Meloxicam

Overview

Meloxicam, a nonsteroidal anti-inflammatory drug (NSAID), is widely used to relieve pain, inflammation, and stiffness in various conditions, including arthritis, osteoarthritis, and rheumatoid arthritis.

Approved by the FDA in 2000, This medication has become a go-to medication for conditions like osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis. It is available under several brand names, including Mobic, Vivlodex, and Qmiiz ODT, and comes in oral tablets, capsules, and suspension formulations.

What is meloxicam used for?

Osteoarthritis (OA)

Osteoarthritis is a degenerative joint disease that affects millions of people, especially the elderly. This medication helps relieve joint pain, stiffness, and swelling associated with OA, making it easier for patients to move and function in daily life.

Rheumatoid Arthritis (RA)

In autoimmune diseases like RA, the body attacks its own joints, leading to chronic inflammation. This medication reduces inflammation, slowing joint damage and improving mobility.

Juvenile Idiopathic Arthritis (JIA)

This medication is approved for children over 2 years of age diagnosed with JIA, offering a safe and effective option for reducing inflammation and joint pain in pediatric patients.

Ankylosing Spondylitis

Though not formally FDA-approved for this condition, meloxi-cam is often prescribed off-label to manage the symptoms of ankylosing spondylitis—a form of spinal arthritis that leads to stiffness and reduced flexibility.

Acute Musculoskeletal Pain

Short-term use of meloxicam may also be prescribed for sprains, strains, and sports injuries, helping to manage acute inflammation and discomfort.

How Meloxicam Works

Meloxicam selectively inhibits cyclooxygenase-2 (COX-2) more than COX-1, although it still affects both. COX enzymes help convert arachidonic acid into prostaglandins, substances that mediate inflammation and pain.

By inhibiting COX-2 more specifically, meloxi-cam tends to cause fewer gastrointestinal problems like ulcers and bleeding compared to older NSAIDs like ibuprofen or naproxen. However, it’s not completely free from risk.

Dosage and Administration

Meloxicam is typically taken once daily, with or without food. Food may help minimize gastrointestinal discomfort. Common dosages include:

• 7.5 mg once daily – for mild to moderate pain
• 15 mg once daily – for more severe pain
• Children (JIA) – dosage is weight-based

This medication should be taken with a full glass of water and should not be crushed or chewed unless prescribed in a dispersible form.

Common Side Effects

While meloxicam is generally well-tolerated, some side effects may occur. These can range from mild discomfort to more severe complications.

Mild Side Effects

• Upset stomach
• Nausea or vomiting
• Diarrhea or constipation
• Dizziness
• Headache
• Sore throat
• Edema (swelling, often in the lower legs or feet)

Serious Side Effects

• Stomach ulcers or bleeding
• Hypertension (high blood pressure)
• Kidney dysfunction
• Liver damage (elevated liver enzymes)
• Severe allergic reactions (rash, hives, swelling)
• Heart attack or stroke (especially with long-term use)

If any severe symptoms occur—such as chest pain, weakness on one side of the body, slurred speech, black or bloody stools—immediate medical attention is necessary.

Warnings and Precautions

Meloxicam carries boxed warnings from the FDA, highlighting the potential for life-threatening cardiovascular and gastrointestinal risks.

Cardiovascular Risks

• Increases the risk of heart attack and stroke, particularly in people with existing heart disease or prolonged use.
• Should be avoided in the post-operative setting of coronary artery bypass graft (CABG) surgery.

Gastrointestinal Risks

• NSAIDs, including meloxi-cam, can cause serious gastrointestinal bleeding, ulcers, and stomach perforation.
• Risk is higher in older adults, alcohol users, smokers, and those on corticosteroids or anticoagulants.

Kidney Function

• Can cause kidney injury, especially in people with existing kidney disease, heart failure, or those who are dehydrated.
• Should be used with caution in the elderly and patients with compromised kidney function.

Liver Function

• Elevated liver enzymes and liver damage have been reported. Regular monitoring may be needed for long-term use.

