Mobic

hello i'm dr ken landau thanks for watching let's talk about mobic or maloxicam this is a non-steroidal anti-inflammatory drug it's in the same family as celebrex and ibuprofen and nap person it was patented in 1977 fda approved in 2000 went generic in 2006 closely related to another nsaid known as feldene or pyroxicam the mobic is the 38th most commonly prescribed medicine in the united states more than 19 million prescriptions every year it's approved for osteoarthritis rheumatoid arthritis juvenile rheumatoid arthritis in children over h2 comes in tablet form seven and a half or 15 milligrams comes in an oral suspension for the children with juvenile rheumatoid arthritis comes seven and a half milligrams in a teaspoon now the fda has approved an intravenous form supposedly for 24-hour pain relief but it seems that for the last six hours of the 24 hours it's no different from placebo remember again take the dose shortest period of time lowest dose possible to reduce the likelihood of side effects you can take it with it without regard to meals if you have rheumatoid arthritis osteoarthritis you start off at seven and a half milligrams taken one time a day if you don't get relief after some period of time can increase it to 15 milligrams again once a day it's not a divided dose you don't take some in the morning and some in the evening you take one dose once a day if you have juvenile rheumatoid arthritis over age we use the oral suspension and the dose is related to body weight now even though celebrex and meloxicam can be used for acute pain they seem to be less effective according to some studies compared to say full doses of the other non-steroidal anti-inflammatories like ibuprofen and the naproxen even though it's anti-inflammatory it does not take the place of prednisone or cortisone in 2016 the fda approved strictly for osteoarthritis not for rheumatoid arthritis but just for osteoarthritis they approved a new form it's a capsule form it's called vivlidex and it comes in five and 10 milligram capsules and the submicron particles in the medicine suppose they are going to be absorbed more rapidly whether there's really any difference as far as the effect is concerned from the standard meloxicam that's doubtful there's a generic form available but it that's been approved but it's not available at the present time in 2018 the fda also approved an orally disintegrating meloxicam tablet comes in blister pack seven and a half milligram 15 milligram again it's approved for osteoarthritis rheumatoid arthritis juvenile rheumatoid arthritis you open up the blister pack place it on your tongue dissolves almost immediately you don't need any water seems to work just as effectively as the standard meloxicam an interesting side note is that the drug seems to work to help the levonorgestrel which is a female hormone that can be used for postcoital contraception so the morning after pill well if you take the levon or gestural in combination with the meloxicam seems to work better than the levon or gestural by itself seems that the meloxicam might alter some of the metabolism inside cancer cells the drug is commonly used in the army it's in the wound medication pack for mild pain you could take it or acetaminophen those two are both provided don't take the drug if you have known hypersensitivity to it don't take it if you have asthma especially if you have what's known as the aspirin triad we have asthma and allergic rhinitis and nasal polyposis if you do take the drug can cause severe even fatal bronchoconstriction narrowing of the wind passageways obviously something to be avoided the bioavailability it's pretty good if you take it with a high fat meal it's going to increase the plasma concentration by about 20 percent but that's not enough to warrant taking it with food specifically so you can take it with or without food it's not reduced in concentration if you happen to take some antacids it's important that there's a liver enzyme known as 2c9 and it's very important in the metabolism of these kind of drugs including naloxone of course it metabolizes the meloxicam to four inactive ingredients for metabolites that are then excreted in the urine in the stool if you happen to have inadequate quantities of 2c9 then the malox cam can build up in the system another interesting side note is it can be used for veterinary use approved for dogs and horses and cattle question about cats goes back and forth originally was okay for cats then it wasn't okay for cats then cats for one dose only around the time of a procedure then okay for cats in general well when we talk about the non-steroidal anti-inflammatory drugs we talk about two different groups we talk about the non-specific cox inhibitors non-specific non-steroidal anti-inflammatory drugs they inhibit both the cox-1 and the cox-2 well the cox 1 is important to keep the intestines working right keep the kidneys working right keep the blood clotting appropriate so we'd rather leave the cox-1 enzyme alone now the mobic or the meloxicam is a non-specific non-steroidal anti-inflammatory drug but at the standard doses it just like with celebrex works principally on the cox too that's the one associated with the inflammation that's the one we would like to get rid of well it comes with a black box warning black box warning suggests that you could increase your risk of cardiovascular problems or gi problems if you take the drug same thing with basically any of the nsaids non-steroidal anti-inflammatory drugs can increase the risk of heart attack and stroke can be fatal certainly the longer you take the drug the higher the dose the greater the risk and if you happen to have other cardiovascular risk factors then that increases the risk still further should not take the drug right