Meloxicam

Approved Uses

Meloxicam is primarily prescribed to manage the symptoms of chronic inflammatory conditions affecting the joints. It works by reducing the substances in the body that cause inflammation and pain.

Osteoarthritis

It is used to treat the signs and symptoms of osteoarthritis, a common condition where the protective cartilage on the ends of bones wears down over time, leading to joint pain and stiffness.

Rheumatoid Arthritis

Meloxicam is used for the long-term treatment of rheumatoid arthritis. This is an autoimmune disorder that causes painful swelling in the lining of the joints and can eventually lead to joint deformity.

Juvenile Rheumatoid Arthritis

This medication is also approved for use in children who are at least 2 years of age to treat the symptoms of juvenile rheumatoid arthritis, specifically the pauciarticular or polyarticular course of the disease.

How Meloxicam Works

Meloxicam belongs to a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by inhibiting the activity of enzymes known as cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2).

These enzymes are responsible for creating prostaglandins, which are chemicals that the body produces in response to injury or certain diseases. Prostaglandins contribute to several symptoms, including:

• Pain and sensitivity
• Inflammation and swelling
• Fever

By reducing the levels of these chemicals, meloxicam helps to decrease the pain, stiffness, and swelling associated with conditions like osteoarthritis and rheumatoid arthritis. While it manages these symptoms, it does not treat the underlying cause of the arthritis itself.

Common Side Effects

Some people may experience mild side effects while taking meloxicam. These symptoms often include:

• Diarrhea or constipation
• Gas or bloating
• Sore throat or runny nose
• Headache
• Dizziness
• Nausea or stomach pain

Serious Side Effects

Seek medical help immediately if you experience any of the following serious symptoms:

• Signs of an allergic reaction, such as skin rash, hives, itching, or swelling of the face, lips, tongue, or throat
• Difficulty breathing or swallowing
• Unexplained weight gain or swelling in the hands, arms, legs, or feet
• Flu-like symptoms, fever, or extreme tiredness
• Yellowing of the skin or eyes
• Pain in the upper right part of the stomach or loss of appetite
• Cloudy, discolored, or bloody urine
• Fast heartbeat or chest pain
• Pale skin or unusual bruising and bleeding
• Back pain or difficult and painful urination

Cardiovascular and Gastrointestinal Risks

Meloxicam has boxed warnings regarding serious safety risks:

• Cardiovascular Events: This medication may increase the risk of serious heart-related events, such as heart attack or stroke, which can be fatal. This risk may increase with longer use or in people with existing heart disease. It should not be used for pain relief before or after heart bypass surgery (CABG).
• Gastrointestinal Issues: NSAIDs like meloxicam increase the risk of bleeding, ulcers, and holes in the stomach or intestines. These conditions can happen without warning and may be fatal, especially in older adults.

Allergic Reactions

Meloxicam should not be used by individuals who have had asthma, hives, or other allergic-type reactions after taking aspirin or other NSAIDs. Severe, sometimes fatal, allergic reactions have been reported in such patients.

Organ Health and Monitoring

The use of meloxicam requires caution in certain health conditions:

• Kidney Function: Long-term use can lead to kidney damage. People with existing kidney disease or those taking certain medications like diuretics may be at higher risk.
• Liver Function: Elevations in liver enzymes may occur. Treatment should be stopped if signs of liver disease develop.
• Fluid Retention: Meloxicam can cause fluid retention and swelling, which may worsen conditions like high blood pressure or heart failure.

Pregnancy Precautions

Healthcare providers generally advise against using meloxicam starting at 20 weeks of pregnancy, as it may cause rare but serious kidney problems in the unborn baby. It should be strictly avoided starting at 30 weeks of pregnancy because it can cause premature closure of a vital heart vessel in the fetus.

Veterinary Warning for Cats

In veterinary medicine, repeated use of meloxicam in cats has been linked to acute kidney failure and death. The FDA has issued a boxed warning specifically for its use in felines.

Pregnancy

Meloxicam is generally not recommended for use during pregnancy, particularly during the second and third trimesters. Starting at 20 weeks of gestation, taking meloxicam may cause rare but serious kidney problems in the unborn baby, which can lead to low levels of amniotic fluid. If a healthcare provider determines that meloxicam is necessary between 20 and 30 weeks of pregnancy, they may monitor amniotic fluid levels.

At 30 weeks of pregnancy or later, meloxicam should be avoided entirely. Use during this period can cause the premature closure of the ductus arteriosus, a blood vessel in the baby's heart, which may lead to heart or lung complications after birth.

Meloxicam may also affect fertility. It can cause a reversible delay in ovulation, which may make it more difficult for some individuals to become pregnant while using the medication.

Breastfeeding

It is not known if meloxicam passes into human breast milk. Because many drugs are excreted in milk and there is a potential for serious adverse reactions in nursing infants, a decision should be made whether to stop nursing or stop the medication. Patients should discuss the risks and benefits with their healthcare provider to determine the best course of action.

Available Forms

Meloxicam is primarily available as an oral medication, but it can also be administered by a healthcare professional through an injection. Common forms include:

• Oral Tablets: The most common form taken by mouth.
• Oral Capsules: An alternative oral form.
• Oral Suspension: A liquid form of the medication, often used for patients who have difficulty swallowing pills.
• Intravenous Injection: A form administered directly into a vein, typically in a clinical setting.
• Orally Disintegrating Tablets: A tablet that dissolves on the tongue without the need for water.

FDA Approval and Indications

Meloxicam is approved by the U.S. Food and Drug Administration (FDA) for the management of signs and symptoms of osteoarthritis and rheumatoid arthritis in adults. It is also approved for the treatment of pauciarticular or polyarticular course juvenile rheumatoid arthritis in pediatric patients weighing 60 kg or more.

Boxed Warnings

The FDA requires a boxed warning for meloxicam due to the following serious safety risks:

• Cardiovascular Risk: Nonsteroidal anti-inflammatory drugs (NSAIDs) may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction (heart attack), and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use. Meloxicam is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
• Gastrointestinal Risk: NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and those with a prior history of peptic ulcer disease or gastrointestinal bleeding are at greater risk for serious gastrointestinal events.

Veterinary Safety Communication

The FDA has issued specific regulatory warnings regarding the use of meloxicam in animals. A boxed warning is required for meloxicam injection in cats, noting that repeated use in cats has been associated with acute renal failure and death. For feline patients, it is only FDA-approved for a single one-time dose prior to surgery.

Prescription Status

Meloxicam is available only by prescription. It is not a controlled substance.

Stopping Meloxicam

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) and is not considered an addictive substance. It does not cause the physiological withdrawal symptoms often associated with medications like opioids or benzodiazepines.

When you stop taking meloxicam, the primary concern is the recurrence of the symptoms the drug was managing. Because meloxicam treats inflammation and pain, discontinuing it may result in:

• Return of symptoms: You may experience a return of joint pain, swelling, and stiffness, especially if you were taking the medication for a chronic condition like osteoarthritis or rheumatoid arthritis.
• No tapering required: For most people, meloxicam can be stopped abruptly without the need to gradually reduce the dose. There is no evidence that a tapering schedule is necessary to prevent physical illness.

If you are planning to stop taking meloxicam, it is important to consult with a healthcare provider. They can help monitor your condition and suggest alternative treatments if your pain or inflammation returns after stopping the medication.