Meloxicam Explained: Uses, Dosage, And Side Effects
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common and most widely used drugs available on the market. According to StatPearls, they are a group of similar-acting medications, loosely categorized into seven types based on their chemical structure. Generally, they are used to relieve pain, reduce fever, and help tone down inflammation. Not all NSAIDs are able to do all three, and some may work better than others. The type of NSAID you will be prescribed with will depend on your specific needs and underlying conditions. They come in a variety of formulations and dosages; some of them are available over-the-counter, while others you can only get through a doctor's prescription. They are notorious for their tendency to cause several side effects, mostly involving the gut, heart, kidneys, liver, and blood.
Some of the most common over-the-counter (OTC) NSAIDs include aspirin (Bayer), ibuprofen (Advil, Motrin), and naproxen (Aleve). NSAIDs are also available as combination drugs like Excedrin and Pamprin Max Formula, both of which are a mixture of acetaminophen, aspirin, and caffeine. (It is important to note that acetaminophen is technically not an NSAID, even though it works similar to them and is often displayed in the same area as them.)
Per Cleveland Clinic, these OTC NSAIDs are typically used for minor aches and pains. On the other hand, prescription-strength NSAIDs are typically given to those with moderate to severe pain, usually caused by rheumatologic conditions. An example of this is meloxicam. Read about its uses, dosage, and side effects here.
How does meloxicam work?
Meloxicam is a prescription-only NSAID. According to Mayo Clinic, it is available as an oral capsule, oral tablet, orally disintegrating tablet, liquid suspension, and injection solution. Its brand names include Vivlodex, Qmiiz, Mobic, and Anjeso.
As an NSAID, meloxicam works by inhibiting enzymes referred to as cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2). Some NSAIDs selectively inhibit COX-2 only, but meloxicam inhibits both. By blocking COX, meloxicam is able to decrease the production of specific prostaglandins in the body (via Drugbank).
Prostaglandins are fatty substances that act like hormones (per Healthline). They have varying and often opposing effects depending on their type, but generally affect blood vessels (narrow or dilate), airways (open up or constrict), platelets (clot or break apart), gut muscles (contract or relax), and the uterus (contractions and cramping). They can also mediate the sensation of pain by increasing or decreasing it, as well as promote inflammation. Meloxicam specifically acts on the prostaglandin responsible for inflammation, making it an effective drug in reducing swelling, pain, and fever.
Interestingly, inhibition of COX-2 is the desired effect of NSAIDs, because COX-2 is the main pathway that leads to inflammation. On the other hand, COX-1 helps maintain the integrity of the lining in the gut. By inhibiting COX-1, the protective barrier of the gut becomes weak, increasing a person's risk of developing ulcers and bleeding (per StatPearls). Although meloxicam inhibits both, its effect on COX-1 is weak compared to its effect on COX-2, making meloxicam less likely to cause gut problems compared to other NSAIDs.
Meloxicam for osteoarthritis
According to the National Institute on Aging (NIA), osteoarthritis is a very common, long-term, degenerative condition that occurs mostly in older adults. Similar to an old door hinge, as time passes, the material between our joints serving as cushions and shock-absorbers slowly and progressively break down. This natural "wear and tear" occurs with aging, after decades of using our joints for bending and moving. It can cause stiffness, varying degrees of pain, swelling, and tenderness. You may also hear or feel crunching as the bones rub against each other.
This can happen to anyone, but certain things can cause it to develop earlier in life, such as being overweight or obese, having a family history of osteoarthritis, having deformed joints, overusing joints with repetitive movements (e.g., athletes), injuring a joint, and having surgery done on a joint. Any joint can develop osteoarthritis, but the most common areas are the neck, hands, lower back, hips, knees, and feet.
Although there is no cure for osteoarthritis, there are things that can be done to prevent it from getting worse. These include exercises for increasing strength and flexibility, weight management, medications, and surgery. Medications such as meloxicam are typically prescribed to help with pain and inflammation. Therapy usually begins at an initial dose of 7.5 milligrams (tablet) or 5 milligrams (capsule) once a day, but this can be increased to up to 15 milligrams (tablet) or 10 milligrams (capsule) once a day if the pain is persistent.
