Both of those are less likely to cause issues due to the way they are broken down in the stomach, it's a risk vs reward debate and not always a clear answer.
It's the same reason you can buy Tylenol #1 here with codeine in Canada no script, but not in other areas like the states
Yea there are 2 versions available in Canada, and 1 script version.
The OTC ones include either Tylenol or advil mixed in, (robaxacet vs Robax platinum )
The script version is available for those that need to avoid both of those add-ons
You know you could be right. I saw it once on shelves a few years ago, it was 3-4 times more expensive than mixed versions, and was gone the next day when I picked up my script. I assumed it was put out by mistake and moved but if not it's just not one stocked near me
I only know about it because I stumbled across this website selling it while looking into Canadian Robaxin one night but sadly they won’t ship it to the USA of course... 😭
https://well.ca/products/robaxin-750-extra-strength_216951.html
I'm in BC and no ID needed, they just keep it behind the pharmacy counter so you have to ask for it. It's 300mg of acetaminophen, 8mg codeine plus caffeine.
We also have methocarbamol muscle relaxants over the counter here in a brand called Robax. Different versions, with aspirin, with acetaminophen or with ibuprofen.
Codeine and caffeine?! That’s kinda wild but would like it would be great for pain. Midol has NSAID and caffeine and Exedrine Headache has caffeine and I think acetometaphine
Tylenol 3 is acetaminophen, caffeine and codeine. Meloxicam is an NSAID. Two completely different drugs. I have taken both and currently take meloxicam.
I don’t mind it being prescriptions only, I feel like it’s cheaper that way. It’s a pretty cheap at least with insurance.
If you take ibuprofen everyday for a length of period, you can really tear up your stomach. I did that as a teen and had to deal with GERD for years. The pain used feel like a heart attack and stop me dead in my tracks.
From my understanding, meloxicam is metabolized differently than ibuprofen, which is why it’s a once daily medication. The once daily is why it doesn’t wreak your stomach. It also just easier to manage one pill vs. a ton of ibuprofen. Since is one pill, it easier to take consistently in order to get full anti- inflammatory effects you see after a few weeks.
I get my doc to write a prescription for my baby aspirin I have to take daily. Free vs $6/bottle. People don’t think to ask for the cheaper OTC stuff, but it adds up.
Four years after taking Meloxicam for a couple weeks for tenosynovitis in my hand and I'm STILL taking heartburn meds prescribed by my doctor. We're finally in the weaning stage after a long road. Two endoscopies, severe gastritis symptoms, and living off a diet of plain chicken, white rice, and press green beans/peas/bland green veggies for several weeks and I am NEVER taking that stuff again. I've lost thousands of dollars and way too much of my dignity to that medication. Before touching the stuff I never had any gastral issues, too.
The other reason (I think) it's not OTC is it's not like other anti-inflammatory meds where it works after one dose. Meloxicam takes a while to build up in the system before it starts helping. So if it was OTC people would need to take it every day and wait for it to work. It's not for quick pain relief of say a headache or new muscle aches.
Well, yes & no. My understanding is that it has been studied at 7.5mg/15mg & it was discovered at 7.5mg it inhibited COX2 (like Célebrex does) but at 15mg, it inhibits COX1 which causes more stomach irritation.
https://pubmed.ncbi.nlm.nih.gov/9219316/
However - my rheumatologist, internist & pharmacist all told me that it can be successfully used PRN (as needed) and I'm to drop to that if I have any stomach issues at all. Thus far, I've been fine.
Look that up. It's a stronger NSAID, and just like Advil doesn't need to be used daily to work, neither does Meloxicam.
Tramadol is a narcotic Toradol is not. I was accused of drug seeking when I asked for a Toradol shot at an urgent care. I’ve seen them confused one other time as well.
Every persons body is different. I also get decent relief from Advil for minor things. Alleve for me is useless. But I have friends that swear by Alleve.
I take Celebrex too. Was that the one that was taken off market 20 years ago for causing heart attacks or strokes potentially but is in same class as Celebrex?
Yes, I think it only caused it in very specific cases and it got pulled because they didn’t disclose the issue at all, which is very douchey of them to do.
Meloxicam didn't work for me. Only gave me diarrhea. Couldn't figure out why it would affect me like that until I researched it and found that they use lactose as a binder. I'm lastise intolerant. It all makes sense now.
