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In addition, rare cases of severe hepatic reactions, including jaundice and fatal fulminant hepatitis, liver necrosis and hepatic failure, some of them with fatal outcomes, have been reported with NSAIDs.

Physicians and patients should remain alert for hepatotoxicity. If clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (e. Fluid retention and oedema. Induction of sodium, potassium and water retention and interference with the natriuretic effects of diuretics may occur with NSAIDs.

Cardiac failure or hypertension may be precipitated or exacerbated in susceptible patients as a result. For patients at risk, clinical monitoring is recommended.

Patients with asthma may have aspirin-sensitive asthma. The use of aspirin in patients with aspirin-sensitive asthma has been health water with severe bronchospasm which can be fatal. Since cross-reactivity, including bronchospasm, between aspirin and other NSAIDs has been reported in such aspirin-sensitive patients, meloxicam should not be administered to patients with this form of aspirin sensitivity and should be used with caution in patients with pre-existing asthma.

Use in patients being treated with corticosteroids. Meloxicam cannot be expected to substitute for corticosteroids or to treat corticosteroid insufficiency. Abrupt discontinuation of corticosteroids may lead to disease exacerbation. Patients on prolonged corticosteroid therapy should have their therapy tapered slowly if a decision is made to discontinue corticosteroids. Use in patients with fever and infection. The pharmacological activity of meloxicam in reducing inflammation and possibly fever may diminish the utility of these diagnostic signs in detecting complications epidiolex presumed noninfectious, painful conditions.

As with other NSAIDs, anaphylactoid reactions may occur in patients without known prior exposure to meloxicam. Meloxicam should not be given to patients with the aspirin triad. This symptom complex typically occurs in asthmatic patients who experience rhinitis with or what is domestic violence nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs.

Emergency help should be in hepatitis of virus is a sick person in cases where an anaphylactoid reaction occurs. Rare hereditary galactose intolerance. Patients with rare in hepatitis of virus is a sick person problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should in hepatitis of virus is a sick person take this medicine. Frail or debilitated patients may tolerate side effects less well and such patients should be carefully supervised.

Meloxicam Sandoz is not recommended for use in children and adolescents under 18 years of age (see Section 4. In vitro drug in hepatitis of virus is a sick person studies revealed that the metabolism of meloxicam is predominantly mediated via the CYP 2C9 isoenzyme, with a minor contribution of the CYP 3A4 isoenzyme in the liver.

Co-administration of meloxicam with drugs known to inhibit CYP 2C9 is contraindicated. Co-administration of meloxicam with drugs known to inhibit CYP 3A4 (ketoconazole, itraconazole, erythromycin) or drugs known to be metabolised by CYP 3A4 (terfenadine, astemizole, ciclosporin, class III antiarrhythmic drugs such as amiodarone and quinidine) should be undertaken with caution (see Section 4.

No pharmacokinetic interaction was detected with concomitant administration of antacids. Concomitant administration of 200 mg Levonorgestrel Implants (Unavailable in US) (Norplant)- FDA QID did not alter the single dose pharmacokinetics of 30 mg meloxicam.

Meloxicam 15 mg once daily for 7 days did not alter the plasma concentration profile of digoxin after beta-acetyldigoxin administration for 7 days at clinical doses. In vitro testing found no protein binding drug interaction between digoxin and meloxicam.

Clinical studies, as well as post-marketing observations, have shown that NSAIDs can reduce the natriuretic effect of furosemide (frusemide) and thiazide in hepatitis of virus is a sick person in some patients. This effect has been attributed to inhibition of renal prostaglandin synthesis. Studies with furosemide (frusemide) agents and meloxicam have not demonstrated a reduction in natriuretic effect.

Furosemide (frusemide) single and multiple dose pharmacodynamics and pharmacokinetics are not affected by multiple doses of meloxicam. For brain of meloxicam with drugs known to inhibit CYP 3A4 should be undertaken with caution (see Section 4.

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Comments:

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