Drug reference

Meloxicam

NSAID · Anti-inflammatory

NSAIDAnti-inflammatory

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

FDA category + note

Top interactionssee all 12 →

AminoglycosideSevereTextbookKDT 7e · p746
AminoglycosidesSevereTextbookKDT 7e
AnticoagulantsSevereTextbookKDT 7e
CorticosteroidsSevereTextbookKDT 7e

Mechanism

Meloxicam is a preferential (but not exclusive) COX-2 inhibitor with a COX-2/COX-1 selectivity ratio of approximately 10:1. At therapeutic doses, it produces measurable inhibition of platelet thromboxane A2 production (a COX-1 function), distinguishing it from the highly selective COX-2 inhibitors (celecoxib). Its preferential selectivity provides anti-inflammatory efficacy comparable to piroxicam with reduced gastrointestinal toxicity, without completely eliminating the cardioprotective effect of low-dose aspirin. Its plasma half-life of 15-20 hours permits once-daily dosing.

Indications

Short-term relief of pain in osteoarthritisLong-term treatment of rheumatoid arthritisAnkylosing spondylitisExacerbation of osteoarthritis (short-term)Pain and inflammation in rheumatic diseaseJuvenile arthritisOsteoarthritisRheumatoid arthritisJuvenile rheumatoid arthritis

Dosing

Adult: BY MOUTH: 7.5 mg once daily, then increased if necessary up to 15 mg once daily for exacerbation of osteoarthritis (short-term).
Pediatric: Child 16–17 years: BY MOUTH: 7.5 mg once daily, then increased if necessary up to 15 mg once daily for exacerbation of osteoarthritis (short-term).
Max dose: 15 mg once daily

Pharmacokinetics

Onset

Peak plasma concentrations (Cp) 4–5 h (and 12–14 h due to biliary recycling)

Half-life

15–20 h

Protein binding

99%

Metabolism

Hydroxylation

Contraindications

patients with history of ischaemic heart disease/hypertension/cardiac failure/cerebrovascular disease (general COX-2 inhibitor precaution)

Side effects

Common

Significantly less gastric injury at 7.5 mg/day compared to piroxicam (20 mg/day), but this advantage is lost with a dosage of 15 mg/day.gastric changes (at lower dose similar to placebo; at higher dose intermediate between placebo and piroxicam)milder gastric side effects

Serious

Cardiovascular risk (as part of the NSAID class black-box warning)
ulcer complications (bleeding, perforation) on long-term use

Pregnancy & lactation

Pregnancy

Lactation

Excretion in breast milk unknown.

Drug interactions

Aminoglycoside

Severe

Textbook

Increased risk of nephrotoxicity.

Avoid concurrent use.

Source: KDT 7e · p746

Aminoglycosides

Severe

Textbook

Increased aminoglycoside levels and potential toxicity.

Monitor aminoglycoside levels and renal function; adjust dosage as needed.

Source: KDT 7e

Anticoagulants

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider alternative analgesics or gastroprotective agents.

Source: KDT 7e

Corticosteroids

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider gastroprotective agents.

Source: KDT 7e

Dapoxetine

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider gastroprotective agents or alternative analgesics.

Source: KDT 7e

Enalaprilat

Severe

Textbook

Reduced effectiveness of ACE inhibitors. Marked hyperkalemia, potentially leading to cardiac arrhythmia.

Use with caution, especially in the elderly and in patients with hypertension, diabetes mellitus, or ischemic heart disease.

Source: G&G 14e · p836

Escitalopram + Clonazepam

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider gastroprotective agents or alternative analgesics.

Source: KDT 7e

Glucocorticoids

Severe

Textbook

Increased risk of gastritis, ulcer formation, and gastrointestinal bleeding. Glucocorticoids can also mask the symptoms of serious gastrointestinal disease, increasing the risk of perforated sigmoid diverticular abscesses.

Not explicitly stated, but implies caution and awareness of increased risk.

Source: G&G 14e · p1013

Quinolones

Severe

Textbook

Enhanced neurological adverse effects.

Use with caution, especially in patients with a history of epilepsy.

Source: G&G 14e · p1144

Acalabrutinib

Severe

Database

Drug interaction classified as: synergy