From the Guidelines
Meloxicam can potentially cause both gastritis and chronic kidney disease (CKD), and its use should be carefully considered, especially in patients with pre-existing kidney disease or those at risk for gastrointestinal toxicity. Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting cyclooxygenase (COX) enzymes, which reduces inflammation and pain. However, this same mechanism can lead to gastrointestinal and kidney complications. For gastritis, meloxicam can damage the protective mucus layer of the stomach by reducing prostaglandins that normally protect the stomach lining, potentially leading to inflammation, erosion, or ulceration. Regarding kidney function, meloxicam can reduce blood flow to the kidneys by inhibiting prostaglandins that help maintain renal blood flow, potentially causing acute kidney injury that may progress to CKD with prolonged use.
The risk of gastritis and CKD associated with meloxicam use is supported by several studies, including a 2021 guideline that recommends avoiding NSAIDs, including meloxicam, in patients with or at risk for CKD and cardiovascular disease 1. Another study published in 2006 found that NSAIDs, including meloxicam, can increase the risk of gastrointestinal toxicity and kidney problems, especially in patients with pre-existing kidney disease or those taking certain medications like diuretics or ACE inhibitors 1.
Some key points to consider when prescribing meloxicam include:
- Using the lowest effective dose for the shortest duration possible to minimize the risk of gastritis and CKD
- Monitoring patients for signs of gastritis (stomach pain, nausea, vomiting, black stools) and kidney problems (decreased urination, swelling, fatigue)
- Avoiding meloxicam in patients with pre-existing kidney disease, heart failure, liver disease, or those taking certain medications like diuretics or ACE inhibitors
- Considering alternative treatments, such as acetaminophen, for patients with noninflammatory pain
- Using gastroprotective agents, such as proton pump inhibitors (PPIs), to reduce the risk of gastrointestinal toxicity in patients taking meloxicam 1.
Overall, while meloxicam can be an effective treatment for pain and inflammation, its potential risks, including gastritis and CKD, must be carefully considered and monitored to minimize harm to patients.
From the Research
Meloxicam and Gastritis
- Meloxicam may cause gastritis, as evidenced by studies showing gastrointestinal complaints such as abdominal pain and dyspepsia 2, 3.
- A study found that the rate of dyspepsia during the first month of exposure to meloxicam was 28.3 per 1000 patient-months 3.
- Another study found that meloxicam caused metaplasia in surface and glandular epithelia and atrophy in stomach samples of rats 4.
Meloxicam and CKD
- Meloxicam may not further compromise renal function in patients with pre-existing mild renal impairment 5, 2.
- A study found that meloxicam was well tolerated in patients with mild to moderate renal impairment, with no difference in incidence of adverse events observable between groups 5.
- However, a study in rats found that meloxicam may cause nephrotoxicity, with glomerular stasis-related hypertrophy and focal interstitial nephritis observed in kidney samples 4.
- Another study found that a history of gastrointestinal disorder in the previous year was associated with an increased rate of dyspepsia, abdominal pain, and peptic ulcer, but did not find a significant increase in risk of CKD 3.