Meloxicam Dosing for Osteoarthritis and Rheumatoid Arthritis
Standard Adult Dosing
For adults with osteoarthritis or rheumatoid arthritis, start meloxicam at 7.5 mg once daily orally, with the option to increase to 15 mg once daily if needed for adequate symptom control after 4-6 weeks. 1
- The 7.5 mg dose is effective for mild to moderate pain with inflammatory symptoms, while 15 mg daily provides greater efficacy for patients requiring more robust symptom control 1, 2
- Both doses demonstrate similar gastrointestinal tolerability to placebo, which is superior to traditional NSAIDs like diclofenac 2
- Use the minimum effective dose for the shortest duration possible, as recommended for all NSAIDs 1, 3
- The once-daily dosing (due to meloxicam's 20-hour half-life) improves compliance compared to shorter-acting NSAIDs 4
Elderly Patients
No dose adjustment is required in elderly patients based on age alone. 4
- However, elderly patients warrant closer monitoring due to increased risk of gastrointestinal, cardiovascular, and renal adverse events 3
- Consider starting at 7.5 mg daily in elderly patients and only escalating if necessary, given their higher baseline risk profile 2
- The 7.5 mg dose is specifically advised for older patients in arthritis management 5
Renal Impairment
For patients with mild to moderate renal impairment, no dose adjustment is necessary, but close monitoring is essential. 6
- Studies demonstrate that meloxicam 15 mg once daily does not further compromise renal function or accumulate in patients with pre-existing mild renal impairment over 28 days 6
- Monitor creatinine clearance and renal function markers at baseline, day 14, and day 28 when initiating therapy in renally impaired patients 6
- Meloxicam should be avoided in severe renal impairment, as with all NSAIDs 4
Hepatic Impairment
For patients with mild to moderate hepatic insufficiency, no dose adjustment is required in short-term use. 4
- Moderate hepatic insufficiency does not significantly alter meloxicam pharmacokinetics 4
- However, long-term safety data in hepatic impairment remains limited, so monitor liver function tests periodically 4
Critical Pre-Treatment Assessment
Before initiating meloxicam, evaluate the following risk factors:
- Gastrointestinal risk: History of ulcers, bleeding, concurrent anticoagulation, or corticosteroid use 3, 1
- Cardiovascular risk: History of heart disease, hypertension, or heart failure 3
- Renal function: Baseline creatinine clearance, particularly in elderly or those with known kidney disease 6
Gastrointestinal Prophylaxis
Prescribe a proton pump inhibitor (PPI) alongside meloxicam for patients with gastrointestinal risk factors, choosing the PPI with the lowest acquisition cost. 3, 1
- This applies to all oral NSAIDs and COX-2 inhibitors regardless of selectivity 3
- High-risk patients include those over 65 years, with prior GI events, or taking concurrent aspirin, anticoagulants, or corticosteroids 3
Role in Treatment Algorithm
Meloxicam serves as adjunctive therapy for symptom control, not as primary disease-modifying treatment in inflammatory arthritis. 1
- For osteoarthritis: Consider paracetamol and/or topical NSAIDs before oral NSAIDs like meloxicam 3
- For rheumatoid arthritis: Methotrexate remains the anchor drug, with meloxicam used for symptomatic relief 1
- Treatment duration should be 4-6 weeks for initial assessment of efficacy 1
Common Pitfalls to Avoid
- Do not combine meloxicam with other NSAIDs, as this increases toxicity without improving efficacy 1
- Do not use meloxicam as monotherapy for long-term management of inflammatory arthritis; disease-modifying drugs are required 1
- Do not exceed 15 mg daily, as higher doses do not provide additional benefit but increase adverse event risk 2, 7
- Do not prescribe without assessing cardiovascular, renal, and gastrointestinal risk factors before initiation 3, 1