Article

Meloxicam (Mobic): Uses, Dosage, Side Effects, and Abuses
January 30, 20190441

 

What is Meloxicam?

As we get older, we start to get aches and pains around our bodies. This is often a normal part of the aging process. In particular, our joints begin to succumb to the normal wear and tear of everyday life. This can result in inflammation around the joints and cause a condition known as arthritis.1

Some people are more likely to suffer from arthritis because they have a family history of the condition. Others are prone to arthritis because of certain lifestyle factors or other existing conditions that can exacerbate this inflammation.

Whilst there is some evidence that certain supplements such as glucosamine and fish oil can slow the development of arthritis, there is no real way to stop arthritis from developing. Thankfully, there are ways we can manage the pain.2

Medications are often prescribed to treat the symptoms of arthritis such as pain and lack of mobility. One medication which is often prescribed for this purpose is meloxicam.

Meloxicam is the generic name of a drug that belongs to a group of medications called non-steroidal anti-inflammatory drugs (NSAIDs for short). You would probably recognize meloxicam from its brand name, Mobic. Like meloxicam, other NSAIDs which you would probably recognize include:

  • Advil (ibuprofen)
  • Celebrex (celecoxib)
  • Voltaren (diclofenac)
  • Aleve (naproxen)

Not all NSAIDs are prescription drugs (such as ibuprofen) but Mobic is a prescription drug and can only be purchased with a prescription from your doctor.

 

How does meloxicam work?

Meloxicam works by reducing inflammation in an area where there is pain and swelling. It does this by blocking the production of a chemical called prostaglandin.

Prostaglandins are a natural part of the body’s inflammation process which responds to injury and helps the body heal. If you have ever sprained your ankle, you will be very familiar with the pain, redness, heat and swelling which occurs around your ankle. These are the four cardinal signs of inflammation and prostaglandin plays an important role in this process. 3

However, when the concentration of prostaglandins is high for a very long time, it can get in the way of life and healing generally. This is when meloxicam comes in. Meloxicam blocks the production of prostaglandins by blocking an enzyme called COX-2 which makes prostaglandins. Meloxicam blocks COX-2 by effectively jamming up its control center. It inhibits it from working properly. This then reduces the amount of prostaglandins swimming around which reduces pain and inflammation. 3

 

Figure: How meloxicam acts on the inflammatory pathway

 

Conditions meloxicam is used to treat

Meloxicam is used to treat a number of different conditions. It is most widely used to treat osteoarthritis and rheumatoid arthritis and has been approved to treat both of these conditions.4

However, osteoarthritis and rheumatoid arthritis are not the only pain-causing conditions that meloxicam is successfully used to treat.

Even though the FDA approves medication for use in specific conditions, doctors often use medications for other purposes too. This is called off-label use and is very common amongst doctors. Sometimes, medications have shown promise in conditions that the drug is not approved for and so doctors will prescribe a medication in the hope that it will have a good effect on a patient. Some of the off-label conditions that meloxicam is used for include: 3,5

  • Acute Injuries
  • Pain caused by inflammation (e.g. menstrual pain, postoperative pain, migraines)
  • Gout
  • Back pain
  • Ankylosing spondylitis
  • Psoriatic arthritis

 

Meloxicam Dosage

 Adult Dosage

The common adult dosage is meloxicam 7.5mg once daily. This is the usual dosage for both osteoarthritis and for rheumatoid arthritis. 5

Your doctor will likely start you at this dosage and only increase the dosage if it is not helping you. The maximum daily dosage is 15mg meloxicam daily. Tablets usually come as either 7.5mg or 15mg tablets.

If you are elderly or you have kidney problems, your doctor is likely to keep you on the lowest dose of meloxicam. This is because the elderly are more likely to experience nasty side-effects such as stomach bleeding, heart failure and kidney damage. 6

Child Dosage

As with most drugs, doctors are hesitant to prescribe meloxicam to young children unless absolutely necessary. This is because the side-effects of meloxicam are more likely in younger children.

The main indication (condition it is used for) for meloxicam in children is juvenile rheumatoid arthritis. Juvenile rheumatoid arthritis is a condition which affects children younger than 17 and causes joint stiffness, pain and swelling for longer than six weeks. This is often treated with meloxicam at a dosage of 0.15-0.3mg/kg per day up to a maximum of 7.5mg a day (only in children greater than two years old).5

 

Meloxicam Side Effects

Like all medications, meloxicam is not immune to causing side effects. Some of these side effects happen very often and do not cause much harm. Others happen very infrequently but can result in some serious harm.

