Meloxicam

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.