What is meloxicam?
Meloxicam is a drug prescribed to reduce inflammation. It is usually prescribed to treat forms of arthritis such as osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis. It is taken orally, usually in the form of tablets or capsules (liquid form is also available).
Meloxicam falls under a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs), which also includes ibuprofen, aspirin, and naproxen, among others. As the name suggests, NSAIDs reduce inflammation but are not corticosteroids (commonly referred to simply as ‘steroids’).
Whereas corticosteroids reduce the inflammatory response of the immune system by mimicking a hormone called cortisol, NSAIDs such as meloxicam reduce the production of a group of compounds called prostaglandins. Prostaglandins promote inflammation that causes pain and fever.
Specifically, NSAIDs block the enzymes that produce prostaglandins, called COX-1 and COX-2. One way in which NSAIDs differ from each other is the extent to which they block each enzyme; the prostaglandins produced by COX-1 and COX-2 have different effects on the body, so different NSAIDs are more suitable for different therapeutic purposes.
NSAIDs also differ in their potency, duration of action, length of time they stay in the body, and side effects. For example, COX-1 prostaglandins protect the inner lining of the stomach, so NSAIDs that block COX-1 and COX-2 (like meloxicam - see question 6: ‘What is the difference between meloxicam and ibuprofen?’ for more info) are more likely to cause ulcers and promote bleeding than those that only block COX-2 (known as ‘COX-2 inhibitors’ or ‘COX-2 selective NSAIDs’).
What is meloxicam used for?
Meloxicam is primarily used to treat osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis.
The pain and swelling caused by arthritis are due to inflammation, so the anti-inflammatory properties of NSAIDs, such as meloxicam, offer relief from these symptoms.
What warnings are there about using meloxicam?
Meloxicam has two black box warnings, which are the strictest warnings issued by the U.S. Food and Drug Administration (FDA). Black box warnings are issued when there is significant evidence that a drug or product is associated with an adverse reaction that may lead to death or serious injury.
The two black box warnings applied to meloxicam apply to all NSAIDs, whether over-the-counter or prescription-only. They are:
Cardiovascular Risk
NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction (heart attack), and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.
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 are at greater risk for serious gastrointestinal events.
If you have concerns about the risks posed by meloxicam and other NSAIDs, you should speak to your doctor or pharmacist.
What are the side effects of meloxicam?
Some people experience side effects when taking meloxicam. They are often mild and go away within a few days as your body adjusts to the medication. Some common side effects are:
- Angina (chest pain)
- Abdominal pain
- Upset stomach/nausea
- Diarrhea
- Indigestion
- Heartburn
- Gas
If you experience more severe forms of these side effects or they persist, you should speak to your doctor or pharmacist.
More serious side effects can include:
- Shortness of breath
- Sudden or unexplained weight gain
- Signs of kidney problems (including changes in how much and how often you urinate, pain while urinating, swelling in your feet or ankles)
- Signs of liver disease (including dark urine, jaundice (yellowing of the skin or eyes), flu-like symptoms, persistent nausea or vomiting, loss of appetite, upper stomach pain, fatigue)
- Signs of stomach bleeding (including coughing up blood, blood in stools)
- Skin rash
- Severe skin reaction (including fever, sore throat, swelling of your face or tongue, burning sensation in eyes, skin pain, a red or purple rash)
- Signs of high blood pressure (including headaches, dizziness, nosebleeds)
- Signs of low red blood cells (including pale skin, light-headedness, rapid heart rate, trouble concentrating)
If you experience any of these side effects, you should contact your doctor as soon as possible.
In rare cases, meloxicam can cause a severe allergic reaction. If you notice symptoms of an allergic reaction, seek medical assistance immediately. Signs of an allergic reaction include:
- Skin rash – for example itchy, red, or swollen skin
- Wheezing
- Tightness in the chest or throat
- Trouble breathing or talking
- Swollen mouth, face, lips, tongue, or throat
While this list covers many of the most common and most severe side effects associated with meloxicam, it is not a complete list of known side effects. For more information about side effects, please read the information leaflet that comes with meloxicam, or speak to your doctor or pharmacist.
