Meloxicam exerts its therapeutic effects through selective inhibition of the cyclooxygenase-2 (COX-2) enzyme. Its key mechanisms include:

1. Selective COX-2 Inhibition:
   • Meloxicam selectively inhibits the COX-2 enzyme, which is induced during inflammation and is responsible for the production of prostaglandins that mediate pain, inflammation, and fever.
   • Unlike non-selective NSAIDs, meloxicam has minimal effect on the COX-1 enzyme, which protects the gastric mucosa and regulates platelet function.
2. Reduction of Prostaglandin Synthesis:
   • By inhibiting COX-2, meloxicam reduces the production of prostaglandins, leading to decreased inflammation, pain, and fever.
3. Minimal Gastrointestinal Effects:
   • Due to its selective action on COX-2, meloxicam has a lower risk of gastrointestinal side effects compared to non-selective NSAIDs.

Meloxicam is approved for a variety of clinical conditions, including:

1. Osteoarthritis:
   • Management of pain and inflammation associated with osteoarthritis.
2. Rheumatoid Arthritis:
   • Treatment of pain and inflammation in rheumatoid arthritis.
3. Ankylosing Spondylitis:
   • Management of pain and inflammation in ankylosing spondylitis.
4. Off-Label Uses:
   • Management of chronic pain conditions (e.g., low back pain).

Adjunctive therapy for dental pain

The dosage of meloxicam varies depending on the indication, patient response, and tolerability. The following dosing guidelines are based on the British National Formulary (BNF) and clinical pharmacology references:

1. Adults:
   • Oral: 7.5–15 mg once daily.
   • Intramuscular (IM): 7.5–15 mg once daily.
2. Elderly Patients:
   • Lower doses (7.5 mg once daily) are recommended due to increased sensitivity to side effects.

Important Considerations:

• Meloxicam is available in oral tablets, oral suspension, and injectable formulations.
• Dose adjustments may be necessary for patients with hepatic or renal impairment.
• Meloxicam should be taken with food or milk to minimize gastrointestinal side effects.

Meloxicam is generally well-tolerated, but it is associated with a range of side effects, some of which can be serious. Common side effects include:

1. Gastrointestinal:
   • Nausea, dyspepsia, and abdominal pain.
   • Gastric ulcers and gastrointestinal bleeding (less common than with non-selective NSAIDs).
2. Cardiovascular:
   • Increased risk of myocardial infarction and stroke, particularly with long-term use or high doses.
3. Renal:
   • Acute kidney injury and interstitial nephritis (rare).
4. Other:
   • Headache, dizziness, and edema.

Serious Side Effects:

• Cardiovascular Events: Increased risk of thrombotic events, such as myocardial infarction and stroke.
• Hypersensitivity Reactions: Stevens-Johnson syndrome (SJS) and anaphylaxis (rare).

Hepatotoxicity: Elevated liver enzymes and, rarely, severe liver damage

Meloxicam requires careful monitoring and adherence to specific precautions to ensure patient safety:

1. Cardiovascular Risk:
   • Use with caution in patients with a history of cardiovascular disease. Regular monitoring of cardiovascular health is recommended.
2. Renal Impairment:
   • Use with caution in patients with impaired kidney function. Avoid use in severe renal impairment (CrCl <30 mL/min).
3. Hepatic Impairment:
   • Use with caution in patients with hepatic impairment. Avoid use in severe hepatic impairment.
4. Pregnancy and Lactation:
   • Meloxicam should be avoided during pregnancy, especially in the third trimester, due to the risk of premature closure of the ductus arteriosus. It is excreted in breast milk, so breastfeeding is generally not recommended.
5. Elderly Patients:
   • Lower doses may be required due to increased sensitivity to side effects, particularly cardiovascular and renal.

Meloxicam has a significant potential for drug interactions due to its effects on prostaglandin synthesis and metabolism. Key interactions include:

1. Anticoagulants:
   • Meloxicam may enhance the anticoagulant effects of warfarin, increasing the risk of bleeding.
2. ACE Inhibitors and Diuretics:
   • Meloxicam may reduce the efficacy of antihypertensive medications and increase the risk of renal impairment.
3. Lithium:
   • Meloxicam may increase lithium levels, increasing the risk of toxicity.
4. Methotrexate:
   • Meloxicam may increase the levels of methotrexate, increasing the risk of toxicity.
5. Other NSAIDs:
   • Concurrent use with other NSAIDs increases the risk of gastrointestinal and cardiovascular side effects.

Meloxicam is the generic name for this medication. It is marketed under various brand names, depending on the country and manufacturer. Some examples include:

• Mobic (a well-known brand in the United States and other regions).
• Meloxicam Accord.
• Meloxicam Mylan.

Meloxicam Sandoz