Meloxicam (Mobic) tablets and capsules are used in the treatment of inflammatory conditions such as joint pains and body aches. It belongs to the class of NSAIDs labeled as partial COX-2 inhibitors (unlike celecoxib and etoricoxib which are fully selective COX 2 inhibitors and Naproxen or Ibuprofen which are non-selective COX 2 inhibitors).
Meloxicam Uses:
-
Osteoarthritis:
- It is used to alleviate pain in patients with osteoarthritis
-
Rheumatoid arthritis (orally disintegrating tablet [ODT], tablet, and suspension only):
- It is used to treat rheumatoid arthritis symptoms and signs (RA)
relief of the signs and symptoms of juvenile polyarticular or pauciarticular RA in patients under the age of two and under the weight of 60 kg.
- It is used to treat rheumatoid arthritis symptoms and signs (RA)
-
Off Label Use of Meloxicam in Adults:
- It is used in acute flares of gout
Meloxicam (Mobic) Dose in Adults:
Note: Even though the total milligramme strength of capsules and orally disintegrating tablets (ODT) is the same as that of other oral meloxicam formulations, they cannot be used interchangeably.
Meloxicam (Mobic) Dose as alternative agent in the treatment of acute flare of gout (off-label):
- Oral: 15 mg once a day: start with in 24-48 hours of onset of flare, discontinue after 2 - 3 days once clinical signs subsides
- The usual duration is 5 - 7 days
Meloxicam (Mobic) Dose in the treatment of Osteoarthritis:
- Capsule: Oral: Initial: 5 mg once a day
- Maximum dose: 10 mg/day
Meloxicam (Mobic) Dose in the treatment of Osteoarthritis and rheumatoid arthritis:
- ODT/Tablet/Suspension: Oral: Initial: 7.5 mg once a day
- Maximum dose: 15 mg/day
Meloxicam (Mobic) Dose in Children:
Meloxicam (Mobic) Dose in the treatment of Juvenile idiopathic arthritis (JIA):
Note: To reduce cardiovascular and gastrointestinal adverse effects, utilise the smallest effective dose for a shorter time; In clinical trials, higher doses (up to 0.375 mg/kg/day or 15 mg/day) did not produce any additional benefits.
-
Oral suspension, tablets (limited data available with tablets):
-
Children ≥2 years and Adolescents:
- 0.125 mg/kg once a day;
- The maximum dose: 7.5 mg/day.
-
-
Orally-disintegrating tablets:
-
Children and Adolescents weighing ≥ 60 kg:
- 5 mg once a day.
-
Pregnancy Category C (D in the 3rd trimester)
- Contradictory data exist regarding birth defects following in utero NSAIDs use. Some studies shows birth defects
- After in utero NSAIDS treatment, there are no teratogenic side effects
- Prenatal constriction, non-closure and postnatal resistance to medical treatment. It should not be used before 30 weeks gestation.
- The newborn may have persistent pulmonary hypertension
- Oligohydramnios
- Necrotizing enterocolitis
- Failure or dysfunction of the renal system
- Intracranial hemorrhage
- NSAIDs are recommended for mild cases of rheumatoid-related arthritis during pregnancy. They should be avoided both early and later in pregnancy.
- Reversible infertility can be caused by prolonged NSAID use in women over the age of 18.
- Miscarriages are more likely when NSAIDs are used before conception
Meloxicam use during breastfeeding:
- It is unknown if Meloxicam is present in breast milk.
- NSAIDs are generally safe to use postpartum. However, it is better to take drugs other than meloxicam.
- Breastfeeding mothers with platelet dysfunction and thrombocytopenia should not receive it
Meloxicam (Mobic) Dose in Kidney Disease:
- CrCl ≥20 mL/minute:
- No dosage adjustment required.
- CrCl <20 mL/minute:
- The manufacturer's labelling does not mention dosage modifications;
- Use is not recommended.
- Hemodialysis (not dialyzable): Use with care and keep an eye on things. .
- Maximum dose: 7.5 mg/day, 5 mg/day (capsule)
- After hemodialysis, no further dose is necessary.
-
KDIGO 2012 guidelines provide the following recommendations for NSAIDs:
- eGFR 30 to <60 mL/minute/1.73 m²:
- Can be taken but discontinue during intercurrent illnesses that increase the risk of acute kidney injury.
- eGFR <30 mL/minute/1.73 m²:
- Not recommended.
- eGFR 30 to <60 mL/minute/1.73 m²:
Dose in Liver disease:
- Mild to moderate impairment (Child-Pugh class A or B):
- No dosage adjustment required.
- Severe impairment (Child-Pugh class C):
- The manufacturer has not provided any dose adjustment;
- Use cautiously.