Does meloxicam cause weight gain?
Meloxicam can cause edema (the medical term for swelling) and sodium retention, which can lead to slight weight gain, usually 1kg to 2kg in the first week of therapy.
More extreme and sudden weight gain is rare and should be treated as a serious side effect. It may be caused by sodium reabsorption, which is also linked to an increased risk or exacerbation of heart failure.
NSAIDs can, in rare cases, cause acute kidney injury (previously known as acute renal failure). A symptom of acute kidney injury is weight gain due to water retention.
Sudden, unexplained, or drastic weight gain is, therefore, a potentially serious side effect of meloxicam and should be treated as soon as possible. If you are concerned about weight gain caused by meloxicam, you should speak to your doctor immediately.
What is the difference between meloxicam and ibuprofen?
The most obvious difference between meloxicam and ibuprofen is that meloxicam is prescription-only, while ibuprofen is available over-the-counter (although certain types and strengths of ibuprofen are also prescription-only).
Ibuprofen was the first NSAID to be made available over-the-counter because it is usually well-tolerated.
Both meloxicam and ibuprofen are NSAIDs, so the way in which they work is fundamentally the same. However, there are differences in their chemical make-ups; the suffix -oxicam refers to NSAIDs that are ‘enolic acids’ while -profen refers to ‘arylpropionic acids’.
It means there are differences regarding aspects such as usage, dosing, longevity, and side effects.
Uses
Both can be used to treat osteoarthritis and rheumatoid arthritis. Meloxicam is also used to treat juvenile idiopathic arthritis in children 2 years of age or older, while ibuprofen is used to treat fever, headache, migraine, and mild to moderate aches and pains.
Longevity
Meloxicam is longer-lasting than ibuprofen, so is usually taken once per day whereas ibuprofen is usually taken every six to eight hours.
Risk of Gastrointestinal Complications
Meloxicam may present a higher risk of gastrointestinal complications than low-level doses of ibuprofen. The risk of complications with ibuprofen increases at stronger doses.
Risk of Cardiovascular Complications
While many studies have shown a link between NSAIDs and an increased risk of cardiovascular complication – hence the FDA's black box warning – there is no conclusive evidence whether meloxicam or ibuprofen presents a greater risk than the other. However, it is widely agreed that the risk increases at higher doses, with long-term use, and in people with a history of cardiovascular disease.
Other differences exist between meloxicam and ibuprofen. Meloxicam, for example, inhibits the COX-2 enzyme to a greater extent to the COX-1 enzyme, while ibuprofen inhibits them equally (it should be noted that some other NSAIDs are more COX-2 selective than meloxicam).
Ultimately, the decision to use meloxicam or ibuprofen (or a different NSAID) is based on your individual therapeutic requirements and your risk profile. If you have any concerns about either meloxicam or ibuprofen, you should speak to your doctor or pharmacist.
What is the difference between meloxicam and Tylenol?
Tylenol is a brand name for the drug known as acetaminophen (in North America) or paracetamol. It is sold under other brand names, including Panadol, or as a generic medication.
It is not in the NSAID class of drugs as it does not appear to inhibit the COX enzyme and has a relatively little anti-inflammatory effect.
In fact, the exact mechanisms of paracetamol are not fully understood. It is thought to prevent the release of chemicals that cause pain and increase temperature.
Paracetamol may be one of the first treatments used to treat pain caused by arthritic conditions. Unlike meloxicam, however, it is not effective in reducing the underlying inflammation. Like ibuprofen, paracetamol is also used to treat mild to moderate aches and pains, headaches, and to reduce fever.
Paracetamol does not interact with NSAIDs. It may, therefore, be used in combination with meloxicam (or other NSAIDs) in the treatment of arthritis.
How long does meloxicam stay in your system?
The half-life of meloxicam is 20-24 hours in healthy patients (it varies from person-to-person and has been found to be shorter in females). Half-life refers to how long it takes for half of the drug to be eliminated from your body. With each half-life, a further 50% is eliminated.
That means after around 80 hours, 6.25% of the drug remains in the body.
This long half-life is why meloxicam is usually taken once per day.
