Meloxicam is a long-acting, preferential cyclooxygenase-2 (COX-2) inhibitor belonging to the enolic acid group of non-steroidal anti-inflammatory drugs (NSAIDs). It is indicated for the symptomatic treatment of painful inflammatory and degenerative conditions such as osteoarthritis and rheumatoid arthritis. Its preferential COX-2 inhibition offers a potentially improved gastrointestinal safety profile compared to non-selective NSAIDs, though cardiovascular and GI risks remain.
Adult: Osteoarthritis: 7.5 mg once daily; may be increased to 15 mg once daily if needed. Rheumatoid Arthritis & Ankylosing Spondylitis: 15 mg once daily.
Note: Take with a full glass of water, preferably with food or milk to minimize gastric upset. Tablet should be swallowed whole, not crushed or chewed. For once-daily dosing, take at the same time each day.
Meloxicam exerts its anti-inflammatory, analgesic, and antipyretic effects by inhibiting the synthesis of prostaglandins. It preferentially inhibits the cyclooxygenase-2 (COX-2) isoenzyme over COX-1. COX-2 is induced during inflammation and is responsible for the synthesis of pro-inflammatory prostaglandins. By inhibiting COX-2, meloxicam reduces the production of these mediators at the site of inflammation.
Pregnancy: Category C (1st & 2nd trimesters): Use only if potential benefit justifies potential fetal risk. Avoid use in 3rd trimester (Category D) due to risk of premature closure of ductus arteriosus, oligohydramnios, and inhibition of labor.
Driving: May cause dizziness, vertigo, somnolence, or visual disturbances. Patients should be cautioned about operating machinery or driving until they know how the drug affects them.
| Warfarin, Acenocoumarol | Increased risk of bleeding due to antiplatelet effect and protein binding displacement. | Major |
| Aspirin (low-dose) or other NSAIDs | Increased risk of GI toxicity (ulcers, bleeding) with no added therapeutic benefit. | Major |
| Lithium | Decreased renal clearance of lithium, leading to increased lithium levels and toxicity. | Major |
| Methotrexate | Decreased renal clearance of methotrexate, increasing risk of bone marrow suppression and toxicity, especially at high MTX doses. | Major |
| Diuretics (Furosemide, Thiazides) | Reduced diuretic and antihypertensive efficacy; increased risk of renal impairment. | Moderate |
| ACE Inhibitors (Ramipril, Enalapril) / ARBs (Losartan) | Reduced antihypertensive effect; increased risk of renal impairment, especially in volume-depleted patients. | Moderate |
| Corticosteroids (Prednisolone) | Synergistic increase in risk of GI ulceration and bleeding. | Moderate |
| SSRIs (Fluoxetine, Sertraline) | Increased risk of upper GI bleeding. | Moderate |
| Cyclosporine, Tacrolimus | Increased risk of nephrotoxicity. | Moderate |
| Antiplatelets (Clopidogrel) | Additive risk of GI bleeding. | Moderate |