COXICAM 15/MG TAB 10/TAB

Indications

Approved Uses

Osteoarthritis and rheumatoid arthritis (adult).

Off-Label Uses

Acute pain (short-term), dysmenorrhea, and gout flares (symptomatic treatment).

Dosage & Administration

Dosing by Condition

Osteoarthritis: 7.5 mg PO once daily; may increase to 15 mg once daily if needed (max 15 mg/day). Rheumatoid arthritis: 15 mg PO once daily; may reduce to 7.5 mg once daily depending on response/tolerability (max 15 mg/day).

Initial Dose

7.5 mg once daily

Maintenance Dose

7.5mg to 15mg once daily.

Maximum Dose

15mg once daily.

Children's Dosage

Not approved for children under 16 years for this formulation; in some countries meloxicam oral suspension is approved for juvenile idiopathic arthritis in children ≥2 years at 0.125 mg/kg/day (max 7.5 mg/day)

Dose Adjustment Notes

Use the lowest effective dose for the shortest duration; in severe renal impairment on hemodialysis, do not exceed 7.5 mg/day; avoid use in severe renal impairment not on dialysis; no adjustment is generally required in mild-moderate renal impairment, and mild-moderate hepatic impairment typically does not require adjustment.

How to Take

Swallow the tablet whole with water; take once daily, preferably with/after food to reduce gastrointestinal upset; take at the same time each day.

Side Effects

Common Side Effects

Dyspepsia/indigestion (including heartburn), abdominal pain, nausea, diarrhea, flatulence, headache, dizziness, and peripheral edema.

Side Effect Frequency

Common (≥1% to <10%): dyspepsia, nausea, abdominal pain, diarrhea, headache, dizziness, rash/pruritus, peripheral edema, increased liver enzymes. Uncommon (≥0.1% to <1%): vomiting, constipation, flatulence, gastritis. Rare/serious: peptic ulcer, GI bleeding/perforation, severe skin reactions, renal impairment/creatinine increase, hypertension, anemia.

Safety & Warnings

Contraindications

Contraindicated in: hypersensitivity to meloxicam or excipients; history of asthma/urticaria/other allergic-type reactions after aspirin or other NSAIDs (incl. aspirin triad); active GI bleeding or active peptic ulcer; peri-operative pain in CABG surgery; and generally avoided/contraindicated in severe renal failure not on dialysis and in late pregnancy (3rd trimester) per NSAID class guidance.

Warnings & Precautions

Key warnings/precautions: CV thrombotic risk (use lowest effective dose/shortest duration; caution in CVD), serious GI bleeding/ulcer/perforation (higher risk in elderly/prior ulcer/anticoagulants), renal toxicity/AKI (monitor in CKD, HF, dehydration; avoid in advanced renal disease), hypertension/edema/HF worsening, serious skin reactions (SJS/TEN), anaphylactoid reactions/aspirin-sensitive asthma, hepatotoxicity (monitor if symptoms/LFTs), may mask infection/fever, and avoid in late pregnancy (ductus arteriosus).

Age Restriction

Adults and adolescents ≥2 years for JRA; this 15 mg oral tablet product typically for adults.

Drug Interactions

Drug Interactions

Clinically important interactions include: anticoagulants/antiplatelets/SSRIs-SNRIs (↑ bleeding), other NSAIDs (additive toxicity), ACEIs/ARBs and diuretics (↓ antihypertensive/diuretic effect; ↑ AKI risk-“triple whammy”), lithium (↑ levels), methotrexate (↑ toxicity), cyclosporine/tacrolimus (↑ nephrotoxicity), and cholestyramine (↑ meloxicam clearance).

