Meloxicam (Mobic) | Medication Reference

Bedside Snapshot

Core Dose: 7.5–15 mg PO once daily (start low, titrate if needed)
Onset/Duration: Peak 4–6 hours; half-life ~15–20 hours (once-daily dosing)
Key Dangers: GI bleeding, AKI, fluid retention/heart failure exacerbation, cardiovascular events (MI, stroke)
Special Considerations: Preferential COX-2 inhibitor; lower GI toxicity than non-selective NSAIDs but still significant risk. Avoid in AKI, advanced CKD, decompensated heart failure, cirrhosis, active GI ulcer/bleed, and late pregnancy

Brand & Generic Names

Generic Name: Meloxicam
Brand Names: Mobic, Vivlodex, generics

Medication Class

Nonsteroidal anti-inflammatory drug (NSAID); preferential COX-2 inhibitor (not as selective as celecoxib)

Pharmacology

Mechanism of Action:

Inhibits cyclooxygenase (COX) enzymes involved in prostaglandin synthesis
Shows relative preference for COX-2 over COX-1 at usual doses, which may confer somewhat lower rates of GI toxicity compared with completely nonselective NSAIDs
GI and cardiovascular risks remain clinically significant despite COX-2 selectivity
Reduces prostaglandin production, decreasing peripheral and central sensitization to pain
Reduces inflammation and fever

Pharmacokinetics:

Absorption: Well absorbed orally; peak plasma concentrations typically reached within 4–6 hours
Distribution: Highly protein bound (~99%); volume of distribution relatively low but extensive tissue penetration
Metabolism: Primarily hepatic via oxidation (CYP2C9 and CYP3A4) and peroxidase pathways to inactive metabolites
Elimination: Excreted in urine and feces as metabolites; terminal half-life ~15–20 hours, supporting once-daily dosing
In renal or hepatic impairment, clearance is reduced and exposure may increase; use lower doses and avoid in severe disease

Indications

Short-term treatment of acute musculoskeletal pain, sprains/strains, back pain, or arthritis flares once serious pathology is excluded and oral intake is reliable
Continuation or adjustment of chronic osteoarthritis or rheumatoid arthritis regimens in stable patients
Generally not a first-line choice in unstable, volume-depleted, or renally compromised ICU patients where NSAIDs can precipitate AKI

Dosing & Administration

Available Forms:

Tablets/capsules: 7.5 mg, 15 mg
Oral suspension: Various strengths (e.g., 7.5 mg/5 mL); verify concentration before dosing

Standard Adult Dosing:

Indication / Scenario	Typical Dose	Frequency	Notes
Osteoarthritis / rheumatoid arthritis (initial)	7.5 mg PO	Once daily	Increase only if needed and tolerated
Osteoarthritis / rheumatoid arthritis (max usual)	15 mg PO	Once daily	Use lowest effective dose; avoid chronic high-dose use in high-risk patients
Acute musculoskeletal pain (short course)	7.5–15 mg PO	Once daily	Limit duration; reassess if pain persists beyond several days
Renal impairment (mild to moderate)	7.5 mg PO	Once daily (max)	Avoid in severe renal impairment or in patients on dialysis unless specialist-directed
Hepatic impairment (mild to moderate)	7.5 mg PO	Once daily	Avoid in severe hepatic impairment; monitor LFTs if used
Geriatric patients (≥65 years)	7.5 mg PO	Once daily (often max)	Higher sensitivity to GI, renal, and CV adverse effects; use lowest effective dose and shortest duration

Contraindications

Absolute Contraindications:

History of asthma, urticaria, or allergic-type reaction after aspirin or other NSAIDs (risk of severe bronchospasm/anaphylaxis)
Use in the setting of coronary artery bypass graft (CABG) surgery (perioperative period)
Active GI bleeding or peptic ulcer disease
Severe renal impairment or progressive kidney disease unless benefits clearly outweigh risks and close monitoring is in place
Third-trimester pregnancy due to risk of premature closure of the ductus arteriosus and fetal renal injury

Major Precautions:

Cardiovascular risk: NSAIDs (including meloxicam) increase risk of serious cardiovascular thrombotic events (MI, stroke), especially with long-term use or preexisting CV disease
GI risk: Increased risk of GI bleeding, ulceration, and perforation; risk higher in older adults, prior ulcer/bleed, concurrent anticoagulants/antiplatelets, corticosteroids, or heavy alcohol use
Renal risk: Can precipitate AKI in volume depletion, CKD, heart failure, cirrhosis, or with concurrent nephrotoxic drugs (ACE inhibitors/ARBs, diuretics, contrast)
Fluid retention and edema: May worsen hypertension and heart failure; monitor BP and volume status
Hepatic effects: Rare severe hepatic injury; monitor for symptoms (fatigue, jaundice, dark urine) and abnormal LFTs
Use caution in asthma, particularly aspirin-exacerbated respiratory disease; NSAIDs may trigger bronchospasm

Black Box Warning: NSAIDs cause increased risk of serious cardiovascular thrombotic events, including MI and stroke. NSAIDs also cause increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal.