More Common Side Effects

Some of the more common meloxicam side effects include:5,6

  • stomach problems including nausea, vomiting, heartburn and diarrhea
  • reflux
  • headache
  • increased blood pressure
  • dizziness
  • cough, cold and flu-like symptoms

Reflux (heartburn) is a very common side-effect of meloxicam and can be reduced by always taking meloxicam immediately after or with food.

Most of these side-effects are fairly harmless and will go away eventually.

If the increased blood pressure does not go away within a day or two, stop taking the meloxicam and see your doctor immediately. If the other side-effects bother you or do not go away, speak to your doctor about reducing your dose or switching to another NSAID.

Serious Side Effects

Sometimes, meloxicam can have some serious side effects. This is very rare but it is important that you are mindful of these in case they happen. If you have any of the following reactions, stop taking the meloxicam and see your doctor immediately:5

  • swelling, sudden weight gain, difficulty urinating or fluid retention of any kind-your kidneys may not be working properly and this needs immediate attention.
  • any kind of rash, redness or itchiness-a sign of an allergic reaction to the meloxicam.
  • coughing up blood, blood in your stool or vomit that looks like coffee grounds- the meloxicam is possibly causing gastrointestinal bleeding which may lead to severe blood loss
  • severe nausea or abdominal pain, dark urine, pale stools or yellowing of the skin-your liver may not be functioning properly
  • facial swelling, fever, painful swallowing, eye pain, red or purple rash- you could be having a reaction called Stevens Johnson Syndrome which needs medical care
  • pale skin, light-headedness, shortness of breath, difficulty concentrating, rapid heart rate- you could be developing a blood disorder such as anemia

Again, these are very rare side-effects (less than 1 in every 1000 people taking meloxicam) but they are good to know about.

 

Warnings for Meloxicam Use

 General Warnings

As with any medication, you may have a reaction to meloxicam when using it for the first time. Signs that you may be having an allergic reaction include:7

  • swelling of the lips and face
  • difficulty breathing
  • rash or redness on the body

This would likely happen in the first few hours after taking meloxicam. If this occurs, seek emergency help immediately as allergic reactions can be fatal.

There is a chance that meloxicam will make you feel light-headed. Do not operate heavy machinery or drive until you know how it will affect you. If this dizziness does not subside, speak to your doctor.

Meloxicam has the potential to make you more sensitive to sunlight and make you burn more easily. To limit the chances of sunburn or skin blistering, always wear sunscreen when going out into the sun and do not visit a tanning salon whilst you are taking meloxicam.8

Meloxicam has the potential to cause kidney problems. This is much more likely to happen if you are dehydrated. When you are dehydrated, your kidneys don’t work as well as they should. Prostaglandins help the kidneys continue working when the amount of water in the body is decreased. Since meloxicam blocks the production of prostaglandins, the kidneys are more likely to stop working properly when you are not getting enough water. Make sure you stay well-hydrated whilst using meloxicam.3

Meloxicam and alcohol are also not a good mix. Alcohol can increase the chances of your stomach bleeding whilst on meloxicam. Alcohol generally reduces the clotting ability of your blood. Though this isn’t usually a problem, when you add meloxicam to the mix (which tends to cause some stomach irritation and also affects the way the blood clots too) you are increasing the likelihood that a small bleed in the stomach will become difficult to stop. For this reason, it is recommended that you do not take meloxicam and alcohol together.5

You are also expected to stop taking all NSAIDs, including meloxicam, for a certain period of time before any surgery (including dental). Make sure your surgeon, nurses and/or dentist know that you are taking meloxicam well before any scheduled procedure.