Side Effects of Meloxicam (Mobic):
-
Cardiovascular:
- Edema
- Angina Pectoris
- Cardiac Arrhythmia
- Cardiac Failure
- Facial Edema
- Hypertension
- Hypotension
- Acute Myocardial Infarction
- Palpitations
- Syncope
- Tachycardia
- Vasculitis
-
Central Nervous System:
- Pain
- Headache
- Dizziness
- Insomnia
- Falling
- Abnormal Dreams
- Anxiety
- Confusion
- Depression
- Drowsiness
- Fatigue
- Malaise
- Nervousness
- Paresthesia
- Seizure
- Vertigo
-
Dermatologic:
- Skin Rash
- Pruritus
- Alopecia
- Bullous Rash
- Diaphoresis
- Skin Photosensitivity
- Urticaria
-
Endocrine & Metabolic:
- Albuminuria
- Dehydration
- Hot Flash
- Increased Gamma-Glutamyl Transferase
- Weight Gain
- Weight Loss
-
Gastrointestinal:
- Dyspepsia
- Diarrhea
- Nausea
- Abdominal Pain
- Constipation
- Flatulence
- Vomiting
- Abdominal Distress
- Aphthous Stomatitis
- Colitis
- Duodenal Ulcer
- Dysgeusia
- Eructation
- Esophagitis
- Gastrointestinal Perforation
- Gastric Ulcer
- Gastritis
- Gastroesophageal Reflux Disease
- Gastrointestinal Hemorrhage
- Hematemesis
- Increased Appetite
- Intestinal Perforation
- Melena
- Pancreatitis
- Xerostomia
-
Genitourinary:
- Urinary Tract Infection
- Urinary Frequency
- Hematuria
-
Hematologic & Oncologic:
- Anemia
- Leukopenia
- Nonthrombocytopenic Purpura
- Thrombocytopenia
-
Hepatic:
- Hepatitis
- Hyperbilirubinemia
- Increased Serum Alanine Aminotransferase
- Increased Serum Aspartate Aminotransferase
-
Hypersensitivity:
- Angioedema
- Hypersensitivity Reaction
-
Neuromuscular & Skeletal:
- Arthralgia
- Back Pain
- Tremor
-
Ophthalmic:
- Conjunctivitis
- Visual Disturbance
-
Otic:
- Tinnitus
-
Renal:
- Increased Blood Urea Nitrogen
- Increased Serum Creatinine
- Renal Failure Syndrome
-
Respiratory:
- Upper Respiratory Tract Infection
- Flu-Like Symptoms
- Pharyngitis
- Bronchospasm
- Dyspnea
- Cough
- Asthma
-
Miscellaneous:
- Accidental Injury
- Fever
Contraindications to Meloxicam (Mobic):
- Hypersensitivity
- History of Aspirin &/or NSAIDs causing asthma, urticaria or other allergic-type reactions
- Use for the placement of coronary bypass graft surgery (CABG).
- Phenylketonuria is only available in ODT.
Additional contraindications for Canadian labelling (not US labeling)
- Pregnancy in the third trimester
- Breastfeeding
- Uncontrolled severe heart failure
- Active or recent GI/gastric/duodenal/peptic ulceration/perforation
- Active GI bleeding
- Other bleeding disorders or cerebrovascular bleeding
- Inflammatory bowel disease (Crohn's disease or ulcerative colitis).
- Severe or active liver disease
- Grave renal impairment (creatinine clearance [CrCl] >30 mL/minute, 0.5 mL/second), or deteriorating renal disease
- Hyperkalemia is a well-known condition
- Pediatric patients under 18 years
- Rare hereditary conditions may make it difficult to use the excipient.
Warnings and precautions
-
Anaphylactoid reactions
- Patients with the "aspirin trifecta" (bronchial asthma and aspirin intolerance, rhinitis) could be at higher risk.
- Patients with bronchospasm or rhinitis or urticaria due to nonsteroidal anti-inflammatory drugs (NSAID) and aspirin therapy are contraindicated.
-
Cardiovascular events: [US Boxed Warn]
- Use of NSAIDs can cause adverse cardiovascular thrombotic effects, such as stroke and MI. These events could be fatal.
- Particularly early in the course of treatment, those with known cardiovascular illness had a greater absolute incidence of thrombotic events.
- However, relative risk was similar to that of either known or unrelated cardiovascular disease.
- The impaired response to diuretics, especially thiazide and loop diuretics, such as NSAIDs, can be caused by NSAIDs.
- Hypertension may be exacerbated or new-onset hypertension. Regularly monitor your BP
- NSAIDs can cause fluid retention and sodium buildup. Be careful with edema.
- Patients with heart failure should be avoided
- If there are more benefits than risks, avoid its use in MI.
- If necessary, use the lowest effective dose and for the shortest time.
-
CNS effects
- It can cause blurred vision, dizziness, and other CNS symptoms. Patients should be cautious when engaging in activities that require mental alertness.
