Xifyrm (meloxicam) is a nonsteroidal anti-inflammatory drug (NSAID) that is used to control pain after certain types of surgery. Using Xifyrm may help to reduce the amount of other medicine that you need to control pain during recovery from surgery.
How Does Xifyrm Work?
Xifyrm works to reduce pain and inflammation in the body by reducing a substance called prostaglandin. Unlike other NSAIDs, Xifyrm has a long duration of action, and it only has to be given one time daily to control pain. However, Xifyrm has a delayed onset of action, so you may need another quick-acting medicine for pain relief.
How Is Xifyrm Given?
Xifyrm is a shot that is given by your health care provider in a hospital or clinic. It is injected once daily into a vein and is used alone or with other medicines to help control pain after certain procedures.
How Was Xifyrm Studied?
Xifyrm was studied in two clinical studies to treat pain in people after elective surgery (non-emergency surgery). Xifyrm was compared to a placebo (a dummy medicine that has no effect) in both studies. People in the studies did not know if they were receiving Xifyrm or a placebo. People in both studies were allowed to take rescue pain medicine if it was needed. Pain was assessed in the studies using the numeric pain rating scale (NPRS), which ranges from 0 to 10.
In the first study, 201 people who had a bunionectomy (toe surgery) with moderate or severe pain received Xifyrm or a placebo for two days starting the day after surgery. Most of the people in the study were female (85%) and people were, on average, 40 years of age. After surgery, the average pain score before receiving study medicine was 6.8.
In the second study, 219 people who had an abdominoplasty (tummy tuck) with moderate or severe pain received Xifyrm or a placebo for two days starting the day of surgery. Most patients in the study were female (98%) and were, on average, 40 years of age. After surgery, the average pain score before receiving study medicine was 7.3.
People were allowed in the studies if they were 18 to 75 years of age with a pain score of at least 4 (moderate to severe pain), had a body mass index of less than 35 kg/m2, and were relatively healthy with no major health issues or a history of bleeding problems. People in the studies could not be:
- Pregnant or breastfeeding
- Taking medicines that could affect bleeding or interact with Xifyrm
- Chronically (for more than one month) taking opioids
- Misusing alcohol or other illicit drugs
People with allergies to NSAIDs were not allowed into the studies. The bunionectomy study also did not allow people with any major surgery within the prior three months.
If there were any issues during the surgery, or people getting an abdominoplasty had their procedure last longer than three hours, or a bunionectomy lasted longer than two hours, they were not allowed into the studies.
What Benefits Were Seen With Xifyrm?
People in each study saw more improvement in their pain scores while receiving Xifyrm as compared with a placebo. The average pain intensity was generally lower with Xifyrm as compared with a placebo over each 24-hour period. Both the number of people who needed rescue pain medicine and the number of rescue medicine doses needed were lower among people who got Xifyrm as compared with a placebo.
Your results may differ from what was seen in the clinical studies.
What Medicines can Xifyrm Interact With?
Several medicines can interact with Xifyrm.
Medicines that affect bleeding. When medicines such as blood thinners, aspirin, selective serotonin reuptake inhibitors (SSRIs), or serotonin norepinephrine reuptake inhibitors (SNRIs) are used with Xifyrm, there is an increased risk of bleeding. Watch for stomach pain, indigestion, black tarry poop, and vomiting blood if you are using Xifyrm, and let your health care provider know right away if any of these happen.
Medicines for high blood pressure. Medicines such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), diuretics (water pills), and beta-blockers commonly used for blood pressure control may not work as well when you are using Xifyrm. Your health care provider will likely monitor your blood pressure while you are receiving Xifyrm. Tell your health care provider if you are taking any medicines for high blood pressure.
Lithium. When lithium (Eskalith, Lithobid) is taken with Xifyrm, lithium levels in the blood may increase, so you should look out for side effects. Side effects from lithium that indicate high blood levels include hand trembling, peeing a lot, feeling thirsty, nausea or vomiting, rashes, dizziness, blurry vision, trouble with coordination, or a decreased appetite. Let your health care provider know if any of these happen.
Methotrexate. Use of methotrexate with Xifyrm can increase the risk of side effects from methotrexate, which can include low platelet levels, kidney problems, and low white blood cells. Your health care provider will check your blood to detect these problems. Make sure all of your health care providers know if you are taking methotrexate before starting Xifyrm.
Cyclosporine. When cyclosporine (Gengraf, Neoral, Sandimmune, and others) is used with Xifyrm, your kidney function could worsen. Your health care provider will monitor your kidneys while you receive Xifyrm. Make sure all of your health care providers know if you are taking cyclosporine before starting Xifyrm.
NSAIDs and salicylates. The risk of serious problems in the stomach increases when NSAIDs such as ibuprofen and naproxen (which are included in many over-the-counter products) or salicylates such as diflunisal or salsalate are used with Xifyrm. Use of these medicines with Xifyrm should be avoided.
Pemetrexed. When pemetrexed (Alimta, Pemfexy) is used with Xifyrm, there is an increased risk of your body not producing enough red blood cells and platelets, and for serious problems in the stomach and kidneys. Your health care provider will check your blood to monitor for adverse effects. Tell your health care provider if you notice that your stomach feels any different. Make sure all of your health care providers know if you are taking pemetrexed before starting Xifyrm.
Inhibitors of cytochrome P450 2C9 (CYP2C9). Cytochrome P450 2C9 is an enzyme that processes and removes some medicines from the body. Taking certain inhibitors of this enzyme can increase the risk of side effects from Xifyrm. Ask your pharmacist or health care provider if any of your medicines inhibit CYP2C9.
This is not a complete list of medicines that may interact with Xifyrm. Tell your pharmacist or health care provider about all the prescription or over-the-counter (OTC) medicines, vitamins/herbals, herbal products, or other supplements you have recently taken. This will help them know if there are any interactions with Xifyrm. Talk to your health care provider about all your medical conditions.
What Are Other Unique Considerations to Be Aware Of?
Tell your health care provider right away if you feel that your pain is not well controlled.
Xifyrm should not be used during certain periods of pregnancy. If you are pregnant or think you may be pregnant, talk with your health care provider before using Xifyrm.
Do not use this medicine if you recently had coronary artery bypass graft (CABG) surgery, a type of heart surgery.
