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Sep 24, 2020
6 min read

What is meloxicam used for? warnings, doses, and more

There is a black box warning about the side effects of meloxicam. A black box warning is the FDA’s most serious advisory on a medication, which comes in the insert for some medications. Meloxicam may increase the risk of heart attacks and strokes, especially in people with heart disease or other cardiovascular risk factors.

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 is a prescription non-steroidal anti-inflammatory drug (NSAID), a type of painkiller, used to treat medical conditions characterized by pain and swelling like arthritis.

Meloxicam is sold as generic meloxicam tablets and under the brand names Mobic and Vivlodex. Generic meloxicam is sometimes referred to as generic Mobic.

The U.S. Food and Drug Administration (FDA) has approved meloxicam to treat pain in patients who have osteoarthritis (the most common form of arthritis), rheumatoid arthritis (a chronic inflammatory condition), and juvenile rheumatoid arthritis. None of these conditions can be cured, but the pain associated with joint inflammation can be managed with NSAIDs like meloxicam (FDA, 2012).

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Meloxicam may also be used off-label to treat the pain associated with gout flare-ups. Gout is a painful type of arthritis characterized by sudden pain, redness, and swelling that most commonly affects one joint of the big toe, but can appear in any joint in the body. It results from a buildup of uric acid in the body, and a range of behavioral factors can trigger flare-ups or attacks in susceptible individuals.

Certain foods, like shellfish and red meat, and drugs, such as aspirin and certain diuretics (“water pills”), increase the levels of uric acid in the body. Meloxicam can help manage gout symptoms but will not prevent future attacks (Gaffo, 2019; Jin, 2012).

Meloxicam dosage

Generic meloxicam tablets and brand name Mobic or Vivlodex tablets are available in 5 mg, 7.5 mg, 10 mg, and 15 mg dosages. There are multiple forms of this medication. Meloxicam comes as an oral suspension (7.5 mg/5 ml), a disintegrating tablet (7.5 mg and 15 mg dosages), and an intravenous (IV) solution (30 mg/mL). IV meloxicam is used in a hospital setting.

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 take your next dose as usual. Don’t take a double dose. Meloxicam tablets should be stored at room temperature and out of the reach of children.

A 30-day supply of meloxicam costs between $4 to over $400 (GoodRx.com). The price depends on the strength and whether you purchase brand name or generic pills. Many insurance plans cover meloxicam.

How long does it take for meloxicam to work?

It may take time to feel the full effects of meloxicam. One study that looked at how the medicine helped RA patients over 18 months found the effectiveness of meloxicam increased during the first six months but plateaued after that.

However, those with RA may begin to feel some relief as early as three weeks into treatment. Another study that only tested the NSAID for three weeks still found a significant improvement in morning joint pain by the end of the study.

Patients with osteoarthritis may experience improvements in their joint pain after two weeks of treatment. Researchers noted evidence that meloxicam was working after just two weeks in patients given both 7.5 mg and 15 mg daily doses of the prescription drug. The results were also dose-dependent; those given higher doses of meloxicam experienced more relief.

Meloxicam side effects

The most common side effects of meloxicam are diarrhea, indigestion, and flu-like symptoms. Other possible side effects include headache, dizziness, skin rash, and other gastrointestinal issues such as heartburn, nausea, and gas (DailyMed, 2019).

The FDA issued a black box warning about this medication and its serious potential side effects on the gastrointestinal (GI) system. Meloxicam can increase your risk of bleeding, ulceration, and perforations in the stomach or intestines. These conditions may occur without warning and may be fatal.

Older people and those with a prior history of GI problems using meloxicam are at higher risk for these adverse effects. Note that this drug does not need to be taken by mouth to cause digestive problems. It does the same when administered as an injection.

NSAIDs act on different parts of the inflammation pathway to decrease symptoms such as swelling. Meloxicam also interferes with blood clotting and slows clotting time. This may increase your risk of bleeding (Martini, 2014).

Drug interactions

Certain medications may increase the risk of bleeding if taken with meloxicam. Blood thinners (like warfarin), antiplatelet agents (such as aspirin), selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors should not be taken with meloxicam for this reason.

Smoking or drinking alcohol while taking meloxicam also increases your risk of bleeding problems. Meloxicam may render medications to treat high blood pressure less effective. Drugs that lower blood pressure like ACE inhibitors, angiotensin receptor blockers, or beta-blockers may be less effective if taken with meloxicam. 

Meloxicam may have this effect on other medications such as diuretics, which are drugs that reduce fluid retention. Loop diuretics (like furosemide), and thiazide diuretics, such as hydrochlorothiazide, may not work as well if taken with meloxicam. These medications may worsen kidney function if taken together, potentially causing kidney failure.