around the time within 10 to 14 days after bypass surgery heart bypass surgery or the cabbage surgery cabg well how long should you wait people argue about that they still find the risk is significantly elevated after a year goes down to pretty much normal after three or four years the black box warning also says that if you take the drug you might increase your risk of gastrointestinal bleeding or ulceration or perforation either the esophagus or the stomach or the small intestine or the large intestine can be fatal can come on without any kind of warning increased risk for elderly individuals can be a little bit toxic to the liver about one percent of the people who take the drug going to have significant elevation of the liver function test and about 15 going to have more mild elevation of the liver function test can either cause new onset hypertension or if you already have hypertension and you're taking medicine might worsen control seems to interfere with the effectiveness of ace inhibitors and angiotensin receptor blockers and the thiazide diuretics can cause fluid retention and if you happen to have a history of heart failure can cause the heart failure to decompensate the cox enzymes are very important as far as the renal perfusion is concerned so the blood gets to the kidney by the grace of the cox enzymes so the prostaglandins that are necessary to get the blood to the kidney well if you happen to take the drugs then you might decrease the blood flow to the kidney and that's especially important in elderly individuals and people who have impaired renal function and people have heart failure people have liver disease people who are dehydrated have vomiting or diarrhea people who are taking the ace inhibitors or those arbs well that's why you shouldn't take these drugs if you have severe renal impairment if you're taking the drug and all of a sudden you start to develop a skin rash and you don't know what the skin rash is stop the drug and see what happens notify your physician because in some very small percentage of individuals the rash may progress to a potentially life-threatening eruption known as either erythema multiforme stevens-johnson syndrome exfoliative dermatitis toxic epidermal necrolysis take it from me you don't want any of those kind of diseases well additionally if you're dehydrated if you've been taking high doses of a diuretic if you've had nausea or vomiting or you're elderly you're bedridden you're not taking enough fluid in you should make sure you're rehydrated before you even start taking the medicines in the first place if we look at the side effects the standard kind of side effects tend to be relatively mild same thing in adults and pediatric population abdominal pain and some diarrhea sometimes some indigestion or some edema well the drug also works to cut down not only the inflammation but it's painkiller of course and it brings the temperature down so if you're taking the drug for osteoarthritis or rheumatoid arthritis and you get some other kind of condition additionally in addition to your osteoarthritis and rheumatoid arthritis maybe the drug is going to delay the recognition of the symptoms of that new disorder because it's going to keep everything relatively under control that could be harmful well if you take the drug you could develop an anemia and the anemia could be because you're retaining fluid and that's just a situation with dilution or it might irritate the intestinal lining a little bit and then you could develop what's known as occult bleeding in the occult bleeding you don't even know your stool looks the same you're not vomiting blood but some people develop gross gi bleeding and the gross gi bleeding can come as very dark or black starry stools in some people less commonly as bright red blood that you pass sometimes it can cause a decrease in the production of a chemical that's important in manufacturing red blood cells erythropoietin and it can decrease that well that means that if you're taking the drug especially if you have a history of anemia you're going to check every once in a while to make sure that you're not losing blood all of these drugs might cause some people to have problems with the coagulation system now it's not anything like aspirin but if you have a coagulation disorder and if you happen to be taking a medicine for instance you're taking the warfarin that increases the bleeding or you're taking aspirin that increases bleeding you might have some problems so too with potentially the selective serotonin reuptake inhibitors and snris have to be careful if you're taking lithium for bipolar disorder the lithium concentration is going to increase by about 20 percent that might be into the toxic level for some people and the liquid form the suspension form has a certain kind of a chemical sorbitol and sorbitol if you happen to be taking a drug to reduce your potassium level that can cause uh intestinal necrosis so part of the intestine can actually die so that obviously is serious do be careful well if you happen to be taking methotrexate if you happen to be taking a cyclosporine both of those drugs with the meloxicum can increase the likelihood of kidney disease doesn't seem to have too much to do with taking lasix doesn't change the digoxin concentration doesn't change the cymetidine but if you're taking a drug known as cholestyramine typically used to reduce the cholesterol typically used for certain other kind of disorders with the bio-acid abnormalities well that increases the clearance of maloxacan by about 50 percent so it decreases the amount of meloxicam in the system quite substantially and it decreases the half-life of the drug from about 19 hours to about 12 hours well if you're a pregnant woman should not take the drug after 30 weeks