What is the recommended dosage and considerations for prescribing Mobic (meloxicam) to an adult patient with osteoarthritis or rheumatoid arthritis, particularly those with a history of gastrointestinal issues, kidney disease, or bleeding disorders?

Meloxicam (Mobic) Dosing and Management

Recommended Dosage

Start meloxicam at 7.5 mg once daily, with the option to increase to 15 mg once daily if needed for adequate symptom control, using the minimum effective dose for the shortest duration possible. 1

• The standard starting dose is 7.5 mg once daily for both osteoarthritis and rheumatoid arthritis 1
• If symptom control is inadequate after 2-4 weeks, increase to 15 mg once daily 1, 2
• For mild inflammatory arthritis pain, use 7.5-15 mg daily for 4-6 weeks 1
• Efficacy becomes evident after 2 weeks of treatment and improves with increasing doses 2

Critical Pre-Treatment Risk Assessment

Before prescribing meloxicam, evaluate three key risk domains: gastrointestinal, renal, and cardiovascular. 1

Gastrointestinal Risk Factors

• History of peptic ulcer disease, GI bleeding, or perforation 1
• Concurrent use of anticoagulants, antiplatelet agents, or corticosteroids 1
• Age >65 years 3
• For high-risk patients, prescribe a proton pump inhibitor for GI prophylaxis 1

Renal Disease Considerations

• Meloxicam demonstrates significantly better renal safety compared to traditional NSAIDs like naproxen 4
• In comparative trials, naproxen caused significant increases in serum creatinine and urea, while meloxicam did not 4
• However, avoid meloxicam in patients with severe renal impairment (CrCl <30 mL/min) 1
• Monitor renal function periodically in patients with mild-to-moderate renal disease 1

Bleeding Disorder Precautions

• Do not combine meloxicam with other NSAIDs 1
• Exercise caution with concurrent anticoagulant or antiplatelet therapy 1
• Meloxicam's COX-2 selectivity provides a theoretical advantage in reducing platelet dysfunction compared to non-selective NSAIDs 5

Gastrointestinal Safety Profile

Meloxicam demonstrates superior GI tolerability compared to traditional NSAIDs:

• GI adverse events occur in 30% of meloxicam patients versus 45% with naproxen 4
• Severe GI complications (perforation, ulceration, bleeding) occur in only 0.1-0.2% of patients on meloxicam 7.5-15 mg, compared to 2.1% with naproxen and 1.2% with piroxicam 3
• The incidence of GI adverse events with meloxicam is comparable to placebo 2
• No ulcers were observed in meloxicam-treated patients in head-to-head trials, while ulcers occurred in 1.1% of naproxen patients 4
• This improved safety profile results from meloxicam's preferential inhibition of COX-2 over COX-1 3, 5

Role in Treatment Algorithm

Meloxicam should be used as adjunctive therapy for symptom control, not as monotherapy for long-term management of inflammatory arthritis. 1

For Rheumatoid Arthritis

• Methotrexate remains the anchor drug in the treatment algorithm 1
• Use meloxicam for symptomatic relief while disease-modifying therapy takes effect 1
• NSAIDs like meloxicam do not slow disease progression 1

For Osteoarthritis

• Consider meloxicam after inadequate response to acetaminophen 1
• Use at the lowest effective dose for the shortest duration 1

For Ankylosing Spondylitis

• Meloxicam is recommended as first-line therapy for symptom management 1
• Continuous treatment is conditionally recommended over on-demand treatment 1

Monitoring Requirements

• Assess efficacy and adverse effects regularly during treatment 1
• Monitor for GI symptoms (dyspepsia, abdominal pain, bleeding) 3
• Check renal function periodically, especially in patients with pre-existing renal disease 4
• Evaluate cardiovascular risk factors before and during therapy 1

Common Pitfalls to Avoid

• Do not use meloxicam in combination with other NSAIDs, as this increases toxicity without improving efficacy 1
• Do not continue meloxicam indefinitely without reassessing the need for therapy—use the shortest duration necessary 1
• Do not neglect GI prophylaxis in high-risk patients, as this is when serious complications occur 1
• Do not assume all NSAIDs have equivalent safety profiles—meloxicam's COX-2 selectivity provides measurably better GI and renal tolerability than traditional NSAIDs 4, 3, 5

Long-Term Safety Data

In an 18-month study of meloxicam 15 mg daily in rheumatoid arthritis patients:

• 66% of patients remained on therapy for the full 18 months 6
• Only 3.9% discontinued due to GI adverse events 6
• Severe GI effects occurred in only 0.8% of patients 6
• Efficacy was maintained throughout the study period 6