Combining meloxicam with other NSAIDs, including over-the-counter ones like naproxen, acetaminophen, or ibuprofen, increases the chance of developing gastrointestinal problems like bleeding or ulcers.

Warnings and risks

There is a black box warning about the side effects of meloxicam. A black box warning is the FDA’s most serious advisory on a medication, which comes in the insert for some medications.

Meloxicam may increase the risk of heart attacks and strokes, especially in people with heart disease or other cardiovascular risk factors. This risk may be higher if you use meloxicam long-term.

Meloxicam should not be used to treat pain right before or after heart surgery, like a coronary artery bypass graft (CABG) procedure, as NSAIDs increase the risk of heart attack or stroke following these procedures. Meloxicam can also increase the risk of bleeding, ulceration, and holes in the stomach or intestines (Kulik, 2015). 

NSAIDs such as meloxicam should also not be taken during the third trimester of pregnancy. These medications may interfere with how the fetus’s heart develops, redirecting blood flow that may result in progressive heart problems later on (Enzensberger, 2012). 

If you’re breastfeeding, discuss meloxicam use with a medical professional. It isn’t known if this medication gets into breastmilk. A healthcare professional can help weigh the benefits of using this medication while nursing.

People who are or wish to become pregnant should discuss NSAID use with a healthcare provider. NSAID use is associated with infertility, which may mean it’s necessary to discontinue use in individuals having a hard time getting pregnant (Bermas, 2014). 

You should seek medical attention immediately if you experience severe abdominal pain, black or bloody stool, dizziness, or loss of consciousness.

Meloxicam may cause severe allergic reactions. Signs of an allergic reaction include hives, trouble breathing, shortness of breath, or a blistering skin rash. If you experience any of these symptoms, get medical help immediately (DailyMed, 2019).

References

  1. American College of Rheumatology (ACR). (2019). Gout. Retrieved on Sep. 16, 2020 from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout
  2. Bloor, M. & Paech, M. (2013). Nonsteroidal Anti-Inflammatory Drugs During Pregnancy and the Initiation of Lactation. Anesthesia & Analgesia, 116(5), 1063-1075. doi:10.1213/ane.0b013e31828a4b54. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23558845/
  3. Bermas, B. L. (2014). Non-steroidal anti-inflammatory drugs, glucocorticoids and disease modifying anti-rheumatic drugs for the management of rheumatoid arthritis before and during pregnancy. Current Opinion in Rheumatology, 26(3), 334-340. doi:10.1097/bor.0000000000000054. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24663106/
  4. DailyMed. (2019). Meloxicam tablet. Retrieved on Sep. 16, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d5e12448-1ca1-46a4-8de4-e8b94567e5a8
  5. Enzensberger, C., Wienhard, J., Weichert, J., Kawecki, A., Degenhardt, J., Vogel, M., & Axt-Fliedner, R. (2012). Idiopathic Constriction of the Fetal Ductus Arteriosus. Journal of Ultrasound in Medicine, 31(8), 1285-1291. doi:10.7863/jum.2012.31.8.1285. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22837295/
  6. Gaffo, A. L. (2019). Treatment of gout flares. Retrieved Sep. 18, 2020 from https://www.uptodate.com/contents/treatment-of-gout-flares/
  7. GoodRx.com. (n.d.). Meloxicam. Retrieved Sep. 16, 2020 from https://www.goodrx.com/meloxicam
  8. Jin, M., Yang, F., Yang, I., Yin, Y., Luo, J. J., Wang, H., & Yang, X. F. (2012). Uric acid, hyperuricemia and vascular diseases. Frontiers in Bioscience (Landmark edition), 17, 656–669. doi:10.2741/3950. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247913/
  9. Kulik, A., Bykov, K., Choudhry, N. K., & Bateman, B. T. (2015). Non-steroidal anti-inflammatory drug administration after coronary artery bypass surgery: Utilization persists despite the boxed warning. Pharmacoepidemiology and Drug Safety, 24(6), 647-653. doi:10.1002/pds.3788. Retrieved from https://scholar.harvard.edu/files/nkc/files/2015_nsaids_after_cabg_pds.pdf
  10. Martini, A. K., Rodriguez, C. M., Cap, A. P., Martini, W. Z., & Dubick, M. A. (2014). Acetaminophen and meloxicam inhibit platelet aggregation and coagulation in blood samples from humans. Blood Coagulation & Fibrinolysis, 25(8), 831-837. doi:10.1097/mbc.0000000000000162. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25004022/
  11. U.S. Food and Drug Administration (FDA). (2012). Mobic (meloxicam) tablets and oral suspension. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/012151s072lbl.pdf