Melocam in lumbago

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treatment of low back pain

treatment of low back pain

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  • 1. Melocam(meloxicam) ..belongs to the oxicam derivatives and it is one of the most strong NSAIDs. a selective inhibitor for COX-2, retains the anti-inflammatory, analgesic & antipyretic actions without the harmful side effects of COX-1 inhibitors.
  • 2. Membrane Phospholipids Phospholipase A2 Arachidonic F.A. Cyclooxygenase (COX) Prostaglandins Thromboxan A2 Prostacyclins
  • 3. cylooxygenase (COX) COX-1 Maintains normal physiological functions COX-2 Involved in inflammation & pain
  • 4.  Non-Selective NSAIDs COX-1 Side effects Stomach Kidney Platelets COX-1 Therapeutic effects Anti-inflammatory Analgesic Antipyretic
  • 5. pharmacokinetic profile of meloxicam ..Prolonged and complete absorption after oral administration. ..Bioavailability of 89%. ..Not affected by concomitant intake of food. ..More than 99 % bound to plasma protein.
  • 6. ..Elimination half-life is 20-24 hours. ..During distribution, meloxicam penetrates the synovial fluid, reaching concentrations are 45-57% of those in plasma. ..Meloxicam was found in synovial fluid 1 hour after administration and reached peak concentrations at approximately 6 hours.
  • 7. …Intramuscular meloxicam is rapidly absorbed, reaches Cmax at 1.5 hours after injection, and its absolute bioavailability is 100%. ..90% of the Cmax is reached within 30 min of injection. ..Concentrations tend to remain stable for at least 5-6 hours, these data support the use of intramuscular meloxicam in patients with acute arthropathies, since it provides a fast relief of pain and inflammation.
  • 8.  pharmacokinetic profile of meloxicam is not altered in :  elderly patients  mild to moderate renal impairment  mild hepatic impairment
  • 9. Indications Immunological Rheumatoid arthritis Ankylosing spondylitis Degenerative Osteoarthritis Musculoskeletal injuries:Skeletal trauma Fracture Dislocation & subluxation Sprains & Strains Tendinitis & bursitis Muscle strains Melocam Ampoules Acute pain of any origin
  • 10. efficacy safety
  • 11. Melocam is a selective Cox2 inhibitor which shows high anti-inflammatory & analgesic potency in the management of arthritis. ..Due to its selectivity on Cox 2 enzyme, Melocam doesn't create the usual problems of classic NSAIDs
  • 12. How to solve this chronic problem without creating problems?
  • 13. Proven Efficacy ….A multicentre, double-blind, study was conducted in patients with osteoarthritis (OA) of the hip or knee in order to compare the efficacy of Meloxicam, with Diclofenac sodium. …336 patients were treated with oral Meloxicam 7.5 mg once daily or Diclofenac 100 mg slow release once daily for 6 months, -meloxicam (n = 169) -diclofenac (n = 167)
  • 14. Thus, Meloxicam is beneficial for patients suffering from this chronic and disabling condition & demonstrates similar efficacy in pain relief & more rapid stiffness relief
  • 15.
  • 16. GI effects {analysis of double-blind studies in rheumatoid arthritis (RA) and osteoarthritis (OA)} Method Meloxicam 7.5 and 15 mg (n = 893 and 3282) Piroxicam 20 mg (n = 906)  Diclofenac 100 mg SR (n = 324) Naproxen 750–1000 mg (n = 243).
  • 17. Result  When examining non-serious GI events (dyspepsia, abdominal pain), severe GI events (perforation, bleeding)  Both meloxicam doses were significantly better than comparator non-steroidal anti-inflammatory drugs (NSAIDs) in most cases.
  • 18. Renal Effect Cycloxygenase inhibitors prevent the synthesis of prostaglandins that are responsible for maintaining renal blood flow. …..In several trials, the percentage of patients recording abnormal elevations in the levels of serum urea & creatinine was significantly lower in Melocam® (meloxicam) groups versus diclofenac & piroxicam.
  • 19. so No need for dose adjustment in patients with mild to moderate renal failure.
  • 20. In Geriatric patients Pharmacokinetic Profile Elderly men exhibited pharmacokinetic profile similar to young men. In a long term study to evaluate the safety & efficacy of Melocam® (meloxicam) 15 mg once daily in patients with rheumatoid arthritis, for age up to 84 years old, proves to be effective & tolerable.
  • 21. No Effect on Platelet Aggregation …..As a result of the decrease in TXA2 inhibitors, platelet aggregation is producing a prolonged bleeding time. by Cox reduced,
  • 22. Platelet aggregation was almost completely inhibited by indomethacin (-87%) as compared to control (100%), but remained unaffected by meloxicam (-1% ) Conclusions: ….Meloxicam 7.5 mg per day is COX-1 sparing & has no effect on platelet aggregation & bleeding time.
  • 23. In Acute Arthropathies  This study was done to compare the efficacy & the local tolerability of an i.m. Meloxicam with i.m. Piroxicam  patients 210 with RA & OA.  -Meloxicam 15 mg (n = 144)  -Piroxicam 20 mg (n = 66)  -Duration= 7 days.
  • 24. 1-Efficacy In patients with RA, global efficacy was rated as 'very good' or 'rather good' by 91% of those treated with Meloxicam and only 71% treated with Piroxicam The corresponding ratings in patients with OA were achieved by 86% of those treated with Meloxicam and 82% treated with Piroxicam.
  • 25. Conclusion Melocam i.m. is effective & tolerable for the treatment of acute rheumatic pain and shows superiority over Piroxicam
  • 26. Cost Effective  Melocam (once daily) is cost-effective versus vs classic NSAIDs in management for chronic arthritis
  • 27. Once daily Which maintain compliance in patients receiving chronic treatment.
  • 28. Dosage & administration In rheumatoid arthritis 15 mg once daily. According to the response, dose could be reduced to 7.5 mg once daily. In acute exacerbations of osteoarthritis 7.5 mg increased to a maximum of 15 mg Once In cases of acute pain Start with ampoule form (1 ampoule /day) and then maintain treatment with tablets or suppositories. e daily.