Maximum Dosage of Meloxicam
The maximum recommended daily dose of meloxicam is 15 mg per day.
Dosage Information
Meloxicam (Mobic) is a nonsteroidal anti-inflammatory drug (NSAID) that selectively inhibits cyclooxygenase-2 (COX-2). The dosing recommendations are as follows:
- Starting dose: 7.5 mg once daily
- Maximum dose: 15 mg once daily
- Elderly patients: Starting dose of 7.5 mg is recommended 1
Clinical Evidence
Research studies have consistently shown that meloxicam is effective at doses between 7.5-15 mg daily for the treatment of osteoarthritis and rheumatoid arthritis. In a 12-week, double-blind trial, meloxicam at 7.5 mg and 15 mg daily was found to be significantly more effective than placebo for all endpoints in osteoarthritis treatment 2.
Long-term studies have demonstrated that meloxicam 15 mg daily maintains efficacy for up to 18 months in patients with rheumatoid arthritis, with 66% of patients remaining on therapy throughout the study period 3.
Safety Considerations
When prescribing meloxicam at the maximum dose, consider the following:
- Gastrointestinal risk: Meloxicam has better GI tolerability compared to some other NSAIDs (like piroxicam and diclofenac), but still carries risk of GI adverse events 4
- Cardiovascular risk: Like all NSAIDs, meloxicam carries cardiovascular risks, especially at higher doses
- Renal function: Monitor renal function in patients on long-term therapy
- Elderly patients: Consider using the lower dose (7.5 mg) in elderly patients due to increased risk of adverse effects
Contraindications
Avoid meloxicam in patients with:
- History of NSAID-associated upper GI tract bleeding
- Moderate to severe kidney disease
- Cirrhosis
- Congestive heart failure
- Aspirin/NSAID-induced asthma
Dose Adjustment Algorithm
- Initial treatment: Start with 7.5 mg once daily
- Efficacy assessment: Evaluate response after 2-4 weeks
- Dose adjustment: If inadequate response and no significant adverse effects, increase to 15 mg once daily
- Maximum dose: Do not exceed 15 mg daily under any circumstances
- Elderly patients: Consider maintaining at 7.5 mg daily
Monitoring
- Assess efficacy using validated pain and function scales
- Monitor for GI symptoms, renal function, and blood pressure
- If adverse effects occur at 15 mg, reduce to 7.5 mg before discontinuing
Remember that the goal is to use the lowest effective dose for the shortest duration necessary to control symptoms, even though 15 mg is the maximum allowable dose.