Because The potential risk of adverse reactions depends on the dose and duration of treatment, the minimum effective dose should be used for the shortest possible short course.
The duration of treatment is determined individually depending on the course of the disease and the effectiveness of the therapy.
Patients with gastrointestinal diseases should undergo regular examination when using the drug Genitron®. The drug should not be prescribed to patients with peptic ulcers or gastrointestinal bleeding. At any time during treatment, with or without previous symptoms or a history of serious gastrointestinal disease, potentially fatal gastrointestinal bleeding, ulceration, or perforation may occur. If ulcerative lesions of the gastrointestinal tract or gastrointestinal bleeding occur, the drug must be discontinued. The most serious effects were observed in older people.
In patients with cardiovascular diseases or with risk factors for the development of such diseases, NSAIDs can increase the risk of serious cardiovascular thrombotic events, myocardial infarction, angina attack and stroke, which can be fatal. With an increase in the duration of treatment, this risk may increase.
NSAIDs can increase sodium, potassium and water retention and reduce the natriuretic effects of diuretics. As a consequence, predisposed patients may experience or increase heart failure or hypertension. Clinical monitoring is recommended for such patients, and adequate hydration should be maintained. Before starting treatment, it is necessary to study kidney function. In the case of combination therapy, renal function should also be monitored.
In patients with reduced renal blood flow, the use of NSAIDs (NSAIDs inhibit the synthesis of renal prostaglandin, which plays an important role in maintaining renal blood flow) can cause renal failure, which occurs when anti-inflammatory therapy with nonsteroidal drugs is discontinued. The greatest risk of such a reaction occurs in elderly patients, with dehydration, with chronic heart failure, cirrhosis of the liver, nephrotic syndrome, chronic kidney disease, who receive concomitant therapy with diuretic drugs, ACE inhibitors or angiotensin II receptor antagonists, or after extensive surgical interventions that led to hypovolemia. Such patients need to monitor diuresis and renal function at the beginning of therapy. In isolated cases, NSAIDs can lead to interstitial nephritis, glomerulonephritis, renal medular necrosis or the development of nephrotic syndrome.
In the treatment of NSAIDs, individual cases of increased activity of transaminases or other indicators of liver function have been described, which in most cases were insignificant and temporary. In case of persistent and significant deviation from the norm, treatment with Genitron® should be discontinued and control tests should be performed. In clinically stable patients with cirrhosis of the liver, there is no need to reduce the dose of Genitron®, it is necessary to monitor the detected laboratory changes.
Weakened patients need more careful monitoring, since their side effects are more severe. As with the treatment of other NSAIDs, the drug should be prescribed with caution to elderly patients who are more likely to have a decrease in kidney, liver and heart function.
The drug Genitron®, like any other NSAID, can mask the symptoms of the underlying infectious disease.
In very rare cases, serious skin reactions (some of them fatal) have been observed with the use of NSAIDs, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis. A high risk of such reactions is 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 the drug Genitron®. Due to the possible occurrence of side effects with localization on the skin and mucous membranes, special attention should be paid to the appearance of appropriate symptoms. If side effects occur, treatment with the drug should be discontinued.
Influence on the ability to drive vehicles and manage mechanisms
During the treatment period, it is possible to reduce the speed of mental and motor reactions, therefore it is necessary to refrain from driving vehicles and engaging in other potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions.
Symptoms: drowsiness, impaired consciousness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, acute renal failure, liver failure, arterial hypertension, arterial hypotension, respiratory arrest, asystole.
Treatment: there is no specific antidote. In case of an overdose of the drug, symptomatic therapy is carried out; in case of an overdose of the drug in the form of tablets, gastric lavage, taking activated charcoal. Forced diuresis, urine alkalinization, hemodialysis are ineffective due to the high degree of binding of the drug to blood proteins.
When used concomitantly with other prostaglandin synthesis inhibitors, including GCS and salicylates, meloxicam may increase the risk of gastrointestinal mucosal ulcers and gastrointestinal bleeding due to their synergism.
The co-administration of meloxicam and other NSAIDs is not recommended.
Together with anticoagulants, heparin for systemic use, and thrombolytic agents, meloxicam increases the risk of bleeding. If it is impossible to avoid their simultaneous use, it is necessary to monitor the indicators of the blood coagulation system.
Simultaneous administration with meloxicam of antiplatelet drugs, serotonin reuptake inhibitors increases the risk of bleeding due to inhibition of platelet function. In the case of simultaneous use, careful monitoring of the blood coagulation system is necessary.
Meloxicam can reduce the renal excretion of lithium, which leads to an increase in its concentration in blood plasma to a toxic level. Simultaneous use of meloxicam with lithium preparations is not recommended. If simultaneous use is necessary, careful monitoring of the concentration of lithium in plasma is recommended throughout the course of the use of lithium preparations.
NSAIDs reduce the excretion of methotrexate by the kidneys, thereby increasing its concentration in plasma. Simultaneous use of meloxicam and methotrexate (at a dose of more than 15 mg per week) is not recommended. The risk of interaction between NSAIDs and methotrexate may also occur in patients using methotrexate in low doses, especially in patients with impaired renal function. In case of simultaneous use, careful monitoring of kidney function and blood formula is necessary. Meloxicam may increase the hematological toxicity of methotrexate, especially in patients with impaired renal function. When meloxicam and methotrexate are used together for 3 days, the risk of increased toxicity of the latter increases.
There is evidence that meloxicam can reduce the effectiveness of intrauterine contraceptives, but this has not been proven.
When using meloxicam together with diuretics, there may be a risk of acute renal failure, therefore, kidney function should be monitored and an adequate level of hydration should be maintained.
Meloxicam reduces the effect of antihypertensive agents (beta-blockers, ACE inhibitors, vasodilators, diuretics) due to inhibition of prostaglandins with vasodilating properties.
Meloxicam and angiotensin II receptor antagonists, as well as ACE inhibitors, have a synergistic effect on reducing glomerular filtration. In patients with existing renal dysfunction, this can lead to acute renal failure.
Colestyramine, binding meloxicam in the gastrointestinal tract, leads to its faster excretion.
Meloxicam, affecting renal prostaglandins, enhances the nephrotoxicity of cyclosporine, which requires enhanced monitoring of kidney function with simultaneous use of drugs.
Meloxicam is almost completely destroyed by hepatic metabolism, approximately 2/3 of which are carried out with the participation of cytochrome (CYP) P450 and 1/3 - by peroxidase oxidation. Pharmacokinetic interaction of meloxicam and other drugs at the stage of metabolism is possible due to their effect on SUR2C9 and / or SUR3A4.
When used simultaneously with hypoglycemic agents for oral administration, meloxicam may enhance their effect, thereby contributing to the risk of hypoglycemia.
Meloxicam can weaken the effect of digoxin, cortisone, diuretics.
With simultaneous administration of meloxicam with antacids, cimetidine, digoxin and furosemide, interaction at the pharmacokinetic level was not revealed.