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Meloxicam: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on June 22, 2021.

1. How it works

  • Meloxicam may be used to relieve pain and inflammation associated with several different medical conditions, trauma, or surgery.
  • Meloxicam works by blocking the effects of the enzymes cyclooxygenase (COX)-1 and COX-2 which prevents prostaglandin synthesis. Prostaglandins elevate body temperature and make nerve endings more sensitive to pain transmission.
  • Meloxicam belongs to a group of medicines known as NSAIDs (nonsteroidal anti-inflammatory drugs).

2. Upsides

  • Effective for the relief of pain and inflammation associated with osteoarthritis and rheumatoid arthritis.
  • May be used to treat menstrual cramps, headaches, colds, or flu symptoms.
  • NSAIDs (including meloxicam) are considered first-line options for mild-to-moderate arthritis-type pain because at correct dosages they are effective, do not cause dependence, and are readily available at a low cost.
  • Relieves pain and inflammation.
  • Available alone and some NSAIDs are available in combination with other medications.
  • May be taken with or without food.
  • Available as oral tablets, capsules, and a suspension. The tablets and suspension are bioequivalent. The suspension is preferred in children weighing less than 60kg because it is easier to calculate the dosage.
  • Dosage adjustment is not necessary for mild to moderate hepatic or renal impairment. Has not been studied in those with severe liver or kidney disease.
  • Generic meloxicam is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Stomach-related side effects including indigestion, heartburn, and bleeding. Constipation, diarrhea, flatulence, nausea, vomiting, or bleeding may also occur. People who are older, taking other medicines that affect the stomach, or who drink more than 3 glasses of alcohol per day may be more at risk of side effects, including stomach-related ones. Meloxicam is considered to have a low potential for stomach-related side effects compared with other NSAIDs.
  • Most NSAIDs have been associated with an increased risk of stroke or heart attack. The risk may be higher in patients with preexisting cardiovascular conditions and with higher dosages. NSAID use may cause or worsen high blood pressure or increase the risk of hospitalization for heart failure.
  • May not be suitable for some people including those with kidney disease, a history of stomach ulcers or other gastrointestinal disorders, pre-existing cardiovascular disease, or a history of recurrent heart attacks. Do not give to patients who have recently had coronary artery bypass graft surgery.
  • May increase liver enzymes up to three-fold. Fatal liver injury is rare. Long-term use may also damage the kidneys, and patients should be monitored for signs of worsening renal function. Increases in potassium levels may also be reported.
  • Not a substitute for aspirin for the prevention of cardiovascular events.
  • May interact with some other medicines such as warfarin, SSRIs, ACE inhibitors, and diuretics.
  • NSAIDs, such as meloxicam should not be used during the last three months of pregnancy because they can cause premature closure of the fetal ductus arteriosus. In addition, the use of NSAIDs at around 20 weeks gestation or later in pregnancy may cause fetal kidney problems leading to oligohydramnios (low amniotic fluid volume) and in some cases kidney impairment. If NSAID treatment is deemed necessary between 20 and 30 weeks of pregnancy, use the lowest effective dose for the shortest possible time. Avoid NSAIDs after 30 weeks gestation.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Meloxicam is effective for the short-term relief of pain and inflammation associated with arthritis; however, like other NSAIDs, it has the potential to adversely affect the stomach or heart and increase bleeding tendency.

5. Tips

  • Can be taken without regard to meals.
  • Use the lowest effective dose for the shortest duration of time.
  • Available as a suspension, tablet, or capsule.
  • Response to different NSAIDs can vary so switching types (such as from meloxicam to naproxen) may improve response.
  • NSAIDs should not be used in the last 3 months of pregnancy; always ask your doctor before using any medication during pregnancy. Do not use NSAIDs such as meloxicam between 20 and 30 weeks gestation without your doctor's advice because this may cause kidney problems and low amniotic fluid volumes in the newborn. Acetaminophen may be considered to treat pain and inflammation during pregnancy.
  • Many products used to treat cold and flu, pain, or sleep disturbances may also contain NSAIDs. Do not double up on NSAIDs and always check with your doctor or pharmacist that meloxicam is safe to take with other medications you may be taking.
  • Avoid if you have a history of asthma or hives after taking aspirin or other NSAIDs, like ibuprofen.
  • Combining with alcohol may increase the risk of stomach ulcers or bleeding.
  • Do not use this medicine in the setting of heart bypass surgery (CABG).
  • See a doctor immediately if you experience any difficulty with breathing, unexplained sickness or fatigue, loss of appetite, vision changes, fluid retention, abnormal bleeding, or any other worrying side effects.

6. Response and effectiveness

  • Peak concentrations are reached within 2 hours (capsule) and 4 to 5 hours (tablets). Meloxicam appears to be recycled in the liver so another peak is reached in 8 hours (capsule) or 12-14 hours (tablet) after the initial dose.

7. Interactions

Medicines that interact with meloxicam may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with meloxicam. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with meloxicam include:

  • ACE inhibitors or ARBs, such as captopril, enalapril, or losartan (monitor BP)
  • antibiotics, such as ciprofloxacin or vancomycin
  • anticoagulants (blood thinners) such as apixaban, dabigatran, fondaparinux, heparin, or warfarin
  • antidepressants, such as citalopram, escitalopram, fluoxetine, or paroxetine
  • antifungals, such as voriconazole
  • aspirin
  • beta-blockers, such as acebutolol, atenolol, bisoprolol, or carvedilol
  • bisphosphonates, such as alendronate
  • diuretics (water pills), such as chlorthalidone, chlorothiazide, hydrochlorothiazide, or furosemide
  • HIV medications (eg, Stribild, tenofovir)
  • other nonsteroidal anti-inflammatories (NSAIDs), such as celecoxib, diclofenac, etodolac, ibuprofen, ketorolac, nabumetone, or naproxen
  • sulfonylureas (a type of diabetes medication), such as glimepiride, glyburide, or glipizide
  • supplements, such as glucosamine, omega-3 fatty acids, vitamin E
  • others, such as cyclosporine, lithium, methotrexate, pemetrexed, pirfenidone, or tacrolimus.

Drinking alcohol while taking meloxicam may increase the risk of gastrointestinal-related side effects or kidney damage.

Note that this list is not all-inclusive and includes only common medications that may interact with meloxicam. You should refer to the prescribing information for meloxicam for a complete list of interactions.

References

Meloxicam. Revised 11/2020. AHSP. https://www.drugs.com/monograph/meloxicam.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Meloxicam only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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