Genitron, 10 mg/ml 1.5 ml 3 pcs

ATC code: M01AC06

Pharmacological group:

NSAIDs

Pharmacological action

Meloxicam belongs to the NSAID class of oxycams, is a derivative of enolic acid and has anti-inflammatory, analgesic and antipyretic effects. The pronounced anti-inflammatory effect of meloxicam has been established in all standard models of inflammation.

The mechanism of action of meloxicam is its ability to inhibit the synthesis of prostaglandins (known mediators of inflammation) as a result of selective inhibition of COX-2 enzymatic activity. When prescribed in high doses, prolonged use and individual characteristics of the body, COX-2 inhibition selectivity decreases.

Meloxicam in vivo inhibits the synthesis of prostaglandins at the site of inflammation to a greater extent than in the gastric mucosa or kidneys. These differences are due to the more selective inhibition of COX-2 compared to COX-1. Inhibition of COX-2 is thought to provide the therapeutic effect of NSAIDs, whereas inhibition of the ever-present COX-1 isoenzyme may cause gastric and renal side effects.

The selectivity of meloxicam against COX-2 has been confirmed in various test systems, both in vitro and in vivo. The selective ability of meloxicam to inhibit COX-2 was shown when using human whole blood as a test system in vitro. Meloxicam (at doses of 7.5 mg and 15 mg) was found to be more active in inhibiting COX-2, having a greater inhibitory effect on prostaglandin E2 production stimulated by lipopolysaccharide (COX-2-controlled response) than on thromboxane production involved in blood clotting (COX-1-controlled response). These effects were dose-dependent. In ex vivo studies, meloxicam (in doses of 7.5 mg and 15 mg) was shown to have no effect on platelet aggregation and bleeding time.

Pharmacokinetics

Intake

After oral administration meloxicam is well absorbed from the GI tract, as evidenced by the high absolute bioavailability (90%). After a single use of meloxicam Cmax in plasma is reached within 5-6 hours. Simultaneous intake of food and antacids does not change absorption.

When the drug is administered orally (in doses of 7.5 and 15 mg) its concentrations are proportional to the dose. Css are reached within 3-5 days. The range of differences between maximal and minimal drug concentrations after a daily dose is relatively narrow, 0.4-1.0 µg/ml with 7.5 mg dose, and 0.8-2.0 µg/ml with 15 mg dose (Cmin and Cmax values are indicated in equilibrium respectively), although values higher than this range have been observed. Cmax of meloxicam in plasma in the equilibrium state is reached within 5-6 hours after oral administration.

After the intravenous administration meloxicam is completely absorbed. Bioavailability of the drug is about 100%. After meloxicam i.v. administration in a dose of 15 mg the Cmax in plasma is reached approximately in 1 hour.

Distribution

Meloxicam binds very well to plasma proteins, especially to albumin (99%). It penetrates through the histohematic barriers as well as into the synovial fluid. The concentration in synovial fluid is approximately 50% of the plasma concentration. Vd after repeated oral administration of meloxicam (in doses from 7.5 mg to 15 mg) is about 16 l, with a coefficient of variation from 11% to 32%, with a Vd of 11 l when administered v/m.

Metabolism

Meloxicam is almost completely metabolized in the liver to form 4 pharmacologically inactive derivatives. The main metabolite, 5′-carboxymeloxicam (60% of the administered dose), is formed by oxidation of the intermediate metabolite, 5′-hydroxymethylmeloxicam, which is also excreted, but to a lesser extent (9% of the administered dose). In vitro studies have shown that CYP2C9 isoenzyme plays an important role in this metabolic transformation, CYP3A4 isoenzyme has additional importance.

The formation of the other two metabolites (which are, respectively, 16% and 4% of the administered dose of the drug) involves peroxidase, the activity of which varies individually.

Elimination

Extracted equally through the intestine and the kidneys, mainly as metabolites.

Less than 5% of daily dose is excreted unchanged through the intestine; in urine the drug is found unchanged only in trace amounts. The average T1/2 of meloxicam varies from 13 to 25 hours (when administered by injection – 20 hours).

Plasma clearance averages 7-12 ml/min after a single dose of meloxicam, when administered by injection – 8 ml/min.

Pharmacokinetics in special groups of patients

Hepatic impairment and renal failure of mild to moderate severity have no significant effect on the pharmacokinetics of meloxicam. The elimination rate of meloxicam from the body is significantly higher in patients with renal failure of moderate severity. Meloxicam binds worse with plasma proteins in patients with terminal renal failure. In terminal renal failure, an increase in Vd may lead to higher concentrations of free meloxicam, so in such patients the daily dose should not exceed 7.5 mg.

