E-DRUG: Re: NSAIDS - do they differ? (3)
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Dear Rodolfo,
Meloxicam is not included in any of the large, pharmacoepidemiologic
studies that have been published in the last few years. That's because it
is fairly recently introduced. Therefore we do not know exactly where it is
placed in the 'hierarchy' of risk for serious upper GI toxicity which
places ibuprofen and diclofenac at the 'least risk' end (in the doses
commonly used) and piroxicam at the 'most risk' end (Langman et al. Risk of
bleeding peptic ulcer associated with individual non-steroidal
anti-inflammatory drugs. Lancet 1994; 343: 769-772; Henry et al.
Variability in risk of gastrointestinal complications with individual
non-steroidal anti-inflammatory drugs: results of a collaborative
meta-analysis. British Medical Journal 1996; 312: 1563-1566.). There seems
to be some correlation with half life of elimination of NSAIDS with short
half life NSAIDs demonstrating least risk. Meloxicam has a long half life
(20 hours) in keeping with once daily dosing. Meloxicam is slightly more
selective for cycloxygenase 2 than 1 which seems to be a property
associated with a better upper GIT safety profile but it is not too
different from diclofenac for example. In fact there are a number of highly
selective cyclooxygenase 2 inhibitors in development (phase 2/3) which may
show better GIT safety. Of importance in all of this is that there is a
relationship between NSAID dose and serious upper GIT bleeding. At this
point we don't know if meloxicam is relatively safe. It would be difficult
to extrapolate relative cost benefits on GI safety at this stage.
Regards
Richard Day
Richard DAY, MD FRACP
Professor of Clinical Pharmacology & Director Clinical Pharmacology &
Toxicology,
St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia, 2010
Tel: 61-(0)2-9361-2331 Fax: 61-(0)2-9361-2724
Email: R.Day@unsw.edu.au
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