Which other drugs and supplements interact with meloxicam?
Meloxicam interacts with 464 different medications, according to Drugs.com, ranging from mild to severe. They include:
Severe
- Sodium polystyrene sulfonate (Kayexalate): Some forms of meloxicam, the oral suspension, in particular, may contain a sugar alcohol called sorbitol. Sodium polystyrene sulfonate, used to treat high potassium levels (hyperkalemia), interacts with sorbitol and can cause fatal intestinal necrosis (death of cells within an organ).
Serious
- Apixaban
- Betrixaban
- Edoxaban
- Enoxaparin
- Ketorolac
- Omacetaxine
- Rivaroxaban
- Tositumomab
- Warfarin
Meloxicam may also increase lithium levels in the blood. If you take lithium, used to treat bipolar disorder and depressive disorders, the effect of meloxicam may put you at risk of lithium toxicity.
Meloxicam may reduce the effect of blood pressure-lowering medications such as angiotensin-converting enzyme (ACE) inhibitors.
Meloxicam thins the blood, so if you are taking blood thinners such as warfarin, which help to prevent blood clots, the additional blood-thinning effect of meloxicam may cause bleeding.
While meloxicam is a prescription-only drug, other NSAIDs, such as ibuprofen, are available over-the-counter. You should not take these drugs together unless instructed to by your doctor. Doing so may increase your risk of liver, kidney, and cardiovascular complications.
Remember, these are just a handful of the most serious and most common medications that interact with meloxicam. There are hundreds of others. It is important you discuss all prescription and over-the-counter medications you take with your doctor, as well as supplements.
Which foods interact with meloxicam?
There are no known interactions between meloxicam and foods.
Can I drink alcohol while taking meloxicam?
Drinking alcohol while taking meloxicam may increase your risk of stomach ulcers and stomach bleeding.
While it is best to abstain from alcohol entirely, the risk is particularly pronounced in people who drink three or more drinks per day.
It is worth talking to your doctor about the amount of alcohol you drink, in order to find a solution that suits your lifestyle and mitigates the risk of serious complications.
Is meloxicam safe to take while pregnant or breastfeeding?
Meloxicam, like other NSAIDs, is linked to an increased risk of miscarriage and birth defects. This risk is believed to be increased in the third trimester of pregnancy.
It is also believed that meloxicam can increase the risk of a miscarriage when taken around the time of conception and in the first trimester.
There is also evidence that meloxicam can cause a delay in ovulation, which can affect your ability to get pregnant.
If you are planning on getting pregnant or learn that you are pregnant, you should speak to your doctor immediately about alternative treatment options.
It is not known whether meloxicam passes into breast milk. If you are breastfeeding, your doctor may recommend an alternative drug that has a more defined safety profile.
Does meloxicam get you high?
No. There are reports that meloxicam has been abused due to the mistaken belief that, because it is a painkiller, it is an opioid. However, meloxicam does not deliver the euphoric “high” of narcotics, nor is it inherently addictive.
There have been calls for non-opioid drugs, including meloxicam, to be the preferred treatment for chronic pain and osteoarthritis in order to help curb opioid abuse. A 2018 study found certain non-opioid drugs, including meloxicam, to be as effective as opioid options.
However, while meloxicam is not an addictive substance, it is still possible to become addicted to or dependent on the anti-inflammatory and pain-reducing effects of meloxicam. The American Addiction Centers used the example of meloxicam being used to relieve a hangover. It notes that the short-term benefits of pain relief are vastly outweighed by the risks of using meloxicam without medical supervision.
If you have concerns about addiction or substance abuse, either regarding yourself or someone you know, we urge you to seek the appropriate medical help or treatment.
Is meloxicam a narcotic?
No. From a medical perspective, the term narcotics (or narcotic analgesics) refers to opioids, such as morphine, codeine, and heroin.
The word ‘narcotics’ has come to be associated with illegal drugs in general. As such, legislation in some countries may consider drugs such as cocaine or cannabis to be narcotics, even though they do not fit the true definition of the word.
Regardless, meloxicam is neither an opioid nor a narcotic.
The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.
