ANTICOX TABLETS

Indications

• Osteoarthritis
• Rheumatoid arthritis
• Ankylosing spondylitis
• Pain management
• Inflammatory conditions

Dosage

Children: Refer to clinical guidelines for appropriate dosing in children, as pediatric dosing must be determined based on weight and clinical indications.

Adults: Refer to clinical guidelines for specific dosing recommendations, as doses may vary based on the condition being treated and patient response.

Mechanism of action

Meloxicam selectively inhibits the COX-2 enzyme more than COX-1, leading to a decrease in the production of prostaglandins involved in the inflammatory process. This selective inhibition helps to reduce inflammation and pain while minimizing gastrointestinal side effects commonly associated with non-selective NSAIDs.

Pharmacodynamics

Meloxicam demonstrates its anti-inflammatory effects by decreasing vascular permeability and inhibiting the accumulation of leukocytes at the sites of inflammation. Its analgesic effects are attributed to the reduction of prostaglandin synthesis, which mediates the sensation of pain. In addition, meloxicam has antipyretic effects, lowering fever by acting on the hypothalamic heat-regulating center.

Pharmacokinetics

Meloxicam is well absorbed after oral administration, with peak plasma concentrations occurring within 4 to 5 hours. It has a long half-life of approximately 15 to 20 hours, allowing for once-daily dosing. The drug is highly protein-bound (approximately 99%) and is metabolized in the liver via cytochrome P450 enzymes, primarily CYP2C9, with metabolites excreted through urine and feces.

Contra-indications

• Known hypersensitivity to meloxicam or any of its excipients
• Active peptic ulcer disease
• Severe renal impairment
• Severe hepatic impairment
• History of gastrointestinal bleeding or perforation related to previous NSAID therapy
• Pregnancy, especially in the third trimester
• Concurrent use of other NSAIDs

Adverse effects

• Gastrointestinal disturbances, such as nausea, vomiting, diarrhea, and constipation
• Abdominal pain
• Dyspepsia
• Headache
• Dizziness
• Rash or other allergic reactions
• Elevated liver enzymes
• Renal impairment
• Cardiovascular events, including hypertension and increased risk of thrombotic events

Interactions

• Increased risk of gastrointestinal bleeding when combined with anticoagulants or other NSAIDs
• Potentially increased plasma levels of lithium, leading to toxicity
• Diuretics may have reduced effectiveness
• Corticosteroids may increase the risk of gastrointestinal ulceration
• ACE inhibitors and angiotensin II receptor antagonists may have reduced antihypertensive effect

Precautions

• Use with caution in patients with a history of gastrointestinal diseases
• Monitor renal function, particularly in patients with pre-existing renal impairment
• Patients with cardiovascular risk factors should be monitored closely due to potential cardiovascular effects
• Caution in elderly patients, who may be more sensitive to side effects

Pregnancy

Meloxicam is contraindicated during pregnancy, particularly in the third trimester, due to potential harm to the fetus and complications during delivery.

Breast-feeding

Meloxicam is excreted in breast milk; caution is advised, and it should only be used if the benefits outweigh the risks.

Storage

Store at room temperature, away from direct sunlight and moisture. Keep out of reach of children.

Formulations

• Tablets
• Oral suspension
• Injectable solution