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    3. Meloxicam-Teva solution for injection 15mg/1.5ml, 5 x 1.5 ml — Made in Czech Republic — Free Delivery

    Meloxicam-Teva solution for injection 15mg/1.5ml, 5 x 1.5 ml — Made in Czech Republic — Free Delivery


    Brand: TEVA
    Product Code: Meloxicam-Teva
    Availability: In Stock
    $28.48
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    Pharmacological properties

    Pharmacodynamics. meloxicam-ratiopharm is an NSAID of the oxicam group with anti-inflammatory, analgesic and antipyretic properties, which are associated with the selective inhibition of the Tsog-2 isoenzyme. the selectivity coefficient ic50 for meloxicam is 2.

    Pharmacokinetics

    Absorption: meloxicam is almost completely absorbed in the gastrointestinal tract. The absolute oral bioavailability is 89%. After a single oral dose, a high plasma level is reached after 5-6 hours (tablets). After repeated administration, the state of equilibrium is achieved 3-5 days after the start of meloxicam administration.
    In the case of ingestion of 7.5 or 15 mg of meloxicam once a day in a stationary mode, the concentration in the blood plasma reaches 0.4-1.0 mg / l (7.5 mg) or 0.8-2.0 mg / l (15 mg) (Cmin – Cmax).
    In the case of long-term treatment, the concentration in blood plasma under stationary conditions does not change. Gastric resorption does not change in the case of simultaneous food intake.
    Distribution: meloxicam has a high degree of binding to blood proteins, mainly albumin (99%). Meloxicam enters the synovial fluid, the concentration in it is ½ the concentration in the blood plasma.
    The volume of distribution is on average 11 liters. Individual fluctuations are about 30-40%.
    Biological transformation: meloxicam is metabolized by liver enzymes. Four different pharmacologically inactive metabolites of meloxicam are identified in urine. The main metabolite, 5'-carboxymeloxicam (60%), is formed by oxidation of the intermediate metabolites of 5'-hydroxymethylmeloxicam. The amount of 5'-hydroxymethylmeloxicam released unchanged is 9%. In vitro, it has been established that the initial stage of this transformation is carried out mainly by CYP 2C9 with a minor participation of CYP 3A4. The formation of two other metabolites (respectively 16 and 4% of the dose taken) is associated with the action of peroxidase.
    Excretion: meloxicam is excreted mainly in the form of metabolites, in equal parts with urine and feces. In urine, meloxicam is determined in insignificant (trace) amounts. Average T½ is about 20 hours. Total plasma clearance is an average of 8 ml / min.
    Linearity: when administered orally at therapeutic doses (7.5 and 15 mg), meloxicam is characterized by linear pharmacokinetics.
    Special patient groups
    Hepatic / renal impairment. Neither mild nor moderate hepatic or renal impairment has a significant effect on the pharmacokinetics of meloxicam. In end-stage renal disease, an increase in the volume of distribution can lead to high concentrations of free meloxicam, so a daily dose of 7.5 mg should not be exceeded.
    Elderly patients. The mean value of clearance in the plateau phase in elderly patients was slightly lower than that recorded for young patients.

    Indications

    Short-term symptomatic treatment of an acute attack of rheumatoid arthritis and ankylosing spondylitis, when the oral and rectal routes of administration cannot be applied.

    Application

    Meloxicam should be used by intramuscular injection.
    One injection of 15 mg once a day.
    Do not exceed 15 mg / day.
    Treatment should be limited to one injection at the beginning of therapy with a maximum duration of up to 2-3 days in justified exceptional cases (for example, when oral and rectal routes of administration are not possible). Adverse reactions can be minimized by using the lowest effective dose for the shortest treatment period necessary to control symptoms (see SPECIAL INSTRUCTIONS).
    The patient's need for symptomatic treatment and his response to treatment should be periodically assessed.
    Special patient groups
    Elderly patients and patients with an increased risk of adverse reactions. The recommended dose for elderly patients is 7.5 mg / day. Patients with an increased risk of developing adverse reactions should start treatment with 7.5 mg / day (half an ampoule of 1.5 ml) (see SPECIAL INSTRUCTIONS).
    Renal failure In patients with severe renal failure on dialysis, the dose should not exceed 7.5 mg / day (half an ampoule of 1.5 ml).
    Patients with mild to moderate renal impairment (namely, patients with creatinine clearance of 25 ml / min) do not require dose reduction. For patients with severe renal impairment without dialysis, see CONTRAINDICATIONS.
    Liver failure. No dose reduction is required in patients with mild to moderate hepatic impairment. For patients with severe hepatic impairment, see the CONTRAINDICATIONS section.
    Mode of application. The preparation should be injected slowly, by deep intramuscular injection into the upper outer quadrant of the buttock, adhering to a strict aseptic technique. In case of repeated injection, it is recommended to change the injection site (alternate the left and right buttocks). It is important to check before injection that the needle point is not in the vessel.
    The injection should be stopped immediately in case of severe pain during the injection.
    In the case of a hip prosthesis, inject into the other buttock.

    Contraindications

    Hypersensitivity to meloxicam or other components of the preparation or to preparations with a similar effect, for example, other NSAIDs, including acetylsalicylic acid. contraindicated in patients who, after using acetylsalicylic acid or other NSAIDs, have symptoms of ba, polyps in the nasal cavity, angioedema or urticaria; 3rd trimester of pregnancy (see. Application during pregnancy and lactation);
    the patient's age is up to 18 years (for solution), up to 16 years - for tablets;
    gastrointestinal bleeding or perforation associated with previous NSAID therapy in history;
    a history of active or recurrent ulcer / bleeding (two or more separate confirmed cases of ulcer or bleeding);
    severe liver failure;
    severe renal failure without dialysis;
    gastrointestinal bleeding, history of cerebrovascular bleeding, or other bleeding disorders;
    violations of hemostasis or the simultaneous use of anticoagulants (contraindications associated with the route of use);
    severe heart failure;
    treatment of perioperative pain in coronary artery bypass grafting.

    Side effects

    Research data and epidemiological data suggest that the use of some NSAIDs (especially at high doses and with long-term treatment) may be associated with a slight increased risk of vascular thrombotic events (for example, myocardial infarction or stroke) (see special instructions).
    Edema, hypertension and heart failure have been observed with NSAID treatment.
    Most of the side effects that have arisen are from the gastrointestinal tract. Possible ulcer, perforation or gastrointestinal bleeding, sometimes fatal, especially in elderly patients (see SPECIAL INSTRUCTIONS). After application, nausea, vomiting, diarrhea, flatulence, constipation, dyspepsia, abdominal pain, melena, blood vomiting, ulcerative stomatitis, exacerbation of colitis and Crohn's disease were observed (see SPECIAL INSTRUCTIONS). Gastritis was observed with a lesser frequency.
    On the part of the blood and lymphatic system: anemia, deviations in blood test parameters from the norm (including a change in the number of leukocytes), leukopenia, thrombocytopenia. Very rare cases of agranulocytosis have been reported (see Description of Selected Serious and / or Frequent Adverse Reactions).
    From the immune system: allergic reactions, including anaphylactic shock, anaphylactoid reactions, anaphylactic reactions.
    Mental disorders: confusion, mood changes, nightmares, insomnia, disorientation.
    From the nervous system: dizziness, headache, drowsiness.
    From the side of the organ of vision: visual impairment, including blurred vision, conjunctivitis.
    On the part of the organ of hearing and vestibular apparatus: dizziness, ringing in the ears.
    From the heart: palpitations, heart failure.
    From the vascular system: increased blood pressure, hot flashes.
    From the respiratory system: in patients with allergic reactions to acetylsalicylic acid or other NSAIDs in history, asthma attacks, upper respiratory tract infections, and coughing may be observed.
    From the digestive tract: abdominal pain, nausea, vomiting, dyspepsia, diarrhea, latent or macroscopic gastrointestinal bleeding, gastroduodenal ulcer, esophagitis, stomatitis, constipation, flatulence, belching, gastrointestinal perforation, gastritis, colitis. A peptic ulcer, perforation, or gastrointestinal bleeding can be severe and potentially fatal, especially in elderly patients.
    From the hepatobiliary system: impaired liver function indicators (for example, increased levels of transaminases or bilirubin), hepatitis, jaundice, liver failure.
    Skin and subcutaneous tissue disorders: itching, rash, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, bullous dermatitis, erythema multiforme, photosensitivity, exfoliative dermatitis.
    From the urinary system: sodium and water retention, hyperkalemia, impaired renal function (increased levels of creatinine and / or urea in the blood plasma), acute renal failure, in particular in high-risk patients, urinary tract infections, urinary disorders, including acute urinary retention ...
    From the musculoskeletal system: arthralgia, back pain, signs and symptoms associated with the joints.
    General disorders and reactions at the injection site: induration at the injection site, pain at the injection site; edema, including edema of the lower extremities, flu-like symptoms.
    Description of selected serious and / or frequent adverse reactions. Cases of agranulocytosis have been reported in patients treated with meloxicam and other potentially myelotoxic preparations (see INTERACTIONS).
    Adverse reactions that have not previously been observed with the use of this preparation, but are characteristic of other preparations in this pharmacotherapeutic group. Renal dysfunction up to renal failure: cases of interstitial nephritis, acute tubular necrosis, nephrotic syndrome, papillary necrosis have been reported.

    Special instructions

    Adverse reactions can be minimized by applying the lowest effective dose for the shortest period of treatment necessary to control symptoms (see application and information on gastrointestinal and cardiovascular risks below).
    The recommended maximum daily dose should not be exceeded in case of insufficient therapeutic effect, and additional NSAIDs should not be used, as this may increase toxicity, while therapeutic benefits have not been proven. The simultaneous use of meloxicam with NSAIDs, including selective COX-2 inhibitors, should be avoided.
    Meloxicam is not used to treat patients requiring acute pain relief.
    If there is no improvement after several days, the clinical benefits of treatment should be reassessed.
    You should pay attention to the history of esophagitis, gastritis and / or peptic ulcer in order to ensure their complete cure before starting therapy with meloxicam. Attention should be regularly drawn to the possible manifestation of relapse in patients treated with meloxicam and in patients with a history of such cases.
    Gastrointestinal disorders. As with other NSAIDs, potentially fatal gastrointestinal bleeding, ulceration, or perforation may occur at any time during treatment with or without prior symptoms or a history of serious gastrointestinal disease.
    The risk of gastrointestinal bleeding, ulceration or perforation is higher with increasing NSAID doses in patients with a history of ulcers, especially those complicated by bleeding or perforation (see CONTRAINDICATIONS), and in elderly patients. These patients should start with the lowest effective dose. For these patients, combination therapy with protective preparations (such as misoprostol or proton pump inhibitors) should be considered, as well as for patients requiring the combined use of low-dose aspirin or other preparations that increase gastrointestinal risks (see information below , and the INTERACTIONS section).
    Patients with a history of gastrointestinal toxicity, especially elderly patients, should report all unusual abdominal symptoms (especially gastrointestinal bleeding), mainly during the initial stages of treatment.
    Caution should be exercised in patients concurrently taking preparations that may increase the risk of ulcers or bleeding, in particular heparin, as radical therapy or in geriatric practice, anticoagulants such as warfarin or other NSAIDs, including acetylsalicylic acid at anti-inflammatory doses (≥1 g single dose or ≥3 g total daily dose) (see INTERACTIONS).
    If gastrointestinal bleeding or ulceration occurs in patients using meloxicam, treatment should be discontinued.
    NSAIDs should be used with caution in patients with a history of gastrointestinal diseases (ulcerative colitis, Crohn's disease), since these conditions may worsen (see SIDE EFFECTS).
    From the liver. In patients who are using NSAIDs (including meloxicam), the level of one or more liver function tests may increase. Such laboratory abnormalities may progress, may remain unchanged, or may be temporary with continued treatment. An increase in ALT or AST is possible (approximately 3 or more times higher than normal). Rare cases of severe hepatic reactions have been reported, including jaundice and fulminant lethal hepatitis, hepatic necrosis and liver failure, some of them fatal.
    Patients with symptoms and / or signs of hepatic dysfunction or who have had abnormal liver function tests should be assessed for the development of symptoms of more severe hepatic impairment during meloxicam therapy. If clinical signs and symptoms are associated with the development of hepatic diseases or if systemic manifestations of the disease are observed (for example, eosinophilia, rashes, etc.), then the use of meloxicam should be discontinued.
    Cardiovascular disorders. Patients with hypertension and / or with a history of mild to moderate congestive heart failure are advised to be closely monitored, since fluid retention and edema have been observed with NSAID therapy.
    Patients with risk factors are recommended clinical observation of blood pressure at the beginning of therapy, especially at the beginning of the course of treatment with meloxicam.
    Research data and epidemiological data suggest that the use of some NSAIDs (especially in high doses and with long-term treatment) may be associated with a slight increased risk of vascular thrombotic events (for example, myocardial infarction or stroke). Insufficient data are available to rule out this risk for meloxicam.
    Patients with uncontrolled hypertension, congestive heart failure, established coronary artery disease, peripheral arterial disease and / or cerebrovascular disease should be treated with meloxicam only after careful analysis. Such an analysis is necessary at the beginning of long-term treatment of patients with risk factors for cardiovascular diseases (such as hypertension, hyperlipidemia, diabetes mellitus, smoking).
    NSAIDs can increase the risk of serious cardiovascular thrombotic complications, myocardial infarction and stroke, which can be fatal. The increased risk is associated with the duration of use. Patients with cardiovascular disease or cardiovascular risk factors may be at increased risk.
    On the part of the skin. With the use of NSAIDs in very rare cases, serious skin reactions were observed, some of them were fatal, including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis (see SIDE EFFECTS). A high risk of such reactions was observed at the beginning of treatment, while in most cases such reactions appeared during the first month of treatment. At the first appearance of skin rashes, lesions of the mucous membranes or other signs of hypersensitivity, it is necessary to stop using meloxicam.
    Anaphylactic reactions. As with the use of other NSAIDs, anaphylactic reactions can be observed in patients without a known reaction to meloxicam. The preparation should not be used in patients with the aspirin triad. This symptomatic complex occurs in patients with asthma who have reported rhinitis with or without nasal polyps, or who have developed severe, potentially fatal bronchospasm following the use of aspirin or other NSAIDs. Emergency measures should be taken if an anaphylactoid reaction is detected.
    Liver parameters and kidney function. As in the treatment of most NSAIDs, isolated cases of an increase in the level of transaminases in the blood plasma, the level of bilirubin in the blood plasma or other indicators of liver function, as well as an increase in creatinine in the blood plasma, blood urea nitrogen and other laboratory abnormalities have been described. In most cases, these deviations were insignificant and temporary. If there is a significant or persistent confirmation of such deviations, the use of meloxicam should be discontinued and control tests should be carried out.
    Functional renal failure. NSAIDs, by inhibiting the vasodilating effect of renal prostaglandins, can 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 urine output and renal function is recommended in patients with the following risk factors:
    • elderly age;
    • simultaneous use with ACE inhibitors, angiotensin II antagonists, sartans, diuretics (see INTERACTIONS);
    • hypovolemia (of any genesis);
    • congestive heart failure;
    • renal failure;
    • nephrotic syndrome;
    • lupus nephropathy;
    • severe hepatic dysfunction (plasma albumin 25 g / l or ≥10 according to the Child-Pugh classification).
    In isolated cases, NSAIDs can lead to interstitial nephritis, glomerulonephritis, renal medullary necrosis, or nephrotic syndrome.
    The dose of meloxicam for patients with end-stage renal failure on dialysis should not exceed 7.5 mg. Patients with mild to moderate renal failure do not need to reduce the dose (creatinine clearance 25 ml / min).
    Retention of sodium, potassium and water. NSAIDs can increase sodium, potassium and water retention and interfere with the natriuretic effect of diuretics. In addition, there may be a decrease in the antihypertensive effect of antihypertensive preparations (see INTERACTIONS). In this regard, in sensitive patients, edema, heart failure, or hypertension may accelerate or worsen. Therefore, patients with such risks are advised to conduct clinical monitoring (see APPLICATION and CONTRAINDICATIONS).
    Hyperkalemia. Hyperkalemia can be promoted by diabetes mellitus or the concomitant use of preparations that increase potassium (see INTERACTIONS). In such cases, you need to regularly monitor the level of potassium.
    Precautions and safety measures. Adverse reactions are often worse tolerated by elderly patients, weak or debilitated patients who need careful monitoring. As with the treatment of other NSAIDs, you need to be careful about elderly patients who are more likely to have a decrease in kidney, liver and heart function. Elderly patients have a higher incidence of adverse reactions to NSAIDs, especially gastrointestinal bleeding and perforation, which can be fatal (see APPLICATION).
    Meloxicam, like any other NSAID, can mask the symptoms of infectious diseases.
    The use of meloxicam may negatively affect reproductive function and is not recommended for women planning pregnancy. Therefore, for women who are planning a pregnancy or undergoing examination for infertility, the possibility of discontinuing meloxicam should be considered (see Use during pregnancy and lactation).
    Masking inflammation and fever. The pharmacological action of meloxicam to reduce fever and inflammation may complicate the diagnosis of suspected non-infectious pain syndrome.
    Treatment with corticosteroids. Meloxicam may not be a likely substitute for corticosteroids in the treatment of glucocorticosteroid deficiency.
    Hematological effects. Anemia can occur in patients receiving NSAIDs, including meloxicam. This may be due to fluid retention, gastrointestinal bleeding of unknown origin, or gross or incompletely described effects on erythropoiesis. Patients on long-term treatment with NSAIDs, including meloxicam, should be monitored for hemoglobin or hematocrit if symptoms and signs of anemia are present.
    NSAIDs inhibit platelet aggregation and may prolong bleeding time in some patients. Unlike acetylsalicylic acid, their effect on platelet function is quantitatively less, short-term and reversible. The condition of patients taking meloxicam and in whom side effects of changes in platelet function, in particular blood clotting disorders, or patients receiving anticoagulants, are possible should be carefully monitored.
    Application for patients with existing asthma. Asthma patients may have aspirin-sensitive asthma. The use of aspirin in patients with aspirin-sensitive asthma is associated with severe bronchospasm, which can be fatal. Given the cross-reaction, including bronchospasm, between acetylsalicylic acid and other NSAIDs, meloxicam should not be used in patients sensitive to acetylsalicylic acid and should be used with caution in patients with existing asthma.
    Other. As with other injectable NSAIDs, abscess and necrosis may develop at the injection site.
    The preparation contains a very small amount of sodium, that is, it is virtually free of sodium.
    Use during pregnancy and lactation. Pregnancy. Inhibition of prostaglandin synthesis can adversely affect pregnancy and / or the development of the embryo and fetus. Data from epidemiological studies suggest an increase in the risk of miscarriage and the development of heart defects and gastroschisis after the use of inhibitors of prostaglandin synthesis in the early period of pregnancy. The absolute risk of developing heart defects increased from less than 1% to about 1.5%. This risk is thought to increase with dose and duration of treatment.
    In the first and second trimester of pregnancy, meloxicam should not be used unless necessary. If a woman is planning a pregnancy or is using meloxicam during the first and second trimester of pregnancy, the dosage and duration of treatment should be minimal.
    In the third trimester of pregnancy, all inhibitors of prostaglandin synthesis can pose a risk to the fetus:
    cardiopulmonary toxicity (with premature closure of the ductus arteriosus and pulmonary hypertension);
    impaired renal function, may develop into renal failure with oligohydroamnion;
    possible risks in the last stages of pregnancy for the mother and the newborn:
    risk of prolongation of bleeding time, antiplatelet effect even at very low doses;
    inhibition of uterine contractions, which leads to a delay or delay in labor.
    Therefore, meloxicam is contraindicated in the third trimester of pregnancy.
    Lactation. Although there is no specific data on meloxicam, it is known about NSAIDs that they can pass into breast milk. Therefore, the use is not recommended for women who are breastfeeding.
    Fertility Meloxicam, like other preparations that inhibit the synthesis of COX / prostaglandin, can negatively affect reproductive function and is not recommended for women who want to become pregnant. Therefore, for women who are planning a pregnancy or undergoing examination for infertility, the possibility of discontinuing meloxicam should be considered.
    Children. The preparation in the form of an injection solution is contraindicated in children under the age of 18; in the form of tablets of 7.5 mg and 15 mg - contraindicated in children under the age of 16.
    The ability to influence the reaction rate when driving or working with other mechanisms. There are no special studies of the effect of the preparation on the ability to drive vehicles or work with mechanisms. However, on the basis of the pharmacodynamic profile and the resulting adverse reactions, it can be assumed that meloxicam tends not to influence or slightly influence the indicated activity. However, patients who have experienced visual impairment, including blurred vision, dizziness, drowsiness, vertigo or other disorders of the central nervous system, are advised to refrain from driving or operating machinery.

    Interactions

    Pharmacodynamic interactions
    Other NSAIDs and acetylsalicylic acid ≥3 g / dose. The combination with other NSAIDs is not recommended (see PRECAUTIONS), including acetylsalicylic acid in anti-inflammatory doses (≥1 g single dose or ≥3 g total daily dose).
    Corticosteroids (eg glucocorticoids). Concomitant use with corticosteroids requires caution due to the increased risk of bleeding or ulceration in the gastrointestinal tract.
    Anticoagulants or heparin used in geriatric practice or at therapeutic doses. The risk of bleeding is significantly increased due to inhibition of platelet function and damage to the gastroduodenal mucosa. NSAIDs can enhance the effects of anticoagulants such as warfarin (see SPECIAL INSTRUCTIONS). The simultaneous use of NSAIDs and anticoagulants or heparin in geriatric practice or in therapeutic doses is not recommended (see SPECIAL INSTRUCTIONS).
    In other cases of heparin use, caution is required because of the increased risk of bleeding. Careful monitoring of the INR (International Normalized Ratio) is required if it is proven impossible to avoid this combination.
    Thrombolytic and antiaggregatory preparations. Increased risk of bleeding due to suppression 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 can reduce the effect of diuretics and other antihypertensive preparations. In some patients with impaired renal function (for example, patients with dehydration or elderly patients with impaired renal function), the simultaneous use of ACE inhibitors or angiotensin II antagonists and preparations that depress COX may lead to further deterioration of renal function, including possible ARF, which usually reversible. Therefore, the combination should be used with caution, especially in elderly patients. Patients need an adequate amount of fluid, and kidney function should be monitored after the start of combination therapy and periodically thereafter (see SPECIAL INSTRUCTIONS).
    Other antihypertensive preparations (eg beta-adrenergic blockers). As in the case of the use of the following preparations, it is possible to reduce the antihypertensive effect of beta-adrenergic receptor blockers (due to the inhibition of prostaglandins with a vasodilating effect).
    Calcineurin inhibitors (eg cyclosporin, tacrolimus). The nephrotoxicity of calcineurin inhibitors may be enhanced by NSAIDs due to mediation of the effects of renal prostaglandins. During treatment, kidney function should be monitored. Careful monitoring of renal function is recommended, especially in elderly patients.
    Intrauterine contraception. NSAIDs reduce the effectiveness of intrauterine contraceptives. A decrease in the effectiveness of intrauterine contraceptives with the use of NSAIDs has previously been reported, but this requires further confirmation.
    Pharmacokinetic interaction: the effect of meloxicam on the pharmacokinetics of other preparations
    Lithium. There is evidence of NSAIDs that increase the level of lithium concentration in the blood plasma (due to a decrease in renal excretion of lithium), which can reach toxic values. The simultaneous use of lithium and NSAIDs is not recommended (see SPECIAL INSTRUCTIONS). If combination therapy is necessary, the level of lithium in the blood plasma should be carefully monitored at the beginning of treatment, when choosing a dose and when stopping treatment with meloxicam.
    Methotrexate. NSAIDs can reduce the tubular secretion of methotrexate, thereby increasing plasma concentration. For this reason, it is not recommended to concomitantly use NSAIDs in patients who take a high dose of methotrexate (more than 15 mg / week) (see SPECIAL INSTRUCTIONS). The risk of interaction between NSAIDs and methotrexate should also be considered in patients receiving a low dose of methotrexate, in particular in patients with impaired renal function. If combined treatment is required, it is necessary to monitor blood counts and kidney function. Caution should be exercised if NSAIDs and methotrexate are taken for 3 consecutive days, as the plasma levels of methotrexate may rise and increase toxicity. Although the pharmacokinetics of methotrexate (15 mg / week) was not affected by concomitant treatment with meloxicam, it should be considered that the hematological toxicity of methotrexate may increase with the treatment of NSAIDs (see information above) (see SIDE EFFECTS).
    Pharmacokinetic interaction: the effect of other preparations on the pharmacokinetics of meloxicam
    Kolestyramine. Accelerates the elimination of meloxicam due to impaired intrahepatic circulation, therefore, the clearance of meloxicam increases by 50% and T½ decreases to 13 ± 3 hours. This interaction is clinically significant.
    There was no clinically significant pharmacokinetic interaction when taken simultaneously with antacids, cimetidine and digoxin.
    Incompatibility. Solution for injection must not be mixed with other preparations in the same syringe.

    Overdose

    Symptoms of acute NSAID overdose are usually limited to lethargy, drowsiness, nausea, vomiting, and gastralgia, which are usually reversible with symptomatic therapy. gastrointestinal bleeding may also occur. severe poisoning can lead to an increase in blood pressure, the development of opn, liver dysfunctions, respiratory depression, coma, seizures, collapse and cardiac arrest.
    Anaphylactoid reactions have been reported while taking NSAIDs in therapeutic doses in case of overdose.
    After an overdose of NSAIDs, patients undergo supportive and symptomatic therapy in accordance with the severity of the overdose and intoxication. In clinical studies, it was found that taking 4 g of cholestyramine orally 3 times a day accelerates the elimination of meloxicam.

    Storage conditions

    At temperatures up to 25 ° C.

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