Meloxicam for rheumatoid arthritis
Unlike osteoarthritis, rheumatoid arthritis (RA) does not occur due to overuse or aging. It is an autoimmune condition, which means that the immune system mistakenly identifies a normal part of the body as harmful (per the Arthritis Foundation). In the case of RA specifically, the target is the lining of the joints, also known as the synovium. When this happens, the joints become inflamed and get stiff, painful, red, and swollen. It often develops in the joints of the hands, knees, and ankles, but can also cause problems in other areas of the body such as the skin, eyes, mouth, heart, lungs, blood, and blood vessels. It is still unclear how RA develops in certain people, but it is theorized that genetics play a role. It is more commonly seen in middle-aged women and people with a family history of RA.
According to Healthline, the treatment of RA typically involves a combination of physical therapy, occupational therapy, medications, surgery, and dietary and lifestyle changes. Because it is a life-long condition, the goals of treatment are to relieve pain, prevent further destruction of the joints, and maintain your ability to move. One of the medications that can be used to help relieve the symptoms of RA is meloxicam in the form of oral tablets or orally disintegrating tablets. A doctor will initially prescribe 7.5 milligrams once daily, but it can be maxed up to a dose of 15 milligrams once a day.
Meloxicam for juvenile rheumatoid arthritis
As explained by Johns Hopkins Medicine, juvenile rheumatoid arthritis or juvenile idiopathic arthritis (JIA) is a transient form of arthritis that can develop in children who are 16 years old or younger. There are many different types, including ones that affect only a few joints (oligoarticular arthritis), affect multiple joints (polyarticular arthritis), are related to psoriasis (psoriatic arthritis), and cause damage to the whole body (systemic onset arthritis).
Much like RA, JIA is an autoimmune disease that is most likely linked to a person's genetics. It can cause inflammation of the joints, but can also lead to fatigue, delayed growth, poor weight gain, decreased appetite, fever, swollen lymph nodes, and skin rash. Unlike RA, children typically have resolution of their JIA as they grow older, but because the disease happens during childhood when bone development is at its peak, they can develop early bone disease such as osteoporosis.
Treatment of JIA includes medications, physical and/or occupational therapy, lifestyle and dietary changes, and possibly surgery. Medications that can be given to children with JIA include NSAIDs, disease-modifying antirheumatic drugs (DMARDs), biologic agents, and steroids (per Mayo Clinic). The dose of medications prescribed are typically lower in children compared to adults. For meloxicam specifically, children can be given meloxicam suspension based on their weight (0.125 milligrams per kilogram). The greater their weight, the higher the dose. Alternatively, children who weigh 60 kilograms or more can be given 7.5 milligrams of oral tablets once a day.
Meloxicam for ankylosing spondylitis
Ankylosing spondylitis (AS) is a relatively rare autoimmune condition that causes arthritis of the backbone (i.e., the spine). Similar to other forms of arthritis in adults, it is a chronic condition with no cure. However, with early and proper treatment, it is possible to manage symptoms and prevent the condition from getting worse.
Males are more likely to develop AS compared to females, and the condition often starts before a person reaches their 30s. It typically begins at the lower back area, right where the spine meets the hip bones. It can spread upward towards the neck, and may even affect other joints throughout the body. AS can cause the individual bones in the back to fuse and become weak, leading to a stiff, inflexible, and painful spine that can be prone to fractures. It can also cause impingement of nerves, which can result in loss of reflexes, bowel control, bladder control, and sexual function and interest (via WebMD).
Per the National Institute of Arthritis and Musculoskeletal and Skin Diseases, to help manage AS, doctors may prescribe medications, refer you to a physical therapist, and/or recommend that you undergo surgery, depending on what is most appropriate for your specific condition. Medical management of AS can include NSAIDs, steroids, biologic agents, and janus kinase inhibitors, or a combination of any of these drugs. According to Profiles of Drug Substances, Excipients and Related Methodology, if meloxicam is used to help relieve AS symptoms, it is usually prescribed as a single 15-milligram dose, taken by mouth once daily.
Meloxicam for pain relief
Oral forms of meloxicam are typically prescribed for pain relief, especially in people with arthritic conditions. However, according to a 2018 review in the Journal of Anesthesiology and Clinical Pharmacology, liquid meloxicam administered through a vein (i.e., intravenously or IV) also exists, and is used to treat acute pain, specifically after surgery.