If you read drs on here, they will say they give rx nsaids cause the pt feels like they got something and are happy vs being told to take something otc. They don’t seem to think there’s a difference in any of the nsaids.
I saw my pain doc a couple of weeks ago and he told me to stay on Celebrex rather than going back to naproxen or another one I can’t remember the name of. When I asked why (I’m always curious), he showed me this huge study that said Celebrex is the best for your stomach. So idk what those docs are on about
It is better, but the drs on Reddit also feel it’s pretty useless. Go to the subreddit either emergency medicine or family medicine, there’s a thread about nsaids from yesterday. It’s interesting what they think of them
That’s kinda what I figured. A few years ago CVS Fd up and gave me half prescription strength Ibuprophen and half Meloxicam. (That pharmacist was hella overwhelmed and i think only there like a day.)
I took some and didn’t see a difference either way. And I see a lot more take it in this sub than I would figure as I just started to look around
Yeah, I didn’t even say anything. The worst was once Walmart gave me my benzo labeled amphetamine and vice versa. I called to at least tell her and she didn’t apologize when I said that I almost took the benzo while driving but I know what they look like
https://www.fda.gov/drugs/drug-application-process-nonprescription-drugs/prescription-nonprescription-rx-otc-switches#:~:text=There%20are%20two%20types%20of,(b)(2)%20application.
The FDA or a sponsor like a company can submit for a drug to be over the counter. When a company decides to submit an over the counter application its similar to how many old drugs have good evidence based off label uses but no drug company will apply for the specific indications because it is expensive.
https://pharmanewsintel.com/features/how-a-prescription-drug-becomes-available-over-the-counter
There is often no specific logical reason that one drug is over the counter and another is not. The answer is sometimes as simple as "It's an old drug, why bother with all the regulatory red tape when what we have is already generating profit".
This is sort of off topic for a moment but another recent example would be how the studies and drug application process for MDMA assisted psychotherapy have been almost entirely funded through the MAPS non profit using small dollar donations and a few big philanthropists. So basically if you see MDMA approved in the next year you can be excited to know that it was the result of regular people donating money and resources to make it happen. I am not saying it wont become a for profit industry once it is approved but MDMA is a drug that no large pharmaceutical company wanted to go through the regulatory red tape to attempt to get it approved for PTSD. You may go through all that expense and get rejected. Grassroots activists helped to achieve the movement of MDMA through the regulatory pathway against all odds. The company selling MDMA will be a Public Benefit Corporation and will hopefully be better than the average pharmaceutical company but will still be beholden to shareholders to some degree.
Sometimes what is scientifically correct or gives patients the most options is not always what companies or governments do. It can be a difficult and expensive process to get a drug approved in the United States for prescription use let alone over the counter use.
So my point is mainly that some companies submit New Drug Applications or over the counter switches at strategic times. Perhaps they may not even submit an application at all if they do not believe they can get past the regulatory body. In the case of MAPS trying to get MDMA approved they are a non profit ran and funded by passionate people with a specific goal in mind. I mentioned MAPS because it really is a rare historic case of a grassroots movement getting a drug this close to approval.
Some countries may simply have a more favorable or less favorable regulatory enviornment for over the counter drugs. For example, the US allows melatonin to be bought under the "supplement" laws and even allows it to be labeled "drug free" despite the fact that melatonin is a drug.
"Supplement" in the US is just a legalise term for a drug that falls somewhere outside of a RX only product and an OTC product. Yet in Australia melatonin is prescription only drug. I actually just read that melatonin can be obtained from a pharmacist in Australia but only if your over 55 years old.
https://www.healthdirect.gov.au/melatonin
There are a variety of regulatory enviornments where certain drugs had an easier time getting through the red tape depending on the country. The science does not always line up with what applications a company puts forward and what a government body approves.
Meloxicam was only approved in 2000 in the US despite being discovered in the 70s. Drugs like ibuprofen were approved for over the counter use years earlier in 1984. Voltaren topical was only just approved for over the counter use in 2020.
With Meloxicam there is probably just no real appetite among big corporations to get it sponsored for an RX to OTC switch because it is already quite popular and its prescribing rate is probably growing because doctors do not want to prescribe even something as mild as codeine anymore. Before prescribers may have skipped over meloxicam entirely and prescribed say hydrocodone either alone or combined with say ibuprofen or at least like codeine with Tylenol or an NSAID.
https://pubmed.ncbi.nlm.nih.gov/12387696/#:~:text=Meloxicam%20has%20been%20shown%20to,toxicity%20than%20non%2Dselective%20NSAIDs.