Elderly patients have similar pharmacokinetic parameters compared to younger patients. Elderly patients have slightly lower mean equilibrium plasma clearance than younger patients.

Elderly women have higher AUC values and prolonged T1/2 compared to young patients of both sexes.

Indications

Short-term symptomatic therapy:

Designed to reduce pain and inflammation at the time of use, does not affect the progression of the disease.

Active ingredient

Composition

1 ml

meloxicam 10 mg

Excipients:

meglumine (N-methylglucamine) – 7 mg,

glycine – 6 mg, poloxamer 188 – 50 mg,

tetrahydrofurfuryl macrogol (glycofurole) – 100 mg,

sodium chloride – 3.5 mg,

0.1M sodium hydroxide solution – to pH 8.4-8.9,

d/i water – to 1 ml.

The solution for intravenous administration is yellow or greenish-yellow, transparent.

How to take, the dosage

Intravenous injection of the drug is indicated only during the first 2-3 days. Later the treatment is continued with the use of oral forms (tablets). The drug is administered deeply in m/m. The drug should not be administered intravenously.

The recommended dose is 7.5 mg (0.75 ml) or 15 mg (1.5 ml) once daily, depending on the intensity of pain and severity of the inflammatory process. The maximum recommended daily dose is 15 mg (1.5 ml).

With regard to possible incompatibilities, meloxicam should not be mixed in the same syringe with other medicinal products.

In patients with severe renal impairment who are on hemodialysis and patients at increased risk of adverse reactions, the dose should not exceed 7.5 mg (0.75 ml)/day. No dose adjustment is required for patients with mild to moderate renal impairment (CKR over 30 ml/min). The drug should not be used simultaneously with other NSAIDs.

The total daily dose of Meloxicam used as tablets, suppositories, oral suspension and injections should not exceed 15 mg.

Interaction

When used concomitantly with other inhibitors of prostaglandin synthesis, 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, thrombolytics meloxicam increases the risk of bleeding. If it is impossible to avoid their simultaneous use, it is necessary to monitor the indicators of the clotting system.

The concomitant use of antiplatelet agents, serotonin reuptake inhibitors with meloxicam increases the risk of bleeding due to inhibition of platelet function. In case of concomitant use, close monitoring of the clotting system is necessary.

Meloxicam may decrease renal excretion of lithium, which leads to an increase in its plasma concentrations to toxic levels. Concomitant use of meloxicam with lithium preparations is not recommended. If concomitant use is necessary, it is recommended to carefully monitor the concentration of lithium in plasma throughout the course of use of lithium drugs.

NSAIDs decrease renal excretion of methotrexate, thus increasing its concentration in plasma. Simultaneous use of meloxicam and methotrexate (in dose 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 concomitant use, careful monitoring of renal function and blood counts is required. Meloxicam may increase hematological toxicity of methotrexate, especially in patients with impaired renal function. When co-administration of meloxicam and methotrexate within 3 days the risk of increased toxicity of the latter increases.

There is evidence that meloxicam may reduce the effectiveness of intrauterine contraceptives, but this has not been proven. When meloxicam is used together with diuretics, there may be a risk of acute renal failure, so renal function should be monitored and adequate hydration should be maintained.

Meloxicam reduces the effect of antihypertensive agents (beta-adrenoblockers, ACE inhibitors, vasodilators, diuretics) due to inhibition of prostaglandins that have vasodilatory 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 may lead to acute renal failure.

Colestyramine, by binding meloxicam in the GI tract, leads to its faster excretion.

Meloxicam, affecting renal prostaglandins, increases nephrotoxicity of cyclosporine, which requires increased monitoring of renal function during concomitant use of the drugs.

Meloxicam is almost completely destroyed by hepatic metabolism, approximately 2/3 of which occurs with cytochrome (CYP) P450 and 1/3 by peroxidase oxidation. Possible pharmacokinetic interaction of meloxicam and other drugs at the metabolic stage due to their effect on CYP2C9 and/or CYP3A4.

When used concomitantly with hypoglycemic agents for oral administration, meloxicam may increase their effect, thus contributing to the risk of hypoglycemia.

Meloxicam may weaken the effects of digoxin, cortisone, and diuretics.

In concomitant use of meloxicam with antacids, cimetidine, digoxin and furosemide, no interaction at the pharmacokinetic level was found.

Special Instructions

The use of the drug is contraindicated during pregnancy.

