Mobic (Meloxicam) Dosing and Treatment Guidelines
Recommended Dosage
For osteoarthritis and rheumatoid arthritis, initiate meloxicam at 7.5 mg once daily, with the option to increase to 15 mg once daily if needed for adequate symptom control. 1
- The starting dose of 7.5 mg once daily is appropriate for most patients with arthritis 1
- Dose escalation to 15 mg once daily can be considered when 7.5 mg provides insufficient symptom relief 1, 2
- For mild pain with inflammatory symptoms, meloxicam 7.5-15 mg daily is recommended for 4-6 weeks 1
- Clinical trials have demonstrated efficacy at both 7.5 mg and 15 mg doses, with dose-dependent improvements in pain and function 2, 3
Critical Safety Principles
Use meloxicam at the minimum effective dose for the shortest duration necessary, as NSAIDs carry cardiovascular, gastrointestinal, and renal risks. 1
- Prior to initiating therapy, evaluate gastrointestinal, renal, and cardiovascular risk factors 1
- Consider proton pump inhibitor co-therapy for GI prophylaxis in high-risk patients (history of ulcers, age >65, concurrent corticosteroid or anticoagulant use) 1
- Do not combine meloxicam with other NSAIDs 1
- Regular assessment of efficacy and adverse effects is mandatory during treatment 1
Role in Treatment Algorithm
Meloxicam serves as adjunctive symptomatic therapy, not as disease-modifying treatment for inflammatory arthritis. 1
For Rheumatoid Arthritis:
- Methotrexate remains the anchor drug per American College of Rheumatology guidelines 4, 1
- Meloxicam provides symptom control while DMARDs are being optimized 1
- NSAIDs do not replace the need for disease-modifying therapy 4
For Osteoarthritis:
- Meloxicam is appropriate after inadequate response to acetaminophen 1
- Both 7.5 mg and 15 mg doses demonstrated superior efficacy compared to placebo, with efficacy evident within 2 weeks 2
Pharmacokinetic Considerations
- Meloxicam has a half-life of approximately 20 hours, supporting once-daily dosing 5
- Steady-state concentrations are achieved within 3-5 days 5
- No dosage adjustment is required in elderly patients or those with moderate renal or hepatic impairment 5
- Absorption is nearly complete and not significantly affected by food 5
Comparative Efficacy and Tolerability
- Meloxicam 7.5-15 mg demonstrated equivalent efficacy to piroxicam 20 mg, naproxen, and diclofenac in controlled trials 6, 2, 3
- Gastrointestinal tolerability was superior to traditional NSAIDs, with GI adverse event rates comparable to placebo at therapeutic doses 6, 2
- The 3.75 mg dose did not consistently achieve statistical significance for all efficacy endpoints and is not recommended 2
Common Pitfalls to Avoid
- Do not exceed 15 mg daily in routine clinical practice; while 22.5 mg has been studied, the standard maximum is 15 mg 3
- Do not use as monotherapy for inflammatory arthritis requiring disease modification 1
- Do not continue indefinitely without reassessing need and risk-benefit ratio 1
- Do not overlook cardiovascular risk assessment before initiating therapy 1