NSAID — Preferential COX-2 Inhibitor Pregnancy: Contraindicated during the third trimester of pregnancy. During the first and second trimester meloxicam should not be given unless clearly necessary, and if used by a woman attempting to conceive or during the first and second trimester the dose should be kept as low and the duration as short as possible. Inhibition of prostaglandin synthesis may adversely affect pregnancy and/or embryo-foetal development; epidemiological data suggest an increased risk of miscarriage, cardiac malformation and gastroschisis after use of a prostaglandin synthesis inhibitor in early pregnancy (absolute risk of cardiovascular malformation increased from less than 1% to approximately 1.5%). In the third trimester all prostaglandin synthesis inhibitors may expose the foetus to cardiopulmonary toxicity (premature closure of the ductus arteriosus and pulmonary hypertension) and renal dysfunction progressing to renal failure with oligohydramnios, and expose mother and neonate to prolonged bleeding time and inhibition of uterine contractions. Breast-feeding: NSAIDs are known to pass into breast milk and administration is not recommended in women who are breast-feeding. Fertility: meloxicam may impair fertility and is not recommended in women attempting to conceive.

Meloxicam

Brand names: Mobic

Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) of the oxicam class used for the relief of pain and inflammation in osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Rheumatoid arthritis and ankylosing spondylitis: 15 mg/day (according to the therapeutic response the dose may be reduced to 7.5 mg/day). Exacerbations of osteoarthrosis: 7.5 mg/day, increased to 15 mg/day if necessary in the absence of improvement

Route: Oral - the total daily amount should be taken as a single dose, with water or another liquid, during a meal

Frequency: Once daily - 'The daily dose should be taken all at once'

Max: 15 mg/day - the SPC states in capitals 'DO NOT EXCEED THE DOSE OF 15MG/DAY'. In patients with end-stage renal disease undergoing haemodialysis the dosage should not exceed 7.5 mg/day. The recommended dose for long-term treatment of rheumatoid arthritis and ankylosing spondylitis in elderly patients is 7.5 mg per day

Source: UK SPC (eMC) for Meloxicam 15 mg Tablets, §4.2 (https://www.medicines.org.uk/emc/product/101306/smpc). Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms, and the patient's need for symptomatic relief and response to therapy should be re-evaluated periodically, especially in osteoarthritis. PATIENTS AT INCREASED RISK: patients with increased risks for adverse reactions - for example a history of gastrointestinal pathologies or risk factors for cardiovascular pathologies - should start treatment with 7.5 mg per day. ELDERLY: the recommended dose for long-term treatment of rheumatoid arthritis and ankylosing spondylitis in elderly patients is 7.5 mg per day. NOT FOR ACUTE PAIN: §4.4 states meloxicam is not appropriate for the treatment of patients requiring relief from acute pain; in the absence of improvement after several days the clinical benefit should be reassessed. CONCOMITANT NSAIDs: the recommended maximum daily dose should not be exceeded in case of insufficient therapeutic effect, nor should an additional NSAID be added; use of meloxicam with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided. GASTROPROTECTION: combination therapy with protective agents (e.g. misoprostol or proton pump inhibitors) should be considered for patients at higher GI risk and for patients requiring concomitant low-dose aspirin or other drugs likely to increase gastrointestinal risk. HEPATIC IMPAIRMENT: no dose reduction is required in mild to moderate hepatic impairment; severely impaired liver function is a contraindication. PAEDIATRIC (no per-kg dose is stated in the UK SPC): meloxicam tablets are contraindicated in children and adolescents aged under 16 years; the SPC notes 'This medicine comes in other forms and strengths that may be more appropriate.' FOR CROSS-REFERENCE ONLY, the US label gives a weight-threshold (not per-kg) juvenile rheumatoid arthritis dose of 7.5 mg once daily in children who weigh 60 kg or more, states there was no additional benefit from increasing the dose above 7.5 mg, and states meloxicam tablets should not be used in children who weigh less than 60 kg - this is not in the UK SPC. Verify any under-18 dosing against a children's formulary. US CROSS-CHECK (openFDA, meloxicam, Lupin Pharmaceuticals, label date 2024-08-08): osteoarthritis and rheumatoid arthritis starting dose 7.5 mg once daily, which may be increased to 15 mg once daily; maximum recommended daily oral dose in adults is 15 mg regardless of formulation; maximum 7.5 mg daily in patients on haemodialysis. Note the US label starts rheumatoid arthritis at 7.5 mg once daily whereas the UK SPC gives 15 mg/day for rheumatoid arthritis - the two labels differ, and the UK figure is used above. The US label also warns that meloxicam tablets are not interchangeable with other approved oral meloxicam formulations even at the same milligram strength.

