From the Guidelines
Mobic (meloxicam) should be used with extreme caution in a 91-year-old patient and is generally not considered safe for routine use in this age group. Elderly patients, especially those over 90, have increased risks of serious side effects from nonsteroidal anti-inflammatory drugs (NSAIDs) like meloxicam, including gastrointestinal bleeding, kidney damage, and cardiovascular events such as heart attack and stroke 1. The European Society of Cardiology working group on cardiovascular pharmacotherapy emphasizes the importance of careful prescription and monitoring of pharmacotherapy in older people with cardiovascular disease and multimorbidity 2.
Key Considerations
- Aging kidneys process medications less efficiently, increasing the risk of adverse effects
- Older patients often have underlying conditions that increase vulnerability to NSAID side effects
- The American Geriatrics Society includes NSAIDs in their Beers Criteria as medications to avoid in older adults
Alternative Options
- If pain management is necessary, starting with acetaminophen (Tylenol) at appropriate doses (not exceeding 3000mg daily in the elderly) is typically safer
- If additional pain control is needed, the lowest effective dose of meloxicam (7.5mg daily rather than 15mg) for the shortest duration possible might be considered, but only after careful assessment of kidney function, cardiovascular risk, and potential drug interactions
Monitoring and Precautions
- Regular monitoring of kidney function, blood pressure, and signs of GI bleeding would be essential if meloxicam is used
- Careful assessment of the patient's overall health and potential interactions with other medications is crucial before initiating meloxicam therapy 1, 2
From the Research
Safety of Mobic for a 91-Year-Old Patient
- Mobic, also known as meloxicam, is a nonsteroidal anti-inflammatory drug (NSAID) that is used to manage rheumatoid arthritis, acute exacerbations of osteoarthritis, ankylosing spondylitis, and juvenile idiopathic arthritis 3.
- The recommended dose for elderly patients is 7.5mg daily, which can be increased to a maximum of 15mg daily if necessary 3.
- However, NSAIDs like meloxicam can increase the risk of serious gastrointestinal (GI) adverse events, including ulceration and bleeding, especially in elderly patients 3, 4, 5.
- A study found that the use of a traditional NSAID plus proton-pump inhibitor is an effective and well-tolerated alternative to COX-2 selective inhibitors for patients at high risk of GI complications 5.
- Another study suggested that concomitant use of NSAIDs with proton pump inhibitors significantly increases the risk of acute kidney injury 6.
- Considering the patient's age, it is essential to weigh the benefits and risks of using Mobic and to monitor the patient closely for any adverse effects 7.
- The patient's medical history, including any history of GI complications, kidney disease, or other health conditions, should also be taken into account when deciding whether to prescribe Mobic 3, 4, 5, 6.