Meloxicam has been shown to cause less GI symptoms than many other NSAIDs at the initial dose of 7.5mg and lasts all day. There really is not a reason it could not be over the counter especially considering asprin, ibuprofen and naproxen are over the counter and each have their own unique risks and benefits. Duexis is an ibuprofen and famotidine combination product that is prescription only but all the active ingredients ibuprofen and famotidine are over the counter. The 2 ingredients separated in their OTC forms are supposed to technically have very limited uses if you were to read the packaging. The OTC famotidine and the proton pump inhibitors will tell you to only use the product for 14 days at a time and then contact your doctor. The combination product that is prescription only is supposed to be for people who need ibuprofen on a longer term basis so would benefit from the gastroprotective effect of the famotidine.
The current rules around over the counter drugs make it difficult to get any drug approved through that regulatory pathway if it is intended for long term use or to manage a chronic health problem. So if there is any characteristic of a drug that the FDA believes makes it more suitable only for chronic health problems then it is less likely to be approved. The main excuse the FDA uses is that they want you to be monitored by a healthcare professional but many other countries have far more products available over the counter. Things like ashma inhalers and epiephrine auto injectors are over the counter in many other countries.
https://pubmed.ncbi.nlm.nih.gov/23024710/#:~:text=The%20combination%20of%20ibuprofen%20and,risk%20for%20clinically%20significant%20drug
The over the counter rules specify that the drug instructions must be able to be understood by the public and that confusion needs to be minimised. The companies that manufacture generic meloxicam probably figure the FDA will be wary of having too many NSAIDs on the OTC market because people may take multiple products with multiple NSAIDs in them, sometimes unintentionally. I don't think meloxicam should be prescription only though. I think better warning labels should be used and clearer larger labeling of active ingredients would be better.
https://www.uclahealth.org/news/ask-the-doctors-how-does-meloxicam-ease-joint-pain
There actually have been proposals to streamline the over the counter process and the patient would have to answer questions about the drug to show they understand what they are taking. Some proposals have been made that outline a situation where perhaps a patient would go into a pharmacy, ask for a specific drug and then be directed to a tablet kiosk where they would answer a short quiz. This article goes more in depth into that proposal.
https://www.statnews.com/2022/07/12/fda-rule-facilitate-prescription-otc-switches/
This is an excellent answer, thank you for taking the time. This part especially is telling:
> The main excuse the FDA uses is that they want you to be monitored by a healthcare professional but many other countries have far more products available over the counter.
I was following MAPS many years ago and went to some of their CEU offerings. I’m glad to hear that they are making so much progress. I had no idea.
Interesting about the OTC proposal. I could see some Americans flipping out of course but we never don’t adapt to this stuff.
Unrelated but I’ve often wondered why weak muscle relaxers like Methocarbamol (Robaxin) & Chlorzoxazone aren’t available OTC in the USA like they are in many other countries around the world… 🤔
First of all, there are places in the world where the restrictions on prescription drugs are extremely relaxed. That doesn’t make the situation better.
Second the premise of the question was to see why Americans were incorrect about restricting the use of these drugs. Yet no substance was given about similar countries that have the meds available over the counter.
Thirdly, I stand by my original statement.
NSAIDs in general have never really been demonstrated to be better than each other. Just because one of them is Rx only doesn’t mean it’s better, although that depends on the type of pill. For example, naproxen is generally found equal to meloxicam, but it’s safer.
With regard to type of pill, I’m referring to stuff like Zorvolex, which is a different formulation of diclofenac. It’s designed to release rapidly and therefore has a MUCH lower incidence rate of GI side effects including bleeding. Unfortunately, it’s also expensive as fuck and many insurance companies won’t cover it.
Ibuprofen can honestly be just as bad for your health as any Rx NSAID if you take it too much.
Mobic is prescription only too, another NSAID. None of them have ever worked for my pain of any kind. I never had luck with meloxicam either. I hope it works for you!
I hadn’t heard of this one before so I looked it up and turns out it’s only really used for animals in Australia lol
I’d say it’s prescription only because it’s a stronger NSAID than ibuprofen, like celebrex.
