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

Meloxicam Dosage and Usage for Arthritis Treatment

For adults with arthritis, meloxicam is recommended at a dosage of 7.5-15 mg once daily, with 7.5 mg being the preferred starting dose due to its comparable efficacy to higher doses while maintaining a gastrointestinal safety profile similar to placebo. This dosing recommendation is based on clinical evidence showing effective symptom control with minimized adverse effects.

Dosage Recommendations

• Starting dose: 7.5 mg once daily
• Maximum dose: 15 mg once daily
• Administration: Oral tablet, taken once daily with or without food
• Duration: Use for the shortest duration necessary to control symptoms

Efficacy by Arthritis Type

Rheumatoid Arthritis

• 7.5 mg daily provides efficacy comparable to naproxen 750 mg daily 1
• 15 mg daily shows sustained efficacy for long-term management (up to 18 months) 2

Osteoarthritis

• 7.5-15 mg daily is effective for symptom control 3
• 3.75 mg daily may be insufficient for optimal symptom control 3

Treatment Algorithm

1. Initial therapy:

   • Start with meloxicam 7.5 mg once daily
   • Assess response after 2 weeks (improvement should be evident by this time) 3

2. Dose adjustment:

   • If inadequate response at 2 weeks, increase to 15 mg once daily
   • If good response, maintain at 7.5 mg daily

3. Adjunctive therapy:

   • For inflammatory arthritis: Consider intra-articular glucocorticoid injections for acute flares 4
   • For persistent disease: Consider adding disease-modifying antirheumatic drugs (DMARDs) like methotrexate 4

Safety Considerations

• Gastrointestinal safety: Meloxicam has better GI tolerability compared to traditional NSAIDs like naproxen and diclofenac 1, 3

  • GI adverse event rate with 7.5 mg meloxicam is comparable to placebo 3
  • Lower incidence of ulcers compared to naproxen 1

• Cardiovascular risk: As with all NSAIDs, there is potential cardiovascular risk

  • Use the lowest effective dose for the shortest duration
  • Exercise caution in patients with cardiovascular disease

• Renal effects: Monitor renal function, especially in elderly patients or those with pre-existing renal impairment

  • Meloxicam shows less impact on serum creatinine and urea compared to naproxen 1

Special Populations

• Elderly: No specific dose adjustment required, but monitor closely due to increased risk of adverse effects
• Hepatic impairment: Use with caution; consider lower starting dose
• Renal impairment: Use with caution in mild to moderate impairment; avoid in severe impairment

Common Pitfalls to Avoid

1. Extended use without monitoring: Regular assessment of efficacy and adverse effects is essential
2. Failure to recognize inadequate response: If symptoms persist after 2-4 weeks, consider dose increase or alternative therapy
3. Concurrent use with other NSAIDs: Avoid combining with other NSAIDs due to increased risk of adverse effects
4. Monotherapy for inflammatory arthritis: Meloxicam should be considered adjunctive therapy in inflammatory arthritis, not sole treatment 4
5. Inadequate gastroprotection: Consider proton pump inhibitors in high-risk patients (elderly, history of GI bleeding, concurrent corticosteroids)

Meloxicam's preferential COX-2 inhibition provides a favorable balance of efficacy and safety, making it a valuable option for arthritis treatment when used at appropriate doses 5, 6.