of gestation it can hurt the unborn child it can cause the connection between the pulmonary artery and the aorta to potentially close and if that happens that stresses the heart taking the drug during other time in the pregnancy first trimester second trimester well it doesn't seem to cause any kind of significant problem at least in pregnant rats but in rabbits it increases the likelihood of what we call a septal defect a hole in the heart between the right side of the heart and the left side of the heart shouldn't take it during labor and delivery shouldn't take a during lactation if you're a child it is approved for those individuals with juvenile rheumatoid arthritis over age two older populations start with the lower end of the dosage form liver disorder mentioned before so if you happen to take the drug and now you develop jaundice or a type of hepatitis or you're feeling poorly one of the things you have to check is liver function kidneys well you don't have to worry about mild to moderate kidney disease could probably take the drug not if you have severe renal disease it seems that people have severe renal disease the free fraction of maloxicum can increase quite substantially and it's that free form of a drug whatever the drug is that tends to get people in trouble well if you happen to be on hemodialysis you could still take the drug but at a dose no higher than seven and a half milligrams a day it's not mutagenic it's not carcinogenic it might cause a temporary problem with fertility seems those prostaglandins are also important in the ovary releasing the follicle so then women who are having difficult time conceiving well probably a good idea to stop the medicine periodically if you're taking the medicine especially for a long period of time ought to check some of the blood chemistries check to make sure you're not becoming anemic if you overdose on the medicine well lethargy and drowsiness and nausea and vomiting epigastric pain are all relatively common less so gastrointestinal bleeding or hypertension or renal failure hepatic dysfunction respiratory problems some people can go on to develop coma and convulsions and cardiac arrest but the overwhelming majority of people who overdose especially if it's relatively mild overdose they all survive and we have that cholestyramine i mentioned a while ago well that can accelerate the clearance of the meloxicam from the body and if you happen to have a person who overdosed and it's within one to two hours after the overdose then activated charcoal will help prevent the absorption well the drug works because it's anti-inflammatory it brings the temperature down and it's analgesic it treats the pain it does all of that by working on the cox enzyme and it works principally on the cox-2 enzyme at the standard lower dose it's less selective for the cox-2 enzyme at a higher dose the absolute bioavailability of the medicine somewhere around 90 percent seems to get to the peak concentration in the system after about four to five hours to take it fasting but interestingly because it works on the biliary system it seems that there's a second peak and the second peak occurs after about 12 to 14 hours after you've been taking the medicine for about five days then you get to a steady state that's higher than if you just took one pill the half-life of the medicine somewhere between about 15 hours and 20 hours in the pediatric population interestingly there's less exposure to the medicine if the child is between the age of two to six then if the child is between the ages of seven and sixteen now if you happen to wanna take it with a high fat meal it's going to increase the peak amount in the system by about 20 but if we look overall at the amount of the drug in the system for a 24-hour time period doesn't seem to make any difference whether it's with food or without food and as i mentioned no change with antacids the amount that's banned somewhere in excess of 99 it seems that if we look inside the synovial fluid inside the joint you're taking it obviously because you have rheumatoid arthritis or osteoarthritis well it seems that the free fraction in the synovial fluid is about two and a half times greater than it is in the plasma and the reason is in the plasma it seems that the drug is bound to albumen in the synovial fluid there isn't much albumin around it's extensively metabolized in the liver to the inactive metabolites they go out in the urine and feces if we look at the geriatric population the overall concentration the steady state concentration same as it is in younger individuals except if a person is a woman over age 65 then there's going to be about a 50 increase in the amount in the system over a 24-hour time period and the peak maximum concentration is going to be about 30 percent more than it is in a woman who is less than age 55. well clinically how does the drug work clinically it works okay it's got significant benefit at seven and a half milligrams 15 milligrams if we look at osteoarthritis if we compare it to placebo on the other hand if we compare it to an active drug like the peroxican or the diclofenac which is same thing as voltaire seems that the drugs pretty much are equal if we look at rheumatoid arthritis a 20 reduction in disparity of rheumatoid arthritis well seven and a half and 15 milligrams seem to be pretty much equivalent if we look at 22 and a half milligrams you don't get any added benefit interestingly in juvenile rheumatoid arthritis well there's question about whether there's any difference between just knapperson and the meloxicam now interestingly there is a study underway combining the tryptan that's like imitrex that's for migraine headache well in the same pill put the tryptan and the meloxicam in well the two hour freedom from