Revmart
Revmart: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Revmart
ATX code: M01AC06
Active ingredient: meloxicam (Meloxicam)
Manufacturer: JSC "ALSI Pharma" (Russia)
Description and photo update: 2019-05-12
Revmart is a non-steroidal anti-inflammatory drug (NSAID) that has anti-inflammatory, analgesic and antipyretic effects.
Release form and composition
The drug is available in the form of tablets: light yellow color with a green tint, round, flat-cylindrical, beveled; tablets with a dosage of 15 mg have a dividing risk (10 pcs. in blisters, in a cardboard box 1, 2, 3, 4 or 5 packages and instructions for use of Revmart).
1 tablet contains:
- active substance: meloxicam - 7.5 or 15 mg;
- auxiliary components: pregelatinized starch, colloidal silicon dioxide (aerosil), sodium citrate, microcrystalline cellulose, magnesium stearate.
Pharmacological properties
Pharmacodynamics
Revmart is an NSAID that has anti-inflammatory, analgesic and antipyretic effects. The mechanism of action of the active substance of the drug, meloxicam, is due to the selective inhibition of the enzymatic activity of COX-2 (cyclooxygenase-2), which is involved in the biosynthesis of prostaglandins in the area of inflammation. Meloxicam tends to suppress tumor necrosis factor-alpha, platelet activating factor, release of histamine and proteases.
Due to the selective action of the drug, inhibition of prostaglandin synthesis in the area of inflammation prevails over similar processes in the kidneys and the mucous membrane of the gastrointestinal tract (GIT). However, with prolonged use of high doses, the selective effect of the active substance may decrease.
The use of Revmart helps to reduce morning stiffness and swelling of the joints, increase the range of motion.
Pharmacokinetics
After taking Revmart inside, meloxicam is well absorbed from the gastrointestinal tract. Its absolute bioavailability is 90%. The maximum plasma concentration (C max) is achieved after 5-6 hours both after a single dose and during the stationary state of pharmacokinetics. The rate and extent of absorption is not affected by the simultaneous ingestion of food or inorganic antacids.
The concentration of the drug is proportional to the dose taken; after taking 3-5 single doses, a steady state of pharmacokinetics is achieved. When using Revmart at a dose of 7.5 mg once a day, the range of differences between C max and C min (minimum plasma concentration) during the stationary state of pharmacokinetics can be 0.4–1 μg / ml, and at a dose of 15 mg 1 time per day - 0.8-2 mcg / ml.
Plasma protein binding, mainly albumin, is 99%. After multiple oral administration of Revmart in therapeutic doses, the volume of distribution is approximately 16 liters (coefficient of variation 11–32%).
The substance overcomes histohematogenous barriers, its concentration in the synovial fluid is up to 50% of the concentration in plasma. Penetrates into breast milk.
It is metabolized almost completely in the liver with the formation of four derivatives that do not have pharmacological activity. By oxidation of an intermediate metabolite (5'-hydroxymethylmeloxicam) with the participation of isoenzymes CYP2C9 and CYP3A4, the main metabolite is formed - 5'-carboxymeloxicam. The formation of other metabolites occurs with the participation of peroxidase; its activity can vary individually.
Meloxicam is excreted mainly in the form of metabolites through the kidneys and intestines.
The half-life (T 1/2) is 13-25 hours.
After a single dose, plasma clearance is 7–12 ml / min.
Lack of liver function does not significantly affect the pharmacokinetics of meloxicam.
With mild or moderate renal failure, the pharmacokinetics of Revmart practically does not change. In patients with moderate renal impairment, the rate of excretion is significantly higher.
In end-stage renal failure, the degree of binding of meloxicam to plasma proteins decreases, the volume of distribution increases, which can lead to higher concentrations of free meloxicam. In this regard, in end-stage renal failure, the maximum daily dose should be no more than 7.5 mg.
In elderly patients, pharmacokinetic parameters are not impaired. During the period of equilibrium, the average plasma clearance in this category of persons is slightly lower than in patients at a young age.
Older women, compared with young patients of both sexes, have higher AUC values (area under the concentration-time pharmacokinetic curve) and increased T 1/2.
Indications for use
The use of Revmart in order to reduce pain and inflammation at the time of use is indicated for the symptomatic treatment of the following diseases and conditions:
- arthropathy, dorsopathy (including low back pain, sciatica, shoulder periarthritis), other inflammatory and degenerative pathologies of the musculoskeletal system, accompanied by pain;
- rheumatoid arthritis;
- osteoarthritis (degenerative joint diseases, arthrosis);
- ankylosing spondylitis.
