Should Meloxicam be discontinued in a patient with impaired renal function?

Meloxicam Use in Patients with eGFR of 57

Meloxicam can be safely continued in a patient with an eGFR of 57 mL/min/1.73m² without dose adjustment, as this represents only mild renal impairment (CKD stage G3a). 1, 2

Renal Function Considerations

• Patients with eGFR >45 mL/min/1.73m² (CKD stages G1-G3a) can safely use meloxicam at standard doses without significant risk of drug accumulation 1
• Pharmacokinetic studies specifically show that patients with mild renal impairment (creatinine clearance 41-60 mL/min) have similar meloxicam plasma concentration profiles compared to those with normal renal function 2
• An eGFR of 57 falls within the G3a category (45-59 mL/min/1.73m²), which is classified as "mild to moderately decreased" kidney function 1

NSAID Use in Renal Impairment

• NSAIDs as a class require caution with declining renal function, but the specific threshold for meloxicam discontinuation is lower than the patient's current eGFR 1
• Temporary discontinuation of NSAIDs including meloxicam is recommended only during episodes of acute illness that increase risk of acute kidney injury (AKI), such as serious intercurrent illness, surgery, or dehydration 1
• Unlike some other NSAIDs, meloxicam has shown no evidence of accumulation or further compromise of renal function in patients with pre-existing mild renal impairment 3

Monitoring Recommendations

• Regular monitoring of renal function is advised while continuing meloxicam therapy in patients with mild renal impairment 1
• If the patient's eGFR declines to <45 mL/min/1.73m² (entering G3b category), then a review of meloxicam therapy would be warranted 1
• Monitor for signs of fluid retention, hypertension, or edema which could indicate worsening renal function 1

When to Consider Dose Reduction or Discontinuation

• Dose reduction should be considered if eGFR declines to 30-44 mL/min/1.73m² (G3b category) 1
• Discontinuation is recommended if eGFR falls below 30 mL/min/1.73m² (G4-G5 categories) 1
• Immediate temporary discontinuation is advised during episodes of acute illness with dehydration, hypotension, or other conditions that increase AKI risk 1

Comparative Safety Profile

• Meloxicam has demonstrated a favorable renal safety profile compared to some other NSAIDs due to its COX-2 selectivity 4
• Studies have shown that meloxicam 15 mg daily does not further compromise renal function in patients with pre-existing mild renal impairment over a treatment period of 28 days 3

Cautions

• While rare, cases of nephrotic syndrome and acute tubular necrosis have been reported with meloxicam use, highlighting the importance of monitoring 5
• If the patient develops signs of worsening renal function, fluid retention, or unexplained weight gain, reassessment of therapy is warranted 1
• Patients with additional risk factors for renal impairment (advanced age, concomitant diuretic use, heart failure) require closer monitoring even with mild renal impairment 1

In conclusion, the current evidence supports continuing meloxicam in a patient with an eGFR of 57 mL/min/1.73m², with appropriate monitoring of renal function.