Is meloxicam (nonsteroidal anti-inflammatory drug (NSAID)) available over the counter (OTC) or by prescription only?

Meloxicam Availability Status: Prescription Only

Meloxicam is available by prescription only and is not available over-the-counter in the United States. 1

Classification and Formulation

• Meloxicam (Mobic) is a nonsteroidal anti-inflammatory drug (NSAID) of the oxicam class that preferentially inhibits cyclooxygenase-2 (COX-2) 2
• It is available in prescription form at dosages of 7.5 mg and 15 mg daily 1
• Unlike some other NSAIDs such as ibuprofen and naproxen sodium, which are available over-the-counter, meloxicam requires a prescription 1

Prescription Status Evidence

• Meloxicam is clearly listed under the "Prescription Nonselective" category in clinical guidelines, confirming its prescription-only status 1
• In contrast, medications like ibuprofen, naproxen sodium, and aspirin are specifically listed as available "over-the-counter" (OTC) in the same guidelines 1
• The prescription requirement applies to all formulations of meloxicam, including oral tablets and injectable forms 3

Clinical Applications

• Meloxicam is commonly prescribed for:
  • Osteoarthritis pain management at doses of 7.5-15 mg daily 4
  • Rheumatoid arthritis treatment at 15 mg daily 5
  • Preemptive pain control for surgical procedures, particularly hysterectomy 1

Safety Considerations

• The prescription-only status of meloxicam reflects its safety profile and potential risks:
  • Risk of gastrointestinal adverse events, though lower than some other NSAIDs 4
  • Potential for cardiovascular complications, especially with long-term use 1
  • Increased risk of intracerebral hemorrhage with regular long-term use 1
  • Drug interactions with anticoagulants and other medications 1

Pharmacokinetic Properties

• Meloxicam has a plasma half-life of approximately 20 hours, making it suitable for once-daily dosing 6
• It undergoes biotransformation to 4 pharmacologically inactive metabolites before excretion 6
• Its long half-life distinguishes it from many OTC NSAIDs that require multiple daily doses 6

Common Pitfalls

• Patients may confuse meloxicam with OTC NSAIDs like ibuprofen or naproxen 1
• Unlike acetaminophen (Tylenol), which can be combined with meloxicam for enhanced pain relief, meloxicam itself requires a prescription 7
• Long-term continuous use increases risk of gastrointestinal, renal, and cardiovascular adverse effects, requiring medical supervision 1, 7

Alternative OTC Options

• For patients seeking OTC NSAIDs, available options include:
  • Ibuprofen (up to 600 mg four times daily) 1
  • Naproxen sodium (Aleve) (220 mg twice daily) 1
  • Aspirin (325 mg daily) 1