Meloxicam tolerance in hypersensitivity to nonsteroidal anti-inflammatory drugs

Patients with aspirin-sensitive respiratory and skin diseases experience cross reactions to all nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxigenase (COX) enzymes. The need to identify an alternative drug that is safe and reliable is a common problem in clinical practice.

The aim of this study was to test the tolerability of meloxicam in NSAID-sensitive patients.

Between January 2005 and February 2006 we performed single-blind oral challenge tests with meloxicam in NSAID-intolerant patients, exposing them first to placebo and then, after 30 minutes, to the first dose of meloxicam (7.5 mg). After 30 minutes, if no response appeared, the last dose of meloxicam (15 mg) was given, for a total accumulated dose of 22.5 mg. The test was considered positive if urticaria, erythema. and/or angioedema appeared.

We tested 114 patients: 36% men and 64% women whose mean age was 45.81 years. Meloxicam was well tolerated in 109 of the 114 patients (95.62%) and only 5 (4.38%) developed an adverse reaction (urticaria in all cases).

This study shows that meloxicam can be a good option for NSAID-intolerant patients: it was safe for over 95% of the patients and is easier to obtain than celecoxib or etoricoxib. However, we think that a patient should be tested in an allergy unit before it is prescribed.