-
GI events: [US Boxed Warning]
- NSAIDs may cause Gastrointestinal events such as GI inflammation, ulceration and bleeding. Patients with a history of GI bleeding, PUD or elderly are at greater risk.
- Therapy may not have any prior warning signs.
- Avoid non-aspirin NSAIDs if there are any history of severe lower GI bleeding.
- This is especially important if the bleeding is due to angioectasia, diverticulosis, or other causes.
- Take care when using the following conditions:
- History of GI ulcers
- Anticoagulants, corticosteroids, and/or aspirin are examples of concurrent therapy that raises the risk of Gastrointestinal bleeding.
- Advanced liver disease
- Coagulopathy
- Smoking
- Alcohol use
- Patients who are elderly or have a disability.
- In high-risk patients, consider alternative therapies. If necessary, use the lowest effective dose for a short time.
- If you take aspirin with it, there is a greater chance of GI problems.
-
Hematologic effects
- It can impair platelet function and cause bleeding to be prolonged
- If a patient is taking anticoagulants, or has a coagulation disorder, be sure to monitor closely
- Anemia can occur. Monitor your NSAID use to prolong your use
- Rarely, NSAIDs can cause blood disorders.
-
Hepatic effects
- Transaminase, a liver enzyme, can be elevated.
- Patients with abnormal LFT should be closely monitored.
- Very rarely, NSAIDs can cause severe hepatic reactions (e.g. severe hepatic reactions, such as hepatic failure or fulminant liver disease. In such cases, discontinue
-
Hyperkalemia:
- NSAIDs can increase the risk of hyperkalemia, especially in the elderly, diabetics, and people with pre-existing renal impairment, as well as when used concurrently with other medications that also cause hyperkalemia (eg, angiotensin-converting enzyme [ACE] inhibitors).
- Keep an eye on potassium levels.
-
Ophthalmic effects
- It is possible to experience hazy or reduced eyesight.
- Quit using and get your eyes checked by an ophthalmologist.
-
Effects on the renal system:
- Use of NSAIDs can cause deranged renal function.
- There is decreased prostaglandin synthesis (dose dependent), reduced renal blood flow, and renal decompensation.
- Risk factors includes
- dehydration, hypovolemia
- heart failure
- Hepatic impairment
- People who are taking diuretics, ACE inhibitors, or ARBs
- The risk of kidney toxicity is greater in the elderly.
- Before starting treatment, hydrate the patient and closely monitor their renal function.
- Renal papillary necrosis can be caused by long-term NSAIDs.
-
Reactions to skin:
- Negative skin effects (NSAIDs) can lead to severe skin reactions, including Stevens-Johnson syndrome or toxic epidermal necrolysis (TEN).
- Do not use if you notice a skin rash or hypersensitivity.
-
Asthma
- Aspirin-sensitive asthma sufferers could be at risk of serious and potentially fatal bronchospasm.
- Be cautious with other forms of asthma.
-
Bariatric surgery
- There is increased chance of anastomotic ulceration/perforation with NSAIDs prolong use after bariatric surgery
- Celecoxib (IV) and ketorolac IV can be used for short-term pain management after surgery.
-
Coronary bypass surgery for coronary artery bypass: [US Boxed Warn]
- Contraindicated for the placement of coronary bypass graft surgery (CABG).
- If you use it within the first 10 to 14 days following CABG surgery, you run the risk of having a stroke or MI.
-
Hepatic impairment
- Avoid use in patients with hepatic impairment.
- Because NSAIDs are highly metabolic in the liver, a lower dose may be necessary.
- Advance liver disease increases the risk of GI bleeding
-
Renal impairment
- It can lead to a worsening or worsening in already severely impaired renal function. It is best to avoid its use.
