Is meloxicam (a nonsteroidal anti-inflammatory drug, NSAID) safe during lactation (breastfeeding)?

From the Guidelines

Meloxicam is considered conditionally acceptable during breastfeeding, and its use should be approached with caution, as it is classified as a nonsteroidal anti-inflammatory drug (NSAID) that can be used during lactation, according to the 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases 1.

Key Considerations

• The American Academy of Pediatrics classifies meloxicam as compatible with breastfeeding, as only small amounts transfer into breast milk.
• Typical adult dosing is 7.5-15 mg once daily, and this limited exposure makes it unlikely to cause adverse effects in most nursing infants.
• However, meloxicam should be used at the lowest effective dose for the shortest duration possible.
• As a non-steroidal anti-inflammatory drug (NSAID), meloxicam works by inhibiting cyclooxygenase enzymes to reduce inflammation and pain.

Important Recommendations

• The 2020 American College of Rheumatology guideline conditionally recommends the use of NSAIDs, including meloxicam, during breastfeeding 1.
• It is essential to monitor the breastfed infant for any unusual symptoms, such as changes in feeding patterns, unusual sleepiness, or gastrointestinal disturbances.
• If pain relief is needed while breastfeeding, acetaminophen (Tylenol) is generally considered the safest first-line option, but meloxicam can be an appropriate alternative when additional anti-inflammatory effects are needed.

Safety Precautions

• The use of meloxicam during breastfeeding should be individualized, and the benefits and risks should be reviewed with each patient.
• Rheumatologists should collaborate with pediatricians when making recommendations for breastfeeding women with rheumatic and musculoskeletal diseases 1.
• It is crucial to note that the safety of meloxicam during breastfeeding is based on the available evidence, and the 2020 American College of Rheumatology guideline provides the most recent and highest-quality recommendations 1.

From the Research

Safety of Meloxicam during Lactation

• The safety of meloxicam, a nonsteroidal anti-inflammatory drug (NSAID), during lactation is not directly addressed in the provided studies.
• However, studies suggest that short-term use of NSAIDs, in general, seems to be compatible with breastfeeding 2, 3.
• It is recommended that the lowest effective maternal dose of an analgesic drug should be given, and infant exposure can be further reduced if breastfeeding is avoided at times of peak drug concentration in milk 2.
• Maternal administration of most NSAIDs results in low infant exposure via breastmilk, such that both cyclooxygenase-1 and cyclooxygenase-2 inhibitors are generally considered safe when breastfeeding 3.
• The general principles of medication use during breastfeeding emphasize the importance of assessing the risks and benefits for both mother and child, considering factors such as pharmacokinetics, duration of maternal therapy, age of the infant, and general health of the infant 4, 5.

Considerations for Medication Use during Breastfeeding

• Most commonly used drugs are relatively safe for breastfed babies, with the dose received via milk generally being small and much less than the known safe doses of the same drug given directly to neonates and infants 4.
• Few medications are contraindicated during breastfeeding, and others may require careful consideration due to the risk of adverse effects on breastfed infants or suppression of breast milk volume 6, 5.
• Healthcare professionals should have access to reliable and updated information on medication safety during breastfeeding to provide accurate advice and minimize the risk of early weaning 5.