Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA

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Caution is advised in patients most at risk of developing a GI complication with NSAIDs: the Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA, patients using any other NSAID or aspirin concomitantly or patients with a prior history of or recent GI disease such as ulceration and GI bleeding.

NSAIDs should be prescribed with caution in patients with a prior history of or recent ulcer disease or gastrointestinal bleeding. For high risk patients, alternate therapies that do not involve NSAIDs should be considered. In clinical trials, meloxicam has been shown to cause fewer GI adverse events (including dyspepsia, abdominal pain, nausea, vomiting, etc.

Caution should be exercised when treating patients with a history of upper gastrointestinal disease and in patients receiving treatment with anticoagulants. Patients with GI symptoms should ipratropium bromide monitored. Meloxicam therapy should cease if peptic ulceration or GI ulceration or bleeding occurs. Co-administration of meloxicam with drugs known to inhibit CYP 3A4 should Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA undertaken with caution.

A combination of meloxicam and substances known to inhibit both CYP 3A4 and CYP 2C9 should be avoided because of the increased risk of Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA. Long term therapy with some COX-2 selective NSAIDs of the coxib class has been shown to increase the risk of serious cardiovascular thrombotic Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA. Meloxicam is a COX-2 selective NSAID. Meloxicam has not been demonstrated to increase the risk of cardiovascular adverse events compared to nonselective NSAIDs in clinical trials.

However, long term placebo controlled data to adequately assess any cardiovascular risk are not available for meloxicam. All NSAIDs, both COX-2 selective and nonselective, may cause an increased risk of serious cardiovascular thrombotic events including myocardial infarction and stroke.

This may increase with dose and duration of use. Patients with cardiovascular disease history of atherosclerotic cardiovascular disease or risk factors for cardiovascular disease may be Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA greater risk. To minimise chair potential risk of an adverse cardiovascular event in patients taking meloxicam especially in those with cardiovascular risk factors the lowest effective dose should be used for the shortest possible duration.

Physicians and patients should remain alert for such cardiovascular events even in the absence of previous cardiovascular symptoms. Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs. Patients appear to be at highest risk of these reactions early in the course of therapy, the onset of the reaction occurring in the majority of cases within the first month of treatment.

Meloxicam should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. NSAIDs inhibit the synthesis of renal prostaglandins, which play a supportive role in the maintenance of renal Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA. In patients whose renal blood flow Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA blood volume are decreased, administration of an NSAID may precipitate overt renal decompensation which is typically followed by recovery to pretreatment state upon discontinuation of nonsteroidal anti-inflammatory therapy.

Patients at greatest risk Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA such a Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Injection (Phesgo)- Multum are elderly individuals, dehydrated patients, those with congestive heart failure, liver cirrhosis, nephrotic syndrome and overt renal disease, those receiving concomitant Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA with a diuretic, ACE inhibitor or angiotensin II coversyl plus 5 mg antagonist or those having undergone major surgical procedures which led to hypovolaemia.

In rare cases, NSAIDs may cause interstitial nephritis, glomerulonephritis, renal medullary necrosis or nephrotic syndrome. The dose of meloxicam in patients with end-stage renal failure on haemodialysis should not exceed than 7. The extent to which metabolites of meloxicam may accumulate in patients with renal failure has not been studied.

Combination use of ACE inhibitors or angiotensin receptor antagonists, anti-inflammatory drugs and thiazide diuretics. The use of an ACE inhibiting drug (ACE-inhibitor or angiotensin receptor antagonist), an anti-inflammatory drug (NSAID or COX-2 inhibitor) and a thiazide diuretic at the same time increases the risk of renal impairment. This includes use in fixed-combination products containing more than one class of drug.

Combined use of these medications should be accompanied by increased monitoring of serum creatinine, particularly at the institution of the combination. The combination of drugs from these three classes should be used with caution particularly in elderly patients or those with pre-existing renal impairment. These laboratory values may progress, may remain unchanged, or may be transient with continuing therapy. 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 associated 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 Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA presumed noninfectious, painful conditions.

As with other NSAIDs, Indacaterol Inhalation Powder (Arcapta Neohaler)- FDA 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 without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs.

Emergency help should be sought in cases where an anaphylactoid reaction occurs. Rare hereditary galactose intolerance. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not 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.

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