Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.
Mobic (Boehringer Ingelheim)
7.5 mg and 15 mg tablets
Approved indication: osteoarthritis
Australian Medicines Handbook Section 15.1
The new cyclo-oxygenase inhibitors are being promoted as drugs which inhibit the COX-2 enzyme more than the COX-1 enzyme. Although meloxicamis in a different class of non-steroidal anti-inflammatory drugs, it also inhibits COX-2 more than COX-1 (see 'COX-2 inhibitors' Aust Prescr 2000;23:30-2).
Patients take meloxicam once a day. It is absorbed slowly and has a half-life of 15-20 hours. Most of the dose is metabolised and this involves cytochromeP450 2C9 and 3A4. Although CYP2C9 predominates, caution is needed if an inhibitor of CYP3A4 is prescribed concurrently with meloxicam. It is contraindicated in patients taking drugs, such as sulfamethoxazole, which inhibit CYP2C9.
In clinical trials meloxicam has been as effective as sustained-release diclofenacin relieving the symptoms of osteoarthritis. For short-term treatment, meloxicam was as effective as piroxicam.
If taken for more than six months, meloxicam is associated with gastrointestinal adverse effects in more than 20% of patients. Common problems include diarrhoea, dyspepsia and nausea. Although the overall incidence may be less than for similar drugs, there is no clear reduction in serious adverse effects such as bleeding or perforation of peptic ulcers.