be used in patients with the aspirin triad. This symptom complex occurs in patients with asthma who have reported rhinitis with or without nasal polyps or who have experienced severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs. Immediate medical attention should be sought if an anaphylactoid reaction occurs.
Liver parameters and kidney function.
As with most NSAIDs, isolated cases of increased serum transaminases, increased serum bilirubin or other liver function parameters, as well as increased serum creatinine and blood urea nitrogen and other laboratory abnormalities have been reported. In most cases, these abnormalities were minor and transient. If significant or persistent abnormalities occur, meloxicam should be discontinued and follow-up tests should be performed.
Functional renal failure.
NSAIDs, by inhibiting the vasodilatory effects of renal prostaglandins, may induce functional renal failure due to a decrease in glomerular filtration. This side effect is dose-dependent. At the beginning of treatment or after increasing the dose, careful monitoring of renal function, including urine output, is recommended in patients with the following risk factors:
old age;
concomitant use with ACE inhibitors, angiotensin II antagonists, sartans, diuretics (see section "Interaction with other medicinal products and other types of interactions");
hypovolemia (of any origin);
congestive heart failure;
renal failure;
nephrotic syndrome;
lupus nephropathy;
severe hepatic dysfunction (serum albumin < 25 g/l or ≥ 10 according to the Child-Pugh classification).
In rare cases, NSAIDs can lead to interstitial nephritis, glomerulonephritis, renal medullary necrosis, or nephrotic syndrome.
The dose of meloxicam for patients with end-stage renal disease on dialysis should not exceed 7.5 mg. In patients with mild to moderate renal impairment (creatinine clearance greater than 25 ml/min), the dose may not be reduced.
Sodium, potassium and water retention.
NSAIDs may increase sodium, potassium and water retention and may interfere with the natriuretic effects of diuretics. In addition, the antihypertensive effect of antihypertensive drugs may be reduced (see section "Interaction with other medicinal products and other forms of interaction"). As a result, edema, heart failure or hypertension may be precipitated or aggravated in susceptible patients. Therefore, clinical monitoring is recommended in patients at risk (see sections "Contraindications" and "Method of administration and dosage").
Hyperkalemia.
Hyperkalemia may be caused by diabetes mellitus or concomitant use of medicinal products that increase potassium levels (see section 4.5). In such cases, potassium levels should be monitored regularly.
Combination with pemetrexed.
In patients with mild to moderate renal impairment receiving pemetrexed, meloxicam treatment should be suspended for at least 5 days prior to, on the day of, and for at least 2 days following pemetrexed administration (see section 4.5).
Other warnings and precautions.
Adverse reactions are often worse tolerated by elderly, frail or debilitated patients who require close monitoring. As with other NSAIDs, caution should be exercised in the elderly, who are more likely to have decreased renal, hepatic and cardiac function. Elderly patients have a higher incidence of adverse reactions to NSAIDs, especially gastrointestinal bleeding and perforation, which can be fatal (see section 4.2).
Meloxicam may impair reproductive function and is not recommended in women attempting to conceive. Therefore, in women attempting to conceive or undergoing investigation of infertility, discontinuation of meloxicam should be considered (see section 4.6).
The medicinal product contains lactose, therefore this medicine is not recommended for patients with rare hereditary problems of galactose intolerance, lactase deficiency or glucose-galactose malabsorption.
Masking inflammation and fever.
The pharmacological action of meloxicam to reduce fever and inflammation may complicate the diagnosis of suspected non-infectious pain conditions.
Corticosteroid treatment.
Meloxicam cannot be a likely substitute for corticosteroids in the treatment of corticosteroid insufficiency.
Hematological effects.
Anemia may occur in patients receiving NSAIDs, including meloxicam. This may be due to fluid retention, gastrointestinal bleeding of unknown origin, or macroscopic or incompletely described effects on erythropoiesis. Patients receiving long-term treatment with NSAIDs, including meloxicam, should have their hemoglobin or hematocrit monitored if they develop symptoms and signs of anemia.
NSAIDs inhibit platelet aggregation and may prolong bleeding time in some patients. In contrast to aspirin, their effect on platelet function is quantitatively smaller, short-lived, and reversible. Patients taking meloxicam who may have adverse effects related to changes in platelet function, including coagulation disorders, and patients receiving anticoagulants should be carefully monitored.
Use in patients with existing asthma.
Patients with asthma may have aspirin-sensitive asthma. The use of aspirin in patients with aspirin-sensitive asthma has been associated with severe bronchospasm, which may be fatal. Because of cross-reactivity, including bronchospasm, between aspirin and other NSAIDs, meloxicam should not be used in patients sensitive to aspirin and should be prescribed with caution in patients with pre-existing asthma.
Use during pregnancy or breastfeeding
Pregnancy.
Inhibition of prostaglandin synthesis may adversely affect pregnancy and/or embryo-foetal development. Epidemiological data suggest an increased risk of miscarriage and of cardiac malformations and gastroschisis following the use of prostaglandin synthesis inhibitors in early pregnancy. The absolute risk of cardiac malformations has increased from less than 1% to approximately 1.5%. This risk is believed to increase with increasing dose and duration of treatment.
During the first and second trimesters of pregnancy, meloxicam should not be used unless clearly necessary. If a woman is trying to conceive or is using meloxicam during the first and second trimesters of pregnancy, the dosage and duration of treatment should be kept to the minimum.