You may find that you bruise more easily with meloxicam. This occurs because meloxicam interferes with the way the blood clots. Let your doctor know if this happens to you.6

Warnings for Special Groups

If you have (or have had) a history of any of the following, ask your doctor before using meloxicam as it may not be suitable for you:5

  • asthma
  • liver disease
  • kidney disease
  • stomach problems
  • heart disease
  • blood clotting disorders
  • high blood pressure
  • stroke

 

If you have heart/ blood clotting disorders:

If you have any heart problems or blood clotting disorders, your doctor will be very cautious when prescribing meloxicam to you. All NSAIDs increase the likelihood of having a heart attack or a stroke in people who are already at risk. This includes people who have already had a stroke or a heart attack in the past.6 If you have heart failure, meloxicam should not be taken at all. This is because meloxicam may increase blood pressure and cause fluid and salt retention which can make your heart failure worse. Make sure your doctor knows if you have had these in the past so he/she can make an informed decision about what to prescribe for you. Also, if you have any blood clotting disorders or are taking aspirin on a daily basis, it is important that your doctor is aware of this.

If you have stomach problems:

If you have ever had a stomach bleed or peptic ulcers, you should not be using meloxicam. You are at a much higher risk of further stomach bleeding and worsening of your ulcers. Also, if you have inflammatory bowel disease, there is a chance that meloxicam will make it worse. If it does, see your doctor.6

If you are sensitive to NSAIDs:

Avoid meloxicam is you have had a bad reaction to an NSAID in the past. If you absolutely need an NSAID for your condition, ask your doctor to send you to a specialist for further investigation and to manage your second attempt at using an NSAID. Sometimes you may be able to tolerate an alternative NSAID but this is best done under the eye of a specialist.9

If you are pregnant, breastfeeding or trying to conceive:

Do NOT take meloxicam (or any NSAID) whilst pregnant, especially in the first or last trimester. In the first trimester, it increases the likelihood of miscarriage. If taken in the last trimester, it can cause birth defects and kidney damage in the baby as well as cause problems during birth.10,11 However, taking meloxicam whilst breastfeeding appears to be safe. Meloxicam may delay or prevent ovulation whilst you are taking it so if you are trying to conceive, speak to your doctor before taking meloxicam. This is not a permanent effect so your ovulation will return to normal when you stop taking this medication.5

 

Meloxicam Compared to Other Similar Drugs

 Meloxicam vs Ibuprofen

Both meloxicam and ibuprofen are NSAIDs. Both cause similar side effects and need to be taken with food. Meloxicam is generally used for pain associated with acute injury or arthritis whilst ibuprofen is used for several other conditions including general aches and pains, headaches, menstrual pain and fever. Unlike meloxicam, ibuprofen can be bought without a prescription and can be used in children from three months of age. However, ibuprofen needs to be taken several times a day whilst meloxicam only needs to be taken once a day.4

Meloxicam vs Vicodin

Vicodin is a combination drug. It contains acetaminophen, which is a pain medication (though not an NSAID) and hydrocodone which is an opioid medication. Vicodin is generally used to treat strong pain. Although acetaminophen is generally considered safer to use than meloxicam, the hydrocodone can cause drowsiness which may limit the usefulness of Vicodin. Also, meloxicam is used to treat inflammation. Vicodin cannot reduce inflammation but it can reduce pain. Meloxicam is not a drug you can become addicted to. Vicodin has the potential for addiction because it contains hydrocodone.

Meloxicam Drug Interactions

It is crucial that all health professionals involved in your care know that you are taking meloxicam as it can interact with several other medications. Many cold and flu preparations and pain medications already contain an NSAID (such as ibuprofen) so adding meloxicam to the mix can significantly increase the chances of side-effects such as stomach bleeding and kidney problems. Always tell your pharmacist or doctor before taking another pain medication with meloxicam.

Some common medications that interact with meloxicam include:5

  • blood pressure medications (captopril, lisinopril, ramipril)
  • fluid retention pills (furosemide, hydrochlorothiazide)
  • blood thinners or anti-platelets (aspirin, warfarin, clopidogrel)
  • NSAIDs (ibuprofen, ketoprofen, naproxen, diclofenac)
  • SSRI anti-depressants (citalopram, escitalopram, fluoxetine, sertraline)
  • steroid medications (prednisone, prednisolone)
  • lithium

 

Meloxicam (Mobic) Abuse

Although meloxicam can have some serious side-effects, it is not capable of giving you a “high” or a feeling of euphoria. Some people mistakenly believe that because it is a pain medication, that it will cause a high and take large doses. If you have a meloxicam overdose, this will cause severe side effects such as stomach and kidney damage but it will not create a feeling of euphoria.