The drug has no effect on the progression of the disease.
Contraindications
Absolute:
- complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses, angioedema or urticaria due to intolerance to NSAIDs and acetylsalicylic acid (including history);
- stage of exacerbation or recently transferred erosive and ulcerative lesions of the stomach and duodenum;
- active gastrointestinal bleeding;
- Crohn's disease, ulcerative colitis in the acute stage;
- severe liver failure;
- active liver disease;
- progressive kidney disease;
- severe renal failure with creatinine clearance (CC) less than 30 ml / min (for patients with confirmed hyperkalemia and in the absence of hemodialysis sessions);
- the presence of diseases of the blood coagulation system;
- recently suffered cerebrovascular bleeding;
- severe uncontrolled heart failure;
- therapy of perioperative pain during coronary artery bypass grafting;
- period of pregnancy;
- lactation;
- age up to 12 years;
- hypersensitivity to drug components.
It should be borne in mind that there is a risk of cross-sensitivity to acetylsalicylic acid and other NSAIDs.
With caution, it is recommended to use Revmart tablets for the treatment of patients with a history of gastrointestinal diseases (including gastric ulcer and duodenal ulcer) and liver; with renal failure (CC 30-60 ml / min), chronic heart failure, coronary heart disease, cerebrovascular pathologies, peripheral arterial diseases, dyslipidemia, hyperlipidemia, diabetes mellitus, the presence of Helicobacter Pylori infection, severe somatic diseases, smoking, frequent alcohol consumption, over the age of 65 (including elderly patients taking diuretics, debilitated patients and patients with low body weight); with the simultaneous use of oral glucocorticosteroids, anticoagulants (including warfarin),antiplatelet agents or selective serotonin reuptake inhibitors (including paroxetine, sertraline, citalopram, fluoxetine); with long courses of NSAID therapy.
Revmart, instructions for use: method and dosage
Revmart tablets are taken orally 1 time a day with meals, drinking plenty of water or other liquid.
Symptomatic NSAID therapy involves the use of the lowest effective dose for the shortest possible period of treatment.
Recommended daily dosage for adults:
- osteoarthritis: the initial dose is 7.5 mg, in the absence of a sufficient therapeutic effect, it can be increased to 15 mg;
- rheumatoid arthritis, ankylosing spondylitis: 15 mg, taking into account the clinical picture, the dose can be reduced to 7.5 mg.
The maximum daily dose (including meloxicam in other dosage forms) should not exceed 15 mg.
With an increased risk of adverse reactions, treatment is recommended to start with a dose of 7.5 mg.
In patients with severe renal failure who are on hemodialysis, the dose should be no more than 7.5 mg. No dose adjustment is required for patients with CC more than 30 ml / min.
The maximum dose for adolescents over the age of 12 years is determined at the rate of 0.25 mg per 1 kg of the patient's body weight.
Side effects
The frequency of side effects of Revmart is grouped according to the following scale of occurrence: very often (> 1/10); often (from ≥ 1/100 to <1/10); infrequently (from ≥ 1/1000 to <1/100); rarely (from ≥ 1/10 000 to <1/1000); very rare (<1/10 000); the frequency has not been established (it is impossible to estimate the incidence of adverse events based on the available data).
- on the part of the blood and lymphatic system: infrequently - anemia; rarely - violations of the leukocyte formula and other changes in the number of blood cells, leukopenia, thrombocytopenia; when combined with methotrexate and other drugs that inhibit the bone marrow - cytopenia;
- from the immune system: infrequently - angioedema; rarely - urticaria; the frequency is not established - anaphylactoid or anaphylactic reactions, up to anaphylactic shock;
- on the part of the psyche: often - a change in mood; frequency not established - disorientation, confusion;
- from the nervous system: often - headache; infrequently - drowsiness, dizziness;
- from the digestive system: often - dyspepsia, abdominal pain, nausea, vomiting, diarrhea; infrequently - belching, stomatitis, bloating, constipation, gastritis, gastrointestinal bleeding (including fatal); rarely - colitis, esophagitis, gastroduodenal ulcers (including fatal); very rarely - perforation of the gastrointestinal tract (including fatal);
- from the hepatobiliary system: very rarely - hepatitis;
- from the side of the vessels: infrequently - flushing of the face, increased blood pressure (BP);
- from the side of the heart: rarely - heart palpitations;
- on the part of the organ of vision: rarely - blurred vision, conjunctivitis, visual impairment;
- from the organ of hearing and labyrinthine disorders: infrequently - vertigo (dizziness); rarely - tinnitus;
- from the respiratory system, chest and mediastinal organs: rarely - bronchial asthma with intolerance to acetylsalicylic acid or other NSAIDs;
- from the urinary system: infrequently - urination disorders, acute urinary retention; very rarely - acute renal failure; frequency not established - interstitial nephritis, glomerulonephritis, nephrotic syndrome, renal medullary necrosis;
- dermatological reactions: infrequently - itching, rash, angioedema; rarely - Stevens-Johnson syndrome, toxic epidermal necrolysis; very rarely - erythema multiforme, bullous dermatitis; frequency not established - photosensitivity;
- changes in laboratory and instrumental studies: infrequently - transient abnormalities in liver function indicators (increased hepatic transaminase activity, increased bilirubin levels), increased serum urea and / or creatinine levels.
