Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) that exerts anti-inflammatory and analgesic effects by inhibiting prostaglandin synthesis.
1. Indications of Meloxicam
Meloxicam is mainly used to relieve pain and inflammation associated with arthritis, for use in adults and children of specified body weight.
1.1 Osteoarthritis
(1) Relieves pain, impaired joint function, and joint stiffness caused by osteoarthritis.
(2) Clinical studies have confirmed that a daily dose of 7.5 mg or 15 mg can effectively improve patients’ conditions.
1.2 Rheumatoid Arthritis
(1) Effectively reduces joint inflammation, pain, and swelling, and improves joint function.
(2) The recommended starting dose is 7.5 mg daily, which may be increased to 15 mg daily according to efficacy.
1.3 Juvenile Rheumatoid Arthritis
(1) Indicated for pediatric patients weighing ≥ 60 kg to relieve symptoms of oligoarticular or polyarticular juvenile rheumatoid arthritis.
(2) The recommended dose is 7.5 mg daily; no additional benefit is gained from increasing the dose.
(3) Contraindicated in children weighing less than 60 kg.
2. Contraindications of Meloxicam
Contraindications must be excluded before use to avoid serious adverse reactions.
2.1 Hypersensitivity
(1) Contraindicated in patients hypersensitive to any ingredient of meloxicam.
(2) Contraindicated in patients with a history of allergic reactions such as asthma or urticaria following administration of aspirin or other NSAIDs.
2.2 Perioperative Period of Cardiovascular Surgery
(1) Absolutely contraindicated in the perioperative period of coronary artery bypass grafting (CABG).
(2) Use of NSAIDs within 10–14 days postoperatively increases the risk of myocardial infarction and stroke.
2.3 Aspirin-Sensitive Asthma
Use of meloxicam in such patients may induce severe, even fatal, bronchospasm; therefore, it is contraindicated.
2.4 History of Severe Skin Reactions
Contraindicated in patients with a history of exfoliative dermatitis, Stevens-Johnson syndrome, or toxic epidermal necrolysis following use of NSAIDs.
2.5 Contraindicated Foods and Drugs
(1) Alcohol consumption: Alcohol should be avoided during treatment, as it increases the risk of gastrointestinal bleeding.
(2) Other NSAIDs: Concomitant use of other NSAIDs or salicylates is prohibited to avoid increased gastrointestinal toxicity.
3. Use in Special Populations
3.1 Pregnancy
(1) Before 20 weeks of gestation: Data are limited; benefit-risk assessment is required.
(2) 20–30 weeks of gestation: If needed, use the lowest dose for the shortest duration. If treatment exceeds 48 hours, ultrasound monitoring of amniotic fluid volume is recommended; discontinue immediately if oligohydramnios occurs.
(3) After 30 weeks of gestation: Contraindicated. Use at this stage may cause premature closure of the fetal ductus arteriosus and renal dysfunction.
3.2 Lactation
There are no data on excretion in human milk. Use should balance the benefits of breastfeeding for the infant and the therapeutic need of the mother.
3.3 Women of Childbearing Potential
(1) Meloxicam may reversibly delay ovulation and cause infertility.
(2) Discontinuation should be considered in women with difficulty conceiving or undergoing infertility evaluation.
3.4 Pediatric Use
(1) Safety has been evaluated in patients aged 2–17 years with juvenile rheumatoid arthritis; no data are available for children under 2 years of age.
(2) The incidence of common adverse reactions in children (abdominal pain, vomiting, diarrhea, headache, fever) is higher than in adults.
3.5 Geriatric Use
(1) The risk of serious cardiovascular, gastrointestinal, and renal adverse reactions is higher than in younger adults.
(2) If used, start at a low dose with close monitoring.
3.6 Hepatic Impairment
(1) Mild to moderate impairment (Child-Pugh Class A/B): No dose adjustment needed.
(2) Severe impairment (Child-Pugh Class C): Data are insufficient; use with caution.
3.7 Renal Impairment
(1) Mild to moderate impairment: No dose adjustment needed.
(2) Severe impairment: Not recommended.
(3) Hemodialysis patients: Daily dose should not exceed 7.5 mg. Meloxicam is not removed by dialysis.
