Meloxicam: A Nonsteroidal Anti-inflammatory Drug (NSAID)
Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that selectively inhibits cyclooxygenase-2 (COX-2) and is primarily used to treat painful inflammatory musculoskeletal conditions including rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and juvenile idiopathic arthritis. It is administered in a single oral dose of 7.5mg daily, which can be increased to a maximum of 15mg daily if necessary (with 7.5mg recommended for elderly patients). 1
Mechanism of Action
- Meloxicam belongs to the oxicam group of NSAIDs and works by inhibiting prostaglandin synthesis through selective inhibition of the COX-2 enzyme 1
- It demonstrates greater selectivity for COX-2 than COX-1, which may explain its improved gastrointestinal safety profile compared to traditional NSAIDs 2
- Like other NSAIDs, meloxicam has anti-inflammatory, analgesic, and antipyretic effects 3
Clinical Uses
- Treatment of rheumatoid arthritis and acute exacerbations of osteoarthritis 1
- Management of ankylosing spondylitis 1
- Treatment of juvenile idiopathic arthritis 3
- Provides superior pain control and functional outcomes compared to acetaminophen in patients with inflammatory conditions 3
Dosage and Administration
- Standard dosing is 7.5mg once daily, which can be increased to 15mg daily if necessary 1
- Lower dose (7.5mg) recommended for elderly patients 1
- Can be administered orally or rectally (as suppositories) 1
- Once-daily dosing is possible due to its long elimination half-life of approximately 20 hours 4
- Steady state is achieved within 3-5 days of regular dosing 4
Efficacy
- Clinical trials have shown meloxicam 7.5mg and 15mg to be significantly more effective than placebo in treating osteoarthritis 5
- Efficacy is comparable to standard NSAIDs such as naproxen (750-1000mg), piroxicam (20mg), and diclofenac (100mg slow release) 2
- In long-term studies, meloxicam has demonstrated sustained efficacy for up to 18 months in patients with rheumatoid arthritis 6
- Improvement in symptoms is typically evident after 2 weeks of treatment 5
Safety Profile and Adverse Effects
- Common side effects include abdominal pain, anemia, and edema 1
- Increased risk of serious gastrointestinal adverse events, including ulceration and bleeding, though this risk appears lower than with traditional NSAIDs 1, 2
- In clinical trials, meloxicam produced significantly fewer gastrointestinal side effects compared to naproxen, piroxicam, and diclofenac 2
- The incidence of perforations, ulcerations, and bleedings was 0.1% with meloxicam 7.5mg compared to higher rates with traditional NSAIDs (up to 2.1% with naproxen) 2
- Like other NSAIDs, meloxicam carries cardiovascular risks including increased risk of myocardial infarction, stroke, heart failure, and hypertension 3
Pharmacokinetics
- Almost complete absorption after oral administration 4
- Highly protein-bound (>99.5%) in plasma 4
- Metabolized to four biologically inactive metabolites 4
- Excreted in both urine and feces 4
- Linear pharmacokinetics across the entire dose range 4
- Different formulations (oral tablets, suppositories) show bioequivalence, allowing for convenient switching between formulations if necessary 4
Special Considerations
- As with all NSAIDs, caution should be exercised when prescribing meloxicam to patients with cardiovascular disease 3
- The risk of adverse cardiovascular effects is likely greatest in patients with a prior history of or at high risk for cardiovascular disease 3
- When used with aspirin for cardioprotection, timing of administration may be important to avoid potential interactions that could reduce aspirin's cardioprotective effects 3
- For temporary pain conditions, traditional NSAIDs with high analgesic effect and low anti-inflammatory activity (e.g., ibuprofen) at the lowest effective dose may be preferred due to cost considerations 3
- For chronic inflammatory conditions, NSAIDs with longer half-lives like meloxicam or naproxen are often preferred 3