Overdose
Symptoms: in case of an overdose of NSAIDs, the following undesirable, usually reversible phenomena may occur - epigastric pain, nausea, vomiting, impaired consciousness. In addition, bleeding from the gastrointestinal tract is possible, in severe poisoning - a decrease in blood pressure, the development of acute renal failure, respiratory arrest, asystole.
Treatment: within the next hour after an overdose, gastric lavage and intake of activated carbon are required, the appointment of symptomatic therapy. For faster elimination of meloxicam from the gastrointestinal tract, the use of cholestyramine is indicated. There is no specific antidote.
Alkalization of urine or the use of hemodialysis and forced diuresis is ineffective.
special instructions
Patients with a history of gastrointestinal diseases or those on concomitant anticoagulant therapy have an increased risk of erosive and ulcerative gastrointestinal lesions.
It should be borne in mind that the occurrence of such potentially life-threatening complications as ulcers, gastrointestinal bleeding or perforation is possible at any stage of therapy, including in the absence of clear prerequisites and indications in the history of serious gastrointestinal complications when using other NSAIDs … Elderly persons require special attention. When symptoms of gastrointestinal tract damage appear, Revmart must be canceled.
When the first signs of hypersensitivity appear (skin rash, changes in mucous membranes), it is necessary to consult a doctor in order to consider an immediate replacement of the drug.
Revmart can mask the symptoms of infectious pathologies.
With prolonged use of NSAIDs, the risk of developing serious thrombosis, angina attack, myocardial infarction in patients with a history of cardiovascular diseases or those predisposed to them increases.
With reduced renal blood flow or a reduced volume of circulating blood, taking Revmart can cause decompensation of latent renal failure. Withdrawal of the drug usually helps restore kidney function to its original level. The risk group for developing such a reaction includes elderly patients, patients with a state of dehydration, chronic heart failure, liver cirrhosis, nephrotic syndrome or kidney disease, concomitant therapy with diuretics, ACE inhibitors, angiotensin II receptor antagonists, in the period after major surgical interventions. In this category of patients at the beginning of treatment, it is necessary to carefully monitor urine output and renal function.
It should be borne in mind that in predisposed patients, the combined use of Revmart and diuretics can cause a delay in the body of sodium, potassium and water or reduce the natriuretic effect of diuretics. Such phenomena affect the aggravation of signs of heart failure or arterial hypertension, therefore, such patients need to study renal function before starting treatment, carefully monitor the condition and maintain adequate hydration during the period of meloxicam use.
Influence on the ability to drive vehicles and complex mechanisms
During the period of application of Revmart, patients are advised to be careful when driving vehicles and mechanisms due to the existing risk of visual impairment and the development of adverse events from the central nervous system (dizziness, drowsiness).
Application during pregnancy and lactation
The use of Revmart during pregnancy and lactation is contraindicated.
Meloxicam can have an adverse effect on fertility, therefore, it is not recommended to take the drug when planning a pregnancy and / or having difficulties with conception.
Pediatric use
The appointment of Revmart is contraindicated for the treatment of children under the age of 12 years.
With impaired renal function
The use of Revmart is contraindicated in progressive kidney diseases, severe renal failure with CC less than 30 ml / min in patients not receiving hemodialysis sessions and in patients with confirmed hyperkalemia.
In patients on hemodialysis with severe renal insufficiency, the dose should be no more than 7.5 mg.
With caution, Revmart should be prescribed for renal failure with a CC of 30-60 ml / min, dose adjustment is not required for this category of patients.
