What labs should be ordered for a patient with slurred speech taking meloxicam (nonsteroidal anti-inflammatory drug) for 1.5 years?

Laboratory Evaluation for Slurred Speech in a Patient Taking Meloxicam

For a patient presenting with slurred speech who has been taking meloxicam for 1.5 years, a focused laboratory workup should include complete blood count, comprehensive metabolic panel, and coagulation studies to rule out medication-related adverse effects and neurological causes.

Initial Assessment

When evaluating slurred speech (dysarthria) in a patient taking meloxicam, it's important to recognize that this is a neurological symptom that warrants prompt investigation. While meloxicam itself can cause slurred speech as documented in the literature 1, other serious neurological conditions must be ruled out.

Key History Elements to Obtain

• Onset and progression of slurred speech (sudden vs. gradual)
• Associated symptoms (weakness, numbness, visual changes, headache)
• Medication history (dose of meloxicam, other medications)
• Recent trauma or falls
• Cardiovascular risk factors

Laboratory Evaluation

First-line Laboratory Tests

• Complete Blood Count (CBC)

  • To assess for anemia, infection, or platelet abnormalities
  • Meloxicam can cause anemia in some patients

• Comprehensive Metabolic Panel (CMP)

  • Electrolytes (sodium, potassium, calcium, magnesium)
  • Renal function (BUN, creatinine) - NSAIDs can affect kidney function
  • Liver function tests (AST, ALT, alkaline phosphatase)
  • Glucose level - to rule out hypoglycemia

• Coagulation Studies

  • PT/INR and PTT - NSAIDs can affect bleeding risk
  • Meloxicam has antiplatelet effects that could potentially contribute to cerebrovascular events

Additional Targeted Tests

• Toxicology screen - to rule out other substances or medications
• Thyroid function tests - hypothyroidism can cause slurred speech
• Vitamin B12 and folate levels - deficiencies can cause neurological symptoms

Imaging and Other Studies

While not laboratory tests, these studies are critical in the evaluation:

• Brain imaging - CT or MRI to rule out stroke or other structural lesions
• Electroencephalogram (EEG) - if seizure activity is suspected
• Laryngoscopy - if dysarthria persists beyond 4 weeks 1, 2

Clinical Considerations

Meloxicam-Related Concerns

Meloxicam is a selective COX-2 inhibitor NSAID 3 that has been associated with:

• Vascular adverse effects (OR 1.35; CI 1.18-1.55) 4
• CNS effects including slurred speech in some cases 1

Red Flags Requiring Immediate Action

• Sudden onset of slurred speech with other neurological deficits
• Signs of respiratory distress or stridor
• Progressive worsening of symptoms

Management Algorithm

1. Immediate assessment: If acute onset with other neurological symptoms, treat as potential stroke and obtain immediate neuroimaging
2. Laboratory evaluation: Order CBC, CMP, and coagulation studies
3. Medication review: Consider temporary discontinuation of meloxicam if no other cause identified
4. Follow-up: If slurred speech persists beyond 4 weeks, refer for laryngoscopy 1
5. Specialist referral: Neurology consultation if laboratory and initial imaging are non-diagnostic

Important Caveats

• Avoid "shotgun" laboratory testing without clinical indication 1
• Targeted testing based on history and physical examination findings is more appropriate than routine panels
• If slurred speech is associated with other neurological symptoms, treat as a neurological emergency
• Remember that while meloxicam can cause slurred speech, it's important to rule out other serious conditions first