During the third trimester of pregnancy, all prostaglandin synthesis inhibitors may pose a risk to the fetus:
cardiopulmonary toxicity (with premature closure of the ductus arteriosus and pulmonary hypertension);
renal dysfunction, which may develop into renal failure with oligohydramnios;
possible risks in the last stages of pregnancy for the mother and newborn:
possibility of prolongation of bleeding time, anti-aggregation effect even at very low doses;
suppression of uterine contractions, leading to delayed or prolonged labor.
Therefore, meloxicam is contraindicated during the third trimester of pregnancy.
Breast-feeding.
Although there is no specific data on the drug, NSAIDs are known to pass into breast milk. Therefore, use is not recommended in women who are breastfeeding.
Fertility.
Meloxicam, like other drugs that inhibit cyclooxygenase/prostaglandin synthesis, may have an adverse effect on reproductive function and is not recommended in women attempting to conceive. Therefore, in women planning pregnancy or undergoing investigation of infertility, discontinuation of meloxicam should be considered.
Ability to influence reaction speed when driving vehicles or other mechanisms
There are no specific studies on the effects of the drug on the ability to drive or use machines. However, based on the pharmacodynamic profile and the observed adverse reactions, it can be assumed that meloxicam has no or negligible influence on these activities. However, patients who have experienced visual disturbances, including blurred vision, dizziness, drowsiness, vertigo or other central nervous system disorders, are advised to refrain from driving or using machines.
Method of administration and doses
For oral use.
Adverse reactions can be minimized by using the lowest effective dose for the shortest duration necessary to control symptoms (see section 4.4). The patient's need for symptomatic relief and response to treatment should be reassessed periodically.
Exacerbation of osteoarthritis:
7.5 mg/day (1 tablet of 7.5 mg or half a tablet of 15 mg). If necessary, the dose can be increased to 15 mg/day (1 tablet of 15 mg or 2 tablets of 7.5 mg).
Rheumatoid arthritis, ankylosing spondylitis:
15 mg/day (1 tablet of 15 mg or 2 tablets of 7.5 mg).
See also the section “Special patient categories” below.
According to the therapeutic effect, the dose can be reduced to 7.5 mg/day (1 tablet of 7.5 mg or half a tablet of 15 mg).
DO NOT EXCEED THE DOSE OF 15 mg/day.
Special categories of patients.
Elderly patients.
The recommended dose for long-term treatment of rheumatoid arthritis and ankylosing spondylitis in elderly patients is 7.5 mg per day (see also sections “Dosage and administration”, “Patients at increased risk of adverse reactions”, and “Special warnings and precautions for use”).
Patients at increased risk of adverse reactions (see section "Special warnings and precautions for use")
Patients at increased risk of adverse reactions, such as those with a history of gastrointestinal disease or risk factors for cardiovascular disease, should start treatment with a dose of 7.5 mg per day.
Kidney failure.
This medicinal product is contraindicated in patients with severe renal impairment not undergoing haemodialysis (see section “Contraindications”).
For patients with end-stage renal disease undergoing hemodialysis, the dose should not exceed 7.5 mg per day. No dose reduction is required for patients with mild to moderate renal impairment (i.e., patients with creatinine clearance greater than 25 ml/min).
Liver failure.
No dose reduction is required in patients with mild to moderate hepatic impairment (for patients with severe hepatic impairment, see section "Contraindications").
Children.
Meloxicam-KV, tablets of 7.5 mg and 15 mg, is contraindicated in children under 16 years of age (see section "Contraindications")
Overdose
Symptoms.
Symptoms of acute NSAID overdose are usually limited to lethargy, drowsiness, nausea, vomiting, and epigastric pain, which are generally reversible with supportive therapy. Gastrointestinal bleeding may occur. Severe poisoning may result in hypertension, acute renal failure, hepatic dysfunction, respiratory depression, coma, convulsions, cardiovascular failure, and cardiac arrest. Anaphylactoid reactions have been reported with therapeutic use of NSAIDs, which may also occur with overdose.
Therapy.
In case of NSAID overdose, symptomatic and supportive measures are recommended. Available data suggest that meloxicam elimination is accelerated by administration of 4 oral doses of cholestyramine 3 times daily.
Adverse reactions
Available data suggest that the use of some NSAIDs (especially at high doses and in long-term treatment) may be associated with a small increased risk of vascular thrombotic events (e.g. myocardial infarction or stroke) (see section "Special warnings and precautions for use").
Edema, hypertension, and heart failure have been observed with NSAID treatment.
Most of the observed side effects are of gastrointestinal origin. Peptic ulcer, perforation or gastrointestinal bleeding, sometimes fatal, may occur, especially in elderly patients (see section "Special instructions"). Nausea, vomiting, diarrhea, flatulence, constipation, dyspepsia, abdominal pain, melena, haematemesis, ulcerative stomatitis, exacerbation of colitis and Crohn's disease (see section "Special instructions"). Gastritis has been observed less frequently after administration.
Severe skin reactions have been reported: Stevens-Johnson syndrome and toxic epidermal necrolysis (see section 4.4).
Criteria for assessing the frequency of adverse drug reactions: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000, < 1/100); rare (<1/10000); unknown (cannot be determined from available data).
From the blood and lymphatic system: infrequently - anemia; rare - deviations of blood test parameters from the norm (including changes in the number of leukocytes), leukopenia, thrombocytopenia.
Cases of agranulocytosis have been reported very rarely (see Selected serious and/or common adverse reactions).
Immune system disorders: uncommon – allergic reactions, except anaphylactic or anaphylactoid; unknown – anaphylactic reaction, anaphylactoid reaction, including shock.
On the part of the psyche: rare - mood changes, nightmares; unknown - confusion, disorientation, insomnia.
Nervous system: frequent - headache; infrequent - dizziness
