Meloxicam Dosing
The standard dosing for meloxicam is 7.5 mg once daily, which can be increased to a maximum of 15 mg once daily if needed for adequate symptom control. 1, 2
Standard Dosing Regimens
Initial and Maintenance Dosing
- Start with 7.5 mg once daily as the initial dose for most inflammatory conditions 2, 3
- Maximum dose is 15 mg once daily if the lower dose provides insufficient relief 1, 2
- Elderly patients should use 7.5 mg daily as the maximum dose due to increased risk of adverse events 2
Administration
- Meloxicam is given as a single daily dose due to its long half-life 2, 4
- Can be administered orally or by rectal suppository in similar doses 2
- For acute pain, injectable forms (intramuscular or intravenous) may be used initially (15 mg/1.5 mL IM for 3-5 days), followed by transition to oral therapy 5
Duration of Treatment
Meloxicam should not be used continuously for more than 2-4 weeks without reassessment, as prolonged NSAID use significantly increases gastrointestinal, cardiovascular, and renal complications 6
Time-Based Limitations
- For acute pain conditions: NSAID monotherapy should generally not exceed 1 month 6
- For inflammatory arthritis: If symptoms persist beyond 2-4 weeks, consider alternative or additional therapies rather than continuing NSAID monotherapy 6
- Continuing NSAID monotherapy beyond 2 months is inappropriate for patients with active arthritis 6
Safety Monitoring Requirements
- Monitor renal function if treatment extends beyond 2 weeks, particularly in elderly patients or those with existing renal impairment 6
- Consider gastroprotection with proton pump inhibitors for patients requiring treatment beyond 2 weeks 6
- Blood pressure monitoring is warranted as NSAIDs can increase blood pressure by approximately 5 mm Hg with continued use 6
Efficacy Evidence
Clinical trials demonstrate that meloxicam 7.5 mg and 15 mg are significantly more effective than placebo and comparable in efficacy to standard NSAIDs such as naproxen 750-1000 mg, piroxicam 20 mg, and diclofenac 100 mg 4, 3
Comparative Safety Profile
- Meloxicam produces significantly fewer gastrointestinal side effects than comparator NSAIDs (p < 0.05) 4
- Perforations, ulcerations, and bleeding occurred in only 0.1-0.2% of meloxicam patients compared to 1.2-2.1% with piroxicam, diclofenac, and naproxen 4
- Better renal tolerability with significantly less decrease in hemoglobin and less increase in serum creatinine compared to naproxen 3
Special Populations
Renal Impairment
- Meloxicam 15 mg once daily does not further compromise renal function in patients with pre-existing mild renal impairment over 28 days of treatment 7
- No evidence of drug accumulation in patients with mild renal impairment 7
- However, caution is still warranted and the 7.5 mg dose may be preferable in this population 2
Common Pitfalls to Avoid
- Do not exceed 15 mg daily (or 7.5 mg in elderly patients) as higher doses increase adverse events without additional efficacy 2
- Do not continue monotherapy indefinitely without reassessing the need for alternative or adjunctive therapies 6
- Do not ignore cardiovascular risk factors as long-term use increases risk of cardiac ischemic events by 3.5 per 1,000 persons 6
- Do not use in patients with active GI ulceration without appropriate gastroprotection 4