Relief of pain and inflammation in juvenile idiopathic
arthritis and other musculoskeletal disorders in children
intolerant to other NSAIDs
▶BY MOUTH
▶Child 12–17 years (body-weight up to 50 kg): 7. 5 mg once
daily
▶Child 12–17 years (body-weight 50 kg and above): 15 mg
once dailylUNLICENSED USENot licensed for use in children under
16 years.
lCONTRA-INDICATIONSActive gastro-intestinal bleeding.
active gastro-intestinal ulceration.history of gastro-
intestinal bleeding related to previous NSAID therapy.
history of gastro-intestinal perforation related to previous
NSAID therapy.history of recurrent gastro-intestinal
haemorrhage (two or more distinct episodes).history of
recurrent gastro-intestinal ulceration (two or more
distinct episodes).severe heart failure
lCAUTIONSAllergic disorders.cardiac impairment (NSAIDs
may impair renal function).cerebrovascular disease.
coagulation defects.connective-tissue disorders.Crohn’s
disease (may be exacerbated).heart failure.ischaemic
heart disease.peripheral arterial disease.risk factors for
cardiovascular events.ulcerative colitis (may be
exacerbated).uncontrolled hypertension
lINTERACTIONS→Appendix 1 : NSAIDs
lSIDE-EFFECTS
▶Common or very commonConstipation.diarrhoea.
gastrointestinal discomfort.gastrointestinal disorders.
headache.nausea.vomiting
▶UncommonAnaemia.angioedema.burping.dizziness.
drowsiness.electrolyte imbalance.fluid retention.
flushing.haemorrhage.hepatic disorders.
hypersensitivity.oedema.skin reactions.stomatitis.
vertigo
▶Rare or very rareAcute kidney injury.asthma.
conjunctivitis.leucopenia.mood altered.nightmare.
palpitations.severe cutaneous adverse reactions (SCARs).
thrombocytopenia.tinnitus.vision disorders
▶Frequency not knownAgranulocytosis.confusion.fertility
decreased female.heart failure.increased risk of arterial
thromboembolism.nephritis tubulointerstitial.nephrotic
syndrome.photosensitivity reaction.renal necrosis
SIDE-EFFECTS, FURTHER INFORMATIONFor information
about cardiovascular and gastrointestinal side-effects, and
a possible exacerbation of symptoms in asthma, see Non-
steroidal anti-inflammatory drugs p. 650.
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with a history of hypersensitivity to aspirin or any
other NSAID—which includes those in whom attacks of
asthma, angioedema, urticaria or rhinitis have been
precipitated by aspirin or any other NSAID.
lPREGNANCYAvoid unless the potential benefit outweighs
the risk. Avoid during the third trimester (risk of closure of
fetal ductus arteriosusin uteroand possibly persistent
pulmonary hypertension of the newborn); onset of labour
may be delayed and duration may be increased.
lBREAST FEEDINGUse with caution during breast-feeding.
Present in milk inanimalstudies—manufacturer advises
avoid.
lHEPATIC IMPAIRMENTUse with caution; there is an
increased risk of gastro-intestinal bleeding andfluid
retention. Avoid in severe liver disease.
lRENAL IMPAIRMENTAvoid if possible or use with caution.
Avoid if estimated glomerularfiltration rate less than
25 mL/minute/ 1. 73 m^2.
Dose adjustmentsThe lowest effective dose should be used
for the shortest possible duration.
MonitoringIn renal impairment monitor renal function;
sodium and water retention may occur and renal function
may deteriorate, possibly leading to renal failure.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Orodispersible tablet
▶Meloxicam (Non-proprietary)
Meloxicam 7.5 mgMeloxicam 7. 5 mg orodispersible tablets sugar free
sugar-free| 30 tabletP£ 15. 50
Meloxicam 15 mgMeloxicam 15 mg orodispersible tablets sugar free
sugar-free| 30 tabletP£ 15. 50
Tablet
CAUTIONARY AND ADVISORY LABELS 21
▶Meloxicam (Non-proprietary)
Meloxicam 7.5 mgMeloxicam 7. 5 mg tablets| 30 tabletP£ 4. 00
DT = £ 0. 87
Meloxicam 15 mgMeloxicam 15 mg tablets| 30 tabletP£ 4. 00
DT = £ 0. 91Naproxen
lINDICATIONS AND DOSE
Pain and inflammation in musculoskeletal disorders|
Dysmenorrhoea
▶BY MOUTH
▶Child: 5 mg/kg twice daily; maximum 1 g per day
Pain and inflammation in juvenile idiopathic arthritis
▶BY MOUTH
▶Child 2–17 years: 5 – 7. 5 mg/kg twice daily; maximum 1 g
per daylUNLICENSED USENot licensed for use in children under
5 years for juvenile idiopathic arthritis. Not licensed for
use in children under 16 years for musculoskeletal
disorders or dysmenorrhoea.
lCONTRA-INDICATIONSActive gastro-intestinal bleeding.
active gastro-intestinal ulceration.history of gastro-
intestinal bleeding related to previous NSAID therapy.
history of gastro-intestinal perforation related to previous
NSAID therapy.history of recurrent gastro-intestinal
haemorrhage (two or more distinct episodes).history of
recurrent gastro-intestinal ulceration (two or more
distinct episodes).severe heart failure
lCAUTIONSAllergic disorders.cardiac impairment (NSAIDs
may impair renal function).cerebrovascular disease.
coagulation defects.connective-tissue disorders.Crohn’s
disease (may be exacerbated).heart failure.ischaemic
heart disease.peripheral arterial disease.risk factors for
cardiovascular events.ulcerative colitis (may be
exacerbated).uncontrolled hypertension
lINTERACTIONS→Appendix 1 : NSAIDs
lSIDE-EFFECTSAgranulocytosis.alopecia.angioedema.
aplastic anaemia.asthma.cognitive impairment.
concentration impaired.confusion.constipation.corneal
opacity.depression.diarrhoea.dizziness.drowsiness.
dyspnoea.erythema nodosum.fatigue.gastrointestinal
discomfort.gastrointestinal disorders.glomerulonephritis
.haemolytic anaemia.haemorrhage.hallucination.
headache.hearing impairment.heart failure.hepatic
disorders.hyperhidrosis.hyperkalaemia.hypersensitivity
.hypertension.increased risk of arterial
thromboembolism.infertility female.inflammatory bowel
disease.malaise.meningitis aseptic (patients with
connective-tissue disorders such as systemic lupus
erythematosus may be especially susceptible).muscle
weakness.myalgia.nausea.nephritis tubulointerstitial.
nephropathy.neutropenia.oedema.optic neuritis.oral
disorders.palpitations.pancreatitis.papillitis.
papilloedema.paraesthesia.photosensitivity reaction.
platelet aggregation inhibition.pulmonary oedema.rashBNFC 2018 – 2019 Pain and inflammation in musculoskeletal disorders 659
Musculoskeletal system10