For violations of liver function
The use of Revmart is contraindicated in case of severe hepatic insufficiency or active liver disease.
The drug should be prescribed with caution for the treatment of patients with a history of liver disease.
With compensated liver cirrhosis, dose adjustment of Revmart is not required.
Use in the elderly
With caution, it is recommended to prescribe Revmart for the treatment of patients over the age of 65 years.
Drug interactions
- potassium-sparing diuretics, potassium salts, angiotensin II receptor antagonists, angiotensin-converting enzyme (ACE) inhibitors, unfractionated and low molecular weight heparin, tacrolimus, trimethoprim, cyclosporins, other NSAIDs: it should be borne in mind that the combined use of hypersensitivity drugs with any group of drugs from the indicated pharmacies;
- other NSAIDs (including acetylsalicylic acid, salicylates), glucocorticoids: the combination of Revmart with these agents causes a synergistic effect, which increases the likelihood of erosive and ulcerative lesions and bleeding in the gastrointestinal tract;
- oral anticoagulants, thrombolytics, heparin for systemic use, antiplatelet drugs, selective serotonin reuptake inhibitors: against the background of concomitant therapy with one of these drugs, the risk of bleeding increases, therefore it is necessary to carefully monitor the indicators of the blood coagulation system;
- ACE inhibitors, beta-blockers, vasodilators, diuretics: the vasodilating effect of antihypertensive drugs decreases;
- diuretics: diuretic therapy in patients with dehydration is associated with a risk of acute renal failure, therefore, if a combination of Revmart and diuretics is necessary, a preliminary study of renal function and adherence to adequate hydration is required;
- other NSAIDs, angiotensin II receptor antagonists, ACE inhibitors: co-therapy with one of these drugs contributes to the development of acute renal failure, especially with impaired renal function;
- cyclosporine: the nephrotoxicity of cyclosporine increases, therefore, with combination therapy, it is necessary to ensure regular monitoring of renal function, especially in elderly patients;
- pemetrexed: care should be taken when combining meloxicam with pemetrexed in patients with CC 45–79 ml / min due to the increased risk of gastrointestinal side effects and myelosuppression. You can start taking Revmart 2 days after discontinuation of pemetrexed and stop 5 days before starting treatment with pemetrexed. If necessary, joint use requires careful monitoring of the patient's condition; with CC less than 45 ml / min, the combination of drugs is contraindicated;
- lithium preparations: it is not recommended to take lithium preparations simultaneously with meloxicam due to an increase in the concentration of the latter in plasma, up to toxic values. If a joint appointment cannot be avoided, then during the entire course of therapy with a lithium drug, it is necessary to carefully monitor the lithium content in the plasma;
- methotrexate: It is not recommended to take methotrexate if the dose is more than 15 mg per week. It should be borne in mind that even at lower doses of methotrexate, its combination with meloxicam leads to an increase in the plasma concentration of methotrexate and an increase in its hematological toxicity, especially in patients with impaired renal function;
- sulfonylurea derivatives, nateglinide, probenecid: these and similar drugs, which are metabolized with the participation of CYP2C9 and / or CYP3A4 enzymes, or have the ability to inhibit them, can pharmacokinetically interact with meloxicam and increase its blood level. In addition, it should be taken into account that a consequence of the interaction may be the development of hypoglycemia against the background of a simultaneous increase in the level of concentration in the blood of the hypoglycemic drug;
- cholestyramine: the combination with cholestyramine promotes the binding of meloxicam in the gastrointestinal tract and its faster excretion;
- digoxin, antacids, cimetidine, furosemide: concomitant therapy with the listed agents does not cause clinically significant pharmacokinetic interactions.
Analogs
Revmart analogs are Amelotex, Artrozan, Bi-ksikam, GenITRON, Liberum, Mataren, Medsikam, Melbek, Melox, Meloxicam, Meloxicam Avexim, Meloxicam Canon, Meloxicam-Akrihin, Meloxicam-Teva, Meloflam, Meloflex-Rompholm, Mirlox, Movagein Express, Movalis, Movasin, Movix, Oksikamoks, Flexibon, Exen-Sanovel, etc.
Terms and conditions of storage
Keep out of the reach of children.
Store at temperatures up to 25 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Revmart
There are no reviews about Revmart.
Price for Revmart in pharmacies
The price of Revmart for a package containing 20 tablets with a dosage of 7.5 mg, on average, can be 132 rubles, 20 tablets with a dosage of 15 mg - 177 rubles, 10 tablets with a dosage of 15 mg - 152 rubles.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