 

Things your pharmacist will tell you

  • Don’t take this medication on an empty stomach
  • Drink plenty of water whilst you’re taking meloxicam
  • If you get swollen ankles, difficulty breathing, chest pain, black stool or coffee-ground vomit whilst you’re taking this, stop it and see your doctor immediately.
  • This may take around two weeks before you see the full effects of the meloxicam
  • Take a missed dose as soon as you remember it. If it is close to your next dose, skip the dose you missed and wait till the next scheduled dose. Do not double up doses.

 

Meloxicam FAQs

  • Is meloxicam safe to take every day?

Yes, and no. Long-term treatment on meloxicam is not advisable unless you are taking it for arthritis. If you are on long-term meloxicam, your doctor will need to do regular checkups which include blood tests, blood pressure checks, urine tests and weight monitoring.

  • Is Meloxicam a narcotic?

No. Meloxicam does not affect the brain and will not produce a “high” like narcotics and opioid medications can. It works in a different way to narcotics to reduce pain.

  • Can I take ibuprofen with meloxicam?

It is best that you don’t. Taking ibuprofen with meloxicam will increase the likelihood of side effects and major problems such as stomach bleeding.

  • Can I take meloxicam with tramadol?

Yes. Both medications help to relieve pain but both work in different ways so they do not interact.

  • Can you take meloxicam and Xanax?

Yes. Meloxicam does not interact with Xanax.

  • Is meloxicam a blood thinner?

Meloxicam does affect the way that platelets (particles in the blood that clump together to form clots) work which can stop the blood from clotting properly. However, this “thinning” ability is very unreliable.

  • How long does it take for meloxicam to take effect?

It can begin to work after the first dose but the best effect occurs after taking it for at least two weeks.

 

References

  1. What Is Arthritis? arthritis.org. http://www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php. Accessed July 26, 2017.
  2. Cooper C, Snow S, McAlindon TE, et al. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000;43(5):995-1000. doi:3.0.CO;2-1″>10.1002/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1.
  3. Noble S, Balfour JA. Meloxicam. Drugs. 1996;51(3):424-430; discussion 431-432. https://www.ncbi.nlm.nih.gov/pubmed/8882380. Accessed July 26, 2017.
  4. Chen Y-F, Jobanputra P, Barton P, et al. Cyclooxygenase-2 Selective Non-Steroidal Anti-Inflammatory Drugs (etodolac, Meloxicam, Celecoxib, Rofecoxib, Etoricoxib, Valdecoxib and Lumiracoxib) for Osteoarthritis and Rheumatoid Arthritis: A Systematic Review and Economic Evaluation. NIHR Journals Library. 2008. https://www.ncbi.nlm.nih.gov/books/NBK56865/. Accessed July 26, 2017.
  5. Handbook AM. AUSTRALIAN MEDICINES HANDBOOK 2017. AUSTRALIAN MEDICINES HAND; 2017.
  6. Singh G, Lanes S, Triadafilopoulos G. Risk of serious upper gastrointestinal and cardiovascular thromboembolic complications with meloxicam. Am J Med. 2004;117(2):100-106. doi:10.1016/j.amjmed.2004.03.012.
  7. Kowalski ML, Makowska JS, Blanca M, et al. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs)–classification, diagnosis and management: review of the EAACI/ENDA and GA2LEN/HANNA. Allergy. 2011;66(7):818-829. http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2011.02557.x/full.
  8. Niza MMRE, Félix N, Vilela CL, Peleteiro MC, Ferreira AJA. Cutaneous and ocular adverse reactions in a dog following meloxicam administration. Vet Dermatol. 2007;18(1):45-49. doi:10.1111/j.1365-3164.2007.00566.x.
  9. Stevenson DD. Aspirin and NSAID sensitivity. Immunol Allergy Clin North Am. 2004;24(3):491-505, vii. doi:10.1016/j.iac.2004.03.001.
  10. Østensen M. Nonsteroidal anti-inflammatory drugs during pregnancy. Scand J Rheumatol. 1998;27(sup107):128-132. doi:10.1080/03009742.1998.11720787.
  11. Ericson A, Källén BA. Nonsteroidal anti-inflammatory drugs in early pregnancy. Reprod Toxicol. 2001;15(4):371-375. https://www.ncbi.nlm.nih.gov/pubmed/11489592.

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