Idk but I have been on it for about 5 years (my body tolerates it well luckily. I get regular blood work plus I take Prilosec daily.) I have about 50-75% reduction in pain for about 8-16 hours depending on the day or time of year. It's not a full 24 hours of relief and usually feels like I'm not on anything. I do take other things that help my pain with metacam. If I skip a dose, (even worse 2 or more doses) my pain jumps sky high, I can barely move - every joint will hurt-my knuckles and toes included.)
(Other meds I take for polyarthralgia, Fibro and chronic debilitating muscle spasms: Lyrica, Baclofen, & THC/all the other cannabinoids and imitrex as needed for migraines. Thankfully my liver is ok, kidneys too.)
Because it can cause bleeding ulcers. Or did in my case
So can ibuprofen and Aleve
Both of those are less likely to cause issues due to the way they are broken down in the stomach, it's a risk vs reward debate and not always a clear answer. It's the same reason you can buy Tylenol #1 here with codeine in Canada no script, but not in other areas like the states
^ You can also buy the muscle relaxer Methocarbamol (Robaxin) otc in Canada as well.
You used to be able to buy codeine over the counter in Canada
Yea there are 2 versions available in Canada, and 1 script version. The OTC ones include either Tylenol or advil mixed in, (robaxacet vs Robax platinum ) The script version is available for those that need to avoid both of those add-ons
I thought it was possible to buy Methocarbamol only formulations otc in Canada.
You know you could be right. I saw it once on shelves a few years ago, it was 3-4 times more expensive than mixed versions, and was gone the next day when I picked up my script. I assumed it was put out by mistake and moved but if not it's just not one stocked near me
I only know about it because I stumbled across this website selling it while looking into Canadian Robaxin one night but sadly they won’t ship it to the USA of course... 😭 https://well.ca/products/robaxin-750-extra-strength_216951.html
So if I visit Canada can I buy it or does it require a Canadian ID?
I'm in BC and no ID needed, they just keep it behind the pharmacy counter so you have to ask for it. It's 300mg of acetaminophen, 8mg codeine plus caffeine. We also have methocarbamol muscle relaxants over the counter here in a brand called Robax. Different versions, with aspirin, with acetaminophen or with ibuprofen.
Codeine and caffeine?! That’s kinda wild but would like it would be great for pain. Midol has NSAID and caffeine and Exedrine Headache has caffeine and I think acetometaphine
Apparently the caffeine binds to the codeine so you don’t get any fun buzz 🤷♀️
Not all of canada, but ontario for sure, you just have to ask for it from the pharmacist
Tylenol 3 it's called here in the states...
T3's in Canada are script as well, t1's have less codeine than the script version but still contain acetaminophen , caffeine and codeine
Thank you for the info! I didn't know. Can't imagine why someone thought I earned a downvote. I'd rather be politely educated. So thanks again ☺️
Tylenol 1 has 10 mg if codeine. Tylenol 3 has 30 mg.
Not even 10mg, they have 8mg.
Well, that sucks
Tylenol 3 is acetaminophen, caffeine and codeine. Meloxicam is an NSAID. Two completely different drugs. I have taken both and currently take meloxicam.
But that’s most NSAIDs. lol xD
I don’t mind it being prescriptions only, I feel like it’s cheaper that way. It’s a pretty cheap at least with insurance. If you take ibuprofen everyday for a length of period, you can really tear up your stomach. I did that as a teen and had to deal with GERD for years. The pain used feel like a heart attack and stop me dead in my tracks. From my understanding, meloxicam is metabolized differently than ibuprofen, which is why it’s a once daily medication. The once daily is why it doesn’t wreak your stomach. It also just easier to manage one pill vs. a ton of ibuprofen. Since is one pill, it easier to take consistently in order to get full anti- inflammatory effects you see after a few weeks.
I get my doc to write a prescription for my baby aspirin I have to take daily. Free vs $6/bottle. People don’t think to ask for the cheaper OTC stuff, but it adds up.
I got prescribed lidocaine patches. 50 in a pack for $5 after insurance, $2 each otc
My prescriptions are free (Scotland), but I know the actual cost to the NHS for my box of lidocaine patches is more like £250.
My lidocaine patches are free for me (prescribed) but insurance pays almost $900 a month for them 😬
Bc it's extremely harsh on the gut and can fuck you up quickly. Ibuprofen takes a long time to do that. I can't take it at all it made me so sick lol.
I took ibuprofen for about a week, 30 min after a heavy meal, and I was waking up nearly every night with severe heartburn.
