What are the contraindications for meloxicam (Nonsteroidal Anti-Inflammatory Drug - NSAID)?

Contraindications for Meloxicam

Meloxicam is contraindicated in patients with a history of NSAID-associated upper GI tract bleeding, congestive heart failure, advanced renal disease, cirrhosis, during the last 6-8 weeks of pregnancy, and in those with known hypersensitivity to meloxicam or other NSAIDs. 1, 2

Absolute Contraindications

• History of NSAID-associated upper GI tract bleeding or ulceration 1, 2
• Severe congestive heart failure 1, 2
• Advanced renal disease or significantly impaired renal function 1, 2
• Cirrhotic liver disease due to increased risk of bleeding complications and renal failure 1, 2
• Concurrent use with other NSAIDs (including aspirin) due to increased risk of adverse effects 3, 2
• Known hypersensitivity to meloxicam or other NSAIDs 4
• Last 6-8 weeks of pregnancy to prevent prolonged gestation, premature closure of the ductus arteriosus, and maternal/fetal complications 1
• Patients with aspirin-exacerbated respiratory disease, especially those with nasal polyps or recurrent sinusitis 1

Relative Contraindications (Use with Caution)

Gastrointestinal Risk Factors

• Advanced age (>60 years) due to increased risk of GI complications 1, 2
• History of peptic ulcer disease 1
• Concurrent use of corticosteroids 1

Cardiovascular Risk Factors

• Hypertension - NSAIDs can increase blood pressure by approximately 5 mmHg 1, 2
• History of cardiovascular disease or elevated risk of cardiovascular events 1, 2
• Risk factors for myocardial infarction or stroke 1

Renal Risk Factors

• Mild to moderate renal impairment 1, 5
• Compromised fluid status or dehydration 1, 2
• Concurrent use of medications that can affect renal function:
  • ACE inhibitors 1, 2
  • Angiotensin receptor blockers 1, 2
  • Diuretics 3
  • Other nephrotoxic drugs 1

Hematologic Risk Factors

• Concurrent use of anticoagulants (warfarin, heparin) - significantly increases bleeding risk 1, 2
• Platelet defects or thrombocytopenia 1
• Concurrent use of SSRIs - increases GI bleeding risk 2

Special Populations

Elderly Patients

• Patients over 60 years require careful monitoring due to increased risk of:
  • GI bleeding (risk is one in 110 adults older than 75 years) 1, 2
  • Renal complications 1, 2
  • Cardiovascular events 1

Pregnant and Breastfeeding Women

• Contraindicated in the last 6-8 weeks of pregnancy 1
• Use with caution during earlier stages of pregnancy 1
• Generally considered safe during breastfeeding, though other NSAIDs like ibuprofen, indomethacin, and naproxen have more established safety data 1

Risk Mitigation When Use Cannot Be Avoided

• For patients with moderate GI risk who must take meloxicam:
  • Consider adding a proton pump inhibitor 1, 2
  • Alternative options include double-dose histamine H2 blockers or misoprostol 1, 2
• Monitor renal function (serum creatinine) after initiating therapy in at-risk patients 1, 2
• Use the lowest effective dose for the shortest duration possible 6, 7
• Monitor blood pressure regularly, especially in patients with hypertension 1

Clinical Pitfalls to Avoid

• Combining meloxicam with other NSAIDs (including aspirin) significantly increases the risk of adverse effects 3, 2
• Failing to recognize that GI symptoms do not correlate well with clinically significant ulcerations - absence of dyspepsia does not rule out serious GI complications 1
• Overlooking potential drug interactions, particularly with anticoagulants, which can increase INR by up to 15% 1
• Assuming that meloxicam's COX-2 selectivity eliminates all GI risks - while it may have better GI tolerability than some NSAIDs, serious GI complications can still occur 8, 6