It is known that NSAIDs penetrate into breast milk, so the use of the drug during breast-feeding is contraindicated.

As a COX/prostaglandin synthesis inhibitor, Genitron® may affect fertility, so it is not recommended for women who are planning to become pregnant. Meloxicam may lead to delayed ovulation. In this regard, in women who have problems with conception and who are undergoing examination for these problems, it is recommended to cancel Genitron®.

As the potential risk of adverse reactions depends on the dose and duration of treatment, the lowest effective dose should be used for the shortest possible course.

The duration of treatment is determined individually depending on the course of the disease and the effectiveness of current therapy.

Patients with gastrointestinal diseases, when using Genitron® should be regularly monitored. The drug should not be administered to patients with peptic ulcer or gastrointestinal bleeding. At any time during treatment, potentially fatal gastrointestinal bleeding, ulceration or perforation may occur with or without previous symptoms, serious gastrointestinal disease in the history. If gastrointestinal ulceration or gastrointestinal bleeding occurs, the drug should be discontinued. The most serious effects have been observed in the elderly.

In patients with cardiovascular disease or with risk factors for such diseases, NSAIDs may increase the risk of serious cardiovascular thrombotic events, myocardial infarction, angina attack and stroke, which may be fatal.

This risk may increase with longer duration of treatment.

The NSAIDs may increase sodium, potassium, and water retention and decrease the natriuretic effects of diuretics. As a consequence, heart failure or arterial hypertension may occur or worsen in predisposed patients. Clinical monitoring is recommended in such patients, and adequate hydration should be maintained.

Before initiating treatment, renal function should be investigated. In case of combined therapy, renal function should also be monitored.

In patients with decreased renal blood flow, use of NSAIDs (NSAIDs inhibit renal prostaglandin synthesis, which plays an important role in maintaining renal blood flow) can cause renal failure that resolves when NSAID anti-inflammatory therapy is stopped.

The greatest risk of this reaction occurs in elderly patients with dehydration, with chronic heart failure, cirrhosis, nephrotic syndrome, chronic kidney disease, who receive concomitant therapy with diuretics, ACE inhibitors or angiotensin II receptor antagonists, or after extensive surgical interventions that resulted in hypovolemia. Such patients require monitoring of diuresis and renal function at the beginning of therapy. In single cases, NSAIDs may lead to interstitial nephritis, glomerulonephritis, renal medullary necrosis, or development of nephrotic syndrome.

In treatment with NSAIDs, there have been individual cases of elevated transaminases or other indicators of liver function, which in most cases have been mild and transient. In cases of persistent and significant abnormalities, treatment with Genitron® should be discontinued and control tests performed. In clinically stable patients with liver cirrhosis there is no need to decrease doses of Genitron®, the observed laboratory changes should be monitored.

Patients who are weakened require closer monitoring because the side effects are more severe in these patients. As with other NSAIDs, caution should be exercised when prescribing the drug in elderly patients who are more likely to have impaired renal, hepatic and cardiac function.

Genitron®, like any other NSAID, may mask symptoms of underlying infectious disease.

In very rare cases, serious skin reactions (some of them fatal) including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis have been observed when using NSAIDs.

The risk of these reactions is high at the start of treatment, with most of these reactions occurring within the first month of treatment. If skin rashes, mucous membrane lesions or other signs of hypersensitivity appear for the first time, discontinue the use of Genitron®. Because of the possibility of side effects to the skin and mucous membranes, special attention should be paid to the appearance of relevant symptoms.

If side effects occur, discontinue treatment with the drug.

The tablet formulation (7.5 mg and 15 mg) contains lactose. That is why this drug is not recommended for patients with congenital lactose intolerance, lactase deficiency or impaired glucose or galactose absorption.

Impact on driving and operating machinery

Mental and motor reaction times may decrease during treatment, therefore, it is necessary to refrain from driving and engaging in other potentially dangerous activities requiring increased concentration and quick psychomotor reactions.

Contraindications

Side effects

The undesirable phenomena presented below are listed according to anatomico-physiological classification and frequency of occurrence. The frequency is determined by WHO and is graded as follows: very common (>10%); common (>1% and < 10%); infrequent (>0.1% and < 1%); rare (>0.01% and < 0.1%); very rare (

Overdose

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 overdose of the drug symptomatic therapy is carried out; in case of overdose of the drug in the form of tablets – gastric lavage, intake of activated charcoal. Forced diuresis, urine alkalinization, hemodialysis are ineffective due to high degree of binding of the drug to blood proteins.

Similarities