Meloxicam (Mobic) is a relatively newer medication used for pain relief. It is commonly used for osteoarthritis and rheumatoid arthritis. It may also cause side effects and interactions that patients should be aware of. Learn about the uses of meloxicam as well as the health risks.
What is Meloxicam?
Meloxicam is a prescription medication that belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAID). This class of drugs is typically used to help reduce fever, pain, and inflammation [1].
NSAIDs are associated with several health risks, including side effects that impact the stomach and heart. Meloxicam may have a lower risk of stomach side effects due to how it works [1].
Meloxicam is FDA-approved to treat chronic inflammatory diseases, including osteoarthritis and rheumatoid arthritis in adults and children. It is also used off-label for other painful conditions, such as lower back pain and pain after surgery [2, 3].
Mechanism of Action
Meloxicam primarily works by blocking COX enzymes [4].
There are two types of COX enzymes, COX-1 and COX-2. Both of these enzymes are responsible for producing various compounds, including prostaglandins and thromboxane [5].
Prostaglandins play a number of different roles in the body, such as regulating inflammation, pain, and fever. For this reason, NSAIDs can reduce pain and inflammation by blocking COX enzymes, which reduces the amount of prostaglandins produced [5].
However, prostaglandins also protect the stomach by regulating acid and mucus production. By blocking prostaglandin activity, NSAIDs can cause problems in the stomach, like ulcers [5].
Meloxicam is unique among NSAIDs because it has selective activity on COX-2. The COX-2 enzyme is not present in the stomach like COX-1 is. This means that meloxicam may not cause as many side effects in the stomach compared to NSAIDs that are non-selective for COX enzymes [4].
Meloxicam Uses
FDA-Approved Uses
1) Osteoarthritis
Osteoarthritis (OA) is a common form of arthritis that affects the joint cartilage that protects the ends of the bones. A number of clinical trials show that meloxicam can reduce pain and inflammation associated with this condition.
For example, a 12-week randomized placebo-controlled trial including 774 patients with OA found that meloxicam can reduce symptoms of pain and stiffness. In the study, the number of stomach side effects did not differ between meloxicam and placebo [6].
Meloxicam also reduced pain in a 6-month multicenter randomized trial of 336 patients with OA. Meloxicam caused fewer side effects than diclofenac, another type of NSAID [7].
In another randomized trial of 229 patients with OA of the lumbar spine, meloxicam improved pain and movement. Meloxicam was better tolerated than diclofenac once again [8].
2) Rheumatoid Arthritis in Adults
Rheumatoid arthritis (RA) is an autoimmune disorder where the body’s immune system attacks its own cells, causing pain and inflammation throughout the body. Meloxicam is approved to treat rheumatoid arthritis in both adults and children [3].
A 12-week randomized placebo-controlled trial of 894 patients with RA suggests that meloxicam may reduce joint swelling, tenderness, pain, and overall symptoms. Meloxicam did not cause significantly more stomach side effects compared to placebo [9].
In a 6 month double-blind trial of 379 patients with RA, meloxicam reduced joint pain and swelling better than naproxen, another common NSAID. Significantly more patients had to discontinue naproxen due to stomach side effects than those on meloxicam [10].
According to an 18-month long-term trial of 357 patients with RA, meloxicam may reduce stiffness and pain, while increasing grip st65rength. When taken daily for 1.5 years, meloxicam was deemed safe, but about 1/3 of patients did experience stomach side effects [11].
Meloxicam is also available as an intramuscular injection. Injections may have similar effectiveness to oral forms, according to a randomized trial of 173 patients with RA. Other studies have found similar results. Injections may have some benefits over oral forms, such as quicker onset of action [12, 13].
3) Rheumatoid Arthritis in Children
Children under the age of 16 can have a type of arthritis called juvenile rheumatoid arthritis. Meloxicam is FDA-approved to treat this condition in patients 2 years of age or older. A liquid suspension form of meloxicam is often used for children [3].
An international multicenter randomized trial of 232 children evaluated the short-term (3 months) and long-term safety and effectiveness of daily meloxicam in liquid form. The researchers suggest that meloxicam is safe and effective for both short-term and long-term use in children [14].
Off-Label Uses
Meloxicam is used for several off-label conditions, which we’ll discuss in the following sections. If you are prescribed this medication, always take the medication as directed by your doctor.
4) Lower Back Pain
A randomized controlled trial of 169 patients with lower back pain (lumbago) found that a 1-week treatment with meloxicam injection and oral doses may reduce pain and limitations to daily life. Other studies have found similar results [15, 16, 17].
Intravenous (IV) meloxicam is also an option for patients in need of immediate pain relief, as the medication can act quickly (within 30 minutes) when given this way [18].
In a randomized controlled trial of 183 patients experiencing sudden lower back pain, meloxicam IV injections followed by daily tablets for 8 days significantly reduced pain [18].
5) Sciatica
Sciatica can be caused by inflammation or pressure on the sciatic nerves in the lower back, which causes pain that can spread down into the legs. Research suggests that meloxicam may be an alternative to opioids for nerve pain relief [19].
In a 6-year open-label study of 72 patients with painful nerve inflammation (including sciatica), meloxicam injections provided long-term pain relief to most patients after 1 to 3 doses [16].
Two randomized placebo-controlled trials with 532 and 489 patients each found that oral meloxicam may be effective for sudden (acute) sciatica [20].
6) Neck Pain
An open-label study of 48 patients with neck and shoulder pain found that 1-3 injections of meloxicam may provide pain relief that lasts up to 90 days. In the study, the functional activity level of all patients increased after receiving the injection [21].
