Is meloxicam (nonsteroidal anti-inflammatory drug (NSAID)) effective for managing ureteral stone pain?

Meloxicam for Ureteral Stone Pain

Meloxicam is not specifically recommended by major guidelines for ureteral stone pain; instead, diclofenac, ibuprofen, and metamizole are the first-line NSAIDs explicitly endorsed for renal colic. 1, 2

First-Line NSAID Recommendations

The European Association of Urology 2025 guidelines specifically name diclofenac, ibuprofen, and metamizole as first-line NSAIDs for renal colic, with no mention of meloxicam in their treatment algorithm. 1, 2 These agents:

• Reduce the need for additional analgesia compared to opioids 1, 2
• Should be used at the lowest effective dose to minimize cardiovascular and gastrointestinal risks 1, 2
• May impact renal function in patients with low glomerular filtration rate, requiring caution 1, 2

NSAIDs achieve greater pain score reduction, decreased need for rescue medications, and fewer vomiting events compared to opioids in acute renal colic. 3

Why Meloxicam Is Not Guideline-Recommended

While meloxicam is a COX-2 selective NSAID with demonstrated anti-inflammatory properties and acceptable renal tolerability in rheumatic disease patients 4, 5, it is conspicuously absent from all major urolithiasis guidelines including:

• European Association of Urology 2025 guidelines 1, 2
• American Urological Association 2016 guidelines 1
• Historical AUA 2007 guidelines 1

The guidelines' specific endorsement of diclofenac, ibuprofen, and metamizole suggests these agents have superior evidence for acute renal colic, likely due to their rapid onset and extensive clinical trial data in this specific indication. 1, 2

Clinical Implications

Use guideline-recommended NSAIDs (diclofenac, ibuprofen, or metamizole) as first-line therapy for ureteral stone pain rather than meloxicam. 1, 2 If NSAIDs are contraindicated or insufficient:

• Opioids serve as second-line analgesics 1, 2
• Avoid pethidine; prefer hydromorphone, pentazocine, or tramadol 1, 2
• NSAIDs are contraindicated in pregnancy; coordinate with obstetrics for alternative pain management 1

Important Caveats

• Monitor renal function when using any NSAID in patients with reduced glomerular filtration rate 1, 2
• Regular pain assessment using validated scales (VAS, VRS, NRS) is recommended to evaluate treatment efficacy 2
• Patients with well-controlled pain, no sepsis, and adequate renal reserve may be candidates for observation with medical expulsive therapy using alpha-blockers for stones >5 mm 1, 2, 6