Anti-Cox II® (Meloxicam) — Updated and Scientifically Reviewed Drug Information
1. Disclaimer
This information is intended for educational and professional reference purposes only and does not replace the official package leaflet, prescribing information, or individualized advice from a qualified physician or pharmacist. Dosage, indications, contraindications, and formulation-specific instructions should be confirmed against the current Egyptian-approved product information before use.
We do not guarantee the accuracy, currency or completeness of information regarding medications or medical products, and official sources should be verified before making any decisions. Readers are responsible for independently verifying the information before relying on it.
2. Summary
Anti-Cox II® contains meloxicam, a nonsteroidal anti-inflammatory drug (NSAID) of the oxicam class. Meloxicam provides anti-inflammatory, analgesic, and antipyretic effects and preferentially inhibits cyclooxygenase-2 (COX-2), while still inhibiting COX-1. It is therefore more accurate to describe meloxicam as a preferential COX-2 inhibitor rather than a completely COX-2-selective drug.
Recent Egyptian pharmacy listings identify Anti-Cox II presentations containing 7.5 mg capsules, 15 mg tablets, 15 mg/3 mL ampoules, and 15 mg rectal suppositories, including the currently listed pack sizes of 20 capsules, 20- and 30-tablet packs, 6 ampoules, and 10 suppositories. Availability and pack configuration may vary by pharmacy and over time.
3. Brand Name
Anti-Cox II®
4. Category
Nonsteroidal anti-inflammatory drug (NSAID); oxicam derivative; preferential COX-2 inhibitor.
It should not be described as a completely selective COX-2 inhibitor, because meloxicam inhibits both COX-1 and COX-2, with greater relative activity against COX-2.
5. Active Ingredient
Meloxicam
6. Pharmaceutical Form & Strength
Available Anti-Cox II forms documented in Egyptian retail sources include:
- Capsules: 7.5 mg meloxicam per capsule; current Egyptian listings include 20 capsules.
- Tablets: 15 mg meloxicam per tablet; current Egyptian listings include 20 tablets and 30 tablets.
- Ampoules: 15 mg meloxicam in 3 mL; current Egyptian listings include 6 ampoules.
- Rectal suppositories: 15 mg meloxicam per suppository; current Egyptian listings include 10 suppositories.
The exact excipients and formulation-specific specifications should be taken from the package leaflet for the particular Anti-Cox II presentation.
7. Manufacturer & Marketing Authorization Holder
Manufacturer: ADWIA Pharmaceuticals / Egyptian Company for Chemicals and Pharmaceuticals (ADWIA), Egypt. ADWIA identifies its manufacturing facility in the 10th of Ramadan City and states that the facility operates under an Egyptian Drug Authority license.
Manufacturing location: 10th of Ramadan City, Egypt. Publicly available current sources confirm ADWIA as the manufacturer; a separate, independently verified current Marketing Authorization Holder designation for Anti-Cox II was not established from an official public product dossier, so no separate MAH is stated here.
8. Mechanism of Action
Meloxicam inhibits cyclooxygenase enzymes involved in the conversion of arachidonic acid to prostaglandins and other eicosanoids. Its pharmacologic effect results principally from reduced prostaglandin synthesis, producing anti-inflammatory and analgesic effects and some antipyretic activity. Meloxicam has greater relative inhibition of COX-2 than COX-1, but clinically relevant COX-1 inhibition remains, which is one reason important gastrointestinal, renal, and other NSAID-related adverse effects can still occur.
9. Spectrum of Activity
Meloxicam has a pharmacologic rather than antimicrobial spectrum. Its therapeutic actions are:
- Anti-inflammatory
- Analgesic
- Antipyretic
Its principal clinical use is symptomatic control of pain, inflammation, and stiffness in inflammatory and degenerative musculoskeletal disorders. It has no antibacterial, antiviral, or antifungal activity.
10. Pharmacokinetics
Meloxicam is well absorbed after oral administration. Published prescribing information reports high oral bioavailability; capsules have demonstrated approximately 89% absolute bioavailability in a comparative pharmacokinetic study. Peak concentrations after oral administration are generally reached after approximately 4–5 hours, and steady-state concentrations are achieved after about 5 days of repeated dosing.
Meloxicam is extensively plasma-protein bound, approximately 99%, mainly to albumin. It is extensively metabolized in the liver, with CYP2C9 playing an important role and CYP3A4 contributing to a lesser extent. Its metabolites are pharmacologically inactive or have no established clinically relevant pharmacologic activity. Elimination occurs mainly as metabolites through approximately equal urinary and fecal routes.