- If necessary, closely monitor
Meloxicam: Drug Interaction
|
5-Aminosalicylic Acid Derivatives |
Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of 5-Aminosalicylic Acid Derivatives. |
|
Acalabrutinib |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.) |
May enhance the antiplatelet effect of other Agents with Antiplatelet Properties. |
|
Alcohol (Ethyl) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. |
|
Aliskiren |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Management: Monitor renal function periodically in patients receiving aliskiren and any nonsteroidal anti-inflammatory agent. Patients at elevated risk of renal dysfunction include those who are elderly, are volume depleted, or have pre-existing renal dysfunction. |
|
Alpelisib |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). |
|
Aminoglycosides |
Nonsteroidal Anti-Inflammatory Agents may decrease the excretion of Aminoglycosides. Data only in premature infants. |
|
Aminolevulinic Acid (Topical) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). |
|
Angiotensin II Receptor Blockers |
May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. |
|
Angiotensin-Converting Enzyme Inhibitors |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Anticoagulants |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin. |
|
Beta-Blockers |
|
|
Bisphosphonate Derivatives |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern. |
|
Cephalothin |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased. |
|
Collagenase (Systemic) |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased. |
|
Corticosteroids (Systemic) |
May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents (Nonselective). |
|
CYP2C9 Inducers (Moderate) |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). |
|
CYP2C9 Inhibitors (Moderate) |
May increase the serum concentration of Meloxicam. |
|
Dasatinib |
May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Deferasirox |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. |
|
Deoxycholic Acid |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased. |
|
Desmopressin |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Desmopressin. |
|
Digoxin |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Digoxin. |
|
Drospirenone |
Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Drospirenone. |
|
Eplerenone |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone. |
|
Fat Emulsion (Fish Oil Based) |
May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. |
|
Felbinac |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Glucosamine |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Haloperidol |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Haloperidol. Specifically including drowsiness and confusion. |
|
HydrALAZINE |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of HydrALAZINE. |
|
Ibritumomab Tiuxetan |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding. |
|
Ibrutinib |
May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. |
|
Inotersen |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Itraconazole |
May decrease the serum concentration of Meloxicam. |
|
Limaprost |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Lumacaftor |
May decrease the serum concentration of CYP2C9 Substrates (High Risk with Inhibitors or Inducers). Lumacaftor may increase the serum concentration of CYP2C9 Substrates (High Risk with Inhibitors or Inducers). |
|
MetFORMIN |
Nonsteroidal Anti-Inflammatory Drugs may intensify MetFORMIN's harmful or hazardous effects. |
|
Multivitamins/Fluoride (with ADE) |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Multivitamins/Minerals (with ADEK, Folate, Iron) |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Multivitamins/Minerals (with AE, No Iron) |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Naftazone |
May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Obinutuzumab |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased. |
|
Omega-3 Fatty Acids |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Pentosan Polysulfate Sodium |
May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents. |
|
Pentoxifylline |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Porfimer |
Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. |
|
Potassium-Sparing Diuretics |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. |
|
PRALAtrexate |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Closely monitor for increased pralatrexate serum levels and/or toxicity if used concomitantly with an NSAID. Monitor for decreased pralatrexate serum levels with NSAID discontinuation. |
|
Probenecid |
May increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. |
|
Prostacyclin Analogues |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Prostaglandins (Ophthalmic) |
Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic). |
|
Quinolones |
Nonsteroidal Anti-Inflammatory Agents may enhance the neuroexcitatory and/or seizure-potentiating effect of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Quinolones. |
|
Rifapentine |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). |
|
Salicylates |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result. |
|
Serotonin/Norepinephrine Reuptake Inhibitors |
May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). |
|
Tacrolimus (Systemic |
Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tacrolimus (Systemic). |
|
Thiazide and Thiazide-Like Diuretics |
May enhance the nephrotoxic effect of Nonsteroidal AntiInflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. |
|
Thrombolytic Agents |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents. |
|
Tipranavir |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Tolperisone |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may enhance the therapeutic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Tricyclic Antidepressants (Tertiary Amine) |
May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). |
|
Vancomycin |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Vancomycin. |
|
Verteporfin |
Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. |
|
Vitamin E (Systemic) |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Voriconazole |
Meloxicam serum levels can rise. |
|
Zanubrutinib |
Agents with antiplatelet properties may have an enhanced antiplatelet impact. |
|
Risk Factor D (Consider therapy modification) |
|
|
Apixaban |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Apixaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of apixaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. |
|
Bemiparin |
Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin and nonsteroidal anti-inflammatory agents (NSAIDs) due to the increased risk of bleeding. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Bemiparin |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Bile Acid Sequestrants |
May decrease the absorption of Nonsteroidal Anti-Inflammatory Agents. |
|
CycloSPORINE (Systemic) |
|
|
Dabigatran Etexilate |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of dabigatran and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. |
|
Dabrafenib |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP2C9 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). |
