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NSAID — Preferential COX-2 Inhibitor Pregnancy: Avoid — especially from 20 weeks; risk of premature ductus arteriosus closure and oligohydramnios

Meloxicam

Brand names: Mobic

Adult dose

Dose: 7.5–15 mg once daily
Route: Oral
Frequency: Once daily
Max: 15 mg/day
Take with food or milk. 7.5 mg for osteoarthritis; 15 mg for rheumatoid arthritis or ankylosing spondylitis. Once-daily dosing improves compliance. Lowest effective dose for shortest duration.

Paediatric dose

Dose: 0.125–0.25 mg/kg
Route: Oral
Frequency: Once daily
Max: 15 mg/day
JIA: 0.125–0.25 mg/kg once daily (licensed for JIA in EU in children ≥2 years)

Dose adjustments

Renal

Avoid if eGFR <30 mL/min; maximum 7.5 mg/day if eGFR 30–60 mL/min

Hepatic

Reduce dose in moderate hepatic impairment; avoid in severe

Paediatric weight-based calculator

JIA: 0.125–0.25 mg/kg once daily (licensed for JIA in EU in children ≥2 years)

Clinical pearls

  • Preferential (not absolute) COX-2 inhibitor — lower GI risk than non-selective NSAIDs but higher than selective COX-2 inhibitors
  • Once-daily dosing advantage: longer half-life (~20 hours) than most traditional NSAIDs; particularly useful in elderly patients where compliance is a concern
  • NSAID-induced asthma: all NSAIDs (including meloxicam) can precipitate bronchospasm in aspirin-sensitive asthma — 8–20% of asthmatics are NSAID-sensitive
  • Avoid in elderly with CKD — risk of acute kidney injury; first choice NSAID should always involve GI and CV risk-benefit assessment
  • Not appropriate as analgesic for acute postoperative pain — not licensed for that indication in UK

Contraindications

  • Active peptic ulcer or GI bleeding
  • Severe renal impairment (eGFR <30 mL/min)
  • Severe heart failure
  • Aspirin/NSAID hypersensitivity (nasal polyps, asthma, urticaria)
  • Pregnancy (especially third trimester)

Side effects

  • GI effects — dyspepsia, nausea; less ulceration than piroxicam/indomethacin
  • Oedema
  • Hypertension
  • Renal impairment
  • Dizziness
  • Skin rash

Interactions

  • ACE inhibitors/ARBs — reduced antihypertensive effect; nephrotoxicity risk
  • Diuretics — reduced diuretic effect; hyperkalemia risk
  • Lithium — NSAIDs reduce renal lithium clearance; increased toxicity risk
  • Warfarin — enhanced anticoagulation; monitor INR

Monitoring

  • Renal function in elderly or CKD patients
  • Blood pressure
  • GI symptoms
  • Oedema

Reference: BNFc; BNF 90; SPC Mobic; NICE Osteoarthritis Guideline (NG226); BSR Inflammatory Arthritis Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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