Bleeding meloxicam

Meloxicam is a partially selective cycloHDxygenase-2 inhibitor and is therefore less likely to cause gastrointestinal side-effects, such as bleeding, than other NSAIDs. 

Gi effects Serious Gl toxicity such as bleeding, ulceration, and perforation can occur at any time, with or without warning symptoms, in patients treated chronically with NSAID therapy. Higher doses of meloxicam (eg, 30 mg/day) were associated with increased risk of serious Gl effects. Do not exceed daily doses of 15 mg. 

Miscellaneous Edema (flurbiprofen, naproxen, meloxicam) thirst pyrexia (fever and chills) sweating breast changes gynecomastia muscle cramps facial edema menstrual disorders impotence vaginal bleeding influenza-like disease/symptoms (meloxicam). 

Geriatric Considerations - Summary Use of NSAIDs in older adults increases the risk of GI complications, including gastric ulceration, bleeding, and perforation. These complications are not necessarily preceded by less severe GI symptoms. Concomitant use of a proton pump inhibitor or misoprostol reduces the risk for gastric ulceration and bleeding, but may not prevent long-term GI toxicity. No clinical data exist to support reduced GI toxicity with the use of meloxicam. 

Clinical trial evidence in general appears to support the theory that COX-2 selective inhibitors are as effective as, but have fewer adverse effects than, non-COX-2 selective compounds for example meloxicam is better tolerated than diclofenac or piroxicam. The relative risk of serious gastrointestinal effects (bleeding peptic ulcers) due to rofecoxib (COX-2 selective) was 0.51 compared with conventional NSAIDs. COX-2 selective drugs are yet associated with significant dyspeptic symptoms (indigestion, heartburn), and these effects may result from inhibition of the (protective) constitutively expressed COX-2 in the stomach. 

Meloxicam should be avoided in patients with known NSAID allergies, pregnancy, and peri-operative period for patients undergoing CABG surgery. Also, meloxicam should be used cautiously in patients with the following cardiovascular disease, HTN, CHF, history of PUD or GI bleeding, concomitant corticosteroid use. 

Meloxicam is only available in oral formulations. An IV formulation is not available for human use but has been employed for pain management in veterinary medicine. Despite studies demonstrating improved tolerability, meloxicam, like other NSAIDs, is associated with the potential for serious gastrointestinal and wound site bleeding. Treatment with meloxicam may worsen renal function or precipitate acute renal failure. 

Serious events - meloxicam has been implicated in the following serious adverse events GI bleeding, MI, stroke, GI ulceration and perforation, anaphylactoid reactions, HTN, CHF, bronchospasm, nephrotoxicity, renal papillary necrosis, hepatotoxicity, exfoliative dermatitis, blood dyscrasias, anemia, toxic epidermal necrosis, Stevens-Johnson syndrome, thromboembolism [1,5]. 

Comparison between celecoxib and meloxicam with respect to smaU-bowel injury was done in a prospective, double-blind, randomized clinical trial among 29 healthy subjects. They were randomized to receive celecoxib (200 mg twice daily) or meloxicam (10 mg once daily) for two weeks. The incidence and number of small-bowel mucosal injuries (bleedings, ulcers and erosions) as detected by capsule endoscopy were compared between both NSAID groups. The incidence of small-bowel... 

---