Dose adjustments

Renal

Contraindicated in patients with severe renal impairment not on dialysis. In patients with end-stage renal disease undergoing haemodialysis the dosage should not exceed 7.5 mg/day. No dose reduction is required in patients with mild to moderate renal impairment (creatinine clearance greater than 25 ml/min).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Third trimester of pregnancy
Children and adolescents aged under 16
Hypersensitivity to the active substance or to any of the excipients, or to substances with a similar action, e.g. NSAIDs, aspirin; must not be given to patients who have developed signs of asthma, nasal polyps, angioneurotic oedema or urticaria following aspirin or other NSAIDs
History of gastrointestinal bleeding or perforation related to previous NSAID therapy
Active, or history of recurrent, peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding)
Severely impaired liver function
Non-dialysed severe renal failure
Gastrointestinal bleeding, history of cerebrovascular bleeding or other bleeding disorders
Severe heart failure
(US label additionally) In the setting of coronary artery bypass graft (CABG) surgery

Side effects

Gastrointestinal - the most commonly observed adverse events; nausea, vomiting, diarrhoea, flatulence, constipation, dyspepsia, anorexia, abdominal pain, melaena, haematemesis, ulcerative stomatitis and exacerbation of colitis and Crohn's disease. Gastroduodenal ulcers, perforation or GI bleeding, sometimes fatal and particularly in the elderly, may occur
Headache (common); dizziness and somnolence (uncommon); vertigo (uncommon), tinnitus (rare)
Blood pressure increased and flushing (uncommon); oedema, hypertension and cardiac failure have been reported in association with NSAID treatment; palpitations (rare)
Anaemia (uncommon); abnormal blood count including differential white cell count, leukopenia and thrombocytopenia (rare); very rare cases of agranulocytosis
Allergic reactions other than anaphylactic/anaphylactoid (uncommon); anaphylactic and anaphylactoid reactions (frequency not known)
Severe cutaneous adverse reactions - Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported. Arterial thrombotic events (e.g. myocardial infarction or stroke) may be associated with some NSAIDs, particularly at high doses and in long-term treatment

Interactions

Anticoagulants such as warfarin - synergistic effect on bleeding; concomitant use carries an increased risk of serious bleeding compared with either drug alone; monitor for signs of bleeding (US label Table 3; UK §4.4 also flags warfarin and curative-dose heparin)
Antiplatelet agents (e.g. aspirin), SSRIs and SNRIs - may potentiate bleeding risk more than an NSAID alone; monitor for signs of bleeding (US label Table 3)
Aspirin - concomitant use with NSAIDs produces no greater therapeutic effect but was associated with a significantly increased incidence of gastrointestinal adverse reactions; caution with anti-inflammatory doses of aspirin (500 mg or more per dose, or 3 g or more total daily) (UK SPC §4.4; US label Table 3)
Other NSAIDs including COX-2 selective inhibitors - concomitant use with meloxicam should be avoided (UK SPC §4.4, §4.5 cross-reference)
Oral corticosteroids - increase the risk of gastrointestinal ulceration or bleeding when given with meloxicam (UK SPC §4.4)
Interactions are taken from the US prescribing information and UK §4.4 because the fetched eMC bundle contains no §4.5 section, and the US Table 3 is truncated at the source-fetch limit - verify against the full UK SPC §4.5

Clinical monograph

How it works

It inhibits cyclo-oxygenase, with relative preference for COX-2, reducing prostaglandin synthesis and thereby pain and inflammation.

Prescribing in practice

Like other NSAIDs it carries gastrointestinal (bleeding, ulceration, perforation), cardiovascular and renal risks, so the lowest effective dose is used for the shortest time, particularly in older and at-risk patients.
It is contraindicated in active gastrointestinal ulceration or bleeding, severe heart failure and severe renal or hepatic impairment, and caution applies with a history of these conditions.
Gastroprotection (such as a proton pump inhibitor) should be considered in patients at increased gastrointestinal risk, and concurrent use with other NSAIDs should be avoided.

Monitoring

Monitor renal function, blood pressure and for gastrointestinal symptoms, especially in older people and those on interacting drugs such as ACE inhibitors and diuretics.

Counselling the patient

Take with or after food and report any black stools, vomiting blood, indigestion or unexpected swelling.
Avoid other anti-inflammatory painkillers, including over-the-counter ibuprofen, unless advised.
Use the lowest dose that controls symptoms and for as short a time as possible.

Evidence & guidelines

NICE and MHRA advise NSAIDs be used at the lowest effective dose for the shortest duration owing to cardiovascular and gastrointestinal risk.

Reference: SPC Mobic; NICE Osteoarthritis Guideline (NG226); BSR Inflammatory Arthritis Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways