Symptoms of acute NSAID overdose: dizziness, lethargy, nausea, vomiting, epigastric pain. These symptoms are usually reversible and amenable to symptomatic treatment. Perhaps bleeding from equipoise dosage the gastrointestinal tract. In severe poisoning may experience acute renal failure, acute liver failure, high blood pressure, respiratory arrest, convulsions, collapse, coma, asystole. Treatment: gastric lavage, no later than 6 hours after administration, forced diuresis, symptomatic therapy. No specific antidote, but shows the use of cholestyramine (4 g three times daily by mouth) in order to reduce absorption of meloxicam. Hemodialysis is ineffective.
Interaction with other drugs
Inductors microsomal oxidation (phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites of meloxicam, increasing the risk of severe intoxication. Inhibitors of microsomal oxidation reduce the risk of hepatotoxic action of meloxicam (by reducing the production of active metabolites). Not recommended simultaneous use of meloxicam and other NSAIDs, since it may increase the risk of gastrointestinal mucosal ulceration and bleeding. with simultaneous use of meloxicam with lithium therapy can decrease the kidney excretion of lithium, which leads to an increase in the concentration of lithium in serum. This combination should be avoided if it is impossible -. Must carefully monitor blood lithium levels before treatment, during treatment and after the abolition of meloxicam may reduce the effect of diuretics and . Antihypertensive drugs in patients with impaired renal function (as in dehydrated or elderly patients) simultaneous reception of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists (ARA) with drugs that inhibit cyclooxygenase, may lead to further deterioration of the renal function up to the equipoise dosage development of acute renal failure (in most cases, reversible).
There may be a reduction in hypotensive effect beta-blockers. with the simultaneous use of meloxicam with corticosteroids orselective serotonin reuptake inhibitors (citalopram, fluoxetine, paroxetine, sertraline) increases the risk of ulceration gastrointestinal mucosa, resulting in can be a serious gastrointestinal bleeding. The risk of nephrotoxicity associated with taking cyclosporine , preparations of gold increases with simultaneous use of meloxicam. in an application also increases the hepatotoxicity of cyclosporine. Concomitant use of meloxicam with methotrexate may lead to an increase in the concentration of the latter in the serum and increase its toxic effects as NSAIDs reduce the tubular secretion of methotrexate (risk of anemia and leucopenia, is recommended for periodic blood count). At a dose of methotrexate for more than 15 mg / week is not recommended to co-use of drugs. Just be careful at simultaneous application of methotrexate and meloxicam with reduced renal function.
With the simultaneous use of meloxicam and antiplatelet agents (aspirin, ticlopidine, clopidogrel), anticoagulants (warfarin, heparin) or thrombolytics(alteplase, streptokinase, urokinase) increases the risk of bleeding . while the use of intrauterine contraceptive devices may reduce the effectiveness of the latter. Caffeine equipoise dosage increases the analgesic effect of meloxicam. Cholestyramine reduces the absorption of meloxicam which can be used in the treatment of an overdose of the drug. with the simultaneous use of meloxicam with hypoglycemic agents for oral administration may enhance their effect, the thus contributing to the risk of hypoglycemia.
The frequency and severity of dose-dependent adverse effects is lower if the drug is used in the lowest effective dose as low as possible short course.
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Gastrointestinal bleeding or perforation of the gastrointestinal tract (including fatal), may occur in the treatment of any NSAID, after various times after the start treatment, including patients with no prior history gastrointestinal diseases and / or of any symptoms from the gastrointestinal tract. GI bleeding risk is higher, the higher the dose of the drug.
During long-term treatment is necessary to monitor patterns of peripheral blood, fluid and electrolyte balance, blood coagulation system and the functional state of the liver and kidneys.
Prolonged treatment is recommended to control the concentration of potassium (especially in patients with diabetes patients diabetes).
in applying the drug can be observed increased concentration “liver” enzymes and urea in the blood serum. These changes are usually ill-defined and are transient. In the case of pronounced changes in the drug should be discontinued.
Caution should be exercised when using the drug in patients with a history of gastric ulcer and duodenal ulcers, as well as in patients receiving anticoagulant therapy. In these patients, increased risk of erosive and ulcerative gastrointestinal lesions.
When the symptoms of gastropathy shows a thorough examination, including conduct esophagogastroduodenoscopy, blood analysis with determination of hematocrit, hemoglobin, fecal occult blood test (after appropriate preparation of the patient).
In order to prevent the development of gastropathy meloxicam recommended combined with gastroprotectives eg misoprostol or proton pump inhibitors.
Long-term use of the drug to patients with diseases of the cardiovascular system (uncontrolled hypertension, heart failure, ischemic heart disease, peripheral arterial occlusive disease and / or cerebrovascular disease), risk factors for heart -sosudistyh diseases (eg, hypertension, hyperlipidemia, diabetes mellitus, smoking) should only be carried out after a thorough examination.
data from clinical and epidemiological studies suggest a small increased risk of arterial thrombosis in the treatment of NSAIDs for a long time.
if necessary, the definition of 17 -ketosteroidov drug should be discontinued 48 hours prior to the study.
patients receiving meloxicam and diuretics simultaneously should take plenty of fluids.
In patients with impaired renal and mild to moderate severity function (creatinine clearance 30-60 ml / min) is not required correction mode .
meloxicam, like other NSAIDs, may mask the symptoms of infectious diseases.
use of the drug is undesirable in new-onset of acute pain (since the use of meloxicam may mask acute disease symptoms).
If the therapy meloxicam improvement does not occur within a few days, it is necessary to solve the desirability of further treatment.
If during treatment any allergic reaction (itching, skin rash, urticaria, photosensitivity), you must immediately stop taking the drug and consult a doctor. The greatest risk of severe complications equipoise dosage from the skin is observed during the first month of treatment.
In patients with an increased risk of side effects, treatment is initiated with a dose of 7.5 mg.
In patients with dehydration of various etiologies, congestive heart failure, liver cirrhosis, nephrotic syndrome, taking diuretics, with clinically severe renal disease should be monitored daily urine output and renal function.
upon receipt of NSAIDs due to the inhibition of synthesis of renal PG and hence reduction of glomerular filtration rate can be observed a dose-dependent development of renal failure.
At the beginning of therapy (or after increasing dose) you need to carefully monitor urine output and renal function, especially in patients with the following risk factors: older age, concomitant treatment with ACE inhibitors / blockers of angiotensin II receptors, diuretics, hypovolemia (any cause), heart failure, renal failure, nephrotic syndrome, lupus nephritis ( lupus nephropathy), severe hepatic impairment (serum albumin <25 g / l or cirrhosis at Child-Pugh> 10 points).
Meloxicam, like other drugs that block the synthesis of PG may affect fertility, so is not recommended for use in women planning pregnancy.
In the period of treatment is not recommended intake of ethanol-containing foods and drinks.
The described side effects most severely manifested in elderly and debilitated patients. Caution must be exercised in the treatment of these groups of patients. anabolic steroids online shop
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