BSN Tracker

meloxicam

Brand: Mobic, Vivlodex (low-dose)

⚠ BBW Beers Criteria Prototype: ibuprofen
Drug Class: nonsteroidal anti-inflammatory drug (NSAID)
Drug Family: NSAID
Subclass: preferential COX-2 inhibitor (oxicam derivative)
Organ Systems: cnsmusculoskeletal

Mechanism of Action

Preferential (not selective) COX-2 inhibitor with approximately 10-fold selectivity for COX-2 over COX-1 at low doses. This partial COX-1 sparing provides somewhat better GI tolerability than non-selective NSAIDs. Produces analgesia and anti-inflammatory effects through prostaglandin synthesis inhibition.

COX-2 (preferential)COX-1 (at higher doses)

Indications

  • osteoarthritis
  • rheumatoid arthritis
  • juvenile idiopathic arthritis (JIA)

Contraindications

  • active GI bleeding/ulceration
  • aspirin sensitivity
  • third trimester pregnancy
  • renal impairment

Adverse Effects

Common

  • GI upset (less than non-selective NSAIDs)
  • nausea
  • diarrhea
  • edema
  • hypertension

Serious

  • GI bleeding/ulceration (reduced but not eliminated vs. non-selective NSAIDs)
  • AKI
  • cardiovascular events

Pharmacokinetics (ADME)

Absorption oral bioavailability ~89%; food has minimal effect
Distribution protein binding >99%
Metabolism primarily CYP2C9 and CYP3A4; inactive metabolites
Excretion renal (50%) and fecal (50%)
Half-life 15-20 hours (allows once-daily dosing)
Onset 1-2 hours
Peak 5-6 hours
Duration 24 hours (once-daily)
Protein Binding >99%
Vd 10 L

Drug Interactions

Drug / Agent Mechanism Severity
anticoagulants additive bleeding risk major
ACE inhibitors/ARBs AKI risk; antihypertensive antagonism major
CYP2C9/CYP3A4 inhibitors increase meloxicam levels moderate

Nursing Considerations

  1. Once-daily dosing simplifies adherence compared to four-times-daily ibuprofen; preferred for chronic arthritis management.
  2. The partial COX-2 preference provides some GI advantage over non-selective NSAIDs, but does not eliminate GI or cardiovascular risk.
  3. Among geriatric patients, meloxicam is considered relatively better tolerated than indomethacin or piroxicam, though it remains on the Beers Criteria.
  4. Liquid formulation available for patients who cannot swallow tablets — useful for elderly patients with dysphagia.

Clinical Pearls

  • Meloxicam occupies a middle ground between non-selective NSAIDs and COX-2 selective inhibitors; its partial COX-2 selectivity provides modest GI improvement without the full cardiovascular risk escalation of pure COX-2 inhibitors.
  • Once-daily dosing and generally favorable tolerability have made meloxicam one of the most commonly prescribed prescription NSAIDs for chronic arthritis management.

Safety Profile

Pregnancy avoid
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Juvenile Idiopathic Arthritis (JIA) Nonsteroidal Anti-inflammatory Drug (NSAID) Osteoarthritis Rheumatoid Arthritis
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