Pregnancy and Breastfeeding

• Avoid use in third trimester of pregnancy due to the risk of premature closure of the fetal ductus arteriosus.
• Consult a doctor during the first and second trimesters.
• Use with caution while breastfeeding as small amounts may pass into breast milk.

Allergic Reactions

• Do not use meloxi-cam if allergic to aspirin, NSAIDs, or have had an anaphylactic reaction to similar medications.

Drug Interactions

Meloxicam may interact with several other drugs, altering its effectiveness or increasing the risk of adverse effects.

Common Interactions Include:

Blood Pressure Medications (ACE Inhibitors, ARBs, Diuretics)

• May reduce the effectiveness of antihypertensives.
• Combined use can increase the risk of kidney damage.

Anticoagulants (e.g., Warfarin)

• Increases the risk of bleeding due to its own antiplatelet effect.

Corticosteroids (e.g., Prednisone)

• Enhanced risk of gastrointestinal side effects.

Lithium

• NSAIDs like meloxi-cam can increase lithium levels, risking toxicity.

Methotrexate

• Increases the risk of methotrexate toxicity.

SSRIs (e.g., Fluoxetine)

• Combined use may heighten the risk of GI bleeding.

Tips to Manage Interactions

• Always inform your doctor about all medications and supplements.
• Do not start or stop medications without professional advice.
• Regular blood tests may be needed when combining with other high-risk medications.

Overdose and Missed Dose

Overdose

Symptoms of meloxicam overdose can be serious and include:

• Severe nausea or vomiting
• Drowsiness
• Bleeding in the stomach
• Difficulty breathing
• Seizures
• Coma (in extreme cases)

Emergency medical help is essential in suspected overdose situations. There is no specific antidote for meloxi-cam; treatment is mainly supportive.

Missed Dose

• Take the missed dose as soon as you remember.
• If it’s almost time for your next dose, skip the missed one.
• Do not double the dose to make up for a missed one.

Who Should Not Take Meloxicam?

Meloxicam is not suitable for everyone. It is contraindicated in individuals who:

• Are allergic to meloxi-cam or other NSAIDs
• Have had asthma attacks or allergic reactions to aspirin
• Are undergoing CABG surgery
• Are in the third trimester of pregnancy
• Have active gastrointestinal bleeding or ulcers

Storage and Handling

• Store at room temperature (20-25°C or 68-77°F)
• Keep away from moisture and direct sunlight
• Keep out of reach of children
• Do not use past the expiration date

Patient Tips for Safe Use

1. Take with food to reduce gastrointestinal discomfort.
2. Stay hydrated to help protect kidney function.
3. Avoid alcohol to reduce the risk of stomach bleeding.
4. Monitor blood pressure if you’re on hypertension medications.
5. Schedule regular check-ups if using long-term.
6. Avoid other NSAIDs unless directed by your healthcare provider.
7. Report any signs of bleeding, like black stools or vomiting blood.

Meloxicam vs Other NSAIDs

Drug	COX-2 Selectivity	Common Use	Dosing	GI Risk
Meloxicam	Moderate	Chronic arthritis	Once daily	Moderate
Ibuprofen	Non-selective	Pain, fever	Every 4–6 hrs	Higher
Naproxen	Non-selective	Inflammation, arthritis	Twice daily	Moderate
Celecoxib	COX-2 selective	Arthritis, pain	Once/twice daily	Lower GI risk

This medication is a balanced option for those who need a once-daily NSAID with moderate GI and cardiovascular risk profiles.

Conclusion

Meloxicam is an effective NSAID for relieving pain, inflammation, and stiffness in various conditions. However, it’s essential to be aware of its potential side effects, warnings, and precautions to ensure safe use. Patients should follow their doctor’s instructions carefully and report any unusual symptoms or side effects. By understanding the uses, side effects, and precautions associated with meloxi-cam, patients can make informed decisions about their treatment and maintain optimal health.

Frequently Asked Questions (FAQs) About Meloxicam