ANJESO
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ANJESO (ANJESO).
Non-steroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis, thereby decreasing inflammation and pain.
| Metabolism | Primarily metabolized by hepatic cytochrome P450 enzymes, including CYP2C9 and CYP3A4, to inactive metabolites. |
| Excretion | Approximately 70% renal (30% unchanged, 40% as glucuronide conjugate), 30% fecal/biliary. |
| Half-life | Terminal elimination half-life is 1.5-2.5 hours in healthy adults. In elderly or renally impaired patients, half-life may extend to up to 6 hours. |
| Protein binding | >99% bound to albumin. |
| Volume of Distribution | Approximately 0.1 L/kg (11 L in 70 kg patient), indicating limited extravascular distribution. |
| Bioavailability | Intravenous: 100%; intramuscular: approximately 80%. |
| Onset of Action | Intravenous: within 5-10 minutes; intramuscular: 15-30 minutes. |
| Duration of Action | Approximately 6-8 hours when administered IV or IM. Duration may be shorter with single doses and is dose-dependent. |
120 mg administered intravenously over 15 minutes, followed by 30 mg intravenously over 15 minutes, with the second dose given 12 to 24 hours after the first dose.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required for mild to moderate renal impairment (CrCl ≥30 mL/min). Not recommended for patients with severe renal impairment (CrCl <30 mL/min) or end-stage renal disease. |
| Liver impairment | No dose adjustment required for mild hepatic impairment (Child-Pugh class A). Not recommended for moderate to severe hepatic impairment (Child-Pugh class B or C). |
| Pediatric use | Safety and efficacy have not been established in pediatric patients. |
| Geriatric use | No dose adjustment required in elderly patients; however, consider the potential for increased sensitivity and monitor renal function. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ANJESO (ANJESO).
| Breastfeeding | Limited data. Meloxicam is excreted into human milk in low concentrations (M/P ratio unknown). Due to potential adverse effects on infant renal function and platelet aggregation, caution is advised. Consider temporary discontinuation or alternative therapy. |
| Teratogenic Risk | ANJESO (meloxicam) is an NSAID. First trimester: Avoid; associated with increased risk of miscarriage and congenital malformations (cardiac, neural tube). Second trimester: Use caution; may cause fetal renal dysfunction and oligohydramnios. Third trimester: Contraindicated; risk of premature closure of ductus arteriosus, persistent pulmonary hypertension, and oligohydramnios. |
■ FDA Black Box Warning
Increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors may be at greater risk. ANJESO is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
| Serious Effects |
["History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.","Perioperative pain in the setting of CABG surgery.","Advanced renal disease or patients at risk for renal failure (unless benefit outweighs risk)."]
| Precautions | ["Cardiovascular thrombotic events: increased risk of MI and stroke.","Gastrointestinal effects: risk of bleeding, ulceration, and perforation.","Renal toxicity: monitor renal function in patients with pre-existing renal disease or risk factors.","Hepatic effects: may cause elevated liver enzymes; discontinue if liver disease or systemic manifestations occur.","Anaphylactoid reactions: may occur in patients with aspirin triad (asthma, rhinitis, nasal polyps).","Hypertension: may worsen blood pressure control.","Heart failure and edema: use with caution in patients with fluid retention or heart failure."] |
Loading safety data…
| Fetal Monitoring | Monitor for oligohydramnios (ultrasound) and fetal ductus arteriosus constriction (echocardiography) if used beyond 20 weeks. Maternal monitoring: renal function (creatinine, BUN), blood pressure, signs of bleeding, and liver function tests. |
| Fertility Effects | ANJESO may impair female fertility via inhibition of prostaglandin synthesis, potentially delaying or preventing ovulation. This effect is reversible upon discontinuation. Not recommended in women attempting to conceive. |
| Food/Dietary |
| Take with food or milk to minimize gastrointestinal irritation. Avoid alcohol, as it increases the risk of GI bleeding. No specific food restrictions otherwise. |
| Clinical Pearls | ANJESO (meloxicam) is an NSAID for acute pain; use lowest effective dose for shortest duration. Monitor renal function in elderly and volume-depleted patients. Avoid in patients with severe hepatic impairment or active GI bleeding. Check for aspirin allergy before administration. Use with caution in patients with cardiovascular risk factors. |
| Patient Advice | Take with food or milk to reduce GI upset. · Avoid alcohol while taking this medication. · Report signs of bleeding (e.g., black/bloody stools, easy bruising). · Inform your doctor if you have heart disease, high blood pressure, or kidney problems. · Do not take with other NSAIDs or aspirin without doctor's approval. · Seek emergency care for chest pain, weakness, or slurred speech. |