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Oct 22, 2020
6 min read

Meloxicam warnings: what you need to know

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.

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) used to treat the pain and swelling associated with inflammatory conditions such as osteoarthritis and rheumatoid arthritis.

This is the most common form of arthritis, typically caused by wear and tear on the joints. Although these conditions cannot be cured, NSAIDs such as meloxicam can help manage the pain associated with them—but they’re not without potential risks. 

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The U.S. Food and Drug Administration (FDA) issued a “black box” warning, their most stringent advisory about prescription drugs, about the potential serious side effects of meloxicam. There are several points within this black box warning you should be aware of if you’re discussing meloxicam use with your healthcare provider.

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, as NSAIDs also increase the risk of heart attack or stroke following these procedures (Kulik, 2015). 

NSAIDs act on different parts of the inflammation pathway to decrease symptoms such as swelling, but they also interfere with blood clotting and slow clotting time. This may increase your risk of bleeding overall.

You shouldn’t take certain medications with meloxicam as it increases this risk including other NSAIDs, blood thinners (such as warfarin), antiplatelet agents (such as aspirin), and selective serotonin reuptake inhibitors (SSRIs). Drinking large amounts of alcohol while taking meloxicam also increases your risk of bleeding problems (NIH, 2020).

Meloxicam can also increase the risk of bleeding, ulceration, and holes (perforations) in the stomach or intestines. These conditions may occur without warning and may be fatal. Older adults and those with a prior history of GI problems using meloxicam are at higher risk for these adverse effects.

This drug does not need to be taken by mouth to cause digestive problems. It does the same when administered as an injection. 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 and redirect blood flow in the fetus’s body, which may result in progressive heart problems later on (Bloor, 2013; Enzensberger, 2012). 

If you’re breastfeeding, get medical advice about using meloxicam. It isn’t known if this medication gets into breastmilk. A healthcare professional can help weigh the benefits of using this medication while nursing (FDA, 2012).

People who are or wish to become pregnant should discuss NSAID use with a healthcare provider. NSAID use may make it harder for the embryo to implant, which may mean it’s necessary to discontinue their use in individuals having a hard time getting pregnant (Bermas, 2014). 

What is meloxicam?

Meloxicam is a prescription NSAID approved by the FDA to manage the pain and swelling associated with osteoarthritis, rheumatoid arthritis (a chronic inflammatory condition), and juvenile rheumatoid arthritis (RA in children ages two and older) (FDA, 2012). 

Meloxicam is also used off-label to manage the inflammation and pain associated with gout flare-ups. Gout is a painful type of arthritis characterized by sudden redness, pain, and swelling of joints. Though it usually affects one joint in the big toe, it can affect any joint in the body.

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

Meloxicam has also been used off-label to treat the pain associated with ankylosing spondylitis (AS), a chronic inflammatory condition that affects the spine. Like OA and RA, there is no cure for ankylosing spondylitis, but NSAIDs such as meloxicam can help manage the pain.

Side effects of meloxicam

The most common side effects of meloxicam are diarrhea, upset stomach, 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).

You should seek medical attention immediately if you experience severe stomach pain that won’t go away, black or bloody stool, dark urine, loss of appetite, dizziness, or loss of consciousness.

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

Meloxicam drug interactions

The black box warning includes an advisory about the increased risk of bleeding while taking meloxicam, but combining this prescription drug with certain other medications may also increase this risk.

Blood thinners (such as warfarin) and antiplatelet agents (such as aspirin) should not be taken with meloxicam for this reason (DailyMed, 2019). 

Combining meloxicam with other NSAIDs (such as over-the-counter NSAIDs naproxen, acetaminophen, or ibuprofen) may also increase your risk of gastrointestinal problems such as stomach bleeding and stomach ulcers.

Meloxicam may also interfere with how well certain other medications work. Meloxicam lowers how well medications are used to lower high blood pressure (antihypertensive drugs) work, like ACE inhibitors, angiotensin receptor blockers (ARBs), or beta-blockers (Fournier, 2012).

Meloxicam also has this effect on other medications such as diuretics (aka “water pills”), drugs that reduce fluid retention. Loop diuretics such as furosemide and thiazide diuretics like hydrochlorothiazide may not work as well if taken with meloxicam. These medications may worsen kidney function if taken together, potentially causing kidney failure (DailyMed, 2019).

Meloxicam may also increase the toxic effect other medications have on the kidneys. Taking meloxicam with these medications like cyclosporine may increase the risk of adverse events such as kidney problems. Combining these drugs may lead to renal impairment or even acute kidney failure.

Meloxicam may also cause too much of certain medications like methotrexate to build up in your system, potentially causing adverse reactions (FDA, 2012).

Dosage and brand names

Meloxicam is available as a generic drug and is also sold as the brand names Mobic and Vivlodex.

Meloxicam tablets, whether they’re generic or branded, 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 costs between $4 to over $400, and many insurance plans cover meloxicam. The price depends on the strength and whether you purchase the brand name or generic medication (GoodRx.com).

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. Fournier, J. P., Sommet, A., Bourrel, R., Oustric, S., Pathak, A., Lapeyre-Mestre, M., & Montastruc, J. L. (2012). Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: a population-based cohort study. European Journal of Clinical Pharmacology, 68(11), 1533–1540. doi:10.1007/s00228-012-1283-9. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22527348/
  7. Gaffo, A. L. (2019, December 4). Treatment of gout flares. Retrieved Sep. 18, 2020 from https://www.uptodate.com/contents/treatment-of-gout-flares/
  8. GoodRx.com. (n.d.). Meloxicam. Retrieved Sep. 16, 2020 from https://www.goodrx.com/meloxicam
  9. 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/
  10. 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
  11. 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/
  12. National Institutes of Health (NIH). (2020, April 15). Meloxicam: MedlinePlus Drug Information. Retrieved from https://medlineplus.gov/druginfo/meds/a601242.html
  13. Song, I. H., Poddubnyy, D. A., Rudwaleit, M., & Sieper, J. (2008). Benefits and risks of ankylosing spondylitis treatment with nonsteroidal anti-inflammatory drugs. Arthritis & Rheumatism, 58(4), 929-938. doi:10.1002/art.23275. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/art.23275
  14. 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