pain is about 20 if you take the drug versus about seven percent if you take an inactive drug doesn't seem to be all that promising if you ask me now the cox enzyme is very important as far as kidney function and protection of the gastrointestinal mucosa and the regulation of the plate the aggregation is concerned and it seems that if we can be more specific and inhibit the too we might be able to get rid of some of the side effects that's the theory with the non-specific nsaids the kind that block both the cox 1 and the cox 2 on the other hand if you take a cox-2 inhibitor and you compare it to say the ibuprofen or the nap person and you combine the ibuprofen and the naproxen with just a standard proton pump inhibitor a drug like amiprazole or nexium then you get basically the same kind of benefit without any extra added risk well just remember that even though we talk about these drugs in such glowing terms in 2004 vioxx which was one of the most widely prescribed medicines it was a cox-2 inhibitor it was supposedly safe well the company did a study and they actually found that it increased the risk of cardiovascular complications so these drugs do need to be treated with certain amount of respect then we talk about the gastrointestinal problems well if you take the drug at standard dose without any kind of warning you're going to develop significant complications after about three to six months and one percent of the population about one year it's going to be about two to four percent and if you happen to have other kind of conditions say you're you have a history of gastrointestinal bleeding or peptic ulcer disease you're going to increase your risk about 10 fold if you take aspirin with it any of the other non-steroidal anti-inflammatory drugs going to increase your risk significantly so don't forget the longer you take the drug the higher the dose the more the complication and if you happen to smoke cigarettes if you happen to drink alcohol if you happen to be older if you happen to have poor general health no that's all going to increase your risk so again shortest period of time lowest dose best thing that you can do they coronary bypass surgery well we know that any of these non-steroidal anti-inflammatory drugs if you take them say 10-14 days after the bypass surgery going to increase the risk of stroke increase the risk of heart attack that's any of the drugs in the family and we know that you're going to increase your risk of complications if you happen to be taking the meloxicam or the mobic with aspirin or with any of the other non-steroidal anti-inflammatory drugs those are going to all significantly increase the risk of gastrointestinal bleeding so you do have to be careful one study showed that if we're talking about the heart well you're going to increase the risk by about threefold if you take meloxicam five-fold if you take the celebrex tenfold if you take the naparasin and 12 fold if you take a relative of ibuprofen and as far as gastrointestinal bleeding is concerned increase the risk according to some studies three to fold about if you take the meloxicam or the celebrex if you take it with nappers and might increase the risk of gi bleeding by about six-fold so again be careful be careful be careful taking these kind of drugs and if you're going to have some kind of surgery it's probably a good idea to stop the drug for a short period of time prior to the surgery especially if you're undergoing some dental surgery seems that if you're taking the drug at the time of dental surgery it might lead to some abnormalities in the taste some ulcerative stomatitis even lead to a dry socket now according to consumer reports there's no evidence that any of these drugs are demonstrably better than any of the other non-steroidal anti-inflammatory drugs so whichever one you take you have to realize they all have some risks and the risks are [Music] all basically the same some a little more some a little less well if you want to take the meloxicam how much is it going to cost well if you go now to a standard store standard pharmacy a month's supply of the seven and a half milligram pills only going to cost you somewhere between 11 and 30 dollars cash if you have a coupon and you have a coupon say from goodrx you could get it for as low as four and a half dollars up to eleven dollars but if you go to either walgreen or to cvs it's going to be more than twenty dollars if you want the brand name drug if you want the mobic that's exactly the same basically as the meloxicam generic well the cash price is going to be over three hundred thirty dollars and the coupon price is going to be about two hundred eighty dollars so that's the story about mobik it's a non-store anti-inflammatory it's actually a non-specific nsaid inhibitor inhibit the cox-1 and the cox-2 but at low-dose at the standard kind of dose we use it acts to inhibit the cox too not the cox one and that's one of the reasons why it's extremely popular it's mostly for osteoarthritis and rheumatoid arthritis juvenile rheumatoid arthritis whether you take the drug for common ordinary pain probably not the best idea and there's some evidence that it doesn't work nearly as well as the standard non-steroidals if you happen to have the acute kind of pain anyway thanks for watching if you enjoyed the show please tell a friend consider subscribing so that you'll be notified as we post new shows appreciate your interest i'm dr cannon landau [Music] [Music] you

Channel: wellnowdoctor

Views: 2,604

Rating: 4.8125 out of 5

Keywords: mobic, meloxicam, osteoarthritis, rheumatoid arthritis, cox 2 inhibitor, NASID, non-specific cox inhibitor, post-coital contraception, pain relief, GI bleeding

Id: m6e7JUhLdHw

Length: 27min 59sec (1679 seconds)

Published: Thu Dec 03 2020