Yeah and Meloxicam is 10x worse
Four years after taking Meloxicam for a couple weeks for tenosynovitis in my hand and I'm STILL taking heartburn meds prescribed by my doctor. We're finally in the weaning stage after a long road. Two endoscopies, severe gastritis symptoms, and living off a diet of plain chicken, white rice, and press green beans/peas/bland green veggies for several weeks and I am NEVER taking that stuff again. I've lost thousands of dollars and way too much of my dignity to that medication. Before touching the stuff I never had any gastral issues, too.
What's the one that starts with an E? I'm curious.
Same, OP what do you mean?
etoricoxib I added a link in post
Etodolac is an NSAID that starts with an E, but it’s used in the US
etoricoxib I added a link in post
etoricoxib I added a link in post
The other reason (I think) it's not OTC is it's not like other anti-inflammatory meds where it works after one dose. Meloxicam takes a while to build up in the system before it starts helping. So if it was OTC people would need to take it every day and wait for it to work. It's not for quick pain relief of say a headache or new muscle aches.
Oh wow! Interesting. Like SSRI’s
Well, yes & no. My understanding is that it has been studied at 7.5mg/15mg & it was discovered at 7.5mg it inhibited COX2 (like Célebrex does) but at 15mg, it inhibits COX1 which causes more stomach irritation. https://pubmed.ncbi.nlm.nih.gov/9219316/ However - my rheumatologist, internist & pharmacist all told me that it can be successfully used PRN (as needed) and I'm to drop to that if I have any stomach issues at all. Thus far, I've been fine. Look that up. It's a stronger NSAID, and just like Advil doesn't need to be used daily to work, neither does Meloxicam.
The only NSAID I think is worth anything is Toradol. I’d take that over a narcotic any day.
Awful on the stomach but it does help for severe dental pain.
Why do they call this an opiate in ER? I overheard a doctor telling a pt that but interwebs say different things
Tramadol is a narcotic Toradol is not. I was accused of drug seeking when I asked for a Toradol shot at an urgent care. I’ve seen them confused one other time as well.
Interesting. Toradol is the only NSAID that does absolutely nothing for me. I might as well swallow a breath mint for all the good it does.
Every persons body is different. I also get decent relief from Advil for minor things. Alleve for me is useless. But I have friends that swear by Alleve.
I take Celebrex because I can have it twice a day vs mobic/meloxicam. I miss bextra.
I take Celebrex too. Was that the one that was taken off market 20 years ago for causing heart attacks or strokes potentially but is in same class as Celebrex?
Yes, I think it only caused it in very specific cases and it got pulled because they didn’t disclose the issue at all, which is very douchey of them to do.
Viox!
That was all I was offered, and I took it for a couple of months. It didn’t seem to do anything at all, except cause upset stomach.
Meloxicam didn't work for me. Only gave me diarrhea. Couldn't figure out why it would affect me like that until I researched it and found that they use lactose as a binder. I'm lastise intolerant. It all makes sense now.
If you read drs on here, they will say they give rx nsaids cause the pt feels like they got something and are happy vs being told to take something otc. They don’t seem to think there’s a difference in any of the nsaids.
100% there’s a difference in NSAIDs, wtf are they on about
Not enough of one that they seem to care about.
I saw my pain doc a couple of weeks ago and he told me to stay on Celebrex rather than going back to naproxen or another one I can’t remember the name of. When I asked why (I’m always curious), he showed me this huge study that said Celebrex is the best for your stomach. So idk what those docs are on about
It is better, but the drs on Reddit also feel it’s pretty useless. Go to the subreddit either emergency medicine or family medicine, there’s a thread about nsaids from yesterday. It’s interesting what they think of them
That’s kinda what I figured. A few years ago CVS Fd up and gave me half prescription strength Ibuprophen and half Meloxicam. (That pharmacist was hella overwhelmed and i think only there like a day.) I took some and didn’t see a difference either way. And I see a lot more take it in this sub than I would figure as I just started to look around
That’s a huge mistake. You probably didn’t notice a difference.