There are also meloxicam adhesive films that are locally applied to mucosal surfaces that have been used to help relieve pain after dental surgery, as well as adhesive patches and gels that can be applied to the skin to relieve pain from a specific area in the body. Based on the authors' findings, studies show that IV meloxicam in dosages of 30 or 60 milligrams provided fast and significant relief of pain, and transmucosal meloxicam with concentrations of 30 and 45 milligrams quickly and adequately controlled pain, without causing any serious side effects. Research also suggests that meloxicam administered intravenously or directly into the spinal canal may have a role in the treatment of pain due to neuropathy.
In 2020, another review in Pain Management looked into the safety and efficacy of IV meloxicam in the treatment of pain following surgery. Based on the results of available studies, not only was IV meloxicam effective in causing pain relief following various types of surgeries, but the side effects experienced by the patients who were given IV meloxicam were no different to the side effects felt by the patients on placebo.
Known side effects of meloxicam
Meloxicam comes with a multitude of side effects. Because it also weakly inhibits COX-1, which is important for maintaining the protective barrier of the gut, it can commonly cause gastrointestinal symptoms like abdominal pain, indigestion, heartburn, excess gas, diarrhea, and constipation.
Other less common side effects you may also experience include bloating, belching, unusual taste in your mouth, altered taste sensation, increased appetite, sore throat, itchy and/or watery eyes, changes in vision, sunken eyes, dry mouth, increased thirst, hot flushes, hearing loss, ringing in the ears, breathing fast, dizziness or vertigo, wrinkled skin, hair loss or thinning, sleep problems, drowsiness, difficulty concentrating, nervousness, irritability, depression, anxiety, confusion, malaise, and tingling or numbness. You may also become more prone to bleeding, which can manifest as bleeding gums, blood in the urine, pinpoint dots on your skin, bruising, bloody bowel movements, and weakness.
You may also develop an allergic reaction, which can present as itching, skin rashes, blisters, peeling skin, fever, swelling (face, lips, tongue, eyelids, throat), shortness of breath, difficulty swallowing, hoarse voice, rapid heartbeat, and pale skin. If you are experiencing any symptoms after taking meloxicam, let your doctor know right away. You will likely need to take a different type of medication. If your symptoms are severe, do not hesitate to call 911 or go to your nearest emergency room.
What to take note of before taking meloxicam
Before giving you meloxicam, your doctor will go over your medical history. This includes taking note of any known allergies you may have, reviewing all of your underlying health conditions (if any), and asking you about alcohol, tobacco, or recreational drug use (per WebMD).
That being said, if you have previously had an allergic reaction to meloxicam, other NSAIDs, or any of their ingredients, it is important to let your doctor know. According to the U.S. Pharmacist, hypersensitivity reactions to NSAIDs can either be allergic or non-allergic, but they may be difficult to clinically distinguish between one another. Non-allergic reactions to NSAIDs are typically caused by inhibition of COX-1, and can be avoided with the use of antihistamines, desensitization, or substituting with COX-2 selective NSAIDs. Meanwhile, allergic reactions to NSAIDs are more related to a chemical structure of a compound, meaning any drug with a similar structure to the drug that you are allergic to should be avoided.
Additionally, let your doctor know if you have any history of asthma, liver disease, gastrointestinal problems, kidney disease, heart problems, strokes, blood disorders, or nasal polyps. These conditions may worsen if you take meloxicam. Tell your doctor also if you actively smoke and regularly drink alcohol, as these can increase your risk of stomach ulcers and bleeding. Lastly, let them know if you use marijuana; both alcohol and marijuana can make you drowsy, which can get worse while taking meloxicam (via WebMD).
Who should not take meloxicam?
Meloxicam comes with a black box warning, an emphasized statement printed on the packaging of certain drugs disclosing important safety information.
Per Medical News Today, anyone taking meloxicam is at an increased risk of developing life-threatening cardiovascular complications such as blood clots, heart attacks, and strokes. This can be worsened by taking meloxicam for long periods of time, taking it at high doses, having pre-existing heart conditions, or being at risk of developing heart disease prior to taking the drug (e.g., high blood pressure, high cholesterol, smoking). This risk is not only limited to meloxicam, but other NSAIDs as well (except for aspirin).
Meloxicam can also increase a person's risk of developing ulcers in the stomach or intestines. This is especially common in older adults, and people who have a history of gastrointestinal bleeding or peptic ulcer disease. If left untreated, ulcers can bleed, perforate the lining of the gut, or penetrate into the walls of nearby organs. These complications can quickly become life-threatening, but what makes it even more dangerous is that you can sometimes develop ulcers without having any symptoms (per Epocrates).