|
Diclofenac (Systemic) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Seek alternatives to the combined use of diclofenac with other nonsteroidal anti-inflammatory agents (NSAIDs). Avoid the use of diclofenac/misoprostol with other NSAIDs. |
|
Edoxaban |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of edoxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. |
|
Enoxaparin |
Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue nonsteroidal anti-inflammatory agents (NSAIDs) prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Enoxaparin |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Enzalutamide |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP2C9 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C9 substrate should be performed with caution and close monitoring. |
|
Heparin |
Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or nonsteroidal anti-inflammatory agents (NSAIDs) if coadministration is required. |
|
Heparin |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required. |
|
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry) |
May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures. |
|
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Bleeding may occur. Management: Concomitant treatment with these agents should generally be avoided. If used concomitantly, increased diligence in monitoring for adverse effects (eg, bleeding, bruising, altered mental status due to CNS bleeds) must be employed. |
|
Lithium |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Lithium. |
|
Loop Diuretics |
Nonsteroidal Anti-Inflammatory Agents may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. |
|
Methotrexate |
Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Methotrexate. Management: Alternative anti-inflammatory therapy should be considered whenever possible, especially if the patient is receiving higher, antineoplastic doses of methotrexate. |
|
MiFEPRIStone |
May increase the serum concentration of CYP2C9 Substrates (High risk with Inhibitors). Management: Use CYP2C9 substrates at the lowest recommended dose, and monitor closely for adverse effects, during and in the 2 weeks following mifepristone treatment. |
|
Rivaroxaban |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of rivaroxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding. |
|
Salicylates |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Salicylates. An increased risk of bleeding may be associated with use of this combination. Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the cardioprotective effect of Salicylates. Salicylates may decrease the serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Exceptions: Choline Magnesium Trisalicylate. |
|
Selective Serotonin Reuptake Inhibitors |
May enhance the antiplatelet effect of Nonsteroidal AntiInflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk. |
|
Sincalide |
Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. |
|
Sodium Phosphates |
May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with NSAIDs, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely. |
|
Tenofovir Products |
Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose. |
|
Vitamin K Antagonists (eg, warfarin) |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the anticoagulant effect of Vitamin K Antagonists. Management: Consider alternatives to this combination when possible. If the combination must be used, monitor coagulation status closely and advise patients to promptly report any evidence of bleeding or bruising. |
|
Risk Factor X (Avoid combination) |
|
|
Acemetacin |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Aminolevulinic Acid (Systemic) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). |
|
Calcium Polystyrene Sulfonate |
Calcium Polystyrene Sulfonate may have a more negative or toxic effect when taken with meloxicam. More precisely, concurrent usage of sorbitol-containing meloxicam oral suspension may raise the risk of intestinal necrosis. |
|
Dexibuprofen |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Dexibuprofen. |
|
Dexketoprofen |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Floctafenine |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Ketorolac (Nasal) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Ketorolac (Systemic) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Macimorelin |
Nonsteroidal Anti-Inflammatory Agents may diminish the diagnostic effect of Macimorelin. |
|
Mifamurtide |
Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Mifamurtide. |
|
Morniflumate |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). |
|
Omacetaxine |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Management: Avoid concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs) with omacetaxine in patients with a platelet count of less than 50,000/uL. |
|
Pelubiprofen |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Phenylbutazone |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Sodium Polystyrene Sulfonate |
Meloxicam might make sodium polystyrene sulfonate more harmful or hazardous. More precisely, concurrent usage of sorbitol-containing meloxicam oral suspension may raise the risk of intestinal necrosis. |
|
Talniflumate |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Tenoxicam |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Urokinase |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase. |
|
Zaltoprofen |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
Monitoring parameters:
- Complete blood cell count (CBC) and chemistry profile
- Occult blood loss
- Liver function tests
- Renal function tests (urine output, serum BUN and creatinine)
- Any clinical features suggestive of GI bleeding
- Blood pressure
- Periodic ophthalmologic exam with long term therapy.
How to administer Meloxicam (Mobic)?
Oral:
- It can be taken either with or without food, but it is preferable to do so to reduce GI issues.
Orally disintegrating tablet (ODT):
- When you're ready to administer, remove from blister.
- Put in the mouth or on the tongue with dry hands, and then let it dissolve.
- swallow while gargling (with or without drinking liquid).
Suspension:
- Shake well before use.
Mechanism of action of Meloxicam (Mobic):
- It inhibits the synthesis prostaglandins precursor through reversible inhibition cyclooxygenase-1 (COX-1) enzymes, mainly COX 2.
- It is an antipyretic, analgesic and anti-inflammatory agent.
Protein binding:
- about 99%, mainly bound to albumin
Metabolism:
- It undergoes inactive metabolite formation in the liver via CYP2C9 and CYP3A4 (minor).
Bioavailability:
- 89% (capsule);
- The suspension is bioequivalent to tablets
Half-life elimination:
- Children 2 - 6 years: 13.4 hours
- Children and Adolescents 7 - 16 years: 12.7 hours
- Adults: ~15 - 22 hours
Time to peak:
- Children and Adolescents 2 - 16 years: Suspension:
- Initial: 1 - 3 hours;
- secondary: 6-12 hours
- Adults:
- Initial:
- Within 2 hours (capsule);
- 4 - 5 hours (tablet);
- 4 - 12 hours (ODT; prolonged with food);
- Secondary:
- ~8 hours (capsule);
- 12 - 14 hours (tablet)
- Initial:
Excretion:
- It is excreted through both Urine and feces (as inactive metabolites);
- Less than 1% is excreted unchanged in the urine.
