What should be done for a patient who develops aphthous ulcers after taking Mobic (meloxicam)?

Management of Aphthous Ulcers After Taking Mobic (Meloxicam)

Discontinue Mobic immediately, as NSAIDs including meloxicam are a known cause of oral ulcers, and initiate topical corticosteroid therapy as first-line treatment. 1, 2, 3

Immediate Action: Drug Discontinuation

• Stop meloxicam (Mobic) immediately since NSAIDs are well-documented to cause oral ulcerations, and continuing the offending agent will prevent healing 3
• Evaluate whether the NSAID is truly necessary or if alternative pain management strategies can be employed 4
• If anti-inflammatory therapy remains essential, discuss alternative options with the prescribing physician, though be aware that other NSAIDs may carry similar risks 4

First-Line Topical Treatment

Begin with topical corticosteroids as primary therapy, which are the most effective first-line agents for aphthous ulcers 1, 2, 5:

• For localized ulcers: Apply clobetasol gel or ointment 0.05% directly to dried lesions twice daily 1, 2
• For multiple or widespread ulcers: Use betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit solution four times daily 1, 2, 5
• Alternative option: Dexamethasone mouth rinse 0.1 mg/mL for difficult-to-reach areas 1

Pain Management

Implement aggressive pain control to maintain oral intake and quality of life 1, 2:

• Benzydamine hydrochloride rinse or spray every 3 hours, particularly before meals 1, 2, 5
• Viscous lidocaine 2% applied topically 3-4 times daily for severe pain 1, 2
• Mucoprotectant mouthwashes such as Gelclair three times daily to provide barrier protection 1, 5

Supportive Oral Hygiene Measures

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 2
• Use antiseptic oral rinses such as 0.2% chlorhexidine digluconate mouthwash twice daily 1, 2, 5
• Apply white soft paraffin ointment to lips every 2 hours if perioral involvement 1
• Avoid sodium lauryl sulfate-containing toothpastes, which can aggravate ulcers 6

Dietary Modifications

• Avoid hard, acidic, spicy, and salty foods that can irritate ulcers 6
• Eliminate alcohol and carbonated drinks during the healing period 6
• Recommend soft, moist foods served at room temperature or cold 4

Second-Line Treatment for Refractory Cases

If ulcers persist beyond 1-2 weeks despite topical therapy 1, 2:

• Consider intralesional triamcinolone injections (weekly, total dose 28 mg) for non-responsive ulcers 1, 5
• Systemic corticosteroids (prednisone/prednisolone 30-60 mg or 1 mg/kg for 1 week with tapering over the second week) for highly symptomatic cases 1, 2, 5
• Colchicine can be effective as first-line systemic therapy, particularly if there are associated features like erythema nodosum 1, 2, 5

Critical Monitoring and Red Flags

Refer to a specialist if ulcers persist beyond 2 weeks or do not respond to 1-2 weeks of treatment, as this warrants biopsy to exclude malignancy 1, 5:

• Any solitary chronic ulcer requires biopsy to rule out squamous cell carcinoma 7
• Consider blood tests including complete blood count, nutritional studies (iron, folate, B12), and screening for systemic conditions if ulcers recur after drug discontinuation 1

Common Pitfalls to Avoid

• Do not prematurely taper corticosteroids before disease control is established 1
• Do not restart meloxicam or switch to another traditional NSAID without considering the risk-benefit ratio, as cross-reactivity may occur 4, 3
• Do not delay referral for persistent ulcers beyond 2 weeks, as this may represent a more serious underlying condition 1, 7

Expected Timeline

• Most drug-induced aphthous ulcers should begin improving within 3-7 days of discontinuing the offending medication and starting topical therapy 7, 6
• Complete healing typically occurs within 2 weeks with appropriate management 1, 6
• If ulcers persist beyond this timeframe despite treatment, reassess the diagnosis and consider alternative etiologies 1, 7