Meloxicam Dosage and Treatment Regimen for Osteoarthritis and Rheumatoid Arthritis
For patients with osteoarthritis or rheumatoid arthritis, meloxicam should be administered at a starting dose of 7.5 mg once daily, with the option to increase to 15 mg once daily if needed for adequate symptom control. 1
Standard Dosing Recommendations
- For adults with osteoarthritis or rheumatoid arthritis, the recommended starting dose is 7.5 mg orally once daily 1
- The dose may be increased to 15 mg once daily if 7.5 mg provides insufficient symptom relief 1, 2
- Meloxicam should be used at the lowest effective dose for the shortest duration possible to minimize adverse effects 1
- The medication demonstrates efficacy within 2 weeks of treatment initiation 2
Administration Considerations
- Meloxicam is administered as a once-daily oral medication due to its approximately 20-hour elimination half-life 3
- The medication can be taken without regard to meals 1
- For patients experiencing gastrointestinal side effects, consider adding a proton pump inhibitor rather than discontinuing meloxicam 4
Treatment Duration and Monitoring
- For mild inflammatory pain in arthritis, a 4-6 week course is typically recommended 1
- In rheumatoid arthritis, regular follow-up visits every 3-6 months are recommended to assess disease activity and medication effectiveness 4
- Periodic laboratory monitoring of renal function is advised for patients on long-term therapy 4
- Cardiovascular risk assessment should be considered, as all NSAIDs carry some cardiovascular risk 4
Safety Profile and Precautions
- Meloxicam has demonstrated better gastrointestinal tolerability compared to other NSAIDs such as diclofenac, piroxicam, and naproxen 5, 6
- At 7.5 mg daily, meloxicam shows gastrointestinal tolerability comparable to placebo 2
- The improved safety profile is likely due to meloxicam's selective inhibition of COX-2 relative to COX-1 5
- Prior to initiating therapy, evaluate gastrointestinal, renal, and cardiovascular risk factors 1
- Meloxicam should not be used in combination with other NSAIDs 1
Role in Treatment Algorithm
- In rheumatoid arthritis, meloxicam is recommended as adjunctive therapy to disease-modifying treatments, not as monotherapy for long-term management 1, 4
- For patients with inadequate response to meloxicam alone, consider adding conventional synthetic DMARDs such as methotrexate 4
- In the treatment algorithm for rheumatoid arthritis, methotrexate remains the anchor drug, with NSAIDs like meloxicam used primarily for symptom control 7
- For osteoarthritis, meloxicam is appropriate after inadequate response to acetaminophen 1
Long-term Efficacy and Tolerability
- Long-term studies (up to 18 months) have demonstrated sustained efficacy of meloxicam 15 mg daily in rheumatoid arthritis patients 8
- In these long-term studies, only 13.7% of patients discontinued due to adverse events, and severe gastrointestinal effects occurred in only 0.8% of patients 8
- Efficacy measures including morning stiffness, grip strength, joint index, and pain showed significant improvement that was maintained throughout treatment 8