International Brand Names of Meloxicam:
- Mobic
- Qmiiz ODT
- Vivlodex
- ACT Meloxicam
- APO-Meloxicam
- Auro-Meloxicam
- DOM-Meloxicam
- Mobicox
- MYLANMeloxicam
- PMS-Meloxicam
- TEVA-Meloxicam
- Acticam
- Aflamid
- Afloxx
- Areloger
- Aroxicam
- Arrox
- Artriclox
- Aspicam
- Avegesic
- Bexxam
- Bienex
- Cambic-15
- Camrox
- Caxlem
- Cloxim
- Coxicam
- Dormelox
- Ecax
- Exel
- Flamoxi
- Flexicam
- Flodin
- Friart
- Hyflex
- Ilacox
- Koniflam
- Letex
- Loxaid
- Loxibest
- Loxicam
- Loxikam
- Loxil
- M-Cam
- Mebilax
- Mecaron
- Mecasel
- Mecon
- Mecox
- Medoxicam
- Mel-OD
- Melart
- Melcam
- Melcox
- Melflam
- Meliam
- Melicam
- Melocam
- Melocid
- Melocox
- Melodyn
- Meloflam
- Melonax
- Melosteral
- Melox
- Meloxibell
- Meloxin
- Memovic
- Merapiran
- Mevamox
- Mexicam
- Mexolan
- Mexpharm
- Mexx
- Miloxam
- Miovalis
- Mobec
- Mobex
- Mobic
- Mobicox
- Mobiflex
- Mobiglan
- Mobitil
- Mobix
- Moov
- Mopik
- Motion
- Movalis
- Moven
- Movi-Cox
- Moxalid
- Moxicam
- Muvera
- Muvik
- Neoxicam
- Nulox
- Nulox Forte
- Ostelox
- Osteoflam
- Oxichem
- Oximal
- Parocin
- Paxicam
- Quicktra
- Rafree
- Recoxa
- Selektine
- Troxicam
- Xiarax
- Xobix
- Zeloxim
Meloxicam Brand Names in Pakistan:
Meloxicam 15 mg Tablets in Pakistan |
|
| Abidacam | Z-Jans Pharmaceutical (Pvt) Ltd. |
| Aloxi | Alson Pharmaceuticals |
| Amcam | Regent Laboratories Ltd. |
| Aponip | Pharmatec Pakistan (Pvt) Ltd. |
| Armex | Qintar Pharmacuticals |
| Arneez | Welmark Pharmaceuticals |
| Artex | Pharmedic (Pvt) Ltd. |
| Articam | Standpharm Pakistan (Pvt) Ltd. |
| Artipro | Helix Pharma (Private) Limited |
| Belcam | Gray`S Pharmaceuticals |
| Beloxi | Wellborne Pharmachem And Biologicals |
| Bicox | Shazals Pharmaceuticals |
| Bonvil | Lexicon Pharmaceuticals (Pvt) Ltd. |
| Brilox | Max Pharmaceuticals |
| Camilox | Akhai Pharmaceuticals. |
| Camsaf | Saaaf Pharmaceuticals |
| Caner | Nawan Laboratories (Pvt) Ltd. |
| Coxibit | Danas Pharmaceuticals (Pvt) Ltd |
| Coxicam | Shaheen Pharmaceuticals |
| Coxlan | Karachi Chemical Industries |
| Dewcam | Fynk Pharmaceuticals |
| Dhanuk | Nimrall Laboratories |
| Eroxx | Nexus Pharma (Pvt) Ltd |
| Flamot | Medisave Pharmaceuticals |
| Florelax | Florence Farmaceuticals (Pvt) Ltd |
| Haricam | Shawan Pharmaceuticals |
| Healcam | Heal Pharmaceuticals Pvt Ltd |
| Jaoxicam | Jawa Pharmaceuticals(Pvt) Ltd. |
| Jorr | Hoora Pharma |
| Joxicam | Jawa Pharmaceuticals(Pvt) Ltd. |
| Lexicon | Tabros Pharma |
| Lotoxicam | Lotus Pharmaceuticals (Pvt) Ltd |
| Loxatec | Martin Dow Pharmaceuticals (Pak) Ltd. |
| Loxicam | Lowitt Pharmaceuticals (Pvt) Ltd |
| Loxidol | Shrooq Pharmaceuticals |
| Loxigood | Goodman Laboratories |
| Loxirax | Shrooq Pharmaceuticals |
| M-Com | Navegal Laboratories |
| M. Com | Wilshire Laboratories (Pvt) Ltd. |
| Magix | Medicaids Pakistan (Pvt) Ltd. |
| Mecam | Fozan Pharmaceuticals Industriers (Pvt) Ltd |
| Megit | Glitz Pharma |
| Mel - 2 - Cox | Elko Organization (Pvt) Ltd. |
| Melcox-15 | Unison Chemical Works |
| Melfax | Agp (Private) Ltd. |
| Mellow Tab | Ferroza International Pharmaceuticals (Pvt) Ltd. |
| Melocam | Flow Pharmaceuticals (Pvt) Ltd. |
| Melomak | Makson Pharmaceuticals |
| Melor | Sami Pharmaceuticals (Pvt) Ltd. |
| Meloran | Roryan Pharmaceutical Industries (Pvt) Ltd |
| Melow | Ferroza International Pharmaceuticals (Pvt) Ltd. |
| Melox | Kobec Pharmacals |
| Meloxadvan | Advanced Pharmaceuticals |
| Meloxisel | Hansel Pharmacueutical Pvt (Ltd) |
| Meloxisure | Medisure Laboratories Pakistan (Pvt.) Ltd. |
| Meloxy | Trigon Pharmaceuticals Pakistan (Pvt) Ltd. |
| Melpar | Valor Pharmaceuticals |
| Melrun | Healthtek (Pvt) Ltd |
| Melticam | Pulse Pharmaceuticals |
| Melzee | Zesion Pharmaceutical (Pvt) Ltd |
| Mepex | Alliance Pharmaceuticals (Pvt) Ltd. |
| Mexi | Akson Pharmaceuticals (Pvt) Ltd. |
| Mexicam | Reko Pharmacal (Pvt) Ltd. |
| Mexiran | Akson Pharmaceuticals (Pvt) Ltd. |
| Mexiran-15 | Genome Pharmaceuticals (Pvt) Ltd |
| Micam | Bosch Pharmaceuticals (Pvt) Ltd. |
| Milim | Jaens Pharma |
| Miroxicam | Miracle Pharmaceuticals(Pvt) Ltd |
| Mits | Shaigan Pharmaceuticals (Pvt) Ltd |
| Mo-Tu | S.J. & G. Fazul Ellahie (Pvt) Ltd. |
| Mobex | Fynk Pharmaceuticals |
| Movera | Mega Pharmaceuticals (Pvt) Ltd |
| Movicox | Paramount Pharmaceuticals |
| Mowin | Bryon Pharmaceuticals (Pvt) Ltd. |
| Mozta | English Pharmaceuticals Industries |
| Mubik | English Pharmaceuticals Industries |
| Mxm | Ethical Laboratories (Pvt) Ltd. |
| Nilem | Atco Laboratories Limited |
| Noxicam | Everest Pharmaceuticals |
| Numelox | Platinum Pharmaceuticals (Pvt.) Ltd. |
| Oxitic | Caraway Pharmaceuticals |
| Oxive | Olive Pharmaceuticals |
| Prosticam | Evergreen Pharmaceuticals Pvt Limited |
| Ravina | Polyfine Chempharma (Pvt) Ltd. |
| Stamelox | Standard Drug Co. |
| Talgesic | Dyson Research Laboratories |
| Talox | Tagma Pharma (Pvt) Ltd. |
| Tolax | Genome Pharmaceuticals (Pvt) Ltd |
| Vcam | Vega Pharmaceuticals Ltd. |
| Weloxicam | Webros Pharmaceuticals |
| Xcid | Bryon Pharmaceuticals (Pvt) Ltd. |
| Xelomin | Axis Pharmaceuticals |
| Xetza | Rakaposhi Pharmaceutical (Pvt) Ltd. |
| Xixicam | Usawa Pharmaceuticals |
| Xobix | Hilton Pharma (Pvt) Limited |
| Xoxilum | Noa Hemis Pharmaceuticals |
| Zaxicam | Zephyr Pharmatec (Pvt) Ltd. |
| Zelfax | Zanctok Pharmaceuticals |
| Zeloxin | Fassgen Pharmaceuticals |
Meloxicam 7.5 Mg Tablets in Pakistan |
|
| Aloxi | Alson Pharmaceuticals |
| Amcam | Regent Laboratories Ltd. |
| Aponip | Pharmatec Pakistan (Pvt) Ltd. |
| Armex | Qintar Pharmacuticals |
| Arneez | Welmark Pharmaceuticals |
| Artex | Pharmedic (Pvt) Ltd. |
| Articam | Standpharm Pakistan (Pvt) Ltd. |
| Artipro | Helix Pharma (Private) Limited |
| Belcam | Gray`S Pharmaceuticals |
| Beloxi | Wellborne Pharmachem And Biologicals |
| Bicox | Shazals Pharmaceuticals |
| Bonvil | Lexicon Pharmaceuticals (Pvt) Ltd. |
| Brilox | Max Pharmaceuticals |
| Camilox | Akhai Pharmaceuticals. |
| Camsaf | Saaaf Pharmaceuticals |
| Caner | Nawan Laboratories (Pvt) Ltd. |
| Coxicam | Shaheen Pharmaceuticals |
| Coxlan | Karachi Chemical Industries |
| Eroxx | Nexus Pharma (Pvt) Ltd |
| Eroxx | Nexus Pharma (Pvt) Ltd |
| Flamot | Medisave Pharmaceuticals |
