Meloxicam

Administration

• Type: NSAID
• Dosage Forms: 7.5, 15mg
• Routes of Administration: PO
• Common Trade Names: Mobic, Vivlodex

Adult Dosing

Osteoarthritis

• 7.5-15mg PO QD
• Max 15mg/day

Rheumatoid arthritis

• 7.5-15mg PO QD
• Max 15mg/day

Pediatric Dosing

[[Juvenile idiopathic arthritis (>60kg)]]

• 7.5mg PO QD
• Max 7.5mg/day

Special Populations

• Pregnancy Rating: C, category D if >30wk gestation
• Lactation risk: safety unknown, inadequate literature available to assess risk

Renal Dosing

• Adult:
  • mild-mod impairment: no adjustment
  • CrCl <15: avoid use
  • HD: max 7.5mg/day

• Pediatric: see Adult dosing

Hepatic Dosing

• Adult:
  • Child-Pugh Class A or B: no adjustment
  • Child-Pugh Class: not defined

• Pediatric: see Adult Dosing

Contraindications

• Allergy to class/drug
• ASA or NSAID-induced asthma or urticaria
• caution if:
  • renal impairment, dehydration, elderly or debilitated
  • history of GI bleed or ulcers, alcohol use, or coagulopathy
  • hepatic impairment
  • asthma
  • cardiovascular disease (or high risk of), including CABG surgery periop use, recent MI, CHF, HTN, smoker
  • fluid retention
  • PKU
  • prolonged use

Adverse Reactions

Serious

• GI bleed, ulcer, perforation
• blood dyscrasias, prolonged bleeding time, anemia
• nephrotoxicity, renal papillary necrosis
• MI, stroke, thromboembolism, HTN, CHF
• hepatotoxicity, hepatic necrosis, pancreatitis
• bronchospasm
• exfoliative dermatitis, SJS/TEN

Common

• dyspepsia, nausea/vomiting, abdominal pain, diarrhea, constipation, flatulence
• headache, dizziness, drowsiness, tinnitus
• dizziness
• rash, pruritus, urticaria, photosensitivity
• fluid retention, peripheral edema
• ecchymosis
• elevated creatinine, ALT/AST
• sinusitis
• vomiting (peds)
• headache (peds)
• fever (peds)
• delayed ovulation

Pharmacology

• Half-life: 15-20 hours
• Metabolism: liver extensively; CYP450 (2C9, 3A4 substrate)
• Excretion: urine (0.2% unchanged); feces (1.6% unchanged)
• Mechanism of Action: exact MOA unknown; inhibits cyclooxyrgenase, reducing prostaglandin and thromboxane synthesis

See Also

NSAID

References

Authors

Kaoru Itakura, Claire, Ross Donaldson, Neil Young