What is the recommended dosing for meloxicam (nonsteroidal anti-inflammatory drug, NSAID)?

Meloxicam Dosing

Start meloxicam at 7.5 mg once daily and increase to a maximum of 15 mg once daily only if needed for adequate symptom control, with treatment duration limited to 2-4 weeks without reassessment due to significant risks of gastrointestinal, cardiovascular, and renal complications. 1

Standard Dosing Regimen

• Initial dose: 7.5 mg once daily 1
• Maximum dose: 15 mg once daily if the lower dose provides insufficient relief 1
• The half-life is approximately 20 hours, allowing for convenient once-daily administration 1, 2
• Steady-state plasma concentrations are achieved within 3-5 days of starting therapy 2

Duration of Treatment and Reassessment

• Do not use meloxicam continuously for more than 2-4 weeks without reassessment, as prolonged NSAID use significantly increases gastrointestinal, cardiovascular, and renal complications 1
• For acute pain conditions, NSAID monotherapy should generally not exceed 1 month 1
• Continuing NSAID monotherapy beyond 2 months is inappropriate for patients with active arthritis without considering alternative or adjunctive therapies 1

Special Population Dosing

Elderly Patients

• Maximum dose of 7.5 mg daily in elderly patients 1
• Consider lower initial doses and slower titration in elderly patients 1
• The risk of gastrointestinal bleeding increases dramatically with age, from 1 in 2,100 in adults under 45 years to 1 in 110 in adults over 75 years 1

Renal Impairment

• Avoid meloxicam in patients with GFR < 30 mL/min/1.73 m² 1
• Prolonged therapy is not recommended in patients with GFR < 60 mL/min/1.73 m² 1
• Temporarily suspend meloxicam during intercurrent illness, planned IV radiocontrast administration, bowel preparation, or prior to major surgery 1

Safety Monitoring Requirements

Renal Function

• Monitor renal function if treatment extends beyond 2 weeks, particularly in elderly patients or those with existing renal impairment 1
• NSAIDs should be prescribed with caution in patients older than 60 years or with compromised fluid status or renal insufficiency 3

Gastroprotection

• Consider gastroprotection with proton pump inhibitors for patients requiring treatment beyond 2 weeks 1
• Evaluate gastrointestinal risk factors before initiating meloxicam, including history of ulcer, previous GI bleeding, and use of anticoagulants 1
• Concomitant use of anticoagulants increases the risk of gastrointestinal bleeding five to six times 1
• Well-tolerated proton pump inhibitors are recommended to reduce gastrointestinal side effects induced by NSAIDs 3

Cardiovascular Monitoring

• Blood pressure monitoring is warranted as NSAIDs can increase blood pressure by approximately 5 mm Hg with continued use 1
• Long-term use increases risk of cardiac ischemic events by 3.5 per 1,000 persons 1

Critical Pitfalls to Avoid

• Do not continue monotherapy indefinitely without reassessing the need for alternative or adjunctive therapies 1
• Do not ignore cardiovascular risk factors when prescribing meloxicam, as cardiovascular risks accumulate with duration of use 1
• History of peptic ulcer disease, advanced age (> 60 years), male gender, and concurrent corticosteroid therapy should be considered before NSAID administration to prevent upper gastrointestinal tract bleeding and perforation 3
• To prevent renal toxicities, prescribe with caution when given with concomitant administration of other nephrotoxic drugs and renally excreted chemotherapy 3

Clinical Efficacy Evidence

• Meloxicam 7.5 mg once daily demonstrates comparable efficacy to naproxen 750 mg daily in rheumatoid arthritis, with significantly better gastrointestinal and renal tolerability 4
• Both 7.5 mg and 15 mg daily doses are statistically significantly more effective than placebo for osteoarthritis treatment, with efficacy evident after 2 weeks and maintained throughout treatment 5
• The 3.75 mg daily dose does not consistently reach statistical significance for all efficacy endpoints and should not be used 5