Can Meloxicam Cause Hallucinations?
Yes, meloxicam can cause psychiatric symptoms including hallucinations, though this is a rare adverse effect. A documented case report describes a patient who developed depressive psychosis with meloxicam that resolved upon discontinuation and recurred with re-exposure 1.
Evidence for Meloxicam-Induced Psychiatric Symptoms
Direct Case Evidence
- A 60-year-old man developed fluctuating depressive psychosis temporally associated with meloxicam administration, which resolved quickly after cessation and recurred upon re-exposure 1.
- The psychiatric manifestations occurred alongside other signs of meloxicam intolerance including skin rash and elevated blood pressure 1.
NSAID Class Effects
- NSAIDs as a class are not typically listed among the primary medications causing hallucinations in major guidelines addressing medication-induced psychiatric symptoms 2.
- The American Geriatrics Society Beers Criteria identifies NSAIDs (including meloxicam) as potentially inappropriate in older adults but primarily for cardiovascular, gastrointestinal, and renal risks—not psychiatric effects 3.
- Data from adverse event reporting systems suggest that COX-2 selective inhibitors (like meloxicam) may have a higher propensity to cause psychiatric adverse effects compared to traditional NSAIDs 1.
Risk Factors to Consider
Patient-Specific Vulnerabilities
- History of mental illness increases risk: Approximately 40% of NSAID-related psychiatric adverse events occur in patients with pre-existing psychiatric conditions 1.
- Advanced age increases susceptibility to medication-induced psychiatric symptoms in general 2.
- Polypharmacy, particularly with other medications that can cause hallucinations, compounds the risk 2.
Drug Interactions
- Meloxicam can interact with other medications to produce serious adverse effects, as demonstrated by a case of meloxicam-desmopressin interaction causing hyponatremia and seizure 4.
Clinical Management Approach
When Hallucinations Occur
- Immediately discontinue meloxicam if psychiatric symptoms develop, as cessation typically leads to rapid resolution 1.
- Evaluate for other potential causes of hallucinations, including medications more commonly associated with this adverse effect (opioids, anticholinergics, benzodiazepines, corticosteroids) 2.
- Consider whether the patient has other signs of meloxicam intolerance (rash, hypertension, gastrointestinal symptoms) 1.
Prevention Strategies
- Use meloxicam with caution in patients with a history of mental illness, as this population has higher risk of psychiatric adverse effects from COX-2 inhibitors 1.
- Monitor elderly patients more closely, as they are particularly susceptible to medication-induced psychiatric symptoms 2.
- Avoid combining meloxicam with other medications that can cause hallucinations or delirium 2.
Important Caveats
Rarity of This Adverse Effect
- Psychiatric manifestations of NSAID intolerance are rare overall 1.
- Standard meloxicam safety profiles emphasize gastrointestinal, cardiovascular, and renal adverse effects rather than psychiatric symptoms 5.
- A tolerability study of 177 NSAID-sensitive patients found only 1.1% had adverse reactions to meloxicam, both manifesting as cutaneous symptoms rather than psychiatric effects 6.
Differential Diagnosis
- Do not automatically attribute hallucinations to meloxicam without considering more common culprits: opioids (especially meperidine), anticholinergics (diphenhydramine, cyclobenzaprine), benzodiazepines, and corticosteroids 2.
- Evaluate for underlying delirium from medical causes (infection, metabolic derangements) rather than medication effect alone 3.
- Consider temporal relationship: psychiatric symptoms should appear after meloxicam initiation and resolve with discontinuation 1.