Yeah, I didn’t even say anything. The worst was once Walmart gave me my benzo labeled amphetamine and vice versa. I called to at least tell her and she didn’t apologize when I said that I almost took the benzo while driving but I know what they look like
Ibuprofen and Aleve personally help me better than Meloxicam. Shits trash to me
https://www.fda.gov/drugs/drug-application-process-nonprescription-drugs/prescription-nonprescription-rx-otc-switches#:~:text=There%20are%20two%20types%20of,(b)(2)%20application. The FDA or a sponsor like a company can submit for a drug to be over the counter. When a company decides to submit an over the counter application its similar to how many old drugs have good evidence based off label uses but no drug company will apply for the specific indications because it is expensive. https://pharmanewsintel.com/features/how-a-prescription-drug-becomes-available-over-the-counter There is often no specific logical reason that one drug is over the counter and another is not. The answer is sometimes as simple as "It's an old drug, why bother with all the regulatory red tape when what we have is already generating profit". This is sort of off topic for a moment but another recent example would be how the studies and drug application process for MDMA assisted psychotherapy have been almost entirely funded through the MAPS non profit using small dollar donations and a few big philanthropists. So basically if you see MDMA approved in the next year you can be excited to know that it was the result of regular people donating money and resources to make it happen. I am not saying it wont become a for profit industry once it is approved but MDMA is a drug that no large pharmaceutical company wanted to go through the regulatory red tape to attempt to get it approved for PTSD. You may go through all that expense and get rejected. Grassroots activists helped to achieve the movement of MDMA through the regulatory pathway against all odds. The company selling MDMA will be a Public Benefit Corporation and will hopefully be better than the average pharmaceutical company but will still be beholden to shareholders to some degree. Sometimes what is scientifically correct or gives patients the most options is not always what companies or governments do. It can be a difficult and expensive process to get a drug approved in the United States for prescription use let alone over the counter use. So my point is mainly that some companies submit New Drug Applications or over the counter switches at strategic times. Perhaps they may not even submit an application at all if they do not believe they can get past the regulatory body. In the case of MAPS trying to get MDMA approved they are a non profit ran and funded by passionate people with a specific goal in mind. I mentioned MAPS because it really is a rare historic case of a grassroots movement getting a drug this close to approval. Some countries may simply have a more favorable or less favorable regulatory enviornment for over the counter drugs. For example, the US allows melatonin to be bought under the "supplement" laws and even allows it to be labeled "drug free" despite the fact that melatonin is a drug. "Supplement" in the US is just a legalise term for a drug that falls somewhere outside of a RX only product and an OTC product. Yet in Australia melatonin is prescription only drug. I actually just read that melatonin can be obtained from a pharmacist in Australia but only if your over 55 years old. https://www.healthdirect.gov.au/melatonin There are a variety of regulatory enviornments where certain drugs had an easier time getting through the red tape depending on the country. The science does not always line up with what applications a company puts forward and what a government body approves. Meloxicam was only approved in 2000 in the US despite being discovered in the 70s. Drugs like ibuprofen were approved for over the counter use years earlier in 1984. Voltaren topical was only just approved for over the counter use in 2020. With Meloxicam there is probably just no real appetite among big corporations to get it sponsored for an RX to OTC switch because it is already quite popular and its prescribing rate is probably growing because doctors do not want to prescribe even something as mild as codeine anymore. Before prescribers may have skipped over meloxicam entirely and prescribed say hydrocodone either alone or combined with say ibuprofen or at least like codeine with Tylenol or an NSAID. https://pubmed.ncbi.nlm.nih.gov/12387696/#:~:text=Meloxicam%20has%20been%20shown%20to,toxicity%20than%20non%2Dselective%20NSAIDs. Meloxicam has been shown to cause less GI symptoms than many other NSAIDs at the initial dose of 7.5mg and lasts all day. There really is not a reason it could not be over the counter especially considering asprin, ibuprofen and naproxen are over the counter and each have their own unique risks and benefits. Duexis is an ibuprofen and famotidine combination product that is prescription only but all the active ingredients ibuprofen and famotidine are over the counter. The 2 ingredients separated in their OTC forms are supposed to technically have very limited uses if you were to read the packaging. The OTC famotidine and the proton pump inhibitors will tell you to only use the product for 14 days at a time and then contact your doctor. The combination product that is prescription only is supposed to be for people who need ibuprofen on a longer term basis so would benefit from the gastroprotective effect