7) Pain Associated with Dental Surgery
In a randomized trial of 60 patients with inflammatory gum disease, an adhesive film containing meloxicam was applied to the gums after gum surgery for 3 days. Researchers found that the higher doses of meloxicam film (30 and 45 mg) may reduce pain after dental surgery [22].
A randomized study of 36 patients suggests that one dose of oral meloxicam before a molar tooth extraction may reduce post-surgery pain, swelling, and symptoms of lockjaw (trismus) [23].
8) Pain After Surgery
Meloxicam is sometimes given as a single dose to reduce pain after surgery. However, a systematic review did not identify any strong clinical trials that support this use [24].
Meloxicam Safety
Side Effects
Meloxicam can cause several side effects. If any side effects persist or worsen, let your doctor know. This is also not a complete list of possible side effects. Tell your doctor if you experience any serious side effects or notice any effects not listed here.
Some common side effects include [3]:
- Dizziness
- Nausea
- Upset stomach
- Diarrhea
- Upper respiratory tract infections
- Indigestion
- Flu-like symptoms
Some serious side effects include [3]:
- Bloody or black stools
- Severe stomach pain
- Severe or persistent headache
- Swelling in the ankles or feet
- Sudden weight gain
- Dark urine
- Persistent nausea or vomiting
Warnings
Heart Risks
Meloxicam is associated with an increased risk for serious cardiovascular complications, including heart attack and stroke. Meloxicam should be used cautiously in patients with heart conditions, such as heart failure [25].
Gastrointestinal Risks
Meloxicam is associated with an increased risk for serious gastrointestinal complications, including ulcers and bleeding. Patients taking meloxicam, especially elderly patients and those with a history of peptic ulcer disease, should be aware of these risks and symptoms [25].
Liver Toxicity
There’s evidence that meloxicam may have toxic effects on the liver. This medication should be discontinued if there are any signs or symptoms of liver disease [25].
Kidney Toxicity
Meloxicam may be toxic to the kidneys. Patients on meloxicam should have their renal function monitored. This medication should not be used in those with advanced kidney disease unless a doctor determines that the benefits outweigh the risks [25].
Contraindications
Meloxicam should not be taken if a patient has any of the following [3]:
- Allergies or sensitivity to meloxicam
- Any allergies to aspirin or other NSAIDs
- Is undergoing CABG surgery
Pregnancy and Breastfeeding
There’s evidence that meloxicam may increase the risk of birth defects when taken during the third trimester of pregnancy. The FDA recommends avoiding the use of NSAIDs, in general, starting in the third trimester (30 weeks) of pregnancy [3].
It’s unclear if meloxicam is present in breast milk. A doctor will weigh the benefits and risks when determining if the use of meloxicam is appropriate during breastfeeding.
Drug Interactions
The following drugs have been reported to interact with meloxicam. However, this is not a complete list, let your doctor know of all the medications you are currently taking to avoid any unexpected interactions.
- Aspirin – Use of meloxicam together with aspirin (even at low doses) is not recommended and can increase the risk of stomach damage [26].
- ACE Inhibitors – Meloxicam can reduce the blood pressure-lowering effect of ACE inhibitors [27].
- Lithium – Meloxicam may dangerously increase lithium levels, causing overdose [28].
- Warfarin – There is an increased risk of severe bleeding (internal or external) in combination with meloxicam [29].
Meloxicam Dosage
The dosing of meloxicam can vary. Always take this medication as directed by a doctor.
Meloxicam is available as tablets, capsules, liquid suspensions, and injections (IV or IM). Gels and patches are also being developed [30, 31].
In general, meloxicam should be used at the lowest effective dose for the shortest duration possible for pain relief.
Tablets are available in strengths of 7.5 and 15 mg.
For osteoarthritis and rheumatoid arthritis in adults, patients are usually started on 7.5 mg per day, which may be increased to 15 mg per day if needed.
Complementary Options
The following section details some complementary options that may help with pain. You should always consult your doctor before changing or stopping your medications.
It’s also important to let your doctor know of all the supplements you are currently taking, in case of potential interactions. These alternatives should not be used to replace medical treatment.
Fish Oil
There’s some evidence that fish oils (DHA and EPA) may help reduce pain and inflammation.
A review of 42 clinical trials found that fish oil supplements may help reduce pain associated with osteoarthritis and rheumatoid arthritis. However, the quality of evidence was low for osteoarthritis, while the quality was only moderate for rheumatoid arthritis [32].
White Willow Bark
White willow bark (Salix alba) contains salicin, the same compound that aspirin is derived from [33, 34].
A review of 14 clinical trials involving 2,050 participants suggests that white willow bark may reduce lower back pain. However, the quality of evidence was moderate at best [35].
Willow bark also shares many of the same safety concerns with aspirin, including interactions with blood thinners and the risk of Reye’s syndrome in children [36, 37].
Resveratrol
Resveratrol is a compound found in many foods, like berries, peanuts, and most famously in red wine [38].
Resveratrol may be effective as an add-on to conventional NSAIDs. A randomized trial of 110 people with osteoarthritis of the knee found that resveratrol supplements plus meloxicam may provide more pain relief than meloxicam alone [39].
Boswellia, Curcumin, and Pycnogenol
A systematic review investigated the effectiveness of 20 different supplements for pain associated with osteoarthritis. According to the 69 trials included in the review, Boswellia, curcumin, and Pycnogenol may be effective for short-term pain relief [40].
However, the researchers concluded that the quality of evidence was very low. There was also no evidence that these supplements improve long-term pain [40].
