Pharmacokinetics of meloxicam in patients with end-stage renal failure on haemodialysis: a comparison with healthy volunteers

Abstract

Objective:

The pharmacokinetics of meloxicam have been studied following administration of a single 15-mg capsule to 12 patients with end-stage renal failure. Pharmacokinetic parameters were determined after haemodialysis. The pharmacokinetic profile obtained in these patients is compared to data obtained from age- and gender-matched healthy volunteers.

Results:

Total plasma meloxicam concentrations were lower in patients with end-stage renal failure (AUC_0–∞12.6 μg ⋅ h ⋅ ml⁻¹) in comparison with healthy volunteers (AUC_0–∞39.3 μg ⋅ h ⋅ ml⁻¹). This was reflected by an increase in total clearance (+211%). However, there was an enhanced free meloxicam fraction (unbound drug) in the end-stage renal failure patients (0.9% vs. 0.3% in healthy volunteers). This was observed in association with raised free C_max (5.0 vs. 2.6 ng/ml) but similar free AUC_0–∞(0.13 vs. 0.11 μg ⋅ h ⋅ ml⁻¹) in both groups. Therefore, the raised free fraction is compensated for by the increased total clearance such that no accumulation of meloxicam occurs. Meloxicam plasma concentrations were similar before and after haemo- dialysis.

Conclusion:

Meloxicam has displayed a pharmacokinetic profile in end-stage renal failure which is similar to that observed for other highly protein bound non-steroidal anti-inflammatory drugs (NSAIDs). However, in view of the higher free C_max value, and despite no evidence of accumulation, it may be prudent to treat this group of patients with a 7.5-mg dose of meloxicam. This is the lower dose normally recommended for adults. Meloxicam is not dialysable.