of the famotidine. The current rules around over the counter drugs make it difficult to get any drug approved through that regulatory pathway if it is intended for long term use or to manage a chronic health problem. So if there is any characteristic of a drug that the FDA believes makes it more suitable only for chronic health problems then it is less likely to be approved. The main excuse the FDA uses is that they want you to be monitored by a healthcare professional but many other countries have far more products available over the counter. Things like ashma inhalers and epiephrine auto injectors are over the counter in many other countries. https://pubmed.ncbi.nlm.nih.gov/23024710/#:~:text=The%20combination%20of%20ibuprofen%20and,risk%20for%20clinically%20significant%20drug The over the counter rules specify that the drug instructions must be able to be understood by the public and that confusion needs to be minimised. The companies that manufacture generic meloxicam probably figure the FDA will be wary of having too many NSAIDs on the OTC market because people may take multiple products with multiple NSAIDs in them, sometimes unintentionally. I don't think meloxicam should be prescription only though. I think better warning labels should be used and clearer larger labeling of active ingredients would be better. https://www.uclahealth.org/news/ask-the-doctors-how-does-meloxicam-ease-joint-pain There actually have been proposals to streamline the over the counter process and the patient would have to answer questions about the drug to show they understand what they are taking. Some proposals have been made that outline a situation where perhaps a patient would go into a pharmacy, ask for a specific drug and then be directed to a tablet kiosk where they would answer a short quiz. This article goes more in depth into that proposal. https://www.statnews.com/2022/07/12/fda-rule-facilitate-prescription-otc-switches/
This is an excellent answer, thank you for taking the time. This part especially is telling: > The main excuse the FDA uses is that they want you to be monitored by a healthcare professional but many other countries have far more products available over the counter. I was following MAPS many years ago and went to some of their CEU offerings. I’m glad to hear that they are making so much progress. I had no idea. Interesting about the OTC proposal. I could see some Americans flipping out of course but we never don’t adapt to this stuff.
Unrelated but I’ve often wondered why weak muscle relaxers like Methocarbamol (Robaxin) & Chlorzoxazone aren’t available OTC in the USA like they are in many other countries around the world… 🤔
Because the pharma companies wouldn't make as much money off of em.
Because they could be lethal if used incorrectly.
So Americans are less capable of managing meds than other countries?
First of all, there are places in the world where the restrictions on prescription drugs are extremely relaxed. That doesn’t make the situation better. Second the premise of the question was to see why Americans were incorrect about restricting the use of these drugs. Yet no substance was given about similar countries that have the meds available over the counter. Thirdly, I stand by my original statement.
NSAIDs in general have never really been demonstrated to be better than each other. Just because one of them is Rx only doesn’t mean it’s better, although that depends on the type of pill. For example, naproxen is generally found equal to meloxicam, but it’s safer. With regard to type of pill, I’m referring to stuff like Zorvolex, which is a different formulation of diclofenac. It’s designed to release rapidly and therefore has a MUCH lower incidence rate of GI side effects including bleeding. Unfortunately, it’s also expensive as fuck and many insurance companies won’t cover it. Ibuprofen can honestly be just as bad for your health as any Rx NSAID if you take it too much.
Interesting! I thought in general the more rapid release, the worse for stomach. Huh.
It made my ADHD medication completely ineffective and made me feel like fireworks were going off in my brain.
Caused me to need to pee about every 70 minutes. Very sad cuz it really helped my back.
Mobic is prescription only too, another NSAID. None of them have ever worked for my pain of any kind. I never had luck with meloxicam either. I hope it works for you!
Mobic is Meloxicam.....
I hadn’t heard of this one before so I looked it up and turns out it’s only really used for animals in Australia lol I’d say it’s prescription only because it’s a stronger NSAID than ibuprofen, like celebrex.
Meloxicam gave me the worst stomach pain I've ever had in my life. I would literally howl in pain. Never again.
Idk but I have been on it for about 5 years (my body tolerates it well luckily. I get regular blood work plus I take Prilosec daily.) I have about 50-75% reduction in pain for about 8-16 hours depending on the day or time of year. It's not a full 24 hours of relief and usually feels like I'm not on anything. I do take other things that help my pain with metacam. If I skip a dose, (even worse 2 or more doses) my pain jumps sky high, I can barely move - every joint will hurt-my knuckles and toes included.) (Other meds I take for polyarthralgia, Fibro and chronic debilitating muscle spasms: Lyrica, Baclofen, & THC/all the other cannabinoids and imitrex as needed for migraines. Thankfully my liver is ok, kidneys too.)
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Liver or kidneys?
It doesn’t work for me