Drug of the Month – Vivlodex™ (meloxicam)

by Alan Rook, PharmD, Clinical Pharmacist
Krupa Patel, PharmD candidate

What is Vivlodex?

Vivlodex (meloxicam) is a single-source brand medication that was FDA approved in October 2015 for the management of osteoarthritis (OA) pain. Vivlodex is a nonsteroidal anti-inflammatory drug (NSAID) that prevents the synthesis of prostaglandins in body tissue by inhibiting COX-1 and COX-2. Current Official Disability Guidelines (ODG) suggest that the use of NSAIDs for osteoarthritis is “recommended at the lowest dose for the shortest period in patients with moderate to severe pain.” Additionally, the ODG says that NSAIDs “have fewer side effects than muscle relaxants and narcotic analgesics,” which explains the widespread use of NSAIDs in workers’ compensation.

The drug’s manufacturer, Iroko Pharmaceuticals, developed a capsule that contains micro-particles of the drug that provide for increased surface area.  This results in faster dissolution of the drug and lower effective doses.

Vivlodex is available as 5 mg and 10 mg capsules. For management of osteoarthritis pain, the recommended starting dosage is 5 mg orally once daily. The maximum recommended daily oral dose is 10 mg.

Benefit vs Cost-effectiveness

The manufacturer defends the drug’s price increase because of the reformulation to the lowest effective dose. However, there is no current evidence to support that dose differences would have a beneficial effect on potential cardiovascular and gastrointestinal adverse events in chronic use patients.

Additionally, the ODG states:

“…there is no evidence to recommend one drug in this class (NSAIDs) over another based on efficacy. In particular, there appears to be no difference between traditional NSAIDs and COX-2 NSAIDs in terms of pain relief. The main concern of selection is based on adverse effects. COX-2 NSAIDs have fewer GI side effects at the risk of increased cardiovascular side effects.” Vivlodex is also considered an “N” drug on the ODG formulary.

Therefore, myMatrixx recommends treatment with more cost-effective generic formulations available that may be equally suitable choices as part of a patient’s therapeutic medication regimen.

AWP Pricing for Vivlodex vs. Generic Meloxicam

The Average Wholesale Price (AWP) of Vivlodex is $23.76 per 5 mg and 10 mg capsules. This medication is dosed once daily, requiring 30 capsules per month—making the AWP $712.8 for a 30-day supply. However, meloxicam is available as a generic in strengths of 7.5 mg and 15 mg tablets, which is a more cost-effective option. For a 30-day supply of meloxicam, the AWP is approximately $144.9 for 15 mg tablets (dosed once daily) and $190.08 for 7.5 mg tablets (dosed twice daily).

Considering that the same amount of pain relief is provided, this difference in pricing is significant. Therefore, myMatrixx recommends the use of a generic drug as an alternative for its lower cost and similar dosing schedule.