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Last updated: Oct 02, 2020
7 min read

Meloxicam: everything you need to know

Mike Bohl, MD, MPH, ALMchimene richa

Medically Reviewed by Mike Bohl, MD, MPH, ALM

Written by Chimene Richa, MD

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Meloxicam (brand names Mobic and Vivlodex) is a non-steroidal anti-inflammatory drug often used to treat painful inflammatory conditions, like arthritis.

Non-steroidal anti-inflammatory drugs, or NSAIDs for short, act on different parts of the inflammation pathway to decrease the symptoms of pain, swelling, tenderness, fever, and more.

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What is meloxicam used for?

Meloxicam is FDA-approved to treat the following conditions (FDA, 2011): 

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis or joint inflammation. Over a lifetime, your risk of developing OA in your knee is about 46%, and in your hip is 25% (ACR, 2019).

And it’s more than just a wear and tear disease—inflammation causes damage to joints, especially hands, knees, hips, and spine. Less often, osteoarthritis affects the shoulders, elbows, wrists, and ankles. It can affect one joint or several and is more common in middle-aged or older people.

Some people have no symptoms, while others may experience pain, tenderness, decreased range of motion, instability of the joint, bone swelling, or changes in the way the joint looks. Taking meloxicam may help improve your OA symptoms (Doherty, 2019). 

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory condition that typically affects the joints in your hands and feet, as well as your elbows, shoulders, ankles, and knees. RA is an autoimmune disease in which your body attacks its own tissues.

RA causes more than just joint pain and swelling—the inflammation can damage the joints to the point that they become deformed. Some people develop lumps or nodules under the skin in the hands or elbows. RA can also affect your eyes, skin, and lungs. Women are more likely to get RA, and almost 75% of people with RA are women.

Symptoms include joint pain, swelling, decreased joint movement, and stiffness, which is usually worse in the morning. Anti-inflammatory drugs like meloxicam can help with joint pain, swelling, and other symptoms of RA (ACR, 2019).

Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis (JRA), also called juvenile idiopathic arthritis (JIA), is a long-term inflammatory condition that affects children of any age, but usually before age 16. 

JRA can affect fewer than five joints, more than five joints, and the ligaments of the spine. It may also be associated with the skin condition psoriasis and is called psoriatic arthritis (ACR, 2019). 

Like adult RA, JRA is also an autoimmune disease. Symptoms of JRA include limping, fever, joint swelling, and morning stiffness. Meloxicam can help decrease inflammation and improve your symptoms. 

Off-label for gout

Meloxicam is also prescribed off-label for gout flare-ups. Off-label means that it was not specifically FDA-approved to treat this condition.

Gout is an inflammatory condition that causes episodes of pain and joint swelling, especially in the big toe and other areas of the foot. These gout flares are caused by crystals of uric acid that accumulate in the joint space and trigger inflammation.

Certain foods, like shellfish and red meat, and drugs, like aspirin and certain diuretics, increase uric acid levels, which can lead to an attack of gout. Meloxicam can help treat the symptoms of a gout flare-up, but will not stop future attacks (ACR, 2019). 

Meloxicam dosing

Meloxicam tablets are available both as generic meloxicam tablets and under the brand names Mobic and Vivlodex.

Tablets are available in 5 mg, 7.5 mg, 10 mg, and 15 mg strengths. It also comes as a disintegrating tablet (7.5 mg and 15 mg), an oral suspension (7.5 mg/5 mL), and an intravenous (IV) solution (30 mg/mL). Most people usually take one pill by mouth daily. If you miss a dose, take the missed dose as soon as you remember it.

However, if it is almost time for the next dose, skip the missed dose and then get back on your regular schedule. Don’t take a double dose. Most insurance plans cover meloxicam. The cost of a 30-day supply ranges from around $4 to over $400. The price depends on the strength and whether you purchase brand name or generic pills (GoodRx.com).

Side effects

The FDA has issued a black box warning (a serious advisory) regarding severe side effects of meloxicam:

  • Cardiovascular risk: Meloxicam and other NSAIDs may cause an increased risk of heart attack and stroke, especially in people with heart disease or other cardiovascular risk factors. These conditions may be fatal and occur without warning. This risk may be higher if you use meloxicam long-term. Do not use meloxicam to treat pain right before or after heart surgery, such as a coronary artery bypass graft procedure.
  • Gastrointestinal (GI) risk: Meloxicam can increase your risk of bleeding, ulceration, and holes (perforations) in the stomach or intestines—these conditions may be fatal and occur without warning. Older people using meloxicam are at higher risk for these gastrointestinal adverse effects. 

Common side effects of meloxicam include: 

  • Diarrhea
  • Headaches
  • Heartburn
  • Stomach pain
  • Nausea
  • Flatulence (gas)
  • Dizziness 
  • Skin rash
  • Flu-like symptoms

Serious side effects of meloxicam include (DailyMed, 2019): 

  • Heart attacks and strokes
  • Intestinal and stomach bleeding, ulcers, and holes (perforations)
  • Liver toxicity 
  • High blood pressure
  • Worsening heart failure symptoms
  • Kidney problems
  • High potassium levels (hyperkalemia)
  • Severe allergic reactions (hypersensitivity), including anaphylaxis or blistering skin rash (Stevens-Johson syndrome)

Seek medical attention immediately if you experience any of these serious adverse effects. 

