meloxicam: clinical use

Prescribing considerations

• Assess gastrointestinal, cardiovascular, renal and hepatic risk before prescribing.
• Consider gastroprotection for patients at increased risk of gastrointestinal complications.
• Meloxicam is unsuitable when immediate relief of acute pain is required.
• Review continued clinical benefit, particularly in osteoarthritis.
• Use particular caution in older, dehydrated or otherwise frail patients and in those with hypertension, heart failure or inflammatory bowel disease.
• Meloxicam can mask fever and other features of infection and may impair female fertility.

Contraindications and cautions

• Hypersensitivity to meloxicam or excipients, or aspirin/NSAID-associated asthma, nasal polyps, angioedema or urticaria.
• Previous NSAID-related gastrointestinal bleeding or perforation; active or recurrent peptic ulceration or haemorrhage.
• Severe hepatic impairment, severe renal failure without dialysis or severe heart failure.
• Gastrointestinal bleeding, previous cerebrovascular bleeding or another bleeding disorder.
• Third trimester of pregnancy.
• Age below 16 years for the selected tablet.

Monitoring

• Blood pressure in patients at cardiovascular risk.
• Renal function and fluid status in older people and patients with renal, cardiac or hepatic disease, hypovolaemia, or interacting medicines.
• Serum potassium when diabetes or potassium-raising treatment increases hyperkalaemia risk.
• Liver tests, renal indices and blood count when clinically indicated or if abnormalities or toxicity symptoms develop.
• Evidence of gastrointestinal bleeding, oedema, skin reactions and loss of clinical benefit.

Clinical pharmacology

Meloxicam is an oxicam NSAID that inhibits prostaglandin biosynthesis. It is well absorbed orally, highly protein bound and extensively metabolised in the liver, mainly through CYP2C9 with a smaller CYP3A4 contribution. Its relatively long elimination half-life contributes to accumulation concerns during breastfeeding.

Formulation and product differences

• The selected product is a yellow, round, uncoated tablet with a score line that is not intended for breaking.
• It contains lactose monohydrate and is essentially sodium-free.

Tablet

Route: Oral

Strengths: 7.5 mg, 15 mg