What is the recommended dosage and treatment regimen for Mobic (meloxicam) in patients with osteoarthritis or rheumatoid arthritis?

Recommended Dosage and Treatment Regimen for Mobic (Meloxicam) in Osteoarthritis and Rheumatoid Arthritis

For patients with osteoarthritis, the recommended dosage of Mobic (meloxicam) is 7.5 mg once daily, which can be increased to 15 mg once daily if needed for symptom control. For rheumatoid arthritis, the recommended dosage is 15 mg once daily 1, 2.

Dosage Recommendations by Condition

Osteoarthritis

• Starting dose: 7.5 mg orally once daily
• Maximum dose: 15 mg orally once daily
• Administration: Can be taken with or without food

Rheumatoid Arthritis

• Standard dose: 15 mg orally once daily
• Administration: Can be taken with or without food

Efficacy and Dose Response

Clinical evidence demonstrates that meloxicam shows dose-dependent efficacy:

• The 7.5 mg dose is significantly more effective than placebo for osteoarthritis symptoms 2
• The 15 mg dose provides additional benefit for more severe symptoms and is the standard dose for rheumatoid arthritis 3
• Doses of 3.75 mg may not consistently reach statistical significance for all efficacy endpoints 2
• Higher doses (up to 22.5 mg) have been studied in rheumatoid arthritis with increased efficacy, but are not FDA-approved 3

Safety Considerations

Meloxicam has a favorable gastrointestinal (GI) safety profile compared to some other NSAIDs:

• At 7.5 mg daily, meloxicam has shown GI tolerability comparable to placebo 2
• The incidence of GI adverse events at therapeutic doses does not differ significantly from placebo (23.2-32.0%) 3
• Meloxicam demonstrates greater inhibitory action against COX-2 than COX-1, which may contribute to its improved GI safety profile 4
• Long-term studies show that severe GI effects (perforation, ulcer, bleeding) occur in only about 0.8% of patients 5

Special Populations and Precautions

• Elderly patients: No specific dose adjustment required, but use the lowest effective dose
• Renal impairment: Use with caution; no specific dose adjustment for mild to moderate impairment
• Hepatic impairment: Use with caution; consider lower doses
• Cardiovascular risk: Like all NSAIDs, meloxicam carries cardiovascular risks that increase with dose and duration

Duration of Treatment

• Meloxicam has been studied for long-term use up to 18 months with maintained efficacy 5
• In clinical practice, use the lowest effective dose for the shortest duration needed to control symptoms
• Regular assessment of continued need and response is recommended

Pharmacokinetic Considerations

• Meloxicam has a long half-life (approximately 20 hours), making it suitable for once-daily dosing 6
• Steady state is achieved within 3-5 days 6
• Absorption is almost complete, with >99.5% protein binding 6

Common Pitfalls to Avoid

1. Inadequate dosing: Starting with doses below 7.5 mg for osteoarthritis may lead to suboptimal response
2. Failure to titrate: Not increasing from 7.5 mg to 15 mg when needed for symptom control
3. Overlooking GI prophylaxis: Consider proton pump inhibitors in high-risk patients
4. Prolonged use without reassessment: Regularly evaluate continued need and efficacy
5. Ignoring drug interactions: Be cautious when combining with other medications that affect renal function or increase bleeding risk

Meloxicam's once-daily dosing, favorable GI profile compared to some other NSAIDs, and established efficacy make it a valuable option for managing osteoarthritis and rheumatoid arthritis symptoms when used at the appropriate dosages.