This list does not include all possible side effects of meloxicam, and others may occur. Seek medical advice from your pharmacist or healthcare provider for more information. 

Drug interactions

Inform your healthcare provider about any other medications you may be taking before starting meloxicam to prevent potential drug interactions, which include the following (DailyMed, 2019):

  • Blood thinners: Examples include warfarin, antiplatelet agents (aspirin), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Taking any of these medications with meloxicam may increase the risk for bleeding issues.
  • Antihypertensive medications: Drugs that lower blood pressure, like ACE inhibitors (lisinopril), angiotensin receptor blockers (losartan), or beta-blockers (propranolol) may lose their effectiveness if taken with meloxicam. 
  • Diuretics: Meloxicam may decrease the effectiveness of loop diuretics (like furosemide and bumetanide) and thiazide diuretics (like hydrochlorothiazide). Also, there is a higher chance of worsening kidney function if diuretics are used with meloxicam.
  • Methotrexate: Taking methotrexate with meloxicam increases the risk of methotrexate toxicity.
  • Other NSAIDs: Combining meloxicam with other NSAIDs (like acetaminophen and ibuprofen) increases the chance of developing gastrointestinal problems, like bleeding or ulcers.
  • Pemetrexed: Pemetrexed is a chemotherapy drug sometimes used to treat certain types of lung cancers. Using meloxicam with pemetrexed increases the risk of having kidney or gastrointestinal problems. Avoid meloxicam five days before and two days after your pemetrexed treatment.
  • Lithium: Lithium is a mood stabilizer often used to treat bipolar disorder. Combining lithium with meloxicam can lead to higher levels of lithium and increases the risk of lithium toxicity.
  • Cyclosporine: Cyclosporine is a drug often given to people who have received an organ transplant to prevent rejection. Taking meloxicam with cyclosporine can increase the risk of cyclosporine toxicity. 

This list does not include all possible drug interactions with meloxicam, and others may exist. Check with your pharmacist or healthcare provider for more information.

Who should not take meloxicam?

Certain groups of people should use meloxicam with caution, or not take it at all. These groups include (DailyMed, 2019):

  • Pregnant women: Meloxicam is classified as pregnancy category C, which means that there is not enough information to determine the risk to the pregnancy. Before the third trimester, pregnant women and their healthcare providers should weigh the risks and benefits of using meloxicam. After the third trimester, pregnant women should avoid meloxicam because it can cause premature closure of a short blood vessel usually only open in fetal hearts.
  • Nursing mothers: Scientists do not know if meloxicam gets into breastmilk, so nursing mothers and their healthcare providers should weigh the risks and benefits of using the drug.
  • People with heart disease or cardiovascular risk factors: Meloxicam increases the risk of blood clots that can lead to heart attacks and strokes, especially in people with predisposing cardiovascular risk factors like high blood pressure, high cholesterol, or with a history of heart disease. 
  • People with a history of stomach ulcers or stomach bleeding: Meloxicam can cause serious gastrointestinal problems, like stomach bleeding, stomach or intestinal ulcers, and perforations. These events can happen without warning or prior symptoms, and may be fatal.
  • People with liver disease: Elevated liver enzymes may occur with meloxicam, and in rare cases, some people get hepatitis or liver failure. Those with severe liver disease should be cautious when using meloxicam.
  • People with high blood pressure: Taking meloxicam can lead to high blood pressure (hypertension) or worsen existing blood pressure issues. Also, it may decrease the effectiveness of certain blood pressure-lowering medications, like angiotensin-converting enzyme (ACE) inhibitors and diuretics. 
  • People with heart failure: People with heart failure may experience a deterioration of their heart failure symptoms with meloxicam. Some people notice a worsening in fluid retention and swelling (edema). People with heart failure taking meloxicam may also be at higher risk of heart attacks, hospitalizations for heart failure, and death compared to those not taking meloxicam.
  • People with kidney problems: Meloxicam may lead to worsening kidney disease like nephritis or kidney failure. It should not be used in people with severe kidney disease. 
  • Older people: Older people are more likely to experience heart, gastrointestinal, or kidney problems with NSAIDs like meloxicam. Use meloxicam with caution, starting with the lowest effective dose and regular monitoring. 

This list does not include all possible at-risk groups, and others may exist. Talk to your healthcare provider or pharmacist for more information.

References

  1. American College of Rheumatology (ACR). (2019). Retrieved on Sep. 16, 2020 from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions
  2. DailyMed – Meloxicam tablet. (2019) Retrieved on Sep. 16, 2020 from  https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d5e12448-1ca1-46a4-8de4-e8b94567e5a8
  3. Doherty, M. & Abhishek, A. (2019) UpToDate-Clinical manifestations and diagnosis of osteoarthritis. Retrieved on Sep. 16, 2020 from https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-osteoarthritis
  4. GoodRx.com. (n.d.). Meloxicam. Retrieved Sep. 16, 2020 from https://www.goodrx.com/meloxicam
  5. MedlinePlus. (2020). Meloxicam. Retrieved on Sep. 16, 2020 from  https://medlineplus.gov/druginfo/meds/a601242.html
  6. UpToDate. (n.d.). Meloxicam: Drug information. Retrieved on Sep. 16, 2020 from  https://www.uptodate.com/contents/meloxicam-drug-information
  7. U.S. Food and Drug Administration (FDA). (2011). Mobic (meloxicam) tablets and oral suspension. Retrieved on Sep. 16, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/012151s072lbl.pdf