Interaction Severity

MAJOR: Anticoagulants/antiplatelets (e.g., warfarin) and other NSAIDs (including aspirin) → increased bleeding/GI bleed risk; Methotrexate → increased toxicity; Lithium → increased lithium levels/toxicity. MODERATE: ACE inhibitors/ARBs and diuretics → reduced antihypertensive/diuretic effect and increased AKI risk; Cyclosporine/tacrolimus → increased nephrotoxicity; SSRIs/SNRIs → increased GI bleeding risk. MINOR: Cholestyramine → increased meloxicam clearance (reduced exposure).

Food Interaction

Take with food.

Alcohol Interaction

Avoid

Special Populations

Pregnancy

FDA Pregnancy Category C (first and second trimesters); D (third trimester).

Children

Not approved for children under 16 years for this formulation; in some countries meloxicam oral suspension is approved for juvenile idiopathic arthritis in children ≥2 years at 0.125 mg/kg/day (max 7.5 mg/day)

Elderly

Start at 7.5 mg once daily; use lowest effective dose; monitor renal function, blood pressure, and gastrointestinal symptoms closely

Kidney Impairment

Mild-to-moderate renal impairment: no adjustment but monitor; severe renal impairment: avoid/not recommended; if on hemodialysis and therapy is necessary, maximum 7.5 mg/day.

Liver Impairment

Mild-to-moderate hepatic impairment: no dosage adjustment; severe hepatic impairment: use not recommended/avoid (often treated as a practical contraindication).

Storage & Patient Advice

Missed Dose

Take the missed dose as soon as remembered the same day; if it is close to the next dose, skip the missed dose and resume the regular schedule; do not double doses.

Overdose

Overdose may cause GI symptoms (nausea/vomiting/epigastric pain), drowsiness/lethargy, GI bleeding, hypertension, acute kidney injury, respiratory depression, coma; management is supportive (consider activated charcoal if early), and cholestyramine can enhance elimination; no specific antidote.

Patient Counseling

Take 1 tablet (15 mg) by mouth once daily as prescribed; do not exceed 15 mg/day. Take with food or milk and a full glass of water to reduce stomach upset. Avoid taking other NSAIDs (e.g., ibuprofen, naproxen, diclofenac) or high-dose aspirin unless your prescriber tells you to; limit alcohol because it increases GI bleeding risk. Seek urgent care for signs of GI bleeding (black/tarry stools, vomiting blood), severe stomach pain, or allergic reaction. Stop and seek urgent care for possible cardiovascular events (chest pain, shortness of breath, sudden weakness/slurred speech) as NSAIDs can increase thrombotic risk. Tell your doctor if you have a history of ulcer/bleeding, heart disease, high blood pressure, kidney or liver disease, are dehydrated, or take anticoagulants/antiplatelets/SSRIs/SNRIs or steroids (higher bleeding risk). Avoid use in the 3rd trimester of pregnancy; use the lowest effective dose for the shortest duration. This product is prescription-only (SFDA legal status: Prescription) and is oral meloxicam 15 mg tablets.

Monitoring Requirements

For long-term use, periodic monitoring of complete blood count (CBC), liver function tests, and renal function (serum creatinine) is recommended. Blood pressure should also be monitored.

Pharmacology

Mechanism of Action

Inhibits cyclooxygenase (COX) enzymes, with preferential inhibition of COX-2 over COX-1 at therapeutic doses, decreasing prostaglandin synthesis and thereby reducing inflammation, pain, and fever.

Duration of Effect

Approximately 24 hours.

Half-Life

15-24 hours.

Bioavailability

Approximately 89% (oral absolute bioavailability).

Excretion

Eliminated as metabolites in approximately equal amounts via urine and feces (about 50% each); minimal unchanged drug.

Protein Binding

>99% protein bound (mainly to albumin).

Product Information

Available Dosage Forms

Tablet (oral).

Composition per Dose

Each tablet: 15 mg meloxicam

Generic Availability

Yes

OTC Alternatives

Ibuprofen and naproxen (OTC where locally available/allowed).

Pain Type

Joint, Muscular

Nsaid

Yes

Opioid

No

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