The mean elimination half-life is approximately 15–20 hours, supporting once-daily administration.
In mild to moderate hepatic impairment, no major change in exposure has been demonstrated and dose adjustment may not be necessary; severe hepatic impairment has not been adequately characterized. Mild to moderate renal impairment does not generally require dosage adjustment, but severe renal impairment is a significant safety concern, and hemodialysis does not meaningfully remove meloxicam.
Elderly patients may have clinically important increases in exposure in some populations, and age itself increases susceptibility to NSAID-related gastrointestinal, renal, and cardiovascular toxicity.
11. Indications
Meloxicam is used for symptomatic relief of pain and inflammation associated with musculoskeletal and rheumatic disorders. Well-established labeled indications for oral meloxicam include:
- Osteoarthritis
- Rheumatoid arthritis
Some meloxicam product information also includes ankylosing spondylitis and selected forms of juvenile inflammatory arthritis, depending on the specific formulation and jurisdiction. Egyptian retail descriptions of Anti-Cox II also mention musculoskeletal pain and several rheumatic conditions.
Acute gout should not automatically be presented as a universally approved Anti-Cox II indication, because approval varies by product and jurisdiction.
12. Administration
For adults, the usual oral dosage of meloxicam is:
- 7.5 mg once daily initially, with an increase to 15 mg once daily when clinically necessary.
- Maximum recommended systemic daily dose: 15 mg/day.
Oral tablets/capsules should be swallowed with water. They may generally be taken with or without food according to current oral prescribing information; taking them with food may be useful for some patients who experience gastrointestinal discomfort.
For the Anti-Cox II 15 mg/3 mL ampoule, current Egyptian pharmacy information describes administration by deep intramuscular injection under medical supervision. Injectable meloxicam should not be self-administered, and the specific route stated on the current package leaflet must be followed.
For the 15 mg suppository, administration is rectal, generally one suppository once daily when prescribed. Rectal treatment should be kept to the shortest clinically appropriate duration because local rectal adverse effects can occur in addition to the systemic risks of meloxicam.
Different formulations should not be combined or switched casually. The total systemic meloxicam exposure should remain within the prescribed daily maximum, and formulation-specific prescribing information should be followed.
13. Method of Preparation
Anti-Cox II is supplied as a finished pharmaceutical product and does not normally require reconstitution by the patient.
- Capsules/tablets: remove from the packaging and swallow with water as directed.
- Suppository: remove the wrapper and administer rectally according to the product instructions.
- Ampoule: the supplied injectable solution should be administered by an appropriately trained healthcare professional according to the current product instructions. No patient-directed dilution or reconstitution should be performed unless specifically stated in the official product information.
14. Contraindications
Meloxicam should not be used in patients with:
- Known hypersensitivity to meloxicam, other NSAIDs, aspirin, or relevant excipients.
- Previous aspirin/NSAID-induced asthma, urticaria, angioedema, or other allergic-type reactions.
- Active or recurrent peptic ulceration or significant gastrointestinal bleeding.
- A history of NSAID-related gastrointestinal bleeding or perforation.
- Severe hepatic impairment.
- Severe renal impairment when not appropriately managed, particularly advanced renal disease.
- Severe or uncontrolled heart failure, where the risk is considered unacceptable.
- Active significant bleeding disorders.
- The peri-operative setting of coronary artery bypass graft (CABG) surgery.
The historical/local Anti-Cox II information also states use in children under 15 years is contraindicated. Because pediatric authorization differs among meloxicam products and jurisdictions, the current Egyptian Anti-Cox II leaflet should be followed for the exact approved age range.
Pregnancy requires particular restriction: NSAID use should generally be limited from around 20 weeks of gestation onward and avoided at approximately 30 weeks and later, unless specifically directed by a physician, because of fetal renal dysfunction/oligohydramnios and premature closure of the ductus arteriosus.
15. Warnings & Precautions
Meloxicam carries the class risks of serious gastrointestinal and cardiovascular adverse events. NSAIDs can increase the risk of myocardial infarction and stroke, and this risk can appear early and increase with treatment duration. They can also cause gastrointestinal ulceration, bleeding, and perforation, sometimes without warning symptoms.