In addition to these black box warnings, the FDA states that pregnant women at 20 weeks or later should avoid taking any NSAIDs because it can affect proper development of their unborn baby's kidneys. Women should also try to avoid meloxicam if they are trying to get pregnant, as it can cause temporary infertility via delayed ovulation (via Medical News Today).
Substances that may interact with meloxicam
According to GoodRx, the main substances that can cause unwanted effects when taken together with meloxicam include other NSAIDs, antihypertensives, blood thinners, antidepressants, lithium, methotrexate, and alcohol.
Unless specifically advised by your doctor, do not take more than one type of NSAID. This can significantly increase your risk of developing gastrointestinal complications such as ulcers and bleeding. You may also be at an increased risk of bleeding if you take meloxicam together with certain antidepressants (e.g., escitalopram, sertraline, fluoxetine), as well as blood thinners like warfarin, apixaban (Eliquis), and clopidogrel (Plavix). As a weak COX-1 inhibitor, meloxicam can inhibit the production of thromboxane A2, an important substance that promotes aggregation of platelets. Following this, meloxicam theoretically has blood thinning capabilities, although some studies seem to prove otherwise.
Certain antihypertensives (e.g., losartan, lisinopril, hydrochlorothiazide) can increase the risk of kidney damage associated with meloxicam. Meloxicam can also reduce the effect of these medications. On the other hand, meloxicam can raise the concentration of lithium (a drug used to manage bipolar disorder) and methotrexate (used for autoimmune conditions like rheumatoid arthritis) in the body to toxic levels.
Lastly, according to Addiction Resource, people taking meloxicam should avoid drinking alcohol as much as possible. Not only does alcohol aggravate the gastrointestinal side effects associated with meloxicam, but it can also independently cause kidney and liver damage, increase the risk of heart disease and its associated complications, and promote acute gout attacks (especially in people with acute gouty arthritis).
What to do if you miss a dose or take too much
While meloxicam can be prescribed for managing both acute and chronic pain, you should always take it as directed by your doctor. Do not prematurely adjust the dose, duration, or frequency of your medication without consulting a healthcare professional.
If you forget a single dose, take it as soon as you remember, and adjust your schedule accordingly; do not try to make up for the dose that you missed (per MedlinePlus). However, if you continuously forget to take meloxicam, you may not get its full effects and your symptoms may not get better. As explained by Medical News Today, this is because a certain concentration of the drug must be maintained in the body for it to work. If you find yourself not being able to stick to your medication schedule, try to use a pill reminder or speak with your doctor. They may be able to switch you to a medication that has a more convenient schedule, or give you advice on how to remember to take your medicine.
In contrast, if you took too much meloxicam, speak with your doctor right away or call the national poison control centers at 1-800-222-1222. Depending on how much you took and your underlying conditions, you may experience nausea, vomiting, abdominal pain, blood in your stool, weakness, drowsiness, shortness of breath, seizures, and/or loss of consciousness. If you are having severe, persistent, or worsening symptoms, call 911 or go to your nearest emergency room immediately.
Alternatives to meloxicam
If your doctor prescribed meloxicam for you and it does not work, they may try to give you other types of NSAIDs, provided that you did not develop an allergic reaction, any adverse effects, or worsening of an existing condition, while taking meloxicam. For example, celecoxib, naproxen, and diclofenac can also be used to manage osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis.
According to SingleCare, your doctor may also give you medication that belongs to a completely different drug class, depending on your specific health condition. Specifically, corticosteroids (e.g., prednisone, hydrocortisone, dexamethasone, methylprednisolone) can help reduce inflammation and pain due to arthritis; the antidepressants duloxetine and venlafaxine have also been found to be a good secondary option to help relieve chronic muscle pain (via the Arthritis Foundation).
If you have heart disease or cardiovascular risk factors and need medication to treat pain, Harvard Health suggests using safer alternatives like acetaminophen (i.e., paracetamol), diclofenac gel directly applied to the skin (Voltaren), topical lidocaine, and aspirin. In addition, regardless if you are using an NSAID or some other medication to treat your pain, you should also supplement this with lifestyle changes (e.g., regular exercise, weight loss) and physical therapy when appropriate. You can also try alternative medicine practices such as massage therapy and acupuncture, especially if you find them to be effective in relieving your pain.