Meloxicam

NSAIDs are of diverse chemical structures salicylates (aspirin, sulphasalazine), indole acetic acids (indomethacin, etodolac), heteroaryl acetic acids (diclofenac), arylpropionic acids (ibuprofen, naproxen), anthranilic acids (mefenamic acid) and enolic acids (piroxicam, meloxicam). 

Oxicams, e.g. piroxicam, tenoxicam, meloxicam and lornoxicam are non-specific inhibitors of COX. Like diclofenac, meloxicam inhibits COX-2 ten times more potently than COX-1. This property can be exploited clinically with doses up to 7.5 mg per day, but at higher doses COX-1-inhibition becomes clinically relevant. Since the dose of meloxicam commonly used is 15 mg daily, this agent cannot be regarded as a COX-2-selective NS AID and considerable caution needs to be exercised when making comparisons between the actions of meloxicam and those of other conventional NSAIDs. The average daily dose in anti-rheumatic therapy is 20 mg for piroxicam and tenoxicam, 7.5-15 mg for meloxicam and 12-16 mg for lornoxicam. Oxicams have long elimination half-lives (lornoxicam 3-5 h, meloxicam - 20 h, piroxicam 40 h and tenoxicam 70 h). 

Ci,HijNOjS i55//-f5-0) see Meloxicam methyl 4-(2-hydroxyethoxy)benzoate (C],)H 204 3204-73-7) see Raloxifene hydrochloride methyl A -(2-hydroxyethyl)dithiocarbamate (CjHijNOSi 56158-48-6) see Flomoxef A -methyl-At-(2-hydroxyethyl)guanidine phosphate (C4H,4Nj05P 33018-83-6) see Creatinolfosfate 5-methyl-10-hydroxyimino-10,ll-dihydro-5H-dibenz-[6/lazepine... 

Celecoxib, a non-steroidal anti-inflammatory drug, is a cyclo-oxygenase-2 selective inhibitor that is as effective as diclofenac and naproxen. It should be used for the shortest period required to control symptoms. Use is associated v/ith an increased risk of thrombotic events and the cyclo-oxygenase-2 selective inhibitors are contraindicated in cerebrovascular disease. Mobic is the proprietary preparation of meloxicam. 

Mobic is the proprietary preparation of meloxicam, a non-steroidal antiinflammatory drug, which is also a selective inhibitor of cyclo-oxygenase-2. It is therefore less likely to cause gastrointestinal side-effects than other nonsteroidal anti-inflammatory drugs. However, it is still best to administer meloxicam after food. 

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

In September 2001, however, a news item in the British Medical Journal reported that further analyses confirmed the increase in rates of myocardial infarction and questioned whether this was an adverse reaction affecting the whole class of COX 2 drugs. The debate continued for the next 3 years with the main emphasis remaining on GI toxicity. A PEM study that included more than 15 000 patients made no mention of cardiovascular adverse events. However, a second paper compared rofecoxib and meloxicam with respect to thromboembolic events which showed that both, to a variable extent were associated with cardiovascular, cerebrovascular and peripheral venous pathology. A meta-analysis published recently in The Lancet suggests that Merck, the licence holder... 

Layton D, Heeley E, Hughes K, et al. Comparison of the incidence rates of thromboem-boUc events reported for patients prescribed rofecoxib and meloxicam in practice in England using prescription event monitoring. Rheumatology 2003 42 1342-53. 

Meloxicam is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery)... 

Meloxicam oral suspension 7.5 mg per 5 mL or 15 mg per 10 mL may be substituted for meloxicam tablets 7.5 or 15 mg, respectively. Shake suspension well before using. 

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