Use particular caution in patients with:
- Previous peptic ulcer disease or gastrointestinal bleeding.
- Cardiovascular disease or cardiovascular risk factors.
- Hypertension or fluid retention.
- Heart failure.
- Renal impairment, dehydration, hypovolemia, or concomitant diuretic therapy.
- Hepatic impairment.
- Asthma, especially aspirin-sensitive asthma.
- Increased bleeding risk or concomitant anticoagulant/antiplatelet treatment.
- Advanced age.
Serious hypersensitivity and skin reactions, including Stevens–Johnson syndrome and toxic epidermal necrolysis, are rare but potentially life-threatening. Treatment should be discontinued and urgent medical evaluation sought if severe rash, mucosal lesions, facial swelling, breathing difficulty, or other serious hypersensitivity symptoms develop.
Long-term treatment may warrant clinical monitoring of blood pressure, renal function, liver function, and blood counts, particularly in high-risk patients.
16. Drug Interactions
Important interactions include:
- Warfarin and other anticoagulants: increased bleeding risk.
- Aspirin and antiplatelet drugs: increased gastrointestinal and bleeding risk; meloxicam does not replace low-dose aspirin for cardiovascular protection.
- SSRIs/SNRIs: may further increase bleeding risk.
- Other NSAIDs or salicylates: increased toxicity with little additional therapeutic benefit; concomitant use is generally not recommended.
- ACE inhibitors/ARBs and beta-blockers: antihypertensive effects may be reduced; renal deterioration may occur in susceptible patients.
- Diuretics: renal effects may be enhanced and diuretic/antihypertensive efficacy may be reduced in some patients.
- Lithium: meloxicam and other NSAIDs may increase lithium concentrations and toxicity risk.
- Methotrexate: potential increase in methotrexate toxicity.
- Cyclosporine: increased nephrotoxicity risk.
- Pemetrexed: increased risk of myelosuppression, renal toxicity, and gastrointestinal toxicity in susceptible patients.
- Systemic corticosteroids: increased gastrointestinal bleeding risk.
Patients should inform their physician or pharmacist about all prescription medicines, over-the-counter analgesics, anticoagulants, antiplatelet drugs, and supplements before starting meloxicam.
17. Side Effects
Common or relatively common adverse effects can include:
Gastrointestinal: dyspepsia, abdominal discomfort/pain, nausea, diarrhea and other gastrointestinal disturbances.
Neurologic: headache and dizziness.
Skin: rash, itching and other hypersensitivity manifestations.
More serious but less frequent reactions include gastrointestinal ulceration/bleeding/perforation, hypertension, edema or worsening heart failure, acute kidney injury, hyperkalemia, hepatotoxicity, serious allergic reactions, and severe cutaneous reactions such as Stevens–Johnson syndrome and toxic epidermal necrolysis.
Seek urgent medical attention for black or bloody stools, vomiting blood, severe chest pain, sudden weakness or speech difficulty, severe shortness of breath, facial/throat swelling, markedly reduced urine output, jaundice, or a severe blistering/peeling rash.
18. Use in Special Populations
Pregnancy: Meloxicam and other NSAIDs should be used only when clearly indicated. Exposure from around 20 weeks may cause fetal renal dysfunction and oligohydramnios; use at approximately 30 weeks and later should be avoided because of the additional risk of premature closure of the fetal ductus arteriosus.
Breastfeeding: Current evidence is limited; LactMed reports that published information on meloxicam during breastfeeding is insufficient and that alternative agents may be preferred, particularly for newborn or preterm infants.
Children: The pediatric status depends on the specific formulation and authorization. Anti-Cox II local information states that use under 15 years is contraindicated; current international meloxicam labeling demonstrates that some specifically authorized pediatric formulations have different age/weight criteria. Therefore, pediatric use should not be extrapolated between formulations.
Older adults: Older age increases susceptibility to gastrointestinal bleeding, renal impairment, fluid retention, and cardiovascular adverse effects. Use the lowest effective dose for the shortest appropriate duration and monitor high-risk patients carefully.
Renal impairment: Mild to moderate impairment generally does not require automatic dose adjustment, but renal function should be monitored in at-risk patients. Severe renal impairment requires avoidance or specialist-directed use; patients on hemodialysis require particular caution and a maximum oral dose of 7.5 mg/day in current oral labeling.
Hepatic impairment: Mild to moderate impairment generally produces no major pharmacokinetic change, but severe hepatic impairment has not been adequately studied and requires specialist assessment.
