What is the recommended use and dosage of Meloxicam (nonsteroidal anti-inflammatory drug (NSAID)) for treating arthritis?

Meloxicam for Treating Arthritis: Recommended Use and Dosage

Meloxicam at a dosage of 7.5-15 mg once daily is recommended for treating arthritis, with 7.5 mg as the initial dose and potential escalation to 15 mg if needed for symptom control. This NSAID offers effective symptom relief with a gastrointestinal safety profile comparable to placebo at recommended doses 1.

Dosing Recommendations

• Initial dose: 7.5 mg once daily
• Maximum dose: 15 mg once daily
• Administration: Oral, taken with food to minimize gastrointestinal effects
• Duration: Use the lowest effective dose for the shortest duration consistent with individual response

Place in Arthritis Treatment Algorithm

For Oligoarticular Juvenile Idiopathic Arthritis (JIA):

1. First-line therapy: A trial of scheduled NSAIDs (including meloxicam) is conditionally recommended as part of initial therapy 2

   • Duration should be brief (2-4 weeks) before reassessing
   • If inadequate response, proceed to intraarticular glucocorticoids

2. Second-line therapy: If inadequate response to NSAIDs and/or intraarticular glucocorticoids:

   • Conventional synthetic DMARDs (methotrexate preferred) 2
   • If still inadequate response, biologic DMARDs

For Adult Arthritis:

1. First-line therapy: NSAIDs including meloxicam for symptomatic relief 2
2. Second-line therapy: Disease-modifying antirheumatic drugs (DMARDs)
3. Adjunctive therapy: Intra-articular glucocorticoid injections for local symptoms

Efficacy Evidence

Meloxicam has demonstrated efficacy comparable to other NSAIDs:

• As effective as diclofenac and piroxicam in osteoarthritis 1, 3
• Comparable efficacy to naproxen and piroxicam in rheumatoid arthritis 3, 4
• Efficacy is dose-dependent with 7.5 mg and 15 mg showing statistically significant improvement over placebo 1
• Onset of action typically within 2 weeks 1

Safety Considerations

Advantages of Meloxicam:

• COX-2 preferential activity at recommended doses 5
• Lower incidence of gastrointestinal adverse events compared to traditional NSAIDs like diclofenac and naproxen 3, 4
• GI tolerability comparable to placebo at 7.5 mg dose 1
• Lower risk of renal side effects compared to naproxen 4

Risk Assessment Before Prescribing:

• Evaluate cardiovascular risk factors
• Assess renal function
• Screen for history of gastrointestinal ulcers or bleeding
• Check for drug interactions

Monitoring:

• Regular monitoring of CBC, liver function tests, and renal function every 6-12 months is conditionally recommended 2
• Monitor for signs of GI bleeding, cardiovascular events, and renal dysfunction

Important Precautions

• Cardiovascular risk: Use the lowest effective dose for the shortest duration
• Gastrointestinal risk: Consider gastroprotective agents in high-risk patients
• Renal function: Use caution in patients with impaired renal function
• Elderly patients: Start at lower doses (7.5 mg) and monitor closely
• Pregnancy: Avoid use in third trimester

Clinical Pearls

• Meloxicam's once-daily dosing improves compliance compared to NSAIDs requiring multiple daily doses
• Long-term studies show maintained efficacy for up to 18 months with acceptable safety profile 6
• In chronic non-bacterial osteitis, meloxicam 15 mg once daily is listed as a potential first-line NSAID option 2
• For juvenile patients, appropriate weight-based dosing should be used
• Taking with food can reduce GI adverse effects without significantly affecting absorption

By following these recommendations, meloxicam can provide effective symptomatic relief for arthritis patients while minimizing potential adverse effects through appropriate patient selection and monitoring.