From the Guidelines
Meloxicam can cause elevated blood pressure due to its mechanism of action as a nonsteroidal anti-inflammatory drug (NSAID), which can lead to sodium and fluid retention, and inhibit prostaglandin production, resulting in increased blood volume and raised blood pressure. According to the 2020 international society of hypertension global hypertension practice guidelines 1, NSAIDs, including meloxicam, can cause an increase in blood pressure of up to 3/1 mm Hg. This effect can be more pronounced in certain individuals, such as the elderly, and those with pre-existing hypertension, heart disease, or kidney problems.
Some key points to consider when prescribing meloxicam include:
- Monitoring blood pressure regularly, especially in patients with pre-existing hypertension or cardiovascular disease
- Being aware of the potential for increased blood pressure with higher doses and longer duration of treatment
- Considering alternative pain medications or adjusting the dose of meloxicam if elevated blood pressure occurs
- Not stopping meloxicam abruptly without medical advice, as this can lead to rebound effects or worsening of the underlying condition.
It is essential to weigh the benefits and risks of meloxicam treatment and to consider the individual patient's profile, including their medical history, current medications, and potential risk factors for hypertension, as noted in the guidelines 1.
From the Research
Meloxicam and Blood Pressure
- Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that has been studied for its effects on blood pressure and renal function 2, 3, 4, 5, 6.
- The available evidence suggests that meloxicam does not significantly affect blood pressure in most patients 2, 3, 4.
- A study in cats with chronic kidney disease found no statistical difference in systolic blood pressure between those receiving meloxicam and those receiving a placebo 5.
- However, another study found that meloxicam may increase the risk of vascular events, which could potentially lead to elevated blood pressure 6.
Renal Function and Meloxicam
- Meloxicam has been shown to be safe for use in patients with mild to moderate renal impairment, with no significant effect on renal function 2, 3, 4.
- A study in cats with chronic kidney disease found that meloxicam did not decline renal excretory function, but did increase proteinuria, which is associated with negative outcomes in cats with CKD 5.
- The effect of meloxicam on renal function in humans is still being studied, but available evidence suggests that it is relatively safe for use in patients with renal impairment 2, 3, 4, 6.
Overall Risk of Meloxicam
- Meloxicam has been found to have a low increased risk of composite cardiovascular and renal events, mainly due to its vascular effects 6.
- The risk of meloxicam is influenced by the type of disease, comparator used, and dose, and is generally lower than that of other NSAIDs 6.
- Overall, meloxicam appears to be a relatively safe NSAID for use in patients with renal impairment, but its effects on blood pressure and renal function should be closely monitored 2, 3, 4, 5, 6.