Can meloxicam be taken twice daily instead of once daily?

Meloxicam Dosing: Once Daily Only

Meloxicam should be taken once daily, not twice daily, as it is specifically designed and approved for once-daily administration due to its 20-hour half-life. 1, 2

Standard Dosing Regimen

• Start with 7.5 mg once daily, which can be increased to a maximum of 15 mg once daily if needed for adequate symptom control. 1
• The 20-hour half-life of meloxicam makes it ideal for once-daily dosing and eliminates any pharmacokinetic rationale for twice-daily administration. 2, 3
• Steady-state plasma concentrations are achieved within 3-5 days of once-daily dosing. 4

Why Twice-Daily Dosing Is Not Appropriate

• The pharmacokinetic profile of meloxicam is specifically designed to avoid high initial drug concentrations through prolonged absorption, making split dosing unnecessary and potentially problematic. 4
• Meloxicam demonstrates linear pharmacokinetics with no accumulation at standard doses, and the extended half-life maintains therapeutic levels throughout a 24-hour period. 2, 5
• Unlike some NSAIDs where twice-daily dosing might be considered for refractory symptoms, meloxicam's prolonged duration of action makes this approach both unnecessary and outside approved dosing parameters. 3

Maximum Dosing and Duration Limits

• The absolute maximum dose is 15 mg once daily—exceeding this dose or splitting it into twice-daily administration is not supported by evidence and increases risk without proven benefit. 1
• Meloxicam should not be used 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

Critical Safety Monitoring

• Monitor renal function if treatment extends beyond 2 weeks, particularly in elderly patients or those with existing renal impairment. 1
• Consider gastroprotection with proton pump inhibitors for patients requiring treatment beyond 2 weeks. 1
• Blood pressure monitoring is warranted as NSAIDs can increase blood pressure by approximately 5 mm Hg with continued use. 1

Special Population Considerations

• In elderly patients, use a maximum dose of 7.5 mg daily. 1
• The risk of gastrointestinal bleeding increases from 1 in 2,100 in adults under 45 years to 1 in 110 in adults over 75 years. 1
• Dosage adjustment is not required based on age alone, but lower maximum doses are recommended for safety. 2, 6

Common Pitfall to Avoid

The most critical error would be attempting twice-daily dosing based on experience with shorter-acting NSAIDs like ibuprofen or naproxen. Meloxicam's unique pharmacokinetic profile distinguishes it from these agents—naproxen requires 500 mg twice daily 7, but meloxicam's extended half-life eliminates this need entirely. 2, 3