Adverse Effects

Common:

Dyspepsia, nausea, abdominal pain, heartburn
Diarrhea or constipation
Headache, dizziness
Peripheral edema, mild BP elevation

Serious:

GI bleeding, gastric or duodenal ulcer, GI perforation
Acute kidney injury or worsening CKD, sometimes requiring dialysis
Myocardial infarction, stroke, new or worsening heart failure
Severe hypersensitivity reactions including anaphylaxis, angioedema, and severe cutaneous adverse reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
Severe hepatotoxicity with jaundice and hepatic failure (rare)

Special Populations

Renal Impairment:

Mild to moderate: Start with 7.5 mg once daily (maximum); monitor closely
Severe or dialysis-dependent: Avoid unless specialist-directed with careful monitoring

Hepatic Impairment:

Mild to moderate: 7.5 mg once daily; monitor liver function tests
Severe: Avoid use

Pregnancy:

Avoid in third trimester (risk of premature closure of ductus arteriosus, fetal renal injury)
Use in first and second trimesters only if benefits outweigh risks

Lactation:

Limited data; use with caution; consider alternative analgesics

Pediatric Use:

Oral meloxicam has pediatric indications for juvenile idiopathic arthritis in some guidelines
Dosing is weight-based and product-specific; always consult pediatric references
ED/ICU use in children is uncommon; pediatric pain often managed with ibuprofen or other agents

Geriatric Patients:

Start with 7.5 mg once daily
Higher sensitivity to GI, renal, and CV adverse effects
Use lowest effective dose for shortest duration

Monitoring

Clinical Monitoring:

Signs/symptoms of GI bleeding (melena, hematemesis, anemia, new abdominal pain)
Blood pressure and signs of fluid retention, especially in patients with hypertension or heart failure
Reassess pain control and need for ongoing NSAID therapy

Laboratory Monitoring:

Baseline and periodic assessment of renal function (serum creatinine, BUN) in patients receiving repeated doses or with CKD, HF, or volume depletion
Monitor liver enzymes periodically if using for longer durations or in patients with hepatic risk factors

Clinical Pearls

Long Half-Life Considerations: Meloxicam's once-daily dosing can improve adherence in subacute pain, but the long half-life means adverse effects (e.g., AKI, GI bleed) may persist longer than with short-acting NSAIDs.

High-Risk Patients: In high-risk patients (CKD, HF, cirrhosis, older adults with prior GI bleed), consider alternatives like acetaminophen, topical NSAIDs, or non-NSAID adjuncts rather than systemic meloxicam.

Renal Protection: If you need an NSAID in a borderline renal patient, ensure they are euvolemic, avoid concurrent nephrotoxins when possible, and limit dose/duration with close follow-up.

OTC NSAID Use: Always ask about and document OTC NSAID use; many patients take ibuprofen or naproxen at home on top of prescribed meloxicam, greatly increasing risk.

ICU Considerations: Avoid starting meloxicam in critically ill ICU patients with fluctuating renal function and borderline perfusion; if an NSAID is needed at all, favor short-acting agents with careful monitoring.

References

1. Lexicomp. (2024). Meloxicam: Drug information. Wolters Kluwer.
2. Boehringer Ingelheim. (2023). Mobic (meloxicam) [Package insert].
3. Schmidt, M., Sorensen, H. T., & Pedersen, L. (2016). Diclofenac use and cardiovascular risks: Series of nationwide cohort studies. BMJ, 353, i2554. https://doi.org/10.1136/bmj.i2554
4. U.S. Food and Drug Administration. (2015). FDA strengthens warning of heart attack and stroke risk for non-steroidal anti-inflammatory drugs. https://www.fda.gov/drugs/drug-safety-and-availability/fda-strengthens-warning-heart-attack-and-stroke-risk-non-steroidal-anti-inflammatory-drugs
5. Noble, S., & Balfour, J. A. (1996). Meloxicam. Drugs, 51(3), 424-430. https://doi.org/10.2165/00003495-199651030-00007