| Haricam | Shawan Pharmaceuticals |
| Healcam | Heal Pharmaceuticals Pvt Ltd |
| Jaoxicam | Jawa Pharmaceuticals(Pvt) Ltd. |
| Jorr | Hoora Pharma |
| Joxicam | Jawa Pharmaceuticals(Pvt) Ltd. |
| Lexicon | Tabros Pharma |
| Lotoxicam | Lotus Pharmaceuticals (Pvt) Ltd |
| Loxatec | Martin Dow Pharmaceuticals (Pak) Ltd. |
| Loxicam | Lowitt Pharmaceuticals (Pvt) Ltd |
| Loxidol | Shrooq Pharmaceuticals |
| Loxigood | Goodman Laboratories |
| Loxirax | Shrooq Pharmaceuticals |
| M-Com | Navegal Laboratories |
| M. Com | Wilshire Laboratories (Pvt) Ltd. |
| Magix | Medicaids Pakistan (Pvt) Ltd. |
| Mecam | Fozan Pharmaceuticals Industriers (Pvt) Ltd |
| Megit | Glitz Pharma |
| Mel - 2 - Cox | Elko Organization (Pvt) Ltd. |
| Melfax | Agp (Private) Ltd. |
| Mellow Tab | Ferroza International Pharmaceuticals (Pvt) Ltd. |
| Melomak | Makson Pharmaceuticals |
| Melor | Sami Pharmaceuticals (Pvt) Ltd. |
| Meloran | Roryan Pharmaceutical Industries (Pvt) Ltd |
| Melow | Ferroza International Pharmaceuticals (Pvt) Ltd. |
| Melox | Kobec Pharmacals |
| Meloxadvan | Advanced Pharmaceuticals |
| Meloxisel | Hansel Pharmacueutical Pvt (Ltd) |
| Meloxisure | Medisure Laboratories Pakistan (Pvt.) Ltd. |
| Meloxy | Trigon Pharmaceuticals Pakistan (Pvt) Ltd. |
| Melpar | Valor Pharmaceuticals |
| Melrun | Healthtek (Pvt) Ltd |
| Melticam | Pulse Pharmaceuticals |
| Melzee | Zesion Pharmaceutical (Pvt) Ltd |
| Mepex | Alliance Pharmaceuticals (Pvt) Ltd. |
| Mexi | Akson Pharmaceuticals (Pvt) Ltd. |
| Mexicam | Reko Pharmacal (Pvt) Ltd. |
| Mexiran | Akson Pharmaceuticals (Pvt) Ltd. |
| Mexiran | Genome Pharmaceuticals (Pvt) Ltd |
| Micam | Bosch Pharmaceuticals (Pvt) Ltd. |
| Milim | Jaens Pharma |
| Mits | Shaigan Pharmaceuticals (Pvt) Ltd |
| Mo-Tu | S.J. & G. Fazul Ellahie (Pvt) Ltd. |
| Mobex | Fynk Pharmaceuticals |
| Movera | Mega Pharmaceuticals (Pvt) Ltd |
| Movicox | Paramount Pharmaceuticals |
| Mowin | Bryon Pharmaceuticals (Pvt) Ltd. |
| Mozta | English Pharmaceuticals Industries |
| Mubik | English Pharmaceuticals Industries |
| Mxm | Ethical Laboratories (Pvt) Ltd. |
| Nilem | Atco Laboratories Limited |
| Noxicam | Everest Pharmaceuticals |
| Numelox | Platinum Pharmaceuticals (Pvt.) Ltd. |
| Oxitic | Caraway Pharmaceuticals |
| Oxive | Olive Pharmaceuticals |
| Prosticam | Evergreen Pharmaceuticals Pvt Limited |
| Ravina | Polyfine Chempharma (Pvt) Ltd. |
| Rel-Xicam | Rasco Pharma |
| Stamelox | Standard Drug Co. |
| Synlox | Ambrosia Pharmaceuticals |
| Talgesic | Dyson Research Laboratories |
| Unicoxin | Unipharma (Pvt) Ltd. |
| Vcam | Vega Pharmaceuticals Ltd. |
| Xcid | Bryon Pharmaceuticals (Pvt) Ltd. |
| Xelomin | Axis Pharmaceuticals |
| Xetza | Rakaposhi Pharmaceutical (Pvt) Ltd. |
| Xobix | Hilton Pharma (Pvt) Limited |
| Xoxilum | Noa Hemis Pharmaceuticals |
| Zaxicam | Zephyr Pharmatec (Pvt) Ltd. |
| Zelfax | Zanctok Pharmaceuticals |
| Zeloxin | Fassgen Pharmaceuticals |
Meloxicam 15 Mg Capsules in Pakistan |
|
| Myocam | Genome Pharmaceuticals (Pvt) Ltd |
Meloxicam 7.5 Mg Capsules in Pakistan |
|
| Myocam | Genome Pharmaceuticals (Pvt) Ltd |
 Injection.webp)