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Meloxicam

Meloxicam

Mobic Vivlodex Qmiiz ODT Movalis Mobicox Recoxa

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Updated: December 06, 2025

Overview

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic and antipyretic properties. It is commonly prescribed for the management of inflammatory conditions such as osteoarthritis and rheumatoid arthritis due to its preferential inhibition of cyclooxygenase-2 (COX-2) over COX-1, which may result in a lower incidence of gastrointestinal side effects compared to non-selective NSAIDs. As a long-acting NSAID with a half-life of 15-20 hours, meloxicam allows for once-daily dosing. It demonstrates good oral bioavailability and extensive protein binding. While generally well-tolerated, it carries the same class warnings as other NSAIDs regarding cardiovascular, gastrointestinal, and renal risks.

Drug Class

Nonsteroidal anti-inflammatory drug (NSAID) Preferential COX-2 inhibitor Therapeutic category: Analgesic, Anti-inflammatory, Antipyretic

Mechanism of Action

Meloxicam works by reversibly inhibiting cyclooxygenase (COX) enzymes, particularly COX-2, which is responsible for prostaglandin synthesis at sites of inflammation. This inhibition: • Reduces prostaglandin-mediated pain and inflammation • Has less effect on COX-1 in gastric mucosa (compared to non-selective NSAIDs) • Decreases production of inflammatory mediators (PGE2, PGI2)

Pharmacokinetics

Absorption: Well-absorbed orally (89% bioavailability), reaches peak plasma concentration in 4-5 hours Distribution: Extensive tissue distribution, 99% protein-bound (primarily to albumin), volume of distribution ~10 L Metabolism: Hepatic via CYP2C9 (major) and CYP3A4 (minor) to inactive metabolites Excretion: Urine (45%) and feces (47%) as metabolites, <5% as unchanged drug Half-life: 15-20 hours (prolonged in elderly and renal impairment)

Pharmacodynamics

• Anti-inflammatory effects via reduced prostaglandin synthesis • Analgesic effects through peripheral pain receptor modulation • Antipyretic action via hypothalamic thermoregulatory center • Reduced gastric prostaglandin production compared to non-selective NSAIDs • Dose-dependent COX-2 selectivity

Indications

• Osteoarthritis: Management of signs and symptoms • Rheumatoid arthritis: Reduction of pain, swelling, and joint stiffness • Juvenile rheumatoid arthritis: Treatment in patients ≥2 years (oral suspension)

Contraindications

Absolute: • Hypersensitivity to meloxicam or other NSAIDs • History of asthma, urticaria, or allergic reactions after taking NSAIDs • Perioperative pain in coronary artery bypass graft (CABG) surgery Relative: • Active peptic ulcer disease/GI bleeding • Severe heart failure (NYHA Class IV) • Severe renal impairment (CrCl <30 mL/min) • Third trimester pregnancy

Dosage & Administration

Osteoarthritis: 7.5 mg once daily, may increase to 15 mg if needed Rheumatoid arthritis: 15 mg once daily Juvenile rheumatoid arthritis (≥2 years): 0.125 mg/kg daily, max 7.5 mg Maximum dose: 15 mg/day regardless of indication

Special Populations

Pediatric: Not recommended <2 years; use weight-based dosing for JRA Geriatric: Start with lowest effective dose (increased risk of adverse effects) Renal impairment: Avoid in severe impairment (CrCl <30 mL/min) Hepatic impairment: Use caution in moderate-severe impairment (Child-Pugh B/C)

Adverse Effects

Common (>10%): • Dyspepsia (10-15%) • Nausea (5-10%) • Diarrhea (5-7%) Serious (<1%): • GI bleeding/perforation • Acute renal failure • Cardiovascular thrombotic events • Anaphylaxis • Stevens-Johnson syndrome

Drug Interactions

• Warfarin: Increased bleeding risk (monitor INR) • ACE inhibitors/ARBs: Reduced antihypertensive effect • Diuretics: Reduced diuretic efficacy and renal function • Lithium: Increased lithium levels • Methotrexate: Increased methotrexate toxicity • SSRIs/SNRIs: Increased GI bleeding risk

Warnings & Precautions

• Increased risk of serious cardiovascular thrombotic events • GI bleeding/ulceration/perforation (can occur without warning) • Hypertension exacerbation/worsening heart failure • Renal toxicity in volume-depleted patients • Severe skin reactions (SJS, TEN) • Hematologic toxicity (anemia, leukopenia)

Pregnancy & Lactation

Pregnancy: Avoid in third trimester (risk of premature ductus arteriosus closure) FDA Category C (first/second trimester), D (third trimester) Lactation: Low concentrations in breast milk; use caution (AAP considers compatible)

Monitoring Parameters

• Renal function (BUN, creatinine) at baseline and periodically • Blood pressure • CBC for anemia (chronic use) • Liver function tests (chronic use) • GI symptoms/signs of bleeding • Fluid retention signs (edema, weight gain)

Patient Counseling

• Take with food or milk to reduce GI upset • Report signs of GI bleeding (black stools, abdominal pain) • Watch for swelling or sudden weight gain • Avoid alcohol (increases GI bleeding risk) • Don't crush or chew tablets • Use lowest effective dose for shortest duration

Storage & Stability

Store at 20-25°C (68-77°F) Protect from moisture Oral suspension: Store at room temperature, discard after 6 months of opening

Clinical Pearls

• COX-2 selectivity may reduce but not eliminate GI risks • Consider PPI co-therapy in high GI risk patients • More suitable for chronic use than short-term pain management • Avoid abrupt discontinuation after long-term use • Less effect on platelet function than non-selective NSAIDs

References

• UpToDate: Meloxicam drug information • Lexicomp: Meloxicam monograph • FDA Prescribing Information for Mobic • Brunton LL, Hilal-Dandan R, Knollmann BC. Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 13th ed • American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults