What is meloxicam used for. How does meloxicam work. What are the common side effects of meloxicam. How should meloxicam be taken. What precautions should be considered before taking meloxicam. How does meloxicam interact with other medications. What are the alternatives to meloxicam for treating arthritis.

Understanding Meloxicam: A Powerful NSAID for Arthritis Treatment

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) commonly prescribed to treat various forms of arthritis. Available as a generic medication, it’s also marketed under the brand name Mobic. This article delves into the uses, dosage, side effects, and important considerations for meloxicam, providing a comprehensive guide for patients and healthcare providers alike.

The Medical Uses of Meloxicam: Targeting Different Types of Arthritis

Meloxicam is primarily used to treat three types of arthritis:

• Osteoarthritis (OA) in adults
• Rheumatoid arthritis (RA) in adults
• Juvenile idiopathic arthritis (JIA) in certain pediatric patients

While these are the main indications, it’s worth noting that meloxicam may also be prescribed for other conditions off-label. Additionally, veterinary formulations of meloxicam exist for use in dogs and cats, though these differ from the human versions.

How Does Meloxicam Work to Relieve Arthritis Symptoms?

Meloxicam works by inhibiting the production of prostaglandins, which are chemicals in the body responsible for inflammation, pain, and fever. By reducing prostaglandin levels, meloxicam helps alleviate the pain, swelling, and stiffness associated with arthritis. This mechanism of action is common to all NSAIDs, but meloxicam is designed to be more selective in targeting specific enzymes, potentially reducing some side effects compared to older NSAIDs.

Meloxicam Dosage and Administration: Finding the Right Balance

Meloxicam is available in tablet form, with two common strengths: 7.5 mg and 15 mg. The appropriate dosage depends on several factors, including the condition being treated, the patient’s age, and their overall health status.

What is the Typical Dosage for Meloxicam?

For adults with osteoarthritis or rheumatoid arthritis, the usual starting dose is 7.5 mg once daily. This may be increased to 15 mg once daily if necessary for better symptom control. In children with juvenile idiopathic arthritis, the dosage is typically based on body weight and should be determined by a pediatric rheumatologist.

It’s crucial to take meloxicam exactly as prescribed by your healthcare provider. Taking higher doses or using the medication for longer than recommended can increase the risk of side effects without providing additional therapeutic benefit.

Side Effects of Meloxicam: What Patients Should Watch For

Like all medications, meloxicam can cause both mild and serious side effects. Understanding these potential effects is essential for patients to make informed decisions about their treatment and to recognize when medical attention may be necessary.

Common Mild Side Effects

Some of the more frequently reported mild side effects of meloxicam include:

• Diarrhea
• Indigestion or upset stomach
• Nausea
• Headache
• Fluid retention and bloating
• Abdominal pain
• Skin rash
• Sore throat
• Upper respiratory infections

These side effects are generally manageable and may resolve on their own as the body adjusts to the medication. However, if they persist or become bothersome, it’s important to consult with a healthcare provider.

Serious Side Effects Requiring Immediate Attention

While less common, meloxicam can potentially cause more serious side effects that require prompt medical attention:

• Elevated potassium levels in the blood
• Kidney damage
• Liver damage
• New or worsening hypertension
• Severe skin reactions (e.g., Stevens-Johnson syndrome)
• Allergic reactions

Patients should be aware of the symptoms associated with these serious side effects and seek immediate medical care if they occur.

Boxed Warnings: Understanding the Risks of Heart and Digestive System Problems

Meloxicam, like other NSAIDs, carries boxed warnings from the FDA regarding potential risks to the cardiovascular and gastrointestinal systems. These warnings highlight the importance of careful consideration and monitoring when prescribing and using this medication.

What Are the Cardiovascular Risks Associated with Meloxicam?

NSAIDs, including meloxicam, may increase the risk of serious cardiovascular thrombotic events, such as heart attacks and strokes. This risk may be higher in patients with existing cardiovascular disease or risk factors for cardiovascular disease. The risk also appears to increase with longer duration of use.

How Does Meloxicam Affect the Digestive System?

Meloxicam can increase the risk of serious gastrointestinal adverse events, including bleeding, ulceration, and perforation of the stomach or intestines. These events can occur at any time during treatment and without warning symptoms. Elderly patients and those with a history of peptic ulcer disease or gastrointestinal bleeding are at higher risk for these complications.

Interactions and Precautions: Ensuring Safe Use of Meloxicam

Before starting meloxicam, it’s crucial to discuss all current medications, supplements, and medical conditions with a healthcare provider. Certain interactions and precautions can significantly impact the safety and efficacy of meloxicam treatment.

What Medications Interact with Meloxicam?

Meloxicam can interact with various medications, potentially altering their effectiveness or increasing the risk of side effects. Some notable interactions include:

• Other NSAIDs or aspirin
• Blood thinners (e.g., warfarin)
• Certain antidepressants (e.g., SSRIs)
• ACE inhibitors and ARBs for blood pressure
• Diuretics
• Methotrexate

This list is not exhaustive, and patients should always consult their healthcare provider or pharmacist about potential drug interactions.

Special Precautions for Certain Patient Groups

Some individuals may need to exercise extra caution when using meloxicam or may not be suitable candidates for this medication:

• Pregnant women, especially in the third trimester
• Breastfeeding mothers
• Patients with a history of gastrointestinal bleeding or ulcers
• Individuals with liver or kidney disease
• Those with heart disease or at high risk for cardiovascular events
• Patients with asthma or allergies to aspirin or other NSAIDs

Healthcare providers will carefully weigh the potential benefits against the risks when considering meloxicam for these patient groups.

Alternatives to Meloxicam: Exploring Other Treatment Options

While meloxicam can be an effective treatment for arthritis, it’s not the only option available. Depending on the specific condition, severity of symptoms, and individual patient factors, healthcare providers may consider alternative treatments.

What Are Some Alternatives to Meloxicam for Arthritis Treatment?

Alternative treatment options for arthritis may include:

1. Other NSAIDs (e.g., ibuprofen, naproxen)
2. Acetaminophen for pain relief
3. Topical pain relievers
4. Disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis
5. Corticosteroid injections
6. Physical therapy and exercise programs
7. Complementary therapies (e.g., acupuncture, massage)
8. Lifestyle modifications (e.g., weight loss, dietary changes)

The choice of treatment should be individualized based on the patient’s specific needs, preferences, and risk factors. A comprehensive approach often involves a combination of pharmacological and non-pharmacological interventions.

Monitoring and Follow-up: Ensuring Optimal Treatment with Meloxicam

Regular monitoring and follow-up are essential components of safe and effective meloxicam therapy. This ongoing assessment helps healthcare providers detect any potential issues early and adjust treatment as needed.

What Should Patients Expect During Follow-up Appointments?

During follow-up appointments, healthcare providers may:

• Assess the effectiveness of meloxicam in managing arthritis symptoms
• Monitor for any side effects or complications
• Perform blood tests to check kidney and liver function
• Measure blood pressure and evaluate cardiovascular risk
• Adjust the dosage if necessary
• Discuss any concerns or questions the patient may have

Patients should be proactive in reporting any new symptoms or changes in their condition between appointments. Open communication with healthcare providers is key to optimizing treatment outcomes and minimizing risks associated with meloxicam use.

In conclusion, meloxicam is a valuable tool in the management of various forms of arthritis, offering relief from pain and inflammation for many patients. However, its use requires careful consideration of potential risks and benefits, appropriate dosing, and ongoing monitoring. By understanding the uses, side effects, and important precautions associated with meloxicam, patients and healthcare providers can work together to ensure safe and effective treatment of arthritis symptoms. As with any medication, individual responses may vary, and treatment plans should be tailored to each patient’s unique needs and circumstances.

Side Effects, Dosage, Uses, and More

Meloxicam is a generic prescription medication* that’s used to treat:

• osteoarthritis (OA) in adults
• rheumatoid arthritis (RA) in adults
• juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis, in some children

To learn more about the use of meloxicam for treating OA, RA, and JIA, see the “What is meloxicam used for?” section below.

* Meloxicam may also be used to treat certain conditions in dogs and cats. But meloxicam prescribed for humans is different from meloxicam prescribed for pets.

Meloxicam basics

Meloxicam is a type of drug called a nonsteroidal anti-inflammatory drug (NSAID). Meloxicam comes as an oral tablet, which is a tablet that you swallow. It also comes as an oral capsule and an oral suspension, but these forms aren’t covered in this article.

Keep reading to learn more about meloxicam, including the drug’s side effects, dosages, uses, and more.

Meloxicam brand-name versions

Meloxicam tablets are also available in a brand-name version called Mobic.

Meloxicam is a generic drug, which means it’s an exact copy of the active drug in a brand-name medication. The brand-name medication that meloxicam is based on is Mobic.

Generic drugs are thought to be as safe and effective as the brand-name drug they’re based on. In general, generics cost less than brand-name drugs do.

If you’d like to know more about taking Mobic instead of meloxicam, talk with your doctor. You can also explore this Healthline article to learn more about the differences between generic and brand-name drugs.

Like most drugs, meloxicam may cause mild or serious side effects. The lists below describe some of the more common side effects that meloxicam may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

• your age
• other health conditions you have
• other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of meloxicam. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a list of some of the mild side effects that meloxicam can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read meloxicam’s prescribing information.

Mild side effects of meloxicam that have been reported include:

• diarrhea
• fluid retention (buildup of fluid in the body) and bloating
• headache
• indigestion (upset stomach)
• nausea
• pain in your belly
• skin rash
• sore throat
• upper respiratory infection, such as the common cold
• mild allergic reaction*

* To learn more about this side effect, see the “Allergic reaction” section below.

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from meloxicam can occur, but they aren’t common. If you have serious side effects from meloxicam, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of meloxicam that have been reported include:

• high level of potassium in the blood
• kidney damage
• liver damage
• new or worsened high blood pressure
• boxed warnings: risk of heart problems and risk of digestive system problems*
• serious skin reactions†
• severe allergic reaction†

* For more information, see the “What should be considered before taking meloxicam?” section.
† To learn more about this side effect, see the “Allergic reaction” section below.

Allergic reaction

Some people may have an allergic reaction to meloxicam.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, usually in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

In addition, severe skin reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported with meloxicam. These specific allergic reactions are life threatening and require immediately treatment. Symptoms of SJS and TEN can include:

• skin rash that blisters and peels
• fever
• body aches
• red or stinging eyes
• generally feeling unwell
• sore throat
• headache

Call your doctor right away if you have an allergic reaction to meloxicam. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Your doctor will recommend the dosage of meloxicam that’s right for you. Below are commonly used dosages, but always take the dosage your doctor prescribes.

Form and strengths (7.5 mg and 15 mg)

Meloxicam comes as tablets that you swallow. They’re available in two strengths: 7.5 milligrams (mg) and 15 mg.

Recommended dosages

You’ll take meloxicam once per day. Below you’ll find the usual dosages for each condition meloxicam is used to treat, including maximum dose.

Dosage for osteoarthritis or rheumatoid arthritis

For treating osteoarthritis (OA) or rheumatoid arthritis (RA) in adults, meloxicam’s recommended dosage is 7.5 mg taken once per day.

If this dose doesn’t relieve your symptoms of OA or RA, your doctor may increase your dose to 15 mg once per day. This is the maximum dose recommended for the drug.

Dosage for juvenile idiopathic arthritis

For treating juvenile idiopathic arthritis (JIA), meloxicam may be prescribed to children ages 2 years and older who weigh at least 60 kilograms (kg).* The recommended dose of the drug for JIA is 7.5 mg once per day. This is also the maximum dose for this purpose.

To learn more about meloxicam’s dosage, see this article.

* One kg equals about 2.2 pounds (lb). So 60 kg is about 132 lb.

Questions about meloxicam’s dosage

Below are some common questions about meloxicam’s dosage.

• What if I miss a dose of meloxicam? If you miss a dose of meloxicam, take it as soon as you remember. But if it’s the next day and nearly time for your next dose, skip the missed dose. Take your next dose at its regularly scheduled time. You should not take more than one dose of meloxicam at a time.
• Will I need to take meloxicam long term? Maybe. Your doctor will recommend taking meloxicam at the lowest dose for the shortest time needed to treat your symptoms. Some people will need to take meloxicam long term to treat their symptoms.
• How long does meloxicam take to work? Meloxicam begins working shortly after you take a dose. But it may take longer before you notice any symptom relief.

Meloxicam may be prescribed to treat the following kinds of arthritis:

• osteoarthritis in adults
• rheumatoid arthritis in adults
• juvenile idiopathic arthritis in children ages 2 years and older who weigh at least 60 kilograms (kg)*

* One kg equals about 2.2 pounds (lb). So 60 kg is about 132 lb.

Below you’ll find an overview of these conditions and how meloxicam helps treat them.

Note: In addition to the uses described here, meloxicam is sometimes prescribed off-label for treating other conditions. With off-label use, a drug approved by the Food and Drug Administration (FDA) for certain uses is prescribed for a different use. For more information about off-label uses of this drug, talk with your doctor.

Meloxicam for osteoarthritis

Osteoarthritis (OA) is a condition that causes cartilage to break down. Cartilage is a protective tissue that covers the ends of your bones. When bones lack cartilage, they can rub against one another. This leads to symptoms such as pain and joint stiffness.

Common causes of OA include age and repeated stress to joints over time. But injury, obesity, and poor posture can also lead to OA.

Meloxicam can treat OA by helping to reduce the pain and inflammation (swelling and damage) caused by this condition.

Meloxicam for rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune condition that causes damage to your joints. With autoimmune conditions, a person’s immune system mistakenly attacks their own body.

In people who have RA, the immune system attacks the linings of joints. Over time, this damage can cause joints to lose shape and function. Without treatment, RA can eventually destroy joints.

Symptoms of RA, which may affect one joint or multiple joints, include:

• aching or pain
• stiffness
• swelling
• tenderness

Meloxicam can treat symptoms of RA by reducing inflammation in the joints.

Meloxicam for juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA), also called juvenile rheumatoid arthritis, is a kind of arthritis that affects children. “Idiopathic” means the condition has no known cause. But JIA is thought to be an autoimmune condition. With autoimmune conditions, a person’s immune system mistakenly attacks their own body.

Symptoms of JIA include pain, stiffness, and swelling in the joints.

Meloxicam is used to treat JIA in children ages 2 years and older who weigh at least 60 kilograms (kg).* It helps ease symptoms of JIA by reducing inflammation in the joints.

* One kg equals about 2.2 pounds (lb). So 60 kg is about 132 lb.

Find answers to some commonly asked questions about meloxicam.

Can meloxicam be taken with pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil)?

It depends on the pain reliever.

Meloxicam should not be used with ibuprofen (Advil) or other nonsteroidal anti-inflammatory drugs (NSAIDs). This is because meloxicam itself is an NSAID. Taking more than one NSAID at the same time can increase your risk of certain side effects these drugs can cause.

You may take acetaminophen (Tylenol) with meloxicam if your doctor says it’s safe for you to do so. But don’t take acetaminophen or any other medication with meloxicam without discussing it with your doctor or pharmacist. They can check whether the medication is safe to take with meloxicam.

Is meloxicam used to treat back pain or muscle pain?

No, the Food and Drug Administration (FDA) has not approved meloxicam to treat back pain or muscle pain.

But these are symptoms caused by conditions meloxicam is FDA-approved to treat: osteoarthritis (OA) or rheumatoid arthritis (RA) in adults, and juvenile idiopathic arthritis (JIA) in some children.* The anti-inflammatory and pain-relieving effects of NSAIDs such as meloxicam may help ease back pain and muscle pain.

That said, doctors might still prescribe meloxicam off-label to treat back or muscle pain. With off-label use, a drug approved by the FDA for certain uses is prescribed for a different use. For more information about off-label uses of meloxicam, talk with your doctor.

* For more information, see the “What is meloxicam used for?” section above.

Does meloxicam make you sleepy?

No, it’s not known to do so. In studies of meloxicam, sleepiness wasn’t a reported side effect.

But drowsiness is a known symptom of overdose from NSAIDs, the group of drugs meloxicam belongs to. Taking more meloxicam than prescribed could lead to overdose, which may cause drowsiness.

To learn more about meloxicam overdose, see the “What should be done in case of overdose?” section below. Your doctor or pharmacist can also discuss this with you.

Do older adults have a higher risk of side effects with meloxicam?

It depends on the side effect. Older adults (ages 65 years and older) have a higher risk of some side effects of meloxicam, but not all.

Side effects that older adults are at higher risk of from taking meloxicam include:

• kidney damage
• boxed warning: risk of heart problems and risk of digestive system problems*

* For more information, see the “What should be considered before taking meloxicam?” section.

Because of these risks, doctors will prescribe the lowest meloxicam dose for the shortest possible time to treat symptoms of OA or RA in older people.

If you have questions about whether meloxicam is safe for you to take, talk with your doctor or pharmacist.

What should I know about alternatives to meloxicam, such as Celebrex?

Meloxicam and Celebrex are both nonsteroidal anti-inflammatory drugs (NSAIDs). So these drugs have many similarities. For example, they’re both commonly used to treat OA and RA.

In addition, both meloxicam and Celebrex have boxed warnings regarding the risk of serious heart or digestive problems that can occur as side effects.* Boxed warnings are serious warnings from the Food and Drug Administration (FDA) about drug effects that may be dangerous.

That said, meloxicam and Celebrex also have some differences. For example, meloxicam is a generic prescription drug, and Celebrex is a brand-name prescription drug. (The active ingredient in Celebrex is celecoxib. An active ingredient is what makes a drug work.)

As well, Celebrex may be taken once or twice per day to treat OA, while meloxicam is taken once per day to treat OA.

To learn more about meloxicam and possible alternatives, talk with your doctor or pharmacist.

* For more information about meloxicam’s boxed warnings, see the “What should be considered before taking meloxicam?” section below. Your doctor can discuss Celebrex’s boxed warnings with you.

Meloxicam comes with several warnings, which may affect whether the drug is a good treatment for your condition.

Interactions

Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.

Before taking meloxicam, be sure to tell your doctor about all medications you take (including prescription and over-the-counter drugs). Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with meloxicam.

For information about drug-condition interactions, see the “Other warnings” section below.

Interactions with drugs or supplements

Meloxicam can interact with several types of drugs. These drugs include:

• other nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Naprosyn) and ibuprofen (Advil)
• blood thinners, such as warfarin (Jantoven), apixaban (Eliquis), and clopidogrel (Plavix)
• selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa)
• serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor XR)
• angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Zestril)
• angiotensin type II receptor blockers (ARBs), such as losartan (Cozaar)
• beta-blockers, such as metoprolol (Lopressor, Toprol XL) and propranolol (Inderal LA, Innopran XL)
• diuretics, such as furosemide (Lasix) and hydrochlorothiazide (Microzide)
• the mental health drug lithium (Lithobid)
• the drug methotrexate (Otrexup, Trexall), which is prescribed for several kinds of conditions
• the organ transplant drug cyclosporine (Gengraf, Neoral)
• the cancer drug pemetrexed (Pemfexy)

This list does not contain all kinds of drugs that may interact with meloxicam. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of meloxicam.

Boxed warnings

Meloxicam has boxed warnings about the risk of heart problems and risk of digestive system problems. These are serious warnings from the Food and Drug Administration (FDA) about drug effects that may be dangerous.

Risk of heart problems. Taking nonsteroidal anti-inflammatory drugs (NSAIDs), including meloxicam, increases the risk of heart problems. Examples include heart attack and stroke. These side effects can happen at any time while taking meloxicam. In rare cases, they can be fatal.

Symptoms of heart attack or stroke can include:

• chest pain
• pain or discomfort in the arms, back, jaw, or neck
• shortness of breath
• sudden, severe headache
• vision problems
• weakness or numbness on one side of the body or face

Immediately call 911 or a local emergency number if you have symptoms of a heart attack or stroke while taking meloxicam.

You’re thought to be at higher risk of heart problems if you take meloxicam and:

• have another heart condition, such as heart disease
• take a higher meloxicam dose
• take meloxicam for a long period of time

Due to these risks, doctors will not prescribe meloxicam if you’ve recently had a heart attack or heart bypass surgery. To learn more about whether meloxicam is safe to take based on your medical history, talk with your doctor.

Risk of digestive system problems. Taking NSAIDs such as meloxicam increases the risk of serious digestive problems. Examples include bleeding, ulcers, and holes in the digestive tract. These side effects can happen at any time while taking meloxicam. In rare cases, they can be fatal.

Symptoms of these digestive problems include:

• a burning sensation in your chest or abdomen
• dark or bloody stool
• vomiting blood or what seems like coffee grounds
• indigestion (upset stomach)

If you have symptoms of digestive problems, contact your doctor right away. They’ll likely have you permanently stop taking meloxicam if they confirm you have a serious digestive problem.

Certain factors increase the risk of digestive problems that meloxicam and other NSAIDs can cause. These factors include:

• taking meloxicam for a long time
• drinking alcohol
• smoking or using tobacco
• being age 65 years or older
• taking meloxicam with certain other drugs

If you have concerns about serious digestive problems while taking meloxicam, talk with your doctor.

Other warnings

Meloxicam can sometimes cause harmful effects in people who have certain conditions. This is known as a drug-condition interaction. Other factors may also affect whether meloxicam is a good treatment option for you.

Talk with your doctor about your health history before you take meloxicam. Factors to consider include those described below.

Asthma. Some people with asthma experience certain side effects after taking aspirin. These side effects, such as sudden tightening in the airways, can be severe or even life threatening in rare cases.

Because meloxicam and aspirin are similar, it’s possible for some people with asthma to have this reaction with meloxicam. If you have aspirin-sensitive asthma, your doctor likely won’t prescribe meloxicam. If you have asthma that isn’t aspirin-sensitive, your doctor will still closely monitor you for worsening asthma symptoms during meloxicam treatment.

Kidney problems. Though rare, meloxicam can cause kidney damage. People who have a kidney problem, such as chronic kidney disease, may have a higher risk of this side effect. If you have a kidney problem, tell your doctor before you start taking meloxicam. Depending on the how severe your kidney problem is, they may prescribe a lower meloxicam dose.

Allergic reaction. If you’ve had an allergic reaction to meloxicam or any of its ingredients, your doctor will likely not prescribe meloxicam. Ask them what other medications are better options for you.

Meloxicam and alcohol

It’s best to avoid or limit alcohol consumption while taking meloxicam.

Alcohol can increase your risk of certain side effects from meloxicam. This includes serious heart problems and serious digestive system problems. Meloxicam has boxed warnings about these problems. Boxed warnings are serious warnings from the FDA about drug effects that may be dangerous. For more information, see the “Boxed warnings” section above.

Before you start taking meloxicam, talk with your doctor about consuming alcohol during treatment. They can advise you on how much alcohol, if any, is safe to drink while taking the drug.

Pregnancy and breastfeeding

Below you’ll find information on taking meloxicam during pregnancy or while breastfeeding.

Meloxicam and pregnancy

It isn’t safe to take meloxicam at week 30 of pregnancy and beyond. Like other NSAIDs, meloxicam can cause harm to a fetus if taken at this point in pregnancy.

It isn’t clear whether it’s safe to take meloxicam during other periods of pregnancy.

To learn more about the risks and benefits of other treatments for your condition during pregnancy, talk with your doctor.

Meloxicam and breastfeeding

It’s not clear whether meloxicam causes side effects in a breastfed child. The drug is known pass into breast milk in small amounts.

If you’re breastfeeding or planning to do so, talk with your doctor about the risks and benefits of taking meloxicam during this time.

Your doctor will explain how you should take meloxicam. They’ll also explain how much to take and how often. Be sure to follow your doctor’s instructions.

Taking meloxicam

Meloxicam comes as a tablet that you take by swallowing.

Accessible medication containers and labels

If it’s hard for you to read the label on your prescription, tell your doctor or pharmacist. Certain pharmacies provide medication labels that:

• have large print
• use braille
• contain a code you can scan with a smartphone to change the text to audio

Your doctor or pharmacist may be able to recommend a pharmacy that offers these options if your current pharmacy doesn’t.

Also, if you’re having trouble opening your medication bottles, let your pharmacist know. They may be able to put meloxicam in an easy-open container. Your pharmacist may also recommend tools to help make it simpler to open the drug’s container.

Questions about taking meloxicam

Below are some common questions about taking meloxicam.

• Can meloxicam be chewed, crushed, or split? No, you should not chew, crush, or split meloxicam tablets. Check out this page for tips if you’re having trouble swallowing pills. You can also talk with your doctor or pharmacist about meloxicam oral suspension (a kind of mixture in liquid that you swallow), which may be easier for you to take.
• Should I take meloxicam with food? You may take meloxicam with or without food. If you find that the drug causes you indigestion (upset stomach), taking your dose with a meal or a small snack may help avoid this side effect.
• Is there a best time of day to take meloxicam? No, there’s no best time of day to take meloxicam. You should take your dose once per day as directed by your doctor.

Questions for your doctor

You may have questions about meloxicam and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

• Before your appointment, write down questions, such as:
  • How will meloxicam affect my body, mood, or lifestyle?
• Bring someone with you to your appointment if doing so will help you feel more comfortable.
• If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So don’t be afraid to ask questions or offer feedback on your treatment.

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use.

Financial assistance to help you pay for meloxicam may be available. Medicine Assistance Tool and NeedyMeds are two websites that provide resources to help reduce the cost of meloxicam.

These websites also offer tools to help you find low-cost healthcare and certain educational resources. To learn more, visit their websites.

Do not take more meloxicam than your doctor prescribes. Taking more than this can lead to serious side effects.

Symptoms of overdose

Symptoms caused by an overdose can include:

• drowsiness or sleepiness
• nausea and vomiting
• pain in the upper belly
• bleeding in the stomach or intestines
• sudden kidney failure
• coma

What to do in case you take too much meloxicam

Call your doctor if you think you’ve taken too much meloxicam. You can also call 800-222-1222 to reach the American Association of Poison Control Centers or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.

Meloxicam is prescribed to treat certain types of arthritis in adults and some children. If you’re interested in taking meloxicam or learning more about the drug, talk with your doctor or pharmacist. Ask questions that help you feel comfortable with the drug and your treatment options.

Questions you may want to ask your doctor include:

• How do meloxicam’s side effects compare with other medications that can treat my condition?
• Are long-term side effects possible with meloxicam?
• What happens if another doctor I go to prescribes a medication that interacts with meloxicam?
• Am I at higher risk of side effects from taking meloxicam based on my age and medical conditions?

To learn more about meloxicam, see this article:

• Meloxicam and Cost: What You Need to Know

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

What is meloxicam? Uses, dosages, and side effects

Meloxicam is an NSAID commonly used to treat osteoarthritis, rheumatoid, and juvenile rheumatoid arthritis

What is meloxicam? | Uses | Dosages | Side effects | Safety info | Alternatives

Living with pain and inflammation from arthritis can be difficult and stressful. However, medications are available. Meloxicam is a prescription drug that is commonly used to help relieve the painful symptoms of arthritis. This article provides an overview of meloxicam including what it is, why it’s prescribed, the usual dosage, possible side effects, and how it compares to other medications used for arthritis.    

What is meloxicam?

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that is often prescribed to treat arthritis. It is an enolic acid that belongs to the oxicam group of NSAIDs. 

Like other NSAIDs, meloxicam is a potent cyclooxygenase (COX-1 or COX-2) inhibitor that blocks the formation of prostaglandins. Prostaglandins are chemicals that help facilitate pain and inflammatory pathways. Blocking these chemicals can help treat pain, stiffness, and inflammation of the joints.   

Meloxicam is a strong painkiller that must be prescribed by a doctor. It can come as a regular tablet, disintegrating tablet, capsule, or oral suspension liquid. Some popular brand names of meloxicam include Mobic, Vivlodex, Qmiiz ODT, and Comfort Pac-Meloxicam. Boehringer Ingelheim Pharmaceuticals produces brand-name Mobic while various other manufacturers, like Apotex and Lupin Pharmaceuticals, make generic meloxicam.  

What is meloxicam used for?

Meloxicam is approved to treat pain and inflammation that results from rheumatoid and osteoarthritis in adults, and juvenile rheumatoid arthritis in children who are at least two years old and weigh at least 60 kilograms. It is sometimes used off-label to treat ankylosing spondylitis, a type of arthritis that affects the spine.    

The main symptoms meloxicam treats are pain, stiffness, swelling, and tenderness of the joints. In one study, patients with osteoarthritis in the knee and hip showed significant improvement after 12 weeks of taking meloxicam compared to placebo. 

For minor aches and pains, some people take an over-the-counter NSAID like Advil (ibuprofen) or Aleve (naproxen). However, over-the-counter ibuprofen or naproxen may not work as well as other NSAIDs for more severe pain. A healthcare provider may recommend to stop taking the over-the-counter pain reliever and instead take meloxicam, a prescription NSAID that is stronger than ibuprofen. 

RELATED: Meloxicam vs. ibuprofen

Meloxicam dosages

For osteoarthritis and rheumatoid arthritis, the standard dosage of meloxicam is 7.5 mg once per day. The maximum daily dosage of meloxicam for osteoarthritis or rheumatoid arthritis in adults is 15 mg per day. For children with juvenile rheumatoid arthritis, the standard dosage is 0.125 mg/kg per day. The maximum dosage of meloxicam in children is 7.5 mg per day.   

Meloxicam can take up to two weeks to start working in full effect. Some people may experience improvements in pain, swelling, tenderness, or stiffness within 24 to 72 hours. For other people, it could take a few months to start noticing an improvement in symptoms. The time it takes to experience relief with meloxicam can vary based on the dosage prescribed. 

Clinical pharmacist Nonye Uddoh says that “meloxicam treats pain, swelling, and inflammation associated with arthritis. It starts working within 30 minutes, but peaks in efficacy at 4 hours when taken by mouth. Its half-life is 15 to 20 hours, meaning it takes 15 hours to eliminate half of it from your body.”

A missed dose should be taken as soon as remembered. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take double doses of meloxicam.

Meloxicam side effects

As with any medication, there is always the potential for adverse effects. Here is a list of some of the common side effects associated with meloxicam:

Common side effects

• Diarrhea
• Heartburn or indigestion
• Stomach pain
• Constipation
• Gas 
• Nausea
• Vomiting
• Dizziness
• Upper respiratory tract infections
• Influenza-like symptoms

Serious side effects

Meloxicam may cause serious side effects including the following:

• Increased risk of heart attack or stroke
• Increased risk of bleeding or ulcers in the stomach, esophagus, or intestines

Like other NSAIDs, meloxicam can cause other serious side effects including:

• New or worsened high blood pressure
• Heart failure
• Liver problems
• Kidney problems
• Low red blood cell count (anemia)
• Allergic reactions
• Skin reactions

Meloxicam carries a black box warning issued by the Food and Drug Administration (FDA) about serious side effects. The most serious side effects of meloxicam include cardiovascular events, such as heart attack or stroke, and gastrointestinal events, such as bleeding or ulcers in the stomach or intestines. These events can be serious and even lead to death. 

Risk factors for cardiovascular events while using meloxicam include high blood pressure, heart disease, and a recent heart attack or stroke. Risk factors for gastrointestinal bleeding include older age, smoking, alcohol use, liver disease, bleeding problems, and a history of stomach ulcers. Long-term use of meloxicam may also increase the risk of serious side effects. 

Seek immediate medical attention if you experience severe chest pain, coughing up blood or vomit that looks like coffee grounds, or black, bloody, or tarry stools. You should stop taking meloxicam and call your doctor immediately if you experience any of these side effects. 

Allergic reactions

Meloxicam may also cause allergic reactions that can be life-threatening. An allergic reaction could cause shortness of breath, hives, or swelling of the lips, tongue, and face. If you believe you are having an allergic reaction, seek medical help immediately.    

This list of side effects is not comprehensive. Ask a healthcare professional for more details regarding the possible side effects of meloxicam.

Restrictions

Meloxicam should not be taken in people who have a known allergy to meloxicam or those who have experienced asthma, itching, or other allergic-type reactions after taking aspirin or an NSAID. Meloxicam should be avoided right before or after a heart procedure called coronary artery bypass graft (CABG). 

Meloxicam should only be taken as prescribed. A healthcare provider normally prescribes the lowest dose that is effective enough to relieve symptoms. It should only be used for the shortest time necessary to relieve symptoms.

Interactions

Meloxicam may need to be avoided with the following drugs due to possible drug interactions:

• Anticoagulants, such as warfarin
• Antiplatelet agents, such as aspirin
• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine 
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine
• Blood pressure medications, such as ACE inhibitors, ARBs, beta-blockers, and diuretics
• Lithium
• Methotrexate
• Cyclosporine
• Pemetrexed
• Other NSAIDs 

Some medications can increase the risk of ulcers and bleeding when taken with NSAIDs like meloxicam. Anticoagulants, antiplatelet agents, and certain antidepressants, such as SSRIs and SNRIs, should be used with caution or avoided if you are also taking meloxicam. 

Meloxicam, like other NSAIDs, can increase blood pressure. Therefore, certain blood pressure medications like ACE inhibitors, ARBs, beta-blockers, and diuretics may be less effective when taken with meloxicam. Your doctor may recommend monitoring your blood pressure if you are taking a blood pressure medication and meloxicam. 

If you are taking lithium, methotrexate, cyclosporine, or pemetrexed, you may be at an increased risk of toxicity from any of these drugs if you are also taking meloxicam. Symptoms of drug toxicity may need to be monitored when taking these drugs with meloxicam.

Tell your doctor about all of the medications you take, including prescription drugs, over-the-counter medications, and herbal products. Your doctor may take these other medications into account when determining whether or not meloxicam is right for you.    

Pregnancy

If you are pregnant, planning to become pregnant, or breastfeeding, you should avoid taking meloxicam. It’s possible that meloxicam could cause infertility or negatively affect an unborn baby. Whether or not meloxicam transfers to babies through breast milk is unclear. Consult with a healthcare provider before taking meloxicam or any other pain reliever while pregnant or breastfeeding.   

Are there alternatives to meloxicam?

There are several alternatives to meloxicam. Any medication that’s classified as an NSAID will work similarly to meloxicam. Some over-the-counter medications, like Aleve or Tylenol, may be recommended first before trying a prescription NSAID. Consult with a medical professional to determine which medication is best for treating your arthritis pain.     

• Aleve (naproxen): Aleve is long-lasting and treats mild to moderate pain, inflammation, and fever. It’s available over the counter or with a prescription, and it is usually taken twice daily.  
• Zorvolex (diclofenac): Zorvolex is approved to treat acute pain and pain from osteoarthritis. It is usually prescribed to be taken three times daily for pain and is comparable to meloxicam and other NSAIDs, like ibuprofen. See diclofenac vs. ibuprofen to learn more about diclofenac and how it compares to ibuprofen.   
• Celebrex (celecoxib): Celebrex is approved to treat pain and inflammation from arthritis. It is also approved to treat menstrual cramps (primary dysmenorrhea). Celebrex is usually taken once or twice per day. Check out meloxicam vs. Celebrex for more information on the differences between meloxicam and Celebrex.  
• Feldene (piroxicam): Feldene can help with joint stiffness, pain, and swelling caused by rheumatoid arthritis and osteoarthritis. It is usually prescribed to be taken once daily.    
• Lodine (etodolac): Lodine is approved to treat acute pain, as well as pain from rheumatoid arthritis and osteoarthritis. Like other NSAIDs, it may take a couple of weeks to experience maximum relief. Lodine has been discontinued as a brand in the United States and is currently prescribed as the generic version, etodolac.   
• Relafen (nabumetone): Relafen is approved to treat pain and inflammation caused by rheumatoid arthritis and osteoarthritis. It is typically taken once or twice per day. Relafen has been discontinued as a brand in the United States and is currently prescribed as the generic version, nabumetone.
• Tylenol Extra Strength (acetaminophen): Tylenol is an over-the-counter drug that helps relieve pain and reduce fevers. It is not an anti-inflammatory drug that helps reduce swelling and inflammation like NSAIDs. Tylenol may be less effective than NSAIDs for inflammatory conditions like arthritis. However, it may be safer and recommended for people with high blood pressure, stomach problems, and other conditions. 
• Prednisone: Prednisone is a prescription medication used to treat a variety of conditions, such as allergic disorders, asthma, psoriasis, lupus, and arthritis. Prednisone is part of a group of drugs called corticosteroids, and it works by decreasing the activity of the immune system to reduce swelling and inflammation. It is often prescribed to treat rheumatoid arthritis flares. 

Natural remedies for arthritis

Some natural and home remedies may help with arthritis symptoms and act as an alternative to meloxicam. Certain herbal supplements have anti-inflammatory effects, and natural treatments like massage therapy, acupuncture, or chiropractic adjustments may help relieve pain. Here’s a list of some of the most popular natural and home remedies that people use to treat the stiffness, pain, aching, and swelling from arthritis:  

• Anti-inflammatory diet. Foods that contain omega-3 fatty acids, vitamin D, and antioxidants may help lower inflammation. An anti-inflammatory diet includes foods like fish, walnuts, flaxseed, kale, and fresh fruits and vegetables. 
• Staying active. Regular exercise can help strengthen the muscles that surround the joints, which gives them more support. Exercise may also help improve flexibility and overall energy. Stretching, walking, strength training, biking, and swimming are all activities that someone with arthritis could benefit from. 
• Ginger and turmeric. Even though herbal supplements like ginger and turmeric aren’t FDA-approved to treat arthritis, many people with arthritis still use them and benefit from their anti-inflammatory effects. Ginger is a natural spice that has been used for thousands of years for its anti-inflammatory effects in the body. Turmeric is a powerful anti-inflammatory agent that contains the main active ingredient curcumin, which may help with joint inflammation and swelling. 
• Boswellia.  Also known as Indian frankincense, boswellia is known for its anti-inflammatory properties. It can be taken orally or applied topically as part of an essential oil. While it may help relieve symptoms of arthritis, more research is needed to determine the overall effects of boswellia on health.  
• Chiropractic care. Chiropractic adjustments may help relieve pain that comes from having osteoarthritis. Treatment can vary on a case-by-case basis, but most chiropractic manipulations are done on the neck, back, and spine. Many chiropractic offices offer massage therapy, which may also help relieve pain.  

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The description of Meloxicam is a simplified author’s version of the a.com.ua website.

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Meloxicam: brief instructions for use

Meloxicam is a drug belonging to the group of non-steroidal anti-inflammatory drugs that have analgesic and antipyretic effects.

The composition of Meloxicam includes the main active ingredient – meloxicam. In addition, each tablet contains excipients such as lactose, starch, magnesium and povidone.

Buy Meloxicam is recommended by many experts, as the drug in question shows high anti-inflammatory activity in all models of inflammatory processes without exception.

Indications for use Meloxicam

• Arthritis of rheumatoid type.
• Osteoporosis, osteoarthritis.
• Inflammation localized in the joints.
• Other inflammatory processes accompanied by intense pain.

What are the possible contraindications to Meloxicam?

• Hypersensitivity to meloxicam or any of the other ingredients of the medicinal product.
• Meloxicam is not recommended for patients who have a history of pathologies such as bronchial asthma, urticaria while taking aspirin and angioedema.
• Pregnancy, lactation and adolescence in patients under 16 years of age.
• Abdominal bleeding that occurred while taking non-steroidal anti-inflammatory drugs.
• Ulcerative lesions of the walls of the gastrointestinal tract.
• Liver or kidney failure.
• Cardiac or vascular insufficiency.

Interactions of Meloxicam with other drugs

If it is recommended to buy Meloxicam for co-administration with other non-steroidal anti-inflammatory drugs, it should be understood that such drug interactions may significantly increase the risk of bleeding.

Meloxicam significantly enhances the effect of anticoagulants, which can cause bleeding.

At the same time taking this drug with diuretics, there may be a violation of the functioning of the renal system.

Antihypertensive drugs slightly lose their effectiveness when combined with meloxicam components.

Meloxicam: method of administration and dosage

How to take Meloxicam, you can consult your doctor or read the instructions for this drug yourself. The daily dose of the drug is taken once a day during a meal, drinking plenty of water.

In order to minimize the possibility of adverse reactions, the lowest effective dosage is recommended initially. In addition, the specialist must keep the patient’s condition under control, timely conducting all the necessary studies, analyzes and examinations.

Meloxicam should be used with caution in elderly patients. This is justified by the fact that in this age group the risk of negative reactions is significantly increased. If any side effects are detected, you should immediately inform your doctor about this and stop taking the medication.

Meloxicam is not recommended for patients under 16 years of age.

In the online pharmacy apteka.com, you can check the price of Meloxicam online, as well as place an order for medicines remotely. We will help you decide on the choice of the drug, as well as send the purchase to your address.

Manual Meloxicam

Manufacturer

HELP S.A., Greece

Country of origin

Greece

Synonyms

MELOXICAM, APO-MELOXICAM, AROXICAM, ARTROZAN, ASPICAM, BI-XICAM, ZELOXIM, ZELOXIM FORTE, LOXIDOL, M-KAM®, MELBEK®, MELOX, MELOXAM, MELOXAN, MELOXIC, MELOXICAM, MELOXICAM ORION, MELOKSIKAM PFAYZER ®, MELOXICAM SOPHARMA, MELOXICAM-APO, MELOXICAM-ASTRAPHARM, MELOXICAM-ZENTIVA, MELOXICAM-KV, MELOXICAM-LUGAL, MELOXICAM-MAXPHARMA, MELOXICAM-RATIOPHARM, MELOMAX, MELOMAX™, MOBIK, MOVALGIN, MOVALIS, MOVALIS®, MOVIX,MOVIKSIKAM ®, REVMALGIN, REVMOKSIKAM, REVMOKSIKAM®, RECOX, SANALIS, EXISTEN-SANOVEL

Meloxicam price in online pharmacy ampoule 1.5ml №5 PL / Berkana /

140.7 UAH Meloxicam tab. 0.0075g №20 71.6 UAH Meloxicam-KV tablets 7.5mg №20 74.7 UAH Meloxicam-LH tablets 0. 0 15g №20 97 UAH Meloxicam-KV tablets 15mg №20 120.7 UAH Meloxicam injection solution 15mg/1.5ml ampoule 1.5ml №5 PL/Berkana/ 134.4 UAH Meloxicam-Berkana solution for infusion 15mg/1.5 ml ampoules 1.5 ml No. 5 152.6 UAH Meloxicam (Meloxicam) solution for injection ampoules 1.5 ml No. 5 156.4 UAH 901 54 Meloxicam-Teva solution 15mg/1.5ml №5 243.4 UAH

Non-steroidal anti-inflammatory drugs “golden mean”

Rapid and complete pain relief is one of the top priorities in medical care. Pain is the most unpleasant manifestation of the main pathological conditions, so its effective suppression can significantly improve the quality of life of patients and gain their confidence, which is important when it comes to the onset of a chronic disease requiring long-term pathogenetic therapy.

Pain therapy is of fundamental importance in musculoskeletal diseases such as osteoarthritis (OA) and low back pain (LBP), which are currently associated with most cases of chronic non-cancer pain [1-3].

From the point of view of medical science, chronic pain is a serious and independent threat to the patient’s life. Persistent severe pain determines the negative changes in homeostasis, mediated by the reaction of the sympathetic-adrenal system – an increase in blood pressure and heart rate, as well as procoagulative changes in the blood coagulation system. These changes lead to a significant increase in the risk of developing dangerous cardiovascular complications (CVS) [1, 2].

In such nosological forms as OA and chronic LBP, which are not accompanied by visceral pathology, but are characterized by severe pain that often persists for months and years, the risk of developing fatal CVCs is significantly increased [1, 2].

This statement is confirmed by a study by Swiss scientists E. Nüesch et al. [4], who assessed the frequency of deaths in 1163 patients with OA with a follow-up period of about 5 years. According to the data obtained, the risk of death due to CVD in patients suffering from this “non-fatal” disease is 1. 7 times higher than in the general population. In the course of the subsequent analysis, the scientists identified the only factor that was clearly associated with the development of fatal CVCs in patients with OA – a pronounced dysfunction of the joints, preventing normal movement. Among the dead, such disorders were observed in 35%, while among the survivors – only 17% (p

Similar results are presented by Japanese researchers M. Tsuboi et al. [5], who observed the dynamics of the state in 944 patients with various rheumatic diseases for 10 years. It was found that in patients with gonarthrosis, the risk of death from CVE is more than 2 times higher than in the population (odds ratio – OR – 2.32).

The work of Australian scientists K. Zhu et al. [6], who followed a group of 1484 elderly women (over 70 years of age) with chronic LBP for 5 years. Among them, 21.7% initially and 26.9%% at the end of the observation period experienced pain daily. In this subgroup, the risk of death from CVE was more than 2 times higher (relative risk – RR 2. 13 at 95% confidence interval – CI – from 1.35 to 3.34) than in the group of patients who had less pain .

It is impossible not to note one more, purely practical aspect of the problem of adequate anesthesia. Patients come to the doctor’s office primarily for relief of suffering; “understanding” the situation, finding out the exact diagnosis is a secondary, although undoubtedly important, goal of seeking medical help. Excessive enthusiasm for diagnostic measures and “basic” means to the detriment of simple and effective methods of pain control can cause a negative attitude of the patient towards the attending physician and turn him away from the methods of classical medicine. On the contrary, the effective elimination of the most painful symptoms will be the most effective way to win the patient’s trust and achieve strict adherence to a complex scheme of long-term pathogenetic therapy [1, 2].

However, effective control of chronic pain is not easy. An illustration of this is the work of the Spanish scientists L. Arboleya et al. [7], who assessed the opinion on the results of treatment of 897 patients with OA who received analgesics for at least 6 months, most often non-steroidal anti-inflammatory drugs (NSAIDs): diclofenac, aceclofenac and piroxicam. 46% of the respondents were dissatisfied with the effect of prescribed drugs, and only 1 patient out of 6 considered himself completely satisfied with the result of analgesic therapy.

In this regard, the data of British researchers M. Gore et al. [8], who evaluated the practice of prescribing analgesics (paracetamol, NSAIDs, tramadol, “weak” and “strong” opioids) in patients with OA and LBP. For various reasons – due to inefficiency, adverse events, etc., during the 1st month of treatment, prescribed drugs were canceled in almost 90% of patients (from 30 to 60% were cases of replacement therapy, up to 15% – its increase – the use of various combinations). It can be seen that in most cases (not less than ⅔), the analgesic drug initially recommended by the doctor did not justify hopes and did not become a solution to the pain problem [8].

It should be remembered that the development of pain, especially chronic pain, is a complex, multicomponent pathological process. Its development involves local inflammation, muscle spasm, damage to the elements of the ligamentous apparatus, biomechanical disorders, dysfunction of the pain system (peripheral and central sensitization, “exhaustion” of antinociceptive mechanisms, etc.) [1, 2, 9, 10]. It is obvious that monotherapy, even with the most effective means, cannot always ensure therapeutic success. Only an integrated approach based on the combined use of drugs with different mechanisms of action can achieve effective control of chronic pain (Table 1) .

First-line pharmacotherapy for musculoskeletal pain is undoubtedly NSAIDs. They have a unique combination of analgesic, anti-inflammatory and antipyretic effects, providing effective relief of the main symptoms associated with the pathology of the OPS organs [1-3].

The main mechanism of the pharmacological action of NSAIDs is associated with the blockade of cyclooxygenase-2 (COX-2), which is formed in the foci of tissue damage and is responsible for the active synthesis of prostaglandins (PG) – the most important mediators of pain and inflammation. It is important to note that the analgesic effect of NSAIDs is realized not only by reducing the excitability of peripheral pain receptors. Probably no less important is the effect of NSAIDs on the central mechanisms of pain formation – the phenomenon of central sensitization, which is also mediated by hyperproduction of PG (aseptic neuronal inflammation) and activation of glial cells that occur in response to persistent and powerful pain stimulation of the structures of the nociceptive system [1-3 ].

Obviously, if inflammation plays an important role in the pathogenesis of acute or chronic pain (even subclinical, as in OA and dorsalgia), accompanied by active synthesis of biologically active substances such as interleukins 1 and 6, tumor necrosis factor, the use of NSAIDs will be appropriate and necessary . Moreover, in this situation, as the data of many clinical studies show, in terms of their therapeutic activity, NSAIDs have a clear advantage over other analgesics – paracetamol and opioids, which do not have anti-inflammatory properties [1-3].

The therapist has an exceptional variety of NSAIDs in his arsenal. This creates difficulties for practitioners, because even experts cannot always determine the criteria for the merit of drugs that should be used to decide on the choice of one or another NSAID. The situation is further complicated by the active advertising activities of some manufacturing companies promoting their product as “the most effective and safe among all possible.” However, real practice clearly shows that none of the NSAIDs can be considered the best, and if the drug has an advantage in any parameter, it is likely that it will also have certain disadvantages.

The analgesic effect of all NSAIDs when used in therapeutic doses is practically the same. At least there is no conclusive data obtained in the course of a series of methodically correctly organized clinical trials that any drug from this group is significantly superior to others in analgesic action. The main difference between NSAIDs (sometimes very significant) is determined by their safety [3].

Among NSAIDs, two polar groups are distinguished, differing in their selectivity for COX-2 (their main pharmacological “target”): non-selective (n-NSAIDs) and highly selective – “coxibs”. The selectivity of NSAIDs avoids the suppression of the activity of the biochemical “brother” of COX-2 – the COX-1 enzyme, the work of which is extremely important for maintaining many vital functions, such as the protective properties of the mucous membrane (CO) of the gastrointestinal tract (GIT). The blockade of COX-1 (characteristic of n-NSAIDs) leads to a significant increase in the risk of developing severe, life-threatening gastrointestinal pathology (gastropathy and enteropathy associated with NSAIDs – NSAID gastropathy and NSAID enteropathy. In this regard, “coxibs” are much less dangerous [3 ].

However, selective suppression of COX-2 (without affecting COX-1) can lead to an imbalance in the synthesis of thromboxane A2 and prostacyclin, which increases the risk of vascular thrombosis. In patients with cardiovascular diseases, this is fraught with an increased risk of developing severe CV events – myocardial infarction (MI) and ischemic stroke [3]. As can be seen, the use of n-NSAIDs and “coxibs” has serious limitations: they are not suitable for all patients (Table 2) . Accordingly, two main scenarios can be presented in which the use of representatives of these drug groups is most appropriate.

Thus, “coxibs” are more suitable for relatively young patients who need short-term analgesic therapy and have a moderate risk of complications in the form of organic and functional disorders of the gastrointestinal tract in the absence of severe concomitant CVS pathology.

n-NSAIDs (except for ketorolac, suitable only for short-term use) are more acceptable for patients of the older age group with a moderate risk of developing CVC, but without significant risk factors for developing NSAID gastropathy. In most cases, these drugs can only be used in combination with a gastroprotector (proton pump inhibitor).

A position between n-NSAIDs and “coxibs” should be assigned to drugs with moderate selectivity for COX-2. Their use should lead to a smaller number of pronounced complications in the form of organic and functional disorders of the gastrointestinal tract, but not be accompanied by a significant increase in the risk of developing CVS. This is a kind of “golden mean”, which is acceptable for most patients and is especially interesting now, when the medical community, after the bad memory of the “coxibs crisis”, is very wary of highly selective COX-2 inhibitors. At the same time, the problem of NSAID gastropathy, which is so characteristic of n-NSAIDs, will never lose its relevance.

In the mid-1990s, this position was occupied by diclofenac. However, at present, this drug no longer meets the high requirements of safe pharmacotherapy. In our country, primarily due to the widespread use of cheap generics of this drug, it is with diclofenac that the greatest number of complications in the form of organic and functional disorders of the gastrointestinal tract are associated [11]. The situation with the MTR is even worse. Thus, according to a meta-analysis conducted by P. McGettigan and D. Henry [12], (30 case-control studies, including 184 946 patients with CVD and 21 cohort studies, a total of > 2.7 million individuals), the risk of MI increases with the use of diclofenac by approximately 40% (OR 1.4). In a population study by Danish scientists E. Fosbøl et al. [13], taking diclofenac was accompanied by the highest risk of developing myocardial infarction, stroke, and death from CVD among NSAIDs, higher than that of coxibs.

Significantly more interest is attracted by another representative of the “golden mean” – a moderately selective COX-2 inhibitor meloxicam, which appeared in 1995 g. Since then, this effective and fairly safe drug remains one of the most popular representatives of the NSAID group, which is actively used in almost all countries of the world.

Meloxicam has been extensively tested in a large number of clinical trials; its effectiveness has been studied in a wide range of diseases and pathological conditions, ranging from anesthetic practice to chronic joint diseases. These studies clearly confirmed that meloxicam is in no way inferior in its therapeutic potential to the “traditional” NSAIDs in the most common diseases characterized by musculoskeletal pain (OA, LBP, rheumatoid arthritis – RA and ankylosing spondylitis – AS) [14-22].

However, the main advantage of meloxicam is its good tolerability. In a series of large randomized clinical trials (RCTs), a significantly lower number of complications in the form of organic and functional disorders of the gastrointestinal tract was unambiguously confirmed when using this drug compared to n-NSAIDs.

The 4-week MELISSA study ( n =9323) compared meloxicam 7.5 mg with diclofenac 100 mg/day. The total number of side effects in the form of organic and functional disorders of the gastrointestinal tract when using meloxicam was significantly less – 13.3% versus 18.7% in the diclofenac group. At the same time, the number of episodes of discontinuation of therapy due to complications in patients treated with meloxicam was 2 times less: 3 and 6. 1%, respectively ( r

RCT SELECT ( n =8656) was carried out according to a similar plan, but piroxicam at a dose of 20 mg was used as a comparison. This study showed a significant advantage of meloxicam in relation to the risk of developing severe complications in the form of organic and functional disorders of the gastrointestinal tract that occurred in 7 and 16 patients, respectively ( r r

D. Yocum et al. [25] 774 patients with OA received meloxicam at a dose of 3.75, 7.5 and 15 mg, diclofenac 100 mg or placebo for 3 months. The results of the study showed that the total number of complications in the form of organic and functional disorders of the gastrointestinal tract while taking meloxicam was significantly less than when using diclofenac – 19and 28% respectively ( r

The safety of meloxicam has also been confirmed in a number of cohort studies such as H. Zeidler et al. [26]. This study involved 2155 German doctors who observed 13,307 rheumatological patients who received meloxicam at a dose of 7. 5 mg (65%) or 15 mg (33%) for 1-3 months. The efficacy and tolerability of the drug was assessed by analyzing the data provided by the attending physicians in the relevant questionnaires. Although the majority of patients were over 60 years old, and 12% had a history of ulcers, undesirable effects in the form of organic and functional disorders of the gastrointestinal tract were noted in 0.8%, and pronounced ones – only in 5 patients (4 uncomplicated gastric ulcers and 1 perforation) [26 ].

Somewhat earlier P. Schoenfeld et al. [27] conducted a meta-analysis of 12 RCTs lasting from 1 to 24 weeks, comparing meloxicam with diclofenac, piroxicam, and naproxen in patients with OA, RA, and dorsalgia. It was shown that taking meloxicam was associated with a significantly lower total number of complications in the form of organic and functional disorders of the gastrointestinal tract (RR 0.64 at 95% CI from 0.59 to 0.69), the incidence of dyspepsia (OR 0.73 at 95% CI from 0.64 to 0. 84), symptomatic ulcers, GI and perforations (OR 0.52 at 95% CI from 0.28 to 0.96), as well as the risk of discontinuation of therapy due to complications in the form of organic and functional disorders of the gastrointestinal tract (OR 0.59 at 95% CI from 0.52 to 0.67).

A later meta-analysis by G. Singh [25], which included data from 28 RCTs (24,196 patients), also confirms the higher safety of meloxicam at a dose of 7.5 mg compared to traditional NSAIDs in relation to the gastrointestinal tract. Thus, the frequency of gastrointestinal bleeding when using this dose of meloxicam was only 0.03% (when taking 15 mg 0.2%), while in those receiving diclofenac at a dose of 100-150 mg / day – 0.15% [28].

In order to study the effect of meloxicam on the upper gastrointestinal tract, several years ago we conducted a retrospective analysis of the development of gastric and/or duodenal ulcers in rheumatological patients who were in 2002-2005. on inpatient treatment at the clinic of the FGBU NIIR RAMS. The studied groups consisted of persons who underwent esophagogastroduodenoscopy during this period for various reasons: 425 patients who received meloxicam, and 2428 – diclofenac (Fig. 1) . Figure 1. Detection of ulcers and multiple (> 10) erosions of the stomach and / or duodenal ulcer in patients who regularly received meloxicam or diclofenac [29]. In patients taking meloxicam, ulcers occurred almost 2 times less often, including patients with such a risk factor as an ulcer history [29].

In recent years, the problem of the negative effects of NSAIDs on the distal gastrointestinal tract has attracted much attention of researchers and practitioners. First of all, we are talking about NSAID enteropathy – a pathology of the small intestine (TC), which is accompanied by an increase in its permeability and the development of chronic inflammation associated with the penetration of bacteria or their components contained in the chyme into the intestinal wall. This complication can manifest itself as severe GI bleeding, perforation and strictures of the TC; however, its most characteristic symptom is subclinical blood loss leading to the development of chronic iron deficiency anemia (IDA) [3, 30, 31]. Recently, interest in this pathology has been very high, since even in the absence of life-threatening complications, NSAID enteropathy can have a significant negative impact on the patient’s health. After all, chronic IDA determines a significant decrease in the oxygen capacity of the blood, a decrease in resistance to stress and, ultimately, an increase in the risk of developing severe CVD.

This is confirmed by the work of G. Sands et al., published in 2012. [32]. The researchers conducted a meta-analysis of 51 RCTs comparing the safety of celecoxib and n-NSAIDs ( n = 50 116) to determine the relationship between reduced hemoglobin levels and the incidence of life-threatening systemic complications. It turned out that anemia dramatically increased the risk of developing severe CVD. Thus, in 932 patients who developed a clinically significant decrease in hemoglobin levels (more than 20 g/l), the incidence of MI was 0.6%, while in patients who did not have signs of anemia, it was only 0. 2%. Similarly, the progression of coronary heart disease (CHD) was observed in 1.2 and 0.3% of patients [32].

NSAID enteropathy is a problem characteristic of “traditional” NSAIDs. There is strong evidence that c-NSAIDs (“coxibs”) are significantly safer than “traditional” NSAIDs in terms of the risk of developing this pathology [3].

The most modern technique for accurately diagnosing pathology of the mucous membrane of the jejunum and ileum, which occurs while taking NSAIDs, is video capsule endoscopy (VCE). It was she who was used in a number of studies that compared the effect of “coxibs” and n-NSAIDs on the state of TC [3, 33].

In recent years, the first reports of a relatively low incidence of NSAID enteropathy with the use of meloxicam have appeared, confirmed by TBEV data. Thus, we recently conducted a study on the effect of meloxicam (Movalis) and diclofenac on the state of TC in 15 patients with AS. The choice of this nosological form for studying the development of NSAID enteropathy was not accidental. Patients with AS have an increased risk of developing TC pathology – there is a known association between chronic inflammatory bowel diseases and seronegative spondylitis. In addition, patients with AS often take NSAIDs, often for a long time and in high doses [34].

According to the results obtained, certain changes in the SO TC – the presence of inflammation, hemorrhages, erosions or ulcers were detected equally often while taking meloxicam 15 mg / day or diclofenac 100-200 mg / day: 71.4 and 75%, respectively. However, the average number of erosions was insignificantly lower in those who received movalis: 6.2±4.7 and 9.4±7.3, respectively [34].

Our data are consistent with those of Y. Maehata et al. [35]. They performed VCE in 29 volunteers with initially normal SO TC who received meloxicam 10 mg/day or celecoxib 200 mg/day for 2 weeks. The number of persons who, after a course of NSAIDs, had a pathology of the TC, when using meloxicam, was less than when taking “coxib” – 26. 7 and 42.9% respectively.

It can be stated that, in relation to CVR, meloxicam is at least no worse than “traditional” NSAIDs. So, in a series of RCTs conducted in the late 90s of the XX century, it was shown that the risk of developing severe CV events when using meloxicam does not exceed that against placebo.

According to the results of the meta-analysis of 28 RCTs conducted by G. Singh [28], the incidence of myocardial infarction with the use of meloxicam was lower than with diclofenac: 0.09% for a dose of 7.5 mg / day, 0.19% for 15 mg/day and 0.22% for diclofenac 100-150 mg/day.

It should be noted that according to the results of the above work by P. McGettigan and D. Henry [12], meloxicam showed a mild (not exceeding the average level for all NSAIDs), inherent in the entire class of NSAIDs, the ability to increase the risk of developing MI – by about 20% (OR 1.2). According to these data, meloxicam is inferior to naproxen, but is at the level of celecoxib and ibuprofen and superior to diclofenac (OR 1. 4, i.e. 40% increased risk).

Comparable results presented by Finnish scientists A. Helin-Salmivaara et al. [36]. They conducted a large population-based study in which the RR for the development of NSAID-related CVD was assessed in 33,309 patients with MI (138,949 – corresponding control; Fig. 2 ). data from a population study conducted in Finland: 33,309 patients with MI, 138,949 – controls) [36]. The risk level for those taking meloxicam was at the average level – OR 1.25. This is somewhat higher than in those taking naproxen (OR 1.19), but clearly less compared to diclofenac (OR 1.35) and especially nimesulide (OR 1.69).

There is a very curious fact: meloxicam was once studied as a component of IHD therapy (!). During the NUT-2 study, 60 patients with acute coronary syndrome who received aspirin and heparin as antithrombotic therapy for 1 month were additionally prescribed meloxicam 15 mg/day. Another 60 patients who underwent similar antithrombotic therapy constituted the control – they were assigned a placebo. Treatment outcomes in the meloxicam group were clearly better. So, among the patients who received this drug, no one developed MI and no patient died; at the same time, there were 2 cases of MI and one coronary death in the control group. In the 1st group, revascularization was required in 6 (10%) patients, and in the 2nd – 15 (25%; r

Nowadays, such a study seems rather like medical casuistry; nevertheless, it can serve as a good illustration of the favorable tolerability of meloxicam in patients with risk factors for CVD.

Meloxicam has another important advantage: unlike “traditional” NSAIDs, it does not interact adversely with low doses of aspirin and does not reduce the antiplatelet potential of the latter. This was confirmed by an epidemiological study by G. Singh et al. [38], based on the analysis of the California Database of Patients with MI ( n =15 343). In patients treated with meloxicam in combination with aspirin, the risk of MI was significantly lower than in patients who received this drug without aspirin: OR 0. 53 and 1.56, respectively. At the same time, the popular analgesic ibuprofen clearly worsened the effect of aspirin. In patients treated with these drugs together, the risk of MI was even slightly higher than in patients who took ibuprofen alone: ​​OR 1.2 and 1.08, respectively [38].

When discussing the benefits of meloxicam, attention should be paid to the low risk of allergic skin reactions. Although these complications are rare with the use of NSAIDs, in some cases they can be a serious problem. Meloxicam in this regard is quite safe. Thus, according to American authors, during the first 2 years of using this drug in the United States, not a single episode of Stevens-Johnson syndrome or toxic epidermal necrolysis was recorded (for example, 47 episodes while taking celecoxib) [39]. The low frequency of skin reactions when using meloxicam was also noted by K. Ward et al. [40], who published a methodological review in 2010.

Moreover, there are a number of studies that have shown the possibility of using meloxicam in patients who have previously experienced skin allergic or bronchospastic reactions when using aspirin or other “traditional” NSAIDs [41, 42].

Severe hepatotoxic reactions are also rare side effects of NSAIDs. Nevertheless, the assessment of the risk of complications in the form of liver dysfunction is relevant for a number of representatives of this drug group, such as diclofenac and nimesulide [3]. For example, among 17,289of participants in an 18-month MEDAL RCT (comparison of etoricoxib and diclofenac) who received diclofenac, a three-fold increase in alanine aminotransferase activity was noted in 3.1%, and a ten-fold increase in 0.5% [43]. Although not a single episode of liver failure or jaundice was recorded, such a clear negative dynamics of biochemical parameters is of concern and is the reason for interrupting therapy.

Fortunately, these problems are not typical for meloxicam.

In the available literature, against the background of treatment with this drug, only isolated cases of asymptomatic, but a significant increase in the level of transaminases or clinically pronounced liver dysfunctions were not noted [44, 45].

Comparative hepatotoxicity of various NSAIDs was studied by Italian authors G. Traversa et al. [46]. They compared the incidence of liver dysfunction in 397,537 patients treated with NSAIDs in 1997-2001. According to the data obtained, meloxicam showed the best tolerance. The frequency of hepatotoxic reactions during its use was 23.6 episodes per 100,000 person-years. A similar indicator for nimesulide, diclofenac and ibuprofen was significant – 35.2, 39,2 and 44 episodes per 100,000 person-years [46].

Concluding the review, it should be noted that the benefits of any drug are determined not only by successful pharmacological properties and favorable results of clinical trials. For practicing physicians, the “reputation” of the drug is of great importance, which is acquired over the years of its successful use in real clinical practice.

Meloxicam is a representative of NSAIDs, whose good “reputation” is beyond doubt. This drug is well known to doctors all over the world, they trust its effectiveness and good tolerance and actively use it in their work.