What is the proper dosage and administration of Mobic (meloxicam) for a female patient of reproductive age to manage menstrual cramps?

Using Mobic (Meloxicam) for Menstrual Cramps

For menstrual cramps (primary dysmenorrhea), meloxicam 7.5 mg or 15 mg taken once daily for 3-5 days starting at the onset of menstruation provides effective pain relief comparable to other NSAIDs, with the advantage of once-daily dosing and potentially better gastrointestinal tolerability. 1

Dosing and Administration

Standard Regimen

• Start meloxicam 7.5 mg once daily at the first sign of menstrual bleeding or cramping 1
• Continue for 3-5 days during the menstrual period 1
• If 7.5 mg provides insufficient relief, increase to 15 mg once daily 1

Timing Considerations

• Take the first dose as soon as menstrual pain begins or when bleeding starts 1
• Both 7.5 mg and 15 mg doses demonstrate similar efficacy profiles for dysmenorrhea 1
• The once-daily dosing offers a compliance advantage over NSAIDs requiring multiple daily doses 1

Efficacy Evidence

Pain Relief Profile

• Meloxicam at both doses (7.5 mg and 15 mg) shows comparable pain reduction to mefenamic acid 500 mg three times daily 1
• The medication effectively reduces dysmenorrhea symptoms including cramping, pain intensity, and associated discomfort 1
• Clinical trials demonstrate consistent pain relief across the treatment period 1

Comparative Effectiveness

• In head-to-head comparisons, meloxicam 7.5 mg was less effective than diclofenac potassium 50 mg or rofecoxib 25 mg for immediate pain relief 2
• However, meloxicam still provided superior pain relief compared to placebo, particularly after the third and fourth doses 2
• The trade-off is once-daily convenience versus potentially faster-acting alternatives 2

Safety and Tolerability

Gastrointestinal Profile

• Meloxicam demonstrates better gastrointestinal tolerability compared to mefenamic acid 1
• In clinical trials, two-thirds of gastrointestinal adverse events occurred in the mefenamic acid group rather than meloxicam groups 1
• No significant differences in laboratory abnormalities between meloxicam doses 1

General Safety

• Both 7.5 mg and 15 mg doses show similar safety profiles 1
• The medication is well-tolerated for short-term cyclical use during menstruation 1

Clinical Considerations and Pitfalls

When Meloxicam May Not Be First Choice

• For women requiring rapid pain relief within the first few hours, diclofenac potassium 50 mg three times daily or naproxen 500-550 mg may be more effective 3, 4
• If severe pain persists despite meloxicam, consider switching to a different NSAID rather than increasing the meloxicam dose above 15 mg 2

Important Contraindications

• Standard NSAID contraindications apply: active peptic ulcer disease, severe renal impairment, aspirin-sensitive asthma, third trimester pregnancy 1
• Avoid in patients with known hypersensitivity to meloxicam or other NSAIDs 1

Alternative First-Line Options

• The American College of Obstetricians and Gynecologists recommends NSAIDs as first-line treatment for dysmenorrhea, with options including ibuprofen, mefenamic acid, or celecoxib 5
• For IUD placement-related pain, naproxen 550 mg or ketorolac (20 mg oral or 30 mg IM) taken 1-2 hours beforehand is preferred 3

When to Consider Hormonal Alternatives

If NSAIDs including meloxicam provide inadequate relief after 2-3 cycles:

• Consider combined oral contraceptives containing 30-35 μg ethinyl estradiol with levonorgestrel or norgestimate 6
• Extended or continuous cycle regimens may provide additional benefit for severe menstrual symptoms 6
• Hormonal contraceptives regulate menstrual patterns and reduce prostaglandin production 7

Practical Prescribing Algorithm

1. Confirm primary dysmenorrhea (exclude secondary causes like endometriosis, fibroids, or pelvic inflammatory disease) 5
2. Start meloxicam 7.5 mg once daily at onset of menses for 3-5 days 1
3. Assess response after 1-2 cycles: if inadequate, increase to 15 mg once daily 1
4. If still inadequate after 2-3 cycles at 15 mg, switch to alternative NSAID (diclofenac, naproxen) or consider hormonal therapy 5, 6
5. Monitor for gastrointestinal symptoms and adjust if needed 1