Contraindications for Mobic (Meloxicam)
Mobic (meloxicam) is contraindicated in patients with known hypersensitivity to meloxicam, history of aspirin or NSAID-induced asthma, urticaria, or allergic-type reactions, and in patients with severe hepatic or renal impairment. 1
Absolute Contraindications
- Known hypersensitivity to meloxicam or other components of the formulation 1
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs 1
- Active peptic ulcer disease 1
- Severe hepatic failure 1
- Severe renal impairment 1
- Third trimester of pregnancy 1
- History of NSAID-induced Stevens-Johnson syndrome or toxic epidermal necrolysis 1
Relative Contraindications/Use with Caution
Cardiovascular Conditions
- Heart failure with reduced ejection fraction (HFrEF) 1
- Hypertension 1
- History of myocardial infarction 1
- Increased risk of cardiovascular events 1
Gastrointestinal Conditions
- History of gastrointestinal bleeding or ulceration 1
- Helicobacter pylori infection 1
- Concomitant use of corticosteroids or selective serotonin reuptake inhibitors (SSRIs) 1
Other Conditions
- Elderly patients (>65 years) - increased risk of adverse effects 1
- Patients with chronic alcohol abuse 1
- Concomitant use of anticoagulants - increased bleeding risk 1
- Mastocytosis - may trigger mast cell degranulation 1
- Renal impairment - may worsen kidney function 1
- Hepatic insufficiency 1
Special Populations
Elderly Patients
- Use with extreme caution in patients >75 years due to significantly increased risk of gastrointestinal bleeding (risk increases from 1 in 2,100 in adults <45 years to 1 in 110 in adults >75 years) 1
- Lower doses should be considered 1
Patients with Asthma
- Meloxicam should be avoided in patients with aspirin-exacerbated respiratory disease (AERD) 1
- However, as a preferentially selective COX-2 inhibitor, meloxicam may be better tolerated than non-selective NSAIDs in some patients with NSAID sensitivity 1, 2
Drug Interactions
- Avoid concomitant use with other NSAIDs including aspirin 1
- Use caution with anticoagulants due to increased bleeding risk 1
- Potential interaction with drugs that prolong QT interval 1
- May reduce effectiveness of antihypertensive medications 1
- May increase risk of methotrexate toxicity 1
Monitoring Recommendations
- Regular assessment for gastrointestinal and renal toxicity 1
- Monitor for hypertension and signs of heart failure 1
- Monitor liver function tests in long-term use 1
- Assess for drug-drug and drug-disease interactions 1
Clinical Pearls
- Although meloxicam is a preferentially selective COX-2 inhibitor, it is not as selective as celecoxib and still carries risks associated with NSAIDs 1, 3
- In patients with NSAID hypersensitivity manifested as urticaria/angioedema, meloxicam may be better tolerated than other NSAIDs, with studies showing only 1.1% cross-reactivity 2
- Patients requiring meloxicam who have a history of gastrointestinal risk factors should receive concomitant gastroprotection with a proton pump inhibitor or misoprostol 1
- Meloxicam belongs to the oxicam class of NSAIDs, which has been associated with higher risk of severe cutaneous adverse reactions compared to other NSAID classes 1