Maximum Dosage of Meloxicam
The maximum recommended dosage of meloxicam is 15 mg once daily, regardless of the indication being treated. 1, 2, 3
Standard Dosing Algorithm
- Starting dose: Begin with 7.5 mg once daily orally 1, 2, 4
- Dose escalation: If symptom control is inadequate after initial trial, increase to the maximum dose of 15 mg once daily 1, 2, 4
- Elderly patients (>75 years): Use 7.5 mg daily as the maximum dose due to increased risk of adverse effects 3
Critical Duration Limitations
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. 1
- For acute pain conditions: Do not exceed 1 month of monotherapy 1
- For chronic inflammatory arthritis: Continuing NSAID monotherapy beyond 2 months is inappropriate without adding disease-modifying therapy 1
- Always use the lowest effective dose for the shortest duration possible 2, 3, 5
Mandatory Safety Monitoring
If treatment extends beyond 2 weeks, implement the following monitoring:
- Renal function assessment: Particularly critical in elderly patients or those with existing renal impairment 1, 3
- Blood pressure monitoring: NSAIDs can increase blood pressure by approximately 5 mm Hg with continued use 1
- Gastroprotection: Consider proton pump inhibitors for patients requiring treatment beyond 2 weeks, especially those with GI risk factors 1, 2, 3
Common Pitfalls to Avoid
- Never combine meloxicam with other NSAIDs: This increases risk without providing additional benefit 2, 3
- Do not continue indefinitely without reassessment: Failure to reassess need for alternative or adjunctive therapies is inappropriate 1
- Do not ignore cardiovascular risk factors: Long-term use increases risk of cardiac ischemic events by 3.5 per 1,000 persons 1
- Avoid in heart failure with reduced ejection fraction (HFrEF): Meloxicam is contraindicated in this population 3
Special Population Considerations
- Patients with mild renal impairment: The 15 mg daily dose has been studied and found not to further compromise renal function over 28 days, though close monitoring remains essential 6
- Elderly patients: Use maximum caution and consider 7.5 mg as the ceiling dose 3
- High cardiovascular risk patients: Use with extreme caution due to increased risk of cardiovascular events 3