What is the typical starting dose of meloxicam (nonsteroidal anti-inflammatory drug, NSAID)?

Meloxicam Starting Dose

The recommended starting dose of meloxicam for adults 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, 3

Standard Dosing Protocol

• Initial dose: 7.5 mg once daily for all adult patients 1, 2, 3
• Maximum dose: 15 mg once daily if the lower dose provides insufficient relief 2
• Administer as a single daily dose (once-daily dosing) 3
• Available in 7.5 mg and 15 mg tablet formulations 3

Dose Titration Strategy

• Start all patients at 7.5 mg daily regardless of indication 1, 3
• If symptom control is inadequate after an appropriate trial period, increase to 15 mg once daily 1, 2
• Clinical trials demonstrate efficacy is evident after 2 weeks of treatment and improves with increasing doses 4
• The 3.75 mg dose has been studied but did not consistently reach statistical significance for all endpoints and is not recommended 4

Special Population Dosing

Elderly Patients (>59-75 years)

• Start with 7.5 mg once daily and maintain at this lower dose 1, 2, 3
• Maximum dose: 7.5 mg daily in elderly patients 2
• Use the lowest effective dose to minimize adverse effects 1
• Risk of GI bleeding increases dramatically from 1 in 2,100 in adults under 45 years to 1 in 110 in adults over 75 years 2

Renal Impairment

• Use caution and consider lower doses in patients with renal impairment 1
• Avoid in patients with GFR <30 mL/min/1.73 m² 2
• Prolonged therapy not recommended in those with GFR <60 mL/min/1.73 m² 2
• Temporarily suspend during intercurrent illness, IV radiocontrast administration, bowel preparation, or prior to major surgery 2

Cardiovascular Risk Factors

• Use the lowest effective dose for the shortest duration possible in patients with cardiovascular disease 3
• Avoid long-term use as NSAIDs increase risk of cardiac ischemic events by 3.5 per 1,000 persons 2

Duration and Monitoring Considerations

Treatment Duration Limits

• Do not use continuously for more than 2-4 weeks without reassessment 2
• For acute pain: NSAID monotherapy should generally not exceed 1 month 2
• Continuing beyond 2 months is inappropriate for patients with active arthritis 2

Required Monitoring

• Monitor renal function if treatment extends beyond 2 weeks, particularly in elderly or those with existing renal impairment 2
• Blood pressure monitoring warranted as NSAIDs can increase BP by approximately 5 mm Hg 2
• Consider gastroprotection with proton pump inhibitors for patients requiring treatment beyond 2 weeks 2

Critical Safety Considerations

Gastrointestinal Protection

• Evaluate GI risk factors before initiating: history of ulcer, previous GI bleeding, use of anticoagulants 2
• Concomitant anticoagulant use increases GI bleeding risk 5-6 times 2
• Consider combining with a proton pump inhibitor or H2 blocker in high-risk patients 3
• Meloxicam has demonstrated GI tolerability comparable to placebo in clinical trials 4

Drug Interactions

• Avoid concurrent use with other NSAIDs due to increased risk of adverse effects 1
• The half-life of meloxicam is approximately 20 hours, requiring consideration for perioperative management 5

Evidence Quality Note

The 7.5 mg starting dose is consistently recommended across multiple high-quality guidelines from the American Academy of Family Physicians 1, 2, 3 and supported by robust clinical trial data demonstrating efficacy with favorable GI tolerability at this dose 4, 6. The dose-response relationship has been well-established, with 7.5-15 mg daily showing statistical superiority over placebo while maintaining safety profiles 4.