title: Tolerability of meloxicam in patients with histories of adverse reactions to nonsteroidal anti-inflammatory drugs.
abstract: BACKGROUND
  Adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) are frequent, particularly among patients with chronic urticaria or asthma. The need to identify an alternative drug that is safe and reliable is a common problem in clinical practice.
  
  
  OBJECTIVE
  To assess the tolerability of meloxicam, a new NSAID that selectively inhibits the inducible isoform of cyclooxygenase, in a group of NSAID-sensitive patients.
  
  
  METHODS
  We studied 177 patients who had suffered adverse reactions to one or more NSAIDs. Cutaneous reactions were reported by 83.1% of the subjects (urticaria in 55, angioedema in 52, urticaria/angioedema in 39, and maculopapular rash in 1), respiratory symptoms by 3.9%, both cutaneous and respiratory symptoms by 9%, Stevens-Johnson's syndrome by 2.3%, and anaphylactoid reactions by 1.7%. All subjects underwent a single-blind, placebo-controlled oral challenge with divided therapeutic doses of meloxicam (1.9 mg + 5.6 mg 1 hour later = cumulative dose 7.5 mg).
  
  
  RESULTS
  Positive reactions were observed in only two cases (1.1%), both manifested exclusively by cutaneous symptoms (urticaria/angioedema in one case and maculopapular rash/facial edema in the second).
  
  
  CONCLUSIONS
  Meloxicam seems to be well tolerated by NSAID-sensitive subjects whose reactions are manifested by urticaria/angioedema. Additional study is needed for a more complete assessment of its tolerability in patients with aspirin-induced asthma and other severe manifestations of NSAID sensitivity.
authors.affiliation: Department of Internal Medicine and Geriatrics, CI Columbus, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Quaratino
authors.forename: A
authors.initials: A
authors.lastname: Romano
authors.forename: M
authors.initials: M
authors.lastname: Di Fonso
authors.forename: G
authors.initials: G
authors.lastname: Papa
authors.forename: M R
authors.initials: MR
authors.lastname: Perrone
authors.forename: F P
authors.initials: FP
authors.lastname: D'Ambrosio
authors.forename: A
authors.initials: A
authors.lastname: Venuti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000139:chemically induced; D000799:Angioedema / Q000139:chemically induced; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy; D002908:Chronic Disease; D016861:Cyclooxygenase Inhibitors; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D000077239:Meloxicam; D008875:Middle Aged; D013843:Thiazines / Q000009:adverse effects*; D013844:Thiazoles / Q000009:adverse effects*; D014581:Urticaria / Q000188:drug therapy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D013843:Thiazines; D013844:Thiazoles; D000077239:Meloxicam