19. Storage Conditions
For the Anti-Cox II product information available publicly in Egypt, store below 30°C, in a dry, cool place and out of the reach of children. Keep the product in its original packaging and follow any more specific storage instruction printed on the particular pack.
20. Additional Sections
Current Egyptian market presentations documented in recent retail listings:
Anti-Cox II 7.5 mg 20 capsules; Anti-Cox II 15 mg 20 tablets; Anti-Cox II 15 mg 30 tablets; Anti-Cox II 15 mg/3 mL 6 ampoules; and Anti-Cox II 15 mg 10 suppositories. These listings demonstrate current market presence but should not by themselves be treated as the regulatory source for formulation authorization or legal prescription status.
Dose principle: The therapeutic objective is the lowest effective dose for the shortest appropriate duration. For adults, the usual maximum systemic daily dose is 15 mg.
Overdose: Excessive NSAID exposure can cause gastrointestinal symptoms, bleeding, renal dysfunction, drowsiness, and other systemic toxicity. Significant overdose requires urgent medical assessment or contact with an appropriate poison-control service; treatment is supportive and specialist-directed.
Important formulation point: Equivalent milligram strengths of different meloxicam formulations should not automatically be assumed to be interchangeable without reference to the applicable product information.
21. Frequently Asked Questions (FAQ)
Is Anti-Cox II a steroid?
No. It contains meloxicam, which is a nonsteroidal anti-inflammatory drug (NSAID).
Is meloxicam a selective COX-2 inhibitor?
It is more accurately described as a preferential COX-2 inhibitor because it inhibits both COX-2 and COX-1. It should not be presented as completely COX-2 selective.
Can Anti-Cox II be taken more than once daily?
Routine adult dosing is once daily. The usual maximum systemic daily dose is 15 mg, and increasing the frequency or combining meloxicam formulations should not be done without medical supervision.
Can Anti-Cox II be taken with ibuprofen, diclofenac, naproxen, or another NSAID?
Generally no, unless specifically directed by a physician, because combining NSAIDs increases toxicity, particularly gastrointestinal and renal toxicity, without reliably improving efficacy.
Can it be taken with aspirin?
Concomitant use may increase gastrointestinal and bleeding risk. Whether aspirin should be continued for cardiovascular protection is an individualized medical decision; meloxicam is not a substitute for prescribed low-dose aspirin.
Does taking meloxicam with food make it safer?
Food does not eliminate NSAID-related ulceration, bleeding, kidney, or cardiovascular risks. Oral meloxicam can generally be taken with or without food; taking it with food may improve tolerability for some patients.
Can the 7.5 mg capsule and 15 mg tablet be substituted freely?
The doses are related, but formulation interchangeability should follow the specific product information and prescriber instructions rather than being assumed solely from the milligram strength.
Is Anti-Cox II safe during pregnancy?
It should not be considered routinely safe during pregnancy. NSAID exposure becomes particularly concerning from approximately 20 weeks onward, and meloxicam should generally be avoided at approximately 30 weeks and later unless a specialist determines otherwise.
Does meloxicam affect the kidneys?
Yes. NSAIDs can reduce renal prostaglandin-mediated blood flow and may precipitate renal injury, especially in dehydration, heart failure, renal disease, older age, or with certain interacting medicines.
Does meloxicam cure arthritis?
No. It provides symptomatic relief of pain and inflammation; it does not cure the underlying degenerative or autoimmune disease.
22. References
- U.S. National Library of Medicine — DailyMed, Meloxicam Tablets, revised January 2025: prescribing information, warnings, dosage, contraindications, interactions, pharmacokinetics and special populations.
- DailyMed — current meloxicam labeling: cardiovascular and gastrointestinal boxed warnings, renal and hepatic precautions, and adverse reactions.
- Medicines.org.uk — Meloxicam 15 mg Summary of Product Characteristics: administration, contraindications, precautions and formulation-specific safety information.
- NCBI Bookshelf / LactMed — Meloxicam, revised July 15, 2025: breastfeeding information.
- NCBI Bookshelf — COX Inhibitors / NSAIDs: pharmacologic classification and COX-1/COX-2 mechanism.
- ADWIA Pharmaceuticals: current company/manufacturing information and Egyptian manufacturing facility details.
- Egyptian retail pharmacy sources: